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PubMed1997

[Hematologic abnormalities in pulmonary tuberculosiss].

This study surveys the extent and severity of haematological abnormalities which occurred in 380 patients with pulmonary tuberculosis. Full blood count, bone marrow aspiration smears, and bone marrow trephine biopsy was analyzed by authors. Anaemia was present in 32 percent of patients. Leucocytosis with neutrophilia occurred in 18 percent. Leucopenia with neutropenia, and lymphopenia was observed in 16 percent in patients with very severe clinical tuberculosis. Elevated platelet count occurred in 8 percent with deep vein thrombosis in legs in 50 percent. Dysmyelopoietic syndrome was diagnosed in one case by bone marrow trephine biopsy. There was a close correlation between the haematological abnormalities and the severity of clinical findings of pulmonary tuberculosis. This survey has revealed that haematological abnormalities are relatively common in severe pulmonary tuberculosis. It seems that body weight loss, white blood cell count, haemoglobin level and erythrocyte sedimentation rate are useful indices of severity of the tuberculosis. The return of these indices to a normal level is a good indication of disease control in that they correlate with sputum conversion to acid-fast bacilli negative.

Anemia↗

PubMed1997

Acute myelofibrosis.

Acute myelofibrosis is a rare disorder. Five such cases have been diagnosed out of 3,149 Bone Marrow (B.M) Aspirations and Trephine Biopsies studied over a period of eight and a half years. Four out of five patients were males and the other female. Their age ranged from 14-71 years. Neither splenomegaly not red cell poikilocytosis (tear drop cells) were prominant features. B.M. trephine biopsy showed increase of atypical megakaryocytes/megakaryoblasts and marked fibrosis. There was rapid downhill clinical course of the disease in all cases.

Acute Disease↗

PubMed1976

Patterns of iron storage in dietary iron overload and idiopathic hemochromatosis.

Bone marrow iron stores rise in proportion to the total body iron store in dietary iron overload. The situation in the genetic disorder of idiopathic hemochromatosis is not as clear. A method for measuring the storage iron concentration chemically on samples of bone marrow obtained by trephine needle biopsy was therefore developed. Its value as a measure of tissue iron stores was established in a preliminary investigation in which specimens of liver, spleen, and bone marrow were obtained at necropsies on 66 South African Negroes among whom dietary iron overload is common. A wide range of nonheme iron concentrations was found, but in each individual there was a highly significant correlation between the concentrations in the three tissues. Nonheme iron concentrations were then determined on trephine bone marrow biopsy specimens from eight Caucasian patients with untreated idiopathic hemochromatosis, and on percutaneous liver biopsy specimens from four of them. The concentrations in the livers were in the anticipated range of 5,000 mug per gram wet weight (2 per cent dry weight). In contrast the geometric mean value for bone marrow iron concentration was 186 mug per gram wet weight, a figure that fell below the fiftieth percentile for marrow iron concentrations in the South African Negroes, whereas the geometric mean liver iron concentration was above the ninetieth percentile. These findings indicate that subjects with idiopathic hemochromatosis whose liver iron stores are grossly increased do not show a comparable rise in bone marrow iron stores.

Adult↗

PubMed2005

Secondary insults and outcomes in patients with hypertensive basal ganglia hemorrhage.

This study was designed to monitor secondary insults and their impact on outcomes of patients with hypertensive basal ganglia hemorrhage (HBGH). One hundred and twelve patients with HBGH (male 73, female 39) of age 42 +/- 8 years (range from 38 to 57 years) were studied. Operations included craniotomy or trephination drainage with urokinase thrombolysis. Conventional therapies were also given to the patients including the administration of mannitol, crystalloid and colloid solution. In the meantime, blood pressure (MAP), temperature (T) and SaO2 and other parameters were recorded in the intensive care unit. The ICP values were recorded, and the early clinical outcome was assessed upon discharge according to Glasgow Outcome Scale. Cerebral Perfusion Pressure was calculated as CPP = MAP-MICP. Outcomes in the group without secondary insults were better than that in the group with secondary insults (P < 0.01). No unfavorable outcomes were found in the 59 cases managed by ultra-early surgery whereas 36.1% of the cases operated after 6 hours of onset had unfavorable outcomes. It is concluded that the high incident rate of secondary insults in HICH patients influences outcome. Ultra-early surgery may also contribute to improved quality of survival.

Adult↗

PubMed1991

Unilateral interhemispheric keyhole approach for anterior cerebral artery aneurysms.

A special midline interhemispheric keyhole approach to the anterior communicating artery aneurysms is described. A small trephine opening of 3 cm in diameter is used in most cases. The detailed microsurgical technique of the unilateral interhemispheric exposure of the anterior cerebral artery complex is presented. For the past 10 years, a total of 138 patients, 112 with Acom AN and 26 with distal ACA AN, were operated upon through this approach. There were 16 cases with non-ruptured aneurysms and the postoperative results were excellent in all of them. The overall results in 122 cases with ruptured aneurysms were excellent and good (working) in 95 cases, fair in 10 cases, poor in 9 and death supervened in 8 cases. The mortality rate in 71 acute operation cases was 8% and 4% in 51 delayed cases. The advantages of this approach include simple and rapid craniotomy, minimum brain retraction, accurate midline exposure of all parent arteries and the aneurysm. This anterior interhemispheric approach is, in our experience, much superior to the conventional pterional approach.

Adolescent↗

PubMed1995

The impact of interactive image guided surgery: the Bristol experience with the ISG/Elekta viewing Wand.

From June 1992 to August 1994 we have accumulated a 305 case experience with the ISG Viewing Wand, the first commercially available system for interactive image guided neurosurgery. Prior to the arrival of the wand 2.5% of intracranial procedures were carried out using the Leksell G frame for image guidance. Since the arrival of the wand that percentage of procedures suitable for image guidance has increased to 10%. The wand was used for 287 supratentorial procedures, 108 craniotomies, 48 trephine exposures, 34 burr hole biopsies, 4 ventriculoscopies and 1 shunt insertion, 19 posterior fossa explorations were performed, 28 skull base procedures, including 22 transsphenoidal pituitary operations, 3 petrousectomies and 3 orbital explorations were also carried out. In addition 3 spinal cases were included in the series, 2 transoral explorations and 1 sacral laminectomy. The technique was applicable to 193 tumour cases, 14 vascular cases including 7 aneurysms and 16 epilepsy cases. Both CT (70%) and MRI (30%) scans were used for image guidance. Contour matching algorithms were used for registration throughout. Since the arrival of the wand conventional stereotaxy has been used for 26 cases, 22 stereotactic biopsies, 2 thalamotomies and 2 craniotomies (0.5% of intracranial procedures). We conclude that contour matching, interactive image guidance using a mechanical arm has replaced frame based stereotaxy in our department except for point source localisation in deep midline structures. It is a technique that has universal application to intracranial neurosurgical procedures and as such represents a major advance in image guided neurosurgery.

Biopsy↗

PubMed1975

Goniotrepanation (gotrep) and further observations on this operation for chronic glaucoma.

The conclusions from the current data on the goniotrepanation, which are based upon the systematic observations on 175 eyes operated on with this microsurgical procedure and for a period of 2 to 4 years, can be characterized as follows: a) Intraocular pressure regulation obtained in 91 per cent of the cases. b) Avoiding excessive hypotony. Mean intraocular pressure value postoperatively 12 to 14 mm Hg. c) Achieving a regular level filtration site overlying the trephination hole, limiting polycystic conjunctival degeneration to 8.5 per cent, which is common with the usual filtration procedures. d) Maintenance of intact visual function in a great percentage of the operated eyes, with a decrease in visual acuity in 5 per cent without any observable visual deterioration. e) The advantages of goniotrepanation listed above, emanating from observations over a 2-year period, point explicitly to the effectiveness of this operative procedure and explain the survival of goniotrepanation up to the present.

Cataract↗

PubMed1989

A new ultrasound-guided brain biopsy technique through a burr hole. Technical note.

There is a disadvantage in brain biopsy by ultrasonic guidance comparing it with the CT guided approach. It is the fact that the ultrasonic method requires a small craniotomy or multiple trephinations because the size of the transducer exceeds the diameter of the burr hole and the echographic information from the trocar which houses the biopsy forceps, becomes poor when the sound beams run nearly parallel with the site of its insertion. The authors devised a brain biopsy technique through only one burr hole under real time monitoring, using a small foot-print transducer, 12 mm in diameter, and a special trocar with engraved scales on its surface. We believe that this new biopsy technique surpasses the traditional CT directed and ultrasound-guided methods in many respects. A representation case biopsied by this technique is presented.

Adult↗

PubMed1977

Biopsy technique for fibro-osseous and osteolytic lesions of the jaws.

A biopsy technique is presented for obtaining small tissue samples from fibro-osseous and osteolytic lesions which are not readily accessible for surgical biopsy. Trephine burs and a nonaspirating biopsy needle may be utilized for obtaining adequate tissue from fibro-osseous and osteolytic lesions for frozen section and routine histopathologic examination.

Biopsy↗

PubMedDate not supplied

The histologic changes of the olecranon fossa membrane in primary osteoarthritis of the elbow.

Eight randomly selected patients undergoing the Outerbridge-Kashiwagi (ulnohumeral arthroplasty) debridement procedure for primary osteoarthritis of the elbow had fenestration of the olecranon fossa by use of a bone trephine. The cores of bone removed were compared histologically with age- and sex-matched controls derived from necropsy samples with no history of osteoarthritis. All components of the olecranon fossa membrane (anterior cortical bone, medullary cavity, posterior cortical bone, and anterior and posterior fibrous tissue) were noted to be of increased thickness in those patients with osteoarthritis of the elbow when compared with the control group. With the exception of the anterior surface fibrous tissue, these differences were of statistical significance by use of the Wilcoxon signed rank test (anterior cortical bone, P =.01; medullary cavity, P =.01; posterior cortical bone, P =.02; and posterior surface fibrous tissue, P =.01). Bone volume was also measured in the two groups and was statistically greater in the patients with osteoarthritis compared with the control group (P =.01).

Case-Control Studies↗

PubMed1975

Diagnostic approaches in metastatic lung disease.

Procedures such as bronchoscopy, bronchial brushing, pleural needle biopsy, mediastinoscopy, and percutaneous aspiration and trephine needle biopsy afford the specialist in pulmonary medicine a wide diagnostic armamentarium and considerable flexibility in the diagnostic management of patients with metastatic lung disease.

Adenocarcinoma↗

PubMed2003

Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma.

BACKGROUND: Although rare, patients with acute subdural hematoma (ASDH) because of severe head injury can develop contralateral acute epi- or subdural hematoma, requiring consecutive surgical procedures. The choice of treatment strategies for such patients is clinically important. METHODS: Among 88 patients with ASDH who were surgically treated over 13 years, we encountered and studied 5 patients who developed contralateral acute epi- or subdural hematoma (5.7%). RESULTS: All 5 patients were male, ranging in age from 17 to 40. According to the Glasgow Coma Scale on admission, 1 patient was rated 3, 1 was 4, 1 was 5, and 2 were 6. All patients underwent consecutive surgical procedures for ASDH and contralateral ASDH and/or acute epidural hematoma, and were given postoperative supportive therapy with barbiturates and mild hypothermia. Patients' outcomes according to the Glasgow Outcome Scale were as follows: 1 patient, good recovery (20.0%); 1, mild disability (20.0%); 2, severe disability (40.0%), and 1, persistent vegetative state (20.0%). No patients died. Although decompressive craniectomy and evacuation of hematoma may lead to contralateral acute epi- or subdural hematoma in patients with ASDH, this therapy is justified because hematoma irrigation with trephination therapy has a poor outcome for comatose patients. CONCLUSION: Awareness of intraoperative brain swelling is important, as it suggests the development of contralateral hematoma. Immediate computed tomography and a rapid return to the operating room are therefore critical.

Adolescent↗

PubMed1999

EEG and implanted sources in the brain.

Localisation procedures are based on models of the EEG that are relatively simple. The models are based on assumptions and choices of parameters that can be mistaken. Thus, it is crucial to validate the localisation procedures used in EEG. One of the options is to use the data obtained with electrodes that are implanted within the brain of an epileptic patient as part of the pre-surgical evaluation. When one of two neighbouring electrodes is used as a current source and the other as a current sink this can be regarded as a current dipole. The current injected has to be below the threshold for activation of cells. The position of this dipole can be deduced from magnetic resonance or X-ray images. The current dipole gives rise to a potential distribution at the scalp that can be measured by EEG. The measurements can be compared with the potential distribution that is calculated in a forward computation. Another method is to use the measured potential at the scalp to localize the source and to compare the result with the actual position of the dipole. In this paper the measured potential distributions at the scalp due to implanted dipoles were used to evaluate different volume conductor models. Since intracerebral and subdural electrodes were introduced through trephine holes over the fronto-central areas, and the diameter of the holes was rather large, approximately 23 mm, special effort was put into modelling the skull. Two important assumptions could be validated in this study: the electric currents within the head are Ohmic and a dipole can be used to model the induced electric activity of pairs of contacts on subdural electrodes or intra cerebral electrodes.

Brain↗

PubMed1997

High power drill systems in neurosurgery.

Neurosurgical drill systems have evolved enormously over the centuries, from the early tools of trephination to the latest motor powered drills. The Midas Rex III Motor system and the Midas Rex driver motor are the newest systems, incorporating features that allow convenient operation by surgeons.

Craniotomy↗

PubMed2001

Microbiology of chronic frontal sinusitis.

OBJECTIVES: To determine bacterial and fungal organisms that are present in patients undergoing surgery for chronic frontal sinusitis. STUDY DESIGN: Retrospective, nonrandomized study. METHODS: Retrospective, nonrandomized bacterial and fungal cultures were performed on 46 sinus aspirates obtained by frontal sinus trephination performed on 30 consecutive patients with chronic frontal sinusitis. RESULTS: Six patients were having sinus surgery for the first time, 19 patients had undergone prior functional endoscopic sinus surgery without instrumentation of the frontal sinus/recess, and the third group included 5 patients who had undergone prior frontal sinus/recess surgery. Preoperative computed tomography scan of the frontal sinuses revealed complete opacification in 63% (29/46 frontal sinuses) and partial opacification in 22% (10/46), and no data were available for 15% (7/46). Aerobic cultures revealed that 38% (13/35 cultures) had no growth, 21% (7/35) grew Staphylococcus aureus, 21% (7/35) grew coagulase-negative Staphylococcus, 9% (3/35) grew Haemophilus influenzae, and 26% (9/35) grew a variety of other organisms. Anaerobic cultures were positive in 3% (1/32) of sinuses, and fungal cultures were positive in 4% (1/24). Haemophilus influenzae was most common in primary cases, whereas coagulase-negative Staphylococcus was most common in patients undergoing revision frontal sinus surgery. There were no other significant differences between cultures from patients undergoing revision frontal sinus surgery, revision functional endoscopic sinus surgery without prior frontal surgery, and primary surgery. CONCLUSIONS: This study suggests that organisms involved in chronic inflammatory disease of the frontal sinus may change after previous sinus surgery. The study failed to support a significant role for anaerobes. The role for coagulase-negative Staphylococcus as a potential pathogen or a contaminating agent remains unclear.

Adult↗

PubMed1990

Skull trepanation among the early Indians of Canada and the United States.

The authors reviewed anthropological reports of skull trepanation (trephination) among the early Indians of Canada and the United States of America. Published reports of 20 trepanations in 19 skulls are reviewed. All were believed to have been performed ante mortem. Most were from the pre-Columbian era. Eleven were from Canada (8 from British Columbia) and 8 from the United States. The location of skull perforation was parietal in 9 cases and less often frontal (3) or occipital (3). The average skull opening was oval or oblong, with a diameter of 3.0 cm. The method of trepanation was probably gradual scraping in most cases. Skull fractures were not present in any case. About 90% of the trepanations showed evidence of healing, indicating survival. The authors discuss the evidence for skull trepanation in the United States and Canada, and compare these findings to the better studied South and Central American material.

Canada↗

PubMed1998

Diseases of the skull in pre-Columbian South American mummies.

OBJECTIVE: The majority of paleopathological investigations focus on the study of the skull. This is because the skull is the most frequently preserved part of the human body recovered from archaeological excavations. From studying the skull, a variety of information can be obtained regarding the individual, such as sex, age, nutritional status, and other disease processes, if present. METHODS: This study represents the examination of more than 700 human skulls recovered from archaeological excavations from the Andean region of southern Peru and northern Chile and dating back more than 8000 years. RESULTS: A variety of skull abnormalities were encountered. The nonmetric variables of Huschke's foramina and palatine tori were common. Cranial deformation was observed in more than 85% of the cases. There were two cases of sagittal synostosis. Iron deficiency anemia resulting in porotic hyperostosis of the skull was evident in certain cultures. Exostoses of the external auditory canal resulting from chronic otitis was evident only among coastal populations. One skull demonstrated a periostitis consistent with Treponema infection. Trephination was encountered only in the skulls from Peru. Fifty-four cases of skull fractures were observed, half of which showed evidence of healing. Finally, only two cases of neoplastic skull lesions were encountered. CONCLUSION: The study of the human skull alone provides a large amount of information regarding the health and diseases of ancient populations.

Adult↗

PubMed2005

Sinus floor elevation via hydraulic detachment and elevation of the Schneiderian membrane.

OBJECTIVES: Minor sinus floor elevation is a method with relatively high predictability but is technically demanding. Improvement of the technique and increase in the predictability are desirable. MATERIAL AND METHODS: A clinical protocol for minor sinus floor elevation with SLA-ITI (large grit acid-etched implants with diameter of 4.8 mm) is described. Using trephine instead of spiral burrs enables the harvesting of autogenous grafts from the implant socket and guarantees a perfect implant socket. The latter is necessary for optimal implant anchoring and for the hydraulic seal between socket and the osteotome. The whole allows a hydraulic detachment of the Schneiderian membrane, where the blood cushion gradually detaches and elevates the membrane, preventing its contact with the graft. RESULTS: Eight patients were successfully treated with the method described above. No membrane perforation occurred and an uneventful healing was observed in all patients. All implants were loaded prosthodontically 3 months after the implantation. CONCLUSIONS: The clinical protocol presented provides high predictability in clinical outcome, together with extremely low morbidity and shortened surgery.

Adult↗