Percutaneous trephine for vertebral biopsy

We performed percutaneous vertebral biopsy on 18 patients (March 1978 to March 1992) using a Craig trephine needle under fluoroscopic control, a more reliable and safer procedure than open vertebral body biopsy. Material for histopathologic examination was obtained in 17 of the 18 patients and there were no complications. Possible complications involve mostly in the cervical and dorsal spine. They can be prevented by using very precise and delicate technique under reliable fluoroscopic control in the operating room.     

Bone marrow involvement in lymphoblastic lymphoma and small non-cleaved cell lymphoma: the role of trephine biopsy

Trephine biopsy (TB) combined with bone marrow aspiration (BMA) is the most common method for evaluating bone marrow (BM) involvement in non-Hodgkin's lymphomas. Nevertheless, the role of TB in high-grade lymphomas remains controversial. We reviewed the results of 42 consecutive BMAs and TBs performed simultaneously in 29 patients with lymphoblastic lymphoma (LL) and small, non-cleaved cell lymphoma (SNCL). In LL, 8M involvement was documented in 35.4% of the cases by BMA and 22.5% of the cases by TB. In SNCL it was documented in 45.4% of the cases by BMA and 36.3% by TB. There were no statistically significant differences (p > 0.05) in the rates of BM involvement found by TB or BMA in the two types of lymphoma, although BMA appeared to be more sensitive than TB. These observations suggest that routine TB may not be necessary in assessing BM involvement in patients with LL and SNCL.     

The bone marrow trephine biopsy: a review of normal histology

Bone marrow trephine biopsies are becoming increasingly common in routine surgical pathology. Familiarity with normal marrow histology plays an important part in understanding and interpreting marrow pathology. The aim of this article is to describe the histological features of normal human bone marrow, in particular those features which are relevant to the diagnostic pathologist. The advantages and disadvantages of different technical aspects, such as choice of embedding material and type of stain, are discussed. The use of immunochemistry in identifying different cell types within the marrow is illustrated.     

The role of transbronchial lung biopsy in diffuse pulmonary disease

A retrospective study of 103 patients with histologically proved cutaneous malignant melanoma was made in order to assess the validity of a simple prognostic index, based upon a multivariate analysis of weighted pathological and clinical factors, in predicting the expected outcome in a given case. The results of the study were almost identical to those observed by Cochran (1968); 16 per cent of the patients with a low prognostic index (less than 20) died or developed recurrence of melanoma during the period of follow-up, in contrast to those with a high prognostic index (greater than 25) of whom 64 per cent were similarly affected. It is concluded that the predicted outcome based upon such an index is valid for the 5 postoperative years in some 90 per cent of patients with cutaneous malignant melanoma. It is suggested that the use of such an index may be of great value in selecting patients in whom the expected outcome to surgical therapy is poor and in whom adjuvant therapy may be of value.     

Thoracoscopic lung biopsy or open lung biopsy for interstitial lung disease

Both traditional open lung biopsy through a limited thoracotomy and VATS lung biopsy are effective methods for obtaining parenchymal samples in patients who have respiratory insufficiency and radiographic pulmonary infiltrates. For patients with slowly progressive disease processes, who require an elective biopsy, VATS biopsy is the procedure of choice because of the ability to visualize and sample multiple areas of the lung, and because of the decreased postoperative pain. On the other hand, when patients are critically ill and already on high-level ventilatory support, the VATS method offers no advantages over the standard minimal thoracotomy.     

Percutaneous biopsy of the thoracic spine

The aspartate aminotransferase gene (AspAT, EC 2.6.1.1) of an extremely thermophilic bacterium, Thermus thermophilus HB8, was cloned and sequenced, and its gene product was overproduced. The purified T. thermophilus AspAT was stable up to about 80 degrees C at neutral pH. T. thermophilus AspAT was strictly specific for acidic amino acid substrates, such as aspartate, glutamate, and the respective keto acids. The gene coding for T. thermophilus AspAT showed that it comprised 1,155 bp with a high G+C content (70 mol%), and encoded a 385-residue protein with a molecular weight of 42,050. The amino acid sequence of T. thermophilus AspAT deduced from its gene showed about 15, 46, and 29% homology with those from Escherichia coli, Bacillus sp. YM-2, and Sulfolobus solfataricus, respectively. When the amino acid sequence of T. thermophilus AspAT was compared with that of E. coli AspAT, the number of Cys was found to have decreased from 5 to 1, that of Asn from 23 to 9, that of Gln from 16 to 8, and that of Asp from 20 to 13, all of which are known to be relatively labile at high temperatures. Conversely, the number of Pro was increased from 15 to 25, Arg from 22 to 32, and Glu 27 to 37. As shown by the E. coli AspAT structure, there was a marked tendency for the extra prolyl residues to be located around the surface of the molecule. This was quite different from that in the case of RecA protein, which shows an increased number of prolyl residues in the interior of its molecule. Different strategies of different proteins as to prolyl contribution to thermostability have been suggested. Despite the high degree of conservation of active-site residues, Arg292 in E. coli AspAT, which interacts with the distal carboxylate of the substrate, was not found in T. thermophilus AspAT. Arg89 may complement the function of Arg292.     

Percutaneous renal biopsy in children: a 27-year experience

BACKGROUND: The introduction of automated biopsy devices and the localization of the kidney by ultrasound were aimed at optimizing efficacy and safety of the percutaneous renal biopsy procedure. We evaluated these technological advances in our renal biopsies performed in children. METHODS: We sequentially used the Silverman needle (1969-1974), the TruCut needle (1974-1990), and the automated Biopty device (1990-1996). Fluoroscopy was used to localize the kidney until 1985, ultrasound examination prior to biopsy from 1985 to 1992, and direct ultrasound guidance since 1992. A total of 962 native kidney biopsies and 119 allograft biopsies were performed. RESULTS: In the native kidney biopsies, the introduction of the Biopty device and ultrasound guidance were independently associated with fewer passes required to obtain adequate tissue and more glomeruli per specimen. The rate of biopsies yielding more than 9 glomeruli increased from 69 to 92% (p < 0.05). The number of glomeruli harvested per centimeter core length was inversely related to patient age (p < 0.01). More appropriate cortical tissue was retrieved in renal allograft biopsy specimens with the application of the new techniques. The occurrence of macroscopic hematuria (9. 6%) in the native kidney biopsies was not affected by the puncture or localization technique applied, but subcapsular hematomas were documented more often with the Biopty device (42%) than with the TruCut needle (16%), probably due to improved ultrasound equipment. In the whole series 2 patients died, and 3 others required renal surgery and 4 blood transfusions. CONCLUSIONS: The automated ultrasound-guided procedure is a feasible and reliable technique for percutaneous renal biopsy in children. It gives a greater yield of diagnostic tissue without increasing the rate of clinical complications.     

Percutaneous large-core biopsy of papillary breast lesions

Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae possess the ability to cleave human IgA1 antibodies, and all successfully colonize and occasionally invade the human upper respiratory tract. N. meningitidis invades the bloodstream after a period of nasopharyngeal colonization. We directly compared levels of IgA1 protease activity in strains (n=52) derived from the cerebrospinal fluid or blood of patients with meningococcal disease with strains of N. meningitidis obtained from asymptomatic carriers (n=25). IgA1 protease activity was determined by a sensitive semiquantitative ELISA assay. Levels of IgA1 protease activity were significantly higher (P<0.0001) in strains associated with invasive meningococcal disease (98% with detectable activity, mean = 580 mU) than with those obtained from asymptomatic carriers (76% with detectable activity, mean = 280 mU). Despite marked variation in enzyme activity, almost all strains (96%) possessed the gene for IgA1 protease. Given the panmictic population structure of the bacterial isolates investigated, these data, obtained from two groups infected with N. meningitidis, but with markedly different clinical outcomes, provide the first quantitative evidence that IgA1 protease activity is a virulence determinant that contributes to the pathogenic phenotype, and suggest IgA1 protease as a potential target for prophylaxis.     

Percutaneous needle muscle biopsy in the horse

The use of the technique of percutaneous needle biopsy in obtaining skeletal muscle samples in the horse is described. The biochemical, ultrastructural and histochemical investigations that can be carried out on this biopsy specimen are outlined. Analyses performed on the specimen may be used to obtain information on racing potential and state of fitness. These studies on normal horses will provide information for future investigations into the structural and biochemical alterations in muscle disorders in the equine.     

Emergency open lung biopsy

Twenty-eight patients underwent open lung biopsy on an emergency basis. The clinical course in each case was deteriorating rapidly, and all were in respiratory failure. The correct diagnosis was established in 96% of the biopsies (27 of the 28 patients). The clinical diagnosis prior to biopsy was in error or incomplete in 15 (55%) of the patients. Specific therapy was lifesaving in 12 of the 28 patients. The value of the procedure outweighed the complications. Thrombocytopenia and positive end-expiratory pressure ventilation were not contraindications to biopsy.     

Percutaneous transhepatic transluminal forceps biopsy in obstructive jaundice

BACKGROUND/AIMS: To evaluate the technical feasibility and sensitivity of percutaneous transluminal forceps biopsy of bile duct diseases. MATERIAL AND METHODS: Seventeen fluoroscopic-guided transluminal forceps biopsies were performed in 16 patients with obstructive jaundice. The technique was performed through an existing percutaneous transhepatic tract. Multiple specimens were obtained after passing the forceps biopsy into a long 9-French sheath and the specimens were fixed with formalin for histopathologic diagnosis. RESULTS: Adequate samples for histological diagnosis was obtained in 12 of 17 procedures (sensitivity, 71%). Pathologic reports included pancreatic head carcinoma n = 2, cholangiocarcinoma n = 3, hepatoma with intrahepatic-bile duct invasion n = 3, common bile duct tumors n = 3 and chronic inflammation n = 1. Minor complications such as pain was noted in three patients while transient hemobilia was seen in two patients. CONCLUSIONS: Percutaneous transhepatic transluminal forceps biopsy is a safe technique which is easy to perform. This can be done through an existing transhepatic biliary tract with a sensitivity rate of 71%.     

The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer

Percutaneous transthoracic needle biopsy (TNB) is a simple and safe procedure with high diagnostic accuracy for the diagnosis and staging of cancer in the lung, hilum, and mediastinum. The complication rate is low and consists primarily of pneumothorax, with only a small percentage of these requiring chest tube reexpansion. Major complications are rare. Computed tomographically guided biopsy is a powerful adjunct to fluoroscopic biopsy and expands the application of TNB to include most thoracic lesions. TNB is the initial diagnostic procedure of choice in peripheral lung lesions, suspected focal metastases, and most hilar and mediastinal masses. Its proper role in the diagnosis and staging of lung cancer requires the close collaboration of the radiologist, cytopathologist, and the patient's primary physician.     

Percutaneous core cutting needle biopsy compared with fine-needle aspiration in the diagnosis of peripheral lung malignant lesions: results in 156 patients

There is concern that the helmet display unit (HDU) used by AH-64 Apache helicopter pilots might contribute to facial injury in a crash. The US Army accident database was searched for HDU-related injuries in survivable Apache accidents 1985-1995. Four aviators in three crashes sustained HDU-related injury. These involved three periorbital contusions and two minor eye injuries. There were no sequelae. This equates to an incidence of 0.57 injured individuals per 100,000 flying hours or 8.0 injured aviators per 100 survivable Class A-C accidents in which the HDU was worn. Applying these data to the projected UK Army Apache flying hour programme suggests that one HDU-related injury might be encountered approximately every 10.1 years. This estimate should be interpreted with caution. Serious injury remains a possibility due to the proximity of the HDU to the eye and face.     

Atherosclerosis: imaging techniques and the evolving role of nuclear medicine

Quantitative assessment of atherosclerotic or atherothrombotic disease during its natural history and following therapeutic interventions is important for understanding the progression and stabilization of the disease and for selecting appropriate medical or surgical interventions. A number of invasive and noninvasive imaging techniques are available to detect and display different characteristics of vascular lesions of clinical and/or research interest. METHODS: Angiography, the traditional "gold standard," detects advanced lesions and measures the degree of stenosis. Angioscopy clearly identifies thrombus. In carotid arteries and arteries in lower extremities, duplex ultrasonography is useful for providing the degree of stenosis, as well as plaque morphology, and assessing changes in wall thickness. RESULTS: Magnetic resonance angiography, being noninvasive, may replace conventional angiography for anatomical imaging of the vasculature. Ultrafast electron beam CT measures the calcium content in the atherosclerotic lesions. Intravascular ultrasound is the only technique that appears to be clinically useful in imaging the unstable, vulnerable plaques in coronary arteries. Magnetic resonance imaging techniques may be able to image vulnerable plaques and characterize plaques in terms of lipid and fibrous content and identify the presence of thrombus associated with the plaques. In regard to the nuclear scientigraphic imaging techniques, radiolabeled lipoproteins, platelets and immunoglobulins have shown some clinical potential as imaging agents, but due to poor target-to-background and target-to-blood ratios these agents are not ideal for imaging coronary or even carotid lesions. Technetium-99m-labeled peptides and monoclonal antibody fragments that clear from circulation rapidly and bind specifically to different components of the atherosclerotic lesion showed significant potential in animal models and in limited clinical studies. FRE Peptides capable of binding to GPIIb/IIIA receptors on activated platelets appear to offer significant diagnostic potential for imaging intra-arterial thrombus. Positron emission tomography with metabolic tracers like [18F]-fluorodeoxyglucose (FDG) also appears to offer new opportunities for noninvasive imaging of atherosclerosis and atherothrombosis.