The age of the surgeon-anatomist: Part 2 – from the beginning of the 18th century to the mid-19th century
Harold Ellis, Sala Abdalla in A History of Surgery, 2018
He described Pott’s puffy tumour, the swelling of the scalp over an extradural abscess, and enumerated the signs by which it can be differentiated from an extradural haematoma. He also recognised the lucid period that can precede the coma of extradural haemorrhage and adds that the initial concussion causes a loss of consciousness that may blend into that of the brain compression without this period of lucidity. He advised the use of trephine in head injuries and employed it much as modern neurosurgeons do when the presence of accumulation of blood beneath the skull cannot otherwise be excluded. He gave a classic description of tuberculous disease of the spine (Pott’s disease of the spine) (Figure 6.13) and a detailed description of fracture dislocation of the ankle, again still to this day called Pott’s fracture (Figure 6.14).
The Renaissance
Arturo Castiglioni in A History of Medicine, 2019
Among the better-known Italian surgeons were giovanni davigo (Rapallo, 1460-1525), surgeon to Pope Julius II, whose chief work, Practica copiosa in arte chirurgica (Rome, 1514), passed through more than forty editions and was translated into French, Italian, Spanish, German, and English. In 1517 he published a compendium of the larger work which was also highly successful. It was divided into nine books, of which the first deals with the anatomical knowledge necessary for a surgeon, while the others consider other surgical conditions and their treatment. Noteworthy in Vigo’s work is the indication as to how the great vessels should be ligated, intromittendo acum sub vena desuper filum stringendo (by inserting the needle beneath the vein and tightening the thread from above). This procedure had been practically abandoned since the time of Celsus. Believing that wounds were poisoned, he advocated their treatment by cautery, and by a plaster containing ground-up frogs, worms, and vipers. He describes a trephine that he invented and a number of new instruments. Vigo believed that major operations should be left by the physicians to the surgeon.
Case 59
Simon Lloyd, Manohar Bance, Jayesh Doshi in ENT Medicine and Surgery, 2018
Medical therapy should be maximised and should include topical intranasal steroids, saline nasal douching and antibiotic treatment based on local microbiology advice. Antibiotic therapy is usually required for a period of 6 to 8 weeks. This is not going to cure this patient's infection, however and he will require surgical treatment of the sinus infection and an urgent opinion from the on call neurosurgeon. Acutely, the brain abscess will require drainage by the neurosurgeons and you will need to drain the frontal sinus infection. Drainage of the frontal sinus infection may be undertaken endonasally or externally. The latter is advisable in the acute setting. The frontal sinus requires trephining followed by washout. The trephine can be undertaken through a small brow incision using a mini-trephine set. Alternatively it can be undertaken using a 3 mm diamond drill. A drain should be left in situ.
Artifacts of the neurosciences: A resource guide to museums and collections
Published in Journal of the History of the Neurosciences, 2019
James M. Edmonson
The Hunterian Museum began with the anatomical and pathological collections of Scottish surgeon John Hunter (1728–1793). The museum is currently closed pending renovation of the College’s home on Lincoln Inn Fields, and is slated to be open to the public again in 2021. In the meantime, one may explore the artifact collections via an online search engine (http://surgicat.rcseng.ac.uk/search/simple). There one will find a truly impressive array of medical and surgical artifacts, including those from the neurosciences. For example, a search with the term “trephine” reveals both preserved tissue as well as surgical instruments. Of the latter, approximately 125 trephines, or trephine sets, can be viewed online, with documentation including maker and owner, physical description, and provenance.
Neuritin provides neuroprotection against experimental traumatic brain injury in rats
Published in International Journal of Neuroscience, 2018
Qi Liu, Hang Zhang, Jian Xu, Dong Zhao
The TBI model was used as previously described [20]. Briefly, the rats were anesthetized by an intraperitoneal injection of chloral hydrate (3.0 mg/kg). Surgery was performed under aseptic conditions, and the rats were mounted on a stereotaxic system (ZH0002053, Zhenghua Instruments, Anhui Province, China). A midline incision on the scalp exposed the skull without requiring muscle retraction. For the trephine method, a 5 millimeter diameter electric trephine (ZH-GSZ, Zhenghua Instruments, Anhui Province, China) was carefully used to penetrate the skull to remove the bone flap. Rats were subjected to TBI on the left part of their brain (bone flap centered at the bregma + 1.5 mm, lateral right 2.5 mm) using a weight-drop device. This consisted of a 20 g weight dropped from 30 cm onto a 4 mm diameter footplate resting on the dura with a controlled depth of 1.0 mm. The craniotomy did not significantly affect physiological parameters (i.e. arterial pressure, heart rate or body weight) and was closed immediately after the TBI.
Evaluation of sensitivity and specificity of bone marrow trephine biopsy tests in an Indian teaching hospital
Published in Alexandria Journal of Medicine, 2018
Sima Chauhan, Sarita Pradhan, Ripunjaya Mohanty, Abhishek Saini, Kumudini Devi, Mahesh Chandra Sahu
BMB is not only the ‘clue’ for infiltration, but also provides pattern of involvement.4 In earlier days surgical trephine biopsy was in practice. With introduction of needle trephine biopsy in late 1950s, things have become much simpler and minimally invasive.4 However, trephine biopsy, unlike aspiration, demands more technical skills and is time consuming as well as a painful procedure. Interpretation depends on numerous factors like quality of tissue section and availability of ancillary techniques like immunohistochemistry, special staining and good coordination between hematopathologists and histopathologists.5 Bone marrow procedures help in confirming the clinical diagnosis as well as some new diagnosis, which were not suspected previously. Few studies have analyzed the diagnostic accuracy of marrow aspirates with trephine biopsies.1, 6–8 Here, we compare these two tests i.e. BMB and BMA, to evaluate the sensitivity and specificity of BMB in haematological and non-haematological patients in the same sitting.