Hysteroscopic sterilization with occlusion of sheep uterine tube using n-butyl-2-cyanoacrylate adhesive

PURPOSE: To evaluate the fertility and analyze the macroscopic, microscopic and morphometric aspects of sheep uterine tube sterilization with a hysteroscopically insert of n-butyl-2-cyanoacrylate adhesive. METHODS: 12 adult sheep, with one previous pregnancy, were distributed as follows: group L (n=3) subjected to laparotomy and Pomeroy uterine tube ligation, group S (n=3) subjected to hysteroscopic application of saline solution in tube isthmus and group AD(n=6), that was subjected to hysteroscopic application of 0.5 ml of n-2-butil-cyanoacrylate in tube isthmus. They were mated with fertile males for ninety days. The non pregnant sheep, at the 90th day, were subjected to laparotomy with uterus and tubes uterine resection. The fragments of uterine tubes were fixated in 10 percent formalin and processes for histology evaluated, and slices dyes for H.E. Data were evaluated by Wilcoxon and Mann-Whitney and Fisher's exact test. RESULTS: All sheep from groups L and AD did not get pregnant (0 percent) in contrast with sheep from group S (100 percent); the adhesive remained integral in the uterine tube lumen. The percentual of adherences (66.6 percent) and fibrosis responses (100 percent) was significantly higher in the group L than group AD (0 percent) (p<0.01). The diameter of the caudal tube in group AD (2652.15 ± 45.76 mm) was significantly wider than that of the group L (1868.27 ± 56.11* μm) (p < 0.05). CONCLUSION: The hysteroscopic insertion of cyanoacrylate in the uterine tube lumen of sheep was effective to obstruct the uterine tube and to promote the sterilization.

OBJETIVO: Avaliar a fertilidade e aspectos macroscópicos, microscópicos e morfométricos da esterilização histeroscópica de tubas uterinas de ovelhas com o adesivo de n-butil-2-cianoacrilato. MÉTODOS: 12 ovelhas adultas, com uma prenhez anterior, foram distribuídas como segue: o grupo L (n=3) submetidas à laparotomia e laqueadura tipo Pomeroy, grupo S (n=3) submetidas à aplicação histeroscópica de solução salina no istmo tubário e grupo AD (n=6), com aplicação histeroscópica de 0,5 ml de cianoacrilato. As ovelhas foram acasaladas com machos de comprovada fertilidade por noventa dias. As ovelhas não prenhes aos 90 dias, foram submetidas à laparotomia com ressecção do útero e tubas uterinas, que foram fixadas em formalina 10 por centos e os cortes histológicos corados em hematoxilina/eosina. Os resultados foram avaliados pelo teste de Wilcoxon e teste exato de Fisher. RESULTADOS: Todas as ovelhas dos grupos L e AD não ficaram prenhes (0 por cento) ao contrário das ovelhas do grupo S (100 por cento); o adesivo permaneceu íntegro no lúmen tubário. O percentual de aderências (66.6 por cento) e de fibrose (100 por cento) foi significativamente maior no grupo L do que no grupo AD (0 por cento) (p<0,01). O diâmetro da porção caudal no grupo AD (2652,15 ± 45,76 μm) foi significativamente maior do que grupo L (1868,27 ± 56.11 mm) (p<0,05). CONCLUSÃO: A inserção histeroscópica do cianoacrilato no lúmen tubário de ovelhas foi eficaz para obstruir a tuba uterina e promover a esterilização.

Validity of microporous polysaccharide hemispheres as a hemostatic agent in hepatic injuries: an experimental study in rats

INTRODUCTION: In the treatment of hepatic injuries, there is not always adequate and secure hemostasis. A hepatic biopsy is indispensable in the evolution of focal or diffuse liver cell disease, being necessary for candidates for liver transplant and post-transplant treatment. Many patients suffer blood clotting that increases the risk of bleeding. For this reason, it is necessary to seek for substances capable of bringing about hemostasis quickly and effectively. PURPOSE: The aim of this study was to recognize the validity of the use of microporous polysaccharide hemispheres (MPH) as a hemostatic agent for hepatic injuries. METHODS: Thirty Wistar rats were used, split into three groups. Under anaesthetic, a laparoptomy was done and resulted in a standard liver injury that was treated in Group A with MPH, in Group B with n-butyl-2-cyanoacrylate and in Group C with fibrin adhesive. Immediate hemostasis, delayed bleeding and histological evolution were timed. RESULTS: The MPH took on average six minutes to promote hemostasis and also resulted in re-bleeding, which required reapplication; the n-butyl-2-cyanoacrylate took twenty seconds and the fibrin adhesive took one minute. The cyanoacrylate resulted in more intense adherence. The three adhesives mainly showed a chronic inflammatory reaction. The injuries treated with cyanoacrylate showed a larger area of injury (p=0,0164). The density of the collagen was similar in all groups. CONCLUSION: The MPH, despite achieving hemostasis, proved to be no more favorable than n-butyl-cyanoacrylate and the fibrin adhesive, the latter resulting in the lowest tissue reaction.

INTRODUÇÃO: No tratamento de lesões hepáticas nem sempre se tem hemostasia adequada e segura. Biópsia hepática é indispensável na evolução de doença hepato-celular difusa ou focal sendo necessária para candidatos à transplante hepático e para acompanhamento pós-transplante. Muitos doentes apresentam coagulopatias que aumentam os riscos de sangramento. Daí a necessidade de se procurar substâncias capazes de promover a hemostasia de forma rápida e efetiva. OBJETIVO: O objetivo deste estudo foi reconhecer a validade do uso de hemosferas microporosas de polissacarídeos (MPH) como agente hemostático para lesões hepáticas. MÉTODOS: Utilizaram-se 30 ratos Wistar distribuídos em três grupos. Sob anestesia, fez-se uma laparotomia e produziu-se um ferimento hepático padrão que foi tratado no grupo A com MPH, no grupo B, com n-butil-2-cianoacrilato e no grupo C com adesivo de fibrina. Cronometrou-se o tempo para a obtenção da hemostasia imediata, a existência de sangramento tardio e a evolução histológica. RESULTADOS: O MPH levou, em média, seis minutos para promover a hemostasia e apresentou re-sangramento exigindo reaplicação, o n-butil-2-cianoacrlato, 20 segundos e o adesivo de fibrina, um minuto. O cianoacrilato promoveu aderências mais intensas. Os três adesivos determinaram principalmente reação inflamatória do tipo crônico. As feridas tratadas com cianoacrilato apresentaram maior área de lesão (p=0,0164). A densidade do colágeno foi semelhante entre os grupos. CONCLUSÃO: O MPH, embora tenha conseguido hemostasia, não se mostrou mais favorável do que o n-butil-2-cianoacrilato e o adesivo de fibrina sendo que este último promoveu a menor reação tecidual.

A Case of Successful Endoscopic Injection Sclerotherapy with N-butyl-2-cyanoacrylate for Ruptured Duodenal Varices / 대한소화기학회지

Duodenal varix is a rare cause of hemorrhage in patients with portal hypertension, however their rupture is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic procedures, surgery, or interventional radiologic procedures. We report a case of duodenal varices rupture in a 45-year-old man with alcoholic liver cirrhosis who presented with melena and dizziness. Emergent upper endoscopy revealed large nodular varices with a ruptured erosion on the top in the distal second portion of duodenum. Two consecutive injections with 1.0 mL of n-butyl-2-cyanoacrylate (Histoacryl; Braun-Melsungen, Germany) mixed with 1.0 mL of lipiodol (Laboratoire-Guerbet, France) were performed intravariceally and achieved successful hemostasis. This suggests that endoscopic injection sclerotherapy with histoacryl may be an effective therapeutic option for the control of ruptured duodenal variceal bleeding.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: angiotomographic assessment and endovascular management

We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL) in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

Effect of Endoscopic Sclerotherapy Using N-butyl-2-cyanoacrylate in Patients with Gastric Variceal Bleeding / 대한간학회지

BACKGROUND/AIMS: Gastric variceal bleeding is a severe complication of cirrhosis, and it has a high mortality rate. This study was conducted to evaluate the efficacy of n-butyl-2-cyanoacrylate injection therapy for patients suffering with gastric variceal bleeding. METHODS: A total of 86 patients diagnosed with gastric variceal bleeding underwent endoscopic n-butyl-2-cyanoacrylate (Histoacryl(R)) injection therapy at our department between April, 2002 and July, 2005, with a mean follow-up period of 44 weeks (range: 2 to 136 weeks). The initial hemostasis rate and the rebleeding rate of endoscopic sclerotherapy were analyzed. Also, the cumulative survival rate was analyzed according to the status of hepatocellular carcinoma and hyponatremia, the MELD score, the Child-Pugh score and the amount of injected Histoacryl(R). RESULTS: The initial hemostasis rate of Histoacryl(R) injection therapy was 93% and the 1 month rebleeding rate was 16.1%. The total number of session for treating the initial hemostasis was 1.2+/-0.4 and the total volume of Histoacryl(R) was 2.7+/-1.2 mL. The cumulative rebleeding-free rates for the patients treated by the Histoacryl(R) injection method at 1 month, 12 months and 34 months period were 95.1%, 83.2% and 74%, respectively. The cumulative survival rates were 78.3% at 1 month, 61.9% at 12 months and 54.6% at 34 months, respectively. No thromboembolic phenomenon occurred. According to the Cox's proportional hazards analysis, only the MELD score (<15) was an independent predicting factor for survival of the patients with gastric variceal bleeding. CONCLUSIONS: Endoscopic sclerotherapy using n-butyl-2-cyanoacrylate was a safe and effective hemostatic method for patients with gastric variceal bleeding. Also, the MELD score (<15) contributed to predicting survival of the patients with gastric variceal bleeding.