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PubMedDate not supplied

Prehistoric trephination of the frontal sinus.

Two examples of prehistoric trephination of the frontal sinus are presented. Both specimens were collected in Peru during the second decade of this century and are currently preserved at the Museum of Man in San Diego. One of the skulls represents trephining by incision and the other by scraping. Both show signs of healing indicating that the operated individuals survived the procedure. No definite clues as to the indications for surgery were found in one of the specimens. Trauma involving the frontal sinus appears to have been the reason for trephination in the other.

Adult↗
PubMed1992

Archaeological origins of cranial surgery: trephination in Mexico.

Archaeological excavations in Mexico and South America have provided evidence that trephination of the skull was performed by the pre-Hispanic Mexican and Incan cultures. Because those who performed such operations on the skull, presumably for ritual, prophylactic, or therapeutic reasons, can be considered predecessors of modern intracranial surgeons, their techniques and results are a subject of considerable current interest. This article, adapted from a lecture presented to the 1986 Congress of Neurological Surgeons, summarizes published descriptions of 34 trephined South and Central American and Mexican skull specimens, 16 of which were unearthed in Mexico and are currently available for review in anthropological museums in Mexico. Examples of several surgical techniques used on these skulls are presented. Although some trephinations were performed by these early cranial surgeons for apparently therapeutic reasons on skulls with obvious evidence of traumatic fractures, the interpretation of the medical, psychiatric, cultural, or religious significance of such procedures remains largely speculative.

Archaeology↗
PubMed2002

[Use of the trephine for harvesting bone from the iliac crest].

For closure of the cleft alveolus usually a choice between a bone graft from the chin or from the iliac crest is made. In the department of Oral and Maxillofacial Surgery of the University Hospital Groningen harvesting of bone from the iliac crest was performed with an open technique. From the results of an earlier study on the morbidity of this procedure until June 1997 it was found that in 26.1% of the cases a contour defect could be observed in the donor region. The mean width of the mature scar was 5.0 +/- 2.4 mm (range 1-10 mm). Especially these findings and the wish to further reduce postoperative pain led the University Hospital to start harvesting iliac crest bone grafts with a trephine in june 1997. In the period june 1997 through december 1999 iliac crest bone grafts were harvested in 28 cleft lip and palate patients (mean age 10.5 years; range 8-12 years) with this trephine technique. The scars were smaller in +/- 0.3 both length (mean 15 +/- 1.5 mm; range 11-24 mm) and width (mean 1.5 +/- 0.3 mm; range 1-3.5 mm). No contour defects and sensory loss occurred. Postoperative pain could adequately be relieved by local infiltration of the donor area with a 0.25% marcaïne solution and analgetics. On the first day post surgery all patients could be mobilised without problems. Based on these findings and recent literature it can be concluded that the use of the trephine is the method of choice for harvesting iliac crest bone in cleft lip and palate patients. Only when large amounts of bone, a bone block or a piece of cortical bone is needed, the open technique should be used.

Alveoloplasty↗
PubMed1991

[A self-made corneal graft marker made from disposable trephine].

A homemade corneal marker was contrived from a Pharmacia Superblade disposable corneal trephine by cutting away one arm of the trephine and then bending the single remaining arm to an angle of 45 degrees to the handle. The radii of the trephines ranged from 6.5mm to 8.5mm, at successive increments of 0.25mm. In optical corneal grafts, this marker can be used to pinpoint the center of the cornea, thus providing more accurate centralization of the area to be grafted. In therapeutic corneal grafts, the marker provides a more accurate determination of the most suitable area to be grafted. Unnecessary removal of healthy tissue or incomplete removal of diseased tissue are thus avoided. This marker is made easily and at no additional expense, and show itself to be a useful instrument to accurately determine the graft area in corneal surgery.

Corneal Transplantation↗
PubMed1988

[2 trephined skulls from Schleswig-Holstein].

In Schleswig-Holstein two trephined skulls are found, one belonging to a man deceased in the first half of adult age, who was buried in a stone grave of Middle Neolithic Age from Nebel on the isle of Amrum (published by Schaefer 1958, 1961). Another well preserved one, but without known site in Schleswig-Holstein, is the calvarium of a young adult presumably male showing a circular trephination without any tendency of healing. There is no symptom of a pathological change at the inner vault of the skull, but for the coronal suture gap . Striking are the grooves at both sides of the frontal bone which are quite unknown in this country. They are sulci arteriosi or nervi as is proved by Spanish skulls from Santa Cruz de Teneriffe and cases presented by Dixon (1904). EPIGENETIC TRAITS: 1. One sutural ossicle. 2. Incisura orbitalis r. 3. Threefold foramen supraorbitale 1. 4. Sulci arteriosi on the frontal bone. 5. Aplasia of left right molar (X-ray). PATHOLOGICAL CHANGES: 1. Hypoplasia of frontal sinuses. 2. Closing alveoli of first right molar. The case of a skull from Bremen (Domsdüne) demonstrates by the applied tool, that there are also trephinations in the Middle Neolithic Age.

Adult↗
PubMed2003

Nonmechanical Q-switched erbium:YAG laser trephination for penetrating keratoplasty: experimental study on human donor corneas.

OBJECTIVE: To assess the alterations in human donor corneal tissue induced by Q-switched erbium (Er):YAG laser corneal trephination. METHODS: Thirty human corneoscleral donor buttons unsuitable for transplantation were placed in an artificial chamber on an automated rotation device. Corneas were trephined with a Q-switched Er:YAG laser (wavelength, 2.94 microm; pulse duration, 400 nanoseconds) along (donor and recipient) aluminum silicate (ceramic) open masks. A spot diameter of 0.65 mm, energy setting of 50 mJ/pulse, and repetition rate of 5 Hz were used. Corneal thermal damage and cut regularity were quantitatively assessed in 24 corneas processed for light microscopy and by transmission and scanning electron microscopy. RESULTS: The stromal thermal damage was the highest (mean [SD], 8.0 [2.7] microm) at a 150-microm cut depth and decreased downward. Cut regularity was very good and did not significantly differ between donors and recipients. Scanning electron microscopy confirmed that the cuts were highly regular; transmission electron microscopy revealed 2 distinctive subzones within the stromal thermal damage zone. CONCLUSIONS: Thermal damage induced by Q-switched Er:YAG nonmechanical corneal trephination was low, and the regularity of the cuts was very good. CLINICAL RELEVANCE: The Q-switched Er:YAG laser may have the potential to become an alternative to the excimer laser for nonmechanical penetrating keratoplasty.

Cornea↗
PubMed1983

Particulate contamination in disposable corneal trephines.

In two cases scheduled for corneal transplantation, edges of donor corneal buttons were discolored by a black contaminant transferred from the disposable trephines. Trephines from two different manufacturers produced this same problem. Scanning electron microscopy and energy-dispersive x-ray analysis indicated that the contaminant was a mixture of stainless steel particles from the trephine and silicon carbide abrasive used in sharpening.

Adult↗
PubMed1979

A bone-fixing trephine for large-diameter iliac biopsies in dogs.

For experimental studies of bone in dogs it may be necessary to collect from the iliac crest biopsies of a larger diameter than is usually obtainable. A disadvantage of using a trephine with a large bore is that the biopsy may be pulled out of the trephine by the forces exerted by tendons inserted in the medial cortex of the ilium. To overcome this difficulty we developed a trephine with an internal bore of 10 mm combined with a biopsy-fixing attachment.

Animals↗
PubMed1998

[Depth of lamellar keratoplasty with the guided trephine system for transplantation of full-thickness donor sections].

BACKGROUND: Despite the fact that deep lamellar keratoplasty (DLKP) is less invasive than to penetrating keratoplasty (PKP), this procedure is rarely performed. We therefore investigated whether or not the DLKP technique we employed can achieve stable improvement of visual acuity. MATERIALS AND METHODS: Thirty-three eyes underwent TLKP for treatment of superficial corneal pathology. The donor tissue transplanted was suitable for PKP. The donor lenticule was obtained on the artificial chamber of the guided trephine system (GTS). The recipient cornea was trephined with the same trephine to a depth of 680 microns. Manual dissection was performed with a bevel-up blade. The donor lenticule with the endothelium peeled off was then sutured in with a 10 x 0 nylon double-running antitorque suture. Cortisone-antibiotic eye drops were administered postoperatively. RESULTS: Throughout the series no complications occurred. The mean best corrected visual acuity (BSCVA) over glasses was 0.29 (+/- 0.21) preoperatively, 0.1 (+/- 0.11) at 1 week, 0.33 (+/- 0.14) at 1 month, 0.5 (+/- 0.13) at 6 months, 0.61 (+/- 0.16) at 1 year and 0.63 (+/- 0.15) at 2 years. Clinically, we observed two subpopulations. In the first group of 87% of the cases, mean BSCVA was 0.67 (+/- 0.07) at 6 months. The remaining cases (BSCVA < or = 0.25 at 6 months) achieved a mean BSCVA of only 0.2 (+/- 0.04) at 1 year. Mean corneal astigmatism measured 2.93 D (+/- 1.62) preoperatively, 2.69 D (+/- 1.18) at 1 month, 2.09 D (+/- 1.07) at 1 year, and 2.22 D (+/- 1.11) at 2 years. We did not observe any graft rejection. CONCLUSION: The technique reported for DLKP provides excellent matching of donor lenticule and recipient bed. Separation of donor and recipient stroma prevents interface healing. DLKP appears to be a safe procedure for the surgical treatment of superficial corneal pathology and may offer a clinically applicable alternative to PKP.

Adolescent↗
PubMed1979

Trephine biopsy of the bone marrow in disseminated histoplasmosis.

Twenty-two patients had bone marrow aspirates for culture and marrow trephine biopsies for histologic examination during the evaluation of an illness eventually proved to be disseminated histoplasmosis. These procedures provided evidence of involvement of the bone marrow with Histoplasma capsulatum in 19 cases. Fungi were demonstrated in trephine biopsy sections in 15 of the patients, permitting a rapid specific diagnosis. Three patterns of bone marrow morphology were observed; each reflected a variation of macrophage proliferation. In two of the patterns, diffuse macrophage proliferation and loose aggregates of macrophages, typical 2 to 4 microns intracellular hisoplasma organisms were numerous and obvious in hematoxylin and eosin-stained sections, were infrequent and were often relatively large (6 to 12 microns). There were four patients from whom H. capsulatum was cultured when organisms could not be demonstrated in either hematoxylin and eosin- or silver-stained sections. The patients with diffuse proliferation of macrophages in the marrow comprised a distinct clinical group associated with immunosuppression, a fulminant course and a fatal outcome despite therapy. Patients in the other two morphologic groups responded well to therapy even though the immune responses on many were also suppressed. Bone marrow examination is an excellent diagnostic procedure in disseminated histoplasmosis. Trephine biopsies permit a rapid diagnosis in most cases and may be of prognostic significance.

Adolescent↗
PubMed1991

Treatment of subungual hematomas with nail trephination: a prospective study.

Subungual hematoma is a commonly encountered problem in the emergency department. We designed a prospective, observational study to determine if treatment of simple subungual hematomas (SUH) by nail trephination alone is without cosmetic or infectious complications. Over a 2-year study period, 48 patients met inclusion criteria. Radiographs of all digits were taken to detect distal phalangeal fracture and SUH size was measured. Nail trephination was performed using electrocautery, and all patients reported relief of pain after the procedure. Follow-up was achieved in 45 of 48 patients with a total of 47 SUH. Average follow-up period was 10.3 +/- 4.3 months. By patient history, average time for the nail to grow back was 4.0 +/- 2.6 months. No complications of infection, osteomyelitis, or major nail deformities occurred in any patients treated by nail trephination, regardless of SUH size or presence of fracture. In simple SUH, regardless of size, nail removal with suture repair of the nail bed, as suggested in previous studies, is unnecessary.

Adolescent↗
PubMed2005

Trephine biopsies are enriched for activated T/NK cells and cytotoxic T cells.

Although bone marrow aspiration is the most commonly obtained human marrow sample type, it yields liquid samples that contain a varying degree of blood contamination. Trephine biopsies, on the other hand, are solid marrow cores and are, therefore, much less likely to contain contaminating peripheral blood. In this study, we utilised a technique to extract viable cells from solid trephine biopsy specimens, by means of mechanical and enzymatic digestion, allowing cytometric comparison of cells in these biopsies and simultaneously obtained liquid aspirate samples. Having established that the digestion procedure itself was not causing any significant alteration in the immunophenotypic composition of the marrow samples, our data show that trephine biopsies were enriched for CD8(+) T cells, with concomitant decrease in the CD4(+) subset, compared to paired aspirates. Furthermore, T cells, NK cells and T cells expressing NK cell receptor (NKR) molecules were all significantly more likely to express both early (CD69) and late (HLA-DR) markers of activation. Bone marrow aspirates do not, therefore, provide truly representative data on the phenotypic composition of bone marrow, and the effect of peripheral blood contamination in aspirates should be taken into account when comparisons are being made between the bone marrow and other human issues or, perhaps more so, between human and murine marrow.

Adult↗
PubMedDate not supplied

Design of computer-generated hologram with ring focus for nonmechanical corneal trephination with Er:YAG laser in penetrating keratoplasty.

PURPOSE: To calculate a beam-shaping optical element for homogeneous intensity distribution within a focal ring to be used in nonmechanical trephination with the Er:YAG laser in penetrating keratoplasty instead of a spot guiding device. METHODS: The phase distribution behind a holographic optical element (HOE) k psi(u) can be described by the addition of the hologram phase phiH(u) to the beam phase phiE(u): k psi(u) = phiH(u) + phiE(u), k = 2pi/lambda, where u denotes the coordinates inside the hologram aperture, k an integer, and lambda the laser wavelength. To avoid discontinuous wavefronts leading to speckle noise, a smooth phase function is necessary. After transforming the hologram aperture coordinates into the focal plane x in a focal distance f, psi can be retrieved from the slope equation: inverted delta psi(u) = x(u) - u/f. RESULTS: Creating a ring focus can be reduced to an essentially one-dimensional problem by separation of variables due to the symmetry condition. We calculated a computer-generated eight-level phase-only HOE with 4096 x 4096 pixels from a Gaussian-distributed 2.94 Er:YAG laser spot with a beam diameter of 10 mm and a focal distance of 100 mm. Thereby, a ring focus with an inner/outer radius of 7/8 mm can be created. To avoid Poisson's spo, the symmetry of the problem was broken by circular modulation of the phase leading to a spiral-like structure. The calculated efficiency of the HOE relating the energy within the ring to the total energy was 91%. CONCLUSION: With an HOE it is possible to redistribute the energy along the desired focal ring. The HOE design can be adapted to the intensity distribution of the impinging laser beam with its characteristic aperture shape. A circular homogeneous corneal trephination depth is possible, because the energy fluctuation from pulse to pulse does not locally affect the ablation process. A ring focus for the Er:YAG laser has the potential to render superfluous a manual beam control via micromanipulator and to allow a more rapid and more regular corneal trephination along aperture masks.

Cornea↗
PubMed1998

A prospective study of trephined bone grafts of the tibial shaft and iliac crest.

Autogenous cancellous bone grafting is a common procedure in maxillofacial surgery. Open harvesting usually results in a long scar and considerable morbidity, but harvesting using a trephine can be done through a smaller scar with minimal morbidity. The commonly used anatomical areas for trephine harvesting are the iliac crest and the tibial shaft. A prospective study was carried out in 30 patients to compare the technique and the morbidity as perceived by patients using a visual analogue scale (VAS) and by an independent observer. The surgical anatomy and techniques are described. The results show no significant difference between the two groups, but the tibial trephine procedure is easier, quicker, and causes less blood loss. The total scores for pain and difficulty in walking were much less for tibial than that for the iliac grafts.

Adolescent↗
PubMed2002

Reliability of lymphoma classification in bone marrow trephines.

The aim of this study was to test and establish the accuracy and reliability of lymphoma classification in bone marrow trephines according to the new World Health Organization (WHO) classification by considering predominantly the morphology and immunophenotype. Therefore, we retrospectively compared lymphoma diagnoses, rendered exclusively on bone marrow trephines without knowledge of lymph node diagnosis in 124 patients, with the results of the reference centres that had reviewed lymph node (n = 90) or extranodal biopsies (n = 34). The overall concordance rate was higher than 85% and 91%, respectively, when patients with discordant malignancy grades were excluded. The concordance rate for low-grade B-cell lymphomas was 93% and for high-grade B-cell lymphomas 84%. The main reasons for discordant diagnoses were divergent immunophenotypes among low-grade B-cell lymphomas (6 out of 81, i.e. 7.4%) and discrepant malignancy grades within high-grade B-cell lymphomas (6 out of 31, i.e. 19.4%). No relationship between discordant diagnoses and chemotherapy given during the course of the disease with the site of biopsy (i.e. lymph nodes, extranodal sites) was noted. We conclude from our results that bone marrow trephines are a reliable tool, not only for establishing bone marrow infiltration, but also for the subtyping of lymphomas.

Biopsy↗
PubMed1999

How large should a skin trephine be for an end stoma?

BACKGROUND: Although much has been written about techniques for making a good stoma, little has been described regarding how to excise a trephine that will perfectly fit a given end stoma. METHODS: A reproducible technique for making a stomal trephine to a precise fit for each stoma is described. RESULTS: More than 20 stomas have been made with good results. CONCLUSION: The skin trephine should have a diameter approximately two-thirds of the width of the crushed bowel end.

Colostomy↗
PubMed2003

Comparison of conventional surgery with motorized trephine in bone harvest from the anterior iliac crest.

OBJECTIVE: A prospective study was performed to compare morbidity associated with the harvest of corticocancellous block grafts (CCBG) by conventional surgery and procurement of cancellous cores (CC) by means of a motorized trephine from the anterior ilium. STUDY DESIGN: Seventy-six patients requiring 30 mL or less of cancellous bone for maxillofacial reconstruction were placed into 2 treatment groups. One group underwent harvest of CCBGs in the traditional open medial approach to the anterior ilium. The second group had CCs harvested through a 0.5- to 1.0-cm incision with a motor-driven trephine. The following parameters were used to evaluate patient morbidity: number of days to unassisted ambulation, length of hospital stay, and pain scores for both the recipient and the donor sites. RESULTS: The mean time to patients' unassisted ambulation following a CCBG was significantly longer (2.8 days) than following CC (0.8 days). The mean length of hospital stay following a CCBG was significantly longer (4.1 days) than following a CC (2.2 days). The mean contemporaneous maxillofacial pain scores following procurement of CCs (day 1: 5.6; day 3: 4.2) and procurement of CCBGs (day 1: 5.8; day 3: 4.5) were not significantly different, whereas the mean hip pain was significantly greater (P <.05) on day 1 in patients having undergone a CCBG (pain score: 6.2) than in patients having undergone a CC graft (pain score: 3.0). Gait disturbance was identified in 15 of 22 patients (68%) who underwent a CCBG. Only 1 of the 54 patients (1.9%) who underwent a CC graft exhibited an abnormal gait. No other complications were noted. The results demonstrated a significant difference in morbidity between the 2 techniques in all variables. CONCLUSION: Where modest amounts of cancellous bone are required for maxillofacial grafting, trephining of cancellous cores results in significantly less morbidity than traditional open methods.

Adolescent↗
PubMed1996

Antigen retrieval by microwave oven heating for immunohistochemical analysis of bone marrow trephine biopsies.

Immunohistochemical analysis of bone marrow trephine (BMT) biopsies with monoclonal antibodies for the analysis of hemopoietic disorders has been hindered by the fixation and decalcification regimens which mask or destroy tissue antigens. This study evaluated the effect of microwave oven treatment on the quality of immunostaining of fixed decalcified trephine biopsies. The aim was to establish whether this method of pre-treatment would enable additional antigens to be detected. Fifty-eight monoclonal and 4 polyclonal antibodies to hemopoietic antigens were assessed to compare no tissue pre-treatment, proteolytic (trypsin) enzyme digestion and microwave oven heating. The microwave heating of the sections was performed by placing them in a boiling solution of 0.01M tri-sodium citrate for a total of 10 mins. Following microwave heating 14 antibodies that previously showed no reactivity in BMT biopsies gave positive staining and 9 antibodies previously known to detect antigens in the absence of pre-treatment gave enhanced staining. Other antibodies showed no staining improvement with microwave heating and some failed to give a positive reaction by any of the pre-treatment methods. Antigen retrieval utilizing microwave oven heating can expose antigenic sites for antibody binding in bone marrow trephine sections. However not all antigens are retrieved and there is variation between epitopes on the one molecule and their ability to be exposed by microwave heating. Utilizing antigen retrieval methods, the range of antibodies applicable to BMT sections is greatly expanded enabling the immunophenotypic analysis of the majority of hemopoietic disorders.

Antibodies, Monoclonal↗