Cyanoacrylate tissue adhesive versus silk sutures for mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: Cyanoacrylate tissue adhesive has been presented as an alternative to sutures and several studies have compared them. The objective of this meta-analysis was to evaluate the effect of cyanoacrylate tissue adhesive on postoperative pain and swelling, following mandibular third molar surgery. MATERIALS AND METHODS: Database search was conducted in MEDLINE/PubMed and Scopus, along with extensive search in the grey literature, including randomized and non-randomized clinical trials that applied cyanoacrylate adhesive for closing mandibular third molar surgical sites and compared it with silk sutures, assessing postoperative pain and swelling. The search ended on September 22, 2023. RESULTS: Of 886 identified articles, six were included and meta-analyzed. Applying cyanoacrylate demonstrated a reduction in the overall postoperative pain (SMD = -0.57, 95% CI -1.00 to -0.15, p = 0.009). A similar outcome was noted when pain was evaluated on the first and last postoperative days, based on controlled clinical trials (SMD = -0.47, 95% CI -0.92 to -0.03, p = 0.04), and randomized trials (SMD = -0.97, 95% CI -1.31 to -0.62, p < 0.00001). Patients/sides received cyanoacrylate showed a decrease in postoperative swelling (SMD = -0.26, 95% CI -0.51 to -0.01, p = 0.04). Following the GRADE rating system, the quality of evidence on pain and swelling was judged as moderate and low, respectively. CONCLUSIONS: The use of cyanoacrylate adhesive may offer benefit in reducing postoperative pain and swelling following mandibular third molar surgery. Nevertheless, this should be further investigated, considering the low number of included reports. CLINICAL RELEVANCE: The current results could help clinicians who perform this procedure to manage postoperative pain and swelling more effectively.

The Effectiveness of Cyanoacrylates versus Sutures for Mesh Fixation after Lichtenstein Repair (SCyMeLi STUDY) A Systematic Review and Meta-Analyze of Randomized Controlled Trials.

Background: Chronic postoperative inguinal pain (CPIP) is still the most frequent complication after open Lichtenstein repair and any strategy to reduce its incidence and implications is a step forward to better outcomes. Between the means of mesh fixation atraumatic glue fixation has been explored as such possibility. A meta-analysis of randomized controlled trials comparing the performance of cyanoacrylate glue versus sutures fixation was conducted. Methods: the meta-analysis was conducted according to the PRISMA guidelines. Randomized controlled trials (RCTs) published between January 2000 and December 2021 were searched for in MEDLINE, PubMed, Web of Science, and Google Scholars. The quality of RCTs and the potential risk of bias were assessed using MINORS criteria and the Cochrane risk of bias tool. Results: of 269 papers the meta-analysis was performed on 19 RCTs including 3578 patients. In the glue fixation group, the operation was shorter (mean pooled difference 6 minutes; SE = 0.47; 95% CI = - 6.77 - - 4.92; t test = -12.36; p 0.0001) and immediate postoperative pain was lower (2.37% vs 13.3%OR - 0.158; 95% CI = 0.064 0.386; p = 0.0001). There was no difference in terms of chronic pain, recurrence rate and wound events. Conclusion: glue fixation of mesh in elective Lichtenstein repair of inguinal hernia seems to be a valid choice for a painful and safe procedure without increasing risk of recurrence.

The Novel Surgical Technique in the Cyanoacrylate Closure for Incompetent Great Saphenous Veins.

OBJECTIVE: The current Instructions for Use (IFU) of cyanoacrylate closure (CAC) is to start initial injection with the catheter tip positioned 5 cm distal to the sapheno-femoral junction (SFJ) to prevent endovenous glue-induced thrombosis (EGIT). However, this defensive design is responsible for the relatively long stump length. Although clinical studies on the long-term recurrence rate are still lacking, the long stump length can predict a higher long-term recurrence rate compared to other surgical methods. The author developed a novel surgical technique that can overcome the weakness of CAC, and the initial outcomes of this technique are described in this article. METHODS: This study retrospectively reviewed 25 great saphenous vein (GSV) in 20 patients who underwent CAC for incompetent GSV at our hospital. The procedure from puncturing the GSV to insertion of the catheter is the same as the conventional method. Place the catheter tip 2-3 cm below the SFJ before cyanoacrylate injection. After confirming the position of the SFJ with the longitudinal view of the ultrasound, press the GSV directly above the SFJ transversely with the second to fifth fingertips of the left hand. Then, the ultrasound probe is placed against the distal part of the fingertips, and CA injection is performed while GSV is monitored in real time. RESULTS: The mean stump length immediately after surgery was 19.3 (± 7.8) mm, with a range of .0-38.4 mm. The mean stump length after 1 week was 12.3 (± 7.4) mm and the range was .1-35.4 mm. The mean stump length after 1 month was 15.4 (± 10.1) mm, and the range was .0-35.4 mm. There was no case with EGIT or recanalization. CONCLUSIONS: The author confirmed the possibility of safely reducing stump length with this novel surgical technique, and expect that this method can help overcome the weakness of CAC.

Prostate artery embolization using n-butyl cyanoacrylate glue for symptomatic benign prostatic hyperplasia: A six-month outcome analysis in 103 patients.

PURPOSE: The purpose of this study was to assess the feasibility, safety, and 6-month outcomes of prostate artery embolization (PAE) using N-butyl-cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms. MATERIALS AND METHODS: Patients with BPH-related lower urinary tract symptoms who were treated by PAE using methacryloxysulfolane-NBCA mixed with ethiodized oil (1:8 ratio) between September 2018 and January 2023 were retrospectively included. Vascular mapping was made using cone-beam computed tomography angiography. PAEs were performed as an outpatient procedure, under local anaesthesia. Outcomes were assessed at six months using the International Prostate Symptoms Score (IPSS) and associated quality-of-life score (IPSS-QoL), prostate-specific antigen (PSA) level, prostate volume, and International Index of Erectile Function form 5 (IIEF5). RESULTS: A total of 103 men with a mean age of 68.4 ± 6 (standard deviation [SD]) years were included. Technical success rate was 100%. The mean fluoroscopy time was 26.4 ± 12.5 (SD) min and the median radiation dose was 23 980 mGy·cm (Q1, Q3: 16 770, 38 450). Compared to baseline, statistically significant improvements were observed at six months for the IPSS (8.9 ± 6.2 [SD] vs. 20.2 ± 6.5 [SD]; P = 0.01), IPSS-QoL (2.1 ± 1.4 [SD] vs. 5.1 ± 0.9 [SD]; P = 0.01), PSA level (3.6 ± 3.2 [SD] ng/mL vs. 4.8 ± 4.2 [SD] ng/mL; P = 0.0001), and prostate volume (78.6 ± 43.5 [SD] mL vs. 119.1 ± 65.7 [SD] mL; P = 0.01). Minor adverse events developed in 19/103 (18.4%) patients. No major complications occurred. Compared to baseline, the IIEF5 did not change significantly at six months (15.3 ± 6.8 [SD] vs. 15.8 ± 6.8 [SD]; P = 0.078). CONCLUSION: PAE with NBCA is a feasible and safe method that provides good outcomes at six months in patients with BPH-related lower urinary tract symptoms. This method deserves further evaluation in randomized trials with longer follow-up.

Surgical adhesive glue to repair first-degree perineal tears in vaginal birth: A randomised controlled clinical trial.

Background: Perineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid the pain that may be caused by perineal repairs with sutures. Objective: To evaluate the effectiveness of surgical adhesive glue in reducing perineal pain when compared to sutures in first-degree perineal tears resulting from vaginal birth. Design: Open-label parallel-group randomised controlled trial. Setting: An alongside birth centre in Sao Paulo, Brazil. Participants: 84 intrapartum women with first-degree perineal tears needing repair. Methods: In the experimental group (n = 42), the perineal tears were repaired with Epiglu® surgical glue (ethyl-2-cyanoacrylate); in the control group (n = 42), the tears were repaired with Vicryl Rapide® (polyglactin 910) sutures. The primary outcome was the intensity of perineal pain after birth measured by a numeric pain rating scale ranging from 0 to 10 points. The secondary outcomes were healing, measured by the "Redness, Oedema, Ecchymosis, Discharge, and Approximation" scale; women's satisfaction with the perineal repair, measured by a visual analogue scale; and the time necessary to complete the repair. Data were collected during postpartum hospitalisation and 10-20 days after discharge, from December 2020 to May 2021. Data were analysed using bivariate analysis and linear models by intention-to-treat. Results: 36-48 h after birth, the mean of perineal pain was 0.2 (95% Confidence Interval [CI] 0.1-0.8) in the experimental group and 0.9 (95% CI 0.5-1.5) in the control group; the perineal healing score was 0.7 (95% CI 0.4-1.2) and 0.8 (95% CI 0.5-1.2), in the experimental and control groups, respectively; satisfaction was higher among women in the experimental group (88.1% versus 83.3% in the control group). After discharge, the mean of perineal pain was 0.1 (95% CI 0.0-0.5) in the experimental group and 1.4 (95% CI 0.8-2.2) in the control group; the perineal healing score was 0.0 (95% CI 0) and 1.0 (95% CI 0.7-1.3) in the experimental and control groups, respectively. Satisfaction was higher in the experimental group (94.9% versus 75.0%). The longitudinal analysis showed statistically significant differences between the groups regarding perineal pain and women's satisfaction. The average time necessary for perineal repair was 6.0 (95% CI 4.7-8.7) minutes in the experimental group and 9.7 (95% CI 8.3-11.5) in the control group (p < 0.001). Conclusions: Surgical glue resulted in less perineal pain, faster repair, and greater satisfaction than perineal sutures after birth. The healing process was similar in both cases. Tweetable abstract: Surgical glue was less painful and promoted greater satisfaction after birth compared to sutures in women with first-degree perineal tears. Registration: Registered on The Brazilian Clinical Trials Registry number RBR-52y5tq (http://www.ensaiosclinicos.gov.br/rg/RBR-52y5tq/), on July 16, 2020. The first recruitment was on December 17, 2020.

Treatment of gastric varices with cyanoacrylate complicated by systemic embolization / Tratamiento de várices gástricas con cianoacrilato complicado con embolización sistémica

ABSTRACT Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.

RESUMEN La hemorragia digestiva por várices gástricas es una afección potencialmente mortal que puede tratarse eficazmente con la inyección endoscópica de cianoacrilato diluida con lipiodol. La mezcla actúa como un adhesivo tisular que se polimeriza cuando entra en contacto con la sangre de la várice gástrica. Este trabajo nos reporta un paciente que acudió al servicio de urgencias con hemorragia digestiva alta debido a hemorragia aguda por várices, que desarrolló embolización sistémica después de la terapia con inyección de cianoacrilato. Esta complicación culminó en infartos cerebrales, esplénicos y renales con desenlace fatal. La embolización sistémica es una complicación muy rara, pero con alta mortalidad, asociada con la inyección endoscópica de cianoacrilato y debe considerarse en pacientes sometidos a este tratamiento.

Use of cyanoacrylate for the stabilization of tissues in root coverage procedures: A case series report with 5 years follow up

ABSTRACT: A variety of periodontal plastic surgery techniques have been proposed to correct aesthetic and functional problems caused by gingival recession, with root coverage using connective tissue grafts being the one most commonly performed. These surgeries, however, are partially dependent on tissue graft stability. In this case series, we describe the use of a tissue adhesive (cyanoacrylate) as a solution for graft stabilization. Two patients with Cairo's type 1 gingival recession were treated with an envelope technique using connective tissue graft stabilized with cyanoacrylate alone. The results were a faster procedure and complete root coverage, even after 5 years of follow-up. Our findings suggest that cyanoacrylates can be an alternative to standard graft stabilizing procedures, leading to a stable root coverage in RT1 recessions.

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.

Resección quirúrgica de tapón de cianoacrilato variceal infectado posterior a esclerosis endoscópica de várices gástricas. Caso clínico

In patients with actively bleeding gastric varices, the treatment of choice is the endoscopic use of sclerosing agents such as cyanoacrylate. We report a 69-year-old man who, after being treated with cyanoacrylate, suffered from recurrent febrile episodes. After an extensive study and broad-spectrum antibiotic treatment, discarding other presumably infectious focus, the superinfection of the cyanoacrylate plug was suspected, and its surgical removal was decided. A partial gastrectomy of the gastric fundus, a splenectomy, and a distal pancreatectomy were performed. The patient evolved without fever and without new episodes of bacteremia, but with decompensation of his cirrhosis manifested by ascites, spontaneous bacterial peritonitis, pneumonia, and collections in the pancreatic bed. These complications were managed with medical treatment consisting in a long course of broad-spectrum antibiotics. Thereafter, the patient evolved satisfactorily.

Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers

ABSTRACT BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.

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.

Uso de cianoacrilato como tratamiento de várices gástricas en un hospital público nivel III en Lima - Perú

Objetivo: Evaluar el éxito de la terapia endoscópica con N-butil-2-cianoacrilato sobre las várices gástricas y determinar las tasas de resangrado y mortalidad. Materiales y métodos: Estudio observacional prospectivo de 47 casos de pacientes con várices gástricas que fueron tratados con N-butil-2-cianoacrilato, utilizando una dilución 1:1 con lipiodol entre febrero de 2013 a marzo de 2017 en un hospital público de nivel III en Lima- Perú. La indicación terapéutica fue hemorragia activa, profilaxis primaria o secundaria. Resultados: De los 47 pacientes, 5 (10,6%) presentaban hemorragia activa, se obtuvo control de la misma en todos los casos, 24 (51,1%) tuvieron estigmas de sangrado reciente durante la endoscopía. Se realizó profilaxis secundaria en 16 (34%) pacientes y profilaxis primaria en 2 (4,7%), 59,6% requirió una sola sesión. El volumen total de cianoacrilato (ml/paciente) promedio fue 1,28 ± 0,44. Se aplicó una sola inyección por sesión en el 87,2% de los pacientes. El hallazgo endoscópico fue GOV-2 en el 78,7% de los casos, IGV-1 en el 12,8% y GOV-1 en el 8,5%. Siete pacientes (14,8%) presentaron resangrado tardío, con nueva terapia exitosa en 6 de ellos, uno fallece por fracaso de la terapia. Seis (12,76%) pacientes fallecen en total, cinco (83,3%) por otras causas. Se realizó 18 meses de seguimiento. No se reportaron eventos adversos relacionados con la terapia. Se constata obturación en 28 (59,5%) pacientes. Conclusiones: El manejo endoscópico de várices gástricas con cianoacrilato es un tratamiento seguro y eficaz, con baja tasa de recurrencia y mortalidad.

Objective: To evaluate the therapeutic success of endoscopic therapy with N-butyl-2-cyanoacrylate and to determine the rebleeding and mortality rates. Materials and methods: Prospective analytical observational study of 47 cases of patients with gastric varices who were treated with N-butyl-2-cyanoacrylate, using a 1: 1 mixture with lipiodol between 2013 and 2017 in a level III public hospital in Lima - Peru. The therapeutic indication was active hemorrhage, primary or secondary prophylaxis. Results: Of the 47 patients, 5 (10.6%) had active hemorrhage, control was obtained in all cases, 24 (51.1%) had stigmas of recent bleeding during endoscopy. Secondary prophylaxis was performed in 16 (34%) patients and primary prophylaxis in 2 (4.7%). 59.6% required a single session with a total volume of cyanoacrylate (ml / patient) of 1.28 ± 0.44. The endoscopic finding was GOV-2 in 78.7% of the cases, IGV-1 in 12.8% and GOV-1 in 8.5%. Seven patients (14.8%) presented late rebleeding, with successful new therapy in 6 of them, one dying due to therapy failure. Of the six (12.76%) patients who died in total, 5 (83.3%) were due to other causes. No adverse events related to the therapy were reported. No adverse events were reported. Variceal obturation was observed in 28 (59.5%) patients. Conclusions: Endoscopic management of gastric varices with cyanoacrylate is a safe and effective treatment, with low recurrence and mortality rates.

Beneficial effects of ethyl-cyanoacrylate coating against candida albicans biofilm formation

Abstract The aim of this study was to verify whether modifications made in a hard chairside reline resin by an ethyl-cyanoacrylate adhesive, ECA (Super Bonder®, Loctite, Itapevi, SP, Brazil) would be able to inhibit or reduce Candida albicans biofilm formation on its surface, comparing to a commercial surface sealant (BisCover®, Bisco, Schaumburg, USA). Reline resin specimens were fabricated and randomly divided into 6 groups (n=8): CG (control group), no surface treatment; ECA1, ECA coating on the surface before sterilization; ECA2, ECA coating after sterilization; ECA3, ECA incorporated in the resin bulk; DPE1, BisCover® coating before sterilization; DPE2, BisCover® coating after sterilization. Specimens were inoculated with C. albicans SC5314 (1x107 cells/mL) and incubated for 24 h. Then, the biofilm were stained with LIVE/DEAD® BaclightTM L7007 Kit and analyzed by Confocal Laser Scanning Microscopy. The images were evaluated by bioImageL® v.2.0 software and total biovolume (µm3), viable cells (%), and covered area (%) were calculated. Data were statistically analyzed by Kruskal-Wallis and Dunn tests (p<0.05). Results showed that ECA-coated groups presented better results, reducing C. albicans biofilm formation. Acquired images revealed that these groups (ECA1 and ECA2) presented a reduced number of cells, mostly in yeast form (less pathogenic), while the other groups presented higher number of cells, mostly in hyphae form (more pathogenic). Based on these findings, a beneficial effect of Super Bonder® coating reline resins surface could be demonstrated, suggesting a promising way to prevent fungal biofilm formation on dentures.

Resumo O objetivo deste estudo foi verificar se as modificações feitas com o adesivo etil cianoacrilato, ECA (Super Bonder ®, Loctite, Itapevi, SP, Brasil) sobre as resinas acrílicas para reembasamento, poderiam inibir ou reduzir a formação de biofilmes de C.albicans sobre sua superfície quando comparado com um selante de superfície comercial (BisCover®, Bisco, Schaumburg, EUA). Amostras de resina acrílica para reembasamento foram fabricadas e divididas aleatoriamente em 6 grupos (n=8): CG (grupo controle), sem tratamento superficial; ECA1, revestimento de ECA na superfície antes da esterilização; ECA2, revestimento de ECA após esterilização; ECA3, ECA incorporado no volume da resina; DPE1, revestimento de BisCover® antes da esterilização; DPE2, revestimento de BisCover® após esterilização. Os espécimes foram inoculados com C. albicans SC5314 (1x107 células/mL) e incubados durante 24 h. Seguidamente, o biofilme foi corado com LIVE/DEAD® BaclightTM L7007 Kit e analisado no microscópio confocal de varredura a laser. As imagens foram avaliadas pelo software bioImageL® v.2.0, no qual foram calculados o biovolume total (μm3), as células viáveis (%) e a área coberta (%). Os dados foram analisados estatisticamente pelos testes de Kruskal-Wallis e Dunn (p<0,05). Os resultados mostraram que os grupos revestidos com ECA apresentaram os melhores resultados, reduzindo a formação do biofilme de C. albicans. As imagens adquiridas revelaram que esses grupos (ECA1 e ECA2) apresentaram um número reduzido de células, principalmente na forma de levedura (menos patogênico), enquanto os outros grupos apresentaram um maior número de células, principalmente na forma de hifas (mais patogênicas). Com base nessas descobertas, encontra-se um efeito benéfico na aplicação do adesivo ECA sobre as superfícies das resinas acrílicas para reembasamento, sugerindo assim uma nova alternativa de prevenir a formação de biofilme fúngico em próteses dentárias.

Incisões cirúrgicas mamárias tratadas com 2-octilcianoacrilato versus sutura intradérmica com fio de nylon: ensaio clínico randomizado / Surgical breast incisions treated with 2-octyl-cyanoacrylate versus intradermal nylon suture: a randomized clinical trial

RESUMO Objetivo: avaliar o perfil de segurança e os resultados estéticos do 2-octilcianoacrilato versus sutura intradérmica com fio de nylon em cirurgias mamárias. Métodos: ensaio clínico randomizado, aberto, que avaliou a ocorrência de complicações, como deiscência, hematoma, infecção e reações alérgicas após o uso do 2-octilcianoacrilato ou do fio de nylon. Também foi analisado o tamanho das incisões, o tempo de fechamento da pele e o tempo cirúrgico total. O resultado estético foi avaliado após 40 e 180 dias da cirurgia, por meio da largura média da ferida operatória e por avaliação subjetiva conceitual (ótimo, bom, razoável ou ruim). Resultados: foram incluídas 79 pacientes, sendo 37 no grupo 2-octilcianoacrilato e 42 no grupo de sutura com fio de nylon. O estudo foi interrompido antes do término do recrutamento dos pacientes pela ocorrência de maior número de deiscências no grupo do adesivo (OR: 11,42; IC95%: 1,36-96,02; p=0,007). Em relação às demais complicações analisadas, ao tempo cirúrgico e ao resultado estético no pós-operatório, não se observaram diferenças significativas entre os grupos. A média do tamanho da ferida operatória foi maior no grupo do adesivo em relação ao grupo da sutura, mas não houve correlação entre o tamanho da ferida e o maior número de deiscências. Conclusão: o 2-octilcianoacrilato apresentou maior risco de deiscência em relação à sutura intradérmica, com resultados estéticos equivalentes.

ABSTRACT Objective: to evaluate the safety profile and aesthetic results of 2-octyl-cyanoacrylate versus intradermal nylon suture in breast surgeries. Methods: an open-label, randomized, clinical trial evaluating the occurrence of complications, such as dehiscence, hematoma, infection, and allergic reactions after the use of 2-octyl-cyanoacrylate or nylon thread. The size of the incisions, skin closure time, and total surgical time were also analyzed. The aesthetic outcome was evaluated at 40 and 180 days after surgery, by means of the average width of the surgical wound and by subjective conceptual assessment (optimal, good, reasonable, or poor). Results: 79 patients were included: 37 in the 2-octyl-cyanoacrylate group and 42 in the nylon suture group. The study was stopped before the end of patient recruitment due to the occurrence of a greater number of dehiscences in the adhesive group (OR: 11.42; 95%CI: 1.36-96.02; p=0.007). Regarding the other analyzed complications, the surgical duration and postoperative aesthetic result, no significant differences were observed between the groups. The mean operative wound size was greater in the adhesive group than in the suture group, but there was no correlation between wound size and the largest number of dehiscences. Conclusion: while the cosmetic outcomes with the two techniques were similar, there was a greater risk of dehiscence with the use of 2-octyl-cyanoacrylate compared to intradermal suturing.

Segurança e eficácia do uso de cianoacrilato + coil guiado por ultrassom endoscópico versus técnica convencional de cianoacrilato no tratamento de varizes gástricas: um ensaio clínico randomizado / Safety and efficacy of eus-guided coil plus cyanoacrylate versus conventional cyanoacrylate technique in the treatment of gastric varices: a randomized controlled trial

ABSTRACT BACKGROUND: One of the most feared complications with the use of cyanoacrylate for treatment of gastric varices is the occurrence of potentially life-threatening systemic embolism. Thus, endoscopists are turning towards new techniques, including endoscopic coiling, as a potentially safer and more effective treatment option. However, no studies have been performed comparing the two techniques. OBJECTIVE: This study aims to compare the safety and efficacy of endoscopic ultrasound guided coil and cyanoacrylate injection versus the conventional technique of injection of cyanoacrylate alone. DESIGN: A pilot randomized controlled trial. METHODS: Patients randomized into group I were treated with coil and cyanoacrylate, and those in group II with cyanoacrylate alone. Flow within the varix was evaluated immediately after the treatment session and one month following initial treatment. If thrombosis was confirmed, additional follow-up was performed 4 and 10 months following initial treatment. All patients underwent a thoracic computerized tomography scan after the procedure. RESULTS: A total of 32 patients, 16 in each group, were followed for an average of 9.9 months (range 1-26 months). Immediately after the procedure, 6 (37.5%) group-I patients and 8 (50%) group-II patients presented total flow reduction in the treated vessel (P=0.476). After 30 days, 11 (73.3%) group-I patients and 12 (75%) group-II patients were found to have varix thrombosis. In both groups, the majority of patients required only one single session for varix obliteration (73.3% in group I versus 80% in group II). Asymptomatic pulmonary embolism occurred in 4 (25%) group-I patients and 8 (50%) group-II patients (P=0.144). No significant difference between the groups was observed. CONCLUSION: There is no statistical difference between endoscopic ultrasound guided coils plus cyanoacrylate versus conventional cyanoacrylate technique in relation to the incidence of embolism. However, a greater tendency towards embolism was observed in the group treated using the conventional technique. Both techniques have similar efficacy in the obliteration of varices. Given the small sample size of our pilot data, our results are insufficient to prove the clinical benefit of the combined technique, and do not yet justify its use, especially in light of higher cost. Further studies with larger sample size are warranted.

RESUMO CONTEXTO: Uma das complicações mais temidas com o uso de cianoacrilato para tratamento de varizes gástricas é a ocorrência de embolia sistêmica potencialmente fatal. Assim, os endoscopistas estão se aprimorando com novas técnicas, incluindo o uso de coils endoscópico, como uma opção de tratamento potencialmente mais segura e eficaz. No entanto, nenhum estudo foi realizado comparando as duas técnicas. OBJETIVO: Este estudo tem como objetivo comparar a segurança e eficácia da injeção de coil com cianoacrilato guiados por ultrassom endoscópico versus a técnica convencional de injeção de cianoacrilato. DESIGN: Um ensaio piloto controlado aleatoriamente. MÉTODOS: Os pacientes randomizados para o grupo I foram tratados com coil + cianoacrilato e os do grupo II apenas com cianoacrilato. O fluxo dentro da variz foi avaliado imediatamente após a sessão de tratamento e um mês após o tratamento inicial. Se a trombose foi confirmada, o acompanhamento adicional era realizado em 4 e 10 meses após o tratamento inicial. Todos os pacientes foram submetidos a uma tomografia computadorizada torácica após o procedimento. RESULTADOS: Um total de 32 pacientes, 16 em cada grupo, foram acompanhados por uma média de 9,9 meses (variação de 1-26 meses). Imediatamente após o procedimento, 6 (37,5%) pacientes do grupo I e 8 (50%) pacientes do grupo II apresentaram redução total do fluxo no vaso tratado (P=0,476). Após 30 dias, 11 (73,3%) pacientes do grupo I e 12 (75%) pacientes do grupo II apresentaram trombose da variz. Em ambos os grupos, a maioria dos pacientes necessitou de apenas uma única sessão para obliteração da variz (73,3% no grupo I versus 80% no grupo II). Embolia pulmonar assintomática ocorreu em 4 (25%) pacientes do grupo I e em 8 (50%) pacientes no grupo II (P=0,144). Nenhuma diferença significativa entre os grupos foi observada. CONCLUSÃO Apesar de não haver diferença estatística entre os dois grupos em relação à incidência de embolia neste estudo piloto, observou-se maior tendência de embolia no grupo tratado pela técnica convencional.

Uso de cianocrilato no fechamento de excisões faciais / Use of cyanocrylate at closing of facials excisions

Introdução: a face é o centro estético do indivíduo. Por isso, lesões nessa região podem repercutir mais negativamente do que em qualquer outra parte do corpo. Os cianoacrilatos, devido às suas vantagens de uso, incluindo a ausência de marcas de ponto, apresentam-se como um atrativo método de fechamento de feridas faciais em suas mais diversas formas. Objetivo: avaliação da eficácia do fechamento de excisões cutâneas faciais, usando o 2-etilcianoacrilato. Metodologia: estudo retrospectivo, no qual 36 feridas foram ocluídas com 2-etilcianoacrilatocomo alternativa à sutura intradérmica. Resultados: feridas excisionais (100%) foram tratadas com 2-etilcianoacrilato e suturas profundas relaxadoras como método de síntese. Cicatrizes inestéticas (13,9%), deiscência (5,6%) e infecção (2,8%) foram os problemas encontrados. Não houve casos de necrose, reações alérgicas ou de queloide. Os resultados foram considerados satisfatórios na maioria dos pacientes (96,4%). Conclusão: o uso do 2-etilcianoacrilato se mostrou seguro e com excelentes resultados cosméticos no grupo de pacientes selecionados.

Introduction: the face is the aesthetic center of the individual. Therefore, lesions in this region may have more negative repercussions than in any other part of the body. Cyanoacrylates (CA), due to their advantages of use, including the absence of dot marks, present themselves as an attractive method of closing facial wounds in their most diverse forms. Objective: to evaluate the efficacy of the closure of facial skin excisions using 2-ethylcyanoacrylate. Methodology: retrospective study in which 36 wounds were occluded with 2-ethylcyanoacrylate as an alternative to intradermal suture. Results: excisional wounds (100%) were treated with 2-ethylcyanoacrylate and deep relaxation sutures as a synthesis method. Unaesthetic scars (13.9%), dehiscence (5.6%) infection (2.8%) were the problems encountered. There were no cases of necrosis, allergic or keloid reactions. The results were considered satisfactory in most patients (96.4%). Conclusion: the use of 2-ethylcyanoacrylate was safe and with excellent cosmetic results in this group of patients.

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.

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.

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.

Feasibility of ossicular chain reconstruction with resin cement / Viabilidade da reconstrução da cadeia ossicular com cimento resinoso

Abstract Introduction: Disjunction of ossicular chain is a common finding in middle ear chronic disease. In addition to ossicular interposition, various materials have been used for reconstruction, such as ceramic prostheses, polyethylene, and titanium. Objective: Because of the high cost of the available options, the authors propose to reconstruct the ossicular chain with resin cement, a material typically used in dental reconstruction and fixation. Methods: Two anatomical parts of the temporal bones were used, creating a disjunction of the ossicular chain between the incus and staples and then reconstructing with resin cement. These reconstructions were repeated four times by three different surgeons to ensure the feasibility of the method. Results: A total of 12 reconstructions were carried out, four per surgeon. After applying the cement, it could be verified by touch that the space was filled properly by the used material. Proper articulation with motion transfer to the entire ossicular chain was also observed. Conclusion: Resin cement is a suitable material in the reconstruction of ossicular chain injury, and it is inexpensive and technically simple.

Resumo Introdução: É frequente a disjunção da cadeia ossicular nas doenças crônicas da orelha média. Além de interposições ossiculares, vários materiais já foram usados com a finalidade de reconstruí-la, como próteses de cerâmica, polietileno e titânio. Objetivo: Devido ao alto custo das opções existentes, propomos reconstruir a cadeia com cimento resinoso, material usado normalmente na reconstrução e fixação dentária. Método: Serão usadas duas peças anatômicas de ossos temporais, nas quais será criada uma disjunção da cadeia entre a bigorna e o estribo que, a seguir, será reconstruída com o cimento resinoso. Essas reconstruções serão repetidas quatro vezes por três cirurgiões diferentes, para certificação da viabilidade do método. Resultados: Foram feitas 12 reconstruções, quatro por cada cirurgião. Após aplicação do cimento, conseguimos, ao toque, perceber que o espaço foi preenchido adequadamente pelo material empregado. Notamos ainda adequada articulação com transferência de movimento para toda a cadeia ossicular. Conclusão: O cimento resinoso é um material viável na reconstrução de lesões da cadeia ossicular e proporciona um método tecnicamente simples e de baixo custo.