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Decomposition process and post mortem changes: review

Teo Chee Hau, Noor Hazfalinda Hamzah, Hing Hiang Lian, Sri Pawita Albakri Amir Hamzah

Sains Malaysiana, 2014;43:1873-1882.

Decomposition is degradation process of a corpse into basic respective constituents macroscopically and microscopically by action of microorganisms, arthropods and scavengers. Post mortem changes could be separated into early post mortem changes (i.e. algor mortis, rigor mortis and livor mortis) and putrefaction stages of corpse. These changes function as suitable indicators for determination of post mortem interval (PMI). In this paper, different stages of post mortem changes, possible variations such as mummification and formation of adipocere and special circumstances such as burial condition is discussed. This article also refers to several arguments in the different texture of adipocere and the influence of different types of fabric in affecting the post mortem changes and formation of adipocere. This is largely due to the property of permeability and resistance of material against degradation process. Undeniably, decomposition process involves numerous potential variables including burial condition, presence of clothing, potential formation of adipocere and mummification. Hence, studies in forensic taphonomy combined with real case scenario are crucial in understanding the nature of decomposition and estimation of PMI with higher accuracy.

Matched MeSH terms: Cadaver
Insect succession associated with a hanging pig carcass placed in an oil palm plantation in Malaysia

Heo CC, Sallehudin Sulaiman, Hidayatulfathi Othman, Baharudin Omar, Jeffery J, Kurahashi H

Sains Malaysiana, 2010;39.

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.

Matched MeSH terms: Cadaver
Opportunistic insects associated with pig carrions in Malaysia

Heo CC, Kurahashi H, Mohamed Abdullah Marwi, Jeffery J, Baharudin Omar

Sains Malaysiana, 2011;40:1179-1186.

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.

Matched MeSH terms: Cadaver
Common celiaco-mesenterico-phrenic trunk and renal vascular variations

Nayak S

Saudi Med J, 2006 Dec;27(12):1894-6.
PMID: 17143371

The knowledge of vascular variations like other anatomical variations, is important during the operative, diagnostic, and endovascular procedures in abdomen. This report describes multiple variations in the upper abdominal vessels as found during the routine dissection in a 60-year-old male cadaver. The variations found were; presence of a celiaco-mesenterico-phrenic trunk, a common inferior phrenic trunk, 2 right renal arteries originating from abdominal aorta, 2 suprarenal arteries originating from the lower right renal artery, 3 right renal veins opening separately into inferior vena cava, and termination of right testicular vein into the lowest vein among the 3 right renal veins. The existence of a celiaco-mesenterico-phrenic trunk has not been reported yet. Although, other variations reported in this case exist as individual variations, a concomitant variation of them has not been reported yet. The knowledge of such variations is quite useful in planning any upper abdominal surgery.

Matched MeSH terms: Cadaver
Role of simulation in arthroscopy training

Madan SS, Pai DR

Simul Healthc, 2014 Apr;9(2):127-35.
PMID: 24096921 DOI: 10.1097/SIH.0b013e3182a86165

Arthroscopy uses a completely different skill set compared with open orthopedic surgery. Hitherto, arthroscopy had not been given enough emphasis in the core orthopedic curricula. Simulation has been seen as an excellent way to teach the skills required in arthroscopy. The simulators used for arthroscopy training can be broadly classified into physical simulators such as cadavers, animals, models and box trainers, virtual-reality simulators, and hybrid simulators that combine virtual-reality simulation with physical components that allow real tactile feedback. The advantages and disadvantages of each of these types have been described in this article. The factors that determine skill acquisition using these simulators have been highlighted. In conclusion, simulation seems to be a valuable tool for arthroscopy training, although further studies are needed to state whether this translates into better operative skill on real patients.

Matched MeSH terms: Cadaver
Fulltext Unique origin of the cystic artery

Hlaing KP, Thwin SS, Shwe N

Singapore Med J, 2011 Dec;52(12):e262-4.
PMID: 22159949

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.

Matched MeSH terms: Cadaver
Fulltext Multiple variations of the tendons of the anatomical snuffbox

Thwin SS, Fazlin F, Than M

Singapore Med J, 2014 Jan;55(1):37-40.
PMID: 24452976

Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis.

Matched MeSH terms: Cadaver
Fulltext Complex pattern of a variant hepatic artery

Hlaing KP, Othman F

Singapore Med J, 2012 Sep;53(9):e186-8.
PMID: 23023911

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.

Matched MeSH terms: Cadaver
Fulltext Unusual variations of the lateral and posterior cords in a female cadaver

Thwin SS, Zaini F, Than M, Lwin S, Myint M

Singapore Med J, 2012 Jun;53(6):e128-30.
PMID: 22711051

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.

Matched MeSH terms: Cadaver
Fulltext Information needs, preferred educational messages and channel of delivery, and opinion on strategies to promote organ donation: a multicultural perspective

Wong LP

Singapore Med J, 2010 Oct;51(10):790-5.
PMID: 21103814

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.

Matched MeSH terms: Cadaver
Fulltext Variations of the origin and branches of the external carotid artery in a human cadaver

Thwin SS, Soe MM, Myint M, Than M, Lwin S

Singapore Med J, 2010 Feb;51(2):e40-2.
PMID: 20358142

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.

Matched MeSH terms: Cadaver
Fulltext Neural Differentiation of Human Pluripotent Stem Cells for Nontherapeutic Applications: Toxicology, Pharmacology, and In Vitro Disease Modeling

Yap MS, Nathan KR, Yeo Y, Lim LW, Poh CL, Richards M, et al.

Stem Cells Int, 2015;2015:105172.
PMID: 26089911 DOI: 10.1155/2015/105172

Human pluripotent stem cells (hPSCs) derived from either blastocyst stage embryos (hESCs) or reprogrammed somatic cells (iPSCs) can provide an abundant source of human neuronal lineages that were previously sourced from human cadavers, abortuses, and discarded surgical waste. In addition to the well-known potential therapeutic application of these cells in regenerative medicine, these are also various promising nontherapeutic applications in toxicological and pharmacological screening of neuroactive compounds, as well as for in vitro modeling of neurodegenerative and neurodevelopmental disorders. Compared to alternative research models based on laboratory animals and immortalized cancer-derived human neural cell lines, neuronal cells differentiated from hPSCs possess the advantages of species specificity together with genetic and physiological normality, which could more closely recapitulate in vivo conditions within the human central nervous system. This review critically examines the various potential nontherapeutic applications of hPSC-derived neuronal lineages and gives a brief overview of differentiation protocols utilized to generate these cells from hESCs and iPSCs.

Matched MeSH terms: Cadaver
Transposition and variant termination of azygos and hemiazygos veins: an extremely rare variation

Nayak SB, Soumya KV

Surg Radiol Anat, 2020 Nov;42(11):1303-1306.
PMID: 32328708 DOI: 10.1007/s00276-020-02471-1

Azygos system of veins is the main source of venous drainage from the thoracic wall. Knowledge of azygos vein anomalies could be of importance to cardiothoracic surgeons and radiologists. We report a rare variation of azygos vein as seen in an adult male cadaver aged 65 years approximately. The azygos vein was formed by the union of left ascending lumbar and subcostal veins. It coursed upwards on the left side of descending thoracic aorta and crossed the left subclavian artery and the left vagus to terminate into the left brachiocephalic vein. It received left superior intercostal vein and left fifth to eleventh posterior intercostal veins. The hemiazygos and accessory hemiazygos veins were situated on the right side of the vertebral column. They received the right posterior intercostal veins and terminated into the azygos vein at the level of eighth thoracic vertebra.

Matched MeSH terms: Cadaver
Fulltext Surgical and embryological perspective of a big loop of internal carotid artery extending laterally beyond internal jugular vein

Nayak SB, Shetty SD

Surg Radiol Anat, 2021 Mar;43(3):413-416.
PMID: 33231750 DOI: 10.1007/s00276-020-02619-z

Knowledge of variations of the internal carotid artery is significant to surgeons and radiologists. The internal carotid artery normally runs a straight course in the neck. Its anomalies can lead to its iatrogenic injuries. We report a case of a large loop of the internal carotid artery in a male cadaver aged about 75 years. The common carotid artery terminated by dividing it into the external carotid artery and internal carotid arteries at the level of the upper border of the thyroid cartilage. From the level of origin, the internal carotid artery coursed upwards, backwards and laterally, and formed a large loop behind the internal jugular vein. The variation was found on the left side of the neck and was unilateral. The uncommon looping of the internal carotid artery might result in altered blood flow to the brain and may lead to misperceptions in surgical, imaging, and invasive procedures.

Matched MeSH terms: Cadaver
Fulltext Sternocleidohyoid muscle: an unreported variant of cleidohyoid muscle

Nayak SB, Shetty SD

Surg Radiol Anat, 2021 Aug;43(8):1327-1330.
PMID: 33527215 DOI: 10.1007/s00276-021-02682-0

Sternohyoid, sternothyroid, omohyoid, and thyrohyoid muscles are collectively known as infrahyoid muscles. These muscles frequently show variations in their attachments. Here, an extremely rare variant muscle belonging to this group has been presented. During cadaveric dissection for undergraduate medical students, an additional muscle was found between sternohyoid and superior belly of omohyoid muscles bilaterally in a male cadaver aged approximately 70 years. This muscle took its origin from posterior surface of the manubrium sterni, capsule of the sternoclavicular joint and the posterior surface of the medial part of the clavicle. It was inserted to the hyoid bone between the attachments of sternohyoid and superior belly of omohyoid muscles and was supplied by a branch of ansa cervicalis profunda. There is no report on such a muscle in the literature and it could be named as "sternocleidohyoid muscle". Knowledge of this muscle could be useful in neck surgeries.

Matched MeSH terms: Cadaver
Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies

Yammine K, Erić M

Surg Radiol Anat, 2020 Mar;42(3):259-267.
PMID: 31741040 DOI: 10.1007/s00276-019-02381-x

INTRODUCTION: The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Easy to access and at proximity to the hand, the palmaris longus tendon is considered as the optimal tendon source for hand reconstructive surgery. However, and besides its inconsistency, the size of the palmaris longus tendon is reported to show variability. The aim of this study is to look for the surgical adequacy of the palmaris longus tendon by conducting a quantitative synthesis on its length and width in human populations and its correlation with the forearm length.
METHODS: Twenty-four studies met the inclusion criteria including 1761 cadaveric limbs.
RESULTS: The results were as following: (a) the mean palmaris longus tendon length was of 13.9 ± 2.6 cm, (b) the mean ratio palmaris longus tendon length/forearm length was of 0.545 ± 0.06, (c) the weighted correlation value was of 0.686, and (d) the mean palmaris longus tendon width was of 4.0 ± 1.7 mm. Only five studies reported a palmaris longus tendon length of more than 15 cm. The palmaris longus tendon length was shown to vary between ancestries; the Japanese had the shortest while Malaysian the longest palmaris longus tendons. All studies but one reported a palmaris longus tendon mean width of more than 3 mm where the minimal mean palmaris longus tendon width was of 2.5 mm.
CONCLUSION: While the requested length depends on the recipient site and/or type of reconstructive surgery, the palmaris longus tendon often met the required diameter for grafting. Our review demonstrated that while palmaris longus length varies between ancestries, its width is often adequate for grafting. In addition, the forearm length could be a good predictor of palmaris longus tendon length; such correlation could assist surgeons when planning to use palmaris longus tendon as a graft source.

Matched MeSH terms: Cadaver
Fulltext Morphometric analysis of patella and patellar ligament: a cadaveric study to aid patellar tendon grafts

Aithal Padur A, Kumar N, Lewis MG, Sekaran VC

Surg Radiol Anat, 2021 Dec;43(12):2039-2046.
PMID: 34570285 DOI: 10.1007/s00276-021-02837-z

PURPOSE: Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders. Dimensions of the patella and the patellar ligament are frequently used in implant design and ACL reconstruction. This study aims to obtain detailed morphometric data on the patellar ligament and its localization based on gross anatomical dissections in the adult cadavers.
METHODS: The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45-85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p

Matched MeSH terms: Cadaver
Organ transplantation in Malaysia: a social-legal study

Ngah AC

Taiwan Yi Xue Ren Wen Xue Kan, 2005 Sep;6(1-2):39-48.
PMID: 16538765

Kidney and corneal transplants have been undertaken since the seventies although other forms of organ transplantation were lesser known. To date more than 1000 kidney transplants, the majority from living related donors have been performed. Nevertheless heart, lung and liver transplant only had an impact in the nineties. The main reason being, the lack of cadaveric donors, which has hampered the development of organ transplantation in Malaysia. It is instructive to note that the Malaysian society has been rather conservative when it comes to organ transplantation. This is compounded by the Asean culture and value system, which are directly derived from our historical background and religious convictions. However attempts had been made by various organisations such as The Malaysian Society of Transplantation, which was set up in 1994 to create greater awareness on organ donation & transplantation amongst both the healthcare professionals and the public.

Matched MeSH terms: Cadaver
Fulltext Awareness, attitude and willingness regards cadaveric organ donation and awaness of brain death among Sarawakians in Kuching, Malaysia

Lim KG, Tan AS, Wong SC, Tee EG, Burud IA

Ceylon Med J, 2022 Nov 30;67(3):113-120.
PMID: 37933994 DOI: 10.4038/cmj.v67i3.9699
Matched MeSH terms: Cadaver
Anomalous Course of Facial Artery Through the Submandibular Gland and its Redundant Loop at the Base of Mandible

Nayak SB, Vasudeva SK, Pamidi N, Sirasanagandla SR

J Craniofac Surg, 2020 Oct;31(7):2015-2016.
PMID: 32472879 DOI: 10.1097/SCS.0000000000006539

Knowledge of variant course and branching pattern of the facial artery gains importance in the surgeries of upper neck and face. The authors report a unilateral anomalous course and a redundant loop of right facial artery as seen in an adult male cadaver. The right facial artery had its origin from the external carotid artery. It pierced through the submandibular salivary gland and formed a redundant loop at the base of the mandible. Its further course and branching pattern was normal. This case could be important for radiologists, plastic surgeons and craniofacial surgeons.

Matched MeSH terms: Cadaver

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