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Neuropathology Consultations

Protocols for Muscle and Nerve Biopsies

GENERAL
Correct interpretation of muscle and nerve biopsies is strongly dependent on the clinical setting. It is therefore imperative that pertinent clinical information, including medications and the name of the physician responsible for the patient, accompanies the specimen. This may be either faxed (503-494-2025) the day the specimen is shipped, or preferably e-mailed to NP@ohsu.edu. E-mailed information may be sent in advance as long as the approximate date of surgery is indicated.

MUSCLE
If a specific muscle is not dictated by the clinical presentation, the following muscles are preferred: In order of preference:     Quadriceps          Adequate size: 1 cm x 0.5 cm x 0.5 cm
                      Biceps                      Needle biopsies are acceptable
                      Deltoid                     but not recommended
     Avoid end stage muscle
     No infiltration with local anesthetic
     No clamps, or tying to tongue blade
     Do not freeze specimen

Preparation for shipment:
     Wrap specimen loosely in saline-moistened gauze or Telfa. Do not immerse in saline.
     Place wrapped specimen into dry container e.g. specimen cup, and seal.
     Surround container with wet ice. Do not ship on dry ice.
     Pack in a Styrofoam container and Ship via courier, cab, FedEx or air.

NERVE
Preferred length: 1.5 cm Avoid stretching or crushing nerve. Keeping the fresh nerve straight, place it on a narrow strip of filter paper, cut slightly longer than nerve. Immerse in 10% neutral buffered formalin. The nerve will adhere to the paper and this will maintain the orientation of the fibers. Exception: if the clinician is suspecting paraproteinemia-associated neuropathy, send two samples: one fresh or in transport medium for immunofluorescence and another fixed in 10% NBF for light and electron microscopy.

Shipping:
Arrival at OHSU should be no later than 4:00 pm.
Notify Flo Leomiti at (503) 494-6781 of expected delivery time and additional pertinent information, e.g., flight number and arrival time, air waybill number, FedEx tracking number.

Cab or courier:FedEx:
   Hatfield Laboratory Services    S. Humayun Gultekin, MD
   Room HRC9D20   Lab Central L471
   Hatfield Research Center   OHSU
   3181 SW Sam Jackson Park Road   3181 Sam Jackson Park Road
   Mailcode HRC9   Portland, OR 97239-3098
   Portland, OR, 97239   Attn: Flo Leomiti X46781
   Notify Neuromuscle Lab, pager 16822, upon arrival 
 Air:
   S. Humayun Gultekin, MD
   Department of Pathology
   OHSU
   3181 Sam Jackson Park Road
   Portland, OR 97239-3098
   Attn: Flo Leomiti (503) 494-6781

If the specimen cannot be delivered to OHSU by 4:00 pm, the following procedure can be followed:

The specimen should be retained at the sending lab until the following OHSU workday. Specimens should be kept on saline-moistened (not soaked) gauze, in a dry closed container, in the refrigerator. If the following day is a Saturday or a holiday, then the specimen should be held (even over the weekend if necessary), until the next available OHSU workday. The next morning, OHSU should be contacted prior to shipping, and then the specimen shipped in the morning on moistened gauze, in a dry container, on wet ice, to Lab Central at OHSU. This is not the recommended treatment for optimal preservation of the specimen. Consideration should be given to rescheduling the biopsy to allow coordination between the sending facility and OHSU.

In all cases, it is imperative to notify Flo Leomiti, 503-494-6781, 8:00 am to 4:30 pm before sending the specimen.

Shipping kits are available containing everything necessary to ship a muscle or nerve biopsy to OHSU. Please contact Flo Leomiti at (503) 494-6781 if you are interested in receiving a shipping kit at least three days in advance of the collection of the specimen so a kit can be sent overnight to you.

SKIN
Suspected cases of small fiber neuropathy undergo a standard 3mm punch biopsy of the skin in distal and proximal extremity locations. These tissues are processed with special tissue techniques and labeled with a PGP 9.5 antibody to quantify the intraepidermal nerve fibers with the light microscope. The results are expressed as a numerical figure as the number of nerve fibers per mm of epidermis and compared with published normal values.

Please contact immunohistochemistry for transport kit and instructions at (503) 494-5755.