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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.

Three patients with postpneumonectomy bronchopleural fistula were treated with endoscopic gluing of the fistula. The technique and the results of this method are described.

Since the nonsuture repair of blood vessels with methyl-2-cyanoacrylate was described in 1960, the advantages of a tissue adhesive over conventional sutures became evident. A survey of 115 otolaryngology programs showed that cyanoacrylates, mainly butyl-2-cyanoacrylate (B2C), are used more extensively than indicated in the literature. Cartilage grafts are commonly used in facial plastic procedures. In a study comparing B2C with conventional suture techniques in securing rabbit auricular cartilage autografts, sutures were used in the left control ear and B2C was used in the right experimental ear. Rabbits sacrificed at two weeks to 12 months showed graft viability in all samples and no statistically significant histologic difference between the grafts secured by either method.

During a low translumbar aortogram, a kidney was damaged leading to uncontrollable haematuria. The damaged segmental artery was selectively occluded by the injection of butyl-2-cyanoacrylate through a catheter. Bleeding stopped immediately, thereby avoiding a nephrectomy which had been planned. The complications and potential hazards of therapeutic embolisation are discussed.

The technique and efficacy of therapeutic catheter embolization of the kidney with butyl-2-cyanoacrylate (Histoacryl) were studied in 80 rabbits (including control groups) and in 10 dogs. A mixture of butyl-2-cyanoacrylate, 50% glucose, and tantalum powder was used for the embolization. Complete and permanent vascular occlusion was found in nearly all cases. The main complication observed was a reflux of embolizing material into the lumbar arteries, which occurred in seven rabbits. Clinically therapeutic embolization was performed in six patients with hypernephroma. The indication for embolization in these patients, as well as in two others with iatrogenic lesions, was pronounced hematuria. Cessation of bleeding was achieved in all cases. For embolization the coaxial catheter technique is recommended; in special cases with extensive arteriovenous shunts, adjunctive balloon occlusion would be advisable.

A stump neuroma is caused by the disorganised growth of axon cylinders into proliferating granulation tissue, but this is stopped by an undamaged epineural sleeve. We report experiments in the rat in which the epineural sleeve of the stump of the sciatic nerve was freed from nerve fascicles for about 5 mm and then sealed with a synthetic tissue adhesive. Neuroma formation was largely prevented in comparison with the results of other methods. This new technique has been used to treat 68 painful neuromas in 36 patients. All but three of the patients were cured or improved and none were made worse.

Despite the development of new alternative embolic agents, the endovascular treatment of brain arteriovenous malformations continues to frequently require the use of cyanoacrylic glue, especially in situations where particulate or sclerosing agents are ineffective, such as when flow is very rapid or fistulous. Because isobutyl 2-cyanoacrylate (IBCA), the most commonly used embolic glue, is no longer available or manufactured, a real need exists for an alternative fast polymerizing agent. In vivo and in vitro studies were performed to compare IBCA with n-butyl 2-cyanoacrylate (NBCA, supplied as Histoacryl Blue), a tissue adhesive approved for surgical use in some countries. Polymerization times in static plasma were compared, and the effect of the addition of iophendylate oil or glacial acetic acid on polymerization was assessed. Polymerization times in vivo were compared after intraarterial injection into the internal carotid artery in pigs using a standardized technique. The histopathologic reactions to each glue in the embolized pig rete were assessed and compared over a period of 0-60 days after embolization. Our results show that while NBCA polymerization is demonstrably faster than IBCA in vitro, intraarterial injections of each glue show no significant difference in polymerization times. Like IBCA, NBCA polymerization can be predictably prolonged by the addition of oil or glacial acetic acid, though the effect is less for NBCA. Histopathologic reactions were similar, with acute vasculitis observed, becoming chronic and granulomatous after about 1 month. Both glues showed frequent foci of extravascular extrusion through the embolized rete and recanalization of previously occluded embolized vessels. We conclude that NBCA has clinical and biologic behaviors similar to IBCA, and therefore should be an acceptable alternative to IBCA for intravascular use.

During the last 5 years, over 1,500 minor lacerations in children were treated in the emergency room of Nahariya Regional Hospital, by the adhesive "Hystoacryl Blue," with gratifying results. The method, its advantages, and special precautions are described.

The tissue adhesive butyl-2-cyanoacrylate mixed with lipiodol and tantulum powder is an excellent agent for superselective catheter embolisation of small vessels. The mixture is low viscous and can be injected through fine catheters. Occlusion is independent of blood clotting and is permanent. A coaxial catheter technique is recommended or, in cases of difficulty, a ballon catheter can be floated in. Super-selective embolisation was used in 15 patients, in seven for the kidney in eight for the pelvis. Indications were bleeding from the kidney, partial defunctioning of the kidney, tumours in single kidneys and bleeding from carcinomas in the bladder, prostate or cervix.

The use of tissue adhesives has been widely studied since the 1960s. Since then they have found use in specialties like plastic surgery, neurosurgery, ENT surgery and dental surgery. Several papers have reported their safe use, both clinically and experimentally, particularly of the newer homologue n-butyl/2-cyanoacrylate (Histoacryl). In this study 43 patients (46 wounds) whose operations involved a groin incision were randomised into two groups for skin closure either with Dexon subcuticular suture (23 wounds) or Histoacryl glue (23 wounds). We found that both sets of wounds healed well with no wound infections or excessive inflammation when assessed at one week and four weeks. However the glued wounds had consistently better cosmesis scores (mean score 4.71 at four weeks) compared to the subcuticular Dexon wounds (mean score 4.00 at four weeks) and P value of less than 0.05. We feel that there is a place for tissue adhesives in skin closure for some general surgical wounds.

Transcatheter arterial embolization is an interesting technique; its usefulness in urology has not yet been well assessed. The properties and characteristics of some embolic materials among the more commonly used were investigated by means of a new experimental model, i.e., transcatheter embolization of rat kidney. Autologous clots and Oxycel were found to give a transient embolization, whereas Gelfoam, barium, and cyanoacrylates did not allow recanalization or revascularization. Only barium was found in venous vessels. The findings are discussed in view of the clinical application of the embolic materials considered.

We report on our two years' experience with the tissue adhesive n-butyl-2-cyanoacrylate. During this period 202 patients suffering from esophagogastric varices were treated endoscopically. With the aid of the tissue adhesive the conventional sclerotherapy with Polidocanol 1% has been clearly improved. Problems concerning early recurrent bleeding and fundic varices are satisfactorily solved. The endoscopic hemostasis of severe variceal bleedings has become safer and surer. The overall hospital mortality of these patients has sunk from 31.5 to 17.5%. Cyanoacrylate is a very useful substance for obliterating large esophagogastric varices. However, the complete elimination of esophageal varices, which is the guarantee for a long-term freedom from recurrent bleeding, can only be achieved by using a genuine sclerosing agent.

The fixation of mini-fragments in phalangeal or metacarpal bones after exact operative reposition is often very difficult. The use of pull-out-wires or Kirschner-wires leads often to a new dislocation or the fragment breaks. Such little fragments we fix with a synthetic glue (Histoacryl). The results are good. Infections have not been observed.

The effect of the adhesive Histoacryl Blue on the abdominal organs (liver, stomach, intestines, colon, kidneys, bladder, aorta inferior vena cava and skin wounds) of 15 dogs was investigated histologically. The adhesive was applied in thin or thick layers in various ways: applied on intact or injured surfaces, or introduced into the parenchymal organs. The animals were killed 1, 2, 4, 8 weeks and 3 and 6 months after application of the adhesive and the organs containing Histoacryl Blue were processed histologically. The success of adhesion depended, irrespective of the organ, upon the technique of application and on the quantity of the adhesive used.

Four patients with central melting perforating corneal ulcers were treated by n-butylcyano acrylate gluing of the ulcer region. The glue facilitated healing of the eyes, and when the glue scaled off weeks later the corneas were left with stable leucomas. The glue membrane appears to prevent tear-borne polymorphonuclear leucocytes (PML) from reaching the ulcer region and to diminish activation of PML, with the consequent dramatic fall in tear fluid polymorphonuclear leucocyte neutral collagenolytic protease (PML-c-ase). After gluing, the tear fluid content of serum antiproteases returns to normal levels within days. This might indicate a decreased leakage of proteins from conjunctival vessels.

We evaluated the use of transvitreal cyanoacrylate retinopexy in the treatment of experimental rhegmatogenous retinal detachment during vitreous surgery in rabbit eyes filled with silicone oil. The view to the fundus was superior to that obtained in our previous model of cyanoacrylate retinopexy in the air-filled eye. Glue delivery was consequently both easier and more precise through silicone oil relative to air. The chorioretinal adhesions produced with cyanoacrylate tissue adhesive were compared with those produced by transscleral retinal cryopexy and were found to be more rapid in onset as well as stronger. An exaggerated tissue response adjacent to the cyanoacrylate site suggested a potential toxic chemical or thermal reaction, or both, to the tissue adhesive, but there was no evidence of any distant ocular effects.

The present study demonstrates the feasibility of chronic anticoagulation in rabbits and of estimating the resulting increase in blood loss following extraction of four front teeth from labeled red cell disappearance curves. This setup proved useful for the evaluation of hemostatic techniques. Socket packing with oxidized cellulose soaked in thrombin solution or local application of cyanobutylacrylate reduced early blood loss; oral administration of tranexamic acid reduced both early and late bleeding; the combination of socket packing and oral tranexamic acid completely abolished the excessive blood loss that resulted from anticoagulation alone.

Osteosynthesis with n-butyl cyanoacrylate was attempted in 10 cases. Maxillomandibular fixation was maintained for only 48-72 hours. No mobility of the fractured segments was found when tested by moderate manual force. Union took place uneventfully in all but one case. Cases were followed from one to six months with appropriate radiographs at regular intervals. Blood, urine, and serum analyses revealed no significant changes when compared pre- and postoperatively. Chromosomal study revealed no rise in the frequency of SCEs postoperatively.

Two cases of unresectable intra-cranial arterio-venous malformation (AVM) are reported, treated by direct intra-operative embolization. A 50% mixture of Butyl-2-Cyano-Acrylate and Mono-Iodo-Stearate of Ethyle (Duroliopaque) was used after catheterization of some of the feeding cortical arteries. No intra-operative angiography was performed. The first patient, admitted after subarachnoid hemorrhage and presenting with a mild transient right hemiparesia and aphasia, showed evidence of a left temporal AVM with a left middle cerebral artery supply and contribution from the left cerebral posterior artery. The AVM was embolized with 3 cc of the mixture. A mild aphasia occurred after surgery and completely recovered after two weeks. Roughly half of the AVM was occluded on the postoperative angiograms. The second patient suffering from a long history of seizures had a huge right frontal AVM, with a right middle cerebral artery and right anterior cerebral artery supply, and contribution from a right lenticulostriate artery, the left anterior cerebral artery and the right posterior cerebral artery. The AVM was embolized with 7 cc of the mixture. A complete palsy of the left upper limb occurred after surgery, with complete recovery after two weeks. On the post-operative angiograms, more than three fourth of the AVM was occluded.

A method for radio-nuclide labelling of histo-acryl/lipiodol with 133Xe gas is described. The method consists of dissolving the gas in lipiodol under sterile conditions. After embolization and angiography, the localisation of the embolizing material can be determined by means of a scintillation camera. The labelling method was used in 15 patients. In all patients the position of the embolizing material, as demonstrated by scintigraphy, corresponded with the radiological findings. It was not possible to demonstrate escape of the material by scintigraphy.

N-butyl cyanoacrylate tissue adhesive can be easily placed in the lid puncta to serve as a temporary method for punctal occlusion. Such a procedure is a useful therapeutic trial in borderline cases of keratoconjunctivitis sicca being considered for further permanent punctal occlusion or in patients where a temporary dry eye condition is expected to be resolved in the near future.

Collateral circulation and recanalization represent the main problems of organ-ablating renal embolization. Different animal models were used to study the influence of central, peripheral, and capillary occlusion on organ necrosis. The first laboratory experiments were performed to optimize transcatheteral application of the embolization media tested (Gelfoam powder, Histoacryl, Ethibloc). Experiments with the model of a normal rat kidney (n = 400) showed that only capillary embolization homogeneously occluding the entire arterial system resulted in complete organ necrosis, while following central (renal artery ligation) or peripheral (Gelfoam powder) occlusion, areas of intact parenchyma remained. Ethibloc/glucose proved to be the embolization medium best suited for capillary embolization (radiopaque, inert, slow resorption). Studies with the model of unilateral renal hypertension of the rat (n = 146) demonstrated the equivalent therapeutic efficiency on blood pressure of Ethibloc embolization (57% cured, 21% improved) compared to surgical nephrectomy (50% cured, 29% improved), whereas renal artery ligation (85% failed) resulted in minor improvement only. In order to adapt capillary embolization with Ethibloc/glucose to clinical angiographic techniques, we performed angioinfarction of canine kidneys (n = 15): the use of a balloon catheter is mandatory. This guarantees blood stasis during the embolization procedure and avoids embolic reflux. Possible clinical indications of capillary embolization in renal hypertension as a less invasive method are, e.g.: malignant nephrosclerosis; renovascular or glomerulonephritic contracted kidneys, and renal dysplasia. Indications for super-selective vaso-occlusion are renal aneurysms, a-v malformations, and segmental hypoplasia.

The tissue adhesive Histoacryl (2-cyano-butylacrylate) was experimentally applied to the stapes region of nine middle ears of baboons. Stapes footplate, labyrinth, and middle ear did not show any damage or injury due to the adhesive application. Only minor inflammatory reactions were observed to surround the adhesive bubbles. Histoacryl is considered safe for use in human ear surgery.

18 cases of cerebral Arterio-Venous malformations (AVM) are reported, treated by direct intra-operative embolisation. A 50% mixture of Butyl-2-Cyanoacrylate and Mono-Iodo-Stearate of Ethyl was used. The clinical history of the patients was a long history of seizures in 8 cases a sub-arachnoid or intra-cerebral hemorrhage in 9 cases, and a transient motor deficit in 1 case. The AVM site was supra-tentorial in 16 cases, and infra-tentorial in 2 cases. The AVM size was large with numerous feeders in 13 cases, and limited with a few feeders in 5 cases. Technically, after catheterisation of a cortical feeder, an intra-operative angiogram was performed (except for the first 6 cases) then the polymerizing mixture was pushed inside the feeder (from 1 cc to 3 cc routinely, depending of the AVM size; exceptionally 7 cc and 11 cc were used). In the immediate postoperative course, 1 patient died (case with the 11 cc embolization), 3 patients had a serious postoperative hemorrhage, 4 patients presented with a transient postoperative deficit, and in 10 patients the postoperative course was uneventful. The long term results are: 1 postoperative death, 1 death after recurrence of intra-cerebral hemorrhage (3 years postoperatively), 1 hemiplegia, 15 patients without long lasting complication. The embolization was performed as unique treatment in 14 cases, and was followed with the AVM removal in 4 cases (immediately in 1 case, delayed in 1 case, late after recurrence of intra-cerebral hemorrhage in 2 cases, respectively after 3 years and 2 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Butyl-2-cyanoacrylate (Histoacryl Blue) tissue adhesive successfully sealed three cases of CSF leaks encountered during orbital surgery. The application of tissue adhesive was followed by prompt cessation of leak. We have found this tissue adhesive to be a valuable technical adjunct in the intraoperative management of this difficult problem and have not seen any general or local toxic reaction to the material.