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PubMed1985

Resection of the interfrontal sinus septum in chronic or recurrent frontal sinusitis. Pre- and post-operative evaluation of the naso-frontal duct.

In 9 patients with recurrent attacks of acute or chronic frontal sinusitis, interfrontal sinus septum resection was performed. In 5 patients there was unilateral disease and in 4 bilateral. As all patients had previously had their frontal sinus trephined, pre- and post-operative naso-frontal duct function tests were performed. Pre-operatively, of 11 naso-frontal ducts tested (2 patients bilaterally) not one showed air flow on spontaneous respiration. Passage of air was obtained at forced inspiration and expiration in one patient and by Valsalva's manoeuvre in 6. No flow of air whatsoever was obtained in 4 of the ducts, whatever the method used. At follow-up performed 1-8 years post-operatively 7 out of the 9 patients had no frontal sinus problems. The remaining 2 patients, who both had nasal allergy, were improved. Post-operative testing of the 9 patients showed flow of air on spontaneous respiration in 4 patients, whereas 4 needed forced inspiration or expiration and only one patient Valsalva's manoeuvre. The sinus septum resection, which is very simple to perform, is a good alternative to more extensive frontal sinus surgery but may be of less value in patients with nasal allergy.

Acute Disease↗

PubMed1987

Non-Hodgkin's lymphoma of the head and neck: prognostic factors.

A series of 127 patients were studied, presenting with non-Hodgkin's lymphoma of the head and neck between 1962 and 1986. Clinical data on the site of tumour, stage, patient's age, sex, condition and outcome were compared with the pathological diagnosis and lymphoma type according to the Kiel classification. Pathological material was received and new preparations made, including immunohistology where appropriate. An exact pathological classification was possible in 102 patients, and most were either centroblastic or centroblastic/centrocytic, with diffuse morphology. Other types of lymphoma were too few in number to enable correlation of histological type with prognosis. The most significant factor was the pathological stage at presentation, and it was important to examine trephine specimens of bone marrow to ensure accurate staging.

Antigens, Neoplasm↗

PubMed1981

Histological study of the bone marrow in chronic granulocytic leukaemia in blast transformation. I. Serial observations before and after autografting.

Sixteen patients with chronic granulocytic leukaemia (CGL) in blast cell transformation (BT) were studied by means of serial bone marrow trephine biopsies (BMB). The BMB were performed during the following stages of the disease: 1 at diagnosis of BT, 2 following ablative therapy and 3 during haematological recovery following autografting. In 10 of the 16 patients, BT was recognized by the presence of a distinctive infiltration with blast cells with a single large hyperchromatic nucleolus. In four of the 16 patients, the diagnosis of BT could only be made by BMB since simultaneous marrow aspiration yielded either a dry tap or no marrow fragments; in two of these four patients the BT was focal in the BMB specimen. Following ablative therapy and during haematological regeneration after autografting, BM aspirates were unsatisfactory in most cases and they were inadequate to assess cellularity or the presence of residual blasts. In contrast, sections of BMB showed clearly whether a decrease in cellularity took place or, in some, residual blasts were still present. BMB samples obtained 2 weeks after autografting showed haemopoietic regeneration consisting of discrete foci of either erythroid, granulocytic or megakaryocytic precursor cells. We conclude that BMB is essential for diagnosing CGL in BT, for monitoring the progress of these patients after therapy and in assessing the haemopoietic regeneration following autografting.

Blood Transfusion↗

PubMed1985

Frozen sections of bone biopsies in metabolic and other bone diseases.

Frozen sections of bone trephine and needle biopsies can be satisfactorily cut in a standard cryostat and, when stained with haematoxylin and eosin, they enable a rapid diagnosis to be made in a wide range of metabolic bone disorders including Paget's disease, osteoporosis, osteomalacia, hyperparathyroidism and renal osteodystrophy. Neoplastic disease of bone may also be diagnosed using the same technique. A tissue diagnosis can be established within an hour of the biopsy being taken, instead of the 1-3 weeks required for resin section diagnosis, with a consequent potential saving in further costly biochemical and radiological investigations, a possible shortening of the patient's stay in hospital and earlier initiation of correct treatment. The method is quick, reliable and highly cost-effective; it is of particular value in laboratories with insufficient workload to justify the expenditure on specialized microtomes and reagents for resin embedding.

Biopsy↗

PubMed1988

Prediction of impending blast cell transformation in chronic granulocytic leukaemia.

Bone marrow trephine biopsy specimens from 24 patients with chronic granulocytic leukaemia were studied to identify bone marrow changes that suggest incipient or impending blast transformation. In the chronic phase of chronic granulocytic leukaemia, blasts and promyelocytes were seen predominantly in the paratrabecular and perivascular regions, while myelocytes, metamyelocytes and segmented polymorphs were seen predominantly in the central intertrabecular marrow space. The patients were divided into two equal groups according to the degree of perivascular and paratrabecular infiltration: those with minimal (one to three layers of blasts and promyelocytes) and those with marked (four to eight layers of blasts and promyelocytes) infiltration. Ten of the 12 patients in the former group did not develop blast transformation and remained in the chronic phase during a 32- to 84-week follow-up period, whereas nine of the 12 patients in the latter group developed blast transformation, with six undergoing transformation within the first 26 weeks. These findings suggest that the histomorphological pattern of bone marrow changes in chronic granulocytic leukaemia may be useful in recognizing a subset of chronic granulocytic leukaemia patients undergoing blast transformation in the ensuing 6 months.

Bone Marrow↗

PubMed1991

Bone marrow diagnosis in lymphoproliferative disorders: comparison of results obtained from conventional histomorphology and immunohistology.

In this study we have investigated 313 bone marrow biopsies from 280 patients with lymphoproliferative disorders. Trephines were sectioned transversely to obtain one cylinder for cryostat sectioning and immunostaining and a second for histomorphological evaluation using a plastic-embedding technique. The results obtained by histomorphological and immunohistological evaluation were compared for their contribution to staging and classification. Using both techniques, bone marrow involvement was seen in 3/43 (7.0%) biopsies from patients with Hodgkin's disease and in 193/270 (71.5%) cases with non-Hodgkin's lymphoma, including multiple myeloma and acute lymphocytic leukaemia. Immunohistology proved superior in detecting minimal mainly interstitial bone marrow infiltration in 15 leukaemia/lymphoma cases. Biopsies showing infiltration with both methods (n = 157) were re-examined for classification of lymphomatous infiltrates. Whereas immunohistology did not provide additional information in cases with Hodgkin's disease and myeloma, this method was crucial for establishing the definitive diagnosis in a number of cases with acute lymphocytic leukaemia and non-Hodgkin's lymphoma. In all of six leukaemia cases, in which no or inadequate material was available for immunophenotyping of cell suspensions, immunohistology clearly defined the subtype. In the 140 cases of non-Hodgkin's lymphoma the majority of cases (76.4%) were identically classified. In some cases, with important prognostic and therapeutic implications, immunohistology alone provided the definitive diagnosis: T-cell lymphoma (n = 2), hairy cell leukaemia (n = 2) and centrocytic non-Hodgkin's lymphoma (n = 3). Bone marrow immunohistology is, therefore, an important supplement for classical lymphoma/leukaemia diagnosis. The differences observed between histomorphology and immunohistology emphasize the importance of lymph node biopsy in lymphoma classification.

Biomarkers↗

PubMed1993

Proliferating cell nuclear antigen expression by erythroid precursors in normal bone marrow, in reactive lesions and in polycythaemia rubra vera.

Using a sequential double-immunostaining technique, a morphometric analysis was performed on routinely processed bone marrow trephines from 20 patients with secondary (reactive) polycythaemia and 28 patients with polycythaemia rubra vera to determine the proliferation capacity of erythropoiesis. Monoclonal antibodies PC10--anti-proliferating cell nuclear antigen (PCNA)--and Ret40f--anti-glycophorin C--were employed. For comparison with the PCNA-labelling index, in a pilot study, Ki-67 was additionally used on frozen-section material. In comparison with normal bone marrow (15 patients) morphometric and statistical evaluation revealed a numerical increase in erythroid precursors (pro-, erythro- and normoblasts) in secondary polycythaemia and to a pronounced degree in polycythaemia rubra vera. In comparison with secondary polycythaemia and the control group, in polycythaemia rubra vera there was a significant enhancement of proliferation according to PCNA-staining reactivity in all haematopoietic cell elements and particularly in the erythroid series. Evaluation of PCNA v. Ki-67 immunostaining disclosed only a slight difference, which could be mainly attributed to various modalities of antigen expression during the cell cycle. Our findings are in keeping with in vitro studies on cultured erythroid progenitor cells and, in problematic cases, may present a valuable aid in differentiation between reactive lesions and polycythaemia rubra vera.

Antibodies, Monoclonal↗

PubMed2006

Haemostatic agents used in periradicular surgery: an experimental study of their efficacy and tissue reactions.

AIM: To evaluate the haemostatic efficacy and the histologic tissue responses after the application of different haemostatic agents used in periradicular surgery. METHODOLOGY: The study was conducted in the calvarium of six rabbits. Standardized bone defects (diameter 4 mm) were trephined, and different haemostatic agents were applied and compared with control defects: bone wax (left for 10 min), Stasis (ferric sulphate, left for 5 s), Expasyl (aluminium chloride, left for 2 min and left permanently in situ), and a combination of Expasyl (2 min) and Stasis (5 s). The sites were photographed before the application and after the removal of the haemostatic agents. Three independent examiners judged the initial and final bleeding (on the photographs) using a bleeding score for each site and treatment. The results were compared using Wilcoxon's signed rank test. For the histologic analysis, three animals were killed after 3 weeks and three animals after 12 weeks. Transverse, nondecalcified sections were stained with combined basic fuchsin and toluidine blue for descriptive histology. RESULTS: The most efficient haemorrhage control was provided by Expasyl in combination with Stasis and by Expasyl alone, whereas bone wax had the weakest bleeding reduction effect. The histologic analysis after 3 weeks demonstrated an inflammatory and foreign body tissue response towards all haemostatic agents. At 12 weeks, this tissue response was less pronounced but still present in sites treated with bone wax or Expasyl. In general, the inflammatory tissue reactions were limited to the bone defects, and never extended into the surrounding tissues. CONCLUSIONS: Expasyl alone or in combination with Stasis appeared to be the most efficient of tested agents to control the bleeding within the bony defects created in a rabbit calvarium model.

Aluminum Chloride↗

PubMed2006

Necrobiotic xanthogranuloma associated with paraproteinemia and non-Hodgkin's lymphoma developing into chronic lymphocytic leukemia: the first case reported in the literature and review of the literature.

A 56-year-old married female presented in May 1998 with a 5-month history of xanthelasma of the eyelids, followed 4 months later by two enlarged lymph nodes of the left side of the neck and three of the left axilla. At the same time, she developed xanthomatous patches on the face, neck, and shoulders (Fig. 1). The cutaneous lesions were xanthomatous nodules and plaques, affecting the periorbital regions. Later, the whole face was affected, followed by ulcerated lesions on the scalp, chest, back, and extremities (Fig. 2). The skin lesions became painful, pruritic, ulcerated tumors (Fig. 3). In July 1998, computed tomography (CT) scans of the chest and abdomen with contrast medium showed pretracheal, bilateral axillary, right retrochural, paracaval, aortocaval, and para-aortic lymph node enlargement. These findings were suggestive of lymphoma. CT scan also showed slight heterogeneous hypodensity in the upper part of the right lobe of the liver, suggesting fatty infiltration. The spleen, pancreas, and suprarenal glands appeared normal. One cervical and two left axillary lymph nodes were excised. They revealed total replacement of the nodular architecture by a diffuse proliferation of mature lymphoid cells having small nuclei and a crumbled chromatin pattern, and very rare mitosis. It was concluded from the lymph node biopsies that these changes were typical of non-Hodgkin's lymphoma, diffuse and small cell type, of low-grade malignancy. A bone marrow aspirate showed a marrow heavily infiltrated by lymphoid cells with some immaturity. The megakaryopoiesis was adequate. Trephine biopsies showed similar changes. Iron stores appeared to be absent. The bone marrow picture was consistent with diffuse, well-differentiated non-Hodgkin's lymphoma, developing into chronic lymphocytic leukemia (CLL). Endoscopy showed antral-type gastric mucosa exhibiting mild chronic gastritis. Skin biopsy from a fresh lesion on the back showed a diffuse inflammatory cell infiltrate with collections of histiocytic cells. It also showed necrobiotic foci, surrounded by mixed inflammatory cells, dark palisaded foamy histiocytes, and a few Touton giant cells. These findings are compatible with necrobiotic xanthogranuloma (NXG) (Figs 4 and 5). Blood film showed normochromic, normocytic erythrocytes with anisopoikilocytotic leukocytes and normal platelets. The sedimentation rate was 90 mm in the first hour. The blood picture also showed monoclonal IgG paraprotein (3170 mg/dL) of the kappa light chain type. The patient was treated by the oncologist for her lymphoma, and was given Cytoxan, prednisolone, endoxan, Leukeran, and melphalan. She showed an excellent response to pulsed treatment with steroids (60 mg prednisolone orally daily for 5 days, repeated every month for 6 months). She also responded to Leukeran at a dose of 5 mg daily for 5 days every month for 6 months, and showed regression in the size of the lymph nodes. The treatment of her skin lesions was unsatisfactory in spite of the fact that she was given cyclosporine and both systemic and topical corticosteroids.

Antineoplastic Agents, Alkylating↗

PubMed1988

High-grade surface osteosarcoma of the left ilium. A case report and review of the literature.

A rare case of high-grade surface osteosarcoma of the left ilium is reported. Trephine biopsy performed on a 31-year-old woman suffering from a huge tumor of the left buttock revealed high-grade osteosarcoma, and hemipelvectomy was undertaken. The surgical specimen showed that the tumor was present on the surface of the left ilium. Ten months after the operation, the patient died of brain metastasis. From these results, we considered this case to be one of high-grade surface osteosarcoma.

Adult↗

PubMed1997

Paré as a neurosurgeon.

The Cowlishaw Collection gives a splendid representation of the works of a Ambroise Paré (1510-1590). His Complete Works, in the great French edition edited by J.F. Malgaigne, are essential in any study of Paré's achievement, but the 1649 English edition provides a good basis for consideration of Paré's practice in what would now be termed neurosurgery. Paré had a large clinical experience in head injury management. His patients included Henri II King of France, who died from a penetrating orbital wound, and be described a number of other craniofacial wounds sustained in war or in warlike sports. His surgical instruments and operative techniques do not appear very innovative, but were doubtless good in their day; his methods of trephination compare favourably with those of the English surgeon John Woodall, his younger contemporary. He operated on head injuries and cranial infection, but had no capacity to treat intradural conditions, such as cerebral abscesses and tumours: his technical limitations are obvious, and the physicians on whom he had to rely could give him no guidance in neurological diagnosis. He was keenly interested in developmental malformations, and described several conditions that would now be referred to a paediatric neurosurgeon. Paré is of great historical importance as an outstanding Renaissance surgeon, whose influence extended throughout the literate world, and as far as Japan. With him, France replaced Italy and Spain in leadership in European surgical progress, a position that France retained at least until the age of Hunter.

Craniotomy↗

PubMed2006

Atropine-induced lens extrusion in an open eye surgery.

A 2-month-old male baby undergoing penetrating keratoplasty (PKP) under general anesthesia developed bradycardia and a decrease in heart rate to 53 b x min(-1) when stay sutures were taken through the superior and inferior recti. A bolus of 0.1 mg intravenous atropine resulted in tachycardia of up to 180-220 b x min(-1), which persisted for 35 min. After corneal trephination was performed the eyeball seemed to pulsate with the heartbeat. Spontaneous extrusion of the lens and vitreous occurred, which necessitated a lensectomy and vitrectomy in addition to PKP. The role of atropine in corneal transplant surgery is discussed here.

Anesthesia, General↗

PubMed2004

Increased microvascular network in bone marrow of HIV-positive haemophilic patients.

OBJECTIVES: Angiogenesis has been associated with the pathogenesis of myelodysplastic syndromes (MDSs). However, less is known about the significance of this process in the bone marrow of HIV-positive patients with myelodysplastic features (MDF). METHODS: Trephines from 22 HIV-positive haemophilic patients were immunostained for CD34 antigen, and the microvessel density (MVD) was quantitatively evaluated and compared with that of 21 biopsies from patients with primary MDS and with that of 12 control bone marrows with no evidence of marrow disease. RESULTS: Bone marrow MVD in HIV-positive haemophilic patients was similar to that in patients with MDS; however, both groups revealed significantly higher MVD counts than those of control bone marrows (P=0.002). Mean MVD counts of HIV-positive haemophilic patients were significantly associated with HIV RNA levels (P=0.008). In contrast, no correlation was found between MVD and clinical HIV stage or CD4 counts at the time of biopsy. CONCLUSIONS: These results suggest a direct involvement of HIV in the pathogenesis of MDF in HIV infection. Elucidation of the mechanisms underlying bone marrow angiogenesis in HIV-positive patients may provide further insights into the pathobiology of AIDS.

Adult↗

PubMed2005

The first case of invasive EEG monitoring for the surgical treatment of epilepsy: historical significance and context.

PURPOSE: Controversy persists about when EEG became a fundamental tool in the preoperative investigation for epilepsy surgery. We revisit Penfield's first use of invasive EEG monitoring, emphasizing its historical importance for the evolution of epilepsy surgery. METHODS: Patients' hospital charts and articles published before 1940 regarding EEG and epilepsy or EEG and cerebral lesions were reviewed to evaluate the historical context of the surgery. RESULTS: In April 1939, Penfield performed trephination over both temporal regions and placed electrodes on the dura, intending to lateralize seizure origin in a patient with bitemporal epilepsy. The patient underwent serial EEGs with this technique. The final report of the recordings from epidural leads was "continued random delta activity in the left temporal region indicating a cortical lesion on this side." The pneumoencephalogram showed "the presence of diffuse cerebral atrophy, particularly in the left cerebral hemisphere." Based on these findings, the patient underwent surgery on April 21, revealing a meningocerebral scar in the posterior part of the left temporal lobe. Brain stimulation and electrocorticography delineated the extent of resection, while preserving the speech area. Seizures did not improve. CONCLUSIONS: We revisit the first case of epidural EEG monitoring for epilepsy surgery and show that the concept of EEG-directed surgery was already present at the Montreal Neurological Institute in the late 1930s.

Adult↗

PubMedDate not supplied

Corticocancellous bone biopsy from the 12th rib of standing horses.

Unicortical corticocancellous bone biopsy specimens 4.5 mm and 6.5 mm in diameter were obtained without long-term complications from the 12th rib in eight standing horses. However, the bone specimens were unsuitable for histologic or histomorphometric evaluation. In in vitro comparisons of biopsy specimens 6.5 mm and 12 mm in diameter, and of unicortical and transcortical biopsy specimens, 12 mm transcortical specimens yielded the most cancellous bone. Transcortical bone biopsy specimens 12 mm in diameter were obtained from eight horses by using power-assisted trephination. The surgical procedure was well tolerated, but some degree of pneumothorax in all horses was treated by aspiration of air from the thorax. Long-term complications were not observed.

Animals↗

PubMedDate not supplied

Evaluation of canine cortical bone graft remodeling.

A stable cortical bone fracture model was developed to evaluate the remodeling rate of cortical bone grafts. Samples of cortical bone were harvested with a trephine and press fit into predrilled holes in the femoral diaphyses of four live dogs. The percentages of new bone, unremodeled graft bone, porosity, forming bone surface area, and resorbing bone surface area were determined morphometrically and compared in cortical autografts, cortical allografts sterilized with 84% ethylene oxide (EO), and allografts sterilized with 12% EO. The host-graft interfaces healed without formation of fibrous tissue or cartilage, indicating a stable fracture surface. The amount of new bone formed in cortical autografts and allografts sterilized with 84% EO was significantly greater than the amount of new bone in allografts sterilized with 12% EO. There was no significant difference between the amounts of new bone formed in the allografts sterilized with 84% EO and the cortical autografts. No significant differences were detected in percentages of porosity or bone surface areas.

Animals↗

PubMedDate not supplied

Computed tomographic assessment of noninvasive intranasal infusions in dogs with fungal rhinitis.

The distribution of infusate administered to 12 dogs with fungal rhinitis, using a noninvasive, intranasal technique, was evaluated by computed tomography (CT). In every dog, contrast medium was identified on the postinfusion CT images, within the frontal sinuses, and throughout all areas of the nasal cavity. Adverse effects were transient and mild. The results of this study indicate that intranasal infusion may be a viable alternative to trephination of the frontal sinuses to administer antifungal medications in dogs with fungal rhinitis.

Administration, Intranasal↗

PubMedDate not supplied

Extensive nasal septum resection in horses using a 3-wire method.

OBJECTIVE: To describe a surgical technique for, and report outcome after, extensive nasal septum resection in horses with congenital or acquired septal diseases. STUDY DESIGN: Retrospective study. ANIMALS: Horses (5) with nasal septal deformity. METHODS: Under general anesthesia, obstetrical wires were preplaced around the ventral, caudal, and dorsal aspects of the nasal septum by combinations of manual guidance (ventral and caudal wires) and use of a trephine hole on the dorsal mid-line (dorsal and caudal wires). The rostral part of the septum was incised with a scalpel and the ventral, dorsal, and caudal septal incisions were made with the preplaced wires. After septum removal, the nasal cavity packed with a tampon and a temporary tracheotomy was performed. RESULTS: The diseased nasal septum was completely removed in all horses. It was possible to direct the caudal cut at a sufficient angle so that the remaining stump was in a wide part of the nasal passage, where it would have minimal effect on airflow. Four horses healed, and returned to intended use but continued to make a slight respiratory noise during exercise. At 13 months after surgery, 1 horse with a concurrent wry nose was retired from race training after 2 additional surgeries failed to relieve exercise intolerance at high speed. CONCLUSIONS: The 3 wire-cut method of nasal septum resection was technically easy to perform and safe, allowed return to function in most horses, and produced an excellent cosmetic appearance. CLINICAL RELEVANCE: This technique for nasal septum resection allows removal of a large portion of the nasal septum and provides a safe alternative to conventional techniques of nasal septum resection in the horse.

Animals↗