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1.
Orv Hetil ; 162(13): 488-496, 2021 03 28.
Artículo en Húngaro | MEDLINE | ID: mdl-33774599

RESUMEN

Összefoglaló. Bevezetés: Az elso szaruhártya-bank 1944-es alapítása óta jelentos változásokon ment át. A szaruhártya túlélését számos tényezo befolyásolja, így a tárolási mód, melynek a szövet lejárati ideje szerint rövid, közép és hosszú távú módszereit fejlesztették ki. Célkituzés: Retrospektív vizsgálatunk célja a 2008. január 1. és 2017. december 31. között perforáló és lamelláris keratoplasztika során felhasznált cadaverbol és multiorgan donorból származó szaruhártyák túlélésének vizsgálata volt a Semmelweis Egyetem Szemészeti Klinikáján. Módszer: Feljegyeztük a recipiens nemét, életkorát, a mutétet indikáló klinikai diagnózist, a mutét idopontját, a szövettani vizsgálat eredményét, valamint, hogy a beültetett szaruhártya cadaverbol vagy multiorgan donorból származott. Meghatároztuk, hogy a recipiens életkora korrelált-e a rekeratoplasztikáig eltelt idovel. Eredmények: 1451 szaruhártya-átültetés történt 1088 beteg (44,6% férfi) 1159 szemén (életkor 62,8 ± 18,5 év), melyek között 938 (64,6%) cadaver és 262 (18,0%) multiorgan donor került felhasználásra, 251 esetben (17,2%) nem állt rendelkezésre adat. A leggyakoribb primer diagnózis a szaruhártya-dekompenzáció volt (325 eset, 28%). A primer keratoplasztikák során felhasznált szaruhártyák 740 esetben (63,8%) cadaverbol, 212 esetben (18,2%) multiorgan donorból származtak, 207 esetben (17,8%) nem állt rendelkezésre adat. Elso rekeratoplasztika a primer keratoplasztikák közül 217 esetben (18,7%) történt. A leggyakoribb szövettani diagnózis az endothelsejt-degeneráció volt (130 esetben, 60,4%). 146 esetben (67,2%) korábban cadaver, 31 esetben (14,2%) multiorgan donor esetén került sor ismételt mutétre, 40 esetben (18,4%) nem állt rendelkezésre adat. Következtetés: Klinikánkon elsosorban cadaverbol származó donorok biztosítják a szaruhártya átültetésekhez szükséges szövetet. Cadaverbol vagy multiorgan donorból származó szaruhártyák esetén nem kerül gyakrabban sor rekeratoplasztikára. A szaruhártya-banki tevékenység további fejlesztésével növelheto a donorok túlélése hazánkban. Orv Hetil. 2021; 162(13): 488-496. INTRODUCTION: Corneal banking methods have been changing since the foundation of the first corneal bank in 1944. Corneal graft survival may be affected by several factors, among others the storage method, which may be short-, middle- and long-term storage. OBJECTIVE: To investigate corneal graft survival at the Department of Ophthalmology, Semmelweis University between 1 January 2008 and 31 December 2017, using cadaver and multiorgan donors for penetrating and lamellar keratoplasty, retrospectively. METHOD: Recipient sex, age, clinical diagnosis, date of surgery, histological examination results and origin of donors (cadaver or multiorgan donor) were recorded. Correlation between recipient age and time to repeat keratoplasty was also analyzed. RESULTS: There were 1451 keratoplasties in 1159 eyes (age 62.8 ± 18.5 years) of 1088 patients (44.6% male) using 938 (64.6%) cadaver and 262 (18.0%) multiorgan donors, data was not available in 251 (17.2%) cases. There was repeat keratoplasty in 217 patients (18.7% of first keratoplasties). The most common histological diagnosis was endothelial decompensation (130 cases, 60.4%) in these cases. In patients with a first repeat keratoplasty, in 146 cases (67.2%) the first donor originated from cadavers, in 31 cases (14.2%) from multiorgan donors and in 40 cases (18.4%) data were not available. CONCLUSION: Corneal donors mainly originate from cadavers at our Department. The necessity of repeat keratoplasties does not differ using cadaver or multiorgan donors. With further development of corneal banking, donor survival may be increased in Hungary. Orv Hetil. 2021; 162(13): 488-496.


Asunto(s)
Trasplante de Córnea , Supervivencia de Injerto , Adulto , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Humanos , Hungría , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Donantes de Tejidos/estadística & datos numéricos
2.
Otol Neurotol ; 42(4): 614-622, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33710998

RESUMEN

HYPOTHESIS: Aerosols are generated during mastoidectomy and mitigation strategies may effectively reduce aerosol spread. BACKGROUND: An objective understanding of aerosol generation and the effectiveness of mitigation strategies can inform interventions to reduce aerosol risk from mastoidectomy and other open surgeries involving drilling. METHODS: Cadaveric and fluorescent three-dimensional printed temporal bone models were drilled under variable conditions and mitigation methods. Aerosol production was measured with a cascade impactor set to detect particle sizes under 14.1 µm. Field contamination was determined with examination under UV light. RESULTS: Drilling of cadaveric bones and three-dimensional models resulted in strongly positive aerosol production, measuring positive in all eight impactor stages for the cadaver trials. This occurred regardless of using coarse or cutting burs, irrigation, a handheld suction, or an additional parked suction. The only mitigation factor that led to a completely negative aerosol result in all eight stages was placing an additional microscope drape to surround the field. Bone dust was scattered in all directions from the drill, including on the microscope, the surgeon, and visually suspended in the air for all but the drape trial. CONCLUSIONS: Aerosols are generated with drilling the mastoid. Using an additional microscope drape to cover the surgical field was an effective mitigation strategy to prevent fine aerosol dispersion while drilling.


Asunto(s)
/prevención & control , Mastoidectomía/efectos adversos , Aerosoles , Cadáver , Humanos , Mastoidectomía/instrumentación , Mastoidectomía/métodos
3.
J Laryngol Otol ; 135(3): 234-240, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33682652

RESUMEN

OBJECTIVE: The extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors. METHOD: Four cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale. RESULTS: A significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus. CONCLUSION: This study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses.


Asunto(s)
Lavado Nasal (Proceso)/instrumentación , Posicionamiento del Paciente/métodos , Cadáver , Endoscopía , Cabeza , Humanos , Senos Paranasales
4.
Bratisl Lek Listy ; 122(4): 242-247, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729815

RESUMEN

BACKGROUND: The aim of this paper was to point out the intradural cranial nerve roots variations in their localization and number to establish the incidence and clinical importance of the cranial nerve root variations. METHODS: The anatomical study was performed on 120 sides in 60 cadavers. There were 51 male cadavers with the mean age 43.3 and 9 female cadavers with the mean age of 39.5 years. RESULTS: Abducens nerve variations were observed in 48 cases (80 %). They were more frequently on the left side, in 25 cases (41.66 %). Duplicated abducens nerve was observed in 25 cases (41.66 %). Double and triple abducens nerve variations were also observed. CONCLUSIONS: Cranial nerve variations are rare, but variations of abducens nerve and atypical exit of the hypoglossal nerve from the fossa cranium posterior is not a rare variation. Knowledge of this variation may be important to various fields of medicine (Tab. 3, Fig. 8, Ref. 34).


Asunto(s)
Nervio Abducens , Nervio Abducens/anatomía & histología , Adulto , Cadáver , Femenino , Humanos , Masculino
5.
Diving Hyperb Med ; 51(1): 10-17, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33761536

RESUMEN

INTRODUCTION: A cadaveric experimental investigation aimed to show the rupture pressure of the tympanic membrane (TM) for otologists to evaluate its tensile strength. METHODS: Twenty adult ears in 10 fresh frozen whole cadaveric heads (four males, six females) mean age 72.8 (SD 13.8) years (range 40-86) were studied. The tensile strength of the TM was evaluated with bursting pressure of the membrane. The dimensions of the membranes and perforations were measured with digital imaging software. RESULTS: The mean bursting pressure of the TM was 97.71 (SD 36.20) kPa. The mean area, vertical and horizontal diameters of the TM were 57.46 (16.23) mm2, 9.54 (1.27) mm, 7.99 (1.08) mm respectively. The mean area, length and width of the perforations were 0.55 (0.25) mm2, 1.37 (0.50) mm, and 0.52 (0.22) mm, respectively. Comparisons of TM dimension, bursting pressure, and perforation size by laterality and gender showed no significant differences. The bursting pressure did not correlate (positively or negatively) with the TM or perforation sizes. CONCLUSIONS: The TM can rupture during activities such as freediving or scuba diving, potentially leading to serious problems including brain injuries. Studying such events via cadaveric studies and data from case studies is of fundamental importance. The minimum experimental bursting pressures might better be taken into consideration rather than average values as the danger threshold for prevention of TM damage (and complications thereof) by barotrauma.


Asunto(s)
Barotrauma , Perforación de la Membrana Timpánica , Adulto , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rotura , Membrana Timpánica , Perforación de la Membrana Timpánica/etiología
6.
Am J Vet Res ; 82(4): 302-309, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33764835

RESUMEN

OBJECTIVE: To evaluate the effect of a continuous locking novel epitendinous suture (nES) pattern with and without a core locking-loop (LL) suture on the biomechanical properties of ex vivo canine superficial digital flexor tendon (SDFT) tenorrhaphy constructs. SAMPLE: 54 cadaveric forelimb SDFTs from 27 musculoskeletally normal adult dogs. PROCEDURES: Tendons were assigned to 3 groups (18 SDFTs/group): sharply transected and repaired with a core LL suture alone (group 1), an nES pattern alone (group 2), or a combination of a core LL suture and nES pattern (group 3). All constructs underwent a single load-to-failure test. Yield, peak, and failure loads; gap formation incidence; and mode of failure were compared among the 3 groups. RESULTS: Mean yield, peak, and failure loads differed significantly among the 3 groups and were greatest for group 3 and lowest for group 1. Mean yield, peak, and failure loads for group 3 constructs were greater than those for group 1 constructs by 50%, 47%, and 44%, respectively. None of the group 3 constructs developed 3-mm gaps. The most common mode of failure was suture pulling through the tendon for groups 1 (12/18) and 2 (12/18) and suture breakage for group 3 (13/18). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested augmentation of a core LL suture with an nES pattern significantly increased the strength of and prevented 3-mm gap formation at the tenorrhaphy site in ex vivo canine SDFTs. In vivo studies are necessary to assess the effectiveness and practicality of the nES pattern for SDFT repair in dogs.


Asunto(s)
Enfermedades de los Perros , Laceraciones , Traumatismos de los Tendones , Animales , Fenómenos Biomecánicos , Cadáver , Perros , Laceraciones/cirugía , Laceraciones/veterinaria , Técnicas de Sutura/veterinaria , Suturas/veterinaria , Traumatismos de los Tendones/cirugía , Traumatismos de los Tendones/veterinaria , Tendones/cirugía , Resistencia a la Tracción
7.
Acta Chir Orthop Traumatol Cech ; 88(1): 39-44, 2021.
Artículo en Checo | MEDLINE | ID: mdl-33764866

RESUMEN

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Lesiones del Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Rango del Movimiento Articular
8.
Arthroscopy ; 37(3): 985-988, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673976

RESUMEN

Magnetic resonance imaging of the torn anterior lateral ligament (ALL) is inconsistent and subject to significant intra- and interobserver variability. Like that of an anterior cruciate ligament (ACL), an ALL tear can vary in degree (first, second, or third) and location (tibial or femoral side). These variations may impact the appropriate surgical intervention. Relevant biomechanical data indicate that the deep iliotibial band fibers are more important than the ALL in controlling pivot shift. Lateral compartment overconstraint after ALL reconstruction does not appear to be a biomechanical or clinical issue. An ALL reconstruction creates a nonisometric construct (tight in extension and lax in flexion), allowing physiologic internal tibial rotation at 90° flexion, whereas lateral extra-articular tenodesis (LET) is more isometric, limiting physiologic internal tibial rotation at 90° flexion. The indications for a combined ACL/ALL reconstruction are evolving, but a Segond fracture and ligamentous hyperlaxity of ≥5 using the modified Beighton system seem reasonable. An ACL/LET reconstruction results in better stability for patients with high-grade pivot shifts.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Tenodesis , Lesiones del Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Humanos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Estudios Retrospectivos , Rotación
9.
Sud Med Ekspert ; 64(2): 23-27, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33739064

RESUMEN

The purpose of this work is to establish the dynamics of the electrical conductivity of various corpse tissues using impedance measurements to assess this method for diagnosing the time of death. It was studied the values of the tissue impedance from the corpses of 8 persons of both sexes and different ages (30-50 years) who died from various causes, with the known date of death. A Keysight U1731 parting was used with two probes, which are stainless steel needles with a diameter of 0.5 mm and a 5 mm immersion length. The analysis of special literature on using indicators of the electrical conductivity dynamics of the corpse tissues, determined by the method of impedance measurement, in the early and late postmortem periods to diagnose the time of death. Trial measurements of a methodological nature were carried out with diagnostic zones: skin, cartilage tissue and tendon. The impedance-metric approach is promising for the purposes of forensic medical diagnostics of the time of death; however, it requires more careful experimental work to establish the dynamics of changes in the total electrical resistance of various tissues of a whole corpse over a long period from the moment of death.


Asunto(s)
Medicina Legal , Cambios Post Mortem , Autopsia , Cadáver , Impedancia Eléctrica , Femenino , Humanos , Masculino
10.
Sud Med Ekspert ; 64(2): 32-36, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33739066

RESUMEN

The aim of this work is to monitor the state of the proteolytic community in time and space for the subsequent development of approaches to an objective assessment of the late postmortem period. The study proposes a combination of standard bacterioscopic and bacteriological research methods with methods of molecular biology and genetics, which make it possible to identify species and strains of mammalian corpses' proteolytics at the level of specific DNA or RNA. On the basis of phenotypic traits and a comparative analysis of the nucleotide sequences of genes encoding 16S rRNA, the species belonging of the isolated strains was proved. The set of methods' combination, including traditional microbiological analysis and molecular genetic studies, seems promising both for the purpose of substantiating and widespread use of microbiological methods in forensic medical practice, and for development an objective scientific base for establishing the cause-and-effect patterns of microbial transformation of organic matter in nature.


Asunto(s)
Medicina Legal , Cambios Post Mortem , Animales , Autopsia , Cadáver , ARN Ribosómico 16S/genética
11.
J Hand Surg Asian Pac Vol ; 26(1): 10-16, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559576

RESUMEN

Background: Locking plate fixation is widely used in large long bone fixation and is now available for small "long" bones in the hand. Potential advantages of unicortical locked fixation are reduced risk of over-drilling and therefore reduced risk of damage to surrounding structures and reduced risk of irritation from proud screws. Furthermore, unicortical fixation may be used where bicortical fixation is technically impossible. Our aim was to compare fixation strength of unicortical locked plate fixation with bicortical non-locked fixation in a human cadaveric model, by assessing strength under cyclical loading conditions and load to failure (LTF). Methods: 16 matched pairs of embalmed and refrigerated human cadaveric metacarpals were randomly allocated to either unicortical locked or bicortical non-locked plate and screw fixation. A transverse osteotomy was made. Fractures were stabilized with 2.0 mm self-tapping locking or cortical screws. Each metacarpal was then loaded with a 3-point cantilever testing using a 100 N cell on an Instron materials testing device, cyclically loading them at 1,000 repetitions of 30 N and 50 N. If there was no visible failure of the fixation from cyclical loading they were then loaded to failure with a 1 kN cell. Results: There was a significant difference of average LTF between the bicortical non-locking and unicortical locking of 38.07-59.95 N (p < 0.01). However, both groups showed no statistically significant difference when comparing their performance under cyclical loading. Conclusions: The authors regard unicortical locked fixation as a useful adjunct to standard plating technique.


Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/cirugía , Ensayo de Materiales , Huesos del Metacarpo/cirugía , Anciano , Cadáver , Femenino , Humanos , Masculino , Huesos del Metacarpo/lesiones , Distribución Aleatoria , Estrés Mecánico , Soporte de Peso
12.
Handchir Mikrochir Plast Chir ; 53(1): 19-25, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33588488

RESUMEN

BACKGROUND: There are no data ensuring a standardized landmark-based-technique for blocking sensitive nerves of the forearm. PURPOSE: To identify locations were with use of good palpable bony landmarks and lines between them sensitive nerve blocks on the forearm can be done with great success. MATERIAL AND METHODS: Dissection of the superficial branch of the radial nerve (SBRN), the dorsal branch of the ulnar nerve (DBUN), the lateral, medial and dorsal antebrachial cutaneous nerve (LACN, MACN, and DACN) as well as the palmar branch of the median nerve (PBMN) was performed on five upper limbs of five different Caucasian cadavers. With respect to radius and ulnar styloid, Lister's tubercle, and the medial and lateral epicondyle of the humerus as well as connecting lines between these bony landmarks locations were defined, where the mentioned nerves can be found and blocked. RESULTS: The six nerves can be safely blocked at the following sites: the SBRN 85 mm proximal to Lister's tubercle on a line drawn between the latter and the medial humeral epicondyle; the LACN 38 mm and the dorsal one 32 mm ulnar from the lateral epicondyle; the MACN 14 mm radial to the medial epicondyle; the DBUN 27 mm proximal to the ulnar styloid in direction to the lateral epicondyle; the PBMN 45 mm proximal to the radial styloid following a line between the latter and the medial epicondyle and 21 mm ulnarwards perpendicular to this line. CONCLUSION: Using superficial good palpable landmarks at the wrist and elbow as well as connecting lines between them the SBRN, DBUN, PBMN, LACN, MACN, and DACN can easily be located.


Asunto(s)
Antebrazo , Muñeca , Cadáver , Mano , Humanos , Articulación de la Muñeca
13.
Handchir Mikrochir Plast Chir ; 53(1): 26-30, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33588489

RESUMEN

BACKGROUND: Decompression of the anterior interosseous nerve can be performed in an open operative exploration or endoscopically. Using an endoscopic decompression superficial anatomical landmarks serve as reference point. The aim of the study was to determine the location of the distribution of the median nerve in relation to the elbow joint in order to facilitate preparation during endoscopic decompression. MATERIALS AND METHODS: The median nerve and the anterior interosseous nerve were dissected in 31 human specimens with regard to the elbow joint. The superficial anatomical landmark was the intercondyle line between the medial and lateral epicondyles. The distance between the origination of the anterior interosseous nerve of the median nerve was measured in relation to the intercondyle line. RESULTS: The anatomical preparation was done using 62 adult cadaveric upper extremities. 11 specimens were formalin fixed and 20 specimens were fresh frozen cadaveric upper extremities. The average of the intercondyle distance was 7.2 cm ± 0.5 (min. 5.8; max. 7.8). The anterior interosseous nerve originated from the median nerve in average 39 mm ± 18 (min. 8; max. 80) distal to the intercondyle line. In 12 cases the distance was within the first 2 cm. There was only a correlation between the length of the upper arm and the nerve junction. CONCLUSION: The anterior interosseous nerve originated from the median nerve in average 4 cm distal to the intercondyle line. Although there was a distribution under 2 cm in around 20 % of the cases. This is very important with regard to the endoscopically technique and should be considered.


Asunto(s)
Descompresión Quirúrgica , Vértebras Lumbares , Adulto , Cadáver , Antebrazo , Humanos , Nervio Mediano/cirugía
14.
Am J Transplant ; 21(3): 911-912, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33641267

Asunto(s)
Pandemias , Cadáver , Humanos
15.
J Vis Exp ; (168)2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33616093

RESUMEN

Accurate measurement of skeletal kinematics in vivo is essential for understanding normal joint function, the influence of pathology, disease progression, and the effects of treatments. Measurement systems that use skin surface markers to infer skeletal motion have provided important insight into normal and pathological kinematics, however, accurate arthrokinematics cannot be attained using these systems, especially during dynamic activities. In the past two decades, biplanar videoradiography (BVR) systems have enabled many researchers to directly study the skeletal kinematics of the joints during activities of daily living. To implement BVR systems for the distal upper extremity, videoradiographs of the distal radius and the hand are acquired from two calibrated X-ray sources while a subject performs a designated task. Three-dimensional (3D) rigid-body positions are computed from the videoradiographs via a best-fit registrations of 3D model projections onto to each BVR view. The 3D models are density-based image volumes of the specific bone derived from independently acquired computed-tomography data. Utilizing graphics processor units and high-performance computing systems, this model-based tracking approach is shown to be fast and accurate in evaluating the wrist and distal radioulnar joint biomechanics. In this study, we first summarized the previous studies that have established the submillimeter and subdegree agreement of BVR with an in vitro optical motion capture system in evaluating the wrist and distal radioulnar joint kinematics. Furthermore, we used BVR to compute the center of rotation behavior of the wrist joint, to evaluate the articulation pattern of the components of the implant upon one another, and to assess the dynamic change of ulnar variance during pronosupination of the forearm. In the future, carpal bones may be captured in greater detail with the addition of flat panel X-ray detectors, more X-ray sources (i.e., multiplanar videoradiography), or advanced computer vision algorithms.


Asunto(s)
Artroplastia/métodos , Radio (Anatomía)/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Grabación de Cinta de Video , Articulación de la Muñeca/diagnóstico por imagen , Muñeca/diagnóstico por imagen , Actividades Cotidianas , Anciano , Algoritmos , Fenómenos Biomecánicos , Cadáver , Femenino , Voluntarios Sanos , Humanos , Persona de Mediana Edad , Radio (Anatomía)/cirugía , Rango del Movimiento Articular , Tomografía Computarizada por Rayos X/instrumentación , Tomografía Computarizada por Rayos X/normas , Muñeca/cirugía , Articulación de la Muñeca/cirugía
16.
Arthroscopy ; 37(2): 477-479, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33546786

RESUMEN

The all-arthroscopic Latarjet is gaining popularity among shoulder surgeons, although the procedure is technically demanding and potentially dangerous, placing the brachial plexus and axillary vessels at risk when using screws for fixation of the bone block from the front. Matsen once wrote that "lateral to the coracoid is the safe side, while medial to the coracoid is the suicide." However, creation of a portal medial to the coracoid during arthroscopic reconstruction of the glenoid is needed to permit accurate positioning of the screws (parallel to the glenoid surface) and coracoid bone block (flush to the glenoid surface). Our own clinical experience with the arthroscopic Latarjet over the last decade has shown us that the safety of the arthroscopic medial transpectoralis portal depends on 3 technical considerations: (1) the portal should always be established in an outside-in fashion from anterior to posterior; (2) passing through the pectoralis major muscle with a relatively superficial trajectory, using a switching stick oriented with a 45° orientation toward the tip of the coracoid; and (3) under visual control of the anterior extra-articular subdeltoid space to end up lateral to the coracoid process. If these conditions are respected, surgeons should not worry: medial to the coracoid can also be a safe side! An inside-out technique (introducing a switching stick from posterior to anterior) is forbidden, as this would end up piercing the neurovascular structures. Once the coracoid has been osteotomized and the conjoint tendon retracted distally, all instruments passing though the transpectoral portal are directly in contact with the neurovascular structures. This is why working through the medial transpectoralis portal should be done only with the help of a cannula or half-pipe. Ideally, the transpectoral portal should not be used as a "working portal" but as a "protecting portal" instead, placing a stick or spreader to protect the neurovascular structures. To avoid working through the anterior medial portal, we have proposed a much safer alternative that consists of drilling the glenoid from posterior to anterior (using a guide and remaining inside the glenohumeral joint) and using cortical-buttons (instead of screws) for coracoid fixation. In this modern technique, the transpectoral portal makes the arthroscopic safe as it allows the introduction of a spreader to retract the subscapularis muscle and protect the neurovascular structures during transfer and fixation of the coracoid bone block.


Asunto(s)
Articulación del Hombro , Hombro , Artroscopía , Cadáver , Humanos , Músculos Pectorales , Articulación del Hombro/cirugía
17.
Arthroscopy ; 37(2): 682-685, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33546804

RESUMEN

The pivot shift and Lachman examinations are "teammates" with complementary but distinct roles in the successful diagnosis and treatment of anterior cruciate ligament rupture and injury to the surrounding soft-tissue envelope of the knee. The Lachman test measures anterior tibial translation in response to an applied anterior tibial load. This test assesses the integrity of the native or reconstructed anterior cruciate ligament and the secondary medial restraints including the medial meniscus and medial collateral ligament. In contrast, the pivot shift exam creates coupled tibiofemoral motions in response to a complex combination of multiplanar loads. This test assesses the stabilizing role of the native or reconstructed anterior cruciate ligament and the secondary lateral restraints including the lateral meniscus and anterolateral complex. The pivot shift grade depends not only on the soft the tissue stabilizers of the knee but also on the shape of the proximal tibia and the distal femur including lateral tibial slope and femoral condylar offset. Both examinations have unique strengths and weaknesses, but when combined as diagnostic tools, they achieve far more collectively than what each can achieve alone.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Inestabilidad de la Articulación , Ligamento Cruzado Anterior , Lesiones del Ligamento Cruzado Anterior/diagnóstico , Fenómenos Biomecánicos , Cadáver , Humanos , Inestabilidad de la Articulación/diagnóstico , Articulación de la Rodilla , Rango del Movimiento Articular , Rotación , Tibia
18.
Med Leg J ; 89(1): 40-53, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33475037

RESUMEN

The activity of the SARS-CoV-2 virus has not yet been studied in a post-mortem setting. The absence of these data has led to the prohibition of exposure of infected corpses during burial procedures. Our aim was to assess the virus's persistence and the possibility of transmission in the post-mortem phase including autopsy staff. The sample group included 29 patients who were admitted to our Covid-19 Centre who died during hospitalisation and the autopsy staff. All the swabs were subjected to a one-step real-time reverse transcription polymerase chain reaction with cycle threshold (Ct) values. Swab collection was performed at 2 h, 4 h, 6 h, 12 h, over 24 since death. The following were the analysis of patients' swabs: 10 cases were positive 2 h after death; 10 cases positive 4 h after death; 9 cases were found positive 6 h after death; 7 cases positive 12 h after death; 9 cases remained positive 24 h after death. The swabs performed on all the forensic pathologist staff on duty who performed the autopsies were negative. The choice to avoid rituals and the display of corpses before and at the burial procedures given appears cautiously valid due to the persistence of the SARS-CoV-2 virus in the post-mortem period. Although the caution in choosing whether or not to perform an autopsy on infected corpses is acceptable, not to perform autopsies is not biologically supported.


Asunto(s)
Autopsia , Cadáver , Cambios Post Mortem , /patogenicidad , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Tiempo , Adulto Joven
19.
Forensic Sci Med Pathol ; 17(1): 101-113, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33394313

RESUMEN

Modern technologies enable the exchange of information about the expansion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the continually increasing number of the coronavirus disease 2019 (COVID-19) cases almost in real time. The gravity of a current epidemiological situation is represented by the mortality rates, which are scrupulously updated daily. Performing autopsies on patients with either suspected or confirmed COVID-19 is of high importance since these might not only improve clinical management but also reduce the risk of SARS-CoV-2 infection expansion. The following paper aimed to present the most crucial aspects of SARS-CoV-2 infection from the point of view of forensic experts and pathologists, recommendations and safety precautions regarding autopsies, autopsy room requirements, possible techniques, examinations used for effective viral detection, recommendations regarding burials, and gross and microscopic pathological findings of the deceased who died due to SARS-CoV-2 infection. Autopsies remain the gold standard for determining the cause of death. Therefore, it would be beneficial to perform autopsies on patients with both suspected and confirmed COVID-19, especially those with coexisting comorbidities.


Asunto(s)
Autopsia/normas , Patologia Forense/normas , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Filtros de Aire , Entierro , Cadáver , Vestuario , Cremación , Reservorios de Enfermedades , Embalsamiento , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Coronavirus del Síndrome Respiratorio de Oriente Medio/aislamiento & purificación , Equipo de Protección Personal , Radiografía , /patogenicidad , Manejo de Especímenes , Tomografía Computarizada por Rayos X
20.
Mymensingh Med J ; 30(1): 154-158, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33397867

RESUMEN

Calcarine sulcus, one of the major sulcus of occipital lobe of cerebral hemisphere which is intimately related with visual function. The detailed anatomy of this lobe is essential for the surgeons and radiologists for clinical investigation & surgery. The aim of the present study was to identify the variation of this sulcus of the occipital lobe. This study was done to establish a normal standard in length of calcarine sulcus in different age & sex groups of Bangladeshi people. Inter-hemispheric age and gender differences of this sulcus was done by cross sectional descriptive study which was performed into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 years & above). The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique. The length of calcarine sulcus was measured by using thread. The mean length of calcarine sulcus was lowest to highest values 7.07±0.616cm to 7.86±0.792cm in male and 6.53±0.808cm to 7.62±0.806cm in female. The mean difference of the length of right calcarine sulcus between group A & D was statistically significant at p<0.05, but not significant in any other age & sex groups for both left and right hemisphere. In present study, the length of the calcarine sulcus showed gradual decreasing values with advancing age. For proper planning of neurosurgical procedures and radiological representation of visual functional areas, detailed knowledge on the variation of this sulcus is essential. Proper knowledge of calcarine sulcus can permit safer access to deep structures and reduce operative complications. The present study will also help to increase the information pool on the length of the calcarine sulcus of Bangladeshi people which will minimize the dependency on foreign standards.


Asunto(s)
Lóbulo Occipital , Autopsia , Bangladesh/epidemiología , Cadáver , Estudios Transversales , Femenino , Humanos , Masculino
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