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ABSTRACT Purpose: The purpose of this study was to evaluate the long-term outcomes of patients with trichiasis treated with a modified interlamellar oral mucosa graft surgery technique using fibrin glue. Methods: A prospective study was conducted at the Oculoplastic Department of Ouro Verde Hospital Complex. Patients with recurrent trichiasis without entropion who did not respond to conventional therapy, underwent intermarginal lamellar splitting of the eyelid and oral mucous graft insertion with fibrin glue replacing sutures. They were then evaluated at 1-day, 1-week, 1-month, 6-month, and 4-year follow-ups. Graft adherence, symptom resolution, esthetic satisfaction, overall patient satisfaction, and trichiasis recurrence were assessed at 6-month and 4-year follow-ups. Results: Fifteen patients (a total of 19 eyes) were included, of whom 10 (66.7%) were female and 5 (33.3%) were male. The mean age was 75.4 ± 10.5 years (range, 54-98 years). Acquired trichiasis was the main cause. Of the patients with acquired trichiasis, 12 (86.7%) had chronic blepharitis, 2 (13.3%) had an undetermined cause, and one (6.7%) had trachomatous trichiasis. Most cases involved only one eyelid segment (89.4%) and =5 lashes (84.2%; minor trichiasis). No adverse reactions from the fibrin glue were reported and no sutures were required after graft placement. At 6 months, no graft failures occurred, 17 eyes of 13 patients (89.4%) showed good graft adherence, 2 eyes of 2 patients (10.5%) showed partial graft adherence, and 2 eyes of 1 patient (10.5%) had trichiasis recurrence. At 4-year follow-up, no graft failure occurred, 3 patients (3 eyes) were lost to follow-up, and 2 eyes of 2 patients (14.2%) had trichiasis recurrence. The 4-year cumulative success rate was 78.9%. Conclusions: The modified interlamellar surgery with fibrin glue showed a good long-term success rate. This technique reduces surgical time, facilitates smaller graft insertion, and therefore, should be considered for recalcitrant minor trichiasis without entropion.>
RESUMO Objetivo: O objetivo deste estudo foi avaliar os resultados a longo prazo da técnica cirúrgica modificada de enxerto interlamelar de mucosa oral usando cola de fibrina para o tratamento de triquíase. Métodos: Um estudo prospectivo foi realizado no Departamento de Óculo-plástica do Complexo Hospital Ouro Verde. Pacientes com triquíase recorrente sem entrópio, que não responderam à terapia convencional, foram submetidos à cirurgia com separação intermarginal das lamelas das pálpebras e inserção de enxerto de mucosa oral usando cola de fibrina, substituindo a sutura. Pacientes foram avaliados 1 dia, 7 dias, 1 mês, 6 meses e 4 anos após a cirurgia. A aderência do enxerto, resolução dos sintomas, satisfação estética, satisfação geral do paciente e recorrência de triquíase foram avaliados aos 6 meses e aos 4 anos. Resultados: Quinze pacientes (total de 19 olhos) foram incluídos, dos quais 10 (66.7%) eram do sexo feminino e 5 (33.3%) do sexo masculino. A média de idade foi 75.4 ± 10.5 anos (intervalo 54-98 anos). Triquíase adquirida foi a principal causa, da qual 12 pacientes apresentaram blefarite crônica (86.7%), 2 pacientes com causa indeterminada (13.3%) e 1 paciente com triquíase tracomatosa (6.7%). A maioria dos casos envolveu apenas um segmento da pálpebra (89.4%) e com =5 cílios (84.2%; triquíase menor). Nenhuma reação adversa foi reportada com o uso da cola de fibrina e nenhum caso necessitou de sutura após inserção do enxerto. Aos 6 meses, não houve nenhuma falha de enxerto, 17 olhos de 13 pacientes (89.4%) apresentaram boa aderência de enxerto, 2 olhos de 2 pacientes (10.5%) mostraram aderência parcial do enxerto e 2 olhos de 1 paciente (10.5%) apresentaram recorrência da triquíase. Aos 4 anos, não houve nenhuma falha de enxerto, 3 olhos de 3 pacientes tiveram perda de seguimento e 2 olhos de 2 pacientes (14.2%) apresentaram recorrência da triquíase. A taxa de sucesso acumulativa após 4 anos foi de 78.9%. Conclusão: A cirurgia modificada de enxerto interlamelar de mucosa oral usando cola de fibrina mostrou uma boa taxa de sucesso a longo prazo. Esta técnica reduz o tempo cirúrgico, facilita a inserção de enxertos menores e, portanto, deve ser considerada em triquíase menor sem entrópio resistente ao tratamento convencional.
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Humans , Female , Male , Middle Aged , Aged , Aged, 80 and over , Fibrin Tissue Adhesive , Mouth Mucosa , Fibrin Tissue Adhesive/therapeutic use , Prospective StudiesABSTRACT
Objective To investigate the clinical characteristics,diagnosis and treatment of congenital tracheobiliary fistula (CTBF) in children.Methods A case of CTBF admitted into the Department of Pediatric Respiration,Hubei Maternal and Child Health Care Hospital in 2016 was reported,and the related literatures were reviewed.The clinical features,diagnostic methods,treatment status and clinical outcomes of the disease were analyzed.Results The patient was 3 years and 7 months old.The main clinical manifestations were recurrent cough,pneumonia and atelectasis.CTBF was diagnosed by means of iodine oil radiography and treated with biological glue plugging under bronchoscopic guidance.So far,only 30 cases of CTBF have been reported in the English literatures,but only 2 cases in the Chinese literatures.The main clinical manifestations were cough,dyspnea,sputum or bile vomiting,aspiration pneumonia,atelectasis or emphysema.Diagnostic methods for CTBF included bronchoscopy,bronchial angiography and cholangiography,hepatobiliary scan,CT scan and magnetic resonance imaging.Except for this case treated with biological glue plugging under bronchoscopic guidance,all other patients were treated with surgery.The operation methods included fistula ligation,gastrostomy,liver resection,fistula jejunum Roux-en-Y anastomosis,hepatic hilum jejunum anastomosis,gallbladder jejunum anastomosis,etc.Only 4 cases died,and the rest of the patients recovered.Conclusions CTBF should be suspected in children with persistent chronic cough.Iodine oil radiography through bronchoscopy is a simple and feasible method for diagnosis of CTBF.Besides surgery,the lavage and the biological glue plugging method through bronchoscopy is also an effective way to treat CTBF in children without severe biliary malformation.
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Objective To investigate the hemostatic function of biological glue in renal trauma.Methods Establishment of rab-bit kidney scratch,partial nephrectomy and renal injury penetrating wound models were available with a biological glue and hemo-static powder processing,observed and recorded the amount of bleeding and bleeding time.Tissue sample were transected from the wound of kidneys in each group after a month,and the renal wound healing condition was observed by pathological examination.Re-sults The hemostatic function of biological glue was better than styptic powder,the amount of bleeding in biological glue group and hemostatic powder group of kidney scratched model were(1.39±0.09)mL,(1.77±0.44)mL,the difference was not statistically significant(P =0.115);the bleeding time were(5.02 ±0.23)s,(66.40± 7.35)s,the difference was statistically significant(P <0.01);the amount of bleeding in two models of partial nephrectomy and renal penetrating wound were(2.07±0.25)mL,(11.42± 1.33)mL;(2.01 ± 0.36)mL,(3.95 ± 0.39)mL and bleeding time were(6.16 ± 0.69)s,(139.38 ± 8.97)s;(7.68 ± 0.80)s, (144.26±9.27)s,the differences were statistically significant(P <0.01).Pathology results showed that the wounds healed well. Conclusion The hemostatic function of biological glue in renal trauma were remarkable and stable,and was worth to be further promoted.
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The GRF glue consists of mixture of gelatine and resorcine. The mixture is hardened by the addition of medical formaldehyde. Resorcine is diphenole which reacts with formaldehyde, creating tridimentional network. We performed microvascular anastomosis of abdominal aorta of the rat using GRF glue and the histologial study by the light microscope and the scanning electron microscope. Re-endoterization began from two days after anastomosis and completed at ten days to two weeks after anastomosis. From scanning electron microscopic study the invasion of macrophages and platelets in the case of anastomosis using GRF glue was less than in the case of manual or laser anastomosis. We revealed that GRF glue is very useful for bonding of micro vessels.
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We have tried fibrin adhesive, which mimics the end stage of plasmatic coagulation, in 26 patients with various neurosurgical problems such as: repair of cerebrospinal fluid (CSF) leaks, sealing of the vascular anastomosis sites, reinforcements of aneurysmal clippings, and hemostasis after resection of brain tumors. Presented in this report are 11 intracranial aneurysms, 11 brain tumors, 2 lipomyelo-meningoceles, and one each of cerebral arteriovenous malformation and torn dura resulting from a mastoidectomy. Procedures which seemed to be impossible or very difficult by conventional neurosurgical techniques could be accomplished in all cases without any complication. Our experience with fibrin adhesive suggests that it is a valuable adjuvant to various microneurosurgical procedures, and it may be potentially useful for protection of major cerebral veins and venous sinuses during cerebral retraction.