title: Detection of epithelial cell transfer in spinal areas by light microscopy and determining any tissue coring via cell culture during combined spinal-epidural interventions.
abstract: OBJECTIVE
  Epithelial tissue coring by spinal needles during subarachnoid injections may cause intraspinal epidermal tumors. Previous studies have investigated tissue transfer with different needle types during subarachnoid or epidural injection. This study deals with the transfer of epithelial tissue during combined spinal-epidural (CSE) anesthesia.
  
  
  METHODS
  We studied 68 American Society of Anesthesiologists I to III adult patients. CSE anesthesia was induced under aseptic conditions at the L2-3 or L3-4 interspace with patients in the lateral decubitus position. Cerebral spinal fluid, spinal needle stylet, fluid used to flush the interior of the spinal needle, fluid used to wash the exterior of the spinal needle, fluid used to flush the interior of the epidural needle, and fluid used to wash the exterior tip of the epidural needle were examined under light microscopy (n = 30 patients) or incubated in a cell-culture medium (n = 38 patients). Samples were incubated in cell-culture medium alone (n = 13) or in a cell-culture medium for 3 weeks and then in a medium with epidermal growth factor (n = 25). As a positive control, skin tissue samples were taken by punch biopsy from 10 randomly chosen patients who underwent CSE interventions. These samples were incubated in an enriched medium serum.
  
  
  RESULTS
  Light microscopy revealed that there was cell transfer in all phases in various rates: samples 1, 2, 3, 4, 5, and 6 contained epithelial cells and debris in ratios of 6.9%, 20.7%, 6.9%, 20.7%, 26.7%, and 33.3%, respectively. Epithelial cell colonization was detected in the cell-culture samples taken from the control group but not in the samples taken from the CSE group.
  
  
  CONCLUSIONS
  We could not reproduce the cells or cell debris obtained during the CSE interventions in vivo, which can be explained by a possible structural deformation of cells or the inadequacy of the amount of cells that were transferred.
authors.affiliation: Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. ytunali@yahoo.com
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Tunali
authors.forename: Guner
authors.initials: G
authors.lastname: Kaya
authors.forename: Gulden
authors.initials: G
authors.lastname: Tunali
authors.forename: Seyhun
authors.initials: S
authors.lastname: Solakoglu
authors.forename: Sedef
authors.initials: S
authors.lastname: Yenice
authors.forename: Mois
authors.initials: M
authors.lastname: Bahar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology; D049109:Cell Proliferation; D002470:Cell Survival; D002478:Cells, Cultured; D002555:Cerebrospinal Fluid / Q000166:cytology; D004824:Epidural Space / Q000166:cytology*; D004847:Epithelial Cells / Q000166:cytology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D007278:Injections, Spinal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D009339:Needles; D013115:Spinal Canal / Q000166:cytology*; D013120:Spinal Cord Neoplasms / Q000209:etiology / Q000473:pathology