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1.
Rev. esp. med. legal ; 46(3): 109-118, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192312

RESUMO

El brote por el Coronavirus/COVID-19, declarado Emergencia de Salud Pública de Importancia Internacional el 30 de enero de 2020 por la Organización Mundial de la Salud, ha sobrepasado en numerosos países la capacidad de respuesta del sistema sanitario por su alta contagiosidad, y la de gestión de las personas fallecidas por su elevado riesgo de letalidad. Se revisan las principales guías y protocolos promovidos por las instituciones y las principales sociedades científicas, orientados a la contención de la pandemia mediante la adopción de medidas de protección de los profesionales y a la adecuada gestión del alto número de cadáveres. Se analizan los centros especiales de recogida de cadáveres en situación de epidemias y las clasificaciones de los cadáveres en función del riesgo infecto-contagioso. Específicamente se resumen las resoluciones dictadas por las autoridades sanitarias y se describen los protocolos de actuación ante fallecidos durante la pandemia COVID-19, incluyendo las autopsias forenses


The Coronavirus/COVID-19 outbreak, declared a Public Health Emergency of International Importance on January 30, 2020 by the World Health Organization, has in many countries exceeded the capacity of health systems to respond, due to its high contagiousness and the capacity to manage the deceased, due to its high fatality risk. A review is necessary of the principal guidelines and protocols promoted by the institutions and the main scientific societies, aimed at containing the pandemic by adopting professional protection measures and appropriately managing the high number of cadavers. The temporary mortuaries in an epidemic crisis and the classification of bodies according to infectious risk are analysed. In particular the resolutions issued by the health authorities are summarised and the protocols for dealing with deaths during the COVID-19 pandemic are described, including forensic autopsies


Assuntos
Humanos , Cadáver , Sepultamento/legislação & jurisprudência , Infecções por Coronavirus/mortalidade , Vírus da SARS/isolamento & purificação , Pandemias/legislação & jurisprudência , Precauções Universais/legislação & jurisprudência , Controle de Doenças Transmissíveis/legislação & jurisprudência
2.
Am J Vet Res ; 81(10): 827-831, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32969730

RESUMO

OBJECTIVE: To compare initial leak pressure (ILP) between cadaveric canine and synthetic small intestinal segments that did and did not undergo enterotomy. SAMPLE: Eight 8-cm grossly normal jejunal segments from 1 canine cadaver and eight 8-cm synthetic small intestinal segments. PROCEDURES: Intestinal segments were randomly assigned to undergo enterotomy (6 cadaveric and 6 synthetic segments) or serve as untreated controls (2 cadaveric and 2 synthetic segments). For segments designated for enterotomy, a 2-cm full-thickness incision was created along the antimesenteric border. The incision was closed in a single layer with 4-0 suture in a simple continuous pattern. Leak testing was performed with intestinal segments occluded at both ends and infused with dilute dye solution (999 mL/h) until the solution was observed leaking from the suture line or serosal tearing occurred. Intraluminal pressure was continuously monitored. The ILP at construct failure was compared between cadaveric and synthetic control segments and between cadaveric and synthetic enterotomy segments. RESULTS: Mean ± SD ILP did not differ significantly between cadaveric (345.11 ± 2.15 mm Hg) and synthetic (329.04 ± 24.69 mm Hg) control segments but was significantly greater for cadaveric enterotomy segments (60.77 ± 15.81 mm Hg), compared with synthetic enterotomy segments (15.03 ± 6.41 mm Hg). CONCLUSIONS AND CLINICAL RELEVANCE: Leak testing should not be used to assess the accuracy or security of enterotomy suture lines in synthetic intestinal tissue. Synthetic intestinal tissue is best used for students to gain confidence and proficiency in performing enterotomies before performing the procedure on live animals.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Doenças do Cão , Anastomose Cirúrgica/veterinária , Animais , Cadáver , Cães , Pressão , Técnicas de Sutura/veterinária , Suturas
3.
Otol Neurotol ; 41(9): 1230-1239, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925848

RESUMO

BACKGROUND: COVID-19 has become a global pandemic with a dramatic impact on healthcare systems. Concern for viral transmission necessitates the investigation of otologic procedures that use high-speed drilling instruments, including mastoidectomy, which we hypothesized to be an aerosol-generating procedure. METHODS: Mastoidectomy with a high-speed drill was simulated using fresh-frozen cadaveric heads with fluorescein solution injected into the mastoid air cells. Specimens were drilled for 1-minute durations in test conditions with and without a microscope. A barrier drape was fashioned from a commercially available drape (the OtoTent). Dispersed particulate matter was quantified in segments of an octagonal test grid measuring 60 cm in radius. RESULTS: Drilling without a microscope dispersed fluorescent particles 360 degrees, with the areas of highest density in quadrants near the surgeon and close to the surgical site. Using a microscope or varying irrigation rates did not significantly reduce particle density or percent surface area with particulate. Using the OtoTent significantly reduced particle density and percent surface area with particulate across the segments of the test grid beyond 30 cm (which marked the boundary of the OtoTent) compared with the microscope only and no microscope test conditions (Kruskall-Wallis test, p = 0.0066). CONCLUSIONS: Mastoidectomy with a high-speed drill is an aerosol-generating procedure, a designation that connotes the potential high risk of viral transmission and need for higher levels of personal protective equipment. A simple barrier drape significantly reduced particulate dispersion in this study and could be an effective mitigation strategy in addition to appropriate personal protective equipment.


Assuntos
Aerossóis , Infecções por Coronavirus/prevenção & controle , Processo Mastoide/cirurgia , Mastoidectomia/efeitos adversos , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Cadáver , Fluoresceína , Humanos , Microscopia , Saúde do Trabalhador , Salas Cirúrgicas , Equipamento de Proteção Individual , Cirurgiões , Osso Temporal/cirurgia
4.
Med Educ Online ; 25(1): 1823089, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32930069

RESUMO

The SARS-CoV-2 virus pandemic has left a huge impact on medical education globally. An area that has not been discussed in medical education is the potential implications of the cessation of body and organ donations on medical education. We explore the implications of this on the future of cadaveric dissections in anatomy teaching amidst the SARS-CoV-2 virus pandemic.


Assuntos
Anatomia/educação , Cadáver , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Pandemias
5.
Bone Joint J ; 102-B(10): 1324-1330, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993324

RESUMO

AIMS: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level. METHODS: A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). RESULTS: The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. CONCLUSION: This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.


Assuntos
Artroplastia do Joelho/instrumentação , Doença Iatrogênica , Lesões dos Tecidos Moles/etiologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Desenho de Equipamento , Humanos , Fatores de Risco , Tomografia Computadorizada por Raios X
7.
Arthroscopy ; 36(8): 2055-2056, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747054

RESUMO

The long head of biceps tendon (LHB) has been evaluated as one of the most important pain generators of the shoulder. In addition, an unstable LHB can cause cartilage lesions of the humerus. For the treatment of LHB lesions, tenodesis or tenotomy has been shown to be appropriate. A well-performed biceps tenodesis provides a lower rate of Popeye-sign deformities compared with tenotomy but must result in low implant complication rates and costs.


Assuntos
Tenodese , Tenotomia , Cadáver , Humanos , Ombro , Tendões/cirurgia
8.
Arthroscopy ; 36(8): 2103-2105, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747058

RESUMO

Suture anchor technologies are constantly being innovated in the quest for improved stability, biological integration and clinical outcomes. However, the decision about the choice of suture-anchor materials remain elusive. There are some factors, including reliability, effectiveness, simplicity, familiarity, and cost, that affect a surgeon's preference. The relative weights placed on different factors by different surgeons play decisive roles in individual choice. But decisions and choices are not arbitrary or merely subjective. Alternative options can be warranted or contested by rational argumentation. At the end, there may be losses and gains in the change of 1 suture anchor for another, but science does progress.


Assuntos
Cirurgiões , Âncoras de Sutura , Cadáver , Humanos , Reprodutibilidade dos Testes
10.
Mymensingh Med J ; 29(3): 701-708, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844814

RESUMO

The clinical importance of the internal thoracic arteries in procedures such as coronary artery bypass grafting, transverse rectus abdominis myocutaneous flaps and minimal incision direct coronary artery bypass surgery is well appreciated. The broad clinical utilization of the internal thoracic artery including the role of its branches in supplying blood to the sternum requires explicit anatomical knowledge of the vessel. The internal thoracic artery and its branches are known to exhibit morphological variations for different ethnic groups. Few studies have provided information regarding structural details and patterns of artery and its branches. The present morphometric study was conducted during year 2019. The internal thoracic artery and its branches were dissected and observed on 100 embalmed adult human cadavers of either sex (200 thoracic halves). The origin, diameter at origin and length of the artery were noted. The branching pattern and variations in branching blueprint were documented in this pioneer study. Mean length of branches of artery and mean distance between anterior intercostal arteries was quantified in this pioneer study. Sternal branches were observed in 87% instances on right side. Incidence of pericardiophrenic branches was 90% cases on left side. The origin of pericardiophrenic artery was found to be in 3rd or 4th intercostal space. The incidence of anterior intercostal arteries arising from musculophrenic artery was 73%. A detailed realization of this branching pattern would definitely allow prevention of sternal necrosis and improve prognosis in internal thoracic artery surgical mobilizations. The quantification of diameter at origin in North Indians would aid in determining central venous pressure, introducing pacemaker and administrating drugs in emergency.


Assuntos
Artéria Torácica Interna , Adulto , Cadáver , Ponte de Artéria Coronária , Humanos , Esterno , Retalhos Cirúrgicos
11.
Plast Reconstr Surg ; 146(2): 269-276, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740573

RESUMO

BACKGROUND: The tumescent face lift uses the concept of subcutaneous cannula lipodissection of the neck, as opposed to wide skin undermining. Lipodissection mobilizes soft tissue while preserving perforating neurovascular branches. The purpose of this study is two-fold: (1) to compare the skin recruitment with subcutaneous lipodissection of the neck alone versus wide undermining and (2) to examine the effect of superiorly oriented superficial musculoaponeurotic system (SMAS) movement on jowl excursion in the tumescent face lift. METHODS: A cadaveric study was performed on five fresh tissue cadavers. Postauricular skin excursion was measured following subcutaneous lipodissection and then measured again after traditional, wide undermining of the neck skin. Jowl excursion (in reference to the mandibular border) was measured following superiorly oriented SMAS excursion. An electronic force gauge was used to measure force application during measurements. RESULTS: Cannula lipodissection resulted in a mean skin excursion of 41.9 mm. There was no significant difference in skin excursion compared to wide undermining (41.9 mm versus 42.1 mm; p = 0.785). Jowl position, in reference to the mandibular border, moved superiorly by a mean distance of 18.3 mm with vertical SMAS excursion. CONCLUSIONS: Subcutaneous cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining of the neck. A superior vector of pull on the SMAS results in vertical excursion of the jowl in reference to the mandibular border.


Assuntos
Ritidoplastia/métodos , Tela Subcutânea/cirurgia , Sistema Musculoaponeurótico Superficial/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Cadáver , Feminino , Humanos , Fatores de Tempo
12.
Plast Reconstr Surg ; 146(3): 283e-291e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842101

RESUMO

BACKGROUND: As rhinoplasty techniques have evolved to more extensive dissections, the incidence of iatrogenic deformities, such as alar rim retraction, has risen. Its mechanism is presently unknown. This study examined the microscopic anatomy of the nasal ala to define architectural support elements at the histologic level to determine why rhinoplasty dissection creates such deformities. METHODS: Eight cadaveric noses were harvested and sectioned through the soft triangle and ala. Various tissue stains were performed. Slides were examined using light microscopy. Anatomical features pertaining to cartilage, skin, mucosa, elastic fibers, and muscle were documented. RESULTS: Four male and four female noses were sectioned. The median cadaver age was 64 years (range, 47 to 83 years). On Elastica van Gieson stain, distinct elastic fibers span from the vestibular lining to the caudal margin of the lower lateral cartilage, and from the caudal edge of the lower lateral cartilage to the external alar skin. In the nasal ala midsection, trichrome stains reveal that skeletal muscle is located far beyond the lower lateral cartilage, close to the free alar margin. The soft triangle shows a distinct microanatomical structure, with heavy longitudinal condensations of elastin. These histologic findings have not been previously reported. CONCLUSIONS: A distinct anatomical alar wall endoskeleton has been identified. It is obligatorily disrupted by specific rhinoplasty maneuvers when dissection is carried out over the lateral crura and into areas without cartilaginous support. This microanatomy may explain factors that contribute to postoperative alar wall retraction. Leaving this area undisturbed or performing adjunctive measures with rhinoplasty can provide structural support to the external valves, thus minimizing the risk of deformity.


Assuntos
Deformidades Adquiridas Nasais/etiologia , Nariz/anatomia & histologia , Complicações Pós-Operatórias/etiologia , Rinoplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade
13.
Nat Commun ; 11(1): 3851, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737314

RESUMO

Intravascular imaging has emerged as a valuable tool for the treatment of coronary and peripheral artery disease; however, no solution is available for safe and reliable use in the tortuous vascular anatomy of the brain. Endovascular treatment of stroke is delivered under image guidance with insufficient resolution to adequately assess underlying arterial pathology and therapeutic devices. High-resolution imaging, enabling surgeons to visualize cerebral arteries' microstructure and micron-level features of neurovascular devices, would have a profound impact in the research, diagnosis, and treatment of cerebrovascular diseases. Here, we present a neurovascular high-frequency optical coherence tomography (HF-OCT) system, including an imaging console and an endoscopic probe designed to rapidly acquire volumetric microscopy data at a resolution approaching 10 microns in tortuous cerebrovascular anatomies. Using a combination of in vitro, ex vivo, and in vivo models, the feasibility of HF-OCT for cerebrovascular imaging was demonstrated.


Assuntos
Artéria Basilar/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Microscopia/métodos , Tomografia de Coerência Óptica/métodos , Artéria Vertebral/diagnóstico por imagem , Angiografia/instrumentação , Angiografia/métodos , Animais , Cadáver , Circulação Cerebrovascular/fisiologia , Humanos , Microscopia/instrumentação , Suínos , Tomografia de Coerência Óptica/instrumentação
15.
Medicine (Baltimore) ; 99(31): e21475, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756171

RESUMO

RATIONALE: Typically, the tendon of the pectoralis major inserts into the crest of the greater tubercle of the humerus. However, anomalous insertion sites of the pectoralis major tendons have been noted. PATIENT CONCERNS: The cadaver of a 95-year-old Japanese man was selected from the bodies used for gross anatomy practice at the Tokai University School of Medicine in 2018. DIAGNOSIS: In this cadaver, the left side of the pectoralis major tendon appeared to insert at the crest of the greater tubercle and lesser tubercle of the humerus, forming a tunnel measuring 2.5 cm in total length. INTERVENTION: We removed the fat and skin around the shoulder joint and upper extremity for observational purposes and carefully examined the structures during gross anatomy. OUTCOMES: The medial side of the insertion of the pectoralis major tendon was not into the humerus but had combined with the tendon of the latissimus dorsi, which then loosely inserted into the humerus. As the roof and both walls comprised the tendon of the pectoralis major and the floor was formed by the tendon of the latissimus dorsi and humerus, the structure formed a tunnel. LESSONS: This study is important for orthopedic and rehabilitation physicians in treating diseases of the long head of the biceps brachii tendon. As part of management, the condition of the tendon of the pectoralis major should be confirmed using magnetic resonance imaging or echocardiography.


Assuntos
Músculos Peitorais/anatomia & histologia , Músculos Superficiais do Dorso/anatomia & histologia , Tendões/anormalidades , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Cadáver , Dissecação , Humanos , Masculino
16.
Palmas; Secretaria de Estado da Saúde; 20200730. 13 p.
Não convencional em Português | LILACS, Coleciona SUS, CONASS, SES-TO | ID: biblio-1122133

RESUMO

Traz orientações de Biossegurança para o manejo de cadáveres suspeitos ou confirmados por Covid-19 pelos serviços de somatoconservação, funerárias, cemitérios, crematórios, serviço de verificação de óbito, autópsia, transladação de cadáveres e velórios no Estado do Tocantins.


It provides Biosafety guidelines for the management of suspected or confirmed corpses by Covid-19 by somatoconservation, funeral services, cemeteries, crematoriums, death verification service, autopsy, transfer of corpses and funerals in the State of Tocantins.


Traz orientações de Biossegurança para o manejo de cadáveres suspeitos ou confirmados por Covid-19 pelos serviços de somatoconservação, funerárias, cemitérios, crematórios, serviço de verificação de óbito, autópsia, transladação de cadáveres e velórios en Estado do Tocantins.


Assuntos
Humanos , Cadáver , Contenção de Riscos Biológicos , Autopsia , Contaminação Biológica/prevenção & controle , Cremação , Equipamento de Proteção Individual , Betacoronavirus , Práticas Mortuárias/normas
19.
PLoS One ; 15(7): e0236286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702004

RESUMO

Functional brown adipose tissue (BAT) was identified in adult humans only in 2007 with the use of fluorodeoxyglucose positron emission tomography imaging. Previous studies have demonstrated a negative correlation between obesity and BAT presence in humans. It is proposed that BAT possesses the capacity to increase metabolism and aid weight loss. In rodents it is well established that BAT is stimulated by the sympathetic nervous system with the interscapular BAT being innervated via branches of intercostal nerves. Whilst there is evidence to suggest that BAT possesses beta-3 adrenoceptors, no studies have identified the specific nerve branch that carries sympathetic innervation to BAT in humans. The aim of this study was to identify and trace the peripheral nerve or nerves that innervate human BAT in the supraclavicular region. The posterior triangle region of the neck of cadaveric specimens were dissected in order to identify any peripheral nerve branches piercing and/or terminating in supraclavicular BAT. A previously undescribed branch of the cervical plexus terminating in a supraclavicular adipose depot was identified in all specimens. This was typically an independent branch of the plexus, from the third cervical spinal nerve, but in one specimen was a branch of the supraclavicular nerve. Histological analysis revealed the supraclavicular adipose depot contained tyrosine hydroxylase immunoreactive structures, which likely represent sympathetic axons. This is the first study that identifies a nerve branch to supraclavicular BAT-like tissue. This finding opens new avenues for the investigation of neural regulation of fat metabolism in humans.


Assuntos
Tecido Adiposo/inervação , Clavícula/inervação , Adipócitos/citologia , Tecido Adiposo/anatomia & histologia , Idoso , Cadáver , Forma Celular , Clavícula/anatomia & histologia , Dissecação , Humanos , Tirosina 3-Mono-Oxigenase/metabolismo
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 634-642, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683822

RESUMO

There has been an upsurge of the theory of membrane anatomy in China, but it is still in the initial stage of establishing preliminary framework. The concept of fasciae in membrane anatomy actually refers to the fasciae constituting the particular plane or the 'holy plane'. Therefore, the membrane anatomy can't simply be defined as the anatomical relationship among fascia. The application of the membrane anatomy is also not just to pursue the avascular plane in the surgical field. Nowadays, nonstandard anatomical terms and diversification of views impede the development of the theory of the membrane anatomy. Fasciae occur in embryonic stage, undergo a series of changes in rotation and fusion, and lose the original features, which bring difficulties in understanding the anatomy of fasciae. In this paper, we restore the origin and continuity of fasciae related to the colorectal surgery by cadaveric study, surgical observation and literature review. Taking the TME for example, we also discuss the core content about the fasciae and plane related to 'mesenteric envelope' and complete mesorectal excision. From the perspective of the fasciae integrity, we illustrate the definitions of important anatomical structure and standardized the terminology of fasciae. To study the origin and architecture of fasciae in the view of embryology, integrity and continuity will contribute to establish the standard theoretical system of membrane anatomy.


Assuntos
Fáscia/anatomia & histologia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Cadáver , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fáscia/irrigação sanguínea , Fáscia/embriologia , Humanos , Mesentério/irrigação sanguínea , Mesentério/embriologia , Reto/cirurgia , Membrana Serosa/anatomia & histologia , Membrana Serosa/irrigação sanguínea , Membrana Serosa/cirurgia
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