Cases reported "Cadaver"

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1/25. Creutzfeldt-Jakob disease in a patient with a lyophilized dura mater graft.

    A 37-year-old patient with Creutzfeldt-Jakob disease (CJD) is presented, who had received a cadaveric dura matter graft 12 year before the onset of neurologic symptoms. Initial clinical presentation included cerebellar symptoms, with dementia and myoclonus developing in later stages of the disease. EEG showed diffuse slowing with sporadic triphasic periodic activity. CT was normal in the early stage but pronounced cerebral and cerebellar atrophy with widened sulci were seen on MRI in the late stage of the disease. The prion protein (PrP) gene was homozygous for valin at the polymorphic codon 129. cerebrospinal fluid analysis for 14-3-3 protein was positive. We believe that this patient is the first Croatian to acquire CJD by dural implant. Based on this case and a review of 66 cases from the literature, it is manifest that the awareness of iatrogenic transmission of CJD and adoption of preventive measures are the only effective way to stop the spread of CJD among surgically treated patients.
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ranking = 1
keywords = cerebral
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2/25. Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery.

    OBJECTIVE: The P2 segment of the posterior cerebral artery has remained a challenging region to expose surgically. We establish a surgical strategy for P2-segment aneurysms. methods: Each segment of the posterior cerebral artery was classified according to Zeal and Rhoton's classification. Fourteen of 18 P2-segment aneurysms were surgically treated. The patient's outcome, the aneurysm location, and the surgical procedures were evaluated. A cadaveric study was performed to clarify the surgical view obtained via three different surgical approaches. RESULTS: Nine aneurysms were clipped, two were trapped, one was coated, and one was excised with parent artery reconstruction. cerebral revascularization techniques were used for three patients. The pterional approach exposed the anterior half of the P2a segment. The subtemporal approach revealed the P2a segment, but its exposure was restricted by its localization in the ambient cistern. Via the occipital interhemispheric transtentorial approach, the P2p segment was visible and could be manipulated. When the posterior half of P2a segment was high on a coronal view of magnetic resonance imaging, it was extremely hard to access via any approach. CONCLUSION: A surgical strategy for the P2 aneurysm can be planned with accurate prediction of the aneurysm location. When the localization of an aneurysm on the posterior half of P2a segment is high, a resection of brain tissue may be required.
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ranking = 6
keywords = cerebral
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3/25. Cadaveric study of blood supply to the lower intraorbital fat: etiologic relevance to the complication of anaerobic cellulitis in orbital floor fracture.

    BACKGROUND AND PURPOSE: Although orbital fractures are common, orbital cellulitis rarely develops following orbital fracture. We hypothesized that compromise of the blood supply to the intraorbital fat during orbital floor fracture is responsible for this condition. The purpose of this study was to determine whether or not the lower intraorbital fat is supplied by a branch of the infraorbital artery along the orbital groove or canal on the orbital floor. MATERIALS AND methods: We dissected 14 orbits from seven fixed human cadavers and 12 orbits from six fresh cadaver heads following dye injection into the maxillary artery. The sites of dye-filled vessels branching from the infraorbital artery supplying the lower intraorbital fat were measured and plotted on a two-dimensional orbital floor graph. RESULTS: A main branch of the infraorbital artery rose through the medial orbital floor to supply the lower intraorbital fat in all of the cadaver orbits. The sites of the branching point of the vessel ranged from 0 to 5 mm (mean, 2.2 mm; n = 14) medial to the line connecting the infraorbital foramen and the infraorbital groove. The shortest distance measured from the branching point to the orbital rim ranged from 3 to 20 mm (mean, 14.1 mm; n = 14). This suggests that if orbital fracture were to occur around the infraorbital groove or canal, this vascular pedicle would be in danger of being incarcerated by bone fragments. CONCLUSION: Our cadaveric investigation revealed that the lower intraorbital fat is supplied by a branch of the infraorbital artery along the infraorbital groove or canal on the orbital floor. This finding suggests that compromised blood supply to the intraorbital fat may cause anaerobic cellulitis or enophthalmos.
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ranking = 32.237351955173
keywords = foramen
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4/25. Applying circular posterior-hinged craniotomy to malignant cerebral edemas.

    Malignant brain edemas are often fatal, regardless of whether they are treated conservatively with sedation, blood pressure management, mannitol-therapy, hyperventilation and hypothermia, or non-conservatively with routine trepanation. Unfortunately, temporal trepanation may result in significant brain damage through herniation of the cerebrum at the edges of the trepanation openings. In one case of a 26-year-old male with severe head injury, a circular posterior-hinged craniotomy (CPHC) was performed after an ineffective unitemporal trepanation for evacuation of an acute subdural hematoma. This ultimately successful operation prompted experimental and morphologic investigations on a new surgical procedure for lowering intracranial pressure (ICP). In 12 of 15 human cadavers, an experimentally ICP was lowered by a CPHC with between 9-21 mm of frontal elevation of the calvaria. Using computer simulation, the frontal elevations of the calvaria were "virtually" performed on 3D reconstructions from CT scans of skulls, and the intracranial volume gained was measured with a computer software program. The volume increase of the cranial cavity showed a relatively constant relation to the cranial capacity and was increased by 6.0% ( /-0.4%) or 78 cm(3) with a 10 mm elevation and by 12.4% ( /-0.7%) or 160 cm(3) with a 20 mm elevation. There were no significant differences with skulls of different ages or ethnic origin; however, a significant effect of gender (F = 7.074; P < or = 0.013) on the gained volume in percent of the cranial capacity for the 20 mm elevation was observed. This difference can be explained by the inverse relationship between volume increase and cranial capacity (r = -0.507; P < or = 0.004).
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ranking = 4
keywords = cerebral
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5/25. Surgical indications and microsurgical anatomy of the transchoroidal fissure approach for lesions in and around the ambient cistern.

    OBJECTIVE: Opening the temporal part of the choroidal fissure (CF) makes it possible to expose the crural cistern, the ambient cistern, and the medial temporal lobe. We examined the microsurgical anatomy and the surgical indications for use of the trans-CF approach. methods: The microsurgical anatomy encountered in the trans-CF approach for lesions in and around the ambient cistern was studied in three cadavers. On the basis of these cadaveric studies, the trans-CF approach was used during surgery in three live patients with such lesions. RESULTS: The angiographic "plexal point," which indicates the entrance of the anterior choroidal artery as it enters the temporal horn of the lateral ventricle, was thought to be a key anatomic landmark of the trans-CF approach. A cortical incision for entry into the temporal horn should be made in the inferior temporal gyrus to minimize the potential damage to the optic radiations and to the speech centers. After the CF is opened posteriorly to the plexal point between the tenia fimbria and the choroid plexus, the posterior cerebral artery (PCA) in the ambient cistern can be observed with minimal caudal retraction of the hippocampus. In this study, surgical procedures using the trans-CF approach were successfully performed on patients with high-positioned P2 aneurysms whose PCA ran close to the plexal point or higher, whose medial temporal arteriovenous malformations were fed mainly by the PCA, and whose tentorial hiatus meningiomas protruded into the temporal horn through the CF, with no resulting postoperative visual or memory disturbances. CONCLUSION: The trans-CF approach is especially useful in surgery for lesions in and around the ambient cistern.
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ranking = 5.3176509628047
keywords = ventricle, cerebral
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6/25. brain neurotransmitter changes in human narcolepsy.

    We measured the concentrations of the three major monoamine neurotransmitters noradrenaline, dopamine, and serotonin, their metabolites, and receptor binding sites in autopsied brain of three patients with narcolepsy. As compared with the controls, concentrations of the noradrenaline and serotonin metabolites MHPG and 5-HIAA, respectively, were markedly elevated in cerebral cortical subdivisions of the narcolepsy patients together with a trend for above-normal neurotransmitter/metabolite "turnover" ratio. A moderately reduced number of alpha 1-adrenoceptors, as judged by the reduced levels of 3H-prazosin binding, was observed in cerebral cortex of two of the three patients with narcolepsy. Mean striatal levels of dopamine and its metabolite homovanillic acid were normal, whereas the concentration of dopamine's second metabolite, dihydroxyphenylacetic acid, was markedly reduced by 50% or greater. This was accompanied by a marked increase ( 125%) in mean 3H-spiperone binding to the D2 dopamine receptor in both caudate and putamen; in contrast, the levels of 3H-SCH 23390 binding to the striatal D1 dopamine receptor were in the normal range. Our data provide evidence for altered brain monoaminergic neurotransmitter function in human narcolepsy.
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ranking = 2
keywords = cerebral
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7/25. An autopsy case of Kawasaki disease with reference to occurrence of acute coronary thrombosis in the convalescent stage.

    A one-year, four month-old boy who had suffered from Kawasaki disease died suddenly during convalescence despite intensive gamma-globulin treatment. autopsy revealed a) sausage-like aneurysms of the left and right coronary arteries and fresh thrombosis in the right coronary aneurysm, b) fresh transmural myocardial necrosis in the whole wall of the left ventricle and the anterior part of the wall of the right ventricle, and c) swelling of the cervical lymph nodes and thymus (60 g). Histologically, fibrocellular thickening of the intima and destruction of the media and internal elastic lamina were conspicuous in the area of the aneurysm, but those of the intima and media in the areas adjacent to the aneurysm were mild. Abrupt narrowing of the lumen at the border between the aneurysm and periphery of the right coronary artery was detected, and this may have been responsible for formation of the thrombus in the right coronary aneurysm. In the systemic arteries, perivascular fibrosis was very noticeable despite less severe injury to the intima and media. These findings suggest that severe inflammation of the periarterial regions was present in the acute phase. The lymph system still showed inflammation, supporting the infectious or toxic nature of Kawasaki disease.
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ranking = 8.6353019256094
keywords = ventricle
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8/25. intestinal perforation after cadaveric renal transplantation.

    We performed cadaveric renal transplantation on a 46-year-old man on long-term hemodialysis. methicillin-resistant staphylococcus aureus (MRSA) enterocolitis occurred on the fifth postoperative day and severe intestinal ulceration and perforation followed. Subtotal abdominal colectomy and the simultaneous removal of the transplant were performed. Postoperatively, disseminated intravascular coagulopathy with pancytopenia and cerebral hemorrhagic infarction developed and the patient died 40 days later.
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ranking = 1
keywords = cerebral
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9/25. On unknown bone bridge and foramen of the atlas.

    The atlas of a 52-year-old male Japanese cadaver, which had been removed and macerated, presented a bilateral unknown bone bridge forming a foramen (Case 1). The bone bridge connected the ponticulus lateralis (PL) and posterior (PP) to form an oval foramen between the superior roots of both ponticuli. The atlas of a 69-year-old male Japanese cadaver was found to have similar variations in situ (Case 2). In this case, the right bone bridge connected the superior root of the incomplete PL and the inferior root of the also incomplete PP to form a long ellipsoid foramen opening medially. The medial opening of the foramen was closed by a ligamentous connective tissue in situ. The condylar emissary vein passed this complete foramen to join the cervical epidural venous plexus. The similar bilateral foramen in case 1 was supposed to pass the same vein as in case 2. The bone bridge between the two ponticuli and the resulting foramen mentioned above have not been described previously, as far as we know. We propose that these structures be called the ponticulus interponticularis atlantis and the foramen atlantoideum interponticulare, respectively.
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ranking = 386.84822346207
keywords = foramen
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10/25. Lateral transsulcal approach to asymptomatic trigonal meningiomas with correlative microsurgical anatomy: technical case report.

    OBJECTIVE: We introduce the lateral transsulcal approach to asymptomatic trigonal meningiomas. methods: The approach was studied in two cadaver brains and three asymptomatic patients with trigonal meningiomas. The posterior part of the sylvian fissure, or superior temporal sulcus, is opened to the bottom. Through a small horizontal cortical incision, the trigone of the lateral ventricle is exposed in the shortest distance. The trigonal meningiomas are detached from the choroid plexus and removed. RESULTS: In patients with meningiomas on the nondominant side, the transsylvian approach was adopted. In patients with meningiomas on the dominant side, the transsylvian approach was adopted for patients with a wide sylvian cistern, and the approach through the superior temporal sulcus was adopted for patients with a narrow sylvian cistern. The transverse gyrus of Heschl was a good anatomic landmark in the operative field of the transsylvian approach. patients with meningiomas on the dominant side exhibited transient amnestic aphasia and dyscalculia, but the symptoms disappeared in a few days or weeks. These patients were discharged without any neurological deficits. Although there are potential risks of damaging association fibers, optic radiation, the transverse gyrus of Heschl, and the parietal lobe, a thorough understanding of the topographical anatomy and careful dissection techniques can avoid morbidity. Wide opening of the sylvian fissure and debulking of the tumor are other important factors to reduce the retraction of the parietal and temporal lobes. CONCLUSION: The lateral transsulcal approach is applicable for small asymptomatic trigonal meningiomas with an acceptable risk of morbidity, even in the dominant hemisphere.
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ranking = 4.3176509628047
keywords = ventricle
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