Search

Uncontrolled bleeding is linked to higher treatment costs, risk of post-surgical infection and increased disease and death. Hemostatic agents are used to treat excessive bleeding. A good hemostatic agent controls bleeding effectively, reduces the need for blood transfusion, removes the need for systemic drugs to control bleeding, results in shorter surgery time, and reduces the cost and length of hospital stay of the patient. Gelatin-based hemostatic agents have been widely used in medical and dental procedures, owing to their biodegradability and biocompatibility, as well as availability and low cost of raw materials. In this narrative literature review, we discuss the background and different types of gelatin-based hemostatic agents in medical and dental procedures, the comparison of gelatin-based and non-gelatin-based hemostatic agents, and the usage and development of enhanced or novel gelatin-based hemostatic agents. Gelatin-based hemostatic agents are effective and important part of bleeding control, as evidenced by its wide application in medicine and dentistry. The development of novel combination gelatin-based hemostatic agents has much potential for effective control of excessive bleeding. [ABSTRACT FROM AUTHOR]

Background Context: Early postoperative MR images are frequently necessary after spine surgery. The appearance of commonly used adjunct hemostatic agents and dural sealants in MR images has not been systematically evaluated.Purpose: The purpose of this experimental study was to systematically analyze and describe the characteristics of the most commonly applied hemostatic agents and dural sealants in spine surgery on early postoperative MR images.Study Design: Cadaver Study METHODS: Four commonly applied dural sealants (Duraseal, Bioglue, Tachosil, Tisseel) and five commonly used hemostatic agents (Surgiflo, Bonewax, , Spongostan, Gelfoam, Avitene) were investigated. The experimental setting involved a human cadaver where a standard left-sided laminotomy was performed on nine levels of the thoracolumbar spine, and the materials were separately applied and mixed with fresh blood or water for hemostatic and dural sealants, respectively. The cadaver model was scanned at a 3 Tesla MRI and the imaging findings for all materials were compared to the surrounding tissue and systematically reported.Results: All investigated dural sealants and hemostatic agents were distinguishable from the surrounding tissue on MR images with different appearances on the MR sequences. A detailed atlas for the identification of the materials in postoperative spine MRI was established.Conclusion: Commonly used hemostatic agents and dural sealants can be successfully identified on early postoperative spine MRI.Clinical Significance: Knowledge about MRI appearances of commonly used adjunct surgical materials helps in interpretation of postoperative imaging and supports clinical decision making. [ABSTRACT FROM AUTHOR]

Gelfoam is a simple and effective hemostatic agent that is used to seal brain corticotomies or skull burr holes. Owing to its low cost, it is one of the most widely used tools in neurosurgical daily practice. However, migration of Gelfoam fragments can cause occlusion of endoscopic third ventriculostomy (ETV) or shunt, leading to hydrocephalus recurrence. Two cases of Gelfoam migration causing recurrent hydrocephalus are presented: a 12-year-old girl who underwent surgery for posterior fossa tumor removal and ETV for associated hydrocephalus, where a portion of Gelfoam (used to seal the burr hole) migrated up to close the ETV, and a preterm 8-month-old boy who was treated by neuroendoscopic brain lavage and afterward by ventriculoperitoneal shunt for posthemorrhagic hydrocephalus, where all the Gelfoam used to close the corticotomy migrated into the lateral ventricle, thus reopening the corticotomy and releasing small fragments that ultimately obstructed the shunt. A new endoscopic procedure was required in both patients (the second patient also required a shunt revision). Review of the pertinent literature discloses other complications of Gelfoam migration (e.g., mass effect, granulomatous reaction) as well as other causes of uncommon ETV/shunt obstruction. Nonetheless, Gelfoam will remain an indispensable tool for neurosurgeons. The present report emphasizes the importance of its correct use to avoid complications. [ABSTRACT FROM AUTHOR]

Summary Introduction Otomycosis is a common clinical condition seen in outpatient department of otorhinolaryngology. The treatment of the otomycosis is also very simple. However, sometime it is difficult to treat otomycosis along with mastoid cavity, chronic suppurative otitis media, immunocompromised patient, etc. with conventional treatment, called recalcitrant otomycosis. Here, we describe a technique of treatment for recalcitrant otomycosis. Materials and methods This is a prospective observational study/clinical trial carried out on 44 patients of recalcitrant otomycosis. They are divided into two groups, each of 22. One group treated with routine clotrimazole topical eardrops whereas other group treated with povidone iodine soaked gelfoam, placed in the external auditory canal. Results There was no significance difference according to the age ( P = 0.134), gender ( P = 0.760) and causative agents ( P = 0.750) between treatment groups. The resolution of the symptoms showed statistically significant on itching ( P = 0.0001), otorrhoea ( P = 0.0033), fullness ( P = 0.0432) and earache ( P = 0.0259), whereas no statistical significant on hearing loss ( P = 0.0683), when treating with povidone iodine soaked gelfoam as compared to routine (clotrimazole) treatment. Resolution of signs like canal wall erythema ( P = 0.0045), tragal tenderness ( P = 0.0012) and congestion of tympanic membrane ( P = 0.0088) is statistically significant when comparing clotrimazole with povidone iodine. Apart from these, we did not reveal any adverse effects from the study populations treated with povidone iodine soaked gelfoam. Conclusion Use of the povidone iodine soaked gelfoam at the external auditory canal in recalcitrant otomycosis is an effective and well-tolerated treatment. [ABSTRACT FROM AUTHOR]

Introduction: Post-operative peridural adhesions increase morbidity after neurosurgical procedures. Aim of this study is to assess safety and efficacy of Chitosan-Dextran (CD) gel as an anti–adhesion agent in a spinal laminectomy sheep model. Methods: Eighteen sheep were used in this study with 6 animals in each treatment arm (namely, CD gel, Gelfoam paste and normal saline control). Posterior lumbar laminectomy was performed in all animals and the dura was exposed intact. Test agents were applied over the exposed dura and the wound was closed in layers. Sheep were euthanized at the end of three months. MRI spine was performed after euthanasia to assess epidural fibrosis. Adhesion in the spinal specimen was assessed by Peel test and histopathology was used to assess safety of the agents. Results: Average scores for the Peel test for CD gel, Gelfoam and normal saline control groups were 1.16 (95% CI, 0.5–1.7), 1.5 (95% CI, 0.6–2.3) and 3 (95% CI, 2.1–3.8) respectively. There was significant reduction in adhesions between treatment and normal saline treated groups ( p = 0.0292), with no difference between Gelfoam and CD gel groups ( p = 0.56). Average scores on MRI for CD gel, Gelfoam and normal saline groups were 1.4 (95% CI, 0.9–1.8), 1.5 (95% CI, 1.2–1.8) and 1.6 (95% CI, 1.3–1.8) respectively, with no significant difference in fibrosis amongst ( p = 0.2992). Histopathology did not show any adverse effects. Conclusion: CD gel is an effective agent to reduce epidural adhesions with a good safety profile in neural tissue. [ABSTRACT FROM AUTHOR]

Despite the optimal therapeutic protocols of cesarean scar pregnancy (CSP) has not been established, and in the majority of cases, most of women's uterus and fertility can be preserved through prompt and active treatment. But due to the rarity of CSP, little is known about the outcome of subsequent pregnancies, especially in an even rarer situation, a recurrent CSP. We report 2 cases of recurrent CSP women who want to preserve their fertility treated by repeated uterine artery embolization and provide a review of the literatures. [ABSTRACT FROM AUTHOR]

Abstract: Background: Frontal sinus (FS) perforation is a common complication in frontal craniotomy. The primary goal of treatment is to seal the FS without destroying physiological function. Objective: This article describes a new FS cavity reconstruction technique using medical aural and encephalic glue (EC glue)-soaked gelfoam. Methods: Between 2007 and 2012, 118 patients underwent FS reconstruction using EC glue-soaked gelfoam. The FS cavity was reconstructed in all patients and no patient experienced intracranial infection, frontal sinusitis, or cerebrospinal fluid (CSF) leakage. Results: Restoring physiological function is the primary goal of FS reconstruction. Difficulty often arises in sealing the sinus opening, especially when the mucosa is damaged. Mucosal border dissection and electric coagulation of the mucosal laceration can help to reconstruct the mucosal cavity. Sealing the sinus with autogenous or exogenous material, such as fascia, bone flap or gelfoam carries increased risks of intracranial infection, frontal sinusitis, and CSF leakage in the short term, and increased the occurrence of a FS mucocoele in the long term. Gelfoam saturated with EC glue obtained good results. Conclusion: We describe the application of gelfoam saturated with EC glue to treat an open FS with or without mucosal violation during frontal craniotomy. Gelfoam saturated with EC glue is a quick, effective, low-cost and reliable means of sealing the FS while preserving its physiological function. [Copyright &y& Elsevier]

Abstract: Extracellular matrix remodeling is a continuous process that is critical to maintaining tissue homeostasis, and alterations in this process have been implicated in chronic diseases such as atherosclerosis, lung fibrosis, and emphysema. Collagen and elastin are subject to ascorbate-dependent hydroxylation. While this post-translational modification in collagen is critical for function, the role of hydroxylation of elastin is not well understood. A number of studies have indicated that ascorbate leads to reduced elastin synthesis. However, these studies were limited to analysis of cells grown under traditional 2D tissue culture conditions. To investigate this process we evaluated elastin and collagen synthesis in primary rat neonatal pulmonary fibroblasts in response to ascorbate treatment in traditional 2D culture and within 3D cross-linked gelatin matrices (Gelfoam). We observed little change in elastin or collagen biosynthesis in standard 2D cultures treated with ascorbate, yet observed a dramatic increase in elastin protein and mRNA levels in response to ascorbate in 3D cell-Gelfoam constructs. These data suggest that the cell-ECM architecture dictates pulmonary cell response to ascorbate, and that approaches aimed toward stimulating ECM repair or engineering functional cell-derived matrices should consider all aspects of the cellular environment. [Copyright &y& Elsevier]

Abstract: Objectives: To retrospectively analyze the outcome of children with edge-everted tympanic membrane (TM) perforations following spontaneous healing and fibroblast growth factor-containing gelfoam patching with or without repair of the edge flaps. Methods: Medical records of children with TM perforations who underwent spontaneous healing (n =69) or received fibroblast growth factor (FGF)-containing gelfoam patching treatment (n =67) were retrieved from the Records Department of the Wenzhou Medical College-Affiliated Yiwu Hospital in China. The demographic data and outcome measures were analyzed and compared between these two groups of patients. Results: Patching with FGF-containing gelfoams significantly improved the healing rate (P <0.01) and the average perforation closure time (P <0.01), as compared with spontaneous healing. Repair of the perforation edge flaps did not significantly affect the outcome of gelfoam patching (P >0.05), despite a slightly reduced healing rate (96.4% versus 100%) and a slightly shorter closure time (10.2±2.6 d versus 10.9±3.3 d) observed as compared with no edge repair. The everted perforation edge flaps formed scabs during the process of spontaneous healing whereas they underwent retraction and eventually dissolved during the process of gelfoam patching-facilitated healing. Conclusions: As compared with spontaneous healing, FGF-containing gelfoam patching had an improved outcome in children with edge-everted traumatic eardrum perforation. Repair of everted edge flaps did not affect the healing outcome. Our results suggest that growth factor-containing gelfoam patching without eardrum flap repair would offer a feasible option to manage traumatic tympanic membrane perforations in children. [Copyright &y& Elsevier]

Introduction The use of angioembolisation in patients with lower gastrointestinal tract haemorrhage has become well established, especially in cases of diverticular bleeding, or in bleeding from arterio-venous malformations. Pseudoaneurysms are rare and the evaluation of selective gelfoam angioembolisation amongst patients with lower gastrointestinal tract bleeding secondary to this etiology has not been extensively studied. The friable nature of pseudoaneurysms may lead to a greater risk of rupture during an attempted angioembolisation procedure. Presentation of case We describe the successful treatment and outcome of a lady who initially presented with perforation of the colon at the rectosigmoid junction, for which she underwent resection and anastomosis. A few days later, she was noted to have persistent hematochezia, which was secondary to bleeding pseudoaneurysms at the rectosigmoid branches of the inferior mesenteric artery. She successfully underwent selective angioembolisation of these pseudoaneurysms with gelfoam. She did not suffer any complications from the procedure. Discussion Although there have been significant advances in the armamentarium associated with percutaneous interventional radiology procedures for hemostasis in gastrointestinal bleeding, the use of selective angioembolisation for bleeding pseudoaneurysms have not been readily adopted due to the friable nature of the wall of the pseudoaneurysm, and its risk for rupture. Our case report illustrates that angioembolisation in such cases is feasible, and should be a consideration especially when the risk of surgical intervention is high. Conclusion Selective gelfoam angioembolisation should be considered in the management of patients with bleeding from the gastrointestinal tract secondary to pseudoaneurysms. [ABSTRACT FROM AUTHOR]

Abstract: Animal models for the evaluation of therapies against human cytomegalovirus (HCMV) are limited due to the species-specific replication of CMV. Models utilizing human fetal tissues implanted into SCID mice have been used but tend to be labor intensive and require human tissues. We therefore developed a model using HCMV-infected human foreskin fibroblasts (HFF) seeded onto a biodegradable gelatin matrix (Gelfoam). Infected HFFs are then implanted subcutaneously into SCID mice. We next evaluated two antivirals in this model. Treatment from days 0 to 5 with ganciclovir (GCV) produced a marginally significant reduction in viral titer while treatment from days 0 to 14 resulted in a more significant reduction in viral titers of 1.47log10 pfu/ml (P <0.0001). Viral titers were similarly reduced in a group receiving GCV treatment from days 7 to 14 post-implantation (1.50log10 pfu/ml, P <0.0001). Cidofovir therapy from days 7 to 14 reduced viral titers by almost 2log10 pfu/ml (from 3.51±0.31log10 pfu/ml in untreated animals to 1.56±0.40log10 pfu/ml in treated animals, P <0.0001). These results indicate that the Gelfoam-HCMV SCID mouse model is suitable for the in vivo evaluation of new antivirals against HCMV and is simpler and more convenient than previous models. [Copyright &y& Elsevier]

Summary: Temporary vocal fold injection is a valuable procedure for vocal fold paralysis or paresis of uncertain permanency and as a trial augmentation to decide the value of vocal fold augmentation. A new material made from glycerin, carboxymethylcellulose, and water has recently been developed for temporary vocal fold augmentation. Eleven patients underwent vocal fold injection for the treatment of glottal incompetence with this material. The duration of effectiveness of this injection material was 2 to 3 months depending on the injection amount. This new material satisfies several requirements for an ideal temporary vocal fold injection material in terms of injectability, convenience, duration of effectiveness, and safety. The authors conclude that this new material is a good option for temporary vocal fold augmentation. [Copyright &y& Elsevier]

Summary: Objective:: To review the charts of patients treated using a gelfoam plug and to determine the efficacy of its use as a grafting material for prevention of perforation when removing retained ventilation tubes. Method:: Following removal of the retained tube, excision and debridement of the rim of the perforation, the perforation was plugged with gelfoam material. Between February 1998 and July 2002, we used this procedure in 27 patients aged 15 years and younger, on a total of 36 ears. Results:: In all 27 cases, complete healing of the perforation was attained. Conclusion:: A minimal tympanoplastic procedure using gelfoam graft concomitantly with tube removal is effective in prevention of perforation resulting from delayed spontaneous extrusion. [Copyright &y& Elsevier]

We report a patient with cauda equina syndrome secondary to retained Surgicel (Ethicon: Johnson & Johnson Medical, Piscataway, NJ, USA) and Gelfoam (Pfizer, New York, NY, USA). Retained hemostatic agents such as these used in spinal surgery can create space occupying lesions that lead to neurological compromise. There are few reports of neurologic symptoms caused by hemostatic devices used in surgery despite their widespread use. Our patient had routine lumbar microdiscectomy with preexisting motor deficits, and the acute postoperative course was complicated by a decline in neurologic function. The findings at the time of reoperation confirmed compression due to Gelfoam and Surgicel in the spinal canal, and subjective and objective symptoms partially improved after reoperation. [ABSTRACT FROM AUTHOR]

Abstract: Intracranial foreign body granulomas are exceedingly rare. We present the case of an intracranial foreign body granuloma found in a 72-year-old male 10 years after he underwent a successful catheter embolisation of a cerebral arteriovenous malformation (AVM). The patient presented to our unit after a fall. He had symptoms of confusion, change in mental status and expressive dysphasia. On initial inquiry, the patient had no past medical history of note. Plain brain CT showed a space-occupying lesion in the left frontal lobe with calcifications suggesting an oligodendroglioma. MRI of the brain revealed a heterogeneously enhancing lesion with cystic-solid areas. The patient underwent a craniotomy and excision of the tumour. A pathological examination of the specimen confirmed that it was a foreign body granuloma. Upon further probing into the patient’s past medical history, his family recalled prior treatment many years ago at another institution. The old records revealed that the patient had undergone catheter embolisation of a frontal lobe AVM 10 years previously. A MEDLINE literature search (1980–2005) revealed a handful of case reports describing intracranial foreign body granulomas secondary to previous intracranial procedures. Although rare, foreign body granulomas should be included in the differential diagnosis of patients who have undergone prior neurosurgical procedures and then present with a space-occupying lesion on imaging. [Copyright &y& Elsevier]

Abstract: Background context: The use of topical hemostatic agents is widespread and has been shown to reduce bleeding during a wide variety of surgical procedures. Nonetheless, as biologically active agents, there is potential for allergic reactions to these products. Purpose: This is a report of intraoperative anaphylaxis to gelatin associated with the use of two topical hemostatic agents. Study design: Case report. There is no outside funding or potential conflict of interest. Patient sample: A patient with anaphylaxis during anterior spinal fusion. Outcome measures: Laboratory assays for tryptase, gelatin-specific immunoglobulin E (IgE), and total IgE. Methods: A 14-year-old male with myelomeningocele and scoliosis was treated with anterior spinal fusion from T12 to L3. Gelfoam sponges were applied during the preparation of the disc spaces. Approximately 1 hour later, Floseal hemostatic matrix was applied to a briskly bleeding screw hole in the L3 vertebral body, and the patient experienced an abrupt onset of hypotension and ventilatory difficulty. Epinephrine, dexamethasone, and blood products were administered for hemodynamic support while the surgical site was closed. Removal of the drapes revealed a widespread erythematous rash, and the patient was then transferred to the intensive care unit. When stable 3 days later, he returned to the operating room for completion of the spinal fusion. Results: Postoperative laboratory assays were sent that revealed elevated levels of tryptase, total IgE, porcine, and bovine gelatin–specific IgE. The patient was counseled to avoid gelatin-containing products. At 6-month follow-up, his instrumented spine was radiographically fused and he reported no further allergic issues. Conclusions: Anaphylaxis may occur because of animal gelatin components of topical hemostatic agents. Previous reports have focused on the thrombin components. Care should be taken in the administration of these products, particularly in the atopic individual. [Copyright &y& Elsevier]

We report a case of a woman in whom uterine arterial embolization was performed using absorbable gelfoam particles for control of refractory postpartum hemorrhage. Ten days after delivery, the woman experienced high fever and low abdominal pain. Histologic findings after hysterectomy were consistent with uterine necrosis and acute suppurative myometritis. [Copyright &y& Elsevier]