Exérese de pterígio em paciente pós-LASIK com técnica de air bubble / Pterygium surgery with air bubble technique in a post-LASIK patient

RESUMO O pterígio é uma das doenças que mais acomete a superfície ocular, principalmente em regiões próximas ao Equador. Ocorre principalmente em adultos jovens, podendo ocasionar sintomas, danos estéticos e ópticos. Relata-se um caso de exérese de pterígio classificado pela extensão corneana em grau II e, pela vascularização, em grau 2 de Tan, com cirurgia prévia de LASIK, a partir de uma nova técnica, a técnica de Moscovici, a qual fundamenta-se na dissecção com bolha de ar, com a finalidade de separar o epitélio conjuntival do estroma profundo e da Tenon, com maior facilidade e rapidez e para obter enxertos finos.

ABSTRACT Pterygium is one of the diseases that most affect the ocular surface, especially in regions close to the equator. It mainly affects young adults and can cause symptoms, as well as aesthetic and optical impairment. We report a case of pterygium excision classified by grade II corneal extension and Tan grade 2 vascularization with previous laser in situ keratomileusis (LASIK) surgery, using a new technique, the Moscovici technique, which is based on dissection with an air bubble to separate easier and faster the conjunctival epithelium from the deep stroma and the Tenon, obtaining thinner grafts.

Uso de cola cirúrgica no reparo de lacerações perineais intraparto: estudo série de casos / Uso de pegamento quirúrgico para reparar desgarros perineales intraparto: estudio serie de casos / Use of surgical glue to repair intrapartum perineal lacerations: a case series study

Resumo Objetivo Descrever o uso da cola cirúrgica no reparo do trauma perineal no parto normal. Métodos Estudo série de casos realizado em três momentos (até 2 horas, 12-24 horas e 36-48 horas após o parto), em Itapecerica da Serra, SP. Foram incluídas mulheres que tiveram parto normal com trauma perineal com indicação de sutura (laceração de primeiro ou segundo graus e episiotomia). O trauma perineal foi reparado exclusivamente com cola cirúrgica Glubran-2®. Avaliou-se: intensidade da dor perineal (Escala Visual Numérica com 11 pontos), processo de cicatrização (escala REEDA de 15 pontos), satisfação com o reparo (escala Likert de 5 pontos). Os dados foram analisados de forma descritiva e inferencial comparando os três momentos. Resultados A técnica de aplicação da cola e a quantidade necessária foram definidas em uma amostra de 19 mulheres. Destas, 78,9% tiveram laceração de primeiro grau, 15,8% de segundo grau e 5,3% episiotomia. Os desfechos nos momentos 1, 2 e 3, foram respectivamente: ausência de dor (73,6%, 94,7% e 89,4%); escore ≤1 na escala REEDA (94,7%, 78,9% e 84,2%); 100% satisfeitas com o reparo em todos os momentos. Não houve diferença pelo teste de Friedman para dor e satisfação. O processo de cicatrização mostrou diferença, porém sem confirmação no pós-teste hoc. Conclusão A aplicação da cola mostrou-se viável para avaliação em uma amostra maior de mulheres, pois os resultados sugerem boa aceitação pelas mulheres e dor de baixa intensidade ou ausente, cicatrização adequada e alta satisfação com o reparo nas primeiras 48 horas após o parto.

Resumen Objetivo Describir el uso de pegamento quirúrgico para reparar traumas perineales en partos vaginales. Métodos Estudio serie de casos realizado en tres momentos (hasta 2 horas, de 12 a 24 horas y de 36 a 48 horas después de parto), en Itapecerica da Serra, estado de São Paulo. Se incluyeron mujeres que tuvieron parto vaginal con trauma perineal e indicación de sutura (desgarro de primer o segundo grado y episiotomía). El trauma perineal fue reparado exclusivamente con pegamento quirúrgico Glubran-2®. Se evaluó la intensidad del dolor perineal (Escala Visual Numérica de 11 puntos), el proceso de cicatrización (Escala REEDA de 15 puntos) y la satisfacción respecto a la reparación (Escala Likert de 5 puntos). Los datos fueron analizados de forma descriptiva e inferencial, comparando los tres momentos. Resultados La técnica de aplicación del pegamento y la cantidad necesaria fueron definidas en una muestra de 19 mujeres. De ellas, el 78,9 % tuvieron un desgarro de primer grado, el 15,8 % de segundo grado y el 5,3 % episiotomía. Los resultados de los momentos 1, 2 y 3 fueron, respectivamente: ausencia de dolor (73,6 %, 94,7 % y 89,4 %); puntuación ≤1 en la escala REEDA (94,7 %, 78,9 % y 84,2 %); 100 % satisfechas con la reparación en todos los momentos. No se observó diferencia de dolor y satisfacción con la prueba de Friedman. El proceso de cicatrización mostró diferencia, pero sin confirmación en la prueba post hoc. Conclusión La aplicación del pegamento demostró ser viable para un análisis con una muestra mayor de mujeres, ya que los resultados sugieren buena aceptación por parte de las mujeres, dolor de baja intensidad o ausente, cicatrización adecuada y alta satisfacción respecto a la reparación en las primeras 48 horas después del parto.

Abstract Objective To describe the use of surgical glue to repair perineal trauma during normal delivery. Methods This is a case series study, which was carried out in three moments (up to 2 hours, 12-24 hours and 36-48 hours after delivery) in Itapecerica da Serra, SP. Women who had a normal delivery with perineal trauma with a suture (first or second degree laceration and episiotomy) were included. Perineal trauma was repaired exclusively with Glubran-2® surgical glue. Perineal pain intensity (11-point Visual Numeric Scale), healing process (15-point REEDA scale), satisfaction with repair (5-point Likert scale) were assessed. Data were analyzed in a descriptive and inferential way comparing the three moments. Results The technique of applying the glue and the required amount were defined in a sample of 19 women. Of these, 78.9% had first-degree lacerations, 15.8%, second-degree lacerations and 5.3%, episiotomy. The outcomes at moments 1, 2 and 3 were absence of pain (73.6%, 94.7% and 89.4%), score ≤1 on the REEDA scale (94.7%, 78.9% and 84, two%); 100% were satisfied with the repair at all times. There was no difference by the Friedman test for pain and satisfaction. The healing process showed a difference, but without confirmation in the hoc post-test. Conclusion The glue application proved to be viable for assessment in a larger sample of women, as the results suggest good acceptance by women and low or no pain, adequate healing and high satisfaction with the repair in the first 48 hours after delivery.

Prevalence and associated factors of medical adhesive-related skin injury in cardiac critical care units / Prevalencia de lesiones de la piel relacionadas con adhesivos médicos y factores asociados en unidades críticas cardiológicas / Prevalência de lesão de pele relacionada a adesivos médicos e fatores associados em unidades críticas cardiológicas

ABSTRACT Objective: To identify and analyze the point prevalence of medical adhesive-related skin injury in patients hospitalized in cardiac Intensive Care Units and demographic and clinical factors associated to their occurrence. Method: Cross-sectional study conducted in Intensive Care Units of two public hospitals, reference centers for cardiology, located in São Paulo city, with 123 patients. Demographic and clinical data from patients' medical records were collected and lesions were identified through skin inspection. The data were analyzed through descriptive statistics and bivariate and multivariate analysis (Classification and Regression Tree). Results: Medical adhesive-related skin injury was presented by 28 patients, which amounts to a 22.7% prevalence. Its main causative agent was transparent polyurethane film (46.9%) and the cervical region was the most affected area (25.1%). From the multivariate analysis, the associated factors were found to be the presence of serum urea higher than or equal to 48.5 mg/dL and platelets lower than 193,500 mm3 or platelets higher than or equal to 193,500 mm3 and systolic blood pressure higher than or equal to 122 mmHg. Conclusion: This study has contributed to knowledge related to the epidemiology of this type of injury, favoring preventive care planning.

RESUMEN Objetivo: Identificar y analizar la prevalencia puntual de las lesiones de la piel relacionadas con adhesivos médicos en pacientes ingresados en Unidades de Cuidados Intensivos cardiológicos y los factores demográficos y clínicos asociados a su aparición. Método: Estudio transversal realizado en las Unidades de Cuidados Intensivos de dos hospitales públicos, de referencia en cardiología, ubicados en la ciudad de São Paulo, con 123 pacientes. Los datos demográficos y clínicos se recogieron de las historias clínicas de los pacientes y las lesiones se identificaron mediante la inspección de la piel. Los datos se analizaron mediante estadísticas descriptivas y análisis bivariado y multivariado (Classification and Regression Tree). Resultados: Hubo 28 pacientes con lesiones de la piel relacionadas con adhesivos médicos, con una prevalencia del 22,7%. El principal agente causante fue la película de poliuretano transparente (46,9%) y la región más afectada fue la cervical (25,1%). Mediante un análisis multivariado, los factores asociados fueron la presencia de urea sérica mayor o igual a 48,5 mg/dL y plaquetas menores de 193.500 mm3 o plaquetas mayores o iguales a 193.500 mm3 y presión arterial sistólica mayor o igual a 122 mmHg. Conclusión: El estudio contribuyó al conocimiento relacionado con la epidemiología de este tipo de lesión, favoreciendo la planificación de la atención preventiva.

RESUMO Objetivo: Identificar e analisar a prevalência pontual de lesão de pele relacionada a adesivos médicos em pacientes internados em Unidades de Terapia Intensiva cardiológicas e os fatores demográficos e clínicos associados à sua ocorrência. Método: Estudo transversal conduzido nas Unidades de Terapia Intensiva de dois hospitais públicos, referência em cardiologia, localizados no município de São Paulo, com 123 pacientes. Foram coletados dados demográficos e clínicos dos prontuários dos pacientes e as lesões foram identificadas por meio de inspeção da pele. Os dados foram analisados por meio de estatística descritiva e análises bivariada e multivariada (Classification and Regression Tree). Resultados: Apresentaram lesão de pele relacionada a adesivos médicos 28 pacientes, perfazendo prevalência de 22,7%. O principal agente causador foi o filme de poliuretano transparente (46,9%) e a região mais acometida foi a cervical (25,1%). Pela análise multivariada, os fatores associados foram presença de ureia sérica maior ou igual a 48,5 mg/dL e plaquetas menores que 193.500 mm3 ou plaquetas maiores ou iguais a 193.500 mm3 e pressão arterial sistólica maior ou igual a 122 mmHg. Conclusão: O estudo contribuiu para os conhecimentos relacionados à epidemiologia desse tipo de lesão, favorecendo o planejamento de cuidados preventivos.

Use of cyanoacrylate-based surgical adhesives associated to the macroporous tape in skin synthesis in rats

Abstract Purpose: To compare the use of new cyanoacrylate surgical adhesive associated with macroporous tapes in cutaneous synthesis. Methods: Male Wistar rats with a longitudinal incision of 4cm were used on the back, divided into four groups: GI used octyl-cyanoacrylate (Dermabond®), GII used N-2-butylcyanoacrylate, GIII used octyl-cyanoacrylate and macroporous tape and GIV used N-2-butyl cyanoacrylate and macroporous tape. On the fourteenth day, the rats were submitted to euthanasia, were divided in two parts, and a layer of skin subcutaneous tissue through an area of operative healing was removed. One part was submitted to the study of rupture strength with the use of tensiometer, and in the other part histological examination was performed. Results: No force test was similar between groups I and II, being different from groups III and IV (P <0.001), which were identical to each other (P> 0.05). The units were compared among the studied groups, and they were different with the use of macroporous tapes (P> 0.05). Conclusions: The purpose of macroporous tapes is associated with CA adhesives in cutaneous tissues that provide more resistant scars. The use of a combination of macroporous tapes leads to complete re-epithelialization, without provoking foreign body reaction, has hemostatic properties and does not cause an absorptive reaction.

The effects of ethyl-2-cyanoacrylate and butyl-2-cyanoacrylate in the process of bone healing in rats. A controlled experimental study / Efeitos do etil-2-cianoacrilato e do butil-2-cianoacrilato no processo de consolidação óssea em ratos. Estudo experimental controlado

ABSTRACT Objective: Synthetic adhesives are used by various medical specialties, especially in surgery; however, studies reporting their use in orthopedic practice are scarce. The aim of this study was to compare the results in using ethyl-2-cyanoacrylate or butyl-2-cyanoacrylate in the treatment of fractures in rats. Methods: This was an experimental prospective controlled study in 90 rats, with humerus, femur, and tibia fractures, treated with ethyl-2-cyanoacrylate (SB group; n = 45) or butyl-2-cyanoacrylate (HA group; n = 45). Biomechanical and histomorphometric analyses were performed at three different moments (60, 120, and 180 days); besides a clinical study performed weekly by measurement of the animals body mass. Results: No differences were observed regarding body mass (p = 0.07). In both groups, there were no significant differences regarding maximum load (p = 0.6), yield point strength (p = 0.6), and stiffness coefficient (p = 0.4) of the femurs. The same was observed in tibias for maximum load (p = 0.4), yield point strength (p = 0.7), and stiffness coefficient (p = 0.6). The humerus from both groups had similar bone callus area (p = 0.66). In both groups, there were no statistical differences related to inflammatory cells (p = 0.4), osteoblasts (p = 0.2), and osteoclasts (p = 0.2). Conclusion: Ethyl-2-cyanoacrylate was more effective than butyl-2-cyanoacrylate in the treatment of fractures in rats.

RESUMO Objetivo: Os adesivos sintéticos são usados em várias especialidades médicas cirúrgicas, contudo, os estudos que relatam seu uso na prática ortopédica são escassos. O objetivo deste trabalho foi comparar os resultados do uso do etil-2-cianoacrilato e do butil-2-cianoacrilato no tratamento de fraturas em ratos. Métodos: Foi realizado um estudo experimental, prospectivo e controlado em 90 ratos com fraturas de úmero, fêmur e tíbia, tratados com etil-2-cianoacrilato (grupo SB; n = 45) ou butil-2-cianoacrilato (grupo HA; n = 45). Foram realizadas análises biomecânicas e histomorfométricas em três momentos (60, 120 e 180 dias), além do estudo clínico pela aferição semanal da massa corporal dos animais. Resultados: Não foram observadas diferenças relacionadas à massa corporal dos animais (p = 0,07). Os fêmures de ambos os grupos não apresentaram diferença com relação à carga máxima (p = 0,6), limite de elasticidade (p = 0,6) e coeficiente de rigidez (p = 0,4). Analisando-se as tíbias, o mesmo foi observado com relação à carga máxima (p = 0,4), ao limite de elasticidade (p = 0,7) e ao coeficiente de rigidez (p = 0,6). Os úmeros de ambos os grupos apresentaram a mesma área de calo ósseo formado (p = 0,66). Em ambos os grupos, não houve diferença estatística relacionada ao número de osteoblastos (p = 0,2), osteoclastos (p = 0,2) e células inflamatórias (p = 0,4). Conclusão: O etil-2-cianoacrilato foi mais eficaz do que o butil-2-cianoacrilato no tratamento de fraturas em ratos.

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.

Nylon, fibrin glue and Vicryl®- the graft fixation techniques in the conjunctival autotransplant for the treatment of primary pterygium / Nylon, cola de fibrina e Vicryl® - Avaliação da fixação do enxerto no autotransplante conjuntival para tratamento do pterígio primário

Abstract Objective: to compare nylon, fibrin glue and Vicryl® in the conjunctival autograft for treatment of primary pterygium. Methods: Prospective study approved by the Ethics Committee following the Declaration of Helsinki. 89 eyes were underwent pterygium excision and conjunctival autograft. They were grouped according to the technique: fibrin glue, nylon 10-0 and 8-0 Vicryl® and followed up for 3 months. Surgical Time, intra and postoperative symptoms, biomicroscopic signs, ocular discomfort ( by Visual Analogue Scale), aesthetic appearance and recurrences (day 21, 90 and 3 years) were evaluated. Results: The operative time was shorter with the fibrin glue (p<0.001). As to intraoperative symptomatology, burning sensation predominated with Vicryl® (p=0,012). The postoperative symptoms and signs: on day 1- secretion with fibrin glue (p=0.02), foreign body sensation (p=0.017) and subconjunctival hemorrhage (p=0.022) with Vycril®; on day 7- chemosis (p=0.035), hyperemia (p<0.001) and eyelid edema (p=0.011) with Vicryl®; on day 21-foreign body sensation (p=0.001) and conjunctival hyperemia (p<0.001) with nylon; on day 90- dry eye (p=0.005) with Vicryl®. Ocular discomfort was greater with Vycril® (p=0.015) on day 7. Final aesthetic appearance was superior with fibrin glue (p=0.003). The recurrences was greater on day 90: 20,7%(nylon), 10%(fibrin glue) and 19%(Vicryl®) (p=0.496) and after 3 years: 4.8% in NG, 0% in FGG, and 5.3% in VG (p=0.536). Conclusion: Fibrin glue showed efficacy, rapidity, less postoperative discomfort and better final aesthetic appearance. Vicryl® showed significant intraoperative and early postoperative symptoms and obvious signs of inflammation, beside ocular discomfort on day 7. Nylon caused more foreign body sensation and conjunctival hyperemia until its removal. The signs of recurrence were similar among the groups.

Resumo Objetivo: comparar o nylon, a cola de fibrina e o Vicryl® no autotransplante conjuntival para o tratamento do pterígio primário. Métodos: estudo prospectivo aprovado pelo Comitê de Ética seguindo a Declaração de Helsinque. 89 olhos foram submetidos à excisão de pterígio e autotransplante conjuntival, agrupados conforme as técnicas: nylon 10-0, cola de fibrina, e Vicryl® 8-0, acompanhados por 3 meses. Tempo cirúrgico, sintomas intra e pós-operatórios, sinais biomicroscópicos, desconforto ocular (Escala Analógica Visual), aspecto estético, recorrências no 21º e 90º dia pós-operatório e aos 3 anos. Resultados: O tempo operatório foi menor com a cola de fibrina e maior com Vicryl® (p<0,001). Sintomatologia intra-operatória: a ardência predominou com Vicryl® (p=0,012). Sintomas e sinais pós-operatórios significativos: no 1º dia, secreção com cola de fibrina (p=0,02), sensação de corpo estranho (p=0,017) e hemorragia subconjuntival (p=0,022) com Vycril®; No 7º dia - quemose (p=0,035), hiperemia (p<0,001) e edema da pálpebra (p=0,011) com Vicryl®; No 21º dia - sensação de corpo estranho (p=0,001) e hiperemia conjuntival (p<0,001) com nylon; No 90º dia - olho seco (p=0,005) com Vicryl®. Desconforto ocular: maior com Vycril® (p=0,015) no 7º dia. Aparência estética final: melhor com a cola (p=0,003). Sinais de recidiva: maior no 90º dia: 20,7%(nylon), 10%(cola) e 19%(Vicryl®) e após 3 anos: 4,8%(nylon), 0%(cola) e 5.3%(Vicryl®) (p=0,536). Conclusão: A cola de fibrina mostrou eficácia, rapidez, menor desconforto pós-operatório e melhor aspecto estético; o Vicryl®, maiores sintomas intraoperatórios, pós-operatórios iniciais e sinais evidentes de inflamação, aliados ao desconforto ocular no 7º dia; o nylon, mais sensação de corpo estranho e hiperemia conjuntival até sua remoção. Os sinais de recidiva foram semelhantes entre os grupos.

Local and systemic effects of fibrin and cyanoacrylate adhesives on lung lesions in rabbits

OBJECTIVES: Tissue adhesives can be used to prevent pulmonary air leaks, which frequently occur after lung interventions. The objective of this study is to evaluate local and systemic effects of fibrin and cyanoacrylate tissue adhesives on lung lesions in rabbits. METHODS: Eighteen rabbits were submitted to videothoracoscopy + lung incision alone (control) or videothoracoscopy + lung incision + local application of fibrin or cyanoacrylate adhesive. Blood samples were collected and assessed for leukocyte, neutrophil and lymphocyte counts and interleukin-8 levels preoperatively and at 48 hours and 28 days post-operatively. After 28 days, the animals were euthanized for gross examination of the lung surface, and lung fragments were excised for histopathological analysis. RESULTS: Fibrin and cyanoacrylate produced similar adhesion scores of the lung to the parietal pleura. Microscopic analysis revealed uniform low-cellular tissue infiltration in the fibrin group and an intense tissue reaction characterized by dense inflammatory infiltration of granulocytes, giant cells and necrosis in the cyanoacrylate group. No changes were detected in the leukocyte, neutrophil or lymphocyte count at any time-point, while the interleukin-8 levels were increased in the fibrin and cyanoacrylate groups after 48 hours compared with the pre-operative control levels (p<0.01). CONCLUSION: Both adhesive agents promoted normal tissue healing, with a more pronounced local inflammatory reaction observed for cyanoacrylate. Among the serum markers of inflammation, only the interleukin-8 levels changed post-operatively, increasing after 48 hours and decreasing after 28 days to levels similar to those of the control group in both the fibrin and cyanoacrylate groups.

Pph and biological glue in patients with high risk of bleeding in stapled hemorrhoidopexy / Pph e cola biológica em pacientes com alto risco de sangramento em hemorroidopexia por grampeamento

ABSTRACT Background: Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue. Aim: Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue. Methods: Between 2005 and 2015, 22 patients were analyzed, in a retrospective cohort study. Results: From 22 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue, only one (4.5%) presented bleeding in the surgical postoperative. Patients do not have any other complications and pain in the postoperative period. The median (IQR) operation duration was 55 (12) min and the median (IQR) length of hospital stay after surgery was 3 (2) days. Conclusion: Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue presented very low rates of bleeding in the postoperative period.

RESUMO Racional: Procedimento para o prolapso hemorroidário é uma forma de tratamento comum para hemorróidas de grau 3. Pacientes que apresentem condições que aumentam o risco de sangramento, como o uso de stents cardíacos associado ao uso de clopidogrel e cirrose hepática, devem receber cuidado redobrado em procedimentos cirúrgicos, devido ao alto risco de sangramento. Por esta razão é aqui proposto o procedimento para prolapso hemorroidário seguido da aplicação de cola biológica em pacientes com hemorróida de grau 3. Objetivo: Avaliar os desfechos cirúrgicos em pacientes com hemorróida de grau 3 e alto risco de sangramento submetidos ao procedimento para o prolapso hemorroidário seguido da aplicação de cola biológica. Métodos: Entre 2005 e 2015, 22 pacientes foram analisados, em estudo coorte retrospectivo. Resultados: Dos 22 pacientes submetidos ao procedimento para o prolapso hemorroidário seguido pelo uso de cola biológica, apenas um (4.5%) apresentou sangramento no pós-operatório. Os pacientes não apresentaram nenhuma outra complicação ou dor no período pós-operatório. O tempo mediano da operação foi de 55 (12) min e a média do tempo de internação hospitalar foi de três (2) dias. Conclusão: Os pacientes com alto risco de sangramento submetidos ao procedimento de prolapso hemorroidário seguidos pela aplicação da cola biológica apresentaram baixa taxa de sangramento.

The aplication of cyanoacrilate surgical glue on skin suture in rats

Abstract Purpose: To compare the use of a new cyanoacrylate-based surgical glue and suture with sepa-rate points in skin wounds closure. Methods: Thirty-six rats were subjected to a 4cm dorsal longitudinal incision. Twelve were sub-jected to simple suture with polyamide 6-0, 12 rats underwent wall synthesis using Dermabond(r) and 12 was performed cutaneous synthesis with N-2-Butyl-Cyanoacrylate. Twelve of each group was euthanized on the seventh postoperative day, their blood was taken to biochemical tests and a layer of skin and subcutaneous tissue surrounding the surgical scar was randomly divided in two segments, to the submission of tension tests and to histological study. Results: There were no significant difference between groups (p>0.05). In the soft dermis there was more type I collagen production in group I (p<0.05), group II and III was similar re-sults (p>0.05). In the compact dermis, all 3 groups showed similar results (p>0.05). The biomechanical study was similarity between the glue groups (p>0.05) but the group III proved to be different from the others having a higher resistance (p>0.05) . Conclusion: This glue does not cause any inflammation or kidney and hepatic toxicity. Polyamide sutures are more resistant and the glue should be used alone only in less tension are-as.

Comparação de resultado estético em cicatrizes com uso de fios cirúrgicos e Prineo® / Comparison between surgical sutures and Prineo® in terms of esthetic result and scar formation

Introdução: Cicatrização de ferida é um processo bem organizado que tem como finalidade a reparação tecidual completa. Colas e adesivos tópicos oferecem uma alternativa não invasiva, de retirada fácil e espontânea; boa força tênsil; menor tempo de aplicação, sendo o Prineo® uma cola adesiva associada a uma malha de poliéster aplicados sobre a ferida. Método: Trata-se de um estudo transversal retrospectivo com análise de 101 procedimentos cirúrgicos no período de 2012 a 2014, nos quais a síntese da ferida operatória ocorreu com fios cirúrgicos de náilon ou Prineo®, sendo aplicada análise estatística. Resultados: Neste estudo, seis pacientes apresentaram dermatite de contato ao uso do Prineo® com significância estatística (p = 0,042). O uso desse sistema diminuiu a taxa de alargamento cicatricial (p < 0,05). O presente trabalho não apresentou diferença estatística (p = 0,068) na qualidade da cicatriz entre os pacientes que utilizaram Prineo® em relação ao grupo controle, demonstrando que em ambos os grupos o resultado cicatricial foi de excelente (87%) a bom (27%) na sua maioria. Conclusão: Conclui-se no estudo que os pacientes que utilizaram o sistema de octil-2-cianocrilato associado a malha, Prineo®, apresentaram menores índices de alargamento cicatricial, dependentes de uma espessura de derme satisfatória, e maiores taxas de dermatites por contato em relação àqueles em que a ferida foi encerrada com fios cirúrgicos. Os dois grupos demonstraram qualidades cicatriciais excelentes a bons, sem diferença estatística em tais resultados estéticos cicatriciais.

Introduction: Wound healing is a well-organized, directed process of tissue repair. The process can be expedited using topical glues and adhesives, which offer a non-invasive, easily removable alternative to suturing. Furthermore, such products have good tensile strength and involve lower application time. In particular, the Prineo® adhesive is applied to a polyester mesh that covers the wound. Method: We carried out a retrospective, cross-sectional study, with subsequent statistical analysis , involving 101 surgical procedures in which wound closure was performed using either nylon sutures or Prineo®. All the procedures were performed between 2012 and 2014. Results: Six patients had contact dermatitis after Prineo® was used, with statistical significance (p = 0.042). Furthermore, Prineo® decreased the rate of scar enlargement (p < 0.05) . There was no statistical difference between the Prineo® and suture groups in terms of scar quality (p = 0.068); in both groups, the scar result was mostly excellent (87 %) to good (27%). Conclusion: Patients whose wounds were closed using Prineo® a system involving octyl-2-cyanoacrylate and an associated polyester mesh displayed lower rates of scar enlargement, which depended on whether the thickness of the dermis was satisfactory. However, the same patients had higher rates of contact dermatitis than those whose wounds were closed using surgical sutures. Both groups showed excellent to good scar quality, with no significant difference in terms of esthetic scar results.

Treatment of fistula-in-ano with cyanoacrylate glue with and without prior seton placement in rats

ABSTRACT PURPOSE: To evaluate the efficacy of ethyl-cyanoacrylate in the treatment of fístula-in-ano in rats with and without prior seton placement. METHODS: Thirty rats Wistar with fístula-in-ano produced surgically, distributed in three groups: group A (ethyl-cyanoacrylate) - treated by application of ethyl-cyanoacrylate into fístula tract; group B (seton + ethyl-cyanoacrylate) - seton placement followed by application of ethyl-cyanoacrylate into fístula tract, 30 days later; group C (control) - no treatment. After 60 days the animals were submited to euthanasia and the specimens were analyzed by pathologist. The results were analyzed by Chi-square test with significant value of p<0.05. RESULTS: One animal of group B died. Were found tracts fully healed: 7, 5 and 2, in groups A, B and C, respectivelly. There was a statistically significant difference between groups A and C (p=0.02). When joined all animals treated with glue (A + B) compared to group C there was also statistically significant difference (p=0.02). CONCLUSIONS: The use of ethyl-cyanoacrylate glue was effective in closing anal fistulae in rats. There was no advantage in the prior application of seton.

Contact lenses as drug controlled release systems: a narrative review / As lentes de contacto como sistema de libertação controlada de fármacos: uma revisão narrativa

ABSTRACT Topically applied therapy is the most common way to treat ocular diseases, however given the anatomical and physiological constraints of the eye, frequent dosing is required with possible repercussions in terms of patient compliance. Beyond refractive error correction, contact lenses (CLs) have, in the last few decades emerged as a potential ophthalmic drug controlled release system (DCRS). Extensive research is underway to understand how to best modify CLs to increase residence time and bioavailability of drugs within therapeutic levels on the ocular surface.These devices may simultaneously correct ametropia and have a role in managing ophthalmic disorders that can hinder CL wear such as dry eye, glaucoma, ocular allergy and cornea infection and injury. In this narrative review the authors explain how the ocular surface structures determine drug diffusion in the eye and summarize the strategies to enhance drug residence time and bioavailability. They synthesize findings and clinical applications of drug soaked CLs as DCRS combined with delivery diffusion barriers, incorporation of functional monomers, ion related controlled release, molecular imprinting, nanoparticles and layering. The authors draw conclusions about the impact of these novel ophthalmic agents delivery systems in improving drug transport in the target tissue and patient compliance, in reducing systemic absorption and undesired side effects, and discuss future perspectives.

RESUMO A forma mais frequente de aplicação terapêutica em oftalmologia consiste na instilação de gotas oculares, mas dadas as limitações anatómicas e fisiológicas do olho, é necessária dosagem frequente com possível repercussão na adesão do paciente à terapêutica. Nas últimas décadas, as lentes de contacto (CLs) têm surgido como um potencial sistema de libertação controlada de fármacos na superfície ocular (DCRS) para correção do erro refrativo. Está em curso uma extensa investigação para entender a melhor forma de modificar as CLs, de modo a aumentar o tempo de residência e a biodisponibilidade do medicamento na superfície ocular dentro de níveis terapêuticos. Ao corrigirem a ametropia, estes dispositivos poderão simultaneamente desempenhar um papel na gestão de perturbações oftalmológicas, tais como a síndrome do olho seco, glaucoma, alergia ocular e infecção corneana, que podem comprometer o porte seguro e confortável das CLs. Nesta revisão narrativa, os autores explicam como as estruturas da superfície ocular determinam a difusão de fármacos no olho e sintetizam as estratégias para aumentar a permanência e biodisponibilidade dos mesmos. Em seguida, apresentam os resultados e as aplicações clínicas das CLs embebidas em fármacos, como DCRS, através da incorporação de barreiras de difusão, de monómeros funcionais, da liberação controlada por iões, da impressão molecular, de nanopartículas e pelo processo camada sobre camada. Os autores concluem avaliando o impacto destes novos sistemas de entrega de agentes farmacológicos ao melhorar o seu transporte no tecido alvo, reduzindo a sua absorção sistémica e os seus efeitos colaterais indesejáveis, e discutem perspectivas futuras.

Uso de adhesivos tisulares para el cierre de heridas en la práctica médica / Use of tissue adhesives for the wound closure in medical practice

Introducción: los adhesivos tisulares generan una película impermeable que una vez aplicados sobre la herida quirúrgica mantienen los bordes juntos hasta que se produce la cicatrización, lo que ayuda a disminuir el riesgo de infección de las heridas tratadas. Su empleo en la medicina permite simplificar procedimientos quirúrgicos complejos y brinda mayor comodidad al paciente. Objetivo: identificar los ámbitos de la práctica médica donde el cierre quirúrgico de heridas con el uso de adhesivos tisulares ofrece mejores resultados. Métodos: estudio descriptivo con un diseño de análisis de decisión, se confeccionó un árbol de decisión que comparó dos posibles alternativas: uso de adhesivos tisulares en adultos y en pediatría. La información se obtuvo de la literatura mediante la revisión de bases de datos médicas en el periodo de enero/2002 a diciembre/2012. Se identificaron 25 estudios (15,4 por ciento) que fueron válidos para estimar las probabilidades de complicaciones y éxito en el cierre de heridas. Resultados: el uso de adhesivos titulares en adultos mostró los mejores resultados con una alta probabilidad de éxito (0,99) para el cierre de heridas en piel y mucosas y especialmente en la cirugía de cabeza y cuello. En pediatría la probabilidad de éxito fue de 0,96 y su mejor uso se decidió en la cirugía de tórax y abdomen. Conclusiones: el uso de adhesivos titulares en adultos y niños ofrece una alta perspectiva de éxito para el cierre de heridas en piel y mucosas, si bien su uso en adultos es su mejor opción(AU)

Introduction: tissue adhesives generate, based on its characteristics, a water-proof film that once spread over the surgical wound, can keep wound edges together until cicatrization, all of which helps to decrease the infection risk. The use of tissue adhesives in medicine allows making complex surgical procedures simpler in addition to making the patient feel more comfortable. Objective: to identify the areas of medical practice where the surgical wound closure with adhesives exhibits better results. Methods: descriptive study with analysis decision design; a decision tree was created to compare two possible alternatives: use of tissue adhesives in adults and in pediatrics. Information was taken from literature through revision of medical database in the period of January 2002 to December 2012. Twenty five studies (15.4 percent), which were valid for estimating the odds of complications and successes of each wound closure option. Results: the use of tissue adhesives in adults showed the best results with high probabilities of being successful (0.99) in closing skin and mucosa wounds, mainly in the head and the neck. The probabilities for success in pediatrics were 0.96 and it is better used in thorax and abdomen surgery. Conclusions: use of tissue adhesives in adults and children provide high success probabilities for the closure of wounds in the skin and in the mucosa, although their use in adult people is the best choice(AU)

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 fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

Uso do n-butil cianoacrilato em cirurgias da parede abdominal. Revisão da literatura / Use of n-butyl cyanoacrylate in surgeries of the abdominal wall. Literature review

O uso de adesivos teciduais à base de cianoacrilato como alternativa às suturas mecânicas tem despertado grande interesse entre os cirurgiões, pela promoção de uma adesão de qualidade dos tecidos em tempo reduzido e, ainda, por suas propriedades hemostáticas e bacteriostáticas. Neste contexto, a presente revisão discute as propriedades dos diversos tipos de adesivos teciduais e suas indicações nas cirurgias da parede abdominal.

The use of cyanoacrylate-based tissue adhesives as an alternative to surgical stapling has arisen great interest among surgeons, for promoting quality tissue adhesion in reduced time, and also for its hemostatic and bacteriostatic properties. In this context, this review discusses the properties of various types of tissue adhesives, and their indications for surgery of the abdominal wall.

Efeito de cianoacrilatos e adesivo tissular a base de veneno de cobra na citotoxicidade sobre fibroblastos gengivais e estresse oxidativo sobre células do biofilme de C. albicans / Effect cyanoacrylate and snake venom tissue adhesive on cytotoxicity of gingival fibroblasts and oxidative stress of C. albicans biofilms

A estomatite protética é uma patologia que acomete muitos usuários de prótese total. Um dos principais fatores da sua etiologia é a fácil adesão de microrganismos, como a Candida albicans, à resina acrílica, principalmente devido às características de superfície facilitadoras deste material. Por esta razão, estuda-se materiais que possam modificar as características de superfície da resina acrílica sem alterar as suas propriedades mecânicas. A investigação das propriedades desses materiais, como a biocompatibilidade e como eles influenciam as células de C. albicans, é de extrema importância para uma futura aplicação clínica. Dessa forma, a proposta desta pesquisa foi avaliar a citotoxicidade sobre fibroblastos gengivais humanos (FGH) e o estresse oxidativo causado em células de C. albicans por 6 produtos (etil-cianoacrilato convencional -ECAc; etil-cianoacrilato em forma de gel formulação a -ECAga; etil-cianoacrilato em forma de gel formulação b -ECAgb; butil-cianoacrilato - BCA; octil-cianoacrilato OCA; selante tissular a base de veneno de cobra-VC;), que quando aplicados na superfície da resina acrílica, modificam suas características de superfície, visando diminuir a formação do biofilme de C. albicans. Espécimes de resina acrílica foram confeccionados e duas camadas de cada produto foram aplicadas nas superfícies. Cada espécime foi deixado em 1, 066 mL de meio de cultura durante 24 horas para extração e utilização do meio condicionado para os dois ensaios. Para a investigação da citotoxicidade, os FGH foram cultivados em placas de 96 poços, meios condicionado de cada grupo foram depositados em cada poço onde permaneceram em contato por 24, 48 e 72 h. Após o processamento para o ensaio de MTT as placas foram analisadas em espectrofotômetro a 500 nm. Foram realizados quatro experimentos independentes em triplicata (n=12). Para a investigação de estresse oxidativo (ERO) causado em C. albicans, biofilme foi desenvolvido em placas de 96 poços durante 24 h. Então, os meios condicionados foram adicionados aos poços e a placa foi mantida em agitadora durante 1 h. Após a retirada dos meios condicionados, foi adicionado a cada poço o reagente CellRox® Deep Red e leituras foram realizadas a cada 30 min durante 3 h em fluorímetro a 640/665nm. Amostras foram coletadas e ensaio de cultura microbiológica foi executado para a realização da normalização dos valores. Foram realizados 3 experimentos independentes em triplicata (n=9). Os resultados obtidos pelo ensaio MTT foram analisados por meio de ANOVA a 2 critérios, seguido pelo teste Tukey para a comparação entre grupos (p<0,05). Para o ensaio ROS, a análise estatística realizada foi ANOVA a 1 critério, seguida, igualmente, por Tukey (p<0,05). Os resultados mostraram que todos os grupos apresentaram certo grau de citotoxicidade quando comparados ao controle, com exceção do VC (ECAc

Denture stomatitis is a disease that affects many denture wearers. One of the main factors of its cause is the easy adhesion of microorganisms, such as Candida albicans, to acrylic resin, mainly due to its permissive surface characteristics. For this reason, materials that can modify surface characteristics of acrylic resin without changing its mechanical properties are being studied. The investigation of these materials features, such as biocompatibility and how they affect Candida albicans, is of utmost importance for future clinical application. Thus, the purpose of this study was to evaluate the cytotoxicity of human gingival fibroblasts (HGF) and oxidative stress in C. albicans cells after contact with 6 experimental products (conventional ethyl-cyanoacrylate -ECAc; ethyl-cyanoacrylate in gel formulation "a" -ECAga; ethyl-cyanoacrylate in gel formulation "b" -ECAgb; butyl- cyanoacrylate - BCA; octyl-cyanoacrylate -OCA; tissue adhesive based on snake venom -VC) applied to the surface of the resin acrylic, modifying its surface characteristics, in order to decrease C. albicans biofilm formation. Acrylic resin specimens were manufactured and two layers of each product were applied to the surfaces. Each specimen was immersed in 1,066 mL of growth media for 24 hours for extraction and the resulting conditioned media were used for both tests. To investigate cytotoxicity, HGF were cultured in 96-well plates and conditioned media from each group were deposited into each well, where they remained in contact for 24, 48 and 72h. After the MTT assay processing, plates were analyzed in a spectrophotometer at 500 nm. Four independent experiments were performed in triplicate (n=12). To investigate oxidative stress (ROS), C. albicans biofilm was developed in 96-well plates for 24 h, conditioned media were added to the wells and the plate was allowed to stir for 1 h. Then, conditioned media were removed and CellRox® Deep Red reagent was added to each well. Readings were performed every 30 min for 3 h in fluorometer at 640/665nm. Samples were collected and microbiological culture test was executed to values normalization. Three independent experiments were performed in triplicate (n=9). Results obtained in MTT assay were analyzed by two-way ANOVA and Tukey's test for comparison between groups (p<0.05). for comparison between groups (p<0.05). For ROS results, one-way ANOVA was performed followed by Tukey test, as well (p<0.05). The results showed that all groups presented different degrees of cytotoxicity when compared to control group, except for VC (ECAc

Use of Bovine Pericardium and Sutureless Biological Glue in Left Ventricular Rupture After Mitral Valve Replacement, Five Years of Follow-up

ABSTRACT Rupture of the left ventricular wall after mitral valve replacement is an infrequent but lethal complication. Reporting correction technique of ventricular rupture with bovine pericardium patch secured with glue and without suturing: a 51 years-old female patient, with double rheumatic mitral lesion, severe stenosis and discrete insufficiency, who had a mitral valve replacement. During surgery, the patient presented a ventricular rupture of the posterior wall (atrioventricular disruption), which was successfully repaired using bovine pericardium with sutureless biological glue over the epicardium of the damaged area. Sixty months after surgery the patient has no symptoms.

Effectiveness of cyanoacrylate adhesive in rabbit aortorrhaphy / Efetividade do adesivo de cianoacrilato para aortarrafia em coelhos

BACKGROUND: Even when properly performed, arterial sutures are not always absolutely hemostatic. Tissue sealants and adhesives have become available that can be used to complete sutures, preventing hemorrhage problems.OBJECTIVES: To evaluate the effectiveness of cyanoacrylate adhesive for sealing aortotomies in rabbits in a coagulopathic state, by analyzing survival of the animals and the time taken to achieve hemostasis.METHODS: Ten-mm long aortotomies were performed on the infrarenal aortas of 12 animals. In four animals, aortorrhaphy was conducted using four interrupted polypropylene sutures and in the remaining animals aortorrhaphy was performed using four or fewer polypropylene stitches, followed by application of a cyanoacrylate adhesive.RESULTS: The four animals sutured without adhesive died within the postoperative period due to severe hemorrhage (3 animals) or intestinal ischemia. The eight animals to which the adhesive was applied exhibited no transoperative bleeding, but one animal died during the postoperative period. Using cyanoacrylate permitted more rapid procedures (p<0.004) and no local reactions were observed in macroscopic examination of tissues.CONCLUSIONS: The cyanoacrylate adhesive demonstrated effectiveness for sealing aortotomies, considering the survival outcomes, duration of procedures and absence of local reactions on macroscopic examination.

CONTEXTO: Ainda quando feitas adequadamente, suturas arteriais não são absolutamente hemostáticas. Vedantes e adesivos teciduais estão disponíveis e podem ser usados para completar as suturas, prevenindo problemas hemorrágicos.OBJETIVOS: Avaliar a efetividade do adesivo de cianoacrilato em vedar aortotomias de coelhos, considerando a sobrevida dos animais e o tempo para hemostasia.MÉTODOS: Em todos os doze animais, aortotomias de 10 mm de extensão foram feitas na aorta abdominal infrarrenal. Em quatro animais a aortorrafia foi feita com quatro pontos separados de polipropileno, e no outro grupo, a aortorrafia foi feita com quatro ou menos pontos separados e, depois, o adesivo de cianoacrilato foi aplicado.RESULTADOS: Os quatro animais que receberam somente a sutura morreram no primeiro dia de pós-operatório devido à hemorragia intensa (três animais) e por isquemia intestinal. Nos oito animais nos quais o adesivo foi aplicado não houve sangramento transoperatório, mas um animal morreu no período pós-operatório. A utilização do cianoacrilato tornou o procedimento mais rápido (p < 0,004). Não foram observadas reações locais sob o ponto de vista macroscópico.CONCLUSÕES: O adesivo de cianoacrilato mostrou efetividade em vedar aortotomias, considerando o desfecho sobrevida e tempo para obter hemostasia e o fato de não ocorrerem reações locais sob o ponto de vista macroscópico.