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PubMed1992

Refractile mycobacteria in Romanowsky-stained bone marrow smears. A comparison of acid-fast-stained tissue sections and Romanowsky-stained smears.

The appearance of mycobacteria was studied in Wright-stained bone marrow preparations of human immunodeficiency virus-infected patients and compared with acid-fast-stained trephine biopsy sections and culture results. Mycobacterium avium complex in Romanowsky-stained preparations may be seen as extracellular and intracellular clear or red refractile beaded rods and nonrefractile "negative images." Refractile mycobacteria were seen in 17 of 20 culture-positive cases. Acid-fast stain of the trephine biopsy demonstrated organisms in only 11 of the 20 cases. Thus, six cases were culture positive and contained refractile rods but had no acid-fast organisms on the trephine biopsy. No false-positive results were seen with Romanowsky stain; the three false-negative results for refractility also were negative with acid-fast stain. Examination of Romanowsky-stained smears or imprints for refractile mycobacteria provides a reliable and sensitive method to identify mycobacteria in this population. Romanowsky-stained bone marrow aspirate and imprint smears should be examined for refractile bacilli when mycobacterial infection is suspected.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Correlation of PCR-detected clonal gene rearrangements with bone marrow morphology in patients with B-lineage lymphomas.

Bone marrow biopsy is the conventional staging and posttherapy evaluation method for assessing marrow involvement by lymphoma. Polymerase chain reactions (PCR) for antigen receptor rearrangements have the potential to increase the detection of minimal degrees of marrow involvement. The present study is a concurrent morphologic and PCR evaluation of 225 staging or posttherapy marrow biopsies from 127 patients with B-lineage non-Hodgkin's lymphoma. The biopsies were morphologically categorized into four groups: group 1 (positive for lymphoma), 60 biopsies (27%); group 2 (suspicious for lymphoma), 20 biopsies (9%); group 3 (lymphocytic lesions of indeterminate biology), 22 biopsies (10%); and group 4 (negative for lymphoma), 123 biopsies (54%). Molecular studies were performed on concurrently obtained aspirates and used consensus immunoglobulin-heavy-chain (IgH) and IgH/bcl-2 gene PCR primers. A molecular clone was detected in 53 of the 225 aspirates (24%): group 1, 34 aspirates (57%); group 2, five aspirates (25%); group 3, one aspirate (5%); and group 4, 13 aspirates (11%). A PCR-positive aspirate was present in 47% of follicular lymphomas, 58% of diffuse large cell lymphomas, and 72% of the other lymphomas in the group I specimens. Morphology or PCR was positive in 79 of the 225 cases (35%). The molecular detection of clonality in the aspirate DNA from cases with positive morphologic findings was lower than anticipated. The discordance between morphology and PCR results may be related to sample variation between the trephine biopsy and aspirate, a failure to aspirate sufficient lymphoma cells, or insufficient primer homology for amplification. DNA extracted from trephine sections may provide results more concordant with morphology, because PCR detected a clone in 10 of 11 DNA specimens extracted from trephine biopsies with positive morphologic findings and PCR negative aspirates.

Base Sequence↗

PubMed1993

An experimental study comparing percutaneous discectomy with chemonucleolysis.

The aim of this study was to assess the macroscopic and microscopic reaction of the intervertebral disc to discectomy with the Automated Nucleotome (Surgical Dynamics, San Leandro, CA), and to compare this with simple trephining of the annulus and with chemonucleolysis. In eight adult sheep, two of four adjacent lumbar discs were randomly incised using the trephine of the Automated Nucleotome, while the remaining levels underwent nuclear excision with the Automated Nucleotome probe. Another four sheep underwent chemonucleolysis at three adjacent lumbar levels. All animals were killed at 6 weeks. The discs that had undergone trephining alone and those treated with the Automated Nucleotome probe had almost identical radiographic and macroscopic changes and showed similarities on microscopic examination. Macroscopically, these discs did not differ from control levels, whereas those treated with chymopapain showed marked changes with a reduction of both nuclear and annular volume. The results of this study suggest that any therapeutic effect of percutaneous discectomy with the Automated Nucleotome is likely to be attributable to the perforation of the annulus alone with the removal of small amounts of nuclear material contributing little, or nothing, to the claimed benefits of the procedure.

Animals↗

PubMed2005

Outcomes of penetrating keratoplasty in keratoconus.

PURPOSE: Keratoconus (KCN) is one of the most common indications of corneal transplantation in Iran. This study was conducted to determine the outcomes of penetrating keratoplasty (PK) for KCN in patients operated in a private practice setting from 1994 to 2001. METHODS: This longitudinal retrospective study included 164 eyes of 164 patients. Variables included preoperative keratometry, trephination and suturing techniques, donor-recipient disparity, surgical complications, immunologic rejection, graft clarity, postoperative spherical and cylindrical refractive error, keratometry, uncorrected and best spectacle-corrected visual acuity, suture management, and the results of keratorefractive procedures. RESULTS: Patients were followed for a mean period of 33.5 months. Mean postoperative best spectacle-corrected visual acuity (BSCVA) at last follow-up was 0.14 +/- 0.11 LogMAR (20/25); mean spherical error and mean corneal astigmatism were -0.61 +/- 2.6 and 3.4 +/- 1.8 D, respectively. Final visual outcomes were not significantly correlated with trephination and suturing techniques or severity of the ectasia. Although donor-recipient disparity did not affect final astigmatism, more myopic shift was observed with greater disparity, but this finding was not of statistical significance. Overall, 26.8% of the patients required keratorefractive surgery, which resulted in 2.9 D reduction in corneal astigmatism. Immunologic graft rejection occurred in 28% of cases; however, all episodes responded to medical management, and none resulted in graft failure. CONCLUSION: Penetrating keratoplasty is a safe and effective procedure with remarkable optical and visual outcomes for patients with keratoconus who are contact lens intolerant or have unacceptable corrected visual acuity. Neither severity of the disorder nor trephination and suturing techniques significantly affects final visual outcomes. Less graft-recipient disparity (0.25 versus 0.50 mm) seems to induce less myopic shift.

Adolescent↗

PubMed2003

Magnetic resonance-guided transcortical biopsy of bone marrow lesions using a magnetic resonance imaging-compatible piezoelectric power drill: preliminary experience.

RATIONALE AND OBJECTIVES: To test utility and specific properties of a commercially available MRI compatible power drill for MR guided transcortical bone biopsy. METHODS: In 17 patients MR-guided bone biopsy was performed in an open low-field scanner (0.2 T), using a piezoelectrically powered drilling machine. Target lesions were osteoblastic in four and nonsclerosed intramedullary in 13 cases. Titanium drills sized 3 to 4 mm and an outer cannula were coaxially used for power assisted cortical trephination. For intramedullary lesion sampling, spring loaded biopsy guns and sharpened cannulas were additionally applied in seven and fluid aspiration in two patients, respectively. RESULTS: The piezoelectric device proved to be fully MR compatible. Trephination and subsequent biopsy was successful in all patients without major complications. The drilling procedure could entirely be performed inside the magnet in case of a lateral approach (n = 11). The net drilling time averaged 7.8 minutes for trephination of nonimpaired diaphyseal bone, but was up to 50 minutes in case of thickened femoral bone. Procedures were complicated by frequent drill loosening, drill obstruction by cortical bone (n = 4) and impaired periosteal grip (n = 5) with damage to the outer cannula (n = 3). CONCLUSIONS: The piezoelectric power drill can be applied safely in a low-field MRI environment and is a valuable tool to facilitate transcortical bone biopsy.

Adolescent↗

PubMed1986

T4: T8-lymphocyte ratios in human bone marrow: the effect of sampling technique.

Marrow aspirate and trephine biopsy T4 : T8-lymphocyte ratios were compared with peripheral blood values. To do this, a new technique for harvesting marrow cells from trephine biopsies is described. Results show that blood and trephine ratios did not overlap. Marrow aspirate ratios were intermediate suggesting that peripheral blood contamination was causing aspirate T4 : T8 ratios to be falsely elevated.

Adolescent↗

PubMed2004

Recurrent and prolonged frontal sinusitis.

The purpose of the study was to find the factors that predict the prolongation or recurrence of frontal sinusitis, to analyse the results of endoscopic surgery and trephination and also to analyse the value of the clinical estimation made by the treating specialist. The study was partly prospective, partly retrospective, and it was carried out in 1995-97. The follow-up continued until the end of 1998. The sample consisted of 456 patients (264 men and 192 women) treated for acute frontal sinusitis in Turku University Central Hospital. The collected information consisted of patient history, treatment, outcome and possible re-operations. To be able to evaluate conservative treatment in relation to operative treatment in patients with prolonged disease, a matched conservatively treated patient was selected for each endoscopically operated patient. Of the 456 patients, 359 healed normally, 85 developed prolonged disease, while recurrences were found in 50 patients. Endoscopic surgery was performed in 35 patients. The mean time interval between the endoscopic sinus operation (FESS) and healing was 8.2 weeks. Trephination was performed in 52 patients and FESS in 35 patients. In the statistical analysis, the factors having significance in predicting the outcome of the disease were, in the bivariate analysis, atopy and type of primary operation, chronic rhinitis, polyps, type of previous operations and of re-operations. Neither trephination nor FESS proved markedly better than the other one. Our conclusion was that the prognosis of frontal sinusitis is difficult to predict with any single factor, but is affected by many of them.

Chronic Disease↗

PubMed1985

Bone marrow biopsy changes in acute myeloid leukaemia. I: Observations before chemotherapy.

Pretreatment bone marrow trephine biopsy sections (BMB) from 34 patients with acute myeloid leukaemia (AML) were studied in parallel with bone marrow aspiration smears and peripheral blood films. In four cases marrow aspiration was inadequate and in five cases it was unsatisfactory. In two other cases hypoplastic AML was diagnosed, the aspirate in one suggested hypercellularity and in another it was unsatisfactory. Trephine biopsy was superior to aspiration for the evaluation of fat and marrow cellularity, pattern and extent of blast cell infiltration, homogeneity of the leukaemic infiltrate, frequency of mitoses, residual haemopoietic activity and presence of inflammatory cells. Of the various features studied in the sections, the presence of an increased number of plasma cells and considerable myelodysplasia (MD) appeared to be unfavourable prognostic features. We conclude that trephine biopsies are essential for the diagnosis of hypoplastic AML and are most useful when marrow aspiration is either inadequate or unsatisfactory. They also provide additional information about the bone marrow changes in AML and suggest that some histological features may also have prognostic significance.

Biopsy↗

PubMed2006

Limitations in the ability of NB84 to detect metastatic neuroblastoma cells in bone marrow.

BACKGROUND: The accurate assessment of metastases is an essential component of the staging process for children with neuroblastoma. AIMS: To study the sensitivity of the immunohistochemical marker neuroblastoma 84 (NB84) for the detection of bone marrow infiltrates in children with stage 4 neuroblastoma. METHODS: Primary tumour specimens, bone marrow trephine biopsy specimens and lymph node metastases, taken from children with neuroblastoma that had metastasised to bone marrow, were assessed with a panel of commonly used immunohistochemical markers for neuroblastoma. A comparison was drawn between the sensitivity of the marker NB84 for primary tumours and for bone marrow metastases. RESULTS: NB84 immunolabelled all pre-chemotherapy and post-chemotherapy (n = 24) paired primary tumour specimens, as well as each of a further 20, unpaired, pre-chemotherapy primary tumour specimens. It also labelled all (n = 4) lymph node metastases. Immunolabelling of bone marrow trephine biopsy specimens (21/33) was less sensitive. Of 16 primary tumour specimens with a paired bone marrow trephine biopsy specimen, all immunostained positive, whereas only 62.5% of bone marrow biopsy specimens immunostained positive for NB84. The number of bone marrow biopsy specimens immunostaining for NB84 was significantly lower than the number of paired primary tumour specimens (p = 0.041). CONCLUSIONS: NB84 remains a useful marker for the diagnosis of neuroblastoma in primary tumour specimens, but not for neuroblastoma that has metastasised to bone marrow.

Antibodies, Monoclonal↗

PubMed1990

Immunocytochemical examination of bone marrow in disseminated neuroblastoma.

To assess the usefulness of immunocytochemical analysis of bone marrow in patients with neuroblastoma, marrow smears from 33 staging procedures in 12 patients were examined using an indirect immunoalkaline phosphatase technique with monoclonal antibodies raised against human neural tissue. Marrow aspirate and trephine collagenase digest specimens from individual sites were each tested with the monoclonal antibody UJ13A and with a pool of three related antibodies. The results were compared with morphological assessment of conventionally stained aspirates and trephine specimens taken at the same time. Immunostaining suggested the presence of tumour in seven of 18 staging procedures in which conventional techniques had shown infiltration. Tumour infiltration was also suggested in four of 10 staging procedures with suspicious trephine specimens, but in none of three with relatively innocent histological and cytological features. Immunological investigation provides no additional information about the presence of infiltration if conventional microscopy has shown definite tumour. When histological appearances are suspicious, immunostaining of stored aspirate smears or collagenase digest specimens may provide evidence of infiltration. There are insufficient data to comment on the value of immunostaining when conventional techniques reveal "normal" marrow, but the impression gained from this study is that immunostaining has a limited role in the detection of metastatic neuroblastoma, which yet remains to be defined.

Bone Marrow↗

PubMed2000

Evaluation of B cell lymphoid infiltrates in bone marrow biopsies by morphology, immunohistochemistry, and molecular analysis.

AIMS: Morphological criteria to distinguish between reactive and neoplastic B cell lymphocytoid infiltrates in trephines have been defined but are not always reliable. Polymerase chain reaction (PCR) analysis of the CDR3 region of the immunoglobulin heavy chain (IgH) gene which, by demonstrating monoclonality, can provide additional arguments in favour of lymphoid malignancy is now frequently used for the detection and follow up of B cell lymphoma (NHL). The aim of this study was to investigate the usefulness of morphological findings in bone marrow biopsies in comparison with data obtained by PCR analysis. METHODS: Eighty nine bone marrow biopsies displaying lymphoid infiltrates were evaluated by morphology and immunohistochemistry as well as by CDR3-PCR using consensus framework 3 (FRW3) and JH primers. RESULTS: The presence of a clonal B cell proliferation was demonstrated by PCR analysis in 45 biopsies, including 21 samples considered to be positive, 17 to be suspicious, and seven to be negative by morphology. In the remaining 44 trephines we found no evidence of clonality, although 12 of these trephines were thought to be positive by morphology. CONCLUSIONS: These results, revealing an incomplete correlation between CDR3-PCR data and immunomorphological findings, indicate that molecular analysis may be more sensitive and specific in general. However, false negative PCR results do occur, which emphasises the necessity to combine both diagnostic tools in the evaluation of lymphoid infiltrates.

Biopsy↗

PubMed1980

Ferrokinetic studies and prognosis in aplastic anaemia.

In a study of 16 patients with aplastic anaemia, an attempt has been made to relate ferrokinetic data to haematological measurements and clinical course. There was a positive relationship of cellularity on trephine biopsy with plasma iron clearance and erythrocyte iron turnover, but not with red cell utilisation. Bone marrow aspirate provided less reliable information on erythropoietic function than did trephine biopsy. There was good correlation between all the ferrokinetic parameters and reticulocyte count, but not between reticulocyte count and marrow cellularity, even by trephine. Patients whose ferrokinetic studies indicate a less severe erythroid depression (i.e., plasma clearance T 1/2 less than 200 min and red cell utilisation greater than 35%) are more likely to survive without transplantation than those with more abnormal ferrokinetic results, but such studies alone are of only limited value in clinical management of the individual patient.

Anemia, Aplastic↗

PubMed2001

Secondary myelofibrosis in visceral leishmaniasis--case report.

A 39-year-old woman with a history of travel to the Montenegrin coast presented with a 9-month long history of fever and weakness, and on examination was found to be emaciated with hepatosplenomegaly and pancytopenia. Marrow aspiration showed poor cellularity with abundant Leishman Donovan (LD) bodies in the macrophages. Bone marrow trephine biopsy revealed a marked myelofibrosis (Manoharan classification: grade III) with osteosclerosis. The impression smears of a trephine biopsy stained with Güiemsa also showed LD bodies. The patient did not exhibit evidence of any risk factors for visceral leishmaniasis (VL). She was treated with meglumine antimoniate (Glucantime) without any adverse effect. The spleen returned to a normal volume after 4 months and bone marrow trephine biopsy performed 6 months after initiation of the therapy had returned to normal. A diagnosis was difficult to establish as VL is rarely encountered in the continental parts of Yugoslavia, and with the presence of associated myelofibrosis it could easily have been mistaken for chronic idiopathic myelofibrosis. The association of myelofibrosis with visceral leishmaniasis has been reported in the literature only three times; we thus feel that documentation of this case is merited.

Adult↗

PubMed1989

The differential diagnosis of polycythaemia--a bone marrow study (the bone marrow in polycythaemia).

Bone marrow sections from posterior iliac crest aspiration and/or trephine specimens have been examined in 39 patients with true polycythaemia, along with a variety of other clinical and laboratory data. The emphasis has been on objective assessment of cellularity and megakaryocyte concentration in a prospective four year study. In patients with untreated primary polycythaemia mean cellularity was 87.0% and 86.4% for aspirate and trephine specimens compared with 55.5% and 48.7% for secondary cases and 48.3% and 45.5% for controls. Eighty per cent of primary polycythemia patients had moderate to marked megakaryocytic hyperplasia. We conclude that, in the presence of an elevated red cell volume, marrow cellularity of greater than 75%, particularly when accompanied by megakaryocytic hyperplasia, of iliac crest aspirate or trephine specimens is sufficient per se to establish a diagnosis of polycythaemia rubra vera.

Bone Marrow Cells↗

PubMedDate not supplied

Improved technique of circular keratotomy for the correction of corneal astigmatism.

BACKGROUND: Based on Gauss' law governing the comparison of hyperbaric pressure in the eye and atmospheric pressure, the authors present a procedure to correct astigmatism. The present paper describes an improvement of a technique for circular keratotomy that was published previously. METHODS: We present data on a consecutive series of 32 eyes with a mean corneal astigmatism of 4.66 diopters (D) (range -2.25 to -6.00 D) with a variety of clinical diagnoses. The astigmatic cornea was trephined with a diameter of 7 mm and a depth of 300 microns. After deepening of the trephination with a diamond knife to 550 microns over the steeper semimeridians, the intraocular pressure created a rounding of the cornea. The amount of astigmatic correction and extent of deepening were controlled intraoperatively with a keratoscope. No sutures were placed. RESULTS: In 32 consecutive eyes, corrections were between 50 and 90% of the initial cylindrical values after 1 week to 1 month. In 29 eyes (91%), the results obtained remained stable during a 1-year follow-up; in two eyes (6%), the 1-month results worsened by more than 1.00 D and in one eye (3%), results improved by more than 1.00 D. There were no complications during or after surgery. Wound gaping resulting in epithelial plugs did not occur. No patient lost one or more lines of spectacle-corrected visual acuity, but 13 eyes (40%) gained one or more lines. CONCLUSION: The technique of correcting corneal astigmatism by trephining to a depth of 300 microns, with deepening of the wound to 550 microns along the steep meridian and using no sutures can correct up to 10.00 D of astigmatism with reasonable stability.

Astigmatism↗

PubMed2000

[Corneal trophism and sensitivity changes after penetrating keratoplasty].

PURPOSE: To evaluate in the rabbit eye the changes in mechanical sensitivity and trophic function of the corneal epithelium after the denervation consecutive to circular trephinations of the peripheral cornea, similar to those produced by penetrating keratoplasty. METHODS: Complete trephination (8 mm diameter) with rotation of corneal button (PK) was performed in 12 eyes. Non-penetrating trephination, affecting 2/3 of the corneal depth, was made in a group of 12 eyes (NPK). A separate group of 16 nonoperated eyes served as control. Mechanical corneal sensitivity was measured with the Cochet-Bonnet esthesiometer (No. 12 filament). Trophic function of the corneal epithelium was assessed by determining the healing rate of epithelial wounds performed with n-heptanol. RESULTS: Three months after surgery, sensitivity in the center of the cornea was significantly reduced in both PK and NPK eyes (240+/-0 mg/S and 179+/-20 mg/S, respectively) when compared with control (88+/-10 mg/S, p<0.001). The ability of denervated corneas to regenerate corneal epithelial defects was similar in both, operated and non-operated eyes. Also, no differences were found between PK and NPK eyes. CONCLUSIONS: Results suggest that three months after corneal graft, throphic maintenance of the epithelium remains unaffected in spite of the significant hypoesthesia recorded at this time. Further experiments are needed to analyze the interaction between corneal epithelial cells and the trigeminal neurons innervating the cornea

Animals↗

PubMed2002

Healing results of prolonged acute frontal sinusitis treated with endoscopic sinus surgery.

In a marked part of patients suffering from acute frontal sinusitis, the symptoms do not resolve after initial therapy (antibiotics and/or trephination). The prolongation of the healing or recurrences may be caused by persistent inflammation or by structural abnormalities at the nasofrontal connection. During the last decade endoscopic surgery (FES) has become a very useful method to restore the frontonasal drainage although long term results of this kind of population are rare. We evaluated the results of endoscopic surgery in two patient groups (total number of 50) both operated after prolongation (persistent symptoms after 4 weeks) of the initial acute phase of the frontal sinusitis. The first group (A, 15 patients, first trephined) was followed-up 4 years, the number of recurrences after the first FES was 60% and in the other group (B, no initial trephination) with over 6 months follow-up, 91% of patients had recurrences. In group A pre- and postoperative CT-scanning was used to determine the possible anatomical variations that could be causing the failures. All but 3 patients showed some kind of abnormal anatomical variation. In group B only preoperative CT was done. In most cases the reasons for recurrences of frontal sinusitis were polyps and/or chronic inflammation at the ethmoidal region.

Acute Disease↗

PubMed2004

The influence of chemotherapy on bone marrow in patients with chronic lymphocytic leukaemia.

In chronic lymphocytic leukaemia (CLL) bone marrow trephine biopsy (BMT) is not required for diagnosis but can have a significant prognostic value and can be used for the detection of the minimal residual disease (MRD) and for assessment of the effectiveness of the treatment applied. The aim of the study was to evaluate the morphological changes in bone marrow after treatment with purine nucleoside analogues cladribine and fludarabine. Bone marrow trephine biopsy was taken routinely from 15 patients with CLL. Bone marrow trephine biopsy was performed on every patient before as well as after chemotherapy. The number of cell elements of the marrow (the degree of atrophy), the patterns of bone marrow infiltration, the presence of reticulin and collagen fibres and the disturbances in bone marrow stroma were assessed. The infiltration of bone marrow by neoplastic cells was observed in all the patients before administration of chemotherapy. The infiltration was followed by an increase in the number of reticulin fibres. After the treatment a regression of the reticulin fibres was observed with the lessening of the infiltration. After the treatment the levels of marrow infiltrate were decreased. Increased hypoplasia of the bone marrow was observed after the chemotherapy.

Adult↗