BackgroundPrecise and accurate field methods for body composition analyses in athletes are needed urgently.AimStandardisation of a novel ultrasound (US) technique for accurate and reliable measurement of subcutaneous adipose tissue (SAT).MethodsThree observers captured US images of uncompressed SAT in 12 athletes and applied a semiautomatic evaluation algorithm for multiple SAT measurements.ResultsEight new sites are recommended: upper abdomen, lower abdomen, erector spinae, distal triceps, brachioradialis, lateral thigh, front thigh, medial calf. Obtainable accuracy was 0.2 mm (18 MHz probe; speed of sound: 1450 m/s). Reliability of SAT thickness sums (N=36): R2=0.998, SEE=0.55 mm, ICC (95% CI) 0.998 (0.994 to 0.999); observer differences from their mean: 95% of the SAT thickness sums were within ±1 mm (sums of SAT thicknesses ranged from 10 to 50 mm). Embedded fibrous tissues were also measured.ConclusionsA minimum of eight sites is suggested to accommodate inter-individual differences in SAT patterning. All sites overlie muscle with a clearly visible fascia, which eases the acquisition of clear images and the marking of these sites takes only a few minutes. This US method reaches the fundamental accuracy and precision limits for SAT measurements given by tissue plasticity and furrowed borders, provided the measurers are trained appropriately.

The pyramidal lobe could be a source of pitfalls in thyroidectomy, due to its frequency but unreliable preoperative diagnosis on scintigraphic images. Special attention has to be paid to the pyramidal lobe to avoid leavings of residual tissue when complete removal of the thyroid is indicated. Sixty cadaveric specimens were examined with special emphasis to the topographical anatomy and expansion of the pyramidal lobe. A pyramidal lobe was found to be present in 55% of the cadavers (32/58). It was found more frequently in men than in women. In men the median length was 14 mm and in women 29 mm. An accessory thyroid gland was present in one specimen, in four cases the isthmus was missing. The pyramidal lobe branched off more frequently from the left part of the isthmus (16) than from the right (7) or the midline (9). In two cases it originated from the left lobe. Additionally 23 scintigraphic images were analyzed to evaluate the visualization of a pyramidal lobe. Only three of them showed enlargements of the isthmus that could be taken as a pyramidal lobe. Due to its frequency the pyramidal lobe should be regarded as a normal component of the thyroid. It is not reliably diagnosed by scintigraphic imaging because scintigraphy can only give functional information but not morphological one. Therefore the anterior cervical region has to be investigated very carefully during operation in order not to leave residual thyroid tissue in total thyroidectomy.

Cadavers embalmed according to Thiel's method should be recommended for ultrasound-guided punctures as a realistic and lifelike model.

IntroductionThe flexibility of cadavers conserved using Thiel's embalming method remains unexplained. We aimed to perform microscopic comparison of muscle and tendon fibres from fresh cadavers (FC), formaldehyde-preserved cadavers (FPC) and cadavers conserved by Thiel's method (TC). Methods Muscle and tendon biopsies performed on FC, FPC and TC were conditioned and stained by Masson's trichrome, Sirius red and Ramon y Cajal, then studied under optical microscope. Alignment and integrity of the muscle and tendon fibres were studied. ResultsWe observed a modification of the muscle fibres in all specimens from TC, regardless of the type of staining used. The muscle fibres taken from FC and FPC were relatively well conserved, both in terms of alignment and integrity. We did not observe any modification of collagen in either muscle or tendon fibres. ConclusionsThe considerable fragmentation of the muscle proteins, probably caused by certain corrosive chemicals, (e.g. boric acid) present in Thiel's embalming solution, could explain the suppleness of the TC. However, we cannot exclude the possibility of alterations in tendon or muscle collagen, since the experimental methods we used, did not allow for the study of collagen ultrastructure.