SPONTANEOUS RUPTURE OF THE RIGHT CONGENITAL DIAPHRAGMATIC EVENTRATION ON THE RIGHT SUBJECTED TO SURGICAL CORRECTION IN A CHILD WITH MEGADOLICOCOLON

Спонтанний розрив гемідіафрагми у випадках вродженої діафрагмальної евентрації зустрічається вкрай рідко, у літературі повідомляють про унікальні випадки.In this context, the authors present the case of an 8-year-old child who was hospitalized in the coloproctology service for abdominal pain, lack of stool for more than 7 days, pronounced abdominal distension. The child suffers from Down's disease. In 2017, he was occasionally diagnosed with right diaphragmatic eventration and underwent surgical correction by thoracic approach. After a thorough evaluation, with signs suggestive of diaphragmatic hernia on the right, the child underwent surgery, intraoperatively the rupture of the right hemidiaphragm was found with intrathoracic ascension of the malrotated intestinal loops, transverse colon and omentum. The repair of the diaphragmatic eventration complicated by rupture was used using the “overcoat” folding procedure, on the suture line being carefully applied a collagen foil covered with components of the fibrin adhesive. The postoperative period passed without complications.Conclusion. Spontaneous rupture of the diaphragm is a rare complication in children with diaphragmatic eventration, especially on the right side, in this case obstruction of the malformative colon ascended intrathoracically with progressive dilation of the intestinal loops being responsible for distension with gradual thinning of the hemidiaphragm sac resulting malformation in diaphragmatic rupture with herniation and progressive obliteration of the pleural space. The case of rupture of the diaphragmatic eventration associated with megadolicocolon confirms that the respiratory symptoms characteristic of this clinical situation may be overshadowed by the predominance of signs of intestinal obstruction, without leading to sudden progressive clinical deterioration, which proved to be a misleading moment in diagnosis. certainty of this serious complication rarity.

The hemostatic and wound healing effects of autologous fibrin adhesive in experimental animals

Objectives: Evaluate the hemostasis and skin graft wound healing effect of autologous fibrin adhesive in experimental animals. Methods: experimental method, conducted on 6 rabbits to determine the role of fibrin glue in hemostasis, ability to heal skin graft in experimental rabbits through assessment of graft status: size, swelling, color, boundary between the puzzle piece and the surrounding skin. Results: 1/ Effective hemostasis: fibrin glue transplant: hemostasis time is 129.33±42.01 seconds, transplant time is 128.33±41.87 seconds; suture stitching: hemostasis time is 475.17±59.97 seconds, stitching time is 350.67±52.23 seconds. At times after 1 day, 3 days, 7 days, 10 days, 14 days, 20 days and 30 days there is an earlier phenomenon of wound healing, the flattened and scarred patch is more beautiful than the skin graft with sewing thread. Conclusions: Using autologous fibrin glue in skin grafting has the ability to stop bleeding, heal wounds and achieve better aesthetics than skin grafting with sutures.

Adesivo tecidual de fibrina versus suturas para o enxerto autólogo de conjuntiva em cirurgias primária de pterígio: uma revisão integrativa / Fibrin tissue adhesive versus sutures for autologous conjunctiva graft in primary pterygium surgery: an integrative review

Introdução: Pterígio caracteriza-se pelo crescimento benigno fibrovascular, que surge da conjuntiva e se estende para a córnea. Atualmente a excisão cirúrgica, com enxerto autólogo de conjuntiva, constitui-se o tratamento padrão-ouro. No entanto, a sutura do enxerto é uma etapa demorada podendo induzir ao processo inflamatório local. Objetivo: Comparar os estudos sobre tratamento cirúrgico de pterígio confrontando a efetividade do adesivo tecidual de fibrina com as suturas no enxerto autólogo de conjuntiva. Método: Tratou-se de revisão integrativa utilizando-se da estrutura PICO para elaboração da pergunta norteadora. Os estudos foram levantados nas bases de dados: Cochrane Library, Medline via portal PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Eletronic Library Online) e Science direct. A ferramenta utilizada para indexação e recuperação de assuntos na literatura foi Descritor de Ciências da Saúde. Os critérios de inclusão foram: ensaios clínicos, randomizados, publicados entre 2015 a 2020 e disponíveis na íntegra. Resultados: Identificou-se duzentos e oitenta e um estudos, no entanto após a aplicação dos critérios de inclusão e exclusão restaram apenas cinco artigos. O tempo cirúrgico variou entre os tipos, sendo de 3,6 minutos a 20,17 ± 3,23 minutos para adesivo de fibrina e de 13,3 minutos a 32,42 ± 4,47 minutos para as suturas. Dentre os desconfortos oculares estavam sensação dolorosa e de corpo estranho, hiperemia conjuntival, hemorragia, edema e secreção. A recorrência foi observada em 19,9% dos voluntários dos estudos sendo 19,8% após o uso do adesivo de fibrina. Conclusão: Adesivo de fibrina mostrou-se seguro e eficaz para fixar enxerto autólogo de conjuntiva nas cirurgias de remoção de pterígio, mostrando-se capaz de reduzir o tempo operatório e as principais queixas dos pacientes no pós operatório imediato. No entanto, não oferece redução na taxa de recorrência, por isso deve-se atentar para risco aumentado de hemorragia conjuntival.Palavras chave: Pterígio, Adesivo tecidual de fibrina, Suturas ABSTRACT Introduction: Pterygium characterized by benign fibrovascular growth that arises from the conjunctiva and extends to a cornea. Currently, surgical excision with autologous conjunctival autograft is the gold standard treatment. However, suturing the graft takes a long time and induces a local inflammatory process. Objective: To compare studies on the surgical treatment of pterygium confronting the effectiveness of fibrin tissue adhesive with sutures in conjunctival autograft. Methodology: It was an integrative review using the PICO structure to elaborate the guiding question. The studies were surveyed in the databases: Cochrane Library, Medline via PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Electronic Library Online) and Science direct. The tool used for indexing and retrieving subjects in the literature was a Health Sciences Descriptor. The inclusion criteria were: clinical trials, randomized, published between 2015 and 2020 and available in full. Results: Two hundred and eighty-one studies were identified, however, after applying the inclusion and exclusion criteria, only five articles remained. The surgical time varied between types, ranging from 3.6 minutes to 20.17 ± 3.23 minutes for fibrin adhesive and 13.3 minutes to 32.42 ± 4.47 minutes for sutures. Among the eye discomforts were a painful sensation and a foreign body, conjunctival hyperemia, hemorrhage, edema and secretion. Recurrence was observed in 19.9% of the study volunteers, with 19.8% after the use of fibrin adhesive.Conclusion: The use of fibrin glue is safe and effective for fixing the autograft in pterygium removal surgeries, proving capable of reducing the operative time and the main complaints of patients in the immediate postoperative period. However, it does not offer a reduction in the recurrence rate and attention should be paid to the increased risk of conjunctival hemorrhage.Keywords: Pterygium, Fibrin tissue adhesive, Sutures

Scleral Patch Graft With Fibrin Adhesive For Post Pterygium Scleral Thinning

Scleral patch graft is commonly done for scleral thinning post pterygium surgeries. This procedure is done with sutures. Review of literature revealed few such cases. Scleral patch graft with fibrin glue has not been done so far. The novelty of our procedure is that we have applied fibrin glue to the scleral bed and pasted the graft over it. Then this graft was secured with minimal sutures. This not only saves the operative time but also increases patient comfort post op. Herein, we present a case of post pterygium surgery scleral melt successfully treated with scleral patch graft with fibrin adhesive.

Experimental evaluation of 2-octyl-cyanoacrylate on dura mater healing

Objective: The aim of the present study was to evaluate the effect of this synthetic glue tissue on the healing of dura mater closure in rabbits. The study was undertaken to investigate the histological and toxicological behavior of dural repair using standard suture techniques and suture supplemented with tissue adhesive. Methods: A total of 54 rabbits was divided into 9 groups of 6 animals, and then were divided equivalently into 3 groups (A, B and C), each one containing 3 sub-groups of 6 rabbits, sacrificed on days 7, 30 and 60 respectively. After 1cm parasagital craniectomy and 0.5cm dural opening, three different procedures were carried out: in group A dura mater was reinforced by using 2-octyl-cyanoacrylate, in group B biological glue (fibrin glue) was applied and in group C only the dura mater suturing was performed. The rabbits were sacrificed on specific days following the operation. Integrity of the sutures, existence of abscess, wound infection and adhesion formation were recorded. The heads were sent for histological examination. Results: The synthetic glue didn’t interfere with the metabolism of the animals. The mean weight of rabbits in groups A and B increased. Temperature did not increase and was not statistically different between the three groups (p=0.210). Dura mater healing process, as assessed by fibroblast activity and inflammatory cell infiltration, did not differ statistically between the three groups (p>0.05). Only neovascularization increased in the control group. Conclusion: Histological sections obtained from the dura mater treated with 2-octyl-cyanoacrylate polymer demonstrated minimal inflammatory response, similar to that treated with fibrin adhesive sealant. Results indicate that this new substance seems to have applications as an adjunctive means of effecting dural closure.