Punch Forceps Research Articles

Efficacy and Safety of the Ultrasonic Bone Scalpel in Lumbar Laminectomies.

Despite recent advances in applied instruments and surgical techniques, the incidence of iatrogenic durotomies caused by traditional techniques remains significant. The ultrasonic bone scalpel (UBS) has been shown to improve speed and reduce complications in laminectomies in the cervical and thoracic spine when compared to traditional methods utilizing high-speed burr, punch forceps, or rongeurs. Thus, in this study, we aim to evaluate whether the use of the UBS in the lumbar spine would result in equivalent safety, efficacy, and patient-reported outcomes (PROs) improvement when compared to traditional methods of laminectomy. Data from a prospectively collected, single-institution registry was queried between January 1, 2019 and September 1, 2021 for patients with a primary diagnosis of lumbar stenosis who received a laminectomy (with or without fusion) using traditional methods or UBS method. Outcomes included 3-month and 12-month values for all PROs Measurement Information System (PROMIS) subdomains, Numerical Rating Scale (NRS) pain score, Oswestry Disability Index (ODI) percentage, Patient Health Questionnaire 9 (PHQ-9) score, operative complications, reoperations, and readmissions. Covariates selected for matching included age, operation type, and number of levels. A variety of statistical tests were utilized. As per our findings, 2:1 propensity matching resulted in 64 "traditional group" patients and 32 "UBS group" patients. Post-match analysis found no differences between the traditional and UBS groups for demographic and baseline measures except for race and ethnicity. For the matched sample, no differences were noted in PROs, reoperations, or readmissions. There was a significant difference in rates of durotomies between the traditional and UBS groups (12.5% vs. 0.0%, p=0.049). Results showed the high-frequency oscillation technology implemented by the UBS helps to decrease the rate of injury to the dura, thus reducing the overall incidence of iatrogenic durotomies. We believe these data provide valuable information to surgeons and patients about the safety and efficacy of the UBS in performing lumbar laminectomies.

Shaeer's punch technique: Trans-corporeal Peyronie's plaque surgery and penile prosthesis implantation

ABSTRACT Introduction Penile prosthesis implantation in cases of severe Peyronie's disease may require plaque excision/incision and grafting, that may require mobilization of the neurovascular bundle (NVB) or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time consuming, possibly increasing infection risk. Objective Evaluating trans-corporeal debulking of Peyronie's plaques by “Shaeer's Punch Technique”. Methods Penile prosthesis implantation and Punch technique (PPI-Punch) was performed for 26 patients. Following corporotomy and dilatation, Peyronie's plaques were punched-out from within the corpora cavernosa using the punch forceps then a penile prosthesis implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile prosthesis implantation was performed. Outcomes were in terms of straightness of the erect penis, complication, satisfaction with length on a 5-point scale , the International Index of Erectile Function-5 (IIEF), and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire (EDITS). Results Average pre-operative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. Following surgery, all patients had a straight penis. No tunical perforations, urethral injuries or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p < 0.0001. Septal plaques in the latter group could not be removed. In the PPI-Punch group, penile sensitivity was preserved in all patients, compared to the excision/grafting group with 7/18 patients reporting hyposthesia of the glans. Infection occurred in 1/26 patients in the PPI-Puch group, compared to 2/18 patients in the excision/grafting group. Satisfaction with length on a 5-point scale was 3.8 ± 0.9 in the punch group, versus 3.1 ± 1.1 in the excision-grafting group, p=0.009.. Conclusions Shaeer's Punch Technique is a minimally invasive procedure for trans-corporeal excavation of Peyronie's plaques prior to penile prosthesis implantation. There is no need for mobilization of the neurovascular bundle or spongiosum, hence low or no risk for nerve or urethral injury and brief plaque surgery time. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Coloplast, BSC, Rigicon).

Shaeer’s Punch Technique: Transcorporeal Peyronie’s Plaque Surgery and Penile Prosthesis Implantation

BackgroundPenile prosthesis implantation in cases of severe Peyronie’s disease may require plaque excision/incision and grafting, which may require mobilization of the neurovascular bundle or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time-consuming, possibly increasing infection risk. AimEvaluating transcorporeal debulking of Peyronie’s plaques by “Shaeer’s punch technique.” MethodsPenile prosthesis implantation and punch technique (PPI-Punch) was performed for 26 patients. After corporotomy and dilatation, Peyronie’s plaques were punched out from within the corpora cavernosa using the punch forceps, and then a penile prosthesis was implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile prosthesis implantation was performed. OutcomesThe study outcomes were straightness of the erect penis, complication, satisfaction with length on a 5-point scale, the International Index of Erectile Function-5, and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. ResultsAverage preoperative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. After surgery, all patients had a straight penis. No tunical perforations, urethral injuries, or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p < 0.0001. Septal plaques in the latter group could not be removed. In the PPI-Punch group, penile sensitivity was preserved in all patients, compared with the excision/grafting group, with 7 of 18 patients reporting hyposthesia of the glans. Infection occurred in 1 of 26 patients in the PPI-Punch group, compared with 2 of 18 patients in the excision/grafting group. Satisfaction with length on a 5-point scale was 3.8 ± 0.9 in the punch group, versus 3.1 ± 1.1 in the excision-grafting group, p=0.009. Clinical ImplicationsThe proposed technique is minimally invasive and prompt, possibly decreasing the known complications of plaque surgery and PPI including sensory loss. Strengths & LimitationsOne limitation is the inability to accurately measure preoperative erect length in patients with erectile dysfunction with poor response to intracavernous injections. ConclusionShaeer’s punch technique is a minimally invasive procedure for transcorporeal excavation of Peyronie’s plaques before penile prosthesis implantation, omitting the need for mobilization of the neurovascular bundle or spongiosum, and hence, there is low or no risk for nerve or urethral injury and brief plaque surgery time.Shaeer O, Soliman Abdelrahman IF, Mansour M, et al. Shaeer’s Punch Technique: Transcorporeal Peyronie’s Plaque Surgery and Penile Prosthesis Implantation. J Sex Med 2020;17:1395–1399.

Effects of submucosal PRP injection on wound healing in endonasal surgeries: an experimental study.

To investigate the effects of submucosal platelet-rich plasma (PRP) injection on nasal mucosal wound healing after endoscopic sinus surgery. 24 New Zealand white rabbits were randomly divided into three groups. To mimic surgery, injury was created using 3-mm punch forceps on ventral turbinate mucosa for all groups. Submucosal PRP was injected to the damaged mucosa in the first group (PRP group, n = 8), where 0.9% saline solution to the second group (saline group, n = 8) and no injection to the third one (control group, n = 8). All the animals were sacrificed 14days after surgery; histopathological examination and hydroxyproline measurements were performed on the mucosa of all groups. Neutrophils, goblet cells, and collagen intensity were found significantly lower (p < 0.05) in PRP group than the control group. Also, the number of ciliary and goblet cells, and collagen intensity were found significantly lower (p < 0.05) in PRP group, than the saline group. In PRP group, hydroxyproline levels were found (p < 0.05) significantly lower than the saline and the control group, and no significant difference was found between the saline group and the control group (p > 0.05). There are many studies in literature showing the positive effects of PRP on wound healing. The results of this study also demonstrated positive effects of PRP on the nasal mucosa. According to these results, PRP injection to the injured nasal mucosa showed anti-inflammatory, mucus-softening, and synechia-reducing effects. Therefore, submucosal PRP injection after endonasal surgeries can be considered an effective application for maintaining nasal physiology.

Effects of Oral Propolis on Mucosal Wound Healing after Endoscopic Nasal Surgery in a Rabbit Model.

If the respiratory nasal mucosa is damaged and the mucosa does not heal properly during nasal or paranasal sinus surgery, a revision surgery may be required. The aim of this study is to investigate the effects of oral propolis application on mucosal wound healing following endoscopic nasal surgery in a rabbit model. Twenty four New Zealand rabbits were randomly divided into three groups, namely the experimental group (EG), the control group (CG), and the negative control group (NCG). Mucosal resection was applied with 3-mm punch forceps in the bilateral ventral nasal concha in the experimental and control groups. 75 mg/kg/day propolis was added to the diet of the rabbits in the EG for 14 days. The CG continued with the standard diet postoperatively. In the NCG, no surgical intervention was made, and no dietary support was given. On postoperative day 14 all rabbits were sacrificed and left nasal specimens were examined histopathologically, hydroxyproline levels were measured in right nasal specimens. There were no statistically significant differences in hydroxyproline level, epithelial and subepithelial thickness, ciliary and goblet cell count, subepithelial fibrosis and collagen density between EG and CG. Neutrophil count was statistically significantly lower in EG, compared to CG (p=0.019, Tamhane test). Although there are many studies that show the positive effects of propolis on wound healing, such effect was not observed in this study. This study is deemed to constitute a unique experimental study that can be a resource for future similar studies to be performed with higher numbers of subjects and higher dosage of propolis.

COMPARISON OF CERVICAL BIOPSY USING PUNCH BIOPSY FORCEPS VERSUS LOOP ELECTRODE

Context: The biopsy of cervix can be obtained by various methods with availability of newer modalities like loop electrode. Objectives: To compare the histo-pathological parameters and clinical outcome of cervical biopsy obtained using punch biopsy forceps versus loop electrode. Methods: Women attending OPD were screened for cervical pathology, and colposcopy was done for those who screened positive. Patients who required cervical biopsy after colposcopy were allocated into 2 group; one undergoing LEEP biopsy and other half biopsied with Punch forceps. During procedure patients were evaluated for the intra-op pain and bleeding and their severity. The histo- pathological diagnosis was carried out and the sample was studied for its size, adequacy, and presence of any thermal or crush artefacts. Result: The two methods of biopsy were comparable in intra-op parameters, except for the increased requirement for additional haemostasis in LEEP biopsy. There was no case of bleeding from biopsy site at the follow-up visit. LEEP biopsy was associated with continued vaginal discharge more often than punch biopsy. An adequate sample for histopathological diagnosis was obtained in 91.25% of all cases. The comparative findings were reflective of comparable efficacy of both methods in providing an acceptable tissue sample for diagnosis. Conclusion: After analysing and comparing the aforementioned parameters, we opined that neither method can be deemed clearly superior to the other as a cervical biopsy procedure.&#x0D; Keywords: Punch biopsy forceps; Loop electrode; Cervical biopsy.

A helpful technique for increasing the size of a tracheostomy window in patients with calcified or challenging tracheas utilising a Kerrison punch forceps.

A helpful technique for increasing the size of a tracheostomy window in patients with calcified or challenging tracheas utilising a Kerrison punch forceps.

Double Posterior Based Flap Technique in Primary Endoscopic Dacryocystorhinostomy With and Without Using Powered Instrument.

To demonstrate the surgical technique and outcomes of double posterior based flap technique in primary endoscopic dacryocystorhinostomy (DCR) with and without use of powered instrument. 28 patients of nasolacrimal duct obstruction were included in the study from September 2012 to February 2015. All underwent endoscopic dacryocystorhinostomy with double posterior based nasal and lacrimal flap technique. In patients of group A (14 patients), bone removal was done with the help of Smith-Kerrison punch forceps and in patients of group B (14 patients), powered drill has been used for the same. Patients were visited the endoscopic clinic at 1, 3, 6months and 1year after the surgery for post operative evaluation. Of 28 patients, 26(92.85%) were found free of symptoms at the end of 1, 3 and at 6months. One from each group had recurrence of symptoms. At the end of 12months of 25 patients, 3(12%) patients were found to have recurrence of symptoms of which 1(8.33%) patients was from group A and 2(15.38%) were from group B and failures were because of granulation tissue and stomal stenosis. Patients assisted with powered drill had more postoperative complications compared to cold instrument. Double posterior based flap technique in primary endoscopic DCR without the assistance of powered drill could be an effective surgical option for the patients of chronic nasolacrimal duct obstruction enabling early epithelisation by preventing peristomal granulation tissue resulting in encouraging surgical outcome with least postoperative complication.

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction.

A dacryocystorhinostomy (DCR) procedure aims to restore drainage of tears by bypassing a blockage in the nasolacrimal duct, through the creation of a bony ostium that allows communication between the lacrimal sac and the nasal cavity. It can be performed using endonasal or external approaches. The comparative success rates of these two approaches have not yet been established and this review aims to evaluate the relevant up-to-date research. The primary aim of this review is to compare the success rates of endonasal DCR with that of external DCR. The secondary aim is to compare the complication rates between the two procedures. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2016, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to 22 August 2016), Embase (January 1980 to 22 August 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to 22 August 2016), Web of Science Conference Proceedings Citation Index- Science (CPCI-S) (January 1990 to 22 August 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 22 August 2016. We requested or examined relevant conference proceedings for appropriate trials. We included all randomised controlled trials (RCTs) comparing endonasal and external DCRs. Two review authors independently assessed studies for eligibility and extracted data on reported outcomes. We attempted to contact investigators to clarify the methodological quality of the studies. We graded the certainty of the evidence using GRADE. We included two trials in this review. One trial from Finland compared laser-assisted endonasal DCR with external DCR, and one trial from India compared mechanical endonasal DCR (using punch forceps) with external DCR. The trials were poorly reported and it was difficult to judge the extent to which bias had been avoided.Anatomic success was defined as the demonstration of a patent lacrimal passage on syringing, or endoscopic visualisation of fluorescein dye at the nasal opening of the anastomoses after a period of at least six months following surgery. Subjective success was defined as the resolution of symptoms of watering following surgery after a period of at least six months. Both included trials used anatomic patency demonstrated by irrigation as a measure of anatomic success. Different effects were seen in these two trials (I2 = 76%). People receiving laser-assisted endonasal DCR were less likely to have a successful operation compared with external DCR (63% versus 91%; risk ratio (RR) 0.69, 95% confidence intervals (CI) 0.52 to 0.92; 64 participants). There was little or no difference in success comparing mechanical endonasal DCR and external DCR (90% in both groups; RR 1.00, CI 0.81 to 1.23; 40 participants). We judged this evidence on success to be very low-certainty, downgrading for risk of bias, imprecision and inconsistency. The trial from Finland also assessed subjective improvement in symptoms following surgery. Resolution of symptoms of watering in outdoor conditions was reported by 84% of the participants in the external DCR group and 59% of those in the laser-assisted endonasal DCR group (RR 0.70, CI 0.51 to 0.97; 64 participants, low-certainty evidence).There were no cases of intraoperative bleeding in any participant in the trial that compared laser-assisted endonasal DCR to external DCR. This was in contrast to the trial comparing mechanical endonasal DCR to external DCR in which 45% of participants in both groups experienced intraoperative bleeding (RR 1.00, 95% CI 0.50 to 1.98; 40 participants). We judged this evidence on intraoperative bleeding to be very low-certainty, downgrading for risk of bias, imprecision and inconsistency.There were only two cases of postoperative bleeding, both in the external DCR group (RR 0.33, 95% CI 0.04 to 3.10; participants = 104; studies = 2). There were only two cases of wound infection/gaping, again both in the external DCR group (RR 0.20, CI 0.01 to 3.92; participants = 40; studies = 1). We judged this evidence on complications to be very low-certainty, downgrading one level for risk of bias and two levels for imprecision due to the very low number of cases. There is uncertainty as to the relative effects of endonasal and external DCR. Differences in effect seen in the two trials included in this review may be due to variations in the endonasal technique, but may also be due to other differences between the trials. Future larger RCTs are required to further assess the success and complication rates of endonasal and external DCR. Different techniques of endonasal DCR should also be assessed, as the choice of endonasal technique can influence the outcome. Strict outcome criteria should be adopted to assess functional and anatomical outcomes with a minimal follow-up of six months.

Thoracic Outlet Syndrome: Past and Present—88 Surgeries in 30 Years at Chang Gung

Background:Thoracic outlet syndrome (TOS) is a highly controversial clinical entity. There is much debate on its terminology, existence, diagnosis, and treatment. The purpose of this study was to describe our opinions about these controversial topics of TOS and the treatment of TOS over the past 30 years.Methods:From 1985 to 2014, a total of 80 patients underwent decompressive surgery for TOS. Eight patients requested a second surgery on the contralateral limb. They all had at least 1-year follow-up. Preoperative evaluation included provocative tests, plain X-ray, magnetic resonance angiography/computed tomography angiography, and electromyography. Surgical intervention for each patient involved a supraclavicular approach and near-total resection of the anterior scalene muscle and the first rib and of any cervical rib if it was present. Rib resection was performed with the use of Kerrison bone punch forceps. The operative time was typically 2 hours.Results:Major postoperative complications were rare. Nearly all patients (98%) experienced significant symptom relief, with improvement in soreness and tightness of the shoulder, neck, and arm immediately on the first postoperative day or within a few weeks thereafter. There were no cases with symptoms recurring.Conclusions:It is evident that decompressive surgery through a supraclavicular approach for TOS not only is an effective and safe procedure but also provides a diagnosis of the cause of TOS. For a patient who meets the criteria for surgical indication, decompressive surgery usually results in resolution of symptoms and no recurrence.

Endonazal dakriyosistorinostomide farklı cerrahi yöntemlerin karşılaştırılması

Objective: The objective of this study is to compare three different techniques applied during dacryocystorhinostomy in terms of recurrence and operative times. Methods: Operative times and follow-up results of the patients who underwent endoscopic dacryocystorhinostomy surgery between January 2011 and April 2014 due to nasolacrimal duct occlusion were compared. Lacrimal sacs of the patients in Group 1 (n=15) were explored using gouge hammer and surrounding bony structures were dilated with diamond drilling instrument. Lacrimal sacs of the patients in Group 2 (n=11) were identified and dilated using Diamond drill. Lacrimal sacs of the patients in Group 3 (n=15), were found with the aid of a gouge hammer and enlarged using Smith-Kerrison punch forceps. Results: There was no significant difference between Groups 1 and 2 as for recurrence rates. However, recurrence rates in Group 3 were found to be higher compared to Groups 1 and 2. Operative times demonstrated significant differences among 3 groups, with at its highest and lowest operative times detected in Groups 1 and 2, respectively. Conclusion: With this study, it was concluded that exploration and identification of lacrimal sac using gouge hammer and expansion of the surrounding bony structure with diamond tipped drills during dacryocystorhinostomy is an improved method with relative shortness of the operative time and lower recurrence rates.

English

Introduction The purpose of this study was to evaluate the complications of arthroscopic partial meniscectomy, especially in the early stages of experience with a review of literature. Materials and methods About 170 patients in the age group of 18–50 years, who underwent arthroscopic partial meniscectomy for isolated meniscal tears volunteered for the study. Results The intraoperative complications were malpositioning of portals (n = 7), difficulty in identifying the components of the tear (n = 11), damage to the articular cartilage (n = 12), excessive resection of the meniscus (n = 8), breakage of blade during portal making (n = 2), breakage of the punch forceps (n = 1), and prolonged surgical time (n = 30). The postoperative complications were haemarthrosis (n = 1), persistent swelling (n = 22), portal site tenderness (n = 12), deep venous thrombosis (n = 2), saphenous nerve injury (n = 1). However, we did not observe any infections (superficial or deep). Most of the intraoperative complications were observed during the initial surgeries. Conclusion Arthroscopic partial meniscectomy is a minimally invasive procedure which, in well-selected patients, is a method of choice for treatment of meniscal injuries when repair techniques are not a viable option. It has low morbidity, fast rehabilitation, and low cost of care. However, even this procedure is not without complications, especially for surgeons who have just started doing the procedure. Since arthroscopy has a steep learning curve, the incidence of complications decreases with the experience of the surgeon. Introduction The wheel has turned full cycle for the menisci, contrary to the previously described ‘functionless’ structure within the knee to the view that they are, indeed, crucial components of the normal biomechanics and functioning of the knee.1 The menisci participate in many important functions, including tibio– femoral load transmission, shock absorption, lubrication, and passive stabilization of the knee joint.2–8 The advent of arthroscopy in the 1970s and a greater understanding of the natural history and long term sequelae of open meniscectomy resulted in a greater emphasis on meniscal preservation by partial meniscectomy/ repair.9 The surgical indications for arthroscopic treatment of meniscal pathology include symptoms of meniscal injury that affect activities of daily living, work, and/or sports; positive physical findings of joint line tenderness, joint effusion, limitation of motion, and provocative signs, such as pain with squatting or a positive McMurray or Apley grind test; failure to respond to non-surgical treatment, including activity modification, medication, a rehabilitation programme; and absence of other causes of knee pain identified on plain radiographs or other imaging studies. Arthroscopic partial meniscectomy, where only damaged or unstable parts of the meniscus are removed leaving the remainder of the meniscus intact, has become an almost routine treatment of the menisci, thus providing early relief from pain, eliminating mechanical symptoms caused by unstable meniscal fragments and allowing early weight bearing, return of the function, significantly reduced morbidity, and reduction of the cost of care.9 Arthroscopy is not an entirely safe procedure. Arthroscopic surgery can be, in some cases, life-threatening and may cause unusual complications. A good preoperative and intraoperative planning and attention to the details of the basic techniques can prevent most of the complications. Familiarity with new techniques through learning centres, operating with colleagues, videos, and staying current with speciality journals allows the surgeon to gain valuable information from the experiences of other colleagues. The present study was carried out to document the complications during arthroscopic partial meniscectomies surgeries and review the literature regarding these complications. Materials and methods This work conforms to the values laid down in the Declaration of Helsinki (1964). The protocol of this study has been approved by the relevant ethical committee related to our institution in which it was performed. All subjects gave full informed consent to participate in this study. * Corresponding author Email: drnasir@in.com Department of Orthopaedics, Hospital for Bone and Joint Surgery, Barzalla, Srinagar, Kashmir, India. A rt hr os co py

Needle plicotomy for synovial plica of the knee: report of a novel technique

We illustrate the technique of needle plicotomy for synovial plica during arthroscopy of the knee. Various techniques have been described for resection of plica including use of punch forceps, shavers and arthroscopic scissors. We describe the use of needle to perform plicotomy. It is quick, easy to perform, less traumatic to tissues and obviates the need for special arthroscopic instruments or shavers.

Is the Traditional Treatment Approach Adequate in Children with Adenoid Hypertrophy?

Aim: We aimed to show the necessity of 1) endoscopic assessment after adenoidectomy performed blindly by adenoid curette, adenotome or adenoid punch forceps after checking adenoid size with finger palpation, which is commonly used in routine practice and 2) extraction of residual adenoids with additional methods. Materials and Methods: Prospective intraoperative flexible endoscopic evaluation of the nasopharynx in a case series of 51 patients was performed. The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically with 2.7-mm 0° telescope (small, moderate, large) after routine transoral adenoidectomy. The telescope was then introduced transnasally, and residual adenoid tissue was both assessed and removed with powered-shaver adenoidectomy. Results: In the first assessment (E1) of 51 patients, 15 (29.4%) cases with moderate- and 36 (70.6%) with large-size adenoids were found, while in the second assessment (E2) after traditional blind curettage adenoidectomy, 26 of the patients had moderate and 25 had small residual adenoid tissue. Adenoid size was reduced 1 level in 41 patients (80.4%) and 2 levels in 10 patients (19.6%). Residual adenoid tissue rate was higher in large adenoids when the adenoid sizes determined in the first assessment were compared (P = 0.024). Conclusions: Residual tissue rate is fairly high after blind curettage adenoidectomy, particularly in large adenoids. Therefore, residual tissues should be cleaned with additional methods.

Endoscopic Biopsy of Human Olfactory Epithelium as a Source of Progenitor Cells

The adult central nervous system contains progenitor cells; however, invasive surgery is required for their harvest. Olfactory neuroepithelium (ONe) has attracted attention because it is extracranial and contains progenitor cells that account for its regenerative capacity. Olfactory progenitor cells have been cultured from postmortem ONe. Our aim was to determine if olfactory progenitors could be obtained via biopsy from patients in a feasible, effective, and safe manner. Endoscopic biopsy was performed on individuals undergoing sinus surgery (n = 42). Olfactory function was assessed pre- and postoperatively. Specimens were cultured under conditions for olfactory progenitor cell development. Progenitor cells emerged in cultures from 50% of our patients. The superior turbinate, biopsied with cutting punch forceps, gave the highest yield. No adverse impact on olfaction or complications with the biopsy were observed. Endoscopic biopsy of ONe for obtaining olfactory progenitor cells from living donors is feasible, effective, and safe.

Methods for thymidylate synthase pharmacodynamics: serial biopsy, free and total TS, FdUMP and dUMP, and H4PteGlu and CH2-H4PteGlu assays.

This report details our methods for performance of the major parameters related to quantitation of TS inhibition resulting from fluoropyrimidine administration to patients, methods equally applicable to preclinical studies. Sampling of tumors before and after drug treatment is done by 4 mm disposable punch biopsy or forceps biopsy via subcutaneous tunneling. Homogenates are prepared using N2 or polytron-mincing. Cytosolic free TS is measured by either the tritium-release method for small biopsies or by [3H]FdUMP ligand-binding. FdUMP and dUMP are separated by DEAE-cellulose column and measured by competitive binding and [14C]dTMP synthesis by the Moran methods. Total, post-FUra TS is measured by pre-incubation dissociation of FdUMP-bound TS after neutral charcoal removal of cytosolic ligands. H4PteGlu and CH2-H4PteGlu are measured by the Priest method using L. Casei TS. The materials and methods are described in sufficient detail to permit wide application of this approach.

NEW INSTRUMENTS IN ADENOIDECTOMY

<i>To the Editor:</i>In answer to Dr Kirchick's letter: His instrument, in so far as I am able to determine from his description, and the one I introduced as a new instrument in the July 1964 issue ofArchives of Otolaryngologyare entirely different. The difference seems to be not only in design but also in function. The Tripp suction punch combines a stainless steel suction tube with an unmodified Meltzer punch forceps. If my interpretation of Dr. Kirchick's letter is correct, he altered the tip (biting component) of the punch forceps before combining the two units to create a suction punch. The second, and by far the most important difference, is one of function. No mention was made in Dr. Kirchick's letter as to what happens to fragments of adenoid tissue after they are removed with the punch forceps. The suction punch which I devised is self-cleaning, ie, bits

CORNEAL TRANSPLANTATION WITH PUNCH FORCEPS

Acta OphthalmologicaVolume 36, Issue 3 p. 394-404 CORNEAL TRANSPLANTATION WITH PUNCH FORCEPS Henrik Sjögren, Henrik Sjögren JönköpingSearch for more papers by this author Henrik Sjögren, Henrik Sjögren JönköpingSearch for more papers by this author First published: June 1958 https://doi.org/10.1111/j.1755-3768.1958.tb00809.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume36, Issue3June 1958Pages 394-404 RelatedInformation

A new cervical biopsy punch forceps

A new cervical biopsy punch forceps

New nasopharyngeal punch forceps.

The surgical removal of lymphoid tissue in the nasopharynx in areas inaccessible to the smaller adenotome has made necessary the use of punch forceps. These instruments have an important place in the surgery of adenoidectomy, particularly in patients with hearing defects. The purpose of this article is to describe an instrument* which I find useful in this procedure. This instrument is not intended to supplant the useful nasopharyngeal punches now in use, but, by virtue of its design, it is an operative aid. The punch has a curved shaft, and this makes for ready access to areas high in the nasopharynx. Lymphoid tissue collections found in the choana during adenoidectomy are easily removed by using the finger as a guide. With proper lighting Nasopharyngeal punch forceps. and exposure by palatal retraction, lateral pharyngeal collections of lymphoid tissue are conveniently removed. Hypertrophic lymphoid tissue in the area of Rosenmuller's fossa can