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Prolonged anastomotic and needle hole bleeding from synthetic vascular prostheses is a common surgical problem in heparinized patients and in the patient with a coagulopathy. The relative effectiveness of various hemostatic agents has not previously been determined by controlled comparisons. In this study 6 mm polytetrafluoroethylene (PTFE) vascular prostheses were used to perform carotid-carotid and femorofemoral bypasses in eight heparinized dogs. The relative effectiveness of isobutyl 2-cyanoacrylate, fibrin adhesive, and oxidized regenerated cellulose was determined by application of these hemostatic agents to three sources of bleeding: arterial-PTFE anastomoses, PTFE-PTFE anastomoses, and 18-gauge needle holes in PTFE vascular prostheses. The mean time to hemostasis (MTH) was determined for each hemostatic agent. Although application of isobutyl 2-cyanoacrylate resulted in the shortest MTH in each experimental group, the reported inflammatory response that it induces and its possible carcinogenicity limits its availability for clinical use. Application of fibrin adhesive prepared from single-donor hepatitis-screened plasma resulted in a significantly shorter MTH in each experimental group when compared with oxidized regenerated cellulose. We recommend clinical use of fibrin adhesive to control needle hole and anastomotic bleeding from PTFE vascular prostheses.

Recent studies have shown improved efficacy of chemotherapy in patients with advanced squamous-cell cancer of the head and neck. Our purpose was to evaluate prospectively the activity of cisplatin plus 5-fluorouracil (5FU) in 37 patients with advanced stage IV squamous-cell cancer of the head and neck. There were two groups. Group 1 consisted of 19 previously untreated patients with either T4 or N3 disease. They received 100 mg/m2 cisplatin (days 1 and 28) and 120-hour infusion of 1,000 mg/m2/24 hours 5FU (days 1 to 5 and 28 to 32). They subsequently were offered preoperative radiotherapy (RT) and surgery. Group 2 consisted of 18 previously treated patients. They received 5FU and cisplatin in the same dosage every 28 days for either recurrent or metastatic disease. It was found that in group 1 there was an 84% response rate (five complete responses (CR) and 11 partial responses (PR) ). Three of those with PR achieved a CR after RT. Seven patients have had RT plus surgery and are disease free at 8 to 27 month follow-up. Six patients (one CR, five PR) refused surgery and progressed within 4 months. In group 2 there was an 11% response rate after two cycles (two PR), three patients had a minimal response (MR, less than 50% response) and received a mean of four cycles of treatment. Three patients with stable disease received a mean of four cycles of chemotherapy until progression. Two of 11 patients who had received previous chemotherapy plus RT showed an MR; nine of these patients had shown a response to their previous chemotherapy. Only one of 14 patients who had RT plus chemotherapy had a PR, and three had MR. Of five patients who had previous surgery, only one had a PR. All five had received chemotherapy as well. It was concluded that 5FU plus cisplatin is an effective combination in previously untreated patients. In previously treated patients with recurrent disease, there is a substantially lower response rate.

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Needle hole bleeding from polytetrafluoroethylene (PTFE) grafts causes blood loss and prolongs vascular procedures. Past studies have shown the cyanoacrylate glues to polymerize rapidly and cause minimal tissue toxicity. This study was undertaken to evaluate the efficacy of ethyl-2-cyanoacrylate glue (Krazy Glue, KG) in obtaining prompt hemostasis in vascular anastomoses in a heparinized canine model. KG effected complete hemostasis in a significantly shorter time than oxidized cellulose and digital pressure in 18gauge needle holes in PTFE grafts, graft to graft end-to-end anastomoses, and end of graft to side of artery anastomoses. The only limitation of KG was the development of a glue-adventitia plaque on the arterial side of some of the PTFE-artery anastomoses, causing the need for regluing. KG is an ideal agent for sealing defects in PTFE grafts.