Search

Radiological and clinical analysis was performed in 5 patients with posterior fossa dural arteriovenous fistulas (DAVFs) with isolated sinus segment due to sinus thrombosis, and their patho physiological, diagnostic, and therapeutic concerns were discussed. Patients ranged in age from 36 to 73 years old with a mean of 57 years and included 2 males and 3 females. Two patients presented with ataxia, one with ataxia and bruit, one with atypical facial pain, and one with parietal dysfunction. One patient had a history of hemorrhagic event. DAVFs were located at transverse-sigmoid sinus (3 cases), superior petrosal sinus (1 case), and straight sinus (1 case). They were fed by many branches of external carotid artery including middle meningeal artery, ascending pharyngeal artery, posterior auricular artery, occipital artery, meningeal branches of vertebral artery and posterior cerebral artery, and meningohypophyseal trunk of internal carotid artery. Shunt flow drained into contralateral transverse-sigmoid or supratentorial sinuses via the isolated venous segment through markedly dilated cortical and/or deep venous systems, which caused altered normal venous drainage pattern and venous hypertension. Transarterial embolization in multiple stages (mean 3.4) using n-butyl cyanoacrylate (NBCA) could alleviate symptoms in all cases. DAVFs were almost totally obliterated in 3 patients. Further embolization in one case, and surgical excision in one case were planed because of some residual dilated cortical venous drainage. Posterior fossa DAVFs with isolated sinus segment accompany markedly dilated cortical and/or deep venous systems. They could cause cerebellar, brainstem, or cranial nerve dysfunctions, and sometimes present distant supratentorial symptoms or hydrocephalus due to abnormal venous drainage and venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

A series of thirteen patients with "polar hands", painful fissuring of fingertips, is documented in Antarctic medical practice together with the results of treatment by cyanoacrylate (Histoacryl Blue) human tissue adhesive. Reduction in tenderness and pain allowing improved finger function and a quicker resolution was observed. Cyanoacrylate is a viable adjunct in the treatment of painful superficial finger fissures.

Over a period of 15 years selective embolization of the renal artery was performed in 22 patients (15 men, 7 women; mean age 47.5 [5-73] years), using a percutaneously introduced coaxial technique with a 3F catheter. Tissue glue (N-butyl-2-cyanoacrylate) was employed in 18 cases, spiral wire in two, detachable balloon in three and gel-foam in one case. The bleeding had been iatrogenic in 20 cases, in one it was the result of a traffic accident, while in another the bleeding was from an angioma. The procedure was successful at the first attempt in 21 patients, permanently arresting bleeding in 18. There were three complications, transitory and not requiring treatment in two. In one patient gel-foam embolization went to a wrong site and a nephrectomy had to be performed.--This form of selective embolization is the treatment of choice in traumatic injury to a renal vessel.

Vein of Galen malformations may present as congestive heart failure in the neonate and are usually fatal if untreated. Early studies using transcatheter embolization techniques, in a series of 22 patients, had a 50% mortality rate and a 37% incidence of severe mental retardation in survivors. Modifications of embolization techniques and neonatal care have improved the outlook in a more recent series of 11 patients. The diagnosis was established within 3 days of life in 91% of the cases. No mortality occurred, and 6 of the patients were functionally normal at up to 30 months' follow-up. Although two patients had severe neurologic deficits and/or a seizure disorder, only one case was possibly temporally associated with the embolization procedure. Some developmental delay was noted in one other patient. These improvements result, in part, from modifications of the treatment protocol, including earlier diagnosis, avoidance of digoxin, improvement in the application of newer microcatheters and acrylic polymers (n-butylcyanoacrylate), avoidance of overly aggressive neurosurgical procedures, and the use of stable central vascular access for total parenteral nutrition accompanying other general improvements in neonatal care.

Background: To investigate the indications, outcomes, and complications of N-butyl cyanoacrylate tissue adhesive for ocular clinical use. This tissue adhesive is under investigation by the Food and Drug Administration., Methods: N-butyl cyanoacrylate was used as an investigational device on 44 patients at the authors' institution over a 2-year period. The charts of these patients were reviewed., Results: The indications for glue application included corneal perforation (19 eyes), descemetoceles (9 eyes), leaking filtering blebs (6 eyes), stromal thinning (5 eyes), wound leaks (4 eyes), and exposure keratopathy (1 eye). A bandage contact lens was used over the dried tissue adhesive in 38 of the 44 eyes. Length of glue adherence ranged from 1 to 660 days (mean, 72 days). Outcome was penetrating keratoplasty (19 eyes), no further intervention (14 eyes), enucleation (4 eyes), surgical revision of a filter (2 eyes), scleral patch graft (1 eye), conjunctival transplant (1 eye), failed tarsorrhaphy (1 eye), suturing of wound (1 eye), and a lamellar graft (1 eye). Vision improved in 52% (23/44) of eyes., Conclusion: This tissue adhesive may soon be available to all ophthalmologists, and the authors' experience demonstrates that it is an effective method of temporary or permanent closure of an impending or frank perforation.

Thirteen patients with ages between 53 and 74 years had development of free wall left ventricular rupture after a myocardial infarction (mean interval, 3.8 days). All patients showed clinical signs of cardiac tamponade. Diagnosis was established by bedside multiple pressure monitoring and echocardiography, which showed pericardial effusion with compression of the right ventricle. Cardiac catheterization was not performed. A new surgical technique was employed for the repair. After the pericardium was opened and cardiac tamponade was relieved, the myocardial tear was identified. A Teflon patch was applied over the area and glued to the heart surface with a surgical glue (cyanoacrylate). Cardiopulmonary bypass was not used except in a patient with a posterior tear. The method was consistently effective in controlling bleeding from the myocardial tear. All patients survived the operation and were discharged from the hospital a mean of 15 days after the operation. Follow-up extending up to 5 years (mean, 26 months) shows a 100% survival, 11 asymptomatic patients, and 2 patients with mild exertional angina. The technique is a simple, effective, and safe method for repair of subacute cardiac rupture and obviates the need for suturing on an infarcted ventricle.

We report a successful endoscopic obliteration of a large recurrent tracheo-esophageal fistula (diameter 0.6 cm, length 2 cm) in a 12-year old girl, using a combination of N-butyl-2-cyanoacrylate followed by polidocanol injected through a polyethylene catheter. The severe pulmonary infection, that rendered surgery potentially life-threatening, resolved after endoscopic closure. The girl remained asymptomatic for 14 months after the first obliteration. Chronic coughing was the symptom of relapse. A follow-up endoscopy revealed that most of the N-butyl-2-cyanoacrylate had disappeared from the fistula, whose endoscopic appearance was unchanged. A second obliteration with the same products was performed. The girl has again been asymptomatic for 10 months. The endoscopic obliteration is a worth-while technique, to be considered as an alternative to surgery in patients presenting with a complicated recurrent tracheo-oesophageal fistula.

A series of 7 cases of aneurysmal bone cysts (ABC), all but 1 located in the pelvic bones, which were treated by transcatheter embolization is presented. Five embolizations were performed for primary treatment, while in 2 patients they were performed preoperatively. In all patients a definite histological diagnosis was established by open biopsy, and plain radiographs as well as computerized tomography (CT) were applied for evaluation of the results. The embolizing materials were tissue adhesive for permanent, and Gelfoam for preoperative vessel occlusions. Of 5 lesions treated for the purpose of definitive embolization, 3 (all located in the superior pubic ramus) showed complete ossification; in one, partial remineralization and progression occurred. In a further patient with a secondary ABC, partial reconstitution was recorded. Both preoperative embolizations resulted in successful en bloc resection with minimal blood loss. Transcatheter embolization is the treatment of choice for the highly vascular ABC in unfavorable anatomical locations.

Endoarterial embolization is now the treatment of choice for traumatic carotid-cavernous fistulas. However, traumatic or surgical occlusion of the carotid artery, or special cases such as unilateral double carotid-cavernous fistula, can make the transarterial approach hazardous or impossible. In such cases transvenous embolization can be an alternative treatment, although it is sometimes difficult or impossible to perform. Three cases of direct traumatic carotid-cavernous fistula and their treatments are described. In the first case, unilateral double carotid-cavernous fistula was treated with detachable balloons. In the second case, the fistula had previously been treated by trapping; percutaneous angioplasty was performed with subsequent plastic embolization of the fistula. In the third case, transarterial and transvenous approaches were impossible, and the patient was cured by combining a surgical procedure and an interventional technique.

The use of Histoacryl glue in the performance of microvascular anastomosis was examined in a rat model. An improvement in efficiency as noted by the decreased ischemic time and diminished bleeding with clamp removal was noted. Histological examination of the anastomosis at one and three weeks revealed a mild foreign body type inflammatory response to glue and suture material with no media necrosis and only minimal fibrointimal proliferation.

In 25 patients with meningiomas, the tumours were embolised with liquid embolising materials following angiography. Nine subselective flow-guided Ethibloc embolisations were performed, four selective Ethibloc embolisations and 16 selective Histoacryl embolisations. The physical properties and pathophysiological behaviour make liquid embolising materials superior to particles. The use of micro-catheter systems introduced as far as possible into the feeding vessels makes Histoacryl embolisation an uncomplicated, effective and painless method for obliterating the vascular bed of the tumour.

In this paper we have reviewed cutaneous wound closure in facial plastic and reconstructive surgery using two different tissue adhesives: (1) Fibrin glue (Tisseel), and (2) N-butyl-2-Cyanoacrylate (Histoacryl Blue). Fibrin glue was used on 23 patients: eight lower blepharoplasties, eight hemi-facelifts, five mid browlifts and seven facial reconstructive procedures. Histoacryl glue was used in 108 blepharoplasty incisions, 30 facelift incisions, 21 submental incisions for liposuction, and 19 local flaps for facial reconstructive procedures. Comparison was made of the adequacy of bonding, cosmetic result of the incision, ease of use and cost. The results of our experience with tissue adhesives indicate the use of fibrin glue mainly on the undersurface of flaps. We think histoacryl glue is the ideal tissue adhesive for surface cutaneous wound closure in regards to safety, reliability, tensile strength and cost effectiveness.

Surgical closure of a bronchopleural fistula following right pneumonectomy for squamous cell carcinoma was achieved with monomeric n-butyl-2-cyanoacrylate. Previous attempts at closure by conservative and endoscopic means were unsuccessful. Tissue adhesives are useful in the surgical or endoscopic management of bronchopleural fistula.

Artificial epithelial corneal barriers of histoacrylic glue have been used since 1968. Experimental and clinical studies have since then indicated that the barrier protects the cornea from repopulation by polymorphonuclear leukocytes from the tears and thereby from tissue-destroying enzymes. Using light-, scanning electron- and transmission electron-microscopical techniques, the differences between a successful and an unsuccessful treatment of a corneal ulcer with histoacrylic glue have been investigated. The successful glue barrier is a continuous membrane tightly bound to the corneal stroma and preventing population of the stroma by polymorphonuclear leukocytes from the tear fluid.

Three patients with distal bronchopleural fistulas, in whom chest tube and drainage did not lead to closure of the fistulas, were successfully treated with tissue glue (Histoacryl), delivered through a thoracoscope. The fistulas were identified by injecting methylene blue through the suction canal of a fibreoptic bronchoscope. Patient 1 had multiple fistulas, needed several treatment sessions, and the effect lasted for 18 months, after which the fistulas recurred. The other two patients showed no sign of recurrence of the fistulas; in one patient until death from other causes after 4 months; and in the other for a follow-up period of 18 months.

An investigation was undertaken to examine the effects of the butylcyanoacrylate adhesives (Histoacryl) on vascular tissue. Using a rat femoral artery model, 18 vessels were prepared. End-to-end anastomoses were completed using three stay sutures of 10-0 nylon inserted at 120 degrees intervals around the vessels, followed by direct application of Histoacryl glue. Results showed a patency rate of 73 percent, the vessels being inspected between two and 14 weeks after anastomosis. Histological examination of the vessels showed an early marked foreign body granulomatous response with giant cell formation, and later extreme thinning of the vessel wall, splitting of the elastic lamina, and calcification of the media. It was concluded that the histologic results of butylcyanoacrylate tissue adhesives on the vessel wall preclude their use on human subjects.

Enbucrilate (butyl-2-cyanoacrylate; Histoacryl [West Germany], no comparable US product) is a tissue adhesive used in the management of corneal perforations that may have a therapeutic value in suppressing selective pathogens isolated, from corneal infections. In three patients with confirmed corneal infections, varying degrees of inhibition were observed. Bacteriostatic activity was most pronounced against gram-positive microorganisms, and no activity was observed against gram-negative organisms. It appears that this chemical adhesive provided an ancillary means of promoting healing of corneal perforations.

The tissue adhesive butyl cyanoacrylate was evaluated in the repair of injured porcine kidneys following low-velocity ballistic trauma. This technique was compared to the classic renal repair using chromic suture and a patch of perirenal fat. The repair with butyl cyanoacrylate was less time consuming (four minutes vs. 28 minutes for the controls) and decreased blood loss (67 cc vs. 180 cc for the controls). Ten days post injury the kidneys repaired with tissue adhesive showed minimal intraparenchymal hemorrhage or perirenal bleeding, while two of the four (50%) suture-repaired kidneys showed intrarenal microhemorrhages and one (25%) developed a perirenal hematoma. Perirenal adhesions were noted in both groups. Vital signs, IVP's, creatinine clearance, and serum and urine chemistries were nearly identical in the two groups. The results show that low-velocity ballistic injuries of renal tissue can be repaired effectively and more efficiently with the use of butyl cyanoacrylate when compared to conventional suturing methods.

This paper presents 4 cases in which the punctum had been temporarily occluded with tissue adhesive, still showing toxic tissue reaction years later. Abscess, dacryocystitis, dacryocystitis with dacryolithiasis, dacryocellulitis and polyposis were found. In the light of these findings and the relevant literature-especially with regard to late injuries-it is not advisable to use tissue adhesive, at least not for the purpose of punctal occlusion.

This study was undertaken to examine the effectiveness of a commercially available n-butyl-2-cyanoacrylate (Histoacryl blue+) as a local treatment for cutaneous ulcers. Two ulcers, approximately 0.5 cm2 each, were made on the backs of 30 hamsters. The right side was covered with a thin film of tissue adhesive, while the left side was left untreated as a control. Animals were sacrificed at various times post-operatively, the tissue excised, processed, and examined with the light microscope. Results showed that cyanoacrylate decreased the inflammatory exudate early in the experiment, and epithelial migration occurred slightly earlier in experimental tissue. Scab formation was absent in experimental sites until the layer of adhesive was lost. After 2 days, healing was comparable in both experimental and control, and the sites were indistinguishable histologically at day 5.

A neuroma arises due to uncoordinated growth of axis cylinders in proliferated granulation tissue. An intact perineurial tube prevents further growth of the funiculi. Animal experiments were designed to close the perineurial tube such that it was impervious to water. Earlier experiments with purse string suture of the perineurial tube or closure with Histoacryl were not always successful. After severance of the sciatic nerve of the rat and shortening of the axons, the epineurial tube was plugged with Histoacryl blue and closed so that it was impervious to water. The preparations were checked optically and histologically. The results were promising, so that this technique was applied clinically.

The management of 12 children is reported in relation to the use of the synthetic adhesive Butyl-Cyanoacrylate in the prevention and treatment of ileus in children. This method is discussed and contrasted to standard procedures.

Bilateral vertical incisions were made in the maxillary and mandibular labial mucosa of eight young green vervet monkeys. Incisions were closed with either interrupted 4-0 black silk sutures or by the application of isobutyl cyanoacrylate. Mucosal specimens containing the incisions were examined histologically and scored for degree of inflammation at 1, 3, 10, and 20 weeks. The results showed that cyanoacrylate and sutures did not produce similar inflammatory responses.

A 62-year-old female with a history of progressive angina experienced an acute myocardial infarction. Seven days later, cardiac rupture ensued. She underwent surgical repair without the aid of extracorporeal circulation. A Teflon patch was glued over the myocardial tear with medical adhesive. She recovered and is leading a normal life, 15 months after surgery.

A prospective evaluation of Histoacryl tissue adhesive for the repair of simple scalp wounds is described. Fifty wounds were repaired using the adhesive and, on examination 5 days later, 49 wounds were fully healed, the remaining wound having only a small area of dehiscence. The advantage of this method of wound repair is discussed.

Failures in vitreous surgery for complex vitreoretinal disorders are frequently due to an inability to keep preexisting or iatrogenic retinal breaks permanently closed. We have used transvitreally delivered cyanoacrylate tissue adhesive to seal retinal breaks in selected patients undergoing vitreous surgery for complicated retinal detachment. With a minimum follow-up period of 6 months, all but one retinal hole have remained closed and complete retinal reattachment posterior to the encircling buckle was achieved in 18 of 25 eyes (72%). In 10 of the 25 eyes (40%) the final visual acuity was 5/200 or better.

The incidence of recurrent tracheoesophageal fistula (TEF) following a primary surgical repair for TEF and esophageal atresia varies between 5% and 15%. Further surgery is not only associated with a high morbidity and mortality but may cause a great deal of stress and anxiety for the parents who in this part of the world are reluctant to allow their child to undergo surgery. This is the first successful endoscopic obliteration of a recurrent TEF in a Saudi child using Histoacryle (n-butyl-z-cyanoacrylate) and Polidocanol (aethoxysclerol).

Transrenal closure of the ureter with butyl-2-cyanoacrylate using adjuvant balloon catheter occlusion was successfully performed for the palliative management of inoperable vesicovaginal and vesicosacral fistulas in 3 patients. Unilateral percutaneous nephrostomy provided supravesical urinary diversion as well as access for permanent embolization of the ureter. The contralateral kidney was nonfunctional in 2 patients. In the third, in addition to unilateral ureteral occlusion, the contralateral kidney was defunctionalized by embolization of the renal artery ("radiological nephrectomy") to avoid the need for bilateral nephrostomy drainage.

Implants of porous calcium sulphate dihydrate with a surface coating of n-butyl 2-cyanoacrylate were studied in circular defects in the skulls of rabbits to determine the extent of their replacement by new bone and to examine the reaction of the surrounding tissue. The defects were compared with control cavities that were allowed to fill with blood clot. The material was well tolerated by the tissues and did not slow bony healing. The pattern of ingrowth of bone in the skulls with implants was different than that of the controls. Further investigations are being undertaken to strengthen the implants and to adjust the rate of biodegradation. Possible future clinical applications are discussed.