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The filtration procedures of trephine, iridencleisis, and corneoscleral cautery are compared to show the superiority of the latter. Pathologic vertification of the three operations suggests the reason for success. Several changes in the original technique as described by Schele are suggested.
Buttons obtained by trephination from both eyes of a 44-year-old myopic man with pigmentary glaucoma were studied by light and electron microscopy. Although clinically both eyes exhibited heavy pigmentation of the trabecular meshwork in the whole circumference, microscopically the trabecular meshwork of the left eye contained more pigment granules than that of the right eye, which appeared relatively acellular with collapse of the trabecular sheets. In both eyes endothelial cells covering the trabecular sheets were filled with pigment and showed various stages of degeneration. The intertrabecular spaces contained free pigment granules as well as cell debris. These observations suggest that plugging of the trabecular spaces by pigment and cell debris together with fragmentation and collapse of trabecular sheets contribute to the decrease in the facility of outflow that occurs in pigmentary glaucoma.
Two cases of late endophthalmitis after trabeculectomy surgery are described. Despite intensive antibiotic therapy, the visual end result in both cases was poor. The incidence of endophthalmitis after trabeculectomy, according to this report is similar to that after Scheie's procedure, but less than that after trephination. A possible cause of endophthalmitis is the anterior dissection of the superficial scleral flap into the cornea.
A 26-year old woman underwent radial keratotomy combined with concentric trephination (6.5 and 8 mm) six months prior to development of multiple epithelial inclusion cysts. A biopsy specimen from one enlarging cyst showed an absence of scarring in addition to the retention of epithelium within a radial incision wound. Adjacent keratocytes were abnormal and seemed to be undergoing degenerative changes. To our knowledge, this is the first report of a failure in corneal wound healing associated with microcystic degeneration of the epithelium following radial keratotomy.
Albino rabbits were treated four or six times daily with 1% prednisolone acetate, 1% medroxyprogesterone acetate, or a control vehicle, after one of three conditions. First, after 3-mm linear perforating stromal incisions; drugs were given for seven days, and wound bursting strength was determined. Prednisolone suppressed wound tensile strength by 20%; medroxyprogesterone suppressed it by 11%. Second, after trephination, drug administration for 14 days decreased collagen formation in the scar buttons by 43% in the prednisolone-treated group and 39% in the medroxy-progesterone-treated group. Third, after thermal burns; when drug application followed the burn immediately, deep ulceration or perforation developed in 85% of the controls, in none of the prednisolone-treated group, and in 17% of the medroxyprogesterone-treated group. When drug delivery was withheld until day 6, severe ulceration developed in 44% of both groups. In both experiments, stromal neovascularization was markedly suppressed by prednisolone, but only moderately decreased by medroxyprogesterone.
Exoplants of porcine retinal pigment epithelium (RPE) attached to Bruch's membrane, choroid, and sclera were maintained in organ culture for up to four weeks. Four-millimeter round buttons of eye wall that contained RPE, choroid, and sclera were trephined from freshly enucleated pig eyes and incubated at 37 degrees C in Eagle's minimum essential medium with 10% fetal calf serum. The RPE cells remained as a monolayer for at least four weeks in organ culture, and individual RPE cells became taller and dome shaped. The RPE cells retained several prominent ultrastructural features, including apical microvilli, intracellular melanosomes and mitochondria, and intercellular tight junctions. Since the cellular substratum can exert important influences on cell behavior, the ability to maintain RPE cells attached to Bruch's membrane provides a new in vitro tool for studying the metabolic activity of this tissue and its response to external stimuli, including laser photocoagulation.
The effects on corneal wound healing of two topical nonsteroidal anti-inflammatory agents, flurbiprofen sodium (0.03%) and diclofenac sodium (0.1%), and the topical corticosteroid, prednisolone sodium phosphate (1%), were evaluated in masked, controlled rabbit studies. Healing of epithelial scrape wounds was significantly retarded in all three treatment groups for the first 3 days after wounding. There was no difference in the epithelial healing rate between the two nonsteroidal or corticosteroid treatment groups. Clinical grading of epithelial quality, conjunctival hyperemia, keratitis, stromal edema, and corneal haze were similar in all groups. There was a significant early decrease in the iritis score in the diclofenac treatment group. The strength of 2-mm central penetrating corneal trephination wounds and the collagen content of these wounds were similar in all groups. Both the topical nonsteroidal anti-inflammatory agents and the corticosteroid used in the preparations and dosages investigated in this study decreased early epithelialization of scrape wounds but had no apparent effect on corneal stromal healing. No toxic effects of the various drugs were found.
BACKGROUND: Most complications of a keratoprosthesis occur at the tissue-to-implant interface. The ideal prosthesis would eliminate this interface by having the tissue actually grow into the supporting material. We present a prospective clinical human study of a novel biocolonizable keratoprosthesis in 24 eyes of 24 patients. DESIGN: To promote implant stability, the 9-mm-diameter haptic was fashioned using a custom-made microporous fluorocarbon with a 4-mm-diameter, 2.67-mm-long, central optic made of medical grade polymethylmethacrylate, giving a global visual field of 110 degrees to 130 degrees. Only bilaterally blind patients with untreatable corneal diseases were included in the study. The haptic was inserted into a lamellar pocket delaminated in the stroma, and the optic was positioned through a hole trephined in the central cornea. RESULTS: The average follow-up was 15.7 months (range, 4 to 28 months). The host corneal fibroblasts penetrated and proliferated into the peripheral microporous fluorocarbon and provided anchorage between the cornea and prosthesis. Seventeen patients (70.8%) had visual acuity improvements. Mean corrected final visual acuity was 20/100 (range, 20/30 to 20/400). Five anatomic failures occurred in the first 6 months (three extrusions, one dislocation of the optic, and one endophthalmitis). We had one case (4.1%) of treatable glaucoma. We successfully removed four of five retroprosthetic membranes that had occurred. No retinal detachment occurred. CONCLUSION: The biocompatible inert microporous polymer did not eliminate all mechanical complications associated with a keratoprosthesis.
Complete and consistent occlusion of the nasofrontal duct of the canine sinus was achieved by introducing acrylic through a trephinated opening in the nasal dorsum. This surgical procedure resulted in the isolation of the frontal sinus, without impairing the integrity of the cavity. In this experimental canine model, potassium penicillin G and erythromycin lactobionate were absorbed into the blood equally well when placement was either in the intramuscular (IM) space or in frontal sinus cavity. When different concentrations of these antibiotics were injected into the IM space, peak blood levels occurred between one and two hours; however, peak sinus levels, following IM introduction, did not occur until four hours. The peak ratios show that between 4% and 20% of penicillin, and 1% and 12% of erythromycin in the blood is transferred across the normal sinus membrane.
Fifty formalin fixed, paraffin-embedded cases of T-acute lymphoblastic leukaemia (T-ALL) from 12 bone marrow trephines and 38 lymph nodes were stained with a new monoclonal antibody, 2TL 242, raised against recombinant TAL1 protein. The antibody recognizes TAL-1 polypeptides of molecular weight 39 and 41 kD (full length). In addition, a variety of other leukaemias and lymphomas were also stained with 2TL 242. Twenty-four of the 50 cases of T-ALL showed nuclear positivity, ranging from 10 to 90 per cent of leukaemic cells. A positive staining reaction was nuclear and stippled in pattern. Nuclear staining was not seen in any other type of leukaemia or lymphoma. Five cases of follicular lymphoma showed diffuse cytoplasmic staining of variable intensity. Although some background staining is obtained with this antibody, positive nuclear staining is easily distinguishable. This monoclonal antibody has a potential role in primary diagnosis and in the detection of minimal residual disease in T-ALL.
A study was performed to investigate the utility of polymerase chain reaction (PCR)-based analysis of immunoglobulin heavy chain (IgH) gene rearrangements for the diagnosis of low-grade malignant B-cell lymphomas on formalin-fixed, EDTA-decalcified, and paraffin-embedded bone marrow trephine biopsies. On amplifying two DNA samples per biopsy, no reproducible monoclonal PCR result was found in 32 patients with reactive lymphoid hyperplasias. In contrast, 5/14 patients with known low-grade B-cell lymphomas, but histomorphologically and immunohistochemically lymphoma-free bone marrow, showed a reproducible monoclonal IgH gene rearrangement. In three of these cases, sequence analysis revealed completely different amplification products on comparing bone marrow and lymph node infiltrations, while in the other two cases the products were identical. In one of the latter biopsies, an unequivocal lymphoma infiltrate was found after step sectioning of the biopsy, while the other case remained lymphoma-free according to conventional criteria. A third group of three patients with known lymphomas and bone marrow findings that were suggestive but not diagnostic of bone marrow involvement showed monoclonal PCR results in all three cases, with identical sequences in bone marrow and extramedullary lymphoma infiltrates. These data suggest that a reproducible monoclonal IgH gene rearrangement is highly specific for the presence of malignant B-cells in bone marrow. In staging procedures for low-grade B-cell lymphomas, PCR yields no additional information in cases that are morphologically and immunohistochemically lymphoma-free after evaluation of representative sections. PCR may be useful in equivocal cases, provided that IgH gene rearrangements of extramedullary lymphoma and bone marrow are sequenced and compared.
A total number of 248 bone marrow trephine biopsies were reviewed and 21 paired biopsy and touch imprints were identified to estimate the role of these two diagnostic methods for detection of tumor metastases from nonhematologic malignancies in the bone marrow. The study period ran between January 1, 1993, and June 1, 1996. Eight histology sections and eight touch imprints were prepared from every case and were reviewed by two pathologists independently. In 20 cases, tumor cells were present without a doubt both on cytologic and histologic preparations. In one touch imprint, single cells were suspicious for malignancy, and the final pathology report was prepared after examination of the histologic sections. There was no positive biopsy in which the imprint was negative for tumor cells, and no positive touch imprint in which the biopsy was negative for such cells. The results from our study show that every one of these approaches has advantages and disadvantages and that they have a complementary role for identification of solid malignancies in the bone marrow.
This article presents a novel photochemically driven surgical tissue adhesive technology using photoreactive gelatins and a water-soluble difunctional macromer (poly(ethylene glycol) diacrylate: PEGDA).The gelatins were partially derivatized with photoreactive groups, such as ultraviolet light (UV)-reactive benzophenone and visible light-reactive xanthene dye (e.g., fluorescein sodium salt, eosin Y, and rose bengal). A series of the prepared photocurable tissue adhesive glues, consisting of the photoreactive gelatin, PEGDA, and a saline solution with or without ascorbic acid as a reducing agent, were viscous solutions under warming, and their effectiveness was evaluated as hemostasis- and anastomosis-aid in cardiovascular surgery. Regardless of the type of photoreactive groups, the irradiation of the photocurable tissue adhesive glues by UV or visible light within 1 min produced water-swollen gels, which had a high adhesive strength to wet collagen film. These were due to the synergistic action of photoreactive group-initiated photo-cross-linking and photograft polymerization. An increase in the irradiation time resulted in increased gel yield and reduced water swellability. A decrease in the molecular weight of PEGDA and an increase in concentration of both gelatin and PEGDA resulted in reduced water swellability and increased tensile and burst strengths of the resultant gels. In rats whose livers were injured with a trephine in laparotomy, the bleeding spots were coated with the photocurable adhesive glue and irradiated through an optical fiber. The coated solution was immediately converted to a swollen gel. The gel was tightly adhered to the liver tissue presumably by interpenetration, and concomitantly hemostasis was completed. The anastomosis treatment with the photocurable glue in the canine abdominal or thoracic aortas incised with a knife resulted in little bleeding under pulsatile flow after declamping. Histological examination showed that the glues photocured on rat liver surfaces were gradually degraded with time in vivo with infiltration of inflammatory cells and connective tissues without necrotic sign in surrounding tissue. In addition, in the laparoscopic surgery, percutaneous delivery of the glue and its in situ photogelation on rat liver surfaces were demonstrated using a specially designed fiberscope. These results indicate that the photocurable glues developed here may serve as a biodegradable tissue adhesive glue usable in cardiovascular surgery and endoscopic surgery.
Thirty-four consecutive patients with intracranial meningiomas underwent 35 resections aided by an interactive surgical navigation system (ISN; "frameless stereotaxy"). System capabilities include real-time display of wand location, orientation, and relationship to nearby structures using multiplanar and three-dimensional presentation of magnetic resonance imaging (MRI) and/or computed tomography (CT) data obtained perioperatively. There were 16 patients with convexity tumors, five patients with sphenoid wing tumors, five patients with falx or parasagittal tumors, and eight patients with skull base tumors (two each: petroclival, cavernous sinus, olfactory groove, and planum sphenoidale). the ISN system was used to locate a minimal craniotomy (i.e., trephine) in 11 (32%) patients, to optimize bone flap design in 13 (38%) patients, to identify the location of parasagittal draining veins in five (15%) patients, and to locate the carotid or basilar arteries in 11 (32%) patients. The techniques provided limited benefit in cranial nerve preservation. No patient had permanent central neurologic morbidity. Where intended preoperatively, tumor resection was complete (i.e., > 98%) in all patients as determined via postoperative MRI. Interactive surgical navigation is a useful adjunct in the operative management of some patients with intracranial meningiomas.
Morphological and clinical features of 39 patients with nodular lymphoma were studied with particular reference to bone marrow and blood involvement. Twenty-one patients (54%) were found to have bone marrow involvement at the time of initial diagnosis. Thirteen (33%) also had peripheral blood involvement. A specific cell type, the small nodular lymphoma cell, was found in the bone marrow smears of 19 and the 21 patients with bone marrow involvement and in the peripheral blood smears of all patients with blood involvement. When large cells predominated in the lymph node or bone marrow sections, the bone marrow smears and the imprints of the lymph node and trephine biopsy demonstrated these large cells to have morphological qualities of lymphocytes rather than histiocytes.
The bone marrow biopsy has an established role in the evaluation of nonhematologic malignancies in adults. The results of the trephine bone marrow biopsy (BMB) and bone marrow aspiration (BMA) in 42 children with solid tumors were reviewed. Bone marrow biopsies were done for the following indications: (1) "dry tap," (2) equivocal presence of tumor in the BMA, (3) definitely no tumor in the BMA, (4) protocol requirements. Of the 42 children, 19 (45%) had metastases in the BMB; 9 (21%) had a positive BMA and BMB, and 10 (23%) had a positive BMB and a questionable or negative BMA. Patients were divided into two groups, according to the presence or absence of metastases in the biopsy. Their clinical, hematologic, and pathologic findings were reviewed. Comparison was made between patients with and those without metastases. No single hematologic parameter was predictive of bone marrow metastases. Nevertheless, percentages of hemoglobin and platelet counts were lower in patients with metastases. This study indicates that, in children as in adults, aspiration and biopsy are complimentary procedures in the workup for metastases in patients with solid tumors.
The hematologic changes and prognostic implications of bone marrow involvement in small cell lung cancer (SCLC) were examined in 133 patients undergoing staging procedures including bone marrow aspiration and trephine biopsy. Bone marrow involvement was found to be present in 27 of 133 (20%) at diagnosis. In most instances bone marrow involvement was associated with the presence of other metastases but in five patients (4%) the bone marrow was the sole site of metastasis. Bone marrow biopsy proved superior (14%) to bone marrow aspiration (5%) in detecting marrow infiltration. Peripheral blood hematologic changes were infrequent even in patients with positive bone marrow biopsy results. Although patients with bone marrow involvement had a shorter median survival (9 weeks) than bone marrow-negative patients (33 weeks) the adverse effect on survival appears to have been mainly due to the presence of concomitant metastases at other sites. Intensive chemotherapy was tolerated to the same degree by bone marrow-positive and bone marrow-negative patients.
The clinical records, scintigrams, radiographic skeletal surveys, and bone marrow aspiration and trephine results of 30 children with neuroblastoma were reviewed to determine the relationship between the result of the scintigram and the clinical outcome of the patient. The nine patients with normal radiographic skeletal surveys and no evidence of bone metastases on scintigraphy are alive and well having been off treatment for between 14 and 83 months. Eleven of the 13 children who had bone metastases on scintigraphy and radiography have died, as have seven of the eight patients who had positive scintigrams and normal radiographs. Scintigraphic evidence of bone metastases is associated with a very poor prognosis irrespective of the results of other investigations.