Cases reported "cadaver"

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11/473. External rotation-lateral view of the ankle in the assessment of the posterior malleolus.

    Demonstration of a posterior malleolar fragment on a radiograph of an ankle fracture is important in the diagnosis and evaluation of posterior malleolus fractures. The size and extent of displacement of a posterior malleolar fragment can be evaluated. The diagnosis of non-union of the posterior malleolus is also important because it can lead to failure of reduction of ankle fractures. The authors present a case in which nonunion of the posterior malleolus was diagnosed by an external-rotation lateral view of the ankle. This could not be demonstrated on the AP or the lateral views. Thirteen cadaver feet were then used to study the external-rotation lateral view. A posterior malleolar fracture was created, and the borders of the fracture line were marked with solder wire. The average external rotation angle required to best demonstrate the posterior malleolar fracture was 50 degrees (range, 43 degrees -55 degrees). The actual size of the posterior malleolus fragment was measured and compared to the x-ray measurement. There was a 0.10 correction for the determination of the actual size of the fragment. The unmarked fragment could not be demonstrated on AP and lateral views. ( info)

12/473. A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA.

    Successful total knee arthroplasty (TKA) relies on proper positioning of prosthetic components to restore the mechanical axis of the lower extremity. This report presents and analyzes a new noninvasive method using the Optotrack (Northern Digital Inc, ontario, canada) to accurately determine the center of the femoral head. This method, together with direct digitization of the bony landmarks of the knee and ankle intraoperatively, permits placement of the lower extremity in proper alignment intraoperatively. It also permits the surgeon to follow all the angles of movement or rotation and all displacements that occur at each step of the operative procedure. knee intraoperatively via a customized Windows-based program. In addition to presenting our first case, which, importantly, represents the first computer-assisted TKA in a patient, we report on the accuracy and reproducibility of the technique for locating the center of the femoral head obtained during an extensive series of cadaver studies. Location of the femoral head, a major aspect of effecting neutral mechanical axis alignment, appears to be possible to within 2-4 mm, which corresponds to an angular accuracy of better than 1 degree. This method requires no computed tomography scans or other preliminary marker placement. The only basic requirement other than the instrumentation described is a freely mobile hip, which is generally present in TKA patients. ( info)

13/473. Clinicopathological study of an autopsy case with sensory-dominant polyradiculoneuropathy with antiganglioside antibodies.

    A previously reported patient presenting sensory-dominant neuropathy with antiganglioside antibodies, bound preferentially to polysialogangliosides including GD1b, was autopsied. While axonal degeneration was predominant in the sural nerve, many demyelinated fibers were present in the spinal roots. Dorsal roots had undergone significant damage. These pathological findings were well correlated with the electrophysiological results showing decreased F-wave conduction velocities and conduction blocks in motor nerves and decreased or absent sensory action potentials in sensory nerves, with distribution of GD1b in nerve tissues such as dorsal root ganglia and paranodal myelin in the ventral and dorsal roots. ( info)

14/473. Postmortem findings two weeks after oral treatment for metastatic candida endophthalmitis with fluconazole.

    The purpose of this histological study was to present postmortem findings in both eyes of a 53-year-old male with liver dysfunction 2 weeks after short-time oral treatment with 200 mg/day fluconazole for metastatic candida endophthalmitis due to intravenous hyperalimentation for 18 days. candida had been demonstrated in the venous blood and on the tip of the intravenous catheter. The bilateral fungal endophthalmitis with hypopyon responded well to fungistatic therapy, but the patient suddenly died from heart failure. Both eyes were obtained at autopsy. candida was demonstrated only in vitreous puff balls but not in the retina or uvea. fluconazole administered for a short period had little effect in eliminating fungus from vitreous puff balls, which have no blood supply. Prolonged administration of the antifungal drug or vitrectomy should be considered when treating an eye with vitreous puff balls in the presence of fungal endophthalmitis. ( info)

15/473. An unusual peritoneal fossa: anatomic report and clinical implications.

    The peritoneal fossae are usually related to rotation and adhesion of the abdominal viscera to the posterior abdominal wall during fetal development, and/or the presence of retroperitoneal vessels running just under the peritoneum and raising serosal folds. These fossae, therefore, are regarded as congenital and have been considered clinically and surgically as sites of internal abdominal hernias. The authors describe a peritoneal fossa interposed between the fourth portion of the duodenum and the abdominal aorta. Due to a scoliosis of the lumbar column, the abdominal aorta had shifted to the left of the duodenum, stretching two semilunar avascular peritoneal folds connecting the vessel with the ascending duodenum. These two folds bounded above and below an entrance into a fossa lined by the posterior parietal peritoneum and bordered by the fourth portion of the duodenum on the right and the aorta on the left. This recess extended as far as the anterior surface of the second and third lumbar vertebrae. On the basis of the anatomic findings, the authors suggest that acquired fossae, because of their size and topography, may play a part in the etiopathogenesis of internal abdominal hernias. ( info)

16/473. Histological findings in the eyelids of AIDS patients.

    PURPOSE: The eyelids of 15 AIDS patients (17 specimens) were examined histologically at postmortem. methods: Formalin-fixed, paraffin-embedded and haematoxylin-eosin stained sections were examined by conventional light microscopy. The presence of calcific deposits was confirmed by special stains and elemental analysis (X-ray energy dispersive spectroscopy). RESULTS: 6 cases had abnormal microscopical findings. In two cases deposits of calcium oxalates were observed in the wall of dermal blood vessels and in epithelial cells of sweat and sebaceous glands, respectively. Precipitates of calcium phosphate were observed in the superficial substantia propria of the palpebral conjunctiva in an additional patient. Other histological findings in the remaining three patients included flat warts, an unusual elastotic degeneration of the forniceal palpebral conjunctiva and more common lesions (chalazion, Demodex folliculorum infestation of the eyelashes, trichilemmal cyst). CONCLUSION: The presence of microscopical lesions in nearly half of this small series demonstrates that the eyelids may be affected subclinically in AIDS patients. ( info)

17/473. rhabdomyolysis associated with concomitant use of atorvastatin and cyclosporine.

    OBJECTIVE: To describe a case of rhabdomyolysis in a cadaveric renal transplant (CRT) patient receiving atorvastatin and cyclosporine. CASE SUMMARY: A 40-year-old Asian woman with a history of systemic lupus erythematosus (SLE) presented with bilateral lower-extremity weakness and elevated concentrations of creatine kinase (CK), aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and alkaline phosphatase after two months of concomitant therapy with atorvastatin and cyclosporine. Her other medications were not known to cause rhabdomyolysis; neither was there evidence of an SLE flare. After atorvastatin was discontinued, her CK concentrations declined dramatically and her symptoms resolved. DISCUSSION: rhabdomyolysis has been reported in patients treated with other 3-hydroxy-3-methylglutaryl coenzyme a (HMG-CoA) reductase inhibitors when used in combination with cyclosporine. Atorvastatin, a relatively new HMG-CoA reductase inhibitor, has not been reported to cause rhabdomyolysis when used concomitantly with cyclosporine. However, its pharmacologic and pharmacokinetic properties make an interaction with cyclosporine possible. CONCLUSIONS: Similar to other members of the HMG-CoA reductase inhibitor class, atorvastatin may interact with cyclosporine and potentially result in rhabdomyolysis. Clinicians should be aware of this possible drug interaction and carefully monitor patients receiving these two drugs concomitantly. ( info)

18/473. Orbital volume expansion of dysthyroid ophthalmopathy by surgical placement of lateral rim implants: a case study.

    PURPOSE: To measure the increase in orbital volume expansion effected by surgical placement of a lateral rim implant. methods: Computed tomography was used to obtain 1-mm axial sections of a normal human cadaver skull. A computer program was used to measure the orbital area of each section and integrate the sum of the areas to obtain the total orbital volume. Following placement of a lateral orbital rim implant, this procedure was repeated to obtain the new orbital volume. RESULTS: The orbital volume increased from 22.2 cm3 to 23.6 cm3 (an increase of 6%) following placement of the lateral orbital rim implant. CONCLUSION: Surgical placement of a lateral orbital rim implant can be an effective method of orbital volume expansion in dysthyroid ophthalmopathy. ( info)

19/473. rectovaginal fistula repair utilizing a cadaveric dermal allograft.

    rectovaginal fistula repair is commonly performed through the vagina. When recurrent fistulae occur, healthy tissue such as a muscle or fat pad may be interposed to facilitate healing and prevent recurrence. A woman developed a postpartum rectovaginal fistula after her third-degree perineal laceration failed to heal completely. Two subsequent fistula repairs were performed, with recurrence following each procedure. The fistula was ultimately repaired by performing a layered closure and interposing a cadaveric dermal allograft between the rectovaginal septum and vaginal epithelium. Allogenic cadaveric graft may be a viable alternative to traditional autologous flaps for the repair of recurrent or complicated rectovaginal fistulae. ( info)

20/473. First case of cadaveric liver transplantation in japan.

    The first case of liver transplantation from a brain-dead donor in japan is described. The recipient was a 43-year-old man with familial amyloid polyneuropathy who manifested various neuropathic symptoms and autonomic dysfunction at the time of transplantation. The graft had three arteries, for which a single trunk was created at the back table. A side-to-side cavacaval anastomosis was performed as an outflow reconstruction. To avoid portal congestion, a temporary shunt between the right posterior branch of the portal vein and the vena cava was constructed, instead of a venovenous bypass. The graft preservation time was 7.2 h and the operation time was 12.2 h. Although sufficient blood flow in the hepatic artery, portal vein, and hepatic vein was confirmed intra- and postoperatively, using Doppler ultrasound, transient graft dysfunction was observed immediately after surgery, but there was spontaneous improvement. The patient was discharged 100 days after transplantation. ( info)
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