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PubMed1999

Quantification of bone harvested from the iliac crest using a power-driven trephine.

PURPOSE: This study describes an alternate approach for harvesting cancellous bone from the anterior iliac crest and quantifies the amount of bone removed using a power-driven trephine without the need for an open procedure. The safety of this technique is also evaluated. MATERIALS AND METHODS: Twenty-five adult cadavers were used to determine the volume and weight of bone that could be harvested using a motorized trephine. A total of 50 anterior iliac crests were sampled. Core samples of cancellous bone were measured, weighed, and the volume calculated. The harvested sites were then dissected and evaluated for perforations. These data were compared with the measurement of the first 40 consecutive cores trephined from patients requiring grafts. RESULTS: The bone harvested took the form of a compact core measuring, on average, 33.5 mm in length and 4.0 mm in diameter. The average weight of each core was 0.44 g, and the average volume was 0.42 cm3. Perforation to the medial aspect occurred in 4 of 50 hips, and lateral perforations occurred in 7 of 50 hips. The greatest number of perforations occurred at depths greater than 30 mm and were found in the most atrophic cadavers. The 40 cores obtained from patients averaged 34.1 mm in length and 0.46 g in weight. The average volume per core was 0.45 cm3. CONCLUSIONS: The amount of trephinated autogenous cancellous bone procurable by means of a motor-driven trephine is suitable for cases of sinus lifting or to fill an alveolar cleft defect. Although the yield of cadaveric bone is slightly less than the amount obtainable from patients, it is a useful model to evaluate potential complications and estimate yields.

Adult↗
PubMed1989

Comparison of hand-held, suction, and automated trephines on experimental corneal wound size.

Three trephines were tested to determine their uniformity in creating a circular opening during penetrating keratoplasty. Twenty-one globes (seven per instrument) were trephined with a hand-held, suction or automated trephine. The mean astigmatism was greatest with the hand-held device (mean 0.73 cm) and least with the automated trephine (mean 0.50 cm). The automated and the suction trephines (mean astigmatism 0.51 cm) may result in reduced corneal astigmatism during penetrating keratoplasty.

Astigmatism↗
PubMed2003

Optimum trephine length in the assessment of bone marrow involvement in patients with diffuse large cell lymphoma.

BACKGROUND: The National Cancer Institute has recommended a bone marrow biopsy length of >/=20 mm for the staging and surveillance of patients with non-Hodgkin's lymphoma. However, there are few published data to support this recommendation, particularly the role of examining multiple levels. PATIENTS AND METHODS: Bone marrow biopsies from 172 patients with newly diagnosed diffuse large cell lymphoma (DLCL) entered in two consecutive trials of the Australasian Leukaemia and Lymphoma Group were analysed. The original haematoxylin and eosin-stained trephine biopsy and two or more deeper sections cut at 0.1-0.2 mm intervals were assessed with respect to the morphology, extent and pattern of lymphomatous involvement. The rate of positive diagnosis was correlated with the length of the biopsy specimen and the number of sections examined. RESULTS: Forty-seven biopsies (27%) demonstrated marrow involvement on examination of a mean of four trephine biopsy sections. The rate of positivity increased with the examination of multiple levels and correlated with increasing trephine length but was not dependent on the number of sites sampled. Twenty per cent of biopsies <20 mm in length were positive for lymphoma; this increased to 35% for biopsies >/=20 mm (P = 0.023). CONCLUSIONS: Morphological bone marrow involvement in DLCL is optimally demonstrated by a 20-mm long trephine biopsy from a single site which is examined at multiple levels (four or more). This obviates the need for bilateral sampling, thereby reducing patient morbidity from the procedure. This study provides evidence to support the National Cancer Institute recommendations regarding trephine biopsy in the staging of DLCL, providing multiple levels are examined.

Biopsy↗
PubMed2006

How low should you go: novel device for nail trephination.

BACKGROUND: The most commonly used treatment for subungual hematomas is nail trephination, a technique that is not standardized and that poorly controls for trephination depth. OBJECTIVE: The objective was to test the safety and tolerance of a new device for nail trephination that uses innovative "mesoscission" or microcutting technology to create holes of specific depths in the nail plate without penetrating the nail bed. MATERIALS AND METHODS: Fourteen adult subjects with healthy toenails had five holes drilled in a random single-blind fashion at different test settings into their right great toenail with this device and were assessed for pain and pressure tolerance as well as perioperative and postoperative complications. RESULTS: Nail trephination with this device in this small pilot study was controlled and well tolerated. LIMITATIONS: The study population was small (n = 14) and the follow-up evaluation relied on patient self-report, which is not always reliable. The follow-up period was only 1 week and did not allow for evaluation of permanent nail plate deformity. CONCLUSION: Mesoscission may be a controlled and practical alternative to traditional nail trephining methods.

Adult↗
PubMed2005

Are routine iron stains on bone marrow trephine biopsy specimens necessary?

AIMS: To determine the role of Perls' staining in bone marrow trephine biopsy sections. METHODS: The haemosiderin content of 155 Perls' stained, formic acid decalcified trephine biopsy sections was assessed and compared with Perls' stained aspirate samples in 105 cases and haematoxylin and eosin (H&E) stained biopsy sections in all cases. RESULTS: An evaluable aspirate film with positive iron or at least seven negative particles was available for 105 biopsies. Only 71 of 95 cases with detectable aspirate iron had haemosiderin detectable on a Perls' stained section. None of 10 samples with a negative aspirate had a positive trephine biopsy. Haemosiderin was positive in 101 of the 155 Perls' stained sections, and was detectable on the H&E stained section in 71 of these cases. In five of 54 cases with negative Perls' staining, a small amount of haemosiderin was thought to be present on H&E staining. CONCLUSIONS: Aspirate smears reflect bone marrow iron stores more reliably than formic acid decalcified trephine biopsy sections. The presence of iron in Perls' stained aspirates in 44% of cases with negative Perls' stained sections indicates that iron is often lost from sections during decalcification. However, 61% of cases with unassessable aspirate samples had a positive trephine biopsy Perls' stain, contributing useful clinical information about iron status. Preparation of Perls' stained sections only in cases in which aspirate samples are inadequate for iron assessment and no obvious haemosiderin is present in an H&E stained section could produce savings in staff time and reagent costs.

Algorithms↗
PubMed1995

Immunohistochemical staining of plastic embedded bone marrow trephine biopsy specimens after microwave heating.

AIMS: To investigate (1) whether adequate immunohistochemical staining can be achieved on sections cut from plastic embedded bone marrow trephine biopsy specimens after microwave heating in citrate buffer; and (2) whether this immunohistochemical staining is comparable with that achieved on routine sections cut from paraffin wax embedded trephine biopsy specimens after decalcification procedures. METHODS: Sixty five consecutive bone marrow trephine biopsy specimens of more than 1 cm in length were divided transversely into two equal parts. One part was processed in paraffin wax followed by decalcification. The other part was embedded in the epoxyresin Polarbed 812 followed by the cutting of 1 micron sections. Both parts underwent immunohistochemical staining by an identical panel of antibodies. With Polarbed 812 plastic embedded sections, microwave heating in citrate buffer was undertaken before the application of antisera. RESULTS: On sections cut from plastic embedded material, immunohistochemical staining was generally satisfactory, easy to interpret and comparable with that achieved with paraffin wax embedded material. Exceptions were antibodies to neutrophil elastase and CD61 where immunostaining was consistently negative on plastic embedded sections. Immunohistochemical staining for CD20 was consistently more reliable on plastic embedded sections. CONCLUSIONS: The results provide evidence that, with few exceptions, satisfactory immunohistochemical staining is possible on plastic embedded bone marrow trephine biopsy specimens after microwave heating in citrate buffer. This, combined with the advantage of superior cellular morphology with semi-thin (1 micron) sections of plastic embedded material, make such embedding procedures the preferred method for the processing of bone marrow trephine biopsy specimens.

Antibodies, Monoclonal↗
PubMed1997

Use of methyl methacrylate resin for embedding bone marrow trephine biopsy specimens.

AIMS: To evaluate the use of methyl methacrylate resin as an embedding medium for undecalcified bone marrow trephine biopsy specimens. METHODS: About 2500 undecalcified bone marrow trephine biopsy specimens were processed, and embedded in methyl methacrylate resin. Semithin sections (2-3 microns) were stained by routine tinctorial and immunocytochemical staining methods with a wide range of antibodies using a standard streptavidin biotin horseradish peroxidase technique. Different antigen retrieval pretreatments were evaluated. RESULTS: Bone marrow trephine biopsy specimens are embedded routinely in methyl methacrylate at the Haematological Malignancy Diagnostic Service at The Leeds General Infirmary. Over 50 different primary antibodies are in current use; for the majority of these, microwave antigen retrieval or trypsin digestion, or both, is either essential or greatly enhances the results. CONCLUSIONS: Embedding bone marrow trephine biopsy specimens in methyl methacrylate resin retains morphology and permits reliable, high quality immunocytochemistry. This is particularly desirable for the demonstration of neoplastic cells in regenerative marrow after chemotherapy, and in the detection of residual disease after treatment. The use of methyl methacrylate for routine use on bone marrow trephine biopsy specimens is advocated.

Biopsy↗
PubMedDate not supplied

Repairs by trephination and suturing of longitudinal injuries in the avascular area of the meniscus in goats.

Trephination may encourage healing of a tear in the avascular area of the meniscus, but healing may not be complete in unstable tears. We studied trephination with suture of longitudinal injuries in the avascular area of the medial meniscus in 20 goats; samples were studied at 3, 8, and 25 weeks. All 20 tears treated by trephination and suture were completely (4 samples) or partly (16 samples) healed. The average tensile strength of the healed repair was 40.4 kg/cm2 at 25 weeks. The level of DNA synthesis and tissue ingrowth decreased with time; DNA synthetic activity was also found in the chondrocytes of the menisci treated by suture alone. Only three of the menisci treated by suture alone were partly healed, and the remainder showed no gross evidence of healing. The addition of trephination to the sutured meniscus appears to promote healing of longitudinal injuries in the avascular area and is recommended rather than suturing or trephination alone. Meniscal suture alone may stabilize the tear and stimulate cell proliferation for healing, but it appears to be significantly restricted without an adequate blood supply.

Animals↗
PubMed2002

Bone marrow trephine biopsy as an adjunct to bone marrow aspiration.

OBJECTIVE: To determine the relative efficacy of bone marrow aspiration as compared to that of trephine biopsy. METHODS: Bone marrow aspiration and bilateral trephine biopsies were performed in 420 consecutive cases. The diagnosis and findings made on bone marrow aspiration were compared with that made on trephine biopsy in each case. RESULTS: Aspiration alone was sufficient in making a diagnosis in 372 (88.6%) cases as it correlated well with the diagnosis made on trephine sections. In the remaining 48 (11.4%) cases trephine biopsy was necessary for making a diagnosis due to incomplete information provided by aspiration or its inability to give a correct diagnosis. These cases were mostly hypoplastic/aplastic marrow, myelofibrosis and marrow involvement by metastatic tumour and lymphomatous infiltration. Often a bilateral marrow biopsy picked up the diagnostic lesion. CONCLUSION: The decision to perform a marrow aspiration alone or in combination with marrow biopsy depends on the diagnosis being considered. In nutritional anaemias, most hematologic malignancies and immune thrombocytopenias, marrow aspiration alone is sufficient, but for detection of disorders with focal marrow involvement bilateral marrow biopsies are a must.

Biopsy, Needle↗
PubMed1991

[Double-guided vacuum trephine system "Asmotom"].

A new, doubly guided cornea suction trephine system is presented. By means of a suction rim placed on the limbus corneal and a suction disc in the centre of the cornea the vault of the cornea is preserved throughout the trephination procedure. Cutting is performed by a motor trephine, which rotates between the inner and the outer suction. The system allows creation of an absolutely safe perforation in a 360 degrees cut. The cut edges are precise and sharp. Both donor and recipient are trephined from the epithelial side. The endothelial cell loss is very low, amounting to 0.170 mm. The suction stabilization prevents any tilting of the trephine and avoids elliptical forms. Preliminary clinical experiences are presented.

Corneal Transplantation↗
PubMed1983

Trephine biopsy of the bone marrow.

We present a review of trephine biopsy of the bone marrow based on an experience of approximately 10 000 examinations. It is our view that, in adults, examination of material obtained by aspiration combined with a trephine biopsy allows for the most thorough morphological assessment of the marrow. Morbidity is limited to transient discomfort to the patient, and even bilateral procedures are conveniently performed on outpatients. There is no absolute contraindication to combining aspiration and trephine biopsy, but in severe bleeding disorders due to acquired or congenital coagulation factor deficiencies replacement therapy is indicated and the patient should be observed in hospital for 24 hours following the procedure. Thrombocytopenia is not associated with significant bleeding from the biopsy site in our experience. The advantages of the trephine biopsy are that it allows better overall assessment of cellularity and morphology and is indispensable in cases where aspiration has failed or where infiltration due to the myeloproliferative syndrome or to haematological and non-haematological malignancies has occurred. With marrow hypoplasia and granulomatous disorders involving the marrow, the trephine biopsy is indispensable for diagnosis.

Biopsy, Needle↗
PubMedDate not supplied

The effect of trephination on corneal topography.

BACKGROUND AND OBJECTIVE: A prospective study was performed to assess the effect of trephination on corneal curvature. MATERIALS AND METHODS: Thirty-seven fresh porcine globes with intact corneal epithelium were used. Radius of curvature, central dioptric power, and powers and axes of the steepest and flattest meridians were obtained using a vertically mounted computerized videokeratography unit. Following 8-mm vacuum trephination of the central donor corneas, the said parameters were reassessed on the resultant buttons. No globes with epithelial defects were included in the study. RESULTS: The mean corneal radius of curvature (mm) increased from 8.68 +/- 0.79 to 10.46 +/- 3.24 (P = .005), the central dioptric power (D) decreased from 39.36 +/- 3.84 to 36.31 +/- 10.15 (P = .08), and the total corneal asphericity (D) increased from 5.03 +/- 2.99 to 7.47 +/- 3.42 (P = .0001). No significant changes in the axes of the steepest and the flattest meridians were noted following trephination. CONCLUSION: Trephination leads to significant corneal flattening and increased asphericity. Corneal topography can be used successfully as a research tool for whole globes and trephined buttons.

Animals↗
PubMed1997

Internal sclerostomy with a mechanical trephine versus the neodymium:YAG laser in dogs.

BACKGROUND AND OBJECTIVES: To experimentally compare and contrast the internal sclerostomy produced using a mechanical trephine with that made by an Nd:YAG laser, and to evaluate the healing patterns, efficacy, and technical advantages of each method. MATERIALS AND METHODS: Four healthy dogs with normal eyes were used in this study. The left eye of each dog had an internal sclerostomy performed with an automated mechanical trephine. The right eye of each dog had an internal sclerostomy performed with an Nd:YAG laser. Postoperatively, the intraocular pressure of each eye was measured at regular intervals. The dogs were euthanized successively at 1, 2, 3, and 4 weeks postoperatively, and the morphology of the surgical sites was studied. RESULTS: The Nd:YAG laser was easier to manipulate and technically less demanding than the mechanical trephine. However, the Nd:YAG laser induced more prominent corneal edema and conjunctival hyperemia compared with the automated trephine. Morphology of the tissue response showed tissue necrosis and greater inflammation with the Nd:YAG laser than with the automated trephine. CONCLUSIONS: These two techniques demonstrate differences in technical demands and tissue response. Both are characterized by minimal reactive fibrosis of the episcleral and Tenon's capsule fibroblast.

Animals↗
PubMed1991

Immune inhibition of repair of canine skull trephine defects implanted with partially purified bovine morphogenetic protein.

The healing of 14-mm trephine skull defects was observed in ten adult mongrel dogs. First and second set trephine operations were performed to determine whether xenogeneic bovine bone morphogenetic protein (bBMP) and associated bone matrix water-insoluble noncollagenous proteins (iNCP) incite an immunological humoral response inhibiting bone repair. The effects of immunization to BMP/iNCP were observed by serum radioimmunoassay, and by correlated roentgenographic and histological analysis of deposits of new bone. The first set implants of bBMP/iNCP induced 96% healing while the regeneration of the second set trephines was 34% less than the first set. The second set was associated with a significant increase in serum anti-BMP antibodies. While xenogeneic bBMP induced complete healing of trephine defects when implanted without previous immunization, and repair in response to a second set of bBMP/iNCP was always incomplete, further research with high purified recombinant BMP is required to measure immune effects in a statistically significant number of pure bred recipients.

Animals↗
PubMed2003

Corneal shrinkage induced by nonmechanical Q-switched erbium:YAG laser trephination for penetrating keratoplasty in porcine eyes.

PURPOSE: To assess the degree of corneal diameter shrinkage induced by Q-switched mid-infrared laser corneal trephination for penetrating keratoplasty in an experimental model. METHODS: Corneal trephination was performed in 80 enucleated porcine eyes fixed in a holder centered on an automated globe rotation device, by Q-switched (2.94 microm) Er:YAG laser along open masks. Four types of masks were used to protect the underlying corneal tissue: metal masks (donor and recipient) and ceramic masks (donor and recipient). Two spot diameters (0.65 mm and 0.96 mm) were combined with two energy settings (40 mJ/pulse and 50 mJ/pulse) for each of the masks used. Repetition rate was fixed at 5 Hz. Diameters of donor buttons/recipient beds (horizontal and vertical) were measured immediately after the trephination and compared to the given mask size. RESULTS: Minimum corneal shrinkage was found in the recipient metal mask group (mean +/- SD=0.3+/-0.4%) with 50 mJ pulse energy and 0.65 mm spot diameter (in the horizontal diameter), while the maximum shrinkage (5.3+/-2.8%) was found in the donor metal mask group with 50 mJ pulse energy and 0.96 mm spot diameter. Corneal shrinkage was less pronounced in recipient beds than in donor buttons (P<0.01). The differences in shrinkage between the use of ceramic and metal masks were insignificant (P>0.05). Mean induced corneal diameter discrepancies between the donor button and the recipient bed (with metal and ceramic masks) were 2.5% and 2.5% in vertical diameter and 3.4% and 2.4% in horizontal diameter. CONCLUSIONS: The Q-switched Er:YAG laser experimental corneal trephination for penetrating keratoplasty may induce minor degrees of corneal diameter shrinkage in donor buttons and recipient openings. Oversizing of donor masks by 0.25-0.35 mm (i.e. 3-4% of graft size) may be a valid option to avoid refractive consequences.

Animals↗
PubMed1998

Minimally invasive bedside craniotomy using a self-controlling pre-adjustable mechanical twist drill trephine.

BACKGROUND: Craniotomy with a mechanical twist drill is a standard, minimally invasive procedure in neurosurgery, widely used for the drainage of chronic subdural hematomas and the placement of ventricular drains. Nevertheless, the use of a standard twist drill trephine bears the risk of causing cerebral lesions. METHOD: A commercially available mechanical twist drill system has been modified by a special self-controlling drill and a pre-adjustable distance holder that limits intracerebral penetration. After initial cadaver testing, the modified trephine has been used for 65 trephinations in patients (37 chronic subdural hematomas, 21 external ventricular drains, 6 frontal hygromas, 1 tumor cyst). RESULTS: There were no complications related to the modified trephine; cerebral lesions caused by drilling too deeply or by uncontrolled penetration were safely prevented. In our series no procedure related infections occurred, and the drilling time was reduced significantly. CONCLUSION: The described modified mechanical twist drill enables fast, easy, and safe craniotomy without jeopardizing the advantages of a mechanical twist drill. Therefore, it can be recommended particularly for difficult emergency conditions.

Brain Injuries↗
PubMed1997

Benjamin Winslow Dudley and early American trephination for posttraumatic epilepsy.

Benjamin Winslow Dudley (1785-1870) was a Kentucky frontier surgeon who received basic medical education in the United States and extensive surgical training in Europe. He returned to Lexington to become a dominant figure and the most prominent surgical teacher in the Mississippi Valley. Written evidence of Dudley's operative accomplishments are sparse, but he seems to have combined the finest French (Dominique Jean Larrey, Guillaume Dupuytren) and British (Henry Cline, John Abernethy, Astley Cooper) surgical training with conservative and thoughtful patient selection. His operative endeavors in the preantiseptic era included trephination for posttraumatic epilepsy in six patients (1819-1832). This was the largest recorded series of such cases, and it stimulated other American surgeons to trephine for relief of posttraumatic seizures. Trephination for decompression and debridement was undertaken at the site of original injury to remove the cause of "cerebral excitement" and restore "corporeal and intellectual function." Dudley considered this a safe operation in "cautious, firm, and intelligent hands." He thought crowded urban hospitals were unsafe and attributed his better surgical results to the clean, rural Kentucky air. Dudley's achievement is contrasted with other Early American preantiseptic trephinations for posttraumatic epilepsy.

Epilepsy, Post-Traumatic↗