Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing tracheal anastomoses.

AIM: The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue, manufactured by CryoLife Inc., Kennesaw, GA, USA) when used on tracheal resections in rabbits, which is a sensitive model to investigate the biocompatibility of the glue. METHODS: The 24 animals were anesthetized and underwent cervicotomy with resection of a 10 mm long tracheal segment. The experimental group (18 animals with 2, 4 and 12 week endpoints) had a tracheal anastomosis performed with a maximum of 4 sutures for the approximation of the tissue margins. The anastomotic line was then circumferentially covered with the adhesive. Control animals (6 animals, 4 week endpoint) had a tracheal anastomosis performed with the use of twice interrupted, airtight running suture. The experiments were conducted after approval by the Institutional Ethics Committee and in accordance with the European Convention on Animal Care. RESULTS: Macroscopic evaluation revealed a tight closure of the anastomosis in 23 animals. One rabbit developed tracheo-cutaneous fistula, 2 rabbits experienced intraluminal granulations due to infection, and 1 rabbit developed tracheal stenosis due to insufficient sutures with axis-displacement of the anastomosed tracheal lumina. On microscopic examination, after 2 weeks an inflammatory tissue response consisting of neutrophils, macrophages and foreign body giant cells was found surrounding the glued area. After 4 weeks the tissue was granulomatous in character with an increasing number of multinucleated giant cells. In general, persistent granulomatous inflammation and fibrous scar tissue was seen after 12 weeks. Both, macroscopically and microscopically, fibroangioblastic tissue responses were found in the control group after 4 weeks. CONCLUSIONS: Despite secondary healing disruptions such as granuloma formation, our investigations suggest that the results of albumin-glutaraldehyde tissue adhesive sealed tracheal anastomoses with a few approximating sutures are comparable with those using suture technique. Short term results demonstrated good biocompatibility of the glue.

Surgical treatment of the spine at the cervicothoracic junction: an illustrated review of a modified sternotomy approach with the description of tricks and pitfalls.

The surgical treatment of burst fracture, tumour or spondylitis remains a challenge with regard to the surgical approach to the anterior aspect of the cervicothoracic junction. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. Fortunately, indications for surgery in this region are rare. However, when it becomes necessary for the surgeon to expose this region, it is useful to be prepared to approach it carefully. In this investigation the anatomy and exposure of the cervicothoracic junction by means of a sternotomy are described. An illustrated review of the sternotomy approach to the cervicothoracic junction with a description of 'tricks and pitfalls' is provided.

Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing pulmonary parenchyma and bronchial anastomoses.

OBJECTIVE: Despite advanced surgical techniques, major complications of bronchial anastomoses and parenchymal repair, including early leak, fistula formation and granulations still occur. The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue), CryoLife Inc., Kennesaw, GA) as a sealant for bronchial anastomoses and parenchyma lesions. METHODS: Twenty-four sheep were split into two surgical groups. The first group consisted of six control sheep receiving standard sutured bronchial anastomosis with a 4-week end-point. The second group included 18 sheep receiving both a bronchial anastomosis and parenchymal defect repair using the adhesive with 2, 4, and 12 week end-point. Histopathologic evaluation was conducted at the study end-points. RESULTS: Bronchial anastomosis and parenchymal tissue repair can be sealed successfully against air leakage with adhesive. Macroscopic evaluation revealed a tight closure of the anastomosis and parenchyma defect in all postoperative stages, initially by the adhesive layer, and later by connective tissue. On microscopic examination, an inflammatory tissue response consisting of polymorphonuclear neutrophils, macrophages, granulation tissue and foreign body giant cells were found surrounding the glued area after 2 weeks. After 4 weeks the tissue response presented a granulomatous character. No granulomatous or foreign body reaction was present in the hand sutured group. After 12 weeks few remnants of adhesive surrounded by fibrous scar tissue were detectable in bronchial anastomosis and parenchymal repair. Healing was not considerably complicated by foreign body reaction or tissue granulation. CONCLUSION: This study supports BioGlue to be effective as an adjunct in sealing bronchial anastomosis and lung parenchyma defects in sheep, with minimal secondary healing disruptions such as granuloma formation. The results of this study indicate that the use of BioGlue in human pulmonary surgery should be effective.

[What is the value of neoadjuvant therapy in bronchial carcinoma?]. / Welchen Stellenwert hat die neoadjuvante Therapie beim Bronchialkarzinom?

Neoadjuvant chemotherapy is obligatory for small-cell lung cancer. When combined with radio-therapy, it reduces the incidence of recurrence and increases the survival rate to a level similar to that seen in non-small-cell lung cancer. Preliminary results suggest that complete remissions (3-year-survival rate 56%) can be achieved through the use of chemotherapy, possibly including high-dose chemotherapy for advanced stage III A cancer. The use of pre-operative chemotherapy in advanced stage III non-small-cell lung cancer is firmly established. In one study the 3-year-survival rate reached 25% in the chemotherapy group as compared to 15% in the group treated by surgery only. Early results of pre-operative chemo- and radiotherapy for stages III A and III B are encouraging. In studies comparing neoadjuvant chemotherapy alone to a combination of neoadjuvant chemo-radiotherapy a higher resection rate (32 to 76%) as well as a longer disease-free survival time could be shown for the combination therapy. To date, a number of innovative neoadjuvant chemoradiotherapy protocols using new substances as well as various modifications of radiotherapy are being studied. It is to be expected that new standard therapies for non-small-cell lung cancer will develop from these studies.

[Resection of solitary pulmonary metastases]. / Resektionsbehandlung solitärer Lungenmetastasen.

From January 1957 to December 1981 45 patients underwent resections (lob-, bilob-, pneumonectomies) due to solitary metastases of the primary tumour in the lung. Concerning the 3- and 5 years survival rate resp. 41 patients could be followed up. The best results could be obtained in patients with metastases from carcinomata of the uterus, kidney and female breasts with an average survival coming up to 44.3%, 32.3% and 32.2%. (22% of our patients had a survival time of more than 5 years, 29% of more than 3 years). In our opinion the resection of solitary pulmonary metastases can be regarded as a surgical method which allows satisfactory results to be obtained.

[Rare complications with multiple hereditary cartilaginous exostosis (author's transl)]. / Seltene Komplikationen durch multiple hereditäre kartilaginäre Exostosen.

A case of hereditary multiple cartilaginous exostosis is reported and the clinical symptoms are discussed. An exostosis of the distal femur was followed by an aneurysma spurium of the left femoral artery. Osteochondromas of the left ribs caused a hematothorax. Thoracotomy was necessary for treatment.

[Diagnosis, clinic and therapy of bronchial adenomas (author's transl)]. / Zur Diagnostik, Klinik und Therapie der Bronchusadenome Bericht über 77 eigene Fälle

Report on diagnosis, clinic and therapy of 77 cases with bronchial adenomas. These semimalign tumours of the respiratory tract amounted to 1.5 per cent of all lung tumours admitted to our clinic within 21 years and were growing predominantly in the central parts of the respiratory tract. Resection therapy is the therapy of choice. Although potential malign, the bronchial adenomas differ markedly from bronchial carcinomas in relation to prognosis and mortality.

[The bronchusplasty with lung-resections -- a conservative method of operation in tumor surgery (author's transl)]. / Die Bronchusplastik bei Lungenresektionen -- eine organerhaltende Operationsmethode in der Tumorchirurgie

Report regarding 32 patients with bronchusplasty in lung resections on account of semimalignant and malignant tumors. Operative indications, -technique, postoperative complications and results up to now are discussed.

[Testing of bronchial carcinoma for sensitivity against cytostatics in tissue culture (author's transl)]. / Zur Sensibilitätsbestimmung von Bronchialkarzinomen in der Zellkultur

Report on determinations of sensitivity against cytostatics of tumour cell cultures from 70 bronchial carcinomas and 5 neoplastic effusions. The take rate was 56%. Most tumors tested were in vitro sensible against vinblastin and cyclophosphamid and resistant (moderately or completely) against 5-fluoro-uracil and Methotrexat.

[Angiofollicular lymph-node hyperplasia of the lung ("zwiebelschalenlymphom") (author's transl)]. / Angiofollikuläre Lymphknotenhyperplasie der Lunge (Zwiebelschalenlymphom)

This is the author's second report on angiofollicular lymph-node hyperplasia of the lung ("Zwiebelschalenlymphom") rarely described in German medical publications. Obviously the tumor has its origin in the bronchopulmonary lymph-nodes. The resection of the upper lobe of the left lung was indicated.