Muscle Biopsy

This is a procedure in which muscle tissue is removed from an organism and examined microscopically. Muscle biopsies can distinguish between Myopathies, (the pathology is in the muscle tissue itself) and neuropathies (pathology is at the nerves innervating those muscles) by means of microscopic analysis. Problems could be detected in a nervous system, in connective tissue, vascular or musculoskeletal system. A variety of Myopathies can cause centronuclear biopsy and hence a specific genetic testing becomes increasingly important.

What is muscle biopsy?

This is a procedure when a small sample of tissue is removed for testing in a laboratory. The test detects an infection or disease in the muscles. This is a relatively simple procedure. It is done as an outpatient basis, and the patient is free to leave on the same day as the procedure. As it is often done on a local anesthesia, the doctor removes the tissue from the area but the patient remains awake for the test.

Reasons for a muscle biopsy

This is done when the doctor suspects an infection in the muscle. The biopsy is done to help the doctor rule out certain conditions that could cause the symptoms and then proceed with an appropriate treatment plan.

• Biopsy is done if the doctor suspects that there may be defects in the way the muscles metabolize or use energy.
• Diseases that affect the blood vessels and connective tissues, where the arteries become swollen.
• Infections related to the muscles, such as the one caused by a type of roundworm.
• Muscle disorders including muscular dystrophy, genetic disorders that lead to muscle weakness.

Risks of a muscle biopsy

There is always a risk of infection or bleeding or bruising possible when a medical procedure that breaks the skin is performed. However, since the incision here is quite small, especially in needle biopsy, the risk is much lower. An electromyography is done in case of recent muscle damage. Very rarely there could be damage to the muscle where the needle is inserted.

Muscle biopsy procedure

There are two ways in which muscle biopsies are performed - the common method is called a needle biopsy and for this procedure, the doctor inserts a thin needle through the skin and remove the muscle tissue. This could be:

Core needle biopsy with a medium sized needle, similar to the way core samples are taken from the earth

Fine needle biopsy using a thin needle attached to a syringe, fluids and cells are drawn out.

Image-guided biopsy where the needle biopsy is guided with imaging procedure; such as x rays and CT scans.

Vacuum assisted biopsy uses suction from a vacuum to collect more cells.

The patient receives a needle biopsy after a local anesthesia and will not feel any pain or discomfort. There will be pressure in the area where the biopsy is taken and the area may be sore for about a week. In case the muscle sample is far to reach and is in deep muscles, the doctor may choose to perform an open biopsy. The doctor will make a small cut in the skin and then remove the muscle tissue from there.

For instance, if patient needs have a biopsy in the leg, he/she must expect to use crutches or another assistive device for two full days after biopsy. Training with crutches is provided. Some patients may need assistance at home during the recuperation period. If patients have had a biopsy in the arm, they must expect to wear a sling for two days. Stitches do not need to be removed but must remain completely dry for a couple of days.

In general, there are few complications and the resulting scar heals well. After the tissue sample is taken, it is sent to a laboratory for testing and the results would be ready in a couple of week's time. A report on frozen or paraffin specimens will be sent to the referring physician. The small piece of muscle tissue is examined by microscopic techniques to check for presence of fibrous tissue or other abnormalities. The extracted tissue can also be stained for detecting absence of presence of particular proteins. Microscopic examination can also reveal if the muscle fibers are being infiltrated by the immune system.

In case the results are abnormal, it could mean there is an infection or disease in the muscles and this may cause them to weaken or die. The doctor may prescribe additional tests to confirm the diagnosis and how far the condition has gone. Treatment options are discussed and further steps taken.

Pathologist

Pathology is the study of disease origin and it paves a way for comprehensive diagnosis of medical conditions for effective prognosis. The role of a pathologist offers significant diagnostic approach in the field of clinical laboratory science. It is important position as it requires exceptional interpretational skills associated with anatomical and physiological changes in the cells, tissues and body fluids.

Pathologists have diverse responsibilities ranging from cytology to molecular studies. Studies such as autopsy are essential in the field of forensic medicine, identification of genetic disorders and also the origin of disease. The results are interpreted by a pathologist. Biopsy on the other hand is a routine procedure for many major health complications to detect the presence of inflammatory diseases and cancer. Many important fields such as microbiology, hematology, biochemistry, immunohistochemistry, transfusion medicine come under clinical pathology, which is very important to determine the cause of any disease. Pathologists in clinical research pave the way for the discovery of new drugs and better diagnostic ventures for comprehensive patient care.

Borderline Personality Disorder

Borderline personality disorder (BPD), is a serious mental illness, though less commonly known than schizophrenia or bipolar disorders. It is a form of pathology lying on the border between psychosis and neurosis. Persons with borderline personality disorder often exhibit intense bouts of anger, depression and anxiety. This may last for hours or sometimes a day. Impulsive aggression, self injury, abuse of drug and alcohol are some other symptoms.

BPD sufferers primarily see the world as extremes, either black or white. They either idealize or vilify everyone they meet. They veer between idealized love and distressing hatred and misery. They are known to develop sudden and stormy attachments toward family, friends and loved ones. Their emotions range from great love to intense hatred.

Usually, the diagnosis of BPD on these parameters is done on adults and not on children as signs and symptoms of BPD may go away with maturity. For diagnosis of BPD, five signs should be significantly present:

• Sense of intense fear and abandonment.
  
• Pattern of unstable relationships
  
• Unstable self image
  
• Impulsive and often self destructive behavior
  
• Erratic mood swings
  
• Chronic feelings of emptiness
  
• Inappropriate and undue anger
  
• Periods of paranoia and loss of contact with reality.