Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection.

INTRODUCTION: Although administration of regional anesthesia nerve blocks has increased during the COVID-19 pandemic, training opportunities in regional anesthesia have reduced. Simulation training may enhance skills, but simulators must be accurate enough for trainees to engage in a realistic way-for example, detection of excessive injection pressure. The soft-embalmed Thiel cadaver is a life-like, durable simulator that is used for dedicated practice and mastery learning training in regional anesthesia. We hypothesized that injection opening pressure in perineural tissue, at epineurium and in subepineurium were similar to opening pressures measured in experimental animals, fresh frozen cadavers, glycol soft-fix cadavers and patients. METHODS: We systematically reviewed historical data, then conducted three validation studies delivering a 0.5 mL hydrolocation bolus of embalming fluid and recording injection pressure. First, we delivered the bolus at 12 mL/min at epimysium, perineural tissue, epineurium and in subepineurium at 48 peripheral nerve sites on three cadavers. Second, we delivered the bolus at using three infusion rates: 1 mL/min, 6 mL/min and 12 mL/min on epineurium at 70 peripheral nerve sites on five cadavers. Third, we repeated three injections (12 mL/min) at 24 epineural sites over the median and sciatic nerves of three cadavers. RESULTS: Mean (95%) injection pressure was greater at epineurium compared with subepineurium (geometric ratio 1.2 (95% CI: 0.9 to 1.6)), p=0.04, and perineural tissue (geometric ratio 5.1 (95% CI: 3.7 to 7.0)), p<0.0001. Mean (95%) injection pressure was greater at 12 mL/min compared with 1 mL/min (geometric ratio 1.6 (95% CI: 1.2 to 2.1), p=0.005). Pressure measurements were similar in study 3 (p>0.05 for all comparisons). DISCUSSION: We conclude that the soft-embalmed Thiel cadaver is a realistic simulator of injection opening pressure.

[Comparative normative on sanitary practices of cadaveric preservation in Spain]. / Normativa comparada sobre prácticas sanitarias de conservación cadavérica en Españ.

In this paper the current regulations on cadaveric preservation practices required for the transfer of corpses in the different Autonomous Communities -Reglamentos de Policía Sanitaria Mortuoria- and national legislation are compared. The criteria taken into account have been: a) which sanitary practices are included in the regulations, b) which ones can be carried out in corpses posing a health risk, c) when they are compulsory to be carried out, d) when they can be carried out after death, and e) what professionals can carry them out and/or take responsibility for them. At the time of finishing the paper, a new mortuary regulation is being passed in Andalusia, as well as a decree from the Ministry of Health on technical and sanitary requirements concerning international transfer of corpses and human remains.

Se comparan las normativas vigentes sobre prácticas sanitarias de conservación cadavérica requeridas para el traslado de cadáveres, en las diferentes Comunidades autónomas y la legislación estatal. Los criterios tenidos en cuenta han sido: qué prácticas sanitarias se incluyen en la normativa, cuáles pueden llevarse a cabo en cadáveres de riesgo sanitario, cuándo se requiere su realización, en qué momento tras el fallecimiento pueden realizarse y qué profesionales las pueden llevarlas a cabo y/o responsabilizarse de las mismas. En el momento de finalizar el artículo se está tramitando la publicación del nuevo decreto de sanidad mortuoria de Andalucía, así mismo se está elaborando, por parte del Ministerio de Sanidad, Consumo y Bienestar Social, un Real Decreto sobre "Condiciones técnico sanitarias básicas en materia de traslado internacional de cadáveres, restos humanos y restos cadavéricos".

Holding donated human bodies in conservation: A novel interactive safe-keeping system meeting high ethical and safety standards.

"Mortui vivos docent". Learning from donated bodies is widely considered a corner stone in pre-clinical education, advanced clinical training, and scientific progress in medicine. Making such use of dead human bodies must, of course, accord with high ethical standards and legal constraints. Piety and respect towards donors require using their remains (i) for valuable purposes, (ii) with what we call 'practical decency', (iii) in an efficient way, and (iv) with the utmost safety for all parties involved. With regard to these goals, practical aspects of preservation, safekeeping procedures (for up to several years), and complete documentation become of great importance, but have so far only been realized unsatisfactorily. Here, we describe the new Safe-Keeping System-Münster (SKS-Münster) that has been developed and implemented in the Anatomy Department of the University of Münster. Integrated components of the system include a paternoster transport system, a removal station with ventilation and an air barrier, RFID transponder technology, and an easy to use software package allowing the system together to provide all required functions in an unprecedented way.

The antimicrobial capacity of embalming solutions: a comparative study.

AIMS: Infectious health risks are associated with handling human cadavers and to decrease such risks, cadavers are embalmed using different chemicals. The aim of this study is to quantify the amount of micro-organisms present in different regions of human cadavers before embalming, after embalming and over a period of 8 months. METHODS AND RESULTS: Human cadavers were embalmed using Thiel, formalin, Genelyn and the Imperial College London soft-preservation (ICL-SP) solution with two cadavers per technique. Sterile swabs were used to collect samples from different regions. Samples were collected every 2 months. All cadavers had a high number of microbial colonies before embalming. While no colonies were detected on formalin and Genelyn embalmed cadavers post-embalming, the number of colonies decreased significantly in Thiel-embalmed cadavers and stayed relatively the same in ICL-SP-embalmed cadavers. CONCLUSIONS: Formalin-embalmed cadavers showed the strongest disinfecting abilities followed by Thiel-embalmed cadavers, then Genelyn-embalmed cadavers and finally by ICL-SP cadavers. SIGNIFICANCE AND IMPACT OF THE STUDY: This study highlights how under researched this area is and the evident variation in the antimicrobial abilities of different embalming solutions on the cadaver as a whole and within different regions of the same cadaver.

Normativa comparada sobre prácticas sanitarias de conservación cadavérica en España / Comparative normative on sanitary practices of cadaveric preservation in Spain

Se comparan las normativas vigentes sobre prácticas sanitarias de conservación cadavérica requeridas para el traslado de cadáveres, en las diferentes Comunidades autónomas y la legislación estatal. Los criterios tenidos en cuenta han sido: qué prácticas sanitarias se incluyen en la normativa, cuáles pueden llevarse a cabo en cadáveres de riesgo sanitario, cuándo se requiere su realización, en qué momento tras el fallecimiento pueden realizarse y qué profesionales las pueden llevarlas a cabo y/o responsabilizarse de las mismas. En el momento de finalizar el artículo se está tramitando la publicación del nuevo decreto de sanidad mortuoria de Andalucía, así mismo se está elaborando, por parte del Ministerio de Sanidad, Consumo y Bienestar Social, un Real Decreto sobre "Condiciones técnico sanitarias básicas en materia de traslado internacional de cadáveres, restos humanos y restos cadavéricos"

In this paper the current regulations on cadaveric preservation practices required for the transfer of corpses in the different Autonomous Communities -Reglamentos de Policía Sanitaria Mortuoria- and national legislation are compared. The criteria taken into account have been: a) which sanitary practices are included in the regulations, b) which ones can be carried out in corpses posing a health risk, c) when they are compulsory to be carried out, d) when they can be carried out after death, and e) what professionals can carry them out and/or take responsibility for them. At the time of finishing the paper, a new mortuary regulation is being passed in Andalusia, as well as a decree from the Ministry of Health on technical and sanitary requirements concerning international transfer of corpses and human remains

El rito de la «Apertura de la Boca» en el Antiguo Egipto: estudio bucodental de una cabeza egipcia momificada / The Ritual of «Opening of the Mouth» in Ancient Egypt: study on a mummified egyptian head

La momificación o embalsamamiento es un proceso que se desarrolló en el Antiguo Egipto para conservar el cuerpo tras la muerte, y preservar así la identidad del individuo en la vida futura, de acuerdo con sus costumbres funerarias. El rito de la «Apertura de la Boca y los Ojos», formaba parte de los ritos funerarios y pretendía devolver al difunto la capacidad de hablar y de observar en el más allá. Se realizaba sobre el cadáver previamente a su embalsamamiento, o bien se «representaba» ante la momia ya embalsamada o una estatua de la misma. Se presenta el caso de un cráneo humano momificado del Museo de Antropología Forense, Paleopatología y Criminalística de la Escuela de Medicina Legal de Madrid. Presenta protrusión lingual y fracturas en los dientes del grupo anterosuperior (AU)

Mummification or embalming is a process which was developed in Ancient Egypt in order to preserve the body after death, and thereby to maintain the individual's identity in the afterlife, in accordance with Ancient Egyptian funerary customs. The ritual of Opening the Mouth and Eyes formed part of the funerary rituals and constituted an attempt to restore the ability of the deceased to speak and see in the life beyond. It was performed on the corpse prior to embalming, or it was «performed» in front of the mummy after embalming or a statue of the mummy. We present the case of a mummified human cranium from the Forensic Anthropology, Paleopathology and Criminal Studies Museum at the Legal Medicine School of Madrid. It displays a protruding tongue and fractures on the teeth in the anterosuperior group (AU)

Improvement of the embalming perfusion method: the innovation and the results by light and scanning electron microscopy.

Embalming is a chemical process that aims the preservation and sanitization of the human body indefinitely. The technique of embalming is an important tool in teaching and research in anatomy enabling the preservation of cadaveric material in good conditions (lessening any significant structural changes and maintaining the natural appearance). This article presents the results of embalmed cadavers in the course of arterial perfusion, through the use of a perfusion machine, particularly designed to this objective, and which allows the control of the embalming fluid injection process. The influence of this technique and the optimization of its parameters on the final quality of embalming were evaluated by sequential histological analysis of the cadaveric tissues using an original method of classification of samples collected from 17 deceased corpses of the Corpses Donation Office of the Department of Anatomy of Faculdade de Ciências Médicas from Universidade Nova de Lisboa, subject to the embalming technique developed in the Department. We concluded that, with this method, there is a decrease of the decomposition process at the time of embalming, which is effective at long term (over a year), requiring merely the maintenance of the body at low temperatures (4° C) and it is possible to observe that the tissue best preserved over time is muscle, showing a conservation considered optimal.

O embalsamamento é um processo químico que visa a preservação e sanitização do corpo humano por tempo indefinido. A técnica de embalsamamento é uma ferramenta importante no ensino e investigação em Anatomia viabilizando a conservação em boas condições de material cadavérico (minorando alterações estruturais significativas e mantendo a aparência natural). Este artigo reporta os resultados de embalsamamento de cadáveres obtidos por perfusão arterial, através da utilização de uma máquina de perfusão especialmente desenhada para o efeito. E que permite o controlo do processo de injecção de fluido de embalsamamento. A influência da técnica e a optimização dos seus parâmetros na qualidade final do embalsamamento foi avaliada através da análise histológicasequencial de tecidos cadavéricos e sua classificação por método original a partir de uma amostra de 17 cadáveres do Gabinete de Doação do Departamento de Anatomia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa, sujeitos à técnica de embalsamamentodesenvolvida no Departamento. Concluímos que, com a utilização deste método, ocorre uma diminuição do processo de decomposição no momento do embalsamamento, o qual é eficaz a longo prazo (mais de um ano), exigindo apenas a manutenção do corpo a baixas temperaturas (4° C), sendo o músculo o tecido melhor preservado, com uma classificação considerada óptima.

A pilot study on ethanol-polyethylene glycol-formalin fixation of farm animal cadavers.

Most embalming of cadavers for anatomical dissection in veterinary medicine has used 6-10% formaldehyde resulting in discoloured and rigid specimens. This project produced teaching specimens of sheep, horse and calf cadavers having their musculoskeletal and visceral structures with a natural appearance using a fixation solution with lowered concentrations of formaldehyde (2% and 3%) together with ethanol and polyethylene glycols. Fixation parameters (palpable consistency, flexibility, colour, tissue hydration and odour) were assessed qualitatively by twice weekly dissections over two months for sheep and three months for horses and calf. Formaldehyde levels, measured in the breathing zone, were below the maximum allowable concentration in all specimens except for a 300 kg horse cadaver. To evaluate the effectiveness of the fixation solution in microbial inhibition, tissue samples were taken and analyzed for the presence of culturable aerobic and anaerobic bacteria, yeasts and moulds. Single colonies of Pseudomonas oryzihabitans, Chryseobacterium sp., Acinetobacter sp. were isolated from lungs, and Micrococcus sp. and Bacillus sp. were isolated from one muscle sample.