Safety and efficacy of modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension

BACKGROUND Gastric variceal hemorrhage is one of the primary manifestations of left-sided portal hypertension(LSPH).The hemorrhage is fatal and requires safe and effective interventions.AIM To evaluate the clinical safety and efficacy of modified endoscopic ultrasound(EUS)-guided selective N-butyl-2-cyanoacrylate(NBC)injections for gastric variceal hemorrhage in LSPH.METHODS A retrospective observational study of patients with LSPH-induced gastric variceal hemorrhage was conducted.Preoperative EUS evaluations were performed.Enrolled patients were divided into modified and conventional groups according to the NBC injection technique.The final selection of NBC injection technique depended on the patients’preferences and clinical status.The technical and clinical success rates,operation time,NBC doses,perioperative complications,postoperative hospital stay,and recurrent bleeding rates were analyzed,respectively.RESULTS A total of 27 patients were enrolled.No statistically significant differences were observed between the two groups regarding baseline characteristics.In comparison to patients in the conventional group,patients in the modified group demonstrated significantly reduced NBC doses(2.0±0.6 mL vs 3.1±1.0 mL;P=0.004)and increased endoscopic operation time(71.9±11.9 min vs 22.5±6.7 min;P<0.001).Meanwhile,the two groups had no significant difference in the technical and clinical success rates,perioperative complications,postoperative hospital stay,and recurrent bleeding rates.CONCLUSION Modified EUS-guided selective NBC injections demonstrated safety and efficacy for LSPH-induced gastric variceal hemorrhage,with advantages of reduced injection dose and no radiation risk.Drawbacks were time consumption and technical challenge.

2-Octyl-Cyanoacrylate Skin Adhesive Used as a Splinting Material in Auricular Surgery

In cases of auricular surgery, postoperative dressings are thought to be important for keeping auricular contour and in helping to prevent from dressing failures due to edema or subcutaneous hematoma, which may result in fibrous or cartilaginous proliferation. However, it is often difficult to achieve success with standard dressings because of the complicated shape of the auricle. We used 2-octyl-cyanoacrylate skin adhesive to dress the auricle after different types of auricular procedures (five cases of cryptotia, two of prominent ear, two of severe auricular laceration, two of skin grafting and one of flap repair of the partial auricle defect). The 2-octyl-cyanoacrlaate skin adhesive was applied to the suture line and the operated and peripheral areas for wider coverage. No dressing materials were placed over the surface. In all cases, the desired outcome was achieved, without subcutaneous hematoma, wound dehiscence, and wound infection. Contact dermatitis caused by the skin adhesive was not observed in any of the cases. Dressing and splinting after auricular surgery can be simply and successfully achieved using 2-octyl-cyanoacrylate skin adhesive. There is no need for more complicated dressings and post-surgical dressing changes, resulting in higher patient satisfaction.

N-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices

AIM: To compare n-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and a mixture of 72% chromated glycerin with hypertonic glucose solution in management of gastric varices. METHODS: Ninety patients with gastric varices presented to Endoscopy Unit of Ain Shams University Hospital were included. They were randomly allocated into three groups; each group included 30 patients treated with intravariceal sclerosant injections in biweekly sessions till complete obturation of gastric varices; Group I(n-butyl-2-cyanoacrylate; Histoacryl), Group II(iso-amyl-2-cyanoacrylate; Amcrylate) and Group III(mixture of 72% chromated glycerin; Scleremo with glucose solution 25%). All the procedures were performed electively without active bleeding. Recruited patients were followed up for 3 mo. RESULTS: 26% of Scleremo group had bleeding during puncture vs 3.3% in each of the other two groups with significant difference,(P < 0.05). None of Scleremo group had needle obstruction vs 13.3% in each of the other two groups with no significant difference,(P > 0.05). Rebleeding occurred in 13.3% of Histoacryl and Amcrylate groups vs 0% in Scleremo group with no significant difference. The in hospital mortality was 6.6% in both Histoacryl and Amcrylate groups, while it was 0% in Scleremo group with no significant difference. In the first and second sessions, the amount of Scleremo needed for obturation was significantly high, while the amount of Histoacryl was significantly low. Scleremo was the less costly of the two treatments. CONCLUSION: All used sclerosant substances showed efficacy and success in management of gastric varices with no significant differences except in total amount, cost and bleeding during puncture.

Cerebral and splenic infarctions after injection of N-butyl-2-cyanoacrylate in esophageal variceal bleeding

Variceal bleeding is the most serious complication of portal hypertension,and it accounts for approximately one fifth to one third of all deaths in liver cirrhosis patients.Currently,endoscopic treatment remains the predominant method for the prevention and treatment of variceal bleeding.Endoscopic treatments include band ligation and injection sclerotherapy.Injection sclerotherapy with N-butyl-2-cyanoacrylate has been successfully used to treat variceal bleeding.Although injection sclerotherapy with N-butyl-2-cyanoacrylate provides effective treatment for variceal bleeding,injection of N-butyl-2-cyanoacrylate is associated with a variety of complications,including systemic embolization.Herein,we report a case of cerebral and splenic infarctions after the injection of N-butyl-2-cyanoacrylate to treat esophageal variceal bleeding.

Endoscopic management of Dieulafoy's lesion using Isoamyl-2-cyanoacrylate

Dieulafoy's lesion (DL) is a rare but important cause of obscure gastrointestinal bleeding that may be over-looked during diagnostic endoscopy. Mortality rates are similar to those of other causes for gastrointestinal bleeding. Diagnosis by upper endoscopy is the modal-ity of choice during acute bleeding. In the absence of active bleeding, the lesion resembles a raised nipple or visible vessel. There are no guidelines regarding effective selective therapy for DL, when diagnosed, en-doscopist experience is the major determinant of the treatment strategy. Following our strategy, an expert endoscopist with a skilled assistant should have a high rate of successful DL diagnosis when an obscured gas-trointestinal lesion is suspected. Cyanoacryltes com-pounds have been used successfully in management of Gastric varices and DLs. To our knowledge, there have been no previous reports regarding use of isoamyl-2-cyanoacrylate (AMCRYLATE ; Concord Drugs Ltd.,Hyderabad, India) as an effective therapy for gastric DL without serious complications. In our case study, Isoamyl-2-cyanoacrylate (AMCRYLATE) was effective and safe for treating DL. Surgical wedge resection of the lesion should be considered as a therapeutic option if endoscopic therapy fails.

Modified endoscopic ultrasound-guided selective N-butyl-2-cyanoacrylate injections for gastric variceal hemorrhage in left-sided portal hypertension:A case report

BACKGROUND Left-sided portal hypertension(LSPH),also known as sinistral portal hypertension or regional portal hypertension,refers to extrahepatic portal hypertension caused by splenic vein obstruction or stenosis.N-butyl-2-cyanoacrylate(NBC)has been widely used in the endoscopic hemostasis of portal hypertension,but adverse events including renal or pulmonary thromboembolism,mucosal necrosis and gastrointestinal(GI)bleeding may occur after treatment.Herein,we report successfully managing gastric variceal(GV)hemorrhage secondary to LSPH using modified endoscopic ultrasound(EUS)-guided selective NBC injections.CASE SUMMARY A 35-year-old man was referred to our hospital due to an upper GI hemorrhage.Gastroscopy revealed GV hemorrhage and computed tomography venography(CTV)confirmed LSPH.The patient requested endoscopic procedures and rejected surgical therapies including splenectomy.EUS-guided selective NBC injections were performed and confluences of gastric varices were selected as the injection sites to reduce the injection dose.The“sandwich”method using undiluted NBC and hypertonic glucose was applied.No complications occurred.The patient was followed up regularly after discharge.Three months later,the follow-up gastroscopy revealed firm gastric submucosa with no sign of NBC expulsion and the follow-up CTV showed improvements in LSPH.No recurrent GI hemorrhage was reported during this follow-up period.CONCLUSION EUS-guided selective NBC injection may represent an effective and economical treatment for GV hemorrhage in patients with LSPH.

Endovascular treatment of traumatic direct carotid cavernous fistulas with n-Butyl-2-Cyanoacrylate

Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n-Butyl-2-Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous fistulas treated by endovascular embolization with n-Butyl-2-Cyanoacrylate. (n-BCA) were retrospectively analyzed,including the

Extraction of palladium(Ⅱ) from hydrochloride solutions with 2-n-octyl-4-isothiazolin-3-one as novel extractant

Solvent extraction of palladium （Ⅱ） from hydrochloric acid solution with 2-n-octyl-4-isothiazolin-3-one （OIT）/cyclohexane was studied. Effects of different parameters on extraction efficiency were evaluated. 99.96 % and 98.26 % palladium （Ⅱ） could be effectively extracted with 0.018 mol·L^-1 OIT/cyclohexane of 0.1 and 4.0 mol·L^-1 HCl medium, respectively. Nonpolar solvent and low acidity could improve the extracting efficiency, and successfully strip palladium （Ⅱ） from the loaded organic phase was achieved with 0.5 mol·L^-1 （NH2）2CS solution. It was proposed that the extraction of Pd com-plexes from HCl medium proceeded through the ion-association mechanism by slope method, NMR and FF-IR spectra.

Extraction of Gold by Di(2-ethylhexyl)Sulfoxide and N-Octyl Sulfoxide

A long chain aliphatic sulfoxide can be used as an extractant.It can extract almost all metallic ions which can be extracted by tributylphosphate (TBP).The extraction of gold was studied by Chekushin,V. S. and Mojski,M.using petroleum sulfoxide and n-dioctyl sulfoxide(DOSO) as an extractant respectively.

稀土复合固体超强酸SO4^2-／ZrO2-2％Sm2O3催化合成乙酸辛酯

采用共沉淀法制备了稀土复合固体超强酸SO42-/ZrO2-2%Sm2O3催化剂,并对以乙酸和辛醇为原料合成乙酸辛酯的反应条件进行了探索。研究表明,当辛醇与乙酸的摩尔比为1∶2,反应时间为6h,反应温度为120℃,催化剂用量为6%辛醇的质量时,酯化率可达91.73%,选择性高达100%。研究发现,该催化剂可重复使用,并能活化再生。

2-辛基十二烷基缩水甘油醚的合成

以固体氢氧化钠、格尔伯特二十醇和环氧氯丙烷为原料,采用四丁基溴化铵为相转移催化剂,合成了2-辛基十二烷基缩水甘油醚。讨论了原料摩尔比、四丁基溴化铵的用量、反应温度、反应时间对反应产率的影响。最终确定最佳反应条件是:n(格尔伯特二十醇)∶n(环氧氯丙烷)∶n(固体氢氧化钠)=1.00∶1.15∶1.20;四丁基溴化铵用量为0.05(相对醇的摩尔比);反应温度为50℃;反应时间为4 h。在此条件下可得产率为79.8%的2-辛基十二烷基缩水甘油醚,用盐酸-丙酮法测得其环氧值为0.232。最终产物结构通过红外光谱分析得到证实。

2-羟基-3-辛基-5-长链烷基苯磺酸钠的合成及表面活性

以脂肪酸、苯酚为原料,经酰化反应、酯化反应、Fries重排、氢化还原反应、磺化以及中和反应等步骤,合成出了2-羟基-3-辛基-5-长链烷基苯磺酸钠表面活性剂。两相滴定法测定了产物的质量分数均大于99%;用核磁共振氢谱、傅立叶红外光谱和质谱对产物进行了结构鉴定。用悬挂滴法测定了30℃时该系列表面活性剂的表面张力。实验发现,纯水溶液中表面活性剂的临界胶束浓度(CMC)达到10-6mol/L数量级,临界胶束浓度下的表面张力(γCMC)均小于28 mN/m;随着苯环上长链烷基碳数(n=8,10,12)的增加,CMC降低,分别为1.06×10-5,3.35×10-6,2.65×10-6mol/L;而γCMC变化不明显,分别为26.77,26.89,27.22 mN/m。结果表明,此类表面活性剂具有比较好的表面活性。

2-乙基己基辛基硫醚树脂固相萃取钯的研究

合成和鉴定了新萃取剂2-乙基己基辛基硫醚(EHOS),研究了EHOS树脂萃取钯的性能。实验表明,在0.1mol·L-1盐酸介质中,EHOS树脂萃Pd(Ⅱ)的萃取率>99%,研究了EHOS树脂萃取钯的机理,结果表明,EHOS树脂通过EHOS分子上的硫原子与钯(Ⅱ)配位,形成2∶1配合物。硫脲是有效反萃剂,从萃合物的晶体结构看出,硫脲通过S原子与Pd(Ⅱ)配位,萃合物以Pd原子为中心构成平面正方型结构。选择了汽车催化剂浸出液进行固相萃取分离试验,钯回收率>97%。

2-丙烯酰胺基辛烷基磺酸钠的合成及其胶束化行为研究

以丙烯腈与1-辛烯为主要原料,合成了表面活性单体2-丙烯酰胺基辛烷基磺酸钠(NaAMC8S)。在n(1-辛烯)∶n(丙烯腈)∶n(发烟硫酸)=1∶6∶1,反应温度25℃,反应时间24h,产品收率(按1-辛烯计)为82.2%。用红外光谱、核磁共振波谱、高分辨质谱和X射线能谱确认了NaAMC8S的化学结构。用电导法与表面张力法测定了NaAMC8S的临界胶束浓度(CMC)。用稳态荧光光谱法测定了CMC和胶束的微极性。结果表明,25℃时,用电导法和表面张力法测得NaAMC8S的CMC分别为44.75mmol/L和51.76mmol/L,对应的表面张力为50.61mN/m;且CMC随温度变化很小。

硫酸铜催化合成丁酸-2-辛基-十二烷醇酯

报道了硫酸铜催化合成丁酸-2-辛基-十二烷醇酯，详细讨论了影响酯化反应的条件，产品收率达81％。

钨(Ⅵ)-4(6-溴-2-苯并噻唑偶氮)邻苯二酚-乳化剂OP三元络合物显色反应的研究及其应用

非离子表面活性剂OP存在下，钨（Ⅵ）与新显色剂4-（6-溴-2-苯并噻唑偶氮）邻苯二酚（6-Br-BTAPC）在pH4.0～5.2介质中反应形成稳定的、带负电荷的、紫红色三元胶束络合物。其中W（Ⅵ）与6-Br-BTAPC的组成比为1∶2；λmax为558nm，表现ε558为7.34X104L·mol-1·cm-1。钨（Ⅵ）含量在0～1.4mg／L范围内遵从比耳定律。建议了络合物的结构。将拟定的分析方法用于合金钢试样中小量或痕量钨的测定，取得了满意的结果。

纳米固体超强酸SO_4^(2-)/CoFe_2O_4催化合成棕榈酸异辛酯的研究

利用硝酸铁和硝酸钴为原料制备了纳米固体超强酸SO24-/CoFe2O4催化剂。透射电镜(TEM)测量结果表明,自制催化剂颗粒粒径在20~50 nm。实验探讨了硫酸铵浸渍浓度、催化剂焙烧温度、焙烧时间对催化剂催化活性的影响;并以纳米固体超强酸SO24-/CoFe2O4为催化剂,研究了棕榈酸与异辛醇合成棕榈酸异辛酯过程中影响酯化率的主要因素。实验确定的最优合成条件是:醇酸物质的量比2.0∶1,催化剂质量分数(占反应物总质量的分数)0.50%,反应时间3.0 h,并添加了带水剂,在此条件下反应的酯化率可达97.4%。

2-羟基-5-特辛基苯乙酮肟的合成及表征

以四氯乙烯为溶剂,对特辛基苯酚、乙酰氯、无水AlCl3和盐酸羟胺为主要原料,采用分步合成法合成了2-羟基-5-特辛基苯乙酮肟.考察了无水AlCl3用量、乙酰氯的用量、Fries重排温度、肟化反应盐酸羟胺用量以及缚酸剂无水碳酸钠用量对产物产率的影响,实验结果表明,当n(AlCl3)∶n(乙酰氯)∶n(对特辛基苯酚)=1.5∶2∶1,Fries重排温度为120℃,n(Na2CO3)∶n(盐酸羟胺)∶n(对特辛基苯酚)=0.5∶1∶1.产物收率64.9%.对合成产物利用核磁共振进行了结构表征.

固体杂多酸盐TiGeW_(12)O_(40)/TiO_2催化合成DIOP

采用固体杂多酸盐催化剂TiGeW12 O40 /TiO2 代替浓硫酸催化合成了邻苯二甲酸二异辛酯 (DIOP)。考察了原料配比、酯化时间、催化剂用量及催化剂回收等对反应的影响。结果表明 :选用TiGeW12 O40 /TiO2 做催化剂具有催化活性高、副产物少、不污染环境等优点 ;合成DIOP的适宜工艺条件为反应温度 13 0℃ ,反应时间 2h ,n (醇 ) /n (酸酐 )为 2 75 /1,催化剂质量分数为 1 0 0 % ;按此工艺条件反应 ,酯化率可达 94 6%。

5,7-二氯-2-辛基-1H-吲哚的合成研究

以2,4-二氯-6-碘苯胺为原料,通过Sonogashira交叉偶联反应以及环合反应合成5,7-二氯-2-辛基-1H-吲哚,反应总收率为86.8%,该反应条件温和,收率较高,产物立体选择性好,产物结构经1H NMR和MS得到了确证。