医用纤维蛋白胶在甲状腺手术中的应用

目的探讨医用纤维蛋白胶在甲状腺手术中的应用价值。方法将79例甲状腺手术患者随机分成实验组（44例）和对照组（35例）。实验组行甲状腺切除术，同时在手术创面喷洒医用纤维蛋白胶5ml，对照组行甲状腺切除术，术中不用医用纤维蛋白胶，两组均放置引流管。观察两组术后总引流量、第1天引流量、拔管时间、伤口感染和拆线时间等情况。结果实验组术后皮下总引流量、第1天引流量和拔管时间均少于对照组（P〈0．05）。两组间伤VI感染发生率、拆线时间无明显差别（P〉0．05）。结论应用医用纤维蛋白胶可有效地减少甲状腺术后创面渗液，促进创面愈合。     

Clinical application of fibrin glue in cardiovascular surgery

Since 1978, fibrin glue has been applied in 268 patients. The indications were: (1) sealing of woven Dacron, (2) sealing of knitted Dacron, (3) control of various bleeding sites. The "blood preclotting" and "fibrin sealing" methods were compared in 32 patients with an aortoventriculoplasty operation using Dacron patches. In the fibrin glue group there was a significant reduction in postoperative blood loss as well as a shortening of the operation time (period of protamin administration to skin closure). From the data it can be concluded that sealing woven Dacron prostheses with fibrin glue is superior to conventional blood preclotting.     

Clinical experience with fibrin glue for local bleeding control and sealing of vascular prostheses

This report concerns our clinical experience with fibrin glue for local bleeding control and for sealing of vascular prostheses. Hemostasis could be achieved in 90% of 124 applications of the glue under different indications. Local application of fibrin adhesive is recommended in all types of bleeding difficult either to approach or control by conventional surgical technique. Complete sealing of low pore vascular grafts could be obtained in all operations under extracorporeal circulation and full heparinization. Highly porous grafts sealed with fibrin glue also were explored under conditions thus far requiring tightly woven grafts.     

Autologous fibrin glue reinforced by platelets in surgery of ascending aorta

OBJECTIVES: Fibrin sealants are popular for the improvement of perioperative hemostasis and reducing blood transfusion needs. Biological glues prepared from pooled human donor plasma have an inherent risk of transmission of blood-borne disease and are quite expensive to use. A system for the production of autologous fibrin sealant re-enforced by platelets has been developed. Its efficacy, safety and economic benefits have been evaluated in a prospective, randomized study. MATERIAL: 20 consecutive patients undergoing replacement of the ascending aorta by the same surgical team had local application of either Tissucol (Group A) or autologous fibrin glue (Group B) for hemostasis. RESULTS: No adverse effects of either glue were recorded. The volume of produced autologous fibrin glue was 25 cc PRP. Platelet yield was 72 %. The two groups were comparable. Efficacy was group comparable. Average cost for sealants in Group A was 470 +/- 100 Euros compared to 273 Euros in Group B, p = 0.004. CONCLUSIONS: Autologous fibrin glue re-enforced by autologous platelets can be safely produced in the operating room in a large volume, with an comparable efficacy at a lower cost than commercial sealants.     

Treatment of postsurgical chylothorax with fibrin glue

The treatment of postsurgical chylothorax with fibrin glue is reported. Chylothorax developed in a 3 1/2-month-old infant 2 days after extrapleural ligation of a patent ductus arteriosus. At rethoracotomy the chyle leak could not be located. To stop chyle effusion, the region of the presumed leakage was sealed with fibrin glue and a pleural flap. It is suggested that early reoperation and closure of the chyle leak with fibrin adhesive should be considered in cases of postsurgical chylothorax in infants.     

Clinical experience with cardiac amyloidosis

OBJECTIVE: Amyloidosis is a systemic disease potentially afflicting the heart. In this study we retrospectively studied patients presenting with major cardiac amyloidotic involvement. METHODS AND RESULTS: From 1997 until 2000, eight patients with major cardiac involvement of amyloidosis resulting in heart failure were diagnosed. All patients presented with heart failure. Diagnostic work-up, clinical, electrocardiographic, echocardiographic characteristics and treatment modalities are presented. Seven patients with acquired (both primary AL and postinflammatory AA) amyloidosis out of a total of eight patients died within one year after diagnosis, as a result of intractable cardiac failure due to both systolic and diastolic left ventricular dysfunction despite state-of-the-art medical treatment of heart failure. Only one patient with hereditary amyloidosis undergoing liver transplantation survived. CONCLUSIONS: Despite optimal medical cardiac failure treatment, acquired cardiac amyloidosis carries an ominous prognosis probably because patients are already in a very advanced stage of the disease at presentation.     

Sutureless colon anastomosis with fibrin glue in the rat

The only technique available for creating an intestinal anastomosis without tissue strangulation is gluing. Theoretically, this could lead to a higher hydroxyproline content and greater mechanical strength than in a sutured anastomosis. To test the hypothesis, 83 rats underwent left colon resection and inverted primary anastomosis with either one layer of sutures (NG group) or fibrin glue (FG group). Seven-day FG anastomoses showed less adhesions (P=.02) but one subclinical leakage and a further radiologic one, compared with a greater amount of adhesions but no leakages in the NG group. The mean bursting pressures (mmHg) in the FG and NG groups, respectively, were 25±20 (SD) and 63±23 (N.S.) 30 minutes after surgery, 107±33 and 115±30 after one day, 81±31 and 133±26 (P<.001) after four days, and 161±36 and 175±24 after seven days. The somewhat earlier rise in hydroxyproline content in the glued anastomoses did not lead to significant intergroup differences. The glued anastomoses were thus weak during the critical lag period of healing. Also, by preventing adhesion formation, the glue may reduce the extra blood supply from perianastomic vessels. The outcomes might have differed more under demanding experimental or clinical situations. Supported financially by a grant from the Paulo Foundation.     

银离子藻酸盐治疗心外科术后伤口脂肪液化体会

目的:探讨两种不同方法治疗心脏外科手术切口脂肪液化的临床疗效。方法:选取2016年7月至2017年1月,于我院心外科门诊收治的心外科手术后脂肪液化的患者52例为研究对象,将患者随机分成对照组20例和治疗组32例,采用传统方法为对照组患者进行治疗,采用银离子藻酸盐为治疗组患者进行治疗,并将对比结果进行分析。结果:用银离子藻酸盐方法治疗脂肪液化具有伤口愈合时间短,换药次数少的优点。结论:用银离子藻酸盐方法治疗脂肪液化的临床效果显著,此方法具有伤口愈合时间短,换药次数少的优点,值得临床推广。     

Five-year experience with cardiac surgery procedures in dialysis-dependent patients

The purpose of this study was to review the outcome of dialysis-dependent patients undergoing cardiac surgery. We retrospectively reviewed 36 dialysis-dependent patients with a mean age of 63 ± 9.4 years who underwent cardiac operations. Surgery included coronary artery bypass grafting (CABG) in 27 patients (75%), valve surgery in 2 (5.5%), combined CABG plus valve surgery in 5 (13.8%), combined valve surgery and MAZE procedure in 1 patient, combined valve surgery, CABG and MAZE procedure in 1 patient, major aortic surgery in 1 patient, suture of injured right ventricle in 1 patient and extirpation of infected right atrial thrombus in 1 patient. In-hospital mortality rate was 11.1%. All the deaths occurred in patients who underwent urgent procedure. Two of the deaths occurred in patients who underwent cardiac surgery procedure on pump (ascending aorta replacement and infected thrombus removing), one death occurred in a patient who underwent suture of injured right ventricle and another one death occurred in patient who underwent the conventional myocardial revascularization. The survival was 77.8% at 1 year. Generally suggested predictors of increased late mortality are heart failure, urgent/emergent surgery, the complexity of the surgical procedures (valve surgery, combined CABG, valve and major aortic surgery) and postoperative low cardiac output syndrome. In dialysis-dependent patients, CABG has an acceptable risk. Results in patients affected by valve lesions associated or not with coronary artery disease are improved by an early referral to surgery, before the onset of symptoms of heart failure.     

Clinical experience with propafenone for cardiac arrhythmias in the young

Seventy-two children were treated with propafenone between 1980and 1990. The mean age was 34 months (range 0.192). Arrhythmiasincluded atrioventricular re-entry tachycardia in 32 patients(44%), atrial flutter in 16 (22%), atrial or junctional ectopictachycardia in 10 (14%), atrial re-entry tachycardias in three(4%) and ventricular arrhythmias in 11 patients (16%). The efficacyof oral treatment was good in patients with atrio-ventricularre-entry tachycardia (80%), atrial flutter (71%) and atrialectopic tachycardia (83%); it was poor in ventricular arrhythmias(40%). The mean oral dose was 13.5 mg. kg^–1. day^–1. Dosageand serum levels of propafenone did not differ whether the patientswere treated successfully or not. No correlation between dosageand serum level was observed. Intravenous propafenone administrationwas only partially successful in suppressing supraventriculartachycardias (6 of 11 patients). The presence of a congenital heart defect and the time of onsetof the arrhythmias had a significant influence on the efficacyof propafenone. Better results were observed in patients withnormal hearts and in whom onset of arrhythmia was pre-natal(success 80%) as well as in patients with arrhythmias seen earlyafter surgery for congenital heart defects (success 87%). Success(65%) was also observed in patients without congenital heartdefects and postnatal onset of supraventricular arrhythmias.Patients with ventricular or supraventricular arrhythmias lateafter corrective surgery showed the poorest response (31%).     

Effect of fibrin glue on irradiated colonic anastomoses

INTRODUCTION: The present study was planned to research the effects of fibrin glue on irradiated colonic anastomoses. METHOD: The effect of fibrin glue on irradiated colonic anastomoses was investigated in four identical groups of rats. In Group I (control group) colonic anastomoses were performed without radiotherapy; in Group II, colonic anastomoses were performed five days after radiotherapy; in Group III, fibrin glue was applied to anastomotic line without radiotherapy; in Group IV, fibrin glue was applied to anastomotic line with radiotherapy. The healing of left colonic anastomoses was evaluated through the bursting pressure of the anastomotic segment and the hydroxyproline contents of the anastomosis. RESULTS: Measurements done on the fourth postoperative day revealed that anastomotic healing was impaired in rats that underwent radiotherapy ( P <0.001); fibrin glue had no effect on anastomotic healing in groups with or without radiotherapy. CONCLUSION: In the early phases of anastomotic healing, fibrin glue cannot help remove unwanted effects of preoperative radiotherapy.     

Chemical pleurodesis induced with fibrin glue in the treatment of inoperable spontaneous pneumothorax

Chemical pleurodesis induced with fibrin glue (fibrinogen 1.0 g, thrombin 500 mu, 2% CaCl2 10 ml, tranexamic acid 10 ml) was performed in 6 cases with spontaneous pneumothorax in whom surgery was not indicated because of various reasons, such as low pulmonary function or old age. These cases were complicated with left pneumonectomy, bilateral emphysema, pulmonary tuberculosis and interstitial pneumonia. In all cases, favorable results were obtained and there was no recurrence. As side effects, only transient low grade fever and slight chest pain were observed with no liver damage or pleural thickening. These results suggest that chemical pleurodesis induced with fibrin glue is very useful in the treatment of inoperable spontaneous pneumothorax.     

Fibrin glue in cardiovascular surgery

A variant of fibrin glue has been designed. This glue can be prepared on the basis of cryoprecipitation in departments of blood transfusion (fibrinogen concentration 60-90 g/l). The glue has been used in urgent abdominal and cardiac surgery in particular for facilitation of hemostasis after sternotomy and suturing of the aorta, pulmonary artery and atria.