Epidemiology and predictors of a poor outcome in elderly patients with candidemia

Background: Candidemia affects patient populations from neonates to the elderly. Despite this, little information is available about the epidemiology of candidemia in elderly patients. Methods: We performed a retrospective analysis of 987 episodes of candidemia in adults (>14 years of age) from the databases of three laboratory-based surveys of candidemia performed at 14 tertiary care hospitals. Patients aged >= 60 years were considered elderly (group 1, n = 455, 46%) and were compared to younger patients (group 2, n = 532, 54%) regarding demographics, underlying diseases, comorbidities, exposure to medical procedures, species, treatment, and outcome. Results: The median APACHE II score was significantly higher in the elderly patients (19 vs. 15, p = 0.03). Variables that were observed significantly more frequently in elderly patients included admission to an intensive care unit, diabetes mellitus, renal failure, cardiac disease, lung disease, receipt of antibiotics or H2 blockers, insertion of a central venous catheter, mechanical ventilation, and candidemia due to Candida tropicalis. The 30-day mortality of elderly patients was significantly higher than that of younger patients (70% vs. 45%, p < 0.001). Factors associated with higher mortality by multivariate analysis included APACHE II score and being in group 1 (elderly). Factors associated with mortality in elderly patients were lung disease and the receipt of mechanical ventilation. Conclusions: Elderly patients account for a substantial proportion of patients with candidemia and have a higher mortality compared to younger patients. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Selection of Top 10 Quality Indicators for Nutrition Therapy

Background: The identification of useful quality indicators for nutrition therapy (QINTs) is of great interest and a challenge. This study attempted to identify the 10 QINTs that best suit the practice of quality control in nutrition therapy (NT) by evaluating the opinion of experts in NT with the use of psychometric techniques and statistical tools. Methods: Thirty-six QINTs available for clinical application in Brazil were assessed in 2 distinct phases. In phase 1, 26 nutrition experts ranked QINTs by scoring 4 attributes (utility, simplicity, objectivity, low cost) to assess each QINT on a 5-point Likert scale. The top 10 QINTs were identified from the 10 best scores obtained, and the reliability of expert opinion for each indicator was assessed by Cronbach's alpha. In phase 2, experts provided feedback regarding the selected top 10 QINTs by answering 2 closed questions. Results: The top 10 QINTs, in descending order, are the frequency of nutrition screening of hospitalized patients, diarrhea, involuntary withdrawal of enteral feeding tubes, feeding tube obstruction, fasting longer than 24 hours, glycemic dysfunction, estimated energy expenditure and protein needs, central venous catheter infection, compliance of NT indication, and frequency of application of subjective global assessment. Opinions were consistent among the interviewed experts. During feedback, 96% of experts were satisfied with the top 10 QINTs, and 100% had considered them in accordance with their previous opinion. Conclusion: The top 10 QINTs were identified according to their usefulness in clinical practice by obtaining adequate agreement and representativeness of opinion of nutrition experts. (Nutr Clin Pract. 2012;27:261-267)

Treatment of Pythiosis in Equine Limbs Using Intravenous Regional Perfusion of Amphotericin B

Objective To evaluate the effects of intravenous regional limb perfusion (IRLP) administration of amphotericin B in horses to treat pythiosis after surgical excision and thermocautery. Study Design Case series. Animals Horses (n = 12) with Pythium insidiosum infection of the distal aspect of the thoracic or pelvic limbs. Methods After surgical excision of granulation tissue and thermocautery, 50 mg amphotericin B was administered by IRLP through a catheter placed in a superficial vein of the affected limb next to the lesion after placing a tourniquet above the injection site. The lesions and locomotor system were evaluated before treatment and at 7, 14, 21, 28, 35, and 60 days. Results Ninety-two percent of horses treated with amphotericin B had complete lesion resolution 35 or 60 days after 1 or 2 IRLP treatments, respectively. IRLP induced limb edema and pain during regional palpation in 42%, and inflammation of the injection site in 33% of horses; however these signs resolved after 14 days. Conclusions IRLP administration of amphotericin B was effective for treating pythiosis in equine limbs, resolving infection with manageable side effects.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: Analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostate-specific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

Abstract Background In patients with advanced non-ischemic cardiomyopathy (NIC), right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA) flow pattern and flow reserve (CFR) are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Methods Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire) data was obtained in RCA and left anterior descendent coronary artery (LAD) before and after adenosine. Resting RCA phasic pattern (diastolic/systolic) was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV) dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress) more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. Results LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS) either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS); RCA vs. LAD was 1.35 vs. 2.85 (p < 0.001). It had no significant correlation among any cardiac mechanical or hemodynamic parameter with RCA-CFR or RCA flow pattern. RCA-CFR had no difference compared with LAD (3.38 vs. 3.34, p = NS), as well as in pulmonary hypertension (3.09 vs. 3.10, p = NS) either in RV dysfunction (3.06 vs. 3.22, p = NS) subgroups. Conclusion In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or hemodynamic parameter with RCA-CFR or RCA phasic flow pattern. RCA flow reserve is still similar to LAD, independently of those right-sided cardiac disturbances.

Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study

Abstract Background Sequential physicochemical alterations in blood and urine in the course of acute kidney injury (AKI) development have not been previously described. We aimed to describe these alterations in parallel to traditional renal and acid–base parameters. Methods One hundred and sixty eight consecutive critically ill patients with no previous kidney disease, who had an indwelling urinary catheter at ICU admission and who remained with the catheter for at least two days without dialysis were included. A sample of blood and spot urine were collected simultaneously, once daily, until catheter removal or dialysis requirement. Traditional acid–base and renal parameters were sequentially evaluated in parallel to blood and urinary physicochemical parameters. Patients were classified during this period as having or not AKI and, for patients with AKI, duration (transient or persistent) and severity (creatinine-based AKIN stage) were evaluated. Results One hundred and thirteen patients (67.3%) had AKI: 92 at ICU admission and 21 during the observation period. AKI development was characterized in blood by increased values of phosphate and unmeasured anions (SIG), decreased albumin, and in urine by decreased values of sodium (NaU), chloride (ClU) as well as high urinary strong ion difference (SIDu). These alterations began to occur before AKI diagnosis, and they reverted in transient AKI but remained in persistent AKI. NaU, ClU and albumin decreased, and phosphate, SIG and SIDu increased with AKI severity progression. NaU and ClU values increased again when AKIN stage 3 was reached. Conclusions Simultaneous physicochemical analysis of blood and urine revealed standardized alterations that characterize AKI development in critically ill patients. These alterations paralleled AKI duration and severity. Future studies should consider including sequential evaluation of urine biochemistry as part of the armamentarium for AKI diagnosis and management.

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

FUNDAMENTO: A avaliação clínico-hemodinâmica à beira do leito e o uso do cateter de artéria pulmonar para a estimativa de dados hemodinâmicos têm sido utilizados na insuficiência cardíaca descompensada. Entretanto, não existem dados com o uso da monitorização hemodinâmica contínua não invasiva. OBJETIVO: Comparar as medidas obtidas com a monitorização hemodinâmica não invasiva com as invasivas em pacientes com insuficiência cardíaca descompensada e refratária ao tratamento. MÉTODOS: As medidas hemodinâmicas não invasivas foram obtidas através da monitorização contínua da pressão arterial sistêmica pelo modelo de ondas de pulso (modelflow) e foram comparadas com as medidas obtidas pela passagem do cateter de artéria pulmonar, simultaneamente. RESULTADOS: Foram realizadas 56 medidas em 14 pacientes estudados em dias e horários diferentes. O índice de correlação entre as medidas da pressão arterial sistólica foi de r = 0,26 (IC 95% = 0,00 a 0,49, p = 0,0492) e da diastólica de r = 0,50 (IC 95% = 0,27 a 0,67, p < 0,0001). A correlação foi de r = 0,55 (IC 95% = 0,34 a 0,71, p 0,0001) para o índice cardíaco e de r = 0,32 (IC 95% = 0,06 a 0,53, p = 0,0178) para a resistência vascular sistêmica. CONCLUSÃO: Houve correlação entre as medidas hemodinâmicas não invasivas quando comparadas às medidas do cateter de artéria pulmonar. A monitorização hemodinâmica contínua não invasiva pode ser útil para pacientes internados com insuficiência cardíaca descompensada.

Cateter urinário: mitos e rituais presentes no preparo do paciente

OBJETIVO: Este estudo buscou identificar e descrever mitos e rituais no preparo do paciente para a inserção do cateter urinário. MÉTODOS: Trata-se de um estudo observacional, exploratório e descritivo, realizado em nove hospitais de um município do interior paulista. Seguidos os preceitos éticos, os dados foram coletados por entrevista, junto ao enfermeiro designado pela instituição, utilizando-se um instrumento semiestruturado. Dentre as 13 instituições do município, nove participaram do estudo. RESULTADOS: Todos os hospitais possuíam o procedimento de cateterismo urinário padronizado e implantado. Durante o preparo do paciente, 5 (55,5%) não fizeram referência à orientação, privacidade e humanização. Todas adotam procedimentos divergentes para higiene e antissepsia do meato uretral, com presença de mitos e rituais que se sobressaem às evidências científicas e destacam o modelo funcionalista nos procedimentos realizados pela equipe de enfermagem. CONCLUSÃO: Há necessidade de reavaliar a intervenção de cateterismo urinário, com discussões interdisciplinares, dando ênfase à utilização de princípios científicos.

Diferença de tempo de positividade: método útil no diagnóstico de infecção de corrente sanguínea relacionada com cateter?

INTRODUÇÃO: As infecções de corrente sanguínea relacionadas com cateter (ICSRCs) apresentam impacto significativo na morbidade e na mortalidade de pacientes internados, além de elevar custos hospitalares. A utilização de equipamentos automatizados no processamento de hemoculturas gerou uma alternativa para diagnóstico de ICSRC por meio da análise da diferença de tempo de positividade (DTP) entre hemoculturas pareadas (coletadas simultaneamente) de sangue periférico e sangue de cateter. Um diagnóstico acurado e rápido dessas infecções pode otimizar as condutas clínicas e terapêuticas, poupando a retirada precoce dos cateteres. OBJETIVOS: Avaliar na rotina a DTP como ferramenta auxiliar no diagnóstico de ICSRC e determinar os principais microrganismos isolados. MÉTODOS: Foram avaliadas retrospectivamente hemoculturas coletadas no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP) de maio a agosto de 2008. Somente amostras que apresentaram DTP maior que 120 minutos foram consideradas possíveis ICSRCs pelo critério laboratorial. RESULTADOS: A seção processou 11.017 hemoculturas aeróbias durante o período de estudo; somente 5% foram coletadas de forma pareada. Destas, 148 (28%) foram positivas, sendo 9% com crescimento somente em sangue periférico, 41% somente em sangue de cateter e 50% em ambas as amostras com 88% de homologia de microrganismos identificados. A DTP apresentou valores acima de 120 minutos em 50% dos casos e os microrganismos mais isolados foram Staphylococcus aureus (22%), Candida spp. (18%), Klebsiella spp. (7%) e Enterobacter spp. (7%). CONCLUSÃO: A determinação da DTP como ferramenta auxiliar no diagnóstico de ICSRC é viável e fácil de ser executada em laboratórios de rotina com automação, porém o processo de coleta das amostras pareadas deve ser rigidamente padronizado.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Prevalência e motivos de remoção não eletiva do cateter central de inserção periférica em neonatos

Estudo transversal, realizado com 67 recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal de um hospital privado de São Paulo, entre julho e dezembro de 2010, submetidos a 84 inserções de Cateteres Centrais de Inserção Periférica (CCIP). Os objetivos foram descrever a prevalência de remoção não eletiva do cateter e seus motivos. Os dados foram coletados de prontuários médicos e do formulário de registro de informações sobre o cateter. A média de idade gestacional corrigida dos neonatos foi 32,8 semanas, peso 1.671,6 g e idade pós-natal 9,4 dias. A remoção não eletiva ocorreu em 33 (39,3%) cateteres, 13,1% por obstrução, 9,5% ruptura, 7,1% edema do membro, 6% suspeita de infecção, 1,2% tração acidental, 1,2% má perfusão e 1,2% extravasamento. A prevalência e os motivos de remoção não eletiva indicaram a necessidade de estratégias para a prevenção de complicações evitáveis relacionadas ao CCIP.

Estudo das complicações do cateter totalmente implantável em oncologia pediátrica: Comparação entre a punção da veia jugular interna e da veia subclávia no implante do cateter

Objetivo: Avaliar, por estudo prospectivo, a incidência de complicações relacionadas ao implante e uso de cateteres de longa permanência totalmente implantáveis (CLP) em crianças com câncer, comparando o implante por punção em veia subclávia (SCL) com o implante por punção em veia jugular interna (J). Método: estudo prospectivo com randomização da escolha da punção em veia subclávia ou veia jugular interna para o implante do cateter. Foram considerados como desfechos as complicações que levaram a retirada ou revisão do cateter. Resultados: 83 implantes foram randomizados no período de janeiro de 2004 a abril de 2006 e acompanhados até março de 2008. Dos 83 implantes selecionados 6 foram excluídos, permanecendo 43 pacientes no grupo SCL e 34 no grupo J. Não houve diferença estatística entre os dois grupos em relação à: distribuição por idade, sexo, número de leucócitos no implante, número de plaquetas, tipo de internação para cirurgia (ambulatorial ou não), se houve quimioterapia prévia ao implante e quanto ao tipo de cateter. Na avaliação das complicações se observou, incidência de infecção de 20% no grupo SCL e 11% no grupo J (p: 0,44), incidência de embolia de 23% no grupo SCL e 8% no grupo J (p: 0,11), e incidência de complicações total de 51% no grupo SCL e 23% no grupo J (p 0,02). A média do tempo de permanência do cateter foi de 12,6 meses para o grupo SCL e 14,8 para o grupo J (p: 0,38). A análise por regressão logística mostrou que o peso (p: 0,001) é um fator de risco envolvido com a infecção; e o peso (p: 0,020) e a marca do cateter (p: 0,03) são fatores de risco para embolia. Conclusões: há maior incidência de complicações tardias no grupo SCL. Os pacientes com menor peso tiveram risco maior de desenvolver infecção. Pacientes com menor peso e a marca do cateter são fatores de risco para a ocorrência de embolia do cateter

Central autonomic control in spontaneously hypertensive rats: a study on phasic phenomena during rapid-eye-movement sleep

The cardiovascular regulation undergoes wide changes in the different states of sleepwake cycle. In particular, the relationship between spontaneous fluctuations in heart period and arterial pressure clearly shows differences between the two sleep states. In non rapid-eye-movement sleep, heart rhythm is under prevalent baroreflex control, whereas in rapid-eye-movement sleep central autonomic commands prevail (Zoccoli et al., 2001). Moreover, during rapid-eye-movement sleep the cardiovascular variables show wide fluctuations around their mean value. In particular, during rapid-eyemovement sleep, the arterial pressure shows phasic hypertensive events which are superimposed upon the tonic level of arterial pressure. These phasic increases in arterial pressure are accompanied by an increase in heart rate (Sei & Morita, 1996; Silvani et al., 2005). Thus, rapid-eye-movement sleep may represent an “autonomic stress test” for the cardiovascular system, able to unmask pathological patterns of cardiovascular regulation (Verrier et al. 2005), but this hypothesis has never been tested experimentally. The aim of this study was to investigate whether rapid-eye-movement sleep may reveal derangements in central autonomic cardiovascular control in an experimental model of essential hypertension. The study was performed in Spontaneously Hypertensive Rats, which represent the most widely used model of essential hypertension, and allow full control of genetic and environmental confounding factors. In particular, we analyzed the cardiovascular, electroencephalogram, and electromyogram changes associated with phasic hypertensive events during rapid-eyemovement sleep in Spontaneously Hypertensive Rats and in their genetic Wistar Kyoto control strain. Moreover, we studied also a group of Spontaneously Hypertensive Rats made phenotypically normotensive by means of a chronic treatment with an angiotensin converting enzyme inhibitor, the Enalapril maleate, from the age of four weeks to the end of the experiment. All rats were implanted with electrodes for electroencephalographic and electromyographic recordings and with an arterial catheter for arterial pressure measurement. After six days for postoperative recovery, the rats were studied for five days, at an age of ten weeks.The study indicated that the peak of mean arterial pressure increase during the phasic hypertensive events in rapid-eye-movement sleep did not differ significantly between Spontaneously Hypertensive Rats and Wistar Kyoto rats, while on the other hand Spontaneously Hypertensive Rats showed a reduced increase in the frequency of theta rhythm and a reduced tachicardia with respect to Wistar Kyoto rats. The same pattern of changes in mean arterial pressure, heart period, and theta frequency was observed between Spontaneously Hypertensive Rats and Spontaneously Hypertensive Rats treated with Enalapril maleate. Spontaneously Hypertensive Rats do not differ from Wistar Kyoto rats only in terms of arterial hypertension, but also due to multiple unknown genetic differences. Spontaneously Hypertensive Rats were developed by selective breeding of Wistar Kyoto rats based only on the level of arterial pressure. However, in this process, multiple genes possibly unrelated to hypertension may have been selected together with the genetic determinants of hypertension (Carley et al., 2000). This study indicated that Spontaneously Hypertensive Rats differ from Wistar Kyoto rats, but not from Spontaneously Hypertensive Rats treated with Enalapril maleate, in terms of arterial pH and theta frequency. This feature may be due to genetic determinants unrelated to hypertension. In sharp contrast, the persistence of differences in the peak of heart period decrease and the peak of theta frequency increase during phasic hypertensive events between Spontaneously Hypertensive Rats and Spontaneously Hypertensive Rats treated with Enalapril maleate demonstrates that the observed reduction in central autonomic control of the cardiovascular system in Spontaneously Hypertensive Rats is not an irreversible consequence of inherited genetic determinants. Rather, the comparison between Spontaneously Hypertensive Rats and Spontaneously Hypertensive Rats treated with Enalapril maleate indicates that the observed differences in central autonomic control are the result of the hypertension per se. This work supports the view that the study of cardiovascular regulation in sleep provides fundamental insight on the pathophysiology of hypertension, and may thus contribute to the understanding of this disease, which is a major health problem in European countries (Wolf-Maier et al., 2003) with its burden of cardiac, vascular, and renal complications.

Rilascio dei biomarkers di danno miocardico dopo iniezione diretta per via percutanea di cellule staminali e terapia genica

Aims: We aimed to quantify the release of bio-markers of myocardial damage in relation to direct intramyocardial injections of genes and stem cells in patients with severe coronary artery disease. Methods and Results: We studied 71 patients with “no-option” coronary artery disease. Patients had, via the percutaneous transluminal route, a total of 11±1 (mean ± SD) intramyocardial injections of vascular endothelial growth factor genes (n=56) or mesenchymal stromal cells (n=15). Injections were guided to an ischemic area by electromechanical mapping, using the NOGA™/Myostar™ catheter system. ECG was monitored continuously until discharge. Plasma CKMB (upper normal laboratory limit=5 μg/l) was 2 μg/l (2-3) at baseline; increased to 6 (5-9) after 8 hours (p < 0.0001) and normalized to 4 (3-5) after 24 hours. A total of 8 patients (17%), receiving a volume of 0.3 ml per injection, had CKMB rises exceeding 3 times the upper limit, whereas no patient in the group receiving 0.2 ml had a more than two fold CKMB increase. No patient developed new ECG changes. There were no clinically important ventricular arrhythmias and no death. Conclusion: Direct Intramyocardial injections of stem cells or genes lead to measurable release of cardiac bio-markers, which was related to the injected volume.

Sistemi adesivi con applicazioni in campo biomedicale

Polymeric adhesives have been used for many applications like suture and embolization, instead of classic surgical methods or as for dental uses. In this work both subjects have been investigated and the results separated in two parts. In the first, new dentinal adhesives with different polymerizable groups (methacrylic or vinyl-ethereal) were synthesized. A low sensitivity to hydrolysis and equal or enhanced properties, compared to existing commercial products, were considered essentials. Moreover, these monomers need to polymerize by radical photopolymerization and functional groups of different characteristics were tested. All these products were characterized by microtensile bond strength test to determine the bonding strength between the adhesive and tooth. Concerning embolization, cyanoacrylates are nowadays the most-used adhesives in surgery. Thus, they must respond to several requirements. For instance, polymerization time and adhesive strength need to be low, to avoid diffusion of the products in the body and adhesion to the catheter. In order to overcome these problems we developed new cyanoacrylates, which practically instantly polymerize upon contact with blood but do not demonstrate strong adhesion to the catheter, thank to the presence of fluorine atoms, linked to the ester chain. The synthesis of these products was carried out in several steps, such as the depolymerization of the corresponding oligomers at high temperature in acid conditions. Two types of adhesion strengths were determined. Bonding strength between human veins and a microcatheter was determined in vitro by using organic materials as the most realistic model. Another test, on two layers of skin, was conducted to verify the possible use of these new cyanoacrylates as a glue for sutures. As a conclusion, we were able to demonstrate that some of the prepared monomers posses adhesive strength and polymerization time lower than the commercial product Glubran2.