Symptomatic pulmonary complications from liquid acrylate embolization of brain arteriovenous malformations.
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PURPOSE: To describe symptomatic pulmonary emboli from brain arteriovenous malformation embolization with liquid acrylates and to analyze the reasons for these complications and describe preventive techniques. METHODS: The clinical records of 182 patients embolized with acrylate glue since 1978 for treatment of brain AVMs were searched for evidence of symptomatic pulmonary complications. Originally iso-butyl-2-cyanoacrylate and more recently n-butyl-2-cyanoacrylate were used in all patients. Arteriovenous malformation morphology, amounts and techniques of glue injection, and clinical and radiologic investigations in the symptomatic patients were recorded. RESULTS: Three patients had pulmonary symptoms within 48 hours of glue injection. One patient with a left frontal arteriovenous malformation had embolization with an isobutyl-2-cyanoacrylate/pantopaque/acetic acid mixture; severe pleuritic chest pain developed 2 days later. One patient with a left temporal and one with a left cerebellar arteriovenous malformation had embolization with n-butyl-2-cyanoacrylate/lipiodol mixtures; a cough, pleuritic chest pain, and bloody sputum developed in both within 24 hours. Two patients experienced a significant drop in PO2. No flow-arrest techniques were used for any of the injections in these three patients. All patients demonstrated significant changes on chest x-ray and CT chest examinations. All were treated conservatively and recovered spontaneously. CONCLUSIONS: Symptomatic pulmonary complications can occur after acrylate glue injection, particularly when delivery systems without flow arrest are used in high-flow vascular brain lesions. Techniques using acetic acid to delay polymerization time and "sandwich" techniques in which glue is pushed with dextrose are also more susceptible to this complication. (+info)
Actinomycetales from corn.
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Mesophilic Actinomycetales were isolated from whole corn, brewers grits, and break flour received from three different mills. In addition, strains were isolated from high-moisture (27 per cent) field corn; high-moisture, silo-stored corn (untreated); and high-moisture corn treated with ammonia, ammonium isobutyrate, or propionic-acetic acid. According to standard techniques, 139 strains were extensively characterized and 207 additional strains were partially characterized. On the basis of these characterizations, the streptomycete strains were identified by both the systems of Pridham et al. and Hutter because these systems are rapid and accurate. In general, only Streptomyces griseus (Krainsky) Waksman and Henrici was isolated from high-moisture whole corn (treated or untreated) except from grain exposed to ammonium isobutyrate. Strains isolated from high-moisture corn subjected to that treatment represented both S. griseus and S. albus (Rossi Doria) Waksman and Henrici. The strains isolated from corn and corn products from the three mills were identified with a number of streptomycete species. Of all Actinomycetales isolated, only three were not streptomycetes--two from brewer's grits and one from break flour. (+info)