A Novel In Vitro Method to Assess the Microbial Barrier Function of Tissue Adhesives Using Bioluminescence Imaging Technique

Background. Tissue glues can minimize treatment invasiveness, mitigate the risk of infection, and reduce surgery time; ergo, they have been developed and used in surgical procedures as wound closure devices beside sutures, staples, and metallic grafts. Regardless of their structure or function, tissue glues should show an acceptable microbial barrier function before being used in humans. This study proposes a novel in vitro method using Escherichia coli Lux and bioluminescence imaging technique to assess the microbial barrier function of tissue glues. Different volumes and concentrations of E. coli Lux were applied to precured or cured polyurethane-based tissue glue placed on agar plates. Plates were cultured for 1 h, 24 h, 48 h, and 72 h with bioluminescence signal measurement subsequently. Herein, protocol established a volume of 5 μL of a 1 : 100 dilution of E. coli Lux containing around 2 × 10 7 CFU/mL as optimal for testing polyurethane-based tissue glue. Measurement of OD600nm, determination of CFU/mL, and correlation with the bioluminescence measurement in p/s unit resulted in a good correlation between CFU/mL and p/s and demonstrated good reproducibility of our method. In addition, this in vitro method could show that the tested polyurethane-based tissue glue can provide a reasonable barrier against the microbial penetration and act as a bacterial barrier for up to 48 h with no penetration and up to 72 h with a low level of penetration through the material. Overall, we have established a novel, sensitive, and reproducible in vitro method using the bioluminescence imaging technique for testing the microbial barrier function of new tissue glues.

Acrylate application of the penis in the surgical treatment of hypospadias in boys: multicenter study

Introduction. One of the most important aspects of the treatment of hypospadias is the use of a postoperative dressing. Currently, many types of dressings are available, with their advantages and disadvantages. The postoperative dressing should be easy to use, able to control edema, prevent bleeding and the formation of hematomas, and prevent other possible complications. In the last decade, there have been publications in which cyanoacrylate adhesives were used with good results in surgical operations on the penis. Materials and methods. The study included 77 boys who underwent correction of the distal form of hypospadias from January 2018 to December 2020. The first group consisted of 47 boys, whose penile skin was applied with cyanoacrylate tissue glue after the operation was completed. The second group included 30 boys who used a standard circular adhesive bandage. All patients received the same type of treatment. Results. In the early postoperative period, 16 (20.78%) patients had various complications associated with bandages, which were distributed according to the Clavien-Dindo classification and assigned to grade I-II, according to clarien-Dingo classification. In the group of acrylate application, five (10.6%) patients needed to perform manipulations on the penis in the form of repeated adhesive application. When using an elastic self-binding bandage, all patients needed to remove the bandage, and 11 (36.7%) patients needed additional bandages (χ2=6.038; p=0.015). Conclusions. The use of acrylate application is an alternative to standard postoperative dressings in the treatment of hypospadias. The technology of use can be easily trained and reproduced by surgical personnel.

Ectopic Embolism after Endoscopic Glue Injection

: A 55-year-old male with a 7-year history of liver cirrhosis was admitted to our department due to recurrent hematemesis and melena. He had been treated with endoscopic tissue glue injection and/or band ligation for gastroesophageal variceal bleeding. He denied any history of viral hepatitis infection or alcohol abuse. At this admission, his pulse rate was 88b.p.m., and blood pressure was 110/51mmHg. Hemoglobin concentration was 81g/L, platelet count was 38X109/L, total bilirubin was 28.4umol/L, and albumin was 24.2g/L. Except for ascites, splenomegaly, and portal vein thrombosis, contrast-enhanced computed tomography scans showed high density within gastric fundal varices, gastro-renal shunt, left renal vein, and inferior vena cava (arrows), suggesting a diagnosis of ectopic embolism from tissue glue injected during a prior endoscopic procedure. Upper gastrointestinal endoscopy demonstrated esophageal varices, post-endoscopic gastric fundal glue removal, and portal hypertensive gastropathy. Esophageal variceal ligation was performed. After that, he was discharged without any other complaints. Currently, endoscopic variceal therapy, mainly including variceal band ligation, sclerotherapy, glue injection, and haemostatic powder spraying is the mainstay treatment option of acute variceal bleeding in liver cirrhosis [1]. There is a benefit of endoscopic glue injection for gastric fundal variceal bleeding in terms of increasing the rate of initial hemostasis and reducing the rate of rebleeding as compared to variceal band ligation [2-3]. Therefore, endoscopic glue injection has been widely employed in cirrhotic patients with gastric variceal bleeding. However, there are some severe complications related to endoscopic glue injection [4-5], especially thromboembolism. The current case further showed a possibility of asymptomatic ectopic embolism after endoscopic glue injection, suggesting that a close surveillance of embolism within portosystemic collateral vessels should be necessary.

Effect of tissue glue versus suture in pterygium surgery in a tertiary care center of North-East India

Background: Pterygium is a triangular fibrovascular tissue of conjunctiva encroaching on to the cornea. Currently, conjunctival autograft technique after excision is reported as the most suitable and safest method. The autograft transplantation can be done either with the help of suture or tissue adhesives. Objective of the study was to evaluate the effects of tissue glue versus suture in limbal conjunctival autograft transplantation among the patients undergoing pterygium excision.Methods: A prospective study was carried out in a tertiary eye care hospital. 60 patients with primary pterygium underwent limbal conjunctival autograft transplantation. They were enrolled into two groups, group-A (tissue glue, N=30) and group-B (suture group, N=30). Operative time, postoperative patient comfort and recurrence of pterygium were assessed. The patients were followed-up for 6 months.Results: The mean surgical time in fibrin glue group (23.56±2.80) was significantly less compared to suture (30.78±2.20) group with p<0.001. Postoperative discomfort in terms of pain, lacrimation and foreign body sensation was significantly less with fibrin glue in comparison to suture (p<0.05). Postoperative complications like redness, subconjunctival hemorrhage, graft edema and graft retraction were significantly more in suture group during late postoperative period. Recurrence of pterygium was noted in two patients (6.67%) in suture group and one patient in fibrin glue group (3.33%) which was not statistically significant (p>0.005).Conclusions: The use of fibrin glue for securing the limbal conjunctival autograft in pterygium surgery significantly reduces the operating time and postoperative discomfort.

New Technique of Posterior Fixation of Tube With Fibrin Sealant Prevents Dysphagia in Patients Undergoing Sleeve Gastrectomy

Introduction This study compared the effects of posterior fixation (PF) of the remnant tube with fibrin tissue glue to prevent sharp angulation and gastric twist and traditional techniques on postoperative dysphagia and vomiting. Methodology In total, 200 patients scheduled to undergo laparoscopic sleeve gastrectomy (LSG) as a bariatric surgical intervention were randomly classified into 2 groups (LSG + PF and LSG alone). We compared postoperative dysphagia symptoms among patients who underwent PF and those who did not. The Dysphagia Handicap Index (DHI) results were compared statistically among these groups. Results The study included a total of 191 patients (85.9% (n = 164) women and 14.1% (n = 27) men) who underwent LSG for obesity. The groups were similar in terms of the patient demographics. The DHI scores of the LSG + PF group were statistically significantly lower than those of the LSG alone group. Conclusion Adoption of a standardized method of PF with a standardized surgical procedure after LSG considerably reduced the rate of surgical complications.

A new approach to the treatment of post-catheterization pseudoaneurysms by ultrasound-guided tissue glue injection or ultrasound-guided thrombin injection depending on a late to early velocity index

Background Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are reports of the use of biologically-derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. TG are more potent procoagulants and may increase the procedure success rates at the cost of higher risk of complications in case too much substance escape into the patient's circulation during the procedure. TG are also more expensive than thrombin so they are often reserved for selected patients. We have previously identified a late to early velocity index (LEVI) &lt;0.2 as a predictor of an increased risk of psA recurrence after standard UGTI. In the current paper we report our first experiences when the choice of the first-line treatment method was based on LEVI. Methods From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI &lt;0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) and 26 had LEVI &gt;0.2 and underwent UGTI. The injection set (containing human thrombin and fibrinogen) was used for UGTGI. Bovine thrombin was used for UGTI. Results The success rate was 100% and no psA recurrence was detected during 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 15 years of experience (0% vs. 13%, p=0.02). All complications were mild and transient and included clinical symptoms of paraesthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. Conclusion The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. Two examples of LEVI calculations Funding Acknowledgement Type of funding source: None