Evaluation of a minimally traumatic alveolar trephination procedure to avoid pain.
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An immunomorphometric study was performed on bone marrow biopsies from 40 patients with primary osteomyelofibrosis--OMF, (agnogenic myeloid metaplasia) by employment of a monoclonal antibody against glycoprotein IIIa (Y2/51) to determine the number of pro-megakaryoblasts. Specimens from 15 individuals without any hematological disorder served as controls. With reference to the pertinent literature on megakaryocyte precursors and following a pilot study on corresponding smears, in tissue sections pro-megakaryoblasts were characterized by a size of 42.1 +/- 2.6 microns 2 (diameter 7.5 +/- 0.3 microns). In comparison with controls, in OMF no relevant increase in the number of pro-megakaryoblasts per square and cubic millimeter bone marrow was evaluable. The relative frequency of these precursors was significantly reduced due to an increase in the total amount of conspicuously large and abnormal megakaryocytes. Statistical analysis failed to reveal any correlations between counts for pro-megakaryoblasts or the total number of Y2/51--positive megakaryocytic elements with the density of argyrophilic fibers (determined by morphometry) or the platelet values. Our findings imply that in OMF the marked increase in circulating progenitor cells of the megakaryocyte lineage may be generated by extramedullary, probably splenic hematopoiesis. Moreover, the evolution of medullary fibrosis is thought to be associated with the striking predominance of large atypical, possibly overaged and hyperpolyploid megakaryocytes and not with an increase in precursor cells.
In a consecutive series of 100 patients suffering from Chronic subdural haematomas, which were treated by burr-hole evacuation and closed external drainage, in 23 patients repeated operations became necessary. The reasons for further operations were: true recurrences in 11 cases, superimposed haematomas in five cases and haematomas on the opposite side in seven cases. All these patients were treated again by burr-hole evacuation and closed external drainage. In contrast to the common opinion craniotomy and removal of the membranes was not necessary in any case.
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To evaluate the feasibility of acute leukemia typing on routinely processed bone marrow biopsy specimens, 72 cases of previously established acute leukemia covering the spectrum of 17 known subtypes were studied immunohistochemically. Most leukemic myeloblasts were positive for myeloperoxidase in 16 (84%) of 19 cases of acute myeloid leukemia, M1-M4, and M6. Most leukemic cells in 11 of 12 M4 and M5 cases were positive for CD68 (PG-M1). All six M6 cases stained with hemoglobin. Leukemic megakaryoblasts in three of four M7 cases were positive for factor VIII-related antigen. Almost all leukemic cells of 8 T-lineage acute lymphoblastic leukemia (ALL) and 19 B-lineage ALL cases were positive for CD3 and CD79a (HM57), respectively. Staining with CD20 (L26) was positive in the more differentiated B-lineage ALL cases and strongest in L3. Immunohistochemical typing of acute leukemia is possible for most types using this panel of cell lineage-specific antibodies.
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Victor Horsley was intrigued by newly discovered, ancient trepanned skulls, especially those that revealed that the operation was performed on living patients. He examined the man-made openings as an expert on the locus of the primate motor cortex and as a surgeon who had successfully removed parts of the motor cortex to treat Jacksonian epilepsy. He postulated that trepanation originated as a way to treat pain and epilepsy caused by depressed cranial fractures over the motor cortex. Like Broca before him, Horsley helped create the exciting Zeitgeist that led others in the late-1 800s to explore, ponder, and write about ancient trepanned skulls.
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A retrospective study of pre-treatment bone marrow biopsies was undertaken to examine the value of bone marrow staging in Hodgkin's Disease. Bone marrow biopsy revealed infiltration in 40 out of 613 cases, (6.5%). These patients were not significantly different from stage 4 patients without marrow involvement with regard to age, sex, anaemia or survival. Peripheral blood lymphopenia and lymphocyte depleted histopathological type were more common in patients with marrow involvement. Bone marrow biopsy altered individual patient management in less than 1% of 613 patients and can no longer be recommended as part of the routine staging in Hodgkin's Disease.
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