A quicker preparation method for autologous fibrin glue

To establish a quicker preparation procedure for cryoprecipitate (Cryo) from a patient's autologous plasma, to be used as fibrin glue, we examined the effects of various conditions on the concentrations and yields of coagulation factors in Cryo. Human plasma from healthy volunteers was divided and treated under various freezing, shaking and defrosting conditions. The concentrations of fibrinogen, plasminogen, fibronectin, and factor XIII in Cryo were then measured. Results were as follows: (1) concentrations and yields of plasma components in Cryo obtained from plasma stored at -20 degrees C were significantly higher than those in Cryo from plasma stored at -80 degrees C; (2) shaking at 70 cycles/min during the freezing process had a favorable effect on the concentrations and yields of coagulation factors in the Cryo; (3) a shaking thaw process in a cold water bath was a rapid method for obtaining adequate yields of coagulation factors; (4) shaking in the defrosting process did not affect the yields of coagulation factors. These results indicated that Cryo containing high concentrations of coagulation factors could be prepared easily and rapidly from a patient's autologous plasma (within 4-5 h).     

Use of autologous fibrin glue in dermatologic surgery: application of skin graft and second intention healing

OBJECTIVE: To evaluate the efficiency of biological sealant, an autologous fibrin glue, in dermatological surgery. DESIGN: Randomized clinical trial. SETTING: The Dermatology Service of Hospital das Clinicas, Universidade de Campinas (UNICAMP), referral center. PATIENTS: 14 patients with malign epithelial cutaneous tumors participated in the evaluation, each having two tumors, generally facial and symmetrical, in order to perform a comparative evaluation on the same individual. PROCEDURES: The glue was prepared beforehand with a sample of autologous blood. Surgical extirpation of the tumor was followed by grafts or second intention healing. OUTCOMES: The efficiency of the sealant was then evaluated in relation to hemostasis, adhesion, surgical time and evolution of the granulation tissue, clinically and histologically. RESULTS: Immediate hemostasis and graft adhesion, with a significant reduction of surgical time, and in the open wounds there was immediate hemostasis and a clinical increase in granulation tissue, but with no histological differences among the groups on the 7th day. CONCLUSION: It is an adjuvant resource in skin cancer surgery.     

The addition of antibiotics to fibrin glue

Coronary artery bypass grafting is the treatment of choice for significant left main coronary artery disease. A patient with an occluded left main coronary artery in the setting of myocardial infarction, who was given streptokinase and subsequently managed with intracoronary stenting, is reported.     

Preparation and use of fibrin glue in surgery

Fibrin glue (FG) is used to control bleeding, to adhere tissues together, and to seal tissue defects. FG is prepared from platelet-rich plasma or by mixing concentrated fibrinogen solutions with thrombin. Concentrated fibrinogen solutions are produced by cryoprecipitation or by chemical precipitation of plasma. The literature on FG preparation is reviewed in order to compare the advantages and disadvantages of the different products reported and to summarize the clinical applications. It is concluded that additional studies are needed to fully evaluate the advantages and disadvantages of fibrinogen concentrated using cryoprecipitation and chemical precipitation and that specific advantages exist for use of both pooled homologous and autologous blood.     

Repair of the aortic arch with fibrin glue in type A aortic dissection

Location of the intimal tear in the aortic arch in type A aortic dissection is for many authors an indication for replacement of the aortic arch, but this operation has a high in-hospital mortality rate: 20% to 40%. Instead, we suggest repairing the aortic arch by injecting fibrin glue, which contains a human sealer protein concentrate, between the two dissected layers under circulatory arrest while replacing the ascending aorta. To evaluate this technique, we reviewed 45 successive patients operated on for type A acute aortic dissection between January 1989 and July 1993, of which 6 had the intimal tear located on or extending into the aortic arch. Mean age was 71 +/- 4.2 years (range 68 to 74). After proximal supracoronary anastomosis with a collagen-impregnated graft, aortic arch repair was achieved by injecting fibrin glue between the two layers, using circulatory arrest at a mean temperature of 22 degrees C, with a mean duration of 24 minutes. This obliterated the dissection in the arch and also the intimal flap. The distal part of the graft was then anastomosed to the proximal portion of the aortic arch at the origin of the innominate artery under circulatory arrest. There were no early or late deaths. All patients were asymptomatic at a mean follow-up of 2.6 years. Follow-up angioscan showed obliteration of the dissection in the aortic arch in all patients; there were two patients with dilatation of the distal aortic arch of 40 and 45 mm.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of fibrin glue in vesico-vaginal fistulas after gynecologic treatment

Vesicovaginal fistulas develop as an early complication following gynaecological operations or as a late complication following irradiation. The waiting period for the surgical closure of the fistula implies social and psychic problems for patients and attending physicians. Three cases report on the exclusive fibrin sealing for closing vesicovaginal fistulas after which continence was re-established.     

Percutaneous fibrin glue therapy of meningeal cysts of the sacral spine

The release of extracellular proteases by the axonal growth cone has been proposed to facilitate its movement by digesting cell-cell and cell-matrix contacts in the path of the advancing growth cone. The serine protease plasminogen activator (PA) has been shown to be secreted and focally concentrated at axonal growth cones of cultured mammalian neurons. Thus, PAs are well-placed to play an active role in growth cone movement and axonal pathfinding in development and regeneration. We discuss recent findings that suggest that the biological action of these proteases is more complex than originally thought.     

The use of fibrin glue in the surgery of breast carcinoma

Twenty-four patients operated on for breast carcinoma with associated axillary node dissection were randomly assigned to two protocols. In the first group fibrin glue was applied intraoperatively, in the second group no complementary treatment was accomplished. The aim of the study was to evaluate the effect of fibrin glue in reducing postoperative axillary sero-lymphatic secretion. In the fibrin glue group a significant reduction of postoperative axillary secretion was observed.     

Comparative study of biological glues: cryoprecipitate glue, two-component fibrin sealant, and "French" glue

BACKGROUND: Although biological glues have been used clinically in cardiovascular operations, there are no comprehensive comparative studies to help clinicians select one glue over another. In this study we determined the efficacy in controlling suture line and surface bleeding and the biophysical properties of cryoprecipitate glue, two-component fibrin sealant, and "French" glue containing gelatin-resorcinol-formaldehyde-glutaraldehyde (GRFG). METHODS: Twenty-four dogs underwent a standardized atriotomy and aortotomy; the incisions were closed with interrupted 3-0 polypropylene sutures placed 3 mm apart. All dogs had a 3- by 3-cm area of the anterior wall of the right ventricle abraded until bleeding occurred. The animals were randomly allocated into four groups: in group 1 (n = 6) bleeding from the suture lines and from the epicardium was treated with cryoprecipitate glue; in group 2 (n = 6) bleeding was treated with two-component fibrin sealant; group 3 (n = 6) was treated with GRFG glue; group 4 (n = 6) was the untreated control group. The glues were also evaluated with regard to histomorphology, tensile strength, and virology. RESULTS: The cryoprecipitate glue and the two-component fibrin sealant glue were equally effective in controlling bleeding from the aortic and atrial suture lines. Although the GRFG glue slowed bleeding significantly at both sites compared to baseline, it did not provide total control. The control group required additional sutures to control bleeding. The cryoprecipitate glue and the two-component fibrin sealant provided a satisfactory clot in 3 to 4 seconds on the epicardium, whereas the GRFG glue generated a poor clot. There were minimal adhesions in the subpericardial space in the cryoprecipitate and the two-component fibrin sealant groups, whereas moderate-to-dense adhesions were present in the GRFG glue group at 6 weeks. The two-component fibrin sealant was completely reabsorbed by 10 days, but cryoprecipitate and GRFG glues were still present. On histologic examination, both fibrin glues exhibited minimal tissue reaction; in contrast, extensive fibroblastic proliferation was caused by the GRFG glue. The two-component and GRFG glues had outstanding adhesive property; in contrast, the cryoprecipitate glue did not show any adhesive power. The GRFG glue had a significantly greater tensile strength than the two-component fibrin sealant. Random samples from both cryoprecipitate and the two-component fibrin glue were free of hepatitis and retrovirus. CONCLUSIONS: The GRFG glue should be used as a tissue reinforcer; the two-component fibrin sealer is preferable when hemostatic action must be accompanied with mechanical barrier; and finally, the cryoprecipitate glue can be used when hemostatic action is the only requirement.     

Application of thrombin based fibrin glue and non-thrombin based batroxobin glue on intact human blood vessels: evidence for transmural thrombin activity

An alternative method of uniting small diameter vessels to obtain tissue union while limiting the thrombogenic effect of suture placement at a vessel anastomosis involves the use of a thrombin based fibrin glue as a surgical sealant. This investigation addresses whether the in vitro application of a thrombin based glue (TG), or batroxobin glue (BG), a non-thrombin based glue made with the snake venom enzyme batroxobin, alters intravascular platelet deposition (PD) or cleaves blood fibrinogen, as measured by fibrinopeptide A (FPA) production, when the respective glue is applied to the external surface of an intact human placental artery or an artery with an anastomosis. When TG was applied to the adventitial surface of an intact vessel or an anastomosis (n = 7) of control and experimental vessels, there was a significant increase in intraluminal platelet deposition, an effect not realized with BG (n = 12, intact vessel TG p = 0.01, BG p = 0.66, anastomosis TG p <0.01, BG p <0.01). Both TG and BG significantly increased FPA levels when human whole blood was perfused through both intact vessels or vessels containing an anastomosis when compared to control vessels (intact vessel TG and BG p <0.01, anastomosis TG and BG p <0.01). Labelled thrombin studies document the rapid passage of thrombin through an intact vessel wall or vessels with an anastomosis when TG was applied to the adventitial surface of the vessel. The data suggest that TG and BG are drug delivery systems for their respective enzymes that either pass through or transfer a message across not only a surgically created anastomosis, but also an intact vessel wall.     

Results with collagen fleece coated with fibrin glue (TachoComb). A macroscopical and histological experimental study

Diffuse bleeding from parenchymatous organs at conventional surgery is eliminated with the usual methods coagulation tamponade or styches. We performed experimental series at 9 dogs. After resection of spleen, liver, pancreas and kidney, the bleeding surface was covered by collagen fleece coated with fibrin glue (TachoComb). Postoperatively 7 days, 10 days, 14 days and 28 days we made a relaparotomy. Then the results were analyzed macroscopically and microscopically. In the abdominal cavity neither significant quantity of blood nor greater adhesions were detected. At all cases the fibrin glue was found on place were it was put before. Histologically a perfect wound healing experienced. The fibrin glue (TachoComb) using at diffuse parenchymatous organs' bleeding give a very good results when the wound area is at least 1 cm beyond the immediate wound margin and the fibrin glue is applied onto the wound and pressed on it for 4-5 minutes.     

Use of human fibrin glue (Tissucol) in the treatment of recurrent fistulas

In this study, the treatment of either primitive or secondary abdominal relapsed fistulas with Human Fibrin Glue (Tissucol) is reported. Twelve patients with different types of fistulas were treated in day hospital with the above mentioned procedure. Apart from two patients, the good percentage of success obtained in a short period of time is stressed. Results show that such a technique may be favourably adopted, nevertheless a correct first surgical procedure is recommended.     

Nerve repair using freezing and fibrin glue: immediate histologic improvement of axonal coaptation

The chicken retina has several types of cone photoreceptor cells, each of which contains a visual pigment, chicken red (iodopsin), green, blue or violet. Although biochemical and photochemical properties of these cone pigments have been well characterized, no information is available about the chicken photoreceptor G-protein, transducin, which couples with the visual pigment to convert a photon signal into a cellular response. To identify alpha-subunits of chicken rod and cone transducins (Tr alpha and Tc alpha, respectively), we produced two site-directed antibodies which discriminate between bovine Tr alpha and Tc alpha. Immunohistochemical studies on chicken retinas revealed that the antibody against bovine Tr alpha specifically stained the rod outer segments. On the other hand, the antibody against bovine Tc alpha uniformly stained the outer segments of the double cones and all types of single cones, while the single cones were immunohistochemically classified into three types by using a combination of antibodies against bovine rhodopsin and chicken iodopsin. Immuno-blot analyses demonstrated that the antibody against Tc alpha recognized a single band of chicken photoreceptor protein, whose molecular weight (42,000) was in good agreement with that of bovine Tc alpha (41,000). The antibody against Tr alpha recognized a protein having the same molecular weight as that of bovine Tr alpha (39,000). These observations strongly suggested that all types of chicken cone cells have a single common Tc alpha (42 kDa) structurally related to bovine Tc alpha, though each cone cell type has a distinct visual pigment.     

Freeze substitution after fast-freeze fixation in preparation for immunocytochemistry

As compared to classical chemical fixation, the physical immobilization of ultrastructures by fast-freeze fixation (FFF) and the subsequent exchange of water in its solid state by freeze substitution (FS) improve the preparation procedure for immunogold labeling (IGL). FFF-FS results in a morphological preservation of unchallenged quality, as well as in a better preservation of antigenic reactivity, thus allowing remarkable precision of labeling on sections. However, FFF, particularly over a cooled metal plate, requires a heavy and expensive machine. It is not suitable for all biological specimens and in the best conditions, which remain difficult to standardize, the thickness of the well-preserved portion of the specimen does not exceed a few microns for compact tissues, and exceptionally 30-40 microns for isolated cells. The FS procedure is long and must be adjusted empirically for every new specimen and antigenic detection. The preservation of a given antigen's reactivity in the presence of fixative agents and embedding resins remains unpredictable. The action of fixative agents is different and milder in FS than when they are used classically in chemical fixation. By chance, one of the best FS procedures for the preservation of both ultrastructure and antigenicity appears to be by using acetone alone, together with a molecular sieve to improve the water exchange process. A large choice of embedding resins usually allows us to find a compromise between ultrastructural and antigenic preservation.     

Stabilization and accurate trimming of nerve ends: practical use of fibrin glue: technical note

OBJECTIVE: Peripheral nerve transection usually results in protrusion of the endoneurial contents ("mushrooming"). Trimming of the nerve ends before repair is often necessary to achieve cut nerve end planes. In this technical report, we describe a technique for stabilization and accurate trimming of nerve ends using fibrin glue. SURGICAL TECHNIQUE: The nerve ends of divided peripheral nerves are coated with fibrin glue and subsequently trimmed using a razor blade before repair. RESULTS: When fibrin glue is applied, a firm layer with a rubbery consistency is formed around the nerve. This layer stabilizes the nerve ends during trimming, and a clear-cut plane of the nerve can be achieved. Moreover, the fibrin glue stabilizes the nerve ends during manipulations caused by suturing of the nerve. CONCLUSION: The technique results in easier handling of the nerve during trimming and manipulation, minimal tissue damage to the nerve, and a clear-cut plane of the nerve.