Popliteal artery occlusion as a late complication of liquid acrylate embolization for cerebral vascular malformation.
Occlusion of arteriovenous malformations of the brain (BAVMs) by means of an endovascular approach with liquid acrylate glue is an established treatment modality. The specific hazards of this procedure are related to the central nervous system. In the case of unexpectedly rapid polymerization of the cyanoacrylate glue and adhesion of the delivering microcatheter to the BAVM, severing the catheter at the site of vascular access is considered an acceptable and safe management. We present a unique complication related to this technique that has not been described yet. Fragmentation and migration of the microcatheter, originally left in place, had caused popliteal artery occlusion, which required saphenous vein interposition, in a 25-year-old man. Suggestions for avoiding this complication are discussed. (+info)
Treatment of intradural paraclinoidal aneurysms.
Intradural paraclinoidal aneurysm still presents conceptual confusion and technical surgical problems. The clinical features of 68 consecutive patients with paraclinoidal aneurysms were analyzed. The pterional approach was used in all patients. Subarachnoid hemorrhage (SAH) occurred in 37 patients from the paraclinoidal aneurysm and in 10 patients from another associated aneurysm. Thirty-four of the 37 ruptured paraclinoidal aneurysms were clipped, two blister-like aneurysms required trapping, and one blister-like aneurysm was coated. Thirteen of the 31 unruptured paraclinoidal aneurysms, consisting of 10 with ruptured associated aneurysm, four symptomatic, and 17 incidental, were clipped and 18 were coated. Favorable outcomes were obtained in 38 of 47 patients with SAH and 17 of 21 patients without SAH. Nine unfavorable outcomes in SAH patients were caused by primary brain damage (5), vasospasm (2), cerebral infarction after trapping (1), and pneumonia (1). All four unfavorable outcomes in non-SAH patients were due to surgical procedures for giant aneurysms or associated basilar artery aneurysm. Removal of the anterior clinoid process was performed to secure the proximal neck in 15 patients with large or giant aneurysms. Multiple clips with or without fenestrated clips were required in all giant aneurysms, and exposure of the cervical internal carotid artery (ICA) in 17 giant or large aneurysms. Fenestrated clips were also useful for one small aneurysm projecting posteriorly. A favorable outcome was achieved in 17 of 19 patients undergoing coating. Coating without clipping might be better for some blister-like ICA aneurysms, even if ruptured. Paraclinoidal aneurysms can be clipped with favorable results using these techniques except for giant aneurysms and associated basilar artery aneurysm. (+info)
Diagnosing dermatomycosis in general practice.
BACKGROUND: Diagnosing dermatomycosis from a clinical image is not always easy. Microscopy of a potassium hydroxide preparation (KOH-test) and culturing are seldomly used in general practice. Cyanoacrylate surface skin scraping (CSSS) is a new diagnostic tool that may be useful and simple. OBJECTIVES: We aimed to investigate the diagnostic value of signs and symptoms, the KOH-test and the CSSS, in patients with erythematosquamous skin lesions, using the culture as the gold standard. Our goal is to formulate an optimal algorithm for the diagnosis of mycosis, based on one or more of these tests and including both optimal accuracy and costs. METHODS: Scales from 148 consecutive general practice patients were tested using a KOH-test, CSSS and culture. Clinical data were collected using a questionnaire. RESULTS: Twenty-six (18%) positive fungal cultures were identified. The sensitivity of the clinical diagnosis was 81% and its specificity 45%; for the KOH-test, these figures were 12 and 93% respectively; and for the CSSS, 62 and 88%, respectively. The positive predictive value of the clinical diagnosis was 24% and the negative predictive value 92%; for the KOH-test these figures were 25 and 83%, respectively, and for the CSSS, 52 and 92%, respectively. Determining CSSS in all patients proved to be the most accurate policy (accuracy = 83%). The likelihood ratio of CSSS in all patients was 5.17 for a positive test result and 0.43 for a negative test result. An approach in which CSSS is obtained in only those patients whom the physician considers by clinical examination to have dermatomycosis, with no testing in other patients, results in positive and negative likelihood ratios of 4.69 and 0.56, respectively. Such a policy would result in an overall sensitivity of 50%, a specificity of 89%, a positive predictive value of 50% and a negative predictive value of 89%. DISCUSSION: The clinical picture of dermatomycosis is not very reliable. The combination of a clinical judgement if this is negative and an additional CSSS in the case of a positive clinical judgement provides us with the best cost-benefit ratio, if both diagnostic accuracy and logistic considerations are taken into consideration. (+info)
Cyanoacrylate glue as an alternative to an additional suture line in the repair of type A aortic dissection.
We describe the use of cyanoacrylate glue in conjunction with gelatin-resorcinol-formalin glue for the treatment of type A aortic dissection. Instead of placing an additional suture line 2-3 cm from the edges of the aortic stumps to create a large pocket for gluing, we have been using a cyanoacrylate adhesive for approximating the walls of the true and false lumina without the risk of tearing them. Moreover, the simplicity and quickness of the procedure enables application of the cyanoacrylate glue even deeper into the aortic arch, creating a wider area for gluing the dissected layers. (+info)
Histological changes in the rat common carotid artery following simultaneous topical application of cotton sheet and cyanoacrylate glue.
Histological changes in and around the arterial walls of rats were investigated following simultaneous topical application of cotton sheet and cyanoacrylate glue. The bilateral common carotid arteries were exposed using sterile techniques, and the test materials were applied to the right artery. The left artery served as a control. Changes in arterial histology were evaluated at 2 weeks, 1 month, 2 months, and 3 months after surgery. Extensive inflammation consisting primarily of histiocytes and multinuclear giant cells was observed around the materials, but tended to decrease by 3 months. Necrosis in the media and fibrosis in the adventitia initially appeared around 2 weeks, and became advanced by 2-3 months. At 2-3 months, disruption of elastic fibers and marked fibrosis in the media were seen, and endothelial proliferation in the intima appeared. Intimal proliferation was observed at both the experimental and other sites of the vessels. The present results suggest that simultaneous use of the test materials can cause the arterial occlusive lesions observed following aneurysmal surgery. (+info)
A useful form of glue ear.
Children and adults commonly present to the emergency department with a foreign body lodged in the ear. Over the past 15 years techniques for cyanoacrylate ("superglue") assisted foreign body removal have been described, but are not widely employed. Two cases of successful and one of unsuccessful removal using this technique are reported, and some advice is offered to aid others. (+info)
Using tissue adhesive for wound repair: a practical guide to dermabond.
Dermabond is a cyanoacrylate tissue adhesive that forms a strong bond across apposed wound edges, allowing normal healing to occur below. It is marketed to replace sutures that are 5-0 or smaller in diameter for incisional or laceration repair. This adhesive has been shown to save time during wound repair, to provide a flexible water-resistant protective coating and to eliminate the need for suture removal. The long-term cosmetic outcome with Dermabond is comparable to that of traditional methods of repair. Best suited for small, superficial lacerations, it may also be used with confidence on larger wounds where subcutaneous sutures are needed. This adhesive is relatively easy to use following appropriate wound preparation. Patients, especially children, readily accept the idea of being "glued" over traditional methods of repair. (+info)
Seeing through the stratum corneum.
The stratum corneum (SC) provides a vital barrier membrane between the external environment and the vulnerable internal tissues of the skin. It impedes the flow of water, the penetration of xenobiotics, and invasion of pathogenic micro-organisms. It also has protective capacity against ultraviolet radiation and thermal injury. As routine histopathology provides a misleading picture of a disorganized and shadowy SC, we would recommend the skin surface biopsy technique. This painless technique is easy and reliable in obtaining information from the SC. It demonstrates the geometric patterns of the surface, the openings of the eccrine ducts and hair follicles. The skin surface biopsy technique is also ideal for the investigation of the in situ microbiology of skin. Staining with periodic acid Schiff reagent makes it possible to see ringworm fungi, pityriasis versicolor, candida species, or erythrasma micro-organisms. Scanning electron microscopy can be employed when the higher magnification is needed. Histochemical applications include silver staining for melanin particle, potassium ferricyanide staining for blood pigments and lipid staining with Sudan red, for sebum. The rate of movement of topically applied drugs into the skin can be measured using the skin surface biopsy technique. The concentration of radiolabelled drugs can be counted and compared. Comedogenicity and DNA analysis are other applications of this non-invasive technique. (+info)