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Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgery. Although the sponge is generally well tolerated, fibrosis occasionally forms in the mesotympanum; some studies indicated that the absorbable gelatin sponge may be responsible. Many of these studies lack statistical analysis. We prospectively studied three absorbable hemostatic agents in the middle ear of adult male Sprague-Dawley rats to determine which promotes fibrosis to the greatest degree: absorbable gelatin sponge (Gelfoam), absorbable gelatin sheet (Gelfilm), or absorbable collagen sheet (Instat). The materials were implanted in the middle ear through a post-auricular approach and the temporal bones were serially harvested at different time intervals so we could examine histologic changes. The nonimplanted ear served as surgical control. Examination of the specimens at 6, 8, and 10 weeks by light microscopy revealed that although absorbable gelatin film and collagen-absorbable hemostat are well tolerated in this animal model, absorbable gelatin sponge promoted the presence of fibrosis to a significantly greater degree, (p = 0.0344). We conclude that absorbable gelatin sponge promotes fibrosis more frequently than do collagen-absorbable hemostat and absorbable gelatin film in this animal model.

A case of a giant pyogenic granuloma of the inferior turbinate secondary to nasal packing is presented and its removal via an endoscopic approach is detailed. The sinus endoscope provides excellent visualization and operative control during excision, obviating the need for a lateral rhinotomy. Pyogenic granulomas of the posterior nasal cavity are rare, and should be considered when a nasal mass is detected after packing for epistaxis.

Background and Objective: This study was designed (1) to determine the overall success of patients who underwent external dacryocystorhinostomy (DCR) using a modified Kasper technique without lacrimal sac and nasal mucosal sutured flaps, and (2) to investigate the possible impact of intraoperative petroleum jelly gauze nasal packing as compared with gelatin sponge nasal packing on the surgical results., Patients and Methods: A retrospective review of 122 consecutive patients who underwent external DCR using a modified Kasper technique was performed. Patients were divided into two groups based on use of petroleum jelly gauze packing or gelatin sponge packing. Criteria for successful surgery included resolution of the main symptom(s) of tearing, chronic mucous discharge (chronic dacryocystitis), and/or recurrent acute dacryocystitis; and patency of the reconstructed lacrimal system., Results: Ninety-four of 96 patients who had petroleum jelly gauze packing had successful DCRs, whereas only 21 of 26 patients who had gelatin sponge packing had successful DCRs (P < .005). Soft tissue rather than bony obstruction of the rhinostomy was the most common cause of DCR failure, as confirmed by office probing, endoscopy, and computed tomography. Three patients in the gelatin sponge packing group who experienced failure subsequently had bacterial sinusitis., Conclusion: This study strongly suggests that gelatin sponge nasal packing, at least when used for patients who undergo DCR without sutured mucosal flaps, may be associated with an increased number of failures as a result of scar tissue formation at the rhinostomy site, as compared with petroleum jelly packing. Petroleum jelly gauze nasal packing may enhance surgical results by reducing scarring between the lacrimal sac fistula and the nasal structures.

Study Design: Case report., Objective: To acknowledge a potential serious complication of Gelfoam use in enclosed space., Summary of Background Data: The gelatin sponge has been used for hemostasis in spine surgery. Its complication rate is very low, but it has the potential for compression of vital tissues when left next to the spinal cord within an enclosed space., Method: Case report., Results: Retained Gelfoam sponges were found in an enclosed space next to the spinal cord. These expanded and compromised the spinal cord., Conclusion: There is potential for expansion of the Gelfoam sponge in enclosed spaces after spinal surgery. There is the possibility of neurologic compromise in these cases. Gelfoam should be removed.

Purpose: To discuss the mechanism of multiple intrahepatic aneurysm formation after transcatheter arterial embolization (TAE) performed in five patients with hepatocellular carcinoma., Materials and Methods: TAE was performed with gelatin sponge particles and iodized oil as embolic materials. Mitomycin C was also used in four cases., Results: Three to 14 aneurysms 1-6 mm in diameter were found in third-to sixth-order branches of the hepatic arteries at repeat angiography performed 25-45 days after TAE. Follow-up angiograms in three cases revealed that most aneurysms were no longer apparent except in one patient in whom two aneurysms remained and were larger than before. In none of the five cases were any signs of aneurysm rupture noted., Conclusion: Radiologists should be aware of this complication of TAE. It is speculated that the main cause of aneurysm formation in these patients was the embolic agents used.

Members of the American Otological Society and the American Neurotology Society were polled regarding stapes surgery and reparative granuloma. Of 467 questionnaires, 176 (38%) were returned, and 319,410 stapes cases were statistically analyzed: 329 reparative granulomas were reported after stapedectomy (incidence = 0.1%) and 29 after stapedotomy (incidence = 0.07%); 77 surgeons reported having encountered at least one reparative granuloma; and 50 surgeons related the occurrence of a reparative granuloma to a specific graft material. Gelfoam was the most common graft material reported when a reparative granuloma was encountered, followed by fat, and vertigo was the most frequently reported presenting symptom. Reported operative techniques as well as manifestations, management, and outcome are discussed.

Eighty patients with inoperable hepatocellular carcinoma (HCC) were treated by transcatheter arterial chemoembolization using an emulsion of Lipiodol and Cisplatin. In 59 patients, gelfoam embolization was also given. The tumour size ranged from 0.5 cm to 33 cm in maximum diameter with the median diameter being 8 cm. The chemoembolization sessions were repeated every 1 1/2 to 3 months. The number of sessions the patients underwent varied from 1 to 11, with the mean number of sessions being 3.7. The HCC either disappeared completely or decreased in size in 44 patients (55%). In patients having an HCC of 12 cm or less in size, 31 out of 41 (75.6%) who had the addition of gelfoam demonstrated decrease in tumour size, while seven out of 11 (63.6%) without the addition of gelfoam demonstrated decrease in tumour size. In patients having an HCC of more than 12 cm in size, only six out of 18 (33.3%) who had the addition of gelfoam demonstrated reduction in tumour size and none of the 10 patients without the addition of gelfoam responded. Thus, HCCs of 12 cm or less in size responded better than larger ones to chemoembolization (P < 0.0001) while the addition of gelfoam enhanced the response (P = 0.039). The 1 year survival rate for the 80 patients was 53% and the 2 years survival rate was 38%. The median survival was 13 months. For patients having an HCC of 12 cm or less in size, the 1 year and 2 year survival rates were 69% and 47% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Gelfoam has routinely been used, according to Larroca and Macnab, to prevent scar formation about the dura mater and the nerve roots after laminectomy. We report a case in which postoperative monoradicular paralysis resulted from compression of the thecal cul-de-sac by a hematoma held in place by the Gelfoam. A review of the literature on prevention of adhesions after laminectomy is included.

A 38-year-old man presented with a cavernous hemangioma in the liver. Transarterial embolization (TAE) using a gelatin sponge was carried out 14 days prior to surgical resection of the tumor. Granulomatous arteritis with massive infiltration by eosinophilic leukocytes and histiocytes was present at the periphery of the hemangioma, and transient eosinophilia in the peripheral blood occurred six days after resection. Granulomatous arteritis was evident in medium-sized arteries and there was narrowing or occlusion of the vascular lumen. In the granulomatous cellular infiltrates in the arteries, giant cells of the foreign body type were numerous. An eosinophilic substance differing from fibrin was present in some of the vascular lumina. As this showed staining for collagen, it was considered likely to be fragments of the gelatin sponge. The patient had no symptoms of fever, chills or general fatigue. The clinical course and pathologic findings suggest a causative role of the gelatin sponge in this case of granulomatous arteritis. Vascular change, a rare complication of TAE therapy, may be induced by a hypersensitivity reaction against the intra-arterial gelatin sponge.

Hepatic biloma (bile cyst) developed in a patient after transcatheter oily chemoembolization (TOCE) with Lipiodol for hepatocellular carcinoma. The patient was treated conservatively and underwent the next TOCE uneventfully. An inappropriately large dose of Lipiodol, anticancer agent, and Gelfoam can induce biloma; however, it is not reasonable to abstain from TOCE for hepatocellular carcinoma in fear of biloma.

A case of myospherulosis, a condition first reported in 1969, is reported following the extraction of mandibular third molars and subsequent placement of Terra-Cortril and Gelfoam into the extraction sites. The lesions were discovered during a periodontal surgical procedure and to the best of our knowledge this is the first such report in the periodontal literature.

Microcrystalline collagen has been reported to be an effective hemostatic agent in brain, liver, kidney, etc. This experimental study in dogs and rats shows that microcrystalline collagen is a more effective hemostat in prostatic hemorrhage than is purified gelatin solution. No gross or histologic evidence of tissue damage or calcification was induced by microcrystalline collagen or purified gelatin solution. Wafers of microcrystalline collagen that are placed in rat bladders dissolve and do not induce calculogenesis.

The effects of various surgical implants, spinal cord hypothermia, and glucocorticoid administration on formation of the laminectomy membrane were evaluated in 32 preconditioned chondrodystrophoid dogs. Modified dorsal laminectomies and full-length durotomies, from T12 to L1, were performed on all dogs. Dogs were allotted to 2 groups. Group-1 dogs (n = 20) were further allocated to 4 subgroups (a, b, c, and d) consisting of 5 dogs each. Group-1a dogs received no implant, group-1b dogs had absorbable gelatin sponges implanted, group-1c dogs had absorbable gelatin films implanted, and group-1d dogs had absorbable gelatin sponges and absorbable gelatin films implanted. Daily neurologic examinations permitted correlation of neurologic dysfunction with secondary spinal cord compression in those dogs in which it developed. The influence of these implants on laminectomy membrane formation and dural healing was assessed by gross and microscopic evaluation of transverse sections of the vertebrae and spinal cord after euthanasia of one member of each subgroup at 1, 2, 4, 8, and 16 weeks after surgery. Group-2 dogs (n = 12) were further allotted to 3 subgroups (a, b, and c) consisting of 4 dogs each. One dog in each group-2 subgroup underwent the same surgical procedures described for the group-1 subgroups (ie, 4 procedures/group-2 subgroup). The additional effects of 3 conventional supportive techniques (selective regional spinal cord hypothermia, glucocorticoid administration, or spinal cord hypothermia and glucocorticoid administration) on laminectomy membrane formation and on immediate postoperative recovery were examined in groups 2a, 2b, and 2c, respectively. Neurologic examinations were performed daily until this time. All dogs in group 2 were euthanatized 1 week after surgery for gross and microscopic examination of transverse sections of the vertebrae and spinal cord. Qualitative histopathologic effects of the different implants and supportive techniques on formation of the laminectomy membrane were determined. Statistical analysis of the degrees of secondary spinal cord compression was performed in group-1 dogs by measuring and comparing ratios of the vertical to the horizontal diameters of the transverse spinal cord sections from locations within (T12 to L1) and out of (T11, T11-12, L1-2, and L2) the region of surgical intervention. The vertical/horizontal diameter ratios measured from transverse sections from T11 to L2 in size-matched, untreated control dogs formed the standards for a mean roundness index of the spinal cord in the various anatomic locations of the vertebral column.(ABSTRACT TRUNCATED AT 400 WORDS)

The commonest causes of failure with the prefabricated wire loop-gel foam pad technique are inferior displacement of the loop in the window, high membrane formation and window fibrosis. As a result of these problems some members of the Otologic Medical Group have abandoned the use of gelfoam in favor of tissue grafts. A comparison of the results with gelfoam, fat grafts, and fascia grafts in 573 primary cases is made. Tissue grafts yielded a lower incidence of postoperative vertigo, of temporary and permanent sensori-neural hearing impairment, of fistulas and of long-term hearing regression. The conclusion is that a tissue graft is preferable to gelfoam as an oval window covering in stapedectomy.

A case is recorded in which a large giant cell reaction to gel-foam is noted after its use in neurosurgery. This caused blockage to the flow of cerebrospinal fluid and also thrombosis of superficial vessels of the brain with subsequent infarction. We recognize the value of gel-foam as a haemostatic agent in neurosurgery but wish to warn against its use too close to viable cerebral tissue, as it can induce a marked giant cell granulomatous reaction.

A patient with dialysis cachexia became paraparetic within hours of therapeutic renal artery embolization. At autopsy, emboli of absorbable gelatin sponge filled spinal arteries, accompanied by spinal cord infarcts. The renal arteries of patients with end-stage renal disease are smaller than normal becaue of intimal fibrosis associated with prolonged dialysis. Embolic material can reflux more readily in these patients than in patients with renal tumors.

Following recent intra- or retroperitoneal surgery, four children in whom hemostasis was obtained by means of abundant use of surgical gelatine sponge, displayed unusual bubbly air collections in the region of the operation. Three of them had vague inflammatory symptoms and signs, while in the fourth the gas was discovered incidentally. The connection between the radiological finding and the hemostatic agent is presented. In the typical case manifesting a mild clinical course, knowledge of this association helps to guard against the diagnosis of abscess, and subsequent unnecessary reoperation can be avoided.

The effect of two absorbable haemostatic materials, oxidized cellulse gauze (Surgicel) and absorbable gelatin sponge (Sterispon) has been investigated in relation to intraperitoneal adhesion formation using the rat as experimental animal. Neither oxidized cellulose gauze nor absorbable gelatin sponge was associated with an increased incidence of adhesions. On the contrary, oxidized cellulose gauze was associated with a decreased incidence of adhesions. If haemostatic material is required in the peritoneal cavity, oxidized cellulose gauze may be preferable to absorbable gelatin sponge since it is associated with a lower incidence of adhesions.

Transcatheter embolization of the hepatic artery for hepatomas was performed with the use of Gelfoam and Lipiodol-ADM in 98 patients (Gelfoam 63 patients; Lipiodol-ADM 35 patients). The cumulative one-year survival rate was 52.9% for the Gelfoam group and 28% for the Lipiodol-ADM group. Response to hepatic embolization was most remarkable in the nodular type; CR was obtained in five patients and PR in 31 patients (response rate: CR + PR = 57.1%) in the Gelfoam group, with no CR and six PRs (response rate, 17.6%) in the Lipiodol-ADM group. Alfa-feto protein (AFP) decrease of more than 50% was observed in 78.1% of the Gelfoam group and 40% of the Lipiodol-ADM group. The side effects were transient and controlled with conservative treatment. Gelfoam seemed to be more effective in the treatment of hepatoma, but the damage to normal tissue was more severe with this embolic material.

A major potential hazard of therapeutic occlusion of arteries by selectively injected Gelfoam pledgets is inadvertent reflux of nonopaque emboli into the aorta with resultant occlusion of other vessels. A simple method of injecting Gelfoam emboli through the standard nonoccluding arterial catheters customarily used for diagnostic arteriography was experimentally tested. The method incorporated certain safety features such as introduction of one embolus at a time using tuberculin syringes, low pressure injection technique, and frequent test injections of contrast to ascertain vessel patency. The results indicate that Gelfoam emboli can be safely and reliably employed using this technique, provided the catheter tip is properly positioned and emboli are only introduced as long as contrast test injections demonstrate rapid antegrade flow and continued patency of the artery. Once stasis or occlusion of most major branches are detected, blood flow in the catheterized artery has effectively ceased and further embolization is risky.

Constriction of a peripheral nerve may precipitate a primary problem of prevent recovery from a pre-existing one. Any surgical technique to minimize subsequent constrictive scar formation would be advantageous. In this study, using rat femoral nerves, various modes of protection were evaluated. Wrapping the nerve with free fat seemed to offer the best prophylaxis.

Selective arterial embolization is a technique with wide therapeutic applicability. However, regardless of the nature of the embolic particles, reflux into the aorta with peripheral embolization is a serious potential complication. A case is described in which this complication occurred. We recommend that all such embolizations be performed with a balloon catheter occluding the target artery.

Myospherulosis is a recently discovered disease apparently caused by the placement of mineral oil- or petrolatum-based products into various tissues. Terra-Cortril (a tetracycline/steroid ointment in a petrolatum base) on Gelfoam has been placed in the sockets of surgically removed third molars in an attempt to eliminate the occurrence of dry sockets. The case report presented here documents the radiographic progress of the disease for 6 years, showing an attempt by the bone to repair itself. A surgical procedure was performed to remove the affected tissue, and photographs were taken to illustrate the clinical appearance of the disease. The specimen consisted of a black, tarlike material which was completely encased in bone. Histologic examination was consistent with a diagnosis of myospherulosis.

An episode of disseminated intravascular coagulation following therapeutic gelfoam embolization to control bleeding from esophageal varices in a patient with liver disease is presented. We have since followed 13 patients prospectively (six control and seven gelfoam/autologous clot) to determine the effect of this procedure on clotting. We were unable to show significant differences between the two groups as measured by the prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and platelet count. However, fibrin (ogen) degradation products were significantly elevated (p less than .01) in the gelfoam/autologous clot group. We suspect this occurred secondary to clot lysis at the site of embolization. No subsequent bleeding diathesis attributable to this abnormality occurred in any of the patients.

A 73-year-old man with a cholangiocarcinoma obstructing the hepatic duct is described. The patient was treated with percutaneous transhepatic catheter and bile duct endoprosthesis for internal drainage. This was complicated by an aneurysm of the liver, which was treated by embolization of the hepatic arteries with Gelfoam, causing an extensive liver necrosis which proved to be fatal.

The removal of an indwelling cochlear implant electrode followed by reinsertion of a new device has been a maneuver of uncertain consequences to the cochlea and its surviving neural population. The present study was conducted in an attempt to elucidate the factors that determine whether a reimplantation procedure will be successful. Cochlear implantation followed by explantation and subsequent reimplantation was performed in eight adult cats. Evaluation of cochlear histopathology suggested a significant increase in electrode insertion trauma when there was proliferation of granulation tissue in the round window area and scala tympani. In other cases, atraumatic reinsertion was achieved without apparent injury to the cochlea. The results of a survey of cochlear implant manufacturers and surgeons indicate that electrode replacement can usually be accomplished without adverse effects. Difficulties have been encountered, however, in removing implants with protuberant electrodes and when reimplantation was attempted on a delayed basis following explantation.

Disturbed wound healing following dentoalveolar procedures may be due to various causes. Necrotizing inflammations with epitheloid cells may easily be mistaken for specific inflammations. Atypical granulomas represent a response to foreign body material (e.g., gelatin sponges). The possibility of sensitization with Gelastypt was tested using immunologic methods.