Hugues Cadas

Postmortem Angiography for Medical Education

The use of angiography in the demonstration of vascularization on fresh human cadavers followed by anatomic preparations to visualize structures provides an additional tool for comparing radiographic images with corresponding tissue slices and dissection in undergraduate anatomy teaching. Several regions were investigated in parts as Master’s theses to prepare teaching modules to supplement self-directed learning of several regions, i.e., the brain, the heart, the pelvic floor, and knee vascularization [1–4]. A comparison of radiographic images with corresponding tissue slices and three-dimensional (3D) reconstructions of CT scans, as well as the dissection of corresponding anatomic areas, allows a transposition and interpretation of radiographic images by comparison of virtual images with the real anatomic structures.

Postmortem Angiography: A Historical Review

Postmortem angiography (PMA) has a much longer history than most people would suspect. Unfortunately, the greater part of this history is still unknown or has been lost. However, a detailed review of the existing literature indicates that it began in the first days after the discovery of x-rays. This chapter explains the history of the visualization of vessels, starting with casting techniques to explore the interior of the hollow anatomic structure, leading to the first injections into the vascular system and the first radiologic PMA images, finally reaching the zenith of classic PMA at the end of the nineteenth and beginning of the twentieth centuries. During that time, various methods have been applied using different injection materials and techniques as well as different preliminary treatments of organs of interest. The types of injected substances can be divided into six groups: vascular casts, corpuscular preparations in gelatin or agar, corpuscular preparations in aqueous solution, hydrosoluble preparations, oily liquids, and miscellaneous formulations. Furthermore, the visualization methods have varied. In the beginning, simple macroscopic observation was used, and injected vessels could be viewed by the naked eye. Eventually, the methods for visualizing blood vessels became more and more sophisticated. With the introduction of radiologic methods, PMA was finally born. Most often, different techniques were combined, allowing comparison of angiography to macroscopic dissection and histology, among others. Although the techniques varied considerably, most of them had one common feature: they were applicable only on single organs or specific for defined anatomic structures. This limitation may be the reason that the classic methods of PMA are not used today in forensic imaging and that new techniques have been developed instead. However, to understand the problems with postmortem vascular injection and perfusion techniques, it is essential to revisit the historical development of the methodology of vascular perfusion and visualization.

Distal Block for Wrist Bone Analgesia: The Anterior and Posterior Interosseous Nerves Must Be Blocked

To the Editor: We read with great interest the article by Dufeu et al, and we totally agree with the concept of a combination of a short-acting proximal block for surgery with long-acting distal nerve block(s) for postoperative analgesia. This combination promotes a long and highlevel analgesia with an early return of upper armmotor function that is very convenient for outpatients. Other benefits are suggested such as facilitation of the goals of tourniquet analgesia, quality of surgical anesthesia, and accelerating anesthesia onset time. However, in some cases (wrist surgery, trapeziometacarpal arthrodesis, and finger amputation), the authors suggested a suboptimal pain control, which could mean that it is not always sufficient in terms of intensity or duration. The use of a catheter could be a good option for finger surgery. In another way, for bone wrist surgery, distal blocks could not be sufficient. Wrist joint innervation is complex and depends mainly on the anterior interosseous nerve (AIN) and the posterior interosseous nerve (PIN). In the article, the option was to check the nerves at the elbow and to track them as distally as possible to limit motor blockade. For wrist bone surgery, we suggest to consider the block of AIN and PIN. Two options could be envisaged: (1) a proximal block at the elbow crease before the division of the median and radial nerves, and (2) association of distal blocks, which includes AIN and PIN. Interosseous nerves can