Papers by Guinevere Granite
The Journal of medical sciences/Journal of medical sciences, Apr 29, 2024
International Journal of Cadaveric Studies and Anatomical Variations, Jun 28, 2022
International Journal of Cadaveric Studies and Anatomical Variations, Jun 28, 2023
During anatomical dissection of fifty donors in the 2020 undergraduate first-year anatomy course ... more During anatomical dissection of fifty donors in the 2020 undergraduate first-year anatomy course at the Uniformed Services University of the Health Sciences, a high origin of the radial and ulnar arteries, also known as a brachioradial artery and a brachioulnar artery, was observed on the left arm of a 90 year-old White female donor. The bifurcation of the brachial artery occurred in the proximal third of the arm. The left brachioradial and left brachioulnar arteries ran superficial and medial to the biceps brachii muscle. The brachioulnar artery continued as the ulnar artery in the forearm, ran superficial and lateral to the flexor carpi ulnaris muscle, traversed the flexor retinaculum, and continued to form the superficial arterial palmar arch. The brachioradial artery ran deep to the pronator teres
The FASEB Journal, May 1, 2021
The occurrence of an aberrant obturator artery is common in human anatomy. Detailed knowledge of ... more The occurrence of an aberrant obturator artery is common in human anatomy. Detailed knowledge of this anatomical variation is important for the outcome of pelvic and groin surgeries requiring appropriate ligation. Familiarity with the occurrence of an aberrant obturator artery is equally important for instructors teaching pelvic anatomy to students. Case studies highlighting this vascular variation provide anatomical instructors and surgeons with accurate information on how to identify such variants and their prevalence. Seven out of eighteen individuals studied (38.9%) exhibited an aberrant obturator artery, with two of those individuals presenting with bilateral aberrant obturator arteries (11.1%). Six of these individuals had an aberrant obturator artery that originated from the deep inferior epigastric artery (33.3%). One individual had an aberrant obturator artery that originated directly from the external iliac artery (5.6%).
Anatomia
While relatively uncommon, a duplication of the inferior vena cava is moderately well-discussed i... more While relatively uncommon, a duplication of the inferior vena cava is moderately well-discussed in the literature. This anatomical variation was noted in a 69-year-old white female donor. This variation is typically asymptomatic; however, it can be associated with complications, such as confusion with a mediastinal mass, increased risk for thromboembolism, and hemorrhage during surgery. It is also associated with a handful of comorbidities, including, but not limited to, congenital renal anomalies such as horseshoe kidney or fused crossed kidney. Research supports that the variation of a duplicated IVC (DIVC) can be due to a failure of the left supracardinal vein to regress during embryonic development.
Anatomical Sciences Education
Anatomia
Forearm extensor muscle variations can be diverse and, in some instances, rare. During a routine ... more Forearm extensor muscle variations can be diverse and, in some instances, rare. During a routine anatomical dissection of human cadaveric donors during the 2021 first-year medical gross anatomy course and 2021 graduate nursing advanced anatomy course at the Uniformed Services University of the Health Sciences, bilateral agenesis of the extensor carpi ulnaris muscle was noted in one 70-year-old white male donor. This variation is described as extremely rare in the literature. The presence of an extensor indicis et digiti medii tendon, a variant of the extensor indicis tendon, appeared to be evident in post-dissection photographs on the left hand. The presence of a duplicated extensor indicis proprious tendon appears to be evident on the right hand. However, further inspection of this region was impeded as the body was sent for cremation prior to the variation being identified. The presence of various juncturae tendinum was also noted bilaterally. Reported prevalence of extensor indic...
Diagnostics
Screening for abdominal aortic aneurysms became the standard of care in 2005, yet screening proce... more Screening for abdominal aortic aneurysms became the standard of care in 2005, yet screening procedures continue to be underutilized. While improvements in mortality rates have been noted over the past 15 years, continued patient mortality from ruptured abdominal aortic aneurysms suggests a need for further research, regarding the effectiveness of the current screening process. Abdominal aortic aneurysms can progress silently, and the risk of rupture increases significantly with increase in diameter. We report a large, untreated infrarenal abdominal aortic aneurysm of 17 cm in length and 8 cm in diameter, showing the chronic atherothrombosis discovered in a 91 year-old white male cadaveric donor. A literature review was conducted to elucidate current understanding of the pathology, risk factors, screening recommendations, and treatment options available for abdominal aortic aneurysms.
Diagnostics
A detailed understanding of the enteric vascular supply is of great importance for pre-operative ... more A detailed understanding of the enteric vascular supply is of great importance for pre-operative planning. In the case of this 68-year-old white male donor, the following variations were observed: a hepatogastrophrenic trunk, a celiacomesenteric trunk, and a middle mesenteric artery. Literature review was conducted to understand the frequency and clinical significance of these variations.
The FASEB Journal, 2019
Head and neck vascular variations are common in humans, but often go undetected. They are general... more Head and neck vascular variations are common in humans, but often go undetected. They are generally asymptomatic. Awareness of such anatomical variations is clinically important for surgeons and interventional radiologists as they may pose risk for iatrogenic complications or even the potential for unanticipated fatalities. Although aortic arch variations are relatively common, branch variations are observed and/or described variably and fairly infrequently during human cadaveric dissection. When aberrant subclavian arteries are described in adults, they frequently involve the right side, and are usually retroesophageal with an absent right brachiocephalic trunk. The following four branches of the aortic arch found most commonly then are: a retroesophageal right subclavian artery, left subclavian artery, and right and left common carotid arteries. During cadaveric dissection of a 76-year-old White male, we observed an additional fifth branch: an accessory left vertebral artery. A co...
Vascular variations of the head and neck are common, but often go unnoticed because they generall... more Vascular variations of the head and neck are common, but often go unnoticed because they generally do not present clear clinical symptoms. Lack of awareness of the presence and location of such variations may result in iatrogenic complications or even fatalities. Medical physicians and surgeons should be cognizant of such deviations due to their potential clinical significance. Vertebral artery variations are prevalent in both number and origin, but are documented infrequently in the literature. In this case study, a White 65-year-old male presented with an accessory left vertebral artery originating from the aortic arch, between the left common carotid artery and the left subclavian artery. This is the most common place for variations of this type. This individual, however, also presented with a normal left vertebral artery branching off of the left subclavian artery. This accessory left vertebral artery coursed cranially and entered the foramen transversarium (FT) at the C5 level. With a prevalence rate of 2.08%, this rare anatomical variant illustrates the clinical importance of extensive anatomical understanding of head and neck vascular variations.
Journal of Wetland Archaeology, 2018
ABSTRACT Three pig forefeet were buried approximately 20 centimetres (cm) below the surface in th... more ABSTRACT Three pig forefeet were buried approximately 20 centimetres (cm) below the surface in the Dartmoor bogs for ten months. To understand the bog environmental chemistry and its potential diagenetic effects on buried porcine remains, we applied Portable X-ray Fluorescence Spectroscopy (pXRF) to the pig bone and burial soil. We also wanted to ascertain whether pXRF allows us to resolve whether the chemical changes that create bog bodies required extended immersion in the bog (millennia versus years or less). To assess the potential diagenetic effects of the bog, we analysed the elemental concentrations of soil samples at 10cm intervals, a soil sample at the burial depth, and a middle phalanx of the first pig using the Skyray Genius 5000 pXRF analyser. The pXRF analyser provided valuable information for understanding that chemical changes occurred within less than year, involving both incorporation and leaching of various elements in the bog.
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Papers by Guinevere Granite
Vertebral artery variations are prevalent in both number and origin, but are documented infrequently in the literature. In this case study, a White 65-year-old male presented with an accessory left vertebral artery originating from the aortic arch, between the left common carotid artery
and the left subclavian artery. This is the most common place for variations of this type. This individual, however, also presented with a normal left vertebral artery branching off of the left subclavian artery. This accessory left vertebral artery coursed cranially and entered the foramen transversarium (FT) at the C5 level. With a prevalence rate of 2.08%, this rare anatomical variant illustrates the clinical importance of
extensive anatomical understanding of head and neck vascular variations.
To assess the potential diagenetic effects of the bog, we analyzed the elemental concentrations of Iron, Lead, Molybdenum, Strontium, Zinc, and Zirconium in the recovered pig bone and burial soil. The significantly higher elemental concentrations of Iron, Lead, Molybdenum, and Zirconium lead to the suggestion that elemental incorporation occurred for those elements in the bog. The low levels of Strontium and Zinc may indicate elemental leaching occurred for those elements in the bog.
PXRFS provides valuable information about the interactions between the bog environment and interred remains. That such chemical changes occurred within less than a year, supports a theory that the chemical processes involved in creating a bog body may occur within a short amount of time compared to archaeological timescales.
Methods: 40 (PGY 2-6) residents were evaluated by trained evaluators before, immediately after and 1-1.5 years after Advanced Surgical Skills Exposure in Trauma training (ASSET) using adjusted Trauma Readiness Index (ATRI) and a standardized script (Figures 1-4) during performance of three vascular exposure/control procedures (axillary [AA], brachial [BA], femoral arteries [FA]) and lower extremity fasciotomy [FAS] in fresh cadavers. Errors were critical technical (CTE: controls wrong structure with vessel loop), management (CME: delay in exposure) or morbidity errors (ME: inadequate prep). Linear mixed modeling including cadaver variability, and receiver operating curve (ROC) were used to predict errors based on pre-training ATRI.
Results: Pre-training, 60% of residents made errors. ATRI increased and CTE decreased immediately after training. However, 5 surgeons with unchanged ATRI had persistent and recurrent errors pre-, immediately after and again when 38/40 (95%) were re-evaluated 1-1.5 years later. ROC values for predicting AA, BA, FA, FAS errors from pre-training ATRI was were 0.95, 0.95, 0.86, and 0.9 respectively and any error in the 4 procedures ROC 0.98 (Figure 5).
Conclusions: Residents who had repeated and persistent errors and failed to increase scores in AIPS can be identified by pre-training ATRI performance (Figures 5-10) that predicts repeated errors. These errors in actual trauma patients could potentially result in serious negative outcome for the patient and the surgeon’s career. Identification of these repeated and persistent errors offers the opportunity for remedial training interventions.