Comparison of Arterial Repair through the Suture, Suture with Fibrin or Cyanoacrylate Adhesive in Ex-Vivo Porcine Aortic Segment.

INTRODUCTION: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. OBJECTIVE: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. METHODS: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. RESULTS: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. CONCLUSION: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Comparison of arterial repair through the suture, suture with fibrin or cyanoacrylate adhesive in ex-vivo porcine aortic segment

Abstract Introduction: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. Conclusion: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Collagen, fibrinogen and thrombin biological addesive is effective in treating experimental liver injuries.

OBJECTIVE: : to evaluate the effectiveness of a collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injury in rats. METHODS: : the study included 30 Wistar rats randomly divided into three groups: A, B and C. All underwent standard liver traumatic injury. In group A the lesion was treated with the adhesive; in group B, with conventional absorbable suture; and in group C, there was no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. RESULTS: : there was no statistical difference in relation to mortality (p = 0.5820). The group treated with the adhesive showed the lowest hemostasis times (p = 0.0573, odds ratio 13.5) and lower incidence of adhesions (p = 0.0119). Microscopic histological alterations of Groups A and B were similar, with foreign body granuloma formation separating the adhesive material or the suture from the hepatic stroma. CONCLUSION: : the adhesive of collagen associated with fibrinogen and thrombin was effective in the treatment of experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures. OBJETIVO: avaliar a eficácia de um adesivo à base de colágeno associado a fibrinogênio e trombina, no trauma hepático experimental em ratos. MÉTODOS: foram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A a lesão foi tratada com o adesivo, no grupo B com sutura convencional com fio absorvível e no grupo C não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. RESULTADOS: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente, as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. CONCLUSÃO: o estudo concluiu que o adesivo de colágeno associado a fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

The collagen, fibrinogen and thrombin biological adhesive is effective in treating experimental liver injuries.

OBJECTIVE: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. METHODS: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. RESULTS: there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. CONCLUSION: the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures. OBJETIVO: avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. MÉTODOS: toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. RESULTADOS: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. CONCLUSÃO: o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

The collagen, fibrinogen and thrombin biological adhesive is effective in treating experimental liver injuries / O adesivo biológico de colágeno, fibrinogênio e trombina é eficaz no tratamento de lesões hepáticas experimentais

ABSTRACT Objective: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. Methods: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results: there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. Conclusion: the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.

RESUMO Objetivo: avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. Métodos: toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. Resultados: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. Conclusão: o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.

A escolha do agente hemostático tópico e do adesivo tecidual / The selective hemostatic agent and topical tissue adhesive

O sangramento durante procedimentos cirúrgicos diversos podem aumentar o tempo operatório e também pode comprometer a visibilidade do cirurgião e o próprio procedimento. A opção pelo uso de um tipo de agente hemostático é guiada por indicações precisas, fornecidas principalmente por resultados de estudos experimentais e clínicos. O objetivo deste artigo é possibilitar de forma didática o conhecimento desses agentes hemostáticos e adesivos teciduais que podem ser utilizados como alternativas no intuito de fazer hemostasia, vedações e junção de tecidos...

[Topical haemostatic agents and tissue adhesives]. / Agentes hemostáticos locais e adesivos teciduais.

In the last ten years the hemostatic agents and tissue adhesives have been frequently used and they are positive alternatives to prevent excessive blood loss. The objective of this review is to discuss the characteristics of each of these agents to facilitate the surgeon's decision when choosing the most suitable product for every type of bleeding and nature of hemorrhage. A survey of the literature on the subject, in English and in Portuguese, was conducted using PubMed (www.pubmed.com) and Google (www.google.com.br) to find recent articles on the topic. Based on these studies, the authors conducted a didactic review on the hemostatic agents and tissue adhesives and concluded that there is a hemostatic agent to be used in each specific scenario.

Agentes hemostáticos locais e adesivos teciduais / Topical haemostatic agents and tissue adhesives

Nos últimos dez anos os agentes hemostáticos e os adesivos teciduais têm sido usados frequentemente e são uma alternativa positiva para evitar a perda sanguínea excessiva. O objetivo dessa revisão é discutir as características de cada um desses agentes para facilitar a decisão do cirurgião na escolha do produto mais adequado para cada tipo de sangramento e natureza da hemorragia. Uma pesquisa da literatura sobre o assunto, nas línguas inglesa e portuguesa, foi conduzida usando o PubMed (www.pubmed.com) e Google (www.google.com.br) para encontrar artigos recentes sobre o tema. Com base nestes estudos, os autores fizeram uma revisão didática sobre os agentes hemostáticos e adesivos teciduais e concluem que existe um agente hemostático a ser usado em cada cenário específico.

In the last ten years the hemostatic agents and tissue adhesives have been frequently used and they are positive alternatives to prevent excessive blood loss. The objective of this review is to discuss the characteristics of each of these agents to facilitate the surgeon's decision when choosing the most suitable product for every type of bleeding and nature of hemorrhage. A survey of the literature on the subject, in English and in Portuguese, was conducted using PubMed (www.pubmed.com) and Google (www.google.com.br) to find recent articles on the topic. Based on these studies, the authors conducted a didactic review on the hemostatic agents and tissue adhesives and concluded that there is a hemostatic agent to be used in each specific scenario.

Experimental study about migration of wires inserted in rabbits´ shoulder / Estudo experimental sobre migração de cabos inseridos no ombro de coelhos

Metallic wires are used to stabilize clavicle, sternoclavicular joint and acromioclavicular joint in cases of fracture or dislocation. In spite of being unusual, these wires can migrate from its original place to inner side of the chest, going to mediastinum, including the heart and great vessels, and in the lungs, promoting potential death risks. The exact mechanism of this migration is unknown, but the literature suggest that intra-thoracic negative pressure and the gravity force have a significant impact. Objective: Study the migration dynamics of metallic wires inserted near the rabbits? shoulder articulation. Methods: Kirschner wire segments were inserted nearly rabbits? left shoulder articulation and after 60 days these material migration dynamics was evaluated through radiography. Results: The wire segments moved upward in 85% of the rabbits, to cephalic direction and to caudal direction. There was no movement toward the ventral or to inner part of the chest.

[Chest wall reconstruction in acquired defects]. / Reconstrução da parede torácica nos defeitos adquiridos.

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com) and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

Reconstrução da parede torácica nos defeitos adquiridos: [revisão] / Chest wall reconstruction in acquired defects: [review]

Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com) and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

A indução de fibrilação atrial não sustentada pré-implante constitui-se em critério para a não utilização da estimulação atrial definitiva? / Is atrial fibrilation inducibility prior to implant a criteria for do not performing permanent atrial pacing?

Este trabalho visa correlacionar a incidência de fibrilação atrial(FA) com os critérios para escolha do modo de estimulação cardíaca definitiva. Foi realizado um estudo prospectivo de 44 pacientes consecutivos, submetidos a implante de marcapasso com estimulação atrial definitiva(EAD). As indicações para o implante foram: disfunção do nó sinusal em 20 pacientes, BAV 3º grau em 11 pacientes, BAV de 2º grau em 7 pacientes, taquicardia paroxística supra-ventricular em 3 pacientes, hipersensibilidade do seio carotídeo em 2 pacientes e síncope vaso-vagal em 1 paciente. O modo de estimulação utilizado foi AAI (47,7 por cento) e DDD(48,7 por cento)e, em todos os casos, a estimulação foi feita com cabo-eletrodo de fixação ativa. O tempo médio de seguimento foi de 47,8 meses. Antes do implante do marcapasso os pacientes foram submetidos a testes de avaliação do sistema juncional AV (determinação do ponto de Wenckebach) e estabilidade atrial, com estimulação atrial transesofágica ou intra-cavitária, sendo selecionados para implante em EAD apenas pacientes que apresentaram fibrilação atrial não sustentada (FANS) ou átrio estável. Dos 44 pacientes etudados, 4 apresentaram FANS durante os testes. Destes,1 paciente desenvolveu FA crônica, tornando desnecessária a EAD, e outro apresentou episódios repetidos de FA, revertidos ao ritmo sinusal com amiodarona. Os outros 2 pacientes ainda estão em seguimento sem apresentar fibrilação atrial. Considerando que: 1 - o marcapasso com EAD associa-se a uma baixa incidência de FA no pós-operatório; 2 - a necessidade de alterar o modo de estimulação é mínima quando são observados os resultados dos testes pré-operatórios;3 - a indução da FANS no pré-operatório parece indicar que o paciente irá desenvolver FA durante a evolução, o que não impede que se proceda a EAD, mesmo que por um período de tempo limitado...