RESUMO
PURPOSE: To evaluate the efficacy of portal vein embolization (PVE) with n-Butyl-cyanoacrylate (NBCA) through an ipsilateral approach before major hepatectomy. Secondary end-points were PVE safety, liver resection and patient outcome. METHODS: Over a 5-year period 50 non-cirrhotic consecutive patients were included with primary or secondary liver cancer treatable by hepatectomy with a liver remnant (FLR) volume less than 25% or less than 40% in diseased livers. RESULTS: There were 37 men and 13 women with a mean age of 57 years. Colorectal liver metastases were the most frequent tumor and patients were previously exposed to chemotherapy. FLR increased from 422 ml to 629 ml (P < 0.001) after PVE, corresponding to anincrease of 52%. The FLR ratio increased from 29.6% to 42.3% (P < 0.001). Kinetic growth rate was 2.98%/week. A negative association was observed between increase in the FLR and FLR ratio and FLR volume before PVE (P = 0.002). In 31 patients hepatectomy was accomplished and only one patient presented with liver insufficiency within 30 days after surgery. CONCLUSIONS: PVE with NBCA through an ipsilateral puncture is effective before major hepatectomy. Meticulous attention is needed especially near the end of the embolization procedure to avoid complications. TRIAL REGISTRATION: Clinical Study ISRCTN registration number: ISRCTN39855523 . Registered March 13th 2017.
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Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Hepatectomia/métodos , Neoplasias Hepáticas/terapia , Veia Porta , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Background In large-caliber pial macrofistulae (pMF), the combination of high blood flow velocity and large efferent artery diameter makes control over the endovascular vessel occlusion difficult and may result in the inadvertent venous passage of occlusive devices or embolic agents. Case descriptions Patient 1: A 27-year-old man presented with headache and ataxia. An infratentorial pMF supplied by both superior cerebellar arteries with venous ectasia was found. The first treatment attempt using balloons and coils failed since the position of either device could not be controlled because of a distal diameter of the feeding artery of 8 mm. In a second session a pCANvas1 (phenox) was deployed at the level of the arteriovenous connection and adenosine-induced asystole allowed the controlled injection of nBCA/Lipiodol with partial occlusion of the pMF. A remaining arteriovenous shunt was occluded under asystole in a third session. The procedures were well tolerated, the patient returned to normal and DSA confirmed the occlusion of the fistula. Patient 2: A 13-year-old boy with hereditary hemorrhagic teleangiectasia presented with an intracerebral hemorrhage from an aneurysm of the left MCA. Twelve weeks after the aneurysm treatment a feeding MCA branch (diameter 4.5 mm) of a right frontal pMF was catheterized. The macrofistula was occluded by deployment of a pCANvas1, followed by the injection of nBCAl/Lipiodol under adenosine-induced asystole. Conclusion pCANvas1 and adenosine-induced asystole allow a controlled injection of nBCA/Lipiodol for the endovascular occlusion of high-flow pMF without venous passage of the embolic agent.
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Fístula Arteriovenosa/terapia , Quimioembolização Terapêutica/métodos , Embucrilato/administração & dosagem , Óleo Etiodado/administração & dosagem , Pia-Máter/irrigação sanguínea , Adenosina/uso terapêutico , Adolescente , Adulto , Angiografia Digital , Fístula Arteriovenosa/diagnóstico por imagem , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Craniotomia , Parada Cardíaca , Humanos , Imageamento por Ressonância Magnética , Masculino , RetratamentoRESUMO
OBJECTIVE: Transarterial chemoembolization is the treatment of choice for intermediate-stage hepatocellular carcinoma. However, there are no clear data supporting transarterial chemoembolization vs . transarterial embolization or regarding the best chemotherapeutic agent, which may suggest a preponderant role of ischemia over chemotherapeutic action. This study sought to evaluate the radiological response and outcome of transarterial chemoembolization modified by n-butyl cyanoacrylate addition compared to conventional transarterial chemoembolization in hepatocellular carcinoma patients. MATERIALS AND METHODS: A retrospective review identified forty-seven patients who underwent modified chemoembolization and thirty-three who underwent conventional chemoembolization between June 2006 and December 2011. The radiological response was reassessed using the modified Response Evaluation Criteria in Solid Tumors. The sustained complete response, time to progression and overall survival rates were also analyzed. RESULTS: Complete response rates were significantly higher in patients who had undergone modified chemoembolization compared to those who had undergone conventional treatment (61.7% and 24.3%, respectively; p <0.001). The rate of sustained complete response was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 236 and 37 days, respectively; p <0.001). Time to progression was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 424 and 201 days, respectively; p =0.042). Overall survival rates revealed no difference between patients who received modified chemoembolization and conventional chemoembolization (median of 483 and 399 days, respectively; p =0.316). CONCLUSION: Transarterial chemoembolization modified by n-butyl cyanoacrylate addition was superior to conventional transarterial chemoembolization in terms of the radiological response in the first imaging control. Although the sustained complete response and time to progression rates were higher for the modified chemoembolization group, no differences in overall survival rates were observed.
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Embucrilato/administração & dosagem , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular , Progressão da Doença , Métodos Epidemiológicos , Artéria Hepática , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas , Angiografia por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Bleeding from gastric varices has high mortality rate, and obliteration using N-butyl-2-cyanoacrylate is the treatment of choice. Recurrent bacteremia is rarely reported following the procedure. We aimed to report a case of recurrent bacteremia after N-butyl-2-cyanoacrylate treatment and to review published cases. CASE PRESENTATION AND REVIEW: In May 2014, a 43-year-old Brazilian male presented with lower gastrointestinal bleeding. Endoscopy showed active bleeding from gastric varix. Injection of N-butyl-2-cyanoacrylate was performed and the patient was discharged. Over the next 4 months he presented with three episodes of bacteremia with severe sepsis and no identifiable focus of infection. Oral prophylaxis was initiated in September 2014 and he has remained free of bacteremia. Six other cases of recurrent bacteremia following sclerosis with N-butyl-2-cyanoacrylate were reported in the literature. All patients had portal hypertension and bleeding from gastric varices. Average age of patients was 55.7 years and the median time from endoscopic procedure to the first episode of bacteremia was 105 days (range 14-365). The mean number of episodes of bacteremia per patient was 2.5. CONCLUSION: Recurrent bacteremia associated with endoscopic treatment with N-2-butyl-cyanoacrylate is rare, but should be suspected in patients in which investigation shows no other focus of infection. Secondary prophylaxis should be considered after the first episode.
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Bacteriemia/induzido quimicamente , Embucrilato/efeitos adversos , Varizes Esofágicas e Gástricas/tratamento farmacológico , Streptococcus anginosus/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Ceftriaxona/uso terapêutico , Embucrilato/administração & dosagem , Hemorragia Gastrointestinal/tratamento farmacológico , Humanos , Injeções , Masculino , Recidiva , Streptococcus anginosus/efeitos dos fármacos , Resultado do TratamentoRESUMO
OBJECTIVE: Transarterial chemoembolization is the treatment of choice for intermediate-stage hepatocellular carcinoma. However, there are no clear data supporting transarterial chemoembolization vs . transarterial embolization or regarding the best chemotherapeutic agent, which may suggest a preponderant role of ischemia over chemotherapeutic action. This study sought to evaluate the radiological response and outcome of transarterial chemoembolization modified by n-butyl cyanoacrylate addition compared to conventional transarterial chemoembolization in hepatocellular carcinoma patients. MATERIALS AND METHODS: A retrospective review identified forty-seven patients who underwent modified chemoembolization and thirty-three who underwent conventional chemoembolization between June 2006 and December 2011. The radiological response was reassessed using the modified Response Evaluation Criteria in Solid Tumors. The sustained complete response, time to progression and overall survival rates were also analyzed. RESULTS: Complete response rates were significantly higher in patients who had undergone modified chemoembolization compared to those who had undergone conventional treatment (61.7% and 24.3%, respectively; p < 0.001). The rate of sustained complete response was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 236 and 37 days, respectively; p < 0.001). Time to progression was significantly higher in the modified chemoembolization group compared to the conventional chemoembolization group (median of 424 and 201 days, respectively; p = 0.042). Overall survival rates revealed no difference between patients who received modified chemoembolization and conventional chemoembolization (median of 483 and 399 days, respectively; p = 0.316). CONCLUSION: Transarterial chemoembolization modified by n-butyl cyanoacrylate addition was superior to conventional transarterial chemoembolization in terms of the radiological response in the first imaging control. Although the sustained complete response and time to progression rates were higher for the modified chemoembolization group, no differences in overall survival rates were observed.
Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Embucrilato/administração & dosagem , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Progressão da Doença , Métodos Epidemiológicos , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: Describe the outcomes of patients diagnosed with indirect carotid-cavernous fistula treated by endovascular methods. DESIGN: A retrospective case series. PARTICIPANTS: Twelve patients with dural cavernous sinus fistula with important ophthalmologic involvement admitted and treated at the National Institute of Neurology and Neurosurgery between February 1990 and January 2005. INTERVENTION: Patients were managed by endovascular embolization for all fistulas. OUTCOME MEASURES: Angiographic controls to 24 hours and at 6 and 12 months were performed. RESULTS: 67 % were female and 33 % male. The mean age was 44 years. 67 % were spontaneous and 33% of traumatic origin. All patients had eye involvement with proptosis (92%) and involvement of the oculomotor nerve (67%). Headache and pulsatile tinnitus were not frequent ophthalmologic data. All were diagnosed by cerebral angiography, 33 % were type C, type D 67 %, and none of the type B classification Barrow. In 17 % of cases the distal arterial robbery showed severe. Predominance of anterior and superior venous drainage in 83 % and 42 % of cases occurred respectively. The surgical approach was arterial in 84% of cases, while in 17 % venous through the superior ophthalmic vein. Cyanoacrylate embolization material was used in 58 % of the cases, as it was associated with the use of removable ball with polyvinyl alcohol particles in 16 % in of venous approach cases. 17% detachable coils were utilized. There were no complications. After angiographic controls at 24 hours 100% occlusion was seen in patients treated with cyanoacrylate (58%) (p = 0.03). The remaining 42% were prescribed maneuver of manual compression. At 12-months angiography all patients had 100% occlusion of the carotid-cavernous fistula. CONCLSUIONS: This is the world's second largest series with indirect carotid-cavernous fistulas treated after trauma. 100 % of cases were cured with the use of a transarterial-controlled approach and N-butyl-cyanoacrylate after long-term observation.
Assuntos
Artéria Carótida Interna , Seio Cavernoso , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Adulto , Angioplastia com Balão/métodos , Artéria Carótida Externa , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Angiografia Cerebral , Traumatismos Craniocerebrais/complicações , Embucrilato/administração & dosagem , Embucrilato/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Álcool de Polivinil/administração & dosagem , Álcool de Polivinil/uso terapêutico , Estudos Retrospectivos , Avaliação de Sintomas , Adesivos Teciduais/administração & dosagem , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento , Tungstênio/administração & dosagem , Tungstênio/uso terapêuticoAssuntos
Humanos , Feminino , Idoso , Embucrilato/administração & dosagem , Embucrilato/efeitos adversos , Hemorragia Gastrointestinal , Varizes Esofágicas e Gástricas/complicações , Adesivos Teciduais/administração & dosagem , Adesivos Teciduais/efeitos adversos , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/etiologia , Literatura de Revisão como Assunto , Varizes Esofágicas e Gástricas/terapiaRESUMO
OBJECTIVE: To evaluate the success of the treatment with cyanoacrylate in primary hemostasis, rebleeding, and gastric varices eradication. MATERIAL AND METHODS: In this retrospective study 65 patients with gastric varices treated with N-butyl-2-cyanoacrylate (Histoacryl) were included from January 1999 to January 2008. We used a solution of 0,5 mL of cyanoacrylate and 0.9 mL of lipiodol, utilizing an average of 3.46 mL of this mixture per session (range 1 to 6 mL). Sclerosing needles of 21 gauge were used. Patients were sedated. Data were analyzed using a chi-squared test. RESULTS: Sixty-five patients were included, 42 men and 23 women with an average age of 53.8 years (range 18 to 76 years). The etiology of the portal hypertension (PH) was cirrhosis in 52 patients (80%), prehepatic PH in 7 (10.8%), and segmentary PH in 3 (4.6%), and non-classified in 3 (4.6%). Cirrhotic patients were classified as Child A in 21 cases, Child B in 25 and Child C in 6. According to the Sarin classification, 7 patients had gastric-oesophageal varices (GOV) type 1, 32 GOV2, 8 GOV1 and 2, and 8 isolated gastric varices (IGV) type 1. Fifty-six patients (86%) presented active bleeding or stigmata of recent bleeding at time of initial endoscopy. Primary hemostasis was achieved in 50 of them (89%) and the remaining 6 required a second session. Eleven patients presented rebleeding within the following 6 weeks and were again treated with cyanoacrylate. Hemostasis was achieved in 8 of them, 2 were referred for surgical management, and 1 received endovascular treatment. Follow-up was able in 53 patients for an average period of 11 months (range 1 to 81 months). During this period, 7 patients presented an episode ofrebleeding and were treated with cyanoacrylate, achieving hemostasis. Eradication of varices was documented on 21 patients (39.6%). The global rate of rebleeding was 37%. One patient developed splenic vein thrombosis as a major complication of treatment. CONCLUSION: Definitive hemostasis was achieved in 94.6% of patients, with primary hemostasis in 89%. The global rate of rebleeding was 37% and the rate of major complications associated with treatment 0.6%. Eradication of gastric varices was achieved in 35.8% of cases. As these data show, it can be concluded that butyl-cyanoacrylate constitutes an effective method for the treatment of gastric variceal bleeding.
Assuntos
Embucrilato/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Soluções Esclerosantes/administração & dosagem , Adolescente , Adulto , Idoso , Varizes Esofágicas e Gástricas/complicações , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
A técnica de lobectomia pulmonar pode ser utilizada para tratamento de neoplasias pulmonares, torção do lobo pulmonar, laceração pulmonar e abscessos pulmonares e dentre as complicações pós-operatórias, destacam-se a deiscência do coto brônquico, escape aéreo prolongado e desenvolvimento de fístula broncopleural. Esses problemas geralmente são decorrentes da má oclusão do coto brônquico e na maioria das vezes o tratamento consiste na realização de um novo procedimento cirúrgico com reabertura da cavidade torácica. Com o presente trabalho, objetivou-se avaliar a eficácia do n-butil cianoacrilato e da braçadeira de náilon como métodos para oclusão do coto brônquico e manutenção da aerostasia, comparando-o com a técnica de sutura manual, em modelo experimental empregando árvores traqueobrônquicas de suínos, submetidas a crescentes níveis de pressão positiva intrabrôquica. Foram utilizadas 30 árvores traqueobrônquicas, onde oito brônquios lobares de cada peça foram selecionados para estudo, sendo quatro de 10 mm e quatro de 5 mm. Posteriormente, as árvores e respectivos brônquios foram distribuídos equitativamente em três grupos experimentais: Grupo Sutura (GS) sutura manual com pontos isolados simples, utilizando náilon cirúrgico nº 2.0; Grupo Cianocrilato (GC) - n-butil cianoacrilato e Grupo Braçadeira (GB) braçadeiras de náilon. Após a oclusão dos cotos brônquicos, as peças foram imersas em água e realizado o teste de hermeticidade empregando-se pressão positiva intrabronquial de 30 cm de H20 por cinco minutos, sendo em seguida, gradualmente aumentada até atingir a pressão de 100 cm de H2O. Nos grupos GS e GB foram observados vazamentos com percentual de 1,25% (1∕80), quando submetidos a uma pressão de 30 cm de H20 e 100 cm de H20, respectivamente. No grupo GC não foi constatado vazamento em nenhum dos cotos brônquicos. Não foram evidenciadas diferenças estatísticas significativas entre três os tratamentos. Conclui-se que tanto o n-butil cianoacrilato, como a braçadeira de náilon, igualmente à sutura manual, são métodos eficazes na execução e manutenção da aerostasia bronquial.
The pulmonary lobectomy technique can be used on the lung cancer, lung lobe torsion,pulmonary laceration and lung abscesses treatment and among the postoperative problems the bronchial stump dehiscence, prolonged air leak and development of bronchopleural fistula are highlighted. These problems are usually resulting from malocclusion of the bronchial stump and most of the times the treatment for those problems consists on a new surgical procedure to reopen the chest cavity. The ain of the present paper was to evaluate the efficiency of n-butyl cyanoacrylate and nylon brassard as methods for occlusion of the bronchial stump andthe aerostasia maintenance, comparing it with the manual suture technique on an experimental model using pig tracheobronchial trees, submitted to increasing levels of positive intrabrochial pressure. 30 pig tracheobronchial trees were used, where eight lobar bronchi from each piece were selected for studying, four of 10 mm and four of 5 mm. Thereafter, the trees and their bronchi were equally distributed into three experimental groups: Suture Group(SG) manual suture with simple isolated stitches, using nº 2,0 surgical nylon; Cyanoacrylate Group (CG) - n-butyl Cyanoacrylate and Brassard Group (BG) nylon brassards. After the bronchial stumps occlusion, the pieces were immersed in water and the tire fitter test was made placing the positive intrabrochial pressure at 30 cm of H2O for five minutes, and then gradually increased to a pressure at 100 cm of H2O. Leaks with a percentage of 1, 25% (1/80) were observed on groups SG and BG, when respectively submitted to a pressure at 30 cm ofH2O and 100 cm of H2O. There were no leaks in any bronchial stumps on group CG. There were no statistically significant differences among the three treatments. It was concluded that,both n-butyl Cyanoacrylate such as nylon brassard, as also the manual suture, are effective methods for implementation and maintenance of bronchial aerostasia.
Assuntos
Brônquios/lesões , Curativos Oclusivos , Embucrilato/administração & dosagem , Pneumonectomia/instrumentação , Técnicas de SuturaRESUMO
A 34-year-old [corrected] woman was diagnosed with Loeys-Dietz syndrome. Five months later, the patient presented with a symptomatic 2.6-cm subclavian pseudoaneurysm. Staged endovascular treatment was initiated with left vertebral artery embolization, followed by sac ablation and stent graft exclusion. The pseudoaneurysm cavity was filled with n-butylcyanoacrylate ("glue") via a microcatheter. Despite balloon occlusion of the pseudoaneurysm orifice, a small amount of glue debris embolized to the brachial artery, necessitating a vein bypass. In this case, distal embolization of glue may have been avoided by leaving a microcatheter in the aneurysm sac for glue injection after first deploying the stent graft.
Assuntos
Falso Aneurisma/terapia , Implante de Prótese Vascular , Embolia/etiologia , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Procedimentos Endovasculares , Síndrome de Loeys-Dietz/terapia , Artéria Subclávia/cirurgia , Adesivos Teciduais/efeitos adversos , Adulto , Falso Aneurisma/diagnóstico por imagem , Oclusão com Balão , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Embolia/cirurgia , Embucrilato/administração & dosagem , Feminino , Humanos , Injeções Intralesionais , Síndrome de Loeys-Dietz/diagnóstico por imagem , Stents , Artéria Subclávia/diagnóstico por imagem , Adesivos Teciduais/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
AIM: We investigated the transcervical hysteroscopy application of n-butyl-2-cyanoacrylate in the uterine tube lumen of a non-rodent animals (sheep) with fallopian tube dimensions similar those in humans. METHODS: Standard hysteroscopic procedures were performed on female Texel sheep (n = 26). The right and left ostia were identified. For each ewe, a urethral catheter (5Fr) was used for the delivery of 0.5 mL of saline or an equal volume of n-butyl-2-cyanoacrylate into the uterine tube. Following the procedure, ewes were housed with males of proven fertility for 90 days (equivalent to 5.5 estrous cycles). Postmortem (dye and burst pressure) and in vivo (hysterosalpingogram) testing for tube patency were both performed 90 days and 180 days following the procedure. RESULTS: All animals receiving the saline treatment became pregnant. Gross inspection of uterine tubes following n-butyl-2-cyanoacrylate treatment revealed no visceral adhesions or fibrosis. However, postmortem testing revealed total obstruction within the fallopian tubes. This was confirmed by hysterosalpingogram, in that iodine contrast did not escape into the abdominal cavity. CONCLUSION: The cyanoacrylate promoted a reliable fallopian tube obstruction without fibrosis in an animal model exhibiting a similar tube diameter to that found in women. The technique can be evaluated for efficacy in vivo using hysterosalpingography.
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Embucrilato/administração & dosagem , Tubas Uterinas/cirurgia , Histeroscopia/veterinária , Ovinos/cirurgia , Esterilização Reprodutiva/veterinária , Adesivos Teciduais/administração & dosagem , Animais , Feminino , Histerossalpingografia/veterinária , Histeroscopia/métodos , Masculino , Gravidez , Distribuição Aleatória , Esterilização Reprodutiva/métodosRESUMO
PURPOSE: We propose the use of fluoroscopic guidance for endoscopic injection of n-butyl-2-cyanoacrylate to treat gastric variceal hemorrhage to achieve placement of the safest quantity of tissue adhesive. METHODS: Ten patients with gastric varices were treated with n-butyl-2-cyanoacrylate endoscopic injection under fluoroscopic guidance for the purpose of hemostasis or prevention of recurrent bleeding. The glue was infused into the varices in the quantities needed to achieve complete obliteration of the gastric varices. RESULTS: The median quantity of tissue adhesive required in this series was 6.6 mL. The procedure was initially considered successful in all patients. There were no complications relating to the procedure. The mean duration of follow-up was 20 months. CONCLUSIONS: Injection of suitable quantities of cyanoacrylate under fluoroscopic guidance seems to be safe and effective for controlling hemorrhagic gastric varices.
Assuntos
Embucrilato/administração & dosagem , Varizes Esofágicas e Gástricas/complicações , Fluoroscopia , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica , Radiografia Intervencionista , Adesivos Teciduais/administração & dosagem , Adulto , Idoso , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-IdadeRESUMO
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 laparotomy 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.
Assuntos
Embucrilato/análogos & derivados , Adesivo Tecidual de Fibrina/administração & dosagem , Hemorragia/terapia , Técnicas Hemostáticas/normas , Fígado/lesões , Polissacarídeos/administração & dosagem , Animais , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Embucrilato/administração & dosagem , Fígado/cirurgia , Masculino , Ratos , Ratos Wistar , Fatores de Tempo , Adesivos Teciduais/administração & dosagemAssuntos
Embolia/induzido quimicamente , Embolização Terapêutica/efeitos adversos , Embucrilato/efeitos adversos , Varizes Esofágicas e Gástricas/terapia , Artéria Esplênica , Infarto do Baço/etiologia , Adesivos Teciduais/efeitos adversos , Diagnóstico Diferencial , Embolia/complicações , Embolia/diagnóstico por imagem , Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Evolução Fatal , Humanos , Injeções Intralesionais/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infarto do Baço/diagnóstico por imagem , Adesivos Teciduais/administração & dosagem , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Animais , Masculino , Ratos , Embucrilato/análogos & derivados , Adesivo Tecidual de Fibrina/administração & dosagem , Hemorragia/terapia , Técnicas Hemostáticas/normas , Fígado/lesões , Polissacarídeos/administração & dosagem , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Embucrilato/administração & dosagem , Fígado/cirurgia , Ratos Wistar , Fatores de Tempo , Adesivos Teciduais/administração & dosagemRESUMO
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.(AU)
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.(AU)
Assuntos
Animais , Masculino , Ratos , Embucrilato/análogos & derivados , Adesivo Tecidual de Fibrina/administração & dosagem , Hemorragia/terapia , Técnicas Hemostáticas/normas , Fígado/lesões , Polissacarídeos/administração & dosagem , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Embucrilato/administração & dosagem , Fígado/cirurgia , Ratos Wistar , Fatores de Tempo , Adesivos Teciduais/administração & dosagemRESUMO
A 3-year-old child with a spinal cord direct arteriovenous fistula successfully treated by endovascular occlusion is presented. Intradural direct arteriovenous fistulae are the most infrequent variety of spinal arteriovenous malformations, although they are not properly identified as such in many published series. Whereas the exact mechanism by which they produce symptoms remains an unresolved issue--steal through fistula or compression by giant venous varices--the evolution of our case, with amelioration after partial occlusion, favors the former. Surgical resection of the thrombosed venous varix was not necessary. Endovascular occlusion proved to be a safe and effective form of treatment in this case of spinal intradural direct arteriovenous fistula, no additional treatment being necessary thereafter.