The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 +/- 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.
We report a unique variation in the origin and branches of both the left and right external carotid artery (ECA) found during the dissection of a human cadaver. Knowledge of the possible anatomical variations of the ECA is especially important in facio-maxillary and neck surgeries. Surgeons need to be aware of the possibility of encountering such variations, as they may lead to difficulties in differentiating between the external and internal carotid arteries, and in identifying the branches and origins. This knowledge is also important for radiologists in the image interpretation of the face and neck regions.
The pupae of Desmometopa sp. (Diptera: Milichiidae) were collected from a human corpse found indoor in active decay stage together with the larvae of Sarcophagidae, Synthesiomyia nudiseta (Wulp), Chrysomya megacephala (Fabricius) and Chrysomya rufifacies (Macquart). This research note is the first report of the Desmometopa sp. recovered from a human corpse in Malaysia.
The latissimus dorsi is a muscle of the back which forms the posterior fold of the axilla and its tendon twists to insert into the floor of the intertubercular sulcus of the humerus. Occasionally, the muscle has a muscular slip which crosses the axilla to insert into the pectoralis major. This muscular slip is often termed as "axillary arch." In the present study, we report bilateral axillary arch detected in a 45-year-old male cadaver. The average vertical length of the axillary arch measured 7 cm. The average maximum width of the uppermost, middle and lower part of the arch measured 2, 3.5 and 3.2 cm, respectively. The presence of the axillary arch is an uncommon finding in humans, considering the fact that it is solely found in the animals who prefer to hang on the trees. A histological study of the axillary arch was also performed and it showed skeletal muscle fibres which was uniformly arranged. The presence of the axillary arch may assist in the adduction of the shoulder. It may also compress the axillary vessels and nerves thereby causing resultant symptoms. Prior anatomical knowledge of the presence of axillary arch may be helpful for surgeons performing radical dissection of the axillary lymph nodes and ligation of axillary vessels, clinicians diagnosing abduction syndromes and interventional radiologists interpreting axillary mass in day to day clinical practice.
A study on insect succession of monkey carcass in a forested area in Ulu Gombak, Selangor, Malaysia was conducted from 9 May to 18 June 2007. The third instar of the housefly, Musca domestica (Linnaeus) (Diptera: Muscidae) were only found on dry stage of a decomposed (Day-33) monkey carcass (Macaca fascicularis Raffles). This observation revealed that M. domestica maggots were found together with other muscid fly maggots, Hydrotaea (=Ophyra) spinigera (Stein) (Diptera: Muscidae) on dry stage of a carcass. However, the role of M. domestica on forensic entomological study remains unknown. This study recorded the first finding of M. domestica maggots on primate carcass in Malaysia.
INTRODUCTION:
This study assessed the information needs, preferred educational messages and channels of delivery, as well as opinions on strategies to promote organ donation. It aimed to provide insight into a culturally sensitive public education campaign to encourage organ donation in diverse ethnic communities in Asia, namely the Malays, Chinese and Indians.
METHODS:
A total of 17 focus group discussions with 105 participants were conducted between September and December 2008. The participants were members of the general public aged 18 to 60 years, who were recruited through convenient sampling in the Klang Valley area of Malaysia.
RESULTS:
Across ethnic groups, there was a general concern about the mistreatment of the deceased's body in the organ procurement process. The Chinese and Indian participants wanted assurance that the body would be treated with respect and care. The Muslims wanted assurance that the handling of a Muslim's body would follow the rules and regulations of the Islamic faith. The most important information requested by the Muslim participants was whether cadaveric donation is permissible in Islam. A lack of national public education and promotion of organ donation was noted. All the three ethnic groups, especially the Malays, required community and religious leaders for support, encouragement and involvement, as sociocultural influences play a significant role in the willingness to donate organs.
CONCLUSION:
The pronounced ethnic differences in information needs suggest that culturally sensitive public educational messages are required. Organ donation and transplantation organisations should work closely with community and religious organisations to address the sociocultural barriers identified.
This study was designed to mimic homicide or suicide cases using gasoline. Six adult long-tailed macaque (Macaca fascicularis), weighing between 2.5 to 4.0 kg, were equally divided into control and test groups. The control group was sacrificed by a lethal dose of phenobarbital intracardiac while test group was force fed with two doses of gasoline LD50 (37.7 ml/kg) after sedation with phenobarbital. All carcasses were then placed in a decomposition site to observe the decomposition and invasion process of cadaveric fauna on the carcasses. A total of five decomposition stages were recognized during this study. This study was performed during July 2007. Fresh stage of control and test carcasses occurred between 0 to 15 and 0 to 39 hours of exposure, respectively. The subsequent decomposition stages also exhibited the similar pattern whereby the decomposition process of control carcasses were faster than tested one. The first larvae were found on control carcasses after 9 hours of death while the test group carcasses had only their first blowfly eggs after 15 hours of exposure. Blow flies, Achoetandrus rufifacies and Chrysomya megacephala were the most dominant invader of both carcasses throughout the decaying process. Diptera collected from control carcasses comprised of scuttle fly, Megaselia scalaris and flesh fly, sarcophagid. We concluded that the presence of gasoline and its odor on the carcass had delayed the arrival of insect to the carcasses, thereby slowing down the decomposition process in the carcass by 6 hours.
The obturator artery (OA) originates from the internal iliac artery. Variation in the origin of the OA may be asymptomatic in individuals and occasionally be detected during routine cadaveric dissections or autopsies. In the present study, we observed the origin and the branching pattern of the OA on 34 lower limbs (17 right sides and 17 left sides) irrespective of sex. The bifurcation of the common iliac artery into internal and external iliac from the sacral ala varied between 4.3-5.3 cm. The distance of the origin of the anterior division of internal iliac artery from the bifurcation of common iliac artery varied between 1-6 cm. The distance of the origin of the posterior division of the internal iliac artery from the point of bifurcation of the common iliac artery varied between 0-6 cm. Out of 34 lower limbs studied, two specimens (5.8%) showed anomalous origin of the OA originating from the posterior division of the internal iliac artery. Of these two, one limb belonged to the right side while the other was from the left side. The anomalous OA gave off an inferior vesical branch to the prostate in both the specimens. No other associated anomalies regarding the origin or branching pattern of the OA were observed. Prior knowledge of the anatomical variations may be beneficial for vascular surgeons ligating the internal iliac artery or its branches and the radiologists interpreting angiograms of the pelvic region.
This study was carried out in an oil palm plantation in Tanjung Sepat, Selangor in September 2007 by using pigs (Sus scrofa L.) as a carcass model in a forensic entomological research. A 2.5 month old pig (10 kg) which died naturally was hanged on a palm tree to observe the insect succession and decomposition stages. Observation was made for 16 days; one afternoon visit per day and all climatological data were recorded. On the first day, adult muscids of Ophyra spinigera Stein and Musca domestica L. were observed, however no blowfly (Calliphoridae) activities were sighted. Fly eggs wer seen on the second day on both sides of the face, inside nostrils and genitourinary area. Adults of Chrysomya megacephala Fabricius and Chrysomya rufifacies (Macquart) congregated on the head and anal areas. Adult flies and maggots (first and second instars) were observed in the mouth and anus of the pig on the third day of hanging. Adult yellow jackets (Vespidae) and spiders (Arachnida) were found preying on some adult flies. Rove beetles (Staphilinidae) were also discovered on the pig carcass. Only a few ants (Formicidae) were sighted. Maggot masses were found in eye orbits, neck, and genital organs on the fourth day of hanging and some maggots were seen falling down to the ground. The dominant maggot species identified on this day was Ch. megacephala. On the sixth day, the head, neck, and anus were in the stage of active decay. Maggots of Ch. rufifacies were abundant on the seventh day and was the dominant species. On day eight the carcass fell onto the ground. Chrysomya rufifacies maggots were found underneath the pig carcass and they started to migrate and pupated under the soil. On the tenth day, third instar Op. spinigera maggots were found under the carcass. The rate of carcass decomposition slowed down and became stable from tenth day onwards to the sixteenth day of decomposition. Thereafter, most of the remaining parts of the body remained dried and devoid of any insects.
There is accumulating evidence that criminals wrap dead bodies in an attempt to conceal evidence. To anticipate the forensic implications of this phenomenon, we examined whether flies that are naturally associated with cadavers exhibit a delay in attendance or differ in species composition and abundance patterns because of the presence of wrapping material. Wrapped and exposed carcasses of dead monkeys placed in an oil plantation in Kedah, Malaysia, were visited over 50 d. On daily visits to each of the six carcasses, visiting adult flies were sampled using hand nets. Flies of 12 families were encountered. Calliphoridae (Chrysomya rufifacies Macquart and C. megacephala (F.) was the most prevalent family, followed by Sphaeroceridae. Some families tended to be more abundant in WRCs (i.e., Calliphoridae, Muscidae, and Phoridae), whereas others (i.e., Piophilidae, Sepsidae, and Psychodidae) were more prevalent in exposed carcasses. Wrapping delayed the arrival of all fly species encountered, with delays varying from 1 to 13 d depending on species. Wrapping did not affect species composition of flies, but prolong the occurrence of some species. The results of the current study emphasize the need to take into consideration the presence of a wrap when estimating postmortem interval.
Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons.
The cystic artery (CA) is known to exhibit variations in its origin and branching pattern. This is attributed to the developmental changes occurring in the primitive ventral splanchnic arteries. During routine dissection of a male cadaver, we observed that the CA originated from the middle hepatic artery (MHA) at a distance of about 1 cm from its origin, and the MHA originated from the right hepatic artery at a distance of 2.1 cm from its origin. The CA traversed for a distance of 1.5 cm, giving off a branch to the cystic duct. It then passed anterior to the cystic duct. The origin of the CA was located to the left of the common hepatic duct, outside the Calot's triangle. The topographical anatomy of the arterial system of the hepatobiliary region and their anomalous origin should be considered during hepatobiliary surgeries. This knowledge is also important for interventional radiologists in routine clinical practice.
In this case report, we report the absence of the fourth tendon of flexor digitorium superficialis (FDS) to the little finger with a concurrent anomalous muscular belly of flexor digitorum profundus (FDP) in the palm. The FDS originated from the medial epicondyle, divided into three tendons for the index, middle and ring fingers with the little finger devoid of any attachment. The FDP exhibited a muscular belly which passed deep to the flexor retinaculum (FR) and continued for another 4 cm thereby dividing into four slips for the index, middle, ring and little fingers. The presence of the muscular belly of the FDP lead us to think whether it was an adhesion between the tendons of the FDP, so we proceeded to histological analysis. The tissue was processed and stained with Hematoxylin and Eosin. Abundant longitudinal muscle fibers with peripherally situated nuclei confirmed it to be a skeletal muscle. Absence of the tendon of FDS to little finger may influence the flexion movement in the middle and proximal interphalangeal joints. Presence of anomalous muscle belly of FDP in the palm may mimic any soft tissue tumour, compress neurovascular structures or even pose difficulty while performing tendon transplant surgeries.
Malaysia's organ and tissue donation rates are among the lowest in the world. The study aims to explore the knowledge, attitudes, practices and behaviors regarding deceased organ donation and transplantation in the diverse ethnic communities in the state of Selangor, Malaysia.
Flies from the family Calliphoridae, Sarcophagidae and Muscidae are usually found on human cadavers or animal carcasses. However, there are many other families of Diptera and Coleoptera that were found associated with animal carcasses, which have not been reported in Malaysia. In this paper, we report dipterans from the family Micropezidae: Mimegralla albimana Doleschall, 1856, Neriidae: Telostylinus lineolatus (Wiedemann 1830); Sepsidae: Allosepsis indica (Wiedemann 1824), Ulidiidae: Physiphora sp. and a beetle (Coleoptera: Hydrophilidae: Sphaeridium sp.) as opportunist species feeding on oozing fluid during the decomposition process. They did not oviposit on the pig carcasses, therefore, their role in estimation of time of death is of little importance. However, they could provide clues such as locality and types of habitats of the crime scene.
A burned human remain was found outdoor (5º 27' N, 100º 16' E) in Penang Island. The deceased was last seen alive on 23 April 2010 at 2230 h and was found burned on 24 April 2010 at 1920 h. Larval aggregation of second instar Chrysomya megacephala was observed on the chest of the deceased.
The use of Chrysomya megacephala larvae for detecting malathion for diagnosing the cause of death was investigated. This could prove useful when the visceral organs have become liquefied during decomposition and therefore cannot be sampled. A field experiment was conducted in which C. megacephala were allowed to colonise naturally the corpses of rabbits that had died of malathion poisoning. The concentration of malathion increased gradually during the larval stages of C. megacephala reaching the maximum concentration in the third instar larvae. The concentration of malathion declined during prepupal stage and reached its lowest level among tenerals. The average malathion concentrations in C. megacephala growing in poisoned rabbit corpses left in a sunlit habitat were significantly higher (p<0.05) than those growing on poisoned rabbits left in a shaded habitat. The concentrations of malathion in the different stages of development of C. megacephala were moderately correlated (r = 0.51-0.69) with the administered doses as well as with those estimated in visceral organs. Thus, it would not be reliable to suggest the formulation of mathematical algorithms for relating the concentration of malathion found in the different stages of development of C. megacephala with those found in the visceral organs. However, in the context of forensic investigation, the qualitative detection of malathion in C. megacephala may prove useful in diagnosing the cause of death, since malathion is a common cause of accidental and suicidal deaths.
This is the first report of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) on a human corpse discovered in a high-rise building in Malaysia. On 5 March 2008, a decomposing body of an adult female was found on the top floor of a thirteen-story building in Kuala Lumpur, Malaysia. Her body was colonized by S. nudiseta larvae, which were normally associated with corpses found indoors at ground level. The post-mortem interval (PMI) was estimated at approximately 5 to 9 days. This case is significant as it demonstrates that this species can locate a dead body even in a high-rise building. Further findings of fly distribution especially in high-rise buildings should be reported to assist entomologists in PMI analysis.
The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions.
Liver transplantation is the only solution for end-stage liver diseases. The common hepatic artery (CHA) arises from the coeliac trunk (CT), and the right (RHA) and left hepatic (LHA) arteries are its terminal branches. An abnormal arterial pattern would influence the surgical outcome. The anterior layer of the lesser omentum of a female cadaver was cleaned to identify the CHA, which was traced backwards for its origin and toward the porta hepatis for its terminal branches. In this case, the replaced RHA originated from the CT and ran posterior to the portal vein and the common bile duct. The replaced LHA arose from the left gastric artery. The CHA originated from the CT and branched out as the middle hepatic and gastroduodenal arteries. The replaced RHA and LHA with alteration in relation to the neighbouring structures is a complex and rare variant. Knowledge of this uncommon arterial anomaly is beneficial for hepatobiliary surgeons.