Use of Tachosil® as an adjuvant therapeutic option in neurotrophic keratopathy in order to prevent perforation

We present two cases of women who suffered from neurotrophic keratopathy (one of them had undergone penetrating keratoplasty) which had led to corneal thinning. Tachosil® was used as an adjuvant treatment after topical medication by itself failed in both cases. To our knowledge, there are no reported cases of the use of Tachosil® in corneal grafts.

Efficacy of TachoSil, a Fibrin-Based Hemostat, for Anterior Lumbar Spine Surgery

STUDY DESIGN: Retrospective case series. PURPOSE: To examine the efficacy of TachoSil for vessel injury in 6 patients who underwent anterior lumbar fusion surgery (ALF). OVERVIEW OF LITERATURE: ALF for the lumbar spine has a high rate of success, although intraoperative concerns and iatrogenic complications are known, and injury of a major vessel is sometimes a complication. The efficacy of TachoSil, a fibrin-based hemostat, has been reported for several types of surgery; however, use of TachoSil for ALF surgery has not been described. Here, we report on the efficacy of TachoSil in 6 patients, who underwent ALF after vascular surgeons having difficulty in repairing vessels. METHODS: Two man and 4 women with average age of 50.8±10.9 (mean±standard deviation) were diagnosed with a vertebral tumor (2 patients), L4 degenerative spondylolisthesis (2 patients), and L5 spondylolytic spondylolisthesis (2 patients) and underwent ALF. The blood vessels injured included the common iliac vein in 2 patients and a branch of a segmental artery from the aorta in 4 patients. We consulted a vascular surgeon to suture or repair the vessels during surgery, and although the vascular surgeon attempted to address the injuries, suturing or repair was not possible in these cases. For this reason, we used TachoSil to repair the injury in the vessels walls or to stop the bleeding. RESULTS: Time to pressure hemostasis using TachoSil was 34±12 minutes, and total blood loss was 1,488±1,711 mL. Nevertheless, all vessel injuries were controlled by the use of TachoSil. CONCLUSIONS: We recommend the use of TachoSil for vessel injuries that vascular surgeons cannot suture or repair during ALF surgery.

Linfangioma quístico retroperitoneal adherido a cabeza pancreática / Cystic retroperitoneal lymphangioma

Cystic retroperitoneal lymphangioma is an unfrequent pathology. Most cases are asymptomatic, and when symptomatic, they tend to present as abdominal pain and bowel obstruction secondary to compres-sion of the bowel loops. Treatment of choice is surgical excisión. We present a case of cystic retroperitoneal lymphangioma with adhesions to the second portion of duodenum and head of the pancreas. Once separated from the pancreas, it remained denudated. To avoid an eventual pancreatic fístula, Tachosil® was placed as sealing method. Postoperative course was uneventful.

El linfangioma quístico retroperitoneal es una patología de poca frecuencia. La mayoría de los casos son asintomáticos y cuando presentan síntomas, lo más frecuente es dolor abdominal u obstrucción intestinal por compresión de asas intestinales. Su tratamiento consiste en la extirpación completa de la lesión. Presentamos un caso de linfangioma quístico retroperitoneal adherido a 2a porción duodenal y cabeza pancreática. Al separarlo del tejido pancreático, quedó un borde cruento. Para evitar una fístula pancreática, se colocó una placa de Tachosil® a modo de sellante. No aparecieron complicaciones postoperatorias.