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PubMed2001

Stafne's bone cavity in the anterior mandible: a possible diagnostic challenge.

Stafne was the first to report the presence of "bone cavities" in the angle of 35 mandibles. Such cavities generally appear in the area between the mandibular first molar and the mandibular angle, and are not considered rare. One of their primary radiological diagnostic features is the characteristic location below the mandibular canal. Stafne's bone cavity is relatively rare in the anterior mandible. The mandibular canal is not present in the anterior mandible. As a result, diagnosis in the anterior mandible may be missed. Needless treatment modalities such as endodontic treatment, bone trephining, and bone exploration may be conducted. The purpose of the present report is to describe a new case of Stafne's bone cavity in the anterior mandible and discuss the differential diagnosis process. The dental computerized tomography scan is suggested as the most suitable noninvasive diagnostic and follow-up modality for this bony configuration in the anterior mandible.

Diagnosis, Differential↗
PubMed2001

A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy.

BACKGROUND: Current management of extraperitoneal rectal injuries involves a laparotomy and diversion of the fecal stream. In this study, we review our experience with laparoscopy and diverting loop sigmoid colostomy without laparotomy in the management of these injuries. METHODS: All patients admitted to the trauma unit at Groote Schuur Hospital between January 1995 and May 2000 with a rectal injury were evaluated. The presence of a rectal injury was confirmed by rectal examination and proctosigmoidoscopy. Intraperitoneal injuries were excluded by laparoscopy. Only patients who did not have intraperitoneal injuries were included in the study. The patients were then managed with a diverting loop sigmoid colostomy created through an abdominal wall trephine without laparotomy. RESULTS: Ten patients were included in the study. In eight patients, laparoscopy excluded intraperitoneal injuries. All 10 patients had a diverting loop sigmoid colostomy fashioned. There were no complications related to either the rectal injury or colostomy. Nine stomas have since been closed. CONCLUSION: In patients with isolated extraperitoneal rectal injuries, laparoscopic exclusion of intraperitoneal injuries, followed by a diverting loop sigmoid colostomy, is a feasible option.

Adolescent↗
PubMed2001

Psychosurgery: a historical overview.

Neurosurgical treatment for psychiatric disorders has a long and controversial history. From the Stone Age use of trephining to release the demons of the spirit to the millimeter accuracy of stereotactic instruments currently used in the operating room, psychosurgery has enjoyed enthusiastic support as well as experiencing scorn. Today, psychosurgery is a minimally invasive and highly selective treatment that is performed for only a few patients with severe, treatment-refractory, affective, anxiety, or obsessive-compulsive disorders. Recent advances in technology and functional neuroanatomic techniques, as well as economic pressures to decrease the costs of caring for chronically ill patients, may provide an opportunity for psychosurgery to become a more attractive option for the treatment of psychiatric diseases. In this historical overview, the rise and fall of psychosurgery are described. A better understanding of the colorful history of this interesting topic should enable modern neurosurgeons and other health care professionals to meet the social, ethical, and technical challenges that are sure to lie ahead.

History, 17th Century↗
PubMed2001

John Bingham Roberts and the first American monograph on human brain surgery.

JOHN BINGHAM ROBERTS (1852-1924) of Philadelphia was an active general surgeon in the latter 19th and early 20th centuries. He made pioneering contributions to a number of areas of surgery. From 1880 until the end of his career, he was one of the few American surgeons to advocate an aggressive exploratory approach to cranial fractures in an effort to avoid consequences such as infection, delayed seizures, and insanity. In his 1885 article in the Transactions of the American Surgical Association titled "The Field and Limitation of the Operative Surgery of the Human Brain," he predicted that with antiseptic precautions and the growing knowledge of cerebral localization, operations on the brain would become commonplace. This work predated that of Horsley, Keen, and many others. Roberts had a continuing interest in head injuries, cranial fractures, and the development of trephines and burrs for reconstructive cranial work, but his active enthusiasm for brain surgery diminished in the 1890s. Nevertheless, Roberts was a very prolific teacher and leader in American surgery who is perhaps best remembered for his monographs and textbooks on general, orthopedic, plastic, and reconstructive surgery.

Brain↗
PubMed1979

Identification of cytomegalovirus in bone marrow biopsy.

The bone marrow trephine biopsy has become a common procedure for evaluating hematopoietic abnormalities. Occasionally, the first clue to an infectious process is obtained from this source. A bone marrow biopsy, done to evaluate pancytopenia in a patient who had received a renal transplant, revealed large intranuclear inclusions diagnostic of cytomegalovirus. Antibody titers were initially negative but rose over the next few weeks to confirm the diagnosis. Even though the bone marrow biopsy may not be the best site for finding CMV inclusions, the careful examination of a random bone marrow biopsy, particularly in an immunosuppressed individual, may contribute to the diagnosis.

Adolescent↗
PubMed1987

Infarction of the orbit and paranasal sinuses in sickle cell disease.

We have reported the case of a 19-year-old black man with sickle cell disease who had swelling over the right frontal and periorbital areas. Plain roentgenograms and CT scans were consistent with frontal sinus disease. At trephination, however, sterile liquescent blood clot was found in the frontal sinus. Awareness of the orbital apex syndrome and infarction of the orbit and sinuses in patients with sickle cell disease is necessary to prevent misdiagnosis of these conditions as suppurative sinusitis.

Adult↗
PubMed1993

Percutaneous biopsy in the anterior thoracic spine.

Over a 24-month period, seven patients have undergone nine diagnostic closed percutaneous biopsies of thoracic vertebral body lesions. Seven of the nine biopsies were performed using the Craig trephine biopsy set. All seven biopsies provided diagnostic material. Two biopsies were performed with 22-gauge needles and aspiration technique. One provided diagnostic material. The only complication was a small pneumothorax that spontaneously resolved. Current editions of orthopedic texts give mixed recommendations as to the route of vertebral body biopsy in the thoracic spine. Most recommend open rather than percutaneous biopsy, particularly above T10. Review of current orthopedic literature, however, reveals overwhelming support for the use of closed biopsy techniques as the procedure of choice for tissue diagnosis of thoracic vertebral body lesions. As in this limited series, the reported positive biopsy ratio is high and the complication rate acceptably low.

Adolescent↗
PubMed2002

Mixed chimerism of the resident macrophage population after allogeneic bone marrow transplantation for chronic myeloid leukemia.

BACKGROUND: Bone marrow macrophages have been recognized to play a crucial role in the functional network that constitutes the microenvironment. In chronic myelogenous leukemia (CML), neoplastic macrophages are presumably responsible for the expansion of the leukemic cell clone. So far, no information is available about a persistence of host-type macrophages after allogeneic bone marrow transplantation (BMT) implicating a lineage-specific mixed chimerism. METHODS: Bone marrow trephine biopsies were investigated in eight male and five female patients with CML after BMT after a sex-mismatched host/donor constellation. Techniques included immunophenotyping (CD68) for identification of resident macrophages and a simultaneous genotyping with X- and Y-chromosome-specific DNA-probes (fluorescence in situ hybridization). Normal bone marrow and specimens of CML patients before BMT served as controls. RESULTS: Contrasting an almost 100% congruence with the genotyping in the controls, a mixed chimerism of the CD68+ macrophages and the other host myeloid cells was found. Until 3 months after BMT, incidence of host-type macrophages ranged from 8% to 10%. This feature was also identifiable in the peculiar subset of pseudo-Gaucher cells (PGCs). The number of host-type macrophages failed to decline significantly during the early posttransplant period, because after almost 4 months these were still detectable. On the other hand, in patients showing an initial-to-manifest leukemic relapse, an insidious conversion of up to 50% from the donor to host-type macrophages and myeloid cells occurred. CONCLUSIONS: The CD68+ resident bone marrow macrophage population including PGCs are involved in the lineage-specific chimerism and minimal residual disease after BMT in CML.

Biopsy, Needle↗
PubMed2000

Treatment options for augmentation of the posterior maxilla.

The uses of conventional sinus augmentation procedures, trephines and osteotomes, with and without concomitant buccal-lingual ridge augmentation are discussed. Indications and contraindications for the application of each therapeutic modality, material selection, and the appropriate timing of implant placement are detailed.

Alveolar Ridge Augmentation↗
PubMed2001

Comparison of anorganic bovine mineral with and without synthetic peptide in a sinus elevation: a case study.

A new tissue-engineered bone substitute that reportedly has the capability to enhance bone regeneration over the more classical bone substitutes, such as decalcified freeze-dried bone allograft and xenograft, was evaluated in bilateral sinus procedures. Anorganic bone mineral with and without a synthetic peptide (P-15) were grafted separately in bilateral sinuses. At the time of implant placement and at four months, trephine cores were obtained and the quality of the grafts deciphered by histomorphometry. The P-15 grafted sinus yielded 45% vital bone compared with 13% for the anorganic bovine material alone. The P-15 dramatically increased the quality and quantity of grafted bone in the sinus.

Adult↗
PubMed2001

The modified trephine/osteotome sinus augmentation technique: technical considerations and discussion of indications.

A technique is presented, which uses trephines of various external diameters followed by an osteotome to implode a core of maxillary posterior alveolar bone before placement of regenerative materials, in anticipation of subsequent implant placement. A mathematical formula is presented, which relates the depth of core displacement to the apico-occlusal dimension of alveolar bone coronal to the floor of the sinus presurgically. Seventy-one sites have been treated. All sites exhibited sufficient regeneration for implant placement. Two of the sites required additional augmentation at the time of implant placement. Fifty-one of the implants have been restored and are in function for up to 3 years. All are functioning successfully, as defined by the Albrektsson criteria. The technique and its indications and contraindications are described in detail.

Aged↗
PubMed2002

Microvessel density in alveolar ridge regeneration with autologous and alloplastic bone.

PURPOSE: The purpose of this study was to conduct a comparative immunohistochemical evaluation of microvessel density (MVD) in alveolar sites augmented with autologous bone or Bio-Oss. MATERIALS AND METHODS: Eighteen patients participated in this study. All patients presented maxillary ridge defects. These defects were filled in a random fashion with autologous bone or Bio-Oss. Endosseous implants were inserted after a mean of 3 months in the sites augmented with autologous bone and after a mean of 6 months in the sites augmented with Bio-Oss. As part of the implant site preparation, a trephine was used to harvest bone cores. As control, bone cores retrieved in nonaugmented sites were used. The mean value of MVD in control bone was 25.6 +/- 3.425. In the sites augmented with autologous bone, the MVD was 29.8 +/- 4.4, while in the sites regenerated with Bio-Oss, the MVD was 29.7 +/- 2.4. The statistical analysis showed that the difference in MVD between control bone and autologous bone (P = 0.057) and between control bone and Bio-Oss (P = 0.023) was statistically significant. The difference between the sites regenerated with autologous bone and those regenerated with Bio-Oss was not significant (P = 0.6889). CONCLUSIONS: Our results show that both sites augmented with autologous bone and Bio-Oss presented a higher and statistically significant quantity of microvessels compared with control specimens. No significant differences were found when comparing the MVD of the sites regenerated with autologous bone and those regenerated with Bio-Oss. The retrieval time was, however, a mean of 3 months for the autologous bone sites and a mean of 6 months for the Bio-Oss sites. These data could support the hypothesis of faster healing for the sites augmented with autologous bone.

Adult↗
PubMed1999

Experimental models of brain trauma.

A short review of the most widely used and popular experimental models of traumatic brain injury is presented. This review focuses on current animal models of traumatic brain injury that apply mechanical energy to the skull or, after trephination of the skull, to the intact dura. Recent experimental studies evaluating the pathobiology of traumatic brain injury using these models are also discussed. This article attempts to provide a broad overview of current knowledge and controversies in experimental animal research on brain trauma.

Animals↗
PubMed2002

Archival fixed histologic and cytologic specimens including stained and unstained materials are amenable to RT-PCR.

Formalin-fixed and paraffin-embedded tissues are increasingly used for analysis of gene expression. However, a large proportion of archival fixed histologic specimens including spare paraffin sections and stained slides, as well as archival cytologic materials, have not been investigated for their suitability for RNA-based analysis. The current study addressed this issue by reverse transcription and polymerase chain reaction (RT-PCR) of the glucose-6-phosphate dehydrogenase (G6PD) transcript in a series of archival histologic and cytologic specimens. The histologic specimens included freshly prepared paraffin sections, spare paraffin sections, hematoxylin and eosin-stained slides, immunostained slides, and decalcified bone marrow trephines. The cytologic specimens comprised cervical smears and various stained and unstained needle aspirates and cell sediments. The G6PD was amplified for five different fragment sizes ranging from 67 bp to 453 bp. It was found that the majority of archival materials were amenable to RT-PCR of small fragments with the overall success rates of 95% and 79% for 67 bp and 151 bp of the G6PD mRNA, respectively. Neither staining nor prolonged storage up to 15 years had major negative effects on RT-PCR, although fine-needle aspirates showed a higher rate of RT-PCR of 242-bp fragment than other types of cytologic specimens and so did Papanicolaou-stained samples than May Grounwald and Giemsa-stained samples. RT-PCR of minute cell populations microdissected from immunostained sections of tonsils and t(11;18)-positive mucosa-associated lymphoid tissue lymphomas showed that as few as 100 cells were adequate for RT-PCR of G6PD and translocation-associated fusion transcript as long as the target fragment was limited to less than 150 bp. Our results demonstrate that archival fixed histologic and cytologic specimens are valuable resources for RT-PCR-based molecular investigations.

Dissection↗
PubMed1997

Corneal topography.

In the review period, limitations of individual Placido disk-based topography systems have been studied and new principles, such as raster photogrammetry, pancorneal slit topography, laser holographic interferometry, and confocal laser scanning topography, have been introduced for laboratory or clinical work. Both Fourier analysis and Zernike decomposition of topographic height data seem to be powerful new tools for cross-sectional analysis of complex topographic corneal images, such as after cataract surgery, penetrating keratoplasty, and refractive surgery, as well as for longitudinal studies of corneal changes, such as in schoolchildren. Subdividing into rational optical components may improve consistency and standardization of topography data from different systems. Topography-based flying-spot-mode excimer laser photoablation after Zernike decomposition of topography height data has been proposed for correction of irregular corneal astigmatism. Topography-based central power measurements are of increasing value for intraocular lens power calculation before cataract surgery in eyes with irregular corneal surfaces, such as in keratoconus or after refractive surgery procedures. Quantitative and qualitative classification of corneal topography maps after corneal transplantation following conventional mechanical and nonmechanical trephination or after refractive surgery may lead to a better understanding of impaired visual acuity despite a clear graft or despite significantly reduced ametropia or corneal astigmatism.

Cornea↗
PubMed2001

Intraocular pressure after homologous penetrating keratoplasty.

PURPOSE: To evaluate intraocular pressure (IOP) changes after homologous central penetrating keratoplasty in a noncomparative interventional case series. METHODS: The study included 245 patients undergoing homologous central penetrating keratoplasty for keratoconus (n = 77), herpetic corneal scars (n = 29), nonherpetic corneal scars (n = 46), Fuchs endothelial dystrophy (n = 24), and secondary corneal endothelial decompensation caused by preceding intraocular operations (n = 69). Mean follow-up time was 30.4 +/- 18.7 months (range, 12.1-111.6 months). The same surgeon operated on all patients, and a peripheral iridotomy was routinely performed. RESULTS: On the first postoperative day, IOP was significantly (P = 0.02) higher than that before keratoplasty. Taking the whole study group and taking the study groups separately, IOP measurements determined on the third postoperative day (P = 0.57), 1 week after surgery (P = 0.55), or later (P > 0.50) were not significantly different from the preoperative values. Eyes undergoing keratoplasty with cataract surgery and eyes undergoing keratoplasty without additional intraocular procedures did not vary significantly (P > 0.10) in IOP measurements. IOP did not differ significantly (P > 0.50) between eyes with an immunologic graft reaction (n = 29) and eyes without a reaction (n = 216). Acute angle-closure glaucoma was not detected in any of the patients. IOP measurements were statistically independent of suture type (P > 0.10), age (P > 0.05), preoperative and postoperative refractive error (P > 0.05), preoperative and postoperative corneal astigmatism (P > 0.10), preoperative and postoperative visual acuity (P > 0.10), diameter of graft and trephine (P > 0.15), and oversize of the graft (P > 0.50). Postoperative IOP measurements were significantly (P < 0.01) correlated with preoperative IOP values. CONCLUSIONS: In eyes with a peripheral iridotomy performed during surgery, homologous central penetrating keratoplasty usually does not markedly change IOP. The main risk factor for postoperatively increased IOP is increased IOP before surgery.

Adolescent↗
PubMed2004

An easy method for manual construction of high-density tissue arrays.

Tissue array technique is a powerful tool for high-throughput in situ analysis on a large cohort of cases. This report describes an easy and effective method for manual construction of high-density tissue array containing 88 (11 x 8) samples, each of which measures 2 mm in diameter. No extraneous device is needed except a conventional 16-gauge bone marrow biopsy trephine apparatus to puncture the paraffin blocks. The authors constructed 563 cases of epithelial neoplasm into 7 blocks. The sectioning is smooth and does not require adhesive tape. They performed immunohistochemical staining for cytokeratins 7 and 20 on these tissue array slides. The samples rarely fell off during the antigen retrieval and staining procedure. The results were generally in agreement with those in previous reports. The authors offer a satisfactory alternative method for building custom arrays for any laboratory that is unable to afford a tissue array apparatus.

Biomarkers, Tumor↗
PubMed2004

Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling.

Osteonecrosis is a disease with a wide ranging etiology and poorly understood pathogenesis seen commonly in young patients. Core decompression has historically been used in patients with small-sized or medium-sized precollapse lesions in an attempt to forestall disease progression. Typically, an 8-10 mm wide cannula trephine is used to do this procedure. The authors report on a new technique using multiple small drillings with a 3-mm Steinman pin to effectuate the core decompression. In this report, there were 32 of 45 hips (71%; 35 patients) with a successful clinical result at a mean followup of 2 years (range, 20-39 months). Twenty four of 30 Stage I hips (80%; 23 patients) had successful outcomes compared with 8 of 15 Stage II hips (57%; 12 patients) with no surgical complications occurring with this technique. This procedure is technically straightforward and led to minimal morbidity with no surgical complications. It may be effective in delaying the need for total hip arthroplasty in young patients with early (precollapse) stages of femoral head osteonecrosis.

Adolescent↗