Use of Beta Blockers for Increasing Survival of Free Fat Grafts

Fat tissue is abundant in the body and preferred in soft tissue augmentation. Since resorption is its greatest disadvantage, many agents have been tried in an attempt to increase fat graft survival in various studies. Yet selective β1 blocker had not been used before. The effect of selective β1 blockers on resorption following auto-transplantation of free fat graft was examined in rats. The effect of selective β1 blockers was compared with those of insulin and saline solution as a control. For this comparison, the weight of fat grafts was measured both during and nine months after operation using the ``liquid overflow method' in which obtained material was put into 5 cc syringe filled with saline solution and the increase in liquid level was recorded as graft volume. Histological examination of grafts and statistical analyses of the results were also made. Our in vivo study demonstrated that selective β1 blocker significantly increased free fat graft survival. It is our conclusion that selective β1 blocker is a promising agent for decreasing fat graft resorption.     

Presacral Donor Site for Lip Augmentation

For over a century surgeons have been in search of the perfect tissue filler. In recent years lip augmentation has become quite popular. Despite the numerous methods employed to enhance the fullness of lips, autogenous free dermal fat grafting (FDFG) still remains a preferred method. FDFG has been extensively investigated clinically as well as histologically. However, despite its efficacy, FDFG has failed to gain widespread clinical acceptance. One reason has been concern about donor-site morbidity. In this paper, we describe a method of lip augmentation, which utilizes a dermal fat graft from the presacral region. This site is optimal because it has thick skin with minimal hair follicles and leaves a minimal scar.     

Tissue-engineered cartilage using fibrin/hyaluronan composite gel and its in vivo implantation

The importance of scaffold biomaterials has been emphasized for in vitro culture of tissue-engineered cartilage in a three-dimensional (3D) environment. In this study, we examined the feasibility of fibrin glue, mixed with hyaluronic acid (HA) as a composite scaffold. Fibrin glue has been a useful cell delivery matrix for cartilage tissue engineering and HA is a key component of normal articular cartilage. Our hypothesis is that compared to fibrin itself, a fibrin/HA composite can have significantly enhanced properties, due mainly to the added benefits of HA in the matrix. Pieces of cartilage were isolated from rabbit knees and the chondrocytes were harvested through enzymatic digestion. Both fibrin and fibrin/HA composite were prepared and subsequently implanted in nude mice (n = 9, each group) for 1, 2, and 4 weeks, respectively. The retrieved specimens were then analyzed and the results were compared. Cartilage-like tissue formation was detected earlier with fibrin/HA specimens. They produced significantly higher amounts of the extracellular matrix (ECM) molecules, GAG, and collagen at each time point than those in fibrin. Interestingly, the fibrin/HA composite was also competent in maintaining its initial size. Histology--Safranin O/fast green and Alcian blue--of the retrieved specimens found more intense, uniform staining in the fibrin/HA composites. Analysis of the gene expression of the ECM molecules also confirmed the benefits of the composite with added HA in the maintenance of phenotypic stability. The present study suggests that fibrin/HA composite may serve as a dependable cell delivery vehicle as well as a structural basis for tissue-engineered cartilage.     

人脂肪来源细胞体内构建组织工程化脂肪的实验研究

目的探讨以组织工程技术，应用脂肪来源细胞（Adipose—derived cells，ADCs）体内构建脂肪组织的可行性。方法吸脂术获得人脂肪组织，一部分直接植入裸鼠体内；另一部分用酶消化法分离、培养ADCs，将第三代细胞接种于纤维凝胶（Fibrin glue）支架中，经成脂肪培养液诱导1周后，植入裸鼠体内，4周后取材，用称重法及油红、HE染色检测结果。实验分为直接注射脂肪组、单纯支架组、细胞-支架复合体脂肪诱导组、非诱导组。结果直接注射组在裸鼠皮下形成脂肪组织，但吸收量大；细胞-支架复合体诱导组有大量脂肪类组织形成，油红染色显示组织有脂滴形成；细胞-支架复合体非诱导组和单纯支架组均未发现脂肪组织形成。结论采用组织下程技术将吸脂术获得脂肪来源细胞接种纤维凝胶支架，体内构建脂肪组织，具有可行性。     

In vivo biological performance of composites combining micro-macroporous biphasic calcium phosphate granules and fibrin sealant

Introduction Fibrin glues are currently used by surgeons and can facilitate the handling of biomaterials. Combining fibrin glue with calcium phosphate bioceramics gives a mouldable composite that cements the granules into the implantation site. In addition to the mechanical aspect of the composite, it has been suggested that the mixture also promotes wound healing. These human blood derivatives contain natural (aprotinin) or synthetic (tranexamic acid) antifibrinolytic substances. We compared the bioactivity of two composites combining calcium phosphate granules with two different types of fibrin glue, one with aprotinin and the other with tranexamic acid.Materials and methods The composite was composed of fibrin glue (Tissucol) and 1 to 2 mm granules of biphasic calcium phosphate granules (MBCP) with a volume ratio of 1 for 2. Bone cavities were drilled in 12 New Zealand rabbits and filled with a composite with aprotinin-fibrin glue on the right condyle and one with tranexamic acid-fibrin glue on the left condyle. The rabbits were randomized into two groups: 3 and 6 weeks of delay. Light microscopy, scanning electron microscopy and image analysis were performed.Results No adverse reactions were observed in either sample. Bony ingrowth associated with bioceramic resorption by osteoclastic TRAP-positive cells was noted. No significant difference was observed between the two composites. The bony ingrowth and ceramic resorption were qualitatively and quantitatively similar with both composites.Conclusion This study demonstrated that the choice of a natural (aprotinin) or synthetic (tranexamic acid) antifibrinolytic agent in the fibrin sealant associated with calcium phosphate granules and used as a bone substitute had no effect on the bioactivity of the composite. It remained efficient in bone reconstruction, no adverse effects were observed, and the bony ingrowth was qualitatively and quantitatively equivalent with the two types of fibrin sealant.     

Lip Augmentation with AlloDerm Acellular Allogenic Dermal Graft and Fat Autograft: A Comparison with Autologous Fat Injection Alone

Many surgical options exist for lip augmentation, none of which consistently provide safe, lasting, and predictable volume gains. We describe and evaluate the use of AlloDerm acellular allogenic dermal graft in combination with fat autograft and compare the postoperative results with those of autologous fat injection alone. Analysis of the preoperative and 1- and 3-month postoperative photographs was done using digital imaging software. Outcome measures included vermilion show and horizontal lip projection from the soft tissue pogonion–subnasale plane. A 61% mean increase in vermilion show was observed in lips augmented with AlloDerm/fat injection, in comparison to a mean increase of 13% in lips augmented with fat injection alone. Lip projection demonstrated a mean increase of 1 mm in AlloDerm/fat lips at 3 months. Postoperatively, no evidence of resorption was seen in lips augmented with AlloDerm/fat between the 1- and the 3-month follow-ups, however, a 9% decrease in vermilion show occurred in lips augmented with fat injection over the same period. No complications occurred in either group. We conclude that AlloDerm in conjunction with autologous fat injection constitutes a safe, reliable, and lasting method of lip augmentation providing increased vermilion show compared to that with autologous fat injection alone.     

Augmentation des Nasenrückens mit Knorpelschrot-Fibrinkleber

Background

The ideal method for augmentation of the nasal dorsum has yet to be found due to specific characteristics of alloplastic materials and autologous tissue. This review article describes a variation of the use of autologous diced cartilage.

Current opinion and practice

In the western world the use of autologous tissue has increasingly become accepted as the gold standard, particularly as a diced cartilage glue graft wrapped in fascia. This review discusses various augmentation techniques and details of a modification of a diced cartilage transplant using fibrin glue. This technique is innovative by impregnating diced cartilage with a thrombin solution, moulding it into the desired form and finally bonded with a fibrin solution. This technique substantially extends the spectrum of possible transplant forms. Its application for more than 5 years and a morphometric study with a 15-month follow-up confirm the long-term stability of the transplant.

Conclusion

The use of autologous tissue for augmentation of the nose is in line with the wishes of the majority of patients and surgeons. The diced cartilage glue graft has proved to be a welcome addition to the rhinoplasty armamentarium.     

可注射型生物蛋白胶包埋骨髓基质细胞工程化组织的体外实验

目的构建可注射型生物蛋白胶包埋骨髓基质细胞的工程化组织,体外培养并研究其生物学特性,探讨将可注射型生物蛋白胶作为组织工程支架用于临床的实验基础。方法体外培养浇铸有骨髓基质细胞的生物蛋白胶,通过倒置相差显微镜、激光共聚焦显微镜观察载体内细胞生长及载体降解情况,5-溴脱氧尿苷(5-Bromodeocyuridine,BrdU)掺入标记后免疫组化等方法研究可注射型载体内包埋细胞的增殖情况。结果骨髓基质细胞包埋于生物蛋白胶内能很好地存活并增殖,2d后细胞呈典型的成纤维细胞形态;6d后生物蛋白胶边缘部分开始降解,细胞脱落至培养板;体外培养14d,细胞生长良好,大部分生物胶降解,脱落的细胞增多,贴壁生长的细胞形态正常;3周后生物蛋白胶完全降解。结论生物蛋白胶聚合后包埋的种子细胞能够正常增殖,生物蛋白胶是一种理想的适用于微创方法修复组织的可注射型组织工程培养和移植的支架。     

纤维蛋白凝胶和脱钙骨基质支架材料复合软骨细胞修复兔膝关节软骨缺损的实验研究

目的：探讨纤维蛋白凝胶和脱钙骨基质支架材料复合软骨细胞作为软骨组织工程支架的可行性及有效性,并为后续研究可注射性材料做基础。方法：体外分离培养软骨细胞后接种到纤维蛋白凝胶和脱钙骨基质支架材料体外培养4周,然后植入兔膝关节软骨缺损区继续培养4、8、12周后取材,分别行大体、组织学、Ⅱ型胶原免疫组织化学观察。并进行Wakitani评分,观察其体内修复关节缺损效果。结果：大体观察4周后,实验组软骨缺损区可有乳白色组织修复,12周可修复完全,并无明显凹凸感。光镜下8周可见大量软骨细胞修复,并在TB染色下见Ⅱ型胶原比4周时明显增多。12周时软骨陷窝结构形成,细胞形态排列及Ⅱ型胶原与正常软骨组织相近。结论：纤维蛋白凝胶和脱钙骨基质支架材料复合软骨细胞可以作为软骨组织工程支架材料,能够用于再生修复软骨的缺损。并为构建可注射性修复材料提供途径。     

Morphological and Functional Features of Clasts in Low Phosphate, Vitamin D-Deficiency Rickets

Focusing on resorption processes, we have extended our previous studies on chondroclasts and osteoclasts in normally developing tissues, using a model of nutritionally induced vitamin D-deficiency rickets. To analyze the resorption process, we investigated the matrix-resorbing cells in this modified and poorly mineralized tissue regarding morphological features and expression of tartrate-resistant acid phosphatase (TRAP) at the subcellular level. Our goal was to test the hypotheses that initiation of resorption is impaired with unmineralized matrix, and that such alterations involve changes in the subcellullar distribution of TRAP, implicating a role for this enzyme in the resorption process. Our results reveal distinctly different morphological appearances of clast-like cells in rickets compared with normal osteoclasts and chondroclasts. Ordinary resorption structures of osteoclasts and chondroclasts at the cell-matrix border, i.e., ruffled borders and clear zones, are profoundly altered in favor of a less well-defined intermediate zone. TRAP distribution at the subcellullar level is also clearly different from that in osteoclasts and chondroclasts from normal rodents, with impaired secretion; consequently, the enzyme is unable to function in the matrix outside the ruffled border. Our ultrastructural observations demonstrate that in rickets, the clasts are incapable of degrading the poorly mineralized cartilage and bone efficiently. Rachitic clasts seem to be recruited to the matrix surface and interaction between cell and matrix is also initiated, but definitive resorption structures at the cell-matrix border are not normally developed. Whether resorption is inhibited by the mere lack of mineral or mineral-associated proteins, or by other mechanisms remains to be settled. Received: 5 January 2000 / Accepted: 12 May 2000 / Online publication: 2 November 2000     

Immediate Reaugmentation of the Breasts Using Bilaterally Divided TRAM Flaps After Removing Injected Silicone Gel and Granulomas

The authors present eight cases of reconstruction of the breasts using bilaterally divided TRAM flaps after removing the injected silicone gel and granulomas. In Japan, we have the opportunity to examine many patients who have had foreign substance injections to the breasts for purposes of augmentation, however, most of them are now suffering from delayed complications. Until now we have reconstructed breasts such cases by use of silicone bag prostheses after removal of granulomas; however, now it is difficult to obtain silicone prostheses. Thus, we have decided to reconstruct by the use of autogenous cutaneous and adipose tissue flaps as presented by us in this article.     

Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial

Fibrin as a tissue sealant has been used since the turn of the century for hemostasis. The development of cryoprecipitate and the resultant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material. Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery. Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy. Human studies, however, have been equivocal. Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal. A prospective randomized trial was conducted consisting of 27 women. All women received modified radical mastectomy. At the completion of the mastectomy they were randomized to receive either standard closure or the application of fibrin glue before standard closure. Patients were then monitored for daily drain output, time to drain removal, and wound complications. A total of 14 women received fibrin glue and 13 received no glue. Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue (1308 vs 754 cm3; P = 0.012). Time to drain removal was also increased by 4 days, although this did not reach statistical significance. The overall complication rate was higher for the fibrin glue group, although again, this did not reach significance. The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy. Time to drain removal was increased as was the complication rate. On the basis of these data fibrin glue cannot be recommended for routine use in modified radical mastectomy.     

Porcine wound healing in full-thickness skin defects using Integra? with and without fibrin glue with keratinocytes

BACKGROUND:

An artificial dermal matrix such as Integra (Integra Life Sciences Corporation, USA) provides a wound bed template for vascular and fibrocyte ingrowth as well as collagen remodelling. Dermal repair leads to epidermal and basement membrane regeneration. Burn wounds in particular have been shown to benefit from Integra by enhanced wound healing.

OBJECTIVE:

To evaluate the effect of fibrin glue to modify the integration of Integra in large excised cutaneous wounds. It was hypothesized that applying fibrin glue on a wound bed would reduce the time needed for matrix vascularization and incorporation of Integra and take of the cultured keratinocytes.

METHODS:

Four separate full-thickness wounds were created on the dorsum of two swine. Wound beds were randomly assigned to either application of fibrin glue or no application of fibrin glue before application of Integra. Full-thickness biopsies were performed at days 7, 14, 21, 29 and 35. On day 21, keratinocytes were applied either as sheets or aerosolized fibrin glue suspension.

RESULTS:

Histological analysis revealed a wave of inflammatory cells and early granulation tissue ingrowth into the Integra from the fascia below on day 7. Only this initial phase was augmented by application of fibrin glue to the wound bed. By day 14, most and by day 21, all of the Integra thickness was incorporated. Accelerated dermal repair proceeded from the base with new collagen deposition in Integra spaces. There was no evidence of keratinocyte engraftment, although re-epithelialization occurred at wound edges extending onto the incorporated Integra.

CONCLUSIONS:

It appears there is an acceleration of early phase (day 7 to day 21) dermal incorporation with fibrin glue application to the wound bed, perhaps secondary to increased cellular migration. Day 21 appears to be too early to apply cultured keratinocytes either as sheets or aerosolized suspension.     

Nasal Correction in Binder's Syndrome: The Evolution of a Treatment Plan

Maxillofacial dysplasia, or Binder's Syndrome is a challenge for the surgeon. The evolution of a surgical treatment plan has led to improved facial contour and patient self-image. We studied 27 patients with maxillonasal dysplasia of variable degrees, both on a short- and long-term basis. In some patients, surgical treatment began as early as 3 years of age, while others were treated as teenagers or young adults. Surgical options included cartilaginous onlay grafts to the pyriform area, nasal dorsal grafts (linear or L-strut in design), and columellar strut grafts. Le Fort osteotomies were reserved for those patients with Class III malocclusion (15% in this series). The overall goals were to augment skeletal deficiencies of the midface and begin the soft tissue expansion process as early as possible. From our long-term follow-ups (up to 15 years) it has become apparent that surgical treatment should begin early. This leads to improved self-image by the child's preschool years, taking advantage from their youthful skin elasticity. In the young patient, sequential lengthening procedures of the dorsum and columella are beneficial. Paranasal and midfacial augmentation is reserved until midfacial growth is near complete when the patient is in their midteenage years.     

Tissue engineering of tendons and ligaments by human bone marrow stromal cells in a liquid fibrin matrix in immunodeficient rats: Results of a histologic study

Introduction The original complex structure and mechanical properties are not fully restored after ligament and tendon injuries. Due to their high proliferation rate and differentiation potential, Bone Marrow Stromal Cells (BMSC) are considered to be an ideal cell source for tissue engineering to optimize the healing process. Ideal matrices for tissue engineering of ligaments and tendons should allow for homogenous cell seeding and offer sufficient stability. Material and methods A mixture of human BMSC and liquid fibrin glue was injected into a standardized full-thickness window defect of the patellar tendon of immunodeficient rats (BMSC group). The histology of the tissue was analysed 10 and 20 days postoperatively and compared to four control groups. These groups consisted of a cohort with a mixture of human fibroblasts and fibrin glue, fibrin glue without cells, a defect group without treatment, and a group with uninjured patellar tendon tissue. Results Tendon defects in the BMSC group revealed dense collagen fibres and spindle-shaped cells, which were mainly orientated along the loading axis. Histologic sections of the control groups, especially of untreated defects and of defects filled with fibrin glue only, showed irregular patterns of cell distribution, irregular formed cell nucleoli and less tissue maturation. Compared to healthy tendon tissue, higher numbers of cells and less intense matrix staining was observed in the BMSC group. No ectopic bone or cartilage formation was observed in any specimen. Conclusions Injection of human BMSC in a fibrin glue matrix appears to lead to more mature tissue formation with more regular patterns of cell distribution. Advantages of this “in-vivo” tissue engineering approach are a homogenous cell-matrix mixture in a well-known and approved biological matrix, and simple, minimally-invasive application by injection.     

Response of Human Osteoblasts to Polymethylmetacrylate In Vitro

The effects of a polymethylmetacrylate (PMMA) powder with a diameter between 0.5 and 25 μm have been studied in vitro on several human osteoblast populations obtained from different sources. Parameters of cell activity such as cell growth, collagen synthesis, osteocalcin, and interleukin-6 (IL-6) production have been evaluated. Cell proliferation and collagen synthesis were inhibited after exposure to bone cement, whereas osteocalcin and IL-6 production were stimulated. These results suggest that PMMA particles could affect osteoblast activity in a way that could contribute, together with other factors, to periprosthetic osteolysis through two different pathways: a reduced periprosthetic bone formation due to the reduced osteoblast proliferation and collagen synthesis, and an osteoblast-mediated activation of osteoclastic bone resorption as suggested by the increased osteocalcin and IL-6 synthesis. In fact, osteocalcin has been demonstrated to have a role in osteoclast recruitment to bone surfaces, and IL-6 is known to induce osteoclastogenesis and to directly stimulate bone resorption. Received: 20 December 1996 / Accepted: 2 July 1997     

The effect of fibrin glue on fat graft survival.

Autologous fat transplantation for filling defects or augmenting tissue is a common procedure but may have unreliable results. While fibrin glues lead to increased proliferation of fibroblasts and local accumulation of vascular endothelial growth factor, which enhances the neovascularisation, in this study the efficacy of fibrin glues on fat graft survival was investigated. Inguinal fat pads from Sprague-Dawley rats were harvested and same volumes of autogenous fat grafts were implanted into the separate pockets with the aid of fibrin glue (Group 1) and saline solution (Group 2). All the fat grafts were harvested, washed, blotted dry, and volumetrically measured with the same method used peroperatively at 6 months after implantation. Mean graft survival values for Group 1 were compared with Group 2 and histopathological evaluation of the grafts was also made. There was a significantly higher survival rate of the grafts in Group 1 than control group (79+/-4% and 55+/-6%, respectively). Histopathological examination of the grafts demonstrated evident increase in neovascularisation of the fat grafts in the experimental group. The authors conclude that the fibrin glue significantly diminishes the fat graft resorption and further well-controlled studies are required before using fibrin glues for clinical purposes.     

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.     

Combined Use of Hair and Fibrin Glue for Soft Tissue Augmentation: Experimental Study

A vast variety of alloplastic materials together with autogenous grafts have been used for the correction of contour deformities related to aesthetic and reconstructive purposes. Despite a number of well-tolerated materials, the ideal has not yet been reached, although well-tolerated autogenous grafts have higher rates of resorption and distortion. The limited volume of autogenous grafts and concerns about donor-site morbidity may obligate the surgeon to use implantation materials. Covering almost every property of an ideal implantation material, hair, an organic autogenous nonvital tissue, was used for soft tissue augmentation in this experimental study. Hair pellets of 10 New Zealand rabbits were prepared and shaped as 1 × 1 × 1-cm cubes with the help of fibrin sealant, then inserted subcutaneously. The materials were evaluated 4 months later. No complications such as infection or extrusion were seen. The materials were intact, with no signs of resorption, but the shapes were distorted due to the pressure of the surrounding tissues. Histopathologic findings also demonstrated that the hair was well tolerated by the adjacent tissues. Different processes may enable hair to be used as a filler material in clinical practice. Well-tolerated, nonresorbable injectable materials or shaped implants may be obtained at low cost using hair.     

The use of fibrin glue in neurosurgical operations

Fibrin glue has been used in 22 neurosurgical patients and following five effects which are very much helpful in neurosurgical practice were recognized. Adhesive effect--Dural defect at cranial base was closed with lyophilized dura and fibrin glue. Hemostatic effect--Fibrin glue soaked oxycel was applied for hemostasis of the bleeding from venous sinus, dura, skull edge and cut surface of tumor. Blocking and sealing effects--In cases of craniopharyngioma, cyst wall around the inserted tube was sealed with oxycel and fibrin glue. CSF leakage from open sphenoidal sinus in aneurysmal operation was closed with fibrin glue soaked gelfoam. Covering and wall strengthening effects--Unclippable aneurysms were coated and wrapped with fibrin glue and oxycel. Packing effect--Huge dead space after removal of mucocele was packed with fibrin glue. In trans-sphenoidal operation of pituitary adenoma, fibrin glue soaked muscle pieces and oxycel were packed in the dead space and sphenoidal sinus. Many other possible availabilities in neurosurgical operations were discussed. Fibrin glue is a biological product, so it can be used with more safety and affinity to the local tissue and with less reaction as foreign body than the artificial adhesives. It takes much time for the preparation of this material for the time being. If this can be prepared instantly, usefulness of this glue will be markedly increased. We have had no hepatitis nor inflammatory complications in our limited experience.