Posterior ventricular septal perforation

We present a case in which the sandwich technique was successfully applied via right ventriculotomy for posterior infarction ventricular septal perforation 2 days after acute posterior myocardial infarction in a 73-year-old male patient. The sealant BioGlue was applied to the space between the two patches instead of gelatin–resorcinol–formaldehyde biological glue. The postoperative course was good, and the patient was discharged on day 24 after surgery with no recognized residual shunt.     

Usefulness of a New Gelatin Glue Sealant System for Dural Closure in a Rat Durotomy Model

Watertight dural closure is imperative after neurosurgical procedures, because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. We used a rat durotomy model to test the usefulness of a new gelatin glue as a dural sealant in a rat model of transdural CSF leakage. All rats were randomly divided into one of the following three treatment groups: no application (control group: N = 18), application of fibrin glue (fibrin glue group: N = 18), and application of the new gelatin glue (new gelatin glue group: N = 18). The craniotomy side was re-opened, and CSF leakage was checked and recorded at 1, 7, and 28 days postoperatively. The new gelatin glue was adequate for stopping CSF leakage; no leakage was observed at postoperative days 1 or 7, and leakage was observed in only one rat at postoperative day 28. This result was statistically significant when compared to the control group (P = 0.002, P = 0.015, P = 0.015, respectively). The pathologic score of the new gelatin group was not different from that of the control or fibrin glue groups. We conclude that our new gelatin glue provides effective watertight closure 1, 7, and 28 days after operation in the rat durotomy model.     

Partial nephrectomy with retroperitoneal laparoscopy

PURPOSE: Laparoscopy has gradually gained acceptance for a variety of ablative procedures of the retroperitoneal organs, and the indications are being extended to more complex reconstructive and organ preserving procedures. We report our experience with retroperitoneal laparoscopic partial nephrectomy. MATERIALS AND METHODS: Retroperitoneal laparoscopic partial nephrectomy was performed for benign conditions in 6, equivocal solid masses in 4 and indeterminate cysts in 3 patients. If malignancy was suspected, laparoscopic sonography was used to assess the intrarenal anatomy and the mass. To facilitate parenchymal closure during nephron sparing surgery we used a hemostatic biological glue that consisted of gelatin, resorcinol and formaldehyde. RESULTS: Average operating time was 113 minutes and average blood loss was 72 ml. Histological examination revealed malignancy in 1 of the 3 cystic lesions and 2 of the 4 equivocal solid masses. There were 2 postoperative urinomas. CONCLUSIONS: Partial nephrectomy with retroperitoneal laparoscopy is feasible, and has a reasonable operating time and blood loss. Laparoscopic ultrasound was an important decision making aid during surgery. The use of biological glue simplified hemostasis and closure of the collecting system but good quality drainage of the collecting system is still required to decrease the risk of urinoma. The development of surgical tools that allow bloodless and nontraumatic section of the renal parenchyma is required to facilitate laparoscopic nephron sparing surgery. The ultrasonic scalpel needs further evaluation in this setting.     

Fibrin glue applications in urology

Fibrin glue is used as a hemostatic and adhesive agent. Until recently, safety issues had delayed approval of the commercial preparation in the United States. Fibrin glue has found several urologic applications, especially as an adhesive agent. It has excellent potential in laparoscopic surgery, where conventional tissue approximation techniques are cumbersome and time-consuming. Fibrin glue has also been used as a delivery vehicle for autologous cell transplantation and may play a major role in tissue engineering techniques in the future.     

BioGlue: albumin/glutaraldehyde sealant in cardiac surgery

BioGlue is a commercially available sealant manufactured by Cryolife (Atlanta, GA) as a hemostatic adjunct for cardiac and vascular surgery. This type of sealant has evolved conceptually from the gelatin resorcinol formalin glue (GRF or "French Glue") in the sense that it is devised not only to act a sealant but also as an agent to strengthen friable tissues, particularly in acute aortic dissection. In fact, the initial availability of BioGlue in the United States was under an FDA humanitarian device exemption for use in acute aortic dissection. This novel regulatory strategy expedited clinical use of BioGlue in acute aortic dissection and was permissible because of the small number of patients (less than 4000 per annum) in the potential treatment population. In this article, we will discuss the mechanism of action and composition of this agent, preclinical experience, the results of a prospective randomized trial as well as the results of our initial experience with BioGlue at MGH.     

The effect of the microenvironment of the liver tissues on the dynamic resorption of hemostatic resorbable materials and of adhesive compositions]

In experiment there was studied up the cells and tissues reaction on implantation of hemostatic alginate material "Gram-1", "hemostatic gauze" preparation, fibrinous glue composition and sulfoacrylate adhesive glue MK-3.     

胶原海绵止血功能的实验研究

目的 验证国产胶原海绵的止血性能。方法 选用健康成年SD大鼠20只,随机分为二组,行肝脏和切口,分别用胶原及明胶少绵止血,观察止血情况;切除肝左前叶造成标准肝创伤模型,分别用二种海绵止血,观察止血情况,并记录即时止血时间及出血量。术后7、14及20天剖腹观察腹腔内粘连、腹腔内感染及肝脏愈合情况,并切除部分再生肝组织进行组织学检查。结果 胶原海绵下肝创面粘附良好,即时止因时间及出血量均明显优于对照组（P＜0.05）。组织切片显示胶原海绵吸收、降解快,可诱导肝细胞再生。结论 胶原海绵止血性能良好,能有效导肝再生,吸收降解快,使用方便,有应用、推广价值。     

Histological effects of fibrin glue on nervous tissue: a safety study in rats

BACKGROUND

Little is known of the histologic effects of fibrin glue on normal nervous tissue. To verify the safety of intracranial application of fibrin glue, we investigated the histologic effects of fibrin glue on brain tissue and intracranial nerves of rats.

METHODS

In Group I (n = 12), bifrontal craniotomy with opening of the dura and arachnoid was performed, and on one side one droplet of fibrin glue was applied into the subarachnoid space. In Group II (n = 12), a unilateral temporal craniotomy was performed, the cavernous sinus was opened, and one drop of fibrin glue was applied to the trigeminal nerve. The controls for Group II (n = 8) were operated in the same way but without application of the fibrin glue. Rats were sacrificed at 1, 3, 7, and 28 days after surgery. The brains and nerves were processed for histologic examination and were semi-quantitatively scored for neuronal damage, gliosis, edema, fibroplasia, inflammatory reaction, axonal damage, and myelin damage.

RESULTS

No differences were found in the occurrence of neuronal damage, gliosis, edema, fibroplasia, axonal damage, or myelin damage between rats with and without fibrin glue application. In Group I the inflammatory reaction seen at Day 7 was more severe on the fibrin glue side when compared to the control side. At Day 28, however, this difference had resolved.

CONCLUSIONS

In this morphological safety study, intracranial application of fibrin glue in a rat model does not induce extra brain damage, intracranial nerve damage, or scar tissue formation.     

Acute intraoperative malfunction of aortic valve due to surgical glue

The use of surgical glues in aortic surgery has gained wide popularity due to their hemostatic and tissue reinforcing properties. Reports of acute complications associated with application of glue are rare. We report the case of a 52-year-old fragile, steroid-dependent woman who developed acute intraoperative dysfunction of an aortic prosthetic valve due to use of BioGlue surgical adhesive. A brief literature review of the acute and long-term complications of the glue is presented.     

Repair of Delayed Left Ventricular Rupture After Mitral Valve Replacement: Report of a Case

Rupture of the left ventricle (LV) after mitral valve replacement (MVR) is a devastating complication, associated with high mortality. A 64-year-old woman with a type I delayed LV rupture, which occurred after MVR with a 27-mm St. Jude Medical mitral prosthesis for mitral stenosis, was successfully treated by a combination of intracardiac and extracardiac surgical repair techniques. The extracardiac repair involved approximating the edges of myocardium around the tear with large sutures bolstered by strips of Teflon felt, then covering the epicardial hematoma with another porcine pericardial patch, using gelatin resorcinol formaldehyde glue and collagen sheets. The intracardiac repair involved suturing the edges of an oval piece of porcine pericardium to the endocardium around the laceration. No LV pseudoaneurysm was detected postoperatively on echocardiography or computed tomography scans. The patient is well 2 years after the operation.     

Surgical treatment of dissecting aortic aneurysm using GRF glue]

A 62-year-old woman underwent primary anastomosis for dissecting aortic aneurysm (DeBakey IIIb) using GRF glue. GRF glue consists of mixture of gelatin and resorcin. The mixture is hardened by the addition of medical formaldehyde. Resorcin is diphenole which reacts with formaldehyde, creating tridimentional network. Primary anastomoses were performed after the lumen of dissected aorta was adhered with GRF glue. It appears that primary anastomosis using GRF glue is a simpler and safer operative method for dissecting aortic aneurysm.     

Effects of fibrin glue on injured rabbit ureter

BACKGROUND AND OBJECTIVE: Fibrin glue is used as a hemostatic agent, has potential as a tissue adhesive, and may promote tissue healing. The histologic effects of fibrin glue on the ureter have not yet been fully investigated. We studied the effect of fibrin glue on the thickness of various layers of injured and uninjured ureters and its effect on vessel density in the rabbit model. MATERIALS AND METHODS: Rabbits were divided into two groups. The ureters were exposed using a midline abdominal incision. In the study group, one of the ureters was crushed, and fibrin glue was instilled around both ureters. In the control group, one of the ureters was crushed, but no fibrin glue was instilled. The animals were sacrificed at 6 weeks and the ureters examined histologically. Using NIH Image Analysis solftware, the thickness of the urothelium, muscular, and adventitial layers and the cross-sectional area of the ureters were measured. The vessel density of the ureters was also assessed. RESULTS: Whereas the thickness of the epithelium was increased in the crushed ureters treated with fibrin glue (20.7 microm v 15.3 microm), the thickness was reduced in the uncrushed ureters treated with fibrin glue compared with controls (16.3 microm v 19.8 microm). There was no statistically significant difference in the thickness of the muscular or adventitial layers in the study and control groups. There was a reduction in the cross-sectional area of the uncrushed ureters treated with fibrin glue compared with controls (7,095 microm2 v 9,409 microm2). In addition, the vessel density in the crushed ureters was reduced in ureters treated with fibrin glue compared with controls (0.00067/microm2 v 0.00108/micro2). In the uncrushed ureters, the difference was not statistically significant. CONCLUSIONS: Fibrin glue has potential as an adhesive agent in the ureter and may promote healing. It may affect epithelial layer thickness and vessel density of the ureter, but these effects were variable. Fibrin glue does not appear to have significant effects on the ureteral muscular and adventitial layers or on the overall cross-sectional area of all three layers. These results indicate that fibrin glue does not appear to have a detrimental effect on the ureter.     

Damage control management of experimental grade 5 renal injuries: further evaluation of FloSeal gelatin matrix

BACKGROUND: We developed a porcine grade 5 renal laceration damage control model to evaluate the hemostatic efficacy of FloSeal gelatin matrix (Baxter Healthcare, Corp., Deerfield, Ill). METHODS: Ten commercial swine underwent celiotomy, contralateral nephrectomy, and cooling to 32 degrees C after a well-established hypothermia protocol to simulate a damage control scenario. Following prospective randomization, a complex grade 5 renal injury was uniformly produced on the remaining kidney. Control animals (group 1, n = 5) were treated with direct manual compression with a gelatin sponge. Experimental animals (group 2, n = 5) were treated by application of FloSeal gelatin matrix followed by direct compression with a gelatin sponge. Operative blood loss and efficacy of hemostasis were compared. Creatinine levels were obtained daily until postoperative day 7. Abdominal computed tomography was performed at 10 days. RESULTS: Use of FloSeal gelatin matrix hemostatic sealant resulted in significantly less mean blood loss than gelatin sponge bolster compression alone (202.4 mL vs. 540.4 mL, respectively, p = 0.016). Hemostasis was complete in 60% (three out of five) of experimental animals after 2 minutes, but was incomplete in all control animals. After an initial increase, serum creatinine approached baseline by postoperative day 7 in all animals. Axial imaging 10 days postoperatively revealed no evidence of significant delayed perirenal hemorrhage. CONCLUSIONS: FloSeal gelatin matrix performed well as a rapidly deployable, effective hemostatic agent in a hypothermic grade 5 renal injury damage control model. The absence of delayed bleeding and nephrotoxicity suggests a possible increased role for FloSeal in the treatment of devastating renal injuries in damage control surgery.     

腹腔镜肠黏连松解联合应用生物蛋白胶治疗黏连性肠梗阻

目的探讨腹腔镜肠黏连松解联合应用生物蛋白胶治疗黏连性肠梗阻的可行性及其疗效。方法总结1998年5月至2003年10月间,28例黏连性小肠梗阻患者进行腹腔镜黏连松解术、并配合留置医用生物蛋白胶防止再黏连的临床资料。结果应用腹腔镜全组均成功实施黏连松解术解除肠梗阻,均于术中留置医用生物蛋白胶防止再黏连,未出现手术并发症和过敏现象;随访3～60个月,未发现肠梗阻症状复发。结论腹腔镜肠黏连松解术配合生物蛋白胶治疗黏连性肠梗阻安全实用,疗效满意,是处理黏连性肠梗阻的理想手段之一。     

Efficacy of ultrasonic tissue dissector and tissue glue for laparoscopic partial nephrectomy in a porcine model

The purpose of this study was to evaluate the efficacy and long-term tissue effects of ultrasonic dissector and cyanoacrylate glue during laparoscopic partial nephrectomy in a porcine model. Nine domestic pigs underwent laparoscopic left lower pole partial nephrectomy without vascular control. An ultrasonic tissue dissector was used to assist in the parenchymal incision, and the raw surfaces of the kidneys, including the exposed urinary system, were sealed with cyanoacrylate glue. No internal stents or additional sutures were placed. Intraoperative hemorrhages and urinary extravasation were recorded. The animals were humanely killed 28 days after undergoing the operations. The long-term effects of ultrasonic dissector and cyanoacrylate glue on the healing process of urothelium and renal parenchyma were determined histologically. All pigs survived the laparoscopic partial nephrectomy, and the blood loss ranged from 0 to 120 ml (mean, 60 ml). The average operative time was 89 +/- 10 min. The severity of the bleeding was minimal in six animals and moderate in three animals. No urinary extravasation was found using intravenous urography at the 28th postoperative day. No urinary fistula or renal abscess formation was found histologically. Cyanoacrylate glue infiltrated into the tissue defects and did not dissolve. The glue was encased by fibrotic tissue with minimal foreign body inflammatory reaction. Ultrasonic dissector was effective in achieving hemostasis during laparoscopic partial nephrectomy without the need of vascular control in pigs. Cyanoacrylate glue achieved good long-term adhesive power. The sealing effects provided by cyanoacrylate glue were adequate to prevent urinary extravasation from urothelial defects at least for 1 month.     

Effect of fibrin glue occlusion of the hepatobiliary tract on thioacetamide-induced liver failure

BACKGROUND: Expression and activation of hepatocyte growth factor (HGF) is stimulated by a complex system of interacting proteins, with thrombin playing an initial role in this process. The impact of temporary occlusion of the hepatobiliary tract with fibrin glue (major component thrombin) on the HGF system in acute and chronic liver damage in a rat model was investigated. METHODS: Chronic liver damage was induced in 40 rats by daily intraperitoneal application of thioacetamide (100 mg/kg) for 14 days. After 7 days half of them received an injection of 0.2 mL fibrin glue into the hepatobiliary system. Daily intraperitoneal administration of thioacetamide continued for 7 consecutive days. The rats were then sacrificed for blood and tissue analysis. Acute liver failure was induced in 12 rats by intraperitoneal administration of a lethal dose of thioacetamide (500 mg/kg per day for 3 days) after an injection with 0.2 mL fibrin glue into their hepatobiliary tract. Survival rates and histological outcome were investigated and compared with control animals. RESULTS: Fibrin glue occluded rats showed significantly lower liver enzyme activities and serum levels of bilirubin, creatinine and urea nitrogen. Immunohistochemistry revealed a significant increase in c-met-, HGFalpha- and especially HGFbeta-positive cells. Rats subjected to a lethal dose of thioacetamide survived when fibrin glue was applied 24 hours prior to the toxic challenge. These animals showed normal liver structure and no clinical abnormalities. CONCLUSION: Fibrin glue occlusion of the hepatobiliary tract induces therapeutic and prophylactic effects on chronic and acute liver failure by stimulating the HGF system. Therefore, fibrin glue occlusion might be useful in treating toxic liver failure.     

Efficacy of acrylate tissue adhesive as vascular repair and hemostatic material

The objective of the study was to determine the efficacy of utilizing n-butyl cyanoacrylate (NBCA) tissue adhesive glue as a vascular repair and hemostatic material in the closure of vascular wounds using a prospective, animal-based design. The study was performed on the carotid arteries of 22 goats. The experiment was performed on bilateral carotid arteries (44 procedures). In each animal, both carotid arteries were opened by a procedure simulating carotid endarterectomy. On one side, the repair material was conventional sutures; on the other side, NBCA tissue glue was utilized. The main outcome measures were duration of total flow arrest (clamping time), duration of time from start of arterial repair to complete hemostasis after clip removal (repair time), any additional stitches required after repairing either by stitch or by NBCA, and hematoxylin and eosin histopathology preparations. Forty-four simulated carotid endarterectomy and repair procedures were performed in 22 adult goats. The average repair time on the stitch side was 437 sec and on the NBCA side, 169 sec (P < 0.001). The average clamping time on the stitch side was 716 sec and on the NBCA side, 477 sec (P < 0.001). Macroscopic pathological study did not reveal any significant luminal stenosis. Foreign body microscopic changes were similarly present in both the NBCA and stitch groups, with no significant difference. This is a prospective animal-based controlled study looking into the efficacy of NBCA tissue glue as a material for arterial repair in comparison to classical suture repair. NBCA tissue adhesive glue may be of value especially when fast control of bleeding is required.     

Use of Soviet fibrin adhesive in liver surgery in experimental animals

The results of a comparative experiment for studying the native glue composition on a fibrin base, which possesses the hemostatic and adhesive properties and has the influence on the processes of regeneration, and modern synthetic medical glues are presented. The essential advantages of a fibrin-based glue were revealed.     

Perivenous application of fibrin glue as external support enhanced adventitial adenovirus transfection in rabbit model

BACKGROUND: Placement of an external support has been reported to prevent intimal hyperplasia of vein grafts. However, it's application limited by potential complications. Peri-adventitial gene delivery is a promising alternative therapy to reduce intimal hyperplasia, but it is limited by low and transient levels of gene transfection. To get more effective inhibition of intimal hyperplasia and to avoid the limitations associated with these two approaches, a study was undertaken to investigate whether mixing adenovirus with fibrin glue may increase the level and prolong the time period of gene expression. METHODS: Right jugular vein to common carotid artery interposition grafting was performed in 36 male New Zealand white rabbits (2.5-3.0 kg) and the animals were divided into four groups: control group (n = 6); fibrin glue group (n = 6); Ad-GAL group (n = 12); fibrin glue/Ad-GAL group (n = 12). Commercially available fibrin glue and adenovirus expressing the gene for beta-galactosidase (Ad-GAL) was applied separately or in mixing around vein grafts. At 7th day and 14th day after implantation, the grafts were harvested to evaluate transfection rate. At 28th day the grafts were harvested for morphometric analysis. RESULTS: Compared with weak staining in 2.1 +/- 0.5% in Ad-GAL alone grafts, a high level of beta-Galactosidase staining was evident in 13.2 +/- 4.6% in fibrin glue/Ad-GAL grafts at 7th day (P < 0.001). At 14th day, almost no staining (0%) was detected in Ad-GAL alone grafts. However, there was still a relative high level staining (6.3 +/- 3.8%) in fibrin glue/Ad-GAL grafts (P < 0.001 versus Ad-GAL alone group). At 28th day, a statistically significantly decrease in neointimal area (0.68 +/- 0.06 mm(2)versus 1.00 +/- 0.08 mm(2), P < 0.05) was shown in fibrin glue grafts compared with unsupported vein grafts (control group). The same statistically significantly difference was also existed in fibrin glue/Ad-GAL group and unsupported group in neointimal area (0.66 +/- 0.07 mm(2), P < 0.05). CONCLUSIONS: A novel method of adventitial gene delivery using fibrin glue as external support is proposed. Fibrin glue may be an ideal candidate for controlled release delivery that would facilitate adventitial gene transfer.     

Fibrin glue for partial nephrectomy.

Fibrin glue, a mixture of concentrated autologous fibrinogen and bovine-derived thrombin, was used to achieve hemostasis during 7 partial nephrectomies. After transected vessels were suture ligated, topically applied fibrin glue filled all renal defects with an adherent clot that resulted in immediate hemostasis. There was no case of delayed hematoma or abscess formation, and no complications were referrable to the use of fibrin glue. Although fibrin glue is no substitute for early vascular control and careful surgical technique, its ability to stop venous oozing from the cut surface of renal parenchymal tissue dramatically facilitates hemostatic control.