Morphometric Analysis of the Neural Arch of C2 Vertebra in Indian Population.

BACKGROUND AND OBJECTIVE: The most common injuries to upper cervical spine are fractures of the second cervical vertebrae. The study aims to evaluate the morphometry of the neural arch of the second cervical vertebrae in the South Indian population. MATERIALS AND METHODS: Sixty-three second cervical vertebrae of undetermined gender and age without any gross defect were used for the study. The dimensions of neural arch, including superior articular facet, inferior articular facet, pediculoisthmic component, lamina, spinous process, foramen transversarium, and vertebral foramen, were measured by two independent observers using digital vernier caliper accurate to 0.1 mm and the data was analyzed. Descriptive statistics were obtained for the variables. Paired t-test was done to compare the measurements between right and left sides. RESULTS: There was no statistical difference between the right and left sides of the dimensions of superior articular facets, foramen transversarium, and the transverse diameter of inferior articular facet. The anteroposterior diameter of the inferior articular facets was more on the right side (P = 0.009). The width of the pediculoisthmic component in both the superior and inferior aspects was found to be less on the right side than that of the left (P = 0.006 and P = 0.031, respectively). The thickness in the middle one-third of laminae was optimum for bilateral safe screw insertion (≥4.0 mm) in 77% specimens. CONCLUSION: In summary, measurements of the transverse diameter of superior articular facet and thickness of lamina differed significantly from those reported in literature. This should be kept in mind while doing neurosurgery procedures in the Indian population.

Riedel's Lobe and Beaver Tail Variant: A Cadaveric Case Report.

Variations of the liver in the form of accessory lobes account for about less than 1%. One of the commonest accessory lobes on the right is Riedel's lobe. An occasional anatomical variant of the left lobe is the beaver tail variant. Both variants are reported to be common in females. We hereby report two cases. A 45-year-old female cadaver was noticed to have Riedel's lobe and beaver tail variant. Riedel's lobe appeared to be a tongue-like projection from the right inferior margin of the liver, almost reaching the level of the iliac crest. It was partially separated from the rest of the liver by a deep fissure. The left lobe was elongated, crossed the midline, and reached the left wall of the abdominal cavity after encircling the spleen. Splenomegaly was noticed, and the left lobe of the liver had a splenic impression. Riedel's lobe was drained by the middle hepatic vein (MHV) and supplied by the right branch of the portal vein (RPV). A similar variation of the beaver tail variant was noticed in an 85-year-old female cadaver. The left lobe of the liver crossed the midline and was related superior to the spleen. The right lobe of the liver and the spleen were normal. The beaver tail variant was drained by the left hepatic vein (LHV) and supplied by the left branch of the portal vein (LPV). These variations are prone to injuries and can be confused with the abdominal mass and could interfere with laparoscopic procedures.

Relation of Langerhans cell size to buccal carcinoma.

Oral cancer decreases quality of life despite timely medical management. The carcinogens in tobacco products and their role in tumorigenesis are well documented. Langerhans cells (LCs) are a subset of antigen-presenting cells (APCs) that monitor the tumor microenvironment and engulf carcinogens and foreign bodies. We investigated the distribution and size of LCs and their relation to the mode of tobacco consumption and clinical outcome in patients with buccal carcinoma. We recruited patients with oral cancer who were scheduled for tumor excision and men with urethral stricture undergoing substitution urethroplasty using buccal mucosa. Normal and tumor-adjacent tissues were stained with CD1a antibody. The distribution and mean diameter of 100 LCs/patient were determined. We found significantly smaller LCs in patients who chewed only tobacco compared to those who consumed tobacco by other means. The size of LCs decreased significantly with progressive stages of malignant disease. We found that patients with larger LCs survived longer than those with smaller LCs during an average follow-up of 24 months. We suggest a relation between the size of LCs and clinical outcomes in patients with buccal carcinoma.

Virtual microscopy as a teaching-learning tool for histology in a competency-based medical curriculum.

Background: Histology forms an important component of first-year medical education. Unfortunately, it is limited to the practical laboratory due to the need for a microscope and good quality slides. Virtual microscopy is a recent advancement, which uses computers as an alternative to microscopes. The aim of the study was to compare virtual microscopy (VM)-based practical classes with traditional microscopy (TM)-based practical classes for two cohorts of first-year medical students, by comparing learning achieved using two different test scores as well as a qualitative assessment of student and faculty perspectives regarding the feasibility and usefulness of VM. Methods: Each cohort of students was divided into two equal batches and each batch underwent eight histology modules of which, four utilised traditional microscopes and four utilised virtual microscopes. Quantitative analysis was performed using a theory test (which assessed preparation, theory knowledge and understanding) as well as a spotter test (which assessed identification skills, reasoning, and recall). Qualitative analysis was performed using a structured questionnaire and focus group discussions. Results: Modules using VM were better when compared with those using TM, showing statistically significant and better grades. Qualitative analysis performed, yielded important information as to how this technology can serve as a good adjunct to traditional histology classes in the competency-based curriculum by increasing student interest, enabling self-study, and reducing students dependence on the tutor. Conclusions: VM forms a good adjunct as well as a standalone modality of learning to TM, as it improves accessibility to slides and promotes self-learning.

Immunolocalization of CD1a expressing dendritic cells in sinonasal polyposis.

Sinonasal polyps are benign projections of edematous nasal mucosa lined by respiratory epithelium. Langerhans cells (LCs) belonging to the dendritic cell family located in respiratory epithelium are involved in antigen presentation and maintenance of local immunological homeostasis. This study aims to elucidate the morphology and distribution of CD1a positive LCs in normal nasal mucosa and compare the same with polypoid nasal mucosa by immunohistochemistry. Normal nasal mucosa (n = 20) was obtained from patients who underwent septoplasty for deviated nasal septum. Polypoid nasal mucosa (n = 22) was obtained from patients with chronic rhinosinusitis (CRS) or allergic fungal rhinosinusitis who underwent excision of nasal polyps. The tissues obtained were processed for immunohistochemistry and stained with CD1a-EP80 Rabbit monoclonal antibody. In the tissues studied, CD1a positive LCs were observed in both the epithelium and lamina propria. Different morphological subtypes of LCs were noted in the epithelium. The cells were distributed adjacent to walls of subepithelial capillaries and cysts. The median number of CD1a positive LCs was significantly higher in polypoid category (13.5 per mm2) as compared with normal nasal mucosa (2.5per mm2) (p = .001). Presence of CD1a positive LCs in polypoid nasal mucosa hints at a critical immunological role in the etiopathogenesis of nasal polyps.

Effect of Silver Nitrate Cauterisation of Nasal Mucosa on Quality-of-Life and Histology in Patients with Intractable Chronic Rhinitis.

Patients with chronic rhinitis causing intractable sneezing which is non-responsive to conventional medication require alternative therapies. The aim of the study was to ascertain the effect of topical 10% silver nitrate solution on the inferior turbinate mucosa as well as quality of life in such patients. Patients with severe chronic rhinitis who failed conventional therapy had application of 10% silver nitrate solution to inferior turbinate mucosa. The number of sneezes/day and mini Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was noted before and 8 to 16 weeks after treatment. Pre- and post treatment turbinate biopsies were performed to assess histological changes. At baseline, 67 patients had a mean of 36.6 sneezes/day and mean mini RQLQ score of 4.0 ± 0.7. Pre-treatment biopsies showed epithelial denudation and hyalinization of basement membrane. Following 10% silver nitrate application, 64/67 (95.5%) patients showed significant reduction in number of sneezes both at 1 week (p < 0.001) and 8-16 weeks (mean = 5.5 ± 7.8; p < 0.001). Post- treatment mean global mini RQLQ score was also significantly reduced (mean = 1.3 ± 1.1; p < 0.001). A single application was sufficient in 70.1% patients. There were no complications. Squamous metaplasia (p = 0.005) and epithelial hyperplasia (p = 0.013) as well as epithelial and basement membrane restoration occurred following therapy. 10% silver nitrate solution application is an effective and safe office- based procedure which significantly reduces sneezing improves QoL with corresponding histological changes.

Prevalence of the additional head of quadriceps femoris in the South Indian population: a cadaveric and radiological study.

Quadriceps femoris is an extensor muscle in the anterior compartment of thigh and is traditionally taught to be composed of four heads. Recently, there is an increased interest in the occurrence of an additional muscle head of quadriceps femoris. But scientific knowledge regarding its incidence is lacking in the South Indian population. This study was done to confirm the presence of the additional head by routine anatomic dissection and radiological imaging techniques. Forty-one formalin fixed human cadaveric lower limbs were dissected and the morphology of the additional head was noted. Retrospective analysis of 88 MRI images of patients was done. The additional muscle head was present in 43.9% of the cadaveric lower limbs and was consistently located between the vastus lateralis and vastus intermedius. It originated from variable portions of the greater trochanter, intertrochanteric line, lateral lip of linea aspera and lateral surface of the shaft of femur and inserted either as a muscle belly or as an aponeurosis into the vastus intermedius (55.6%), vastus lateralis (22.2%) or directly into the base of the patella. It received its vascular supply from branches of the lateral circumflex femoral artery and was innervated by branches from the posterior division of the femoral nerve. In addition, the additional muscle head was identified by MRI and its incidence was reported to be 30.68% for the first time in living subjects. The result of this study provides additional information in understanding the morphology of the quadriceps femoris muscle.

Emergency remote learning in anatomy during the COVID-19 pandemic: A study evaluating academic factors contributing to anxiety among first year medical students.

BACKGROUND: 'Emergency remote learning' (ERL) has been undertaken as an emergency response globally to facilitate online shift of medical education due to COVID-19. Although medical students world-wide have reported an increased level of anxiety, factors in the academic setting during ERL that influenced anxiety levels have not been studied yet. The present study aimed to evaluate anxiety levels of first year medical students and its correlation with academic factors during ERL. METHODS: ERL for neuroanatomy was conducted for six weeks mainly by online small group teaching. At completion, feedback was collected from students (n = 97) which included a GAD-7 questionnaire for anxiety levels and a modified VARK analysis to record changes in learning styles. RESULTS: Of 97 students (M46, F51) 43.30% had minimal, 31.96% mild, 10.31% moderate and 14.43% severe anxiety. Academic exchanges such as student-teacher interaction (80.41%), tutor feedback (90.72%) and mentor meetings (81.44%) were reported to be advantageous. There was a significant (p = 0.0056) correlation between enjoyment of small group discussion and lower GAD-7 scores. There was significant change in perceived learning styles during ERL. Video calls (p = 0.018) and gaming (p = 0.022) were significant modes of stress relief. There was significant correlation (p = 0.022) between gaming and GAD-7 scores. CONCLUSION: About one-fourth of the students faced anxiety issues during ERL period. Small group interactions with focus on promoting connectedness and interaction, augmented by feedback, mentorship, familial and social support are important in reducing anxiety which should be kept in mind by educators while delivering such learning experiences.

Structured, functional histology practical modules: An answer to medical students' histology nightmare and the way forward for relevant histology instruction in the Indian undergraduate medical curriculum?

Background: . It is often a challenge to make histology instruction relevant and interesting. We assessed whether structured, worksheet-based histology practical modules with emphasis on functional histology and clinical application, would improve the learning experience and help students focus on relevant functional and clinical correlates. Methods: . In eight practical sessions, 100 students worked as two groups, one group undergoing new intervention practical modules and another group undergoing the routine laboratory practical exercises as a control group. For every pair of laboratory practical exercises, the groups alternated. Spot tests administered in the following week assessed identification ability as well as application of knowledge. Feedback was collected in the form of written questionnaires from faculty and students, student focus group discussion and in-depth interviews. Analysis of test scores as well as feedback was done. Results: . Test scores were better following the intervention method when comparing the overall score as well as its subcomponents of identification and analysis-type questions (p<0.001). The weaker performers in the class as well as high achievers showed better test scores with the intervention method (p<0.001). Feedback from faculty and students reflected better student experience with the intervention method. Suggestions were made to improve the approach further. Conclusion: . Studying histology through structured modules, which emphasize functional and clinical correlates, appears to improve the identification and application ability of the student as well as the student experience.

Branching pattern of the portal vein in Indian population

Thorough knowledge of the variation of intrahepatic course of the portal vein is essential for pre-operative assessment of various hepatic surgeries like hepatectomy and live donor liver transplant. This study aims to determine the variation in the branching pattern of the portal vein in South Indian population. The branching pattern of the portal vein was studied by 3D reconstruction of 100 contrast-enhanced computed tomography images and in 15 formalin fixed livers using modified luminal casting technique. Radiologically, the normal portal vein anatomy was seen in 89%. The most common variation was trifurcation of portal vein (5%). A rare anomaly was noted in one case where the left portal vein gave a branch to segment VII. Using the modified luminal casting technique all the 15 specimens displayed Type I portal vein anatomy. The most common variation in the intrahepatic branching pattern ob-served was the right posterior segmental division supplying segment VIII. A rare left portal vein variation, in which it gave branches to segments V and VIII was noted. In this study, variations in the segmental supply of the portal vein were observed, which have not been studied in detail previously in the Indian population. Variations on the left portal vein are infrequent. A prior knowledge of such variations will help the interventional radiologists to reduce misinterpretations and subsequent misdiagnosis and guide the hepatobiliary

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Non-dendritic Langerhans cells: A new entity in normal and malignant buccal mucosa

Langerhans cells (LCs) are the most effective antigen presenting cells against foreign bodies and carcinogens. Since the oral cavity is a portal of entry for these antigens, the aim of this study was to morphologically classify CD1a+ LCs, quantify them in the normal and malignant buccal mucosa, and evaluate their relation to the age of patients. Healthy buccal mucosal samples collected from 16 patients undergoing reconstructive operation, and malignant samples obtained from 15 patients undergoing radical oncological resection. were processed for immunohistochemistry four- to fivemicron thick sections were stained with CD1a antibody (CD1a). At 40X magnification, CD1a+ LCs were morphologically classified and quantified manually for a 25mm length of basement membrane using Cellsens image analysing software and the data was analysed. Two categories of CD1a+ LCs were identified in the normal and malignant buccal mucosa a) typical dendritic LCs and b) non-dendritic LCs (a new entity). Non-dendritic LCs were of significantly higher number compared to the typical dendritic LCs in the normal tissues (p -0.001). In the malignant group, the non-dendritic CD1a+ LCs were significantly fewer in number (p0.004), when compared to the normal group. Nondendritic LCs were also significantly fewer (p0.026) in patients over 60 years of age. This is the first report of non-dendritic Langerhans cells in normal buccal mucosa and malignant buccal mucosa using the CD1a marker. The significantly higher number of these cells in normal tissues and younger individuals supports their role as accessory antigen presenting cells

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Morphological and morphometric analysis of accessory mental foramen in dry human mandibles of south indian population.

BACKGROUND: Mental foramen (MF) is an important landmark for administration of local anesthesia in surgical procedures involving the mandible. Additional mental foramina, called accessory mental foramina (AMF) transmitting branches of mental nerve, have been reported. Detection of AMFs in presurgical imaging may reduce postoperative pain in dental surgical procedures. Aim: The aim of the study was to study the incidence and morphometric analysis of accessory MF in the dry human mandibles of South Indian population. MATERIALS AND METHODS: Two hundred and sixty dry human mandibles were studied for the presence, location, shape of AMF, and its relation to MF. The horizontal diameter of AMF, and its distance from symphysis menti, the posterior border of mandible and from the base of mandible were measured and statistically analyzed. RESULTS AND CONCLUSIONS: In our study, AMF were present in 8.85% mandibles (unilateral - 7.6% [4.6% - left, 2.69% - right] and bilateral 1.6%). The most common position was below the second premolar (48.1%). AMF were round in shape (74%) and was often located either superomedial or inferolateral to MF. Their transverse diameter ranged from 0.5 to 1 mm. The AMF were situated at a mean distance of 2.96 mm from MF, 23.47 mm from symphysis menti, 11.24 mm from the lower border of the body of the mandible, and 57.35 mm from the posterior border of ramus of mandible. The knowledge of the presence of AMF and its dimensions would enable the clinicians to do mandibular procedures carefully and avoid injury to the branches of mental nerve that may be passing through it.

Follicular dendritic cells in normal and infected human appendix

Follicular dendritic cells (FDCs) that reside within the lymphoid follicles play a central role in humoral immunity. They bind immune complexes and present antigen to follicular B cells and in the generation of B cell memory. This study aims to demonstrate the distribution of CD35 positive FDCs in normal and infected appendix by immunohistochemistry. Four normal and 5 infected appendix specimens were used for the study. Tissues collected were processed for immunohistochemistry, stained with mouse antihuman CD35 monoclonal antibody using the Polymer - HRP Detection System. Double immunostaining was done with mouse antihuman CD20 monoclonal antibody to find out the association CD35 positive Langerhans cells with B lymphocytes. Cells were viewed under the light microscope (Olympus DP21). In the normal appendix, CD35 positive FDCs were present in a reticular pattern in the germinal centre of the follicle. In acute appendicitis, the lymphatic follicles were not intact and FDCs were scattered in the mucosa of the appendix. Few discrete CD35 positive cells were seen surrounding the intestinal glands. CD20 positive B lymphocytes were noted in the lymphatic follicle, interfollicular areas, around the crypts and in the lamina propria. Apposition of CD35 and CD20 cells was noted. The dendrites of FDCs demonstrated in the follicles of appendix displayed an antigen-retaining reticulum which aids in trapping of immune complexes. Their association with CD20 positive B cells confirm the role of appendix in humoral immunity

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Morphology of Sigmoid Colon in South Indian Population: A Cadaveric Study.

INTRODUCTION: Sigmoid volvulus is a common etiological factor in acute large bowel obstruction. The increased length of sigmoid colon is attributed as one of the causes of sigmoid volvulus. AIM: The aim of this study was to find the morphology of sigmoid colon in South Indian population using cadavers. MATERIALS AND METHODS: The present study was performed with 31 cadavers used for teaching purpose. The sigmoid colon was classified into classical, long-narrow and long- broad types by their disposition in the abdominal cavity. The sigmoid loop's relation to pelvic brim was also observed and grouped as pelvic and suprapelvic in position. The length of sigmoid colon along the mesenteric and antimesenteric border, height and width of sigmoid mesocolon in relation to the pelvic brim and the root of mesentery were measured in the study. RESULTS: The study showed that the majority of the sigmoid colons fell into the classical type (47.6%). The sigmoid colon in pelvic position was significantly more prevalent. The mean length of sigmoid colon was 15.2 ± 4.4cm and 19.2 ± 6cm considering the pelvic brim and root of mesentery as reference points of measurement respectively. The mean length along antimesenteric border was 22.3 ± 7.9cm and 25 ± 8.7cm along the same reference points. The mean length of mesocolon height was 6.5 ± 3cm with reference to pelvic brim and 7.3 ± 3cm with reference to root of Sigmoid mesocolon respectively. The mean width of mesocolon was 7.4 ± 3cm (pelvic brim) and 8 ± 2cm (root of Sigmoid mesocolon) There was a positive correlation of sigmoid colon length with the height of the mesocolon. The gender analysis showed that males had statistically significant longer sigmoid colon and mesocolon. CONCLUSION: This study documents that the South Indian population has a more classical type of sigmoid colon and that the anatomical dimensions of sigmoid colon and its mesocolon is significantly longer in males.

Comparison of CT numbers of organs before and after plastination using standard S-10 technique.

Plastination is the art of preserving biological tissues with curable polymers. Imaging with plastinates offers a unique opportunity for radiographic, anatomical, pathological correlation to elucidate complex anatomical relationships. The aim of this study was to make plastinates from cadavers using the standard S-10 plastination technique and to compare the radiological properties of the tissue before and afterwards to examine the suitability of plastinates as phantoms for planning radiotherapy treatment. An above-diaphragm and a below-diaphragm specimen were obtained from a male and a female cadaver, respectively, and subjected to the standard S-10 plastination technique. CT images were obtained before and after plastination and were compared using Treatment Planning System for anatomical accuracy, volume of organs, and CT numbers. The plastinated specimens obtained were dry, robust, and durable. CT imaging of the plastinated specimens showed better anatomical detail of the organs than the preplastinate. Organ volumes were estimated by contouring the organs' outline in the CT images of the preplastinated and postplastinated specimens, revealing an average shrinkage of 25%. CT numbers were higher in the plastinated specimens except in bones and air-filled cavities such as the maxillary air sinus. Although plastination by the standard S-10 technique preserves anatomical accuracy, it increases the CT numbers of the organs because of the density of silicone, making it unsuitable for radiation dosimetry. Further improvements of the technique could yield more suitable plastinated phantoms.

Ultrastructural demonstration of antigen presenting cells in human uterine tube

Langerhans cells (LCs) are the predominant antigen-presenting cells distributed in the mucosa of various organs with high antigenic exposure. They capture antigens, process and present them to the T lymphocytes. LCs are known to be present in the human female reproductive tract. Very few studies have demonstrated the presence of LCs in human uterine tubes. The aim of the present study was to demonstrate the morphology and distribution of LCs in the normal and postpartum human uterine tube by electron microscopy. Tissues from two normal and three postpartum uterine tubes were studied under electron microscopy. The epithelium of the uterine tube varied from simple ciliated columnar epithelium to stratified ciliated columnar epithelium. LCs with a single dendritic process could be identified in the epithelium. The dendritic process displayed the unique Birbeck granules in the cytoplasm. Close apposition of LCs with the intraepithelial lymphocytes was noted. In addition, there were M cells in the epithelium of the normal uterine tube. In the lamina propria, LCs with two or three processes were present which displayed Birbeck granules. They were in close association with lymphocytes as well as with the endothelial cells of the capillaries. A few high endothelial venules (HEVs) were present in the lamina propria of the postpartum uterine tube. The presence of LCs, M cells and HEVs in the uterine tube indicates that the uterine tube is an integral part of mucosa-associated lymphoid tissue

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Morphological study of dendritic cells in human cervix by zinc iodide osmium method.

BACKGROUND: Dendritic cells (DCs) are a heterogeneous population of antigen presenting cells that have been identified in several tissues including the female reproductive organs. The aim of the present study is to demonstrate the morphological differences of dendritic cells in normal human exocervix using the Zinc Iodide Osmium (ZIO) procedure. MATERIALS AND METHODS: Normal cervical tissues obtained from nine patients who underwent abdominal hysterectomies for various ailments were processed for histochemical study. Six microns thick serial sections were taken and viewed under a light microscope. The diameters of the cells were measured under a magnification of 40x using the Cellsens image analysing software and analysed using SPSS version 16. RESULTS AND CONCLUSION: In the normal human exocervix, a greater density of ZIO-positive DCs was noted in the epithelium and subepithelium and their distribution was not uniform. In some areas of epithelium, the ZIO-positive cells in the basal layer showed a typical dendritic morphology, while the cells in the intermediate and superficial layers were nondendritic polygonal cells. Intraepithelial capillaries were noted, which were surrounded by ZIO-positive nondendritic polygonal cells. There was significant difference in the mean diameters of typical DCs (8.61±1.86 µm) and nondendritic polygonal cells (10.97±1.93 µm). In the subepithelium the DCs had typical morphology and their distribution varied. ZIO positive DCs were noted in the epithelium and cervical glands of endocervix also. In conclusion, the human cervix has different subsets of ZIO positive DCs with varied distribution. Their functional role has yet to be defined.

Different subsets of Langerhans cells in human uterine tubes and uterus.

AIM: Langerhans cells (LC) are antigen-presenting cells present in tissues with high antigenic exposure. Their role in the upper female reproductive tract is not fully understood. This study aims to determine the distribution and morphology of LC in the normal and post-partum human uterine tubes and uterus by staining with the specific LC markers, CD1a and zinc iodide-osmium (ZIO), and to determine their association with helper and cytotoxic T cells. MATERIAL AND METHODS: Normal and post-partum uterine tube and uterine specimens were stained with CD1a and ZIO and their morphology and distribution noted. Double immune staining with CD1a-CD4 and CD1a-CD8 in post-partum uterine tube were also done. RESULTS: It was noted that CD1a-positive cells were significantly fewer and smaller in diameter than ZIO-positive cells in the uterine tube and both types of cells were significantly more prevalent in post-partum tubes. Perivascular clusters of ZIO-positive cells were seen in the post-partum tubes. Close association of CD1a-positive cells with CD4- and CD8-positive T cells was noted in the post-partum uterine tube. In the uterus, scanty CD1a-positive cells were present in the surface and glandular epithelium and endometrial stroma. ZIO-positive cells were absent. CONCLUSION: This study suggests that CD1a-positive and ZIO-positive cells may be different subsets of LC that are needed for presentation of antigen to immunocompetent cells. Their respective functions are yet to be determined.

Oblique sectional planes of block plastinates eased by Sac Plastination.

To find an oblique cutting plane of a plastinate, e.g. to cut gamma-nails in the femur, the Block Plastination technique was modified. After CT and MRI examination, the specimens were plastinated with the standard resin mixture E6/E12/E600. Instead of using a box to form a block during the casting and curing stage, we embedded the specimen in a sac made of polyester foil. A polymerized wooden block was attached to the specimen. The sac was wrapped with tape to the embedded specimen with the block. This approach limited the amount of required resin to the inner volume of the plastinate. Then, the plastination sac was put in the incubator for further polymerization and curing. When the foil was removed from the plastinated specimen, the wooden block served as a socket for the grip when sawing. The outer shape of the specimen remained visible. Doing so, the adequate cutting plane could be determined easily.