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Purpose: To compare the effectiveness of portal vein embolization (PVE) performed using gelfoam or a gelfoam-coil combination before major hepatic resection in patients with chronic liver disease. Materials and Methods: PVE using gelfoam or a gelfoam-coil combination was performed in 37 patients. From April 2003 to September 2007, PVE was performed using gelfoam (n = 17) and a gelfoam-coil combination (n = 20) to induce hypertrophy. Computed tomography volumetry was performed 2-4 weeks after PVE to assess the changes in liver volume. Results: The mean percentage increase in future liver remnant volume was 23.7 ± 23.7% in the gelfoam group and 36.7 ± 18.5% in the gelfoam-coil group (p = 0.02). Recanalization was found in 15 gelfoam group patients and 8 gelfoam-coil group patients (p = 0.003). The mean tumor size increased from 4.5 ± 2.9 cm before PVE to 5.0 ± 3.5 cm after PVE in the gelfoam group and from 4.3 ± 2.2 cm before PVE to 4.7 ± 2.5 cm after PVE in the gelfoam-coil group (p = 0.80). Conclusion: The gelfoam-coil combination was more effective than gelfoam alone for induction of compensatory hypertrophy by PVE in patients with chronic liver disease. [ABSTRACT FROM AUTHOR]

Conclusions: No significant subepithelial healing differences were found between Gelfoam and polyurethane foam (PUF). However, levels of hyperplasia of the mucosal lining and inflammation were lower with PUF packing. PUF packing is not feasible as a middle ear packing material for abraded mucosa. Further studies are required before clinical application. Objective: To date, there have been few reports on the antiadhesive effect of PUF as a middle ear packing. The purpose of this study was to investigate the antiadhesive effect of PUF soaked with saline in an animal model of mucosal trauma. Methods: Bioresorbable PUF soaked with saline was placed over abraded mucosa in the experimental group ( n = 7), and compressed Gelfoam soaked with saline was placed in the control group ( n = 7). After measurement of auditory brainstem responses (ABRs), the animals were sacrificed 3 weeks after packing placement for histological observation. Results: The ABR results at postoperative week 3 showed no statistically significant difference between the preoperative and post-packing values. An adhesion pattern with subepithelial thickening was observed in the control group. Adhesion was not observed in the experimental group; however, subepithelial fibrous thickening was noted. [ABSTRACT FROM AUTHOR]

Although diagnosis of cholesterol granulomas of the skull base can be straightforward with computed tomography (CT) and magnetic resonance imaging (MRI) appearance, treatment is controversial with various skull base approaches described in the literature. This report describes a 35-year-oldman who presented with a symptomatic, enlarging cystic lesion in the left petrous apex and clivus that had imaging features of a cholesterol granuloma (cholesterol cyst). Due to a prior history of treatedmediastinal germ cell tumor, pathologic confirmation of the lesion was requested. A CT-guided percutaneous aspiration revealed dark used motor oil-like fluid. Continued aspiration yielded a change in the character of the fluid to marrow red. Injection of contrast revealed no communication with cerebrospinal fluid. Gelfoam (Pfizer, New York, New York, USA) was subsequently injected percutaneously into the residual cavity. Histopathology showed no evidence of malignancy and follow-up MRI at 1 month, 3 months, 6 months, and 1 year demonstrated continued decrease in size and signal of the lesion. [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]

Preoperative endovascular tumor embolization has been used for 40 years. Meningiomas are the most common benign intracranial tumor in which preoperative embolization has been most extensively described in the literature. Advocates of embolization report that it reduces operative blood-loss, and softens the tumor, thus making surgery safer and easier. Opponents suggest that it adds additional risk and cost for patients without controlled studies showing conclusive benefit. The literature suggests a 3 to 6% neurological complication rate related to embolization. The combined external and internal carotid artery blood supply and complex anastomoses of the meninges can make embolization challenging. Positive outcomes require thorough knowledge of the pertinent vascular anatomy, familiarity with the neurovascular equipment and embolics, and meticulous technique. There remains debate on several aspects of embolization, including tumors most appropriate for embolization, embolic agent of choice, ideal size of embolic, and the choice of vessel(s) to embolize. This detailed review of pertinent vascular anatomy, embolization technique, results, and complications should allow practitioners to maximize treatment outcomes in this setting. [ABSTRACT FROM AUTHOR]

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]

Background: Achieving and maintaining haemostasis is of paramount importance in neurosurgery. Chitosan has been shown in both animal and human models to be significantly effective in haemostasis as well as in reducing adhesion formation. Objectives: To evaluate the haemostatic potential and to study histopathological changes caused by novel chitosan dextran gel in a neurosurgical sheep model. Method: Ten sheep underwent neurosurgical burr hole procedure. Bleeding control was tested at the level of bone, dura and brain separately with both chitosan gel and Gelfoam paste on separate burr holes. Baseline bleeding was measured at the time of injury using the Boezaart scale, and then every 2 min after the application of each agent until complete haemostasis or 10 min, whichever was earlier. Safety was assessed through MRI scans and histopathological analysis. Results: Mixed modeling showed no statistical difference in time to haemostasis between chitosan gel and Gelfoam paste (means of log-normalized areas under the curve were 1.3688 and 1.3196 respectively) for each burr hole ( p = 0.7768). Logistic regression modeling showed that Chitosan significantly decreased the incidence of bleeding beyond the first time point measured after application of the treatment when compared to Gelfoam (OR = 2.7, p = 0.04). Average edema volume (cm) on post-operative MRI was 0.97 for Gelfoam and 1.11 for ( p = 0.49) while average histology scores were 2.5 for Gelfoam versus 3.3 for chitosan ( p = 0.32). Conclusion: Chitosan dextran gel is an effective haemostatic agent to control bleeding in brain tissue. It is safe and nontoxic to neural tissue. [ABSTRACT FROM AUTHOR]

Background: Frontal sinus exposure is a common consequence of frontal craniotomy. Cerebrospinal fluid leakage and infection are the major postoperative complications that may occur as a result of the open frontal sinus. The successful filling of the open frontal sinus provides an approach to prevent significant complications caused by frontal sinus exposure., Objective: This article describes a new technique to reconstruct the exposed frontal sinus cavity with the combined application of gelatin sponge and a vascularized pericranial flap., Methods: A total of 140 patients underwent frontal sinus reconstruction using gelfoam and vascularized pericranial flaps from 2016 to 2021. Gelatin sponge was used to fill the frontal sinus, and a vascularized pericranial flap was used to cover the frontal sinus when the bone flap was retracted., Results: Postoperative cerebrospinal fluid leakage and infection did not occur in any patient., Conclusion: Our results validated the effectiveness of our technique in the prevention of exposed frontal sinus-related postoperative complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Guo, Fu, Yin, Jiang, Kuang, Wu, Cao, Tan and Jiang.)

Percutaneous portal vein interventions require minimally invasive access to the portal venous system. Common approaches to the portal vein include transjugular hepatic vein to portal vein access and direct transhepatic portal vein access. A major concern of the transhepatic route is the risk of postprocedural bleeding, which is increased when patients are anticoagulated or receiving pharmaceutical thrombolytic therapy. Thus percutaneous portal vein access and subsequent closure are important technical parts of percutaneous portal vein procedures. At present, various techniques have been used for either portal access or subsequent transhepatic tract closure and hemostasis. Regardless of the method used, meticulous technique is required to achieve the overall safety and effectiveness of portal venous procedures. This article reviews the various techniques of percutaneous transhepatic portal vein access and the various closure and hemostatic methods used to reduce the risk of postprocedural bleeding. [ABSTRACT FROM AUTHOR]

After functional endoscopic sinus surgery (FESS), nasal packing may be necessary and a packing material which has benefits in both cost and efficacy would be required. This study aimed to determine the efficacy of Gelfoam packing on hemostasis and wound healing after FESS. Patients who underwent bilateral FESS due to chronic bilateral rhinosinusitis were enrolled. Randomly, one side was selected for Gelfoam packing and the other side for no packing. Subjective symptoms and objective findings such as synechia, granulation, pus discharge, edema, stenosis, and crust were evaluated. A total of 21 patients (17 men and 4 women; mean age 39.7 years ranging from 12 to 75 years) were included. There were no statistical significant differences between two groups regarding both subjective symptoms and objective findings during 4 months after surgery. Three patients had postoperative bleeding in the no packing side. Gelfoam packing may be recommendable in terms of efficacy and cost-benefit after FESS. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the effect of autologous bone marrow mesenchymal stem cells (MSCs) seeded into Gelfoam® on structural bone allograft healing. Thirty New Zealand white rabbits were divided into two groups. Segmental bone defect was created on diaphysis of the femur, and the defect was reconstructed with structural bone allograft. In experimental group, structural allograft was wrapped around by Gelfoam® containing autologous MSCs, whereas cells were not included in control group. At 4, 8, 12 weeks, the femur of rabbits underwent radiographic and histologic evaluation for bony union. Bone morphogenic protein-2 (BMP-2), BMP-4, BMP-7, vascular endothelial growth factor (VEGF), and receptor activator of nuclear factor-kappa B ligand (RANKL) were measured within the grafted periosteal tissue. Bony union was not achieved in both groups at 4 and 8 weeks. At 12 weeks, three out of five femurs in experimental group were united, but one out of five in control group was united. Mean Taira scores were significantly different between two groups. The expression of BMP-2 was significantly higher at 4, 8 weeks, the expressions of BMP-4 and BMP-7 were significantly higher at 8 and 12 weeks, and the expression of VEGF and RANKL were significantly higher at all time points in experimental group. Incorporation of the structural bone allograft could be enhanced if allograft is covered with Gelfoam® containing autologous MSCs. MSCs have influence on not only bone formation, but neo-angiogenesis, and bone resorption. [ABSTRACT FROM AUTHOR]

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]

Objective. To compare absorbable gelatin sponge (AGS) with an injectable esterified hyaluronic acid (EHA) as middle ear packing material after mucosal trauma.Study Design. Randomized, blinded, and controlled study.Setting. Tertiary university-based hospital.Subjects and Methods. Twenty-three guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears and one ear packed with either EHA or AGS. Contralateral ears were used as nonpacked paired controls. Auditory brainstem response (ABR) thresholds were measured preoperatively and repeated at 1, 2, and 6 weeks postoperatively. Macroscopic and microscopic analysis measured inflammatory reaction in each group.Results. ABR threshold changes from baseline in the EHA and both control groups were minor. Threshold levels were higher in the AGS group compared with the AGS control group. This trend was seen in each frequency tested at each time interval. Macroscopic analysis showed tympanic membrane perforation was rare, effusions were common in the AGS group, mucosal edema was most frequent in the AGS group, and unabsorbed packing was usually detected in the AGS group with little EHA detectable at 6 weeks. Microscopic analysis showed normal mucosal healing in all groups. Two AGS ears demonstrated excessive middle ear packing with exuberant osteoneogenesis.Conclusions. Middle ear function and mucosal healing after surgery occurred similarly between the EHA control group and the EHA group. In contrast, the AGS group demonstrated worse hearing and a greater level of osteoneogenesis compared with the AGS control group. These results support EHA as an alternative middle ear packing material in otologic surgery. [ABSTRACT FROM PUBLISHER]

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]

Liver biopsy is a common procedure, with an inherent risk of bleeding. There are different ways to help avoid hemorrhage, including biopsy through a transjugular venous route or embolization of the tract with liquid or solid materials. We describe an image-guided percutaneous core needle liver biopsy with tract embolization using thick Gelfoam slurry in a pediatric oncology patient. Imaging studies acquired after the biopsy indicated that the Gelfoam mixture had likely migrated to the gallbladder and common bile duct. We report this rare occurrence with its striking imaging in order to make those performing biopsies aware of this possibility. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the risk and clinical significance of purulent necrosis following Gelfoam™ uterine artery embolization in the minimally invasive management of uterine leiomyomata. This study compares the incidence of purulent necrosis in leiomyomata affecting women who underwent Gelfoam™ embolization with those who had embolization with traditional particles. From January 20 to May 26, 2005, 54 patients were embolized for symptomatic fibroids. Forty-three were embolized with traditional particles, 11 with Gelfoam™ alone. Of the Gelfoam™ group, four women suffered purulent necrosis of leiomyomata, whereas in the traditional particle group, only one patient experienced this complication (p = 0.005). The women in the Gelfoam™ group were generally younger than those in the particle group (p = 0.00014). The average gravida and parity of the Gelfoam™ group were less than for the particle group - (p = 0.221) and (p = 0.041), respectively. The total uterine volume was similar for both groups. Within the Gelfoam▒ group there was no significant difference in fertility, age, total uterine volume, largest fibroid size, or number of pledglets used (P>0.05) when comparing women with and without purulent necrosis. The average time from embolization to onset of symptomatic purulent necrosis was 11 days. All four patients with purulent necrosis of leiomyomata were successfully treated with myomectomy (three abdominal, one vaginal). Notwithstanding the small numbers in the series, patients embolized with Gelfoam™ appear to be at higher risk for development of post-embolization purulent necrosis of leiomyomata than patients who are embolized with traditional particles. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of patient and graft variables on the successful closure of tympanic membrane perforations treated with myringoplasty at the Children's Hospital of Pittsburgh from 2000 to 2005. Study Design: Retrospective chart review at an academic tertiary-care children's hospital. Methods: Charts were reviewed for 604 children, ages 1 to 18 years old, with complete records who underwent myringoplasty by the pediatric otolaryngology practice at Children's Hospital of Pittsburgh of UPMC from 2000 to 2005, totaling 777 procedures. Results: Significant variables include patient age, number of prior tubes, perforation etiology ( P < .000), presence of a retained tube ( P < .000) as well as tube type ( P = .016), graft material ( P = .001), and history of Down syndrome ( P = .035). Nonsignificant variables include season of procedure ( P = .599), status of adenoid tissue ( P = .910), prior otorrhea ( P = .175), as well as perforation location ( P = .318) and duration ( P = .150). Conclusions: Proper patient and graft material selection can affect the outcome of myringoplasty procedures. Practical implications from these data suggest that Gelfoam myringoplasty is more successful than either paper patch or fat graft closures, with a 90.8% success rate ( P = .001). Myringoplasty should not be deferred during the winter months as the season of procedure does appear to not affect the success of closure ( P = .60). Similarly, the presence or absence of adenoid tissue did not affect the success of closure ( P = .91). [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]

Conclusion. The changes of hearing by packing after middle ear surgery should be anticipated and carefully interpreted. Objectives. To evaluate the amount and patterns of hearing loss resulting from packing in middle ear cavity (MEC) and external auditory canal (EAC) after middle ear surgery. Method. We obtained pure tone thresholds by bone (BC) and air conduction (AC) up to 12 weeks after middle ear surgery in 17 patients who had minimal middle ear pathology. To observe the effects of packing only in the EAC as in cases of explorative tympanotomy or stapes surgery, BC and AC threshold were obtained after packing only in the EAC in 18 volunteers. The changes of BC and AC thresholds in terms of pure tone average (PTA) and high frequency PTA were analyzed. Results. PTA by AC increased significantly by a maximal value of 38.7 dB at the second postoperative day, by 35.0 dB at 1 week after middle ear surgery. PTA by BC also increased maximally at the second postoperative day by 4.8 dB. The elevation of BC threshold at high frequencies (2, 3, 4 kHz) was more pronounced. Packing of EAC without MEC packing resulted in elevation of AC threshold by 43.0 dB, with similar patterns of BC threshold changes as MEC and EAC packing. [ABSTRACT FROM AUTHOR]

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]

Objective. The purpose of this study was to compare the hemostatic efficacy of the common surgical hemostatic agents with fibrin sealant (FS) and to assess their functional strength to secure hemostasis in lieu of placing additional sutures.Methods. End-to-end anastomosis of transected abdominal aorta was performed in moderately anticoagulated rabbits using 4 or 6 interrupted sutures. The suture line was covered either with gauze alone (“untreated”) or with gauze plus Gelfoam, Avitene, Surgicel, FloSeal, or FS, following which blood flow was restored. Blood loss was absorbed by gauze and measured. The surviving rabbits were recovered and the repaired vessel was examined histologically 4 weeks after operation. The investigators were blinded to the treatment groups. Aortic anastomoses using 8 or 12 sutures (untreated) were also performed.Results. Untreated 4-suture anastomosis of aorta resulted in a profuse hemorrhage with an average 108.0 ± 19.2 (mean ± SD) ml blood loss and 100% mortality (n = 4). FS application sealed the anastomoses, prevented blood loss (P < 0.01 vs untreated) and exsanguination of the rabbits (n = 4). Other hemostatic agents reduced the bleeding to varying degrees compared to the untreated animals (Gelfoam 66.4 ± 17.6, Avitene 80.6 ± 34, Surgicel 66.7 ± 16.7, FloSeal 44.2 ± 8.5 ml blood loss, n = 4/group), but the changes were not statistically significant. One to three rabbits in each group survived the operation. Six-suture aortic anastomoses, untreated, resulted in 67.7 ± 21.8 ml blood loss and 100% survival (n = 6). Application of FS produced immediate and sustained hemostasis in all the animals (P < 0.01 vs untreated). Other hemostatic agents also reduced the bleeding (Gelfoam 42.5 ± 10, Avitene 50.9 ± 12.4, Surgicel 32.1 ± 14, FloSeal 33.9 ± 5.4 ml blood loss, n = 6/group), but the changes were not statistically significant. The 8- and 12-suture aorta repairs resulted in a moderate blood loss (43.9 ± 19 and 21.3 ± 14.9 ml, respectively), followed by a stable hemostasis that precluded the need to use any hemostatic agent. The aortic cross-clamping time of the 12-suture and time to hemostasis for both the 8- and the 12-suture techniques were significantly longer than those of the 4-suture plus FS application (P < 0.01, P < 0.01 and P < 0.05, respectively).Conclusion. In a moderate coagulopathy, FS was proven to be the most efficacious hemostatic agent, producing immediate and sustained hemostasis at the arterial anastomotic site. This high efficacy is in part attributed to the strong tissue adhesive property of this agent. FS application may potentially ease the anastomosis and shorten the duration of timely critical vascular procedures. [Copyright &y& Elsevier]

Background: Gelatin sponges, such as Gelfoam, are used as hemostatic agents during surgery and are generally absorbed over the course of 4-6 weeks in most body cavities. The time course of the dissolution of Gelfoam sponges within the cerebral ventricles has not been described., Observations: The authors present a case of intraventricular migration of Gelfoam after ventriculoperitoneal shunt placement in a 6-week-old infant. The infant was imaged regularly after ventriculoperitoneal shunt placement, and the Gelfoam sponge persisted within the ventricles on all images until 11 months after surgery. At no time during follow-up did the patient have any symptoms of hydrocephalus requiring retrieval of the sponge or shunt revision., Lessons: This is the first case describing time until absorption of a gelatin sponge within the ventricle and successful conservative management.

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]

Anaphylaxis under anesthesia is a life-threatening medical emergency that requires rapid identification and treatment. Allergies to agents with which the general population are likely to come into contact are usually identified, but patients are exposed to uncommon agents during anesthesia and surgery. Here, we describe a case of anaphylaxis under anesthesia implicating Gelfoam sponges. [ABSTRACT FROM AUTHOR]

We report two patients with bleeding stomal varices following total colectomy and ileostomy. The varices were demonstrated by superior mesenteric angiography and percutaneous transhepatic mesenteric venography; dilated ileal veins drained via the stomal varices into abdominal wall veins. Bleeding from the stomal varices was treated by transhepatic embolization. The first patient required three transhepatic embolizations after recurrent bleeding due to recanalization of the embolized ileal vein and the development of collaterals from the adjacent ileal veins over a one-year period. The second patient died of respiratory failure 1 week after embolization. Neither patient developed mesenteric or stomal ischemia. [ABSTRACT FROM AUTHOR]

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications. [ABSTRACT FROM AUTHOR]

Therapeutic splenic embolization has been commonly performed for hypersplenism, tumor palliation, and other indications, but has not been reported as a therapy specifically for pain relief. We describe 1 patient with chronic pain secondary to severe splenomegaly in whom surgery was contraindicated. Selective partial splenic embolization achieved a pain-free state for the patient without significant complications. [ABSTRACT FROM AUTHOR]

Nine high-risk patients with endoscopic evidence of bleeding from the left gastric artery territory without angiographic extravasation were embolized to prevent rebleeding. Three were embolized with Gelfoam particles, 1 with Gianturco coils, and 5 with Gelfoam plus coils. Three patients rebled; 2 were embolized with Gelfoam only, and the third with coils only. No rebleeding occurred in the 5 patients treated with Gelfoam plus coils. No ischemic complications occurred. We conclude that embolization of the left gastric artery, despite absence of extravasation, is effective in preventing rebleeding in high-risk patients and that both Gelfoam and coils be used. [ABSTRACT FROM AUTHOR]

In 121 renal tumor embolizations with four different embolic agents (Gelfoam, Ivalon, ethanol, coils) the mean complication rate was 9.9%, with a mortality of 3.3%. Because of the large embolized tumor mass and the severely impaired health of patients, the complication rate in palliative embolizations was about four times as high as in preoperative procedures. Complications most commonly encountered were renal failure and unintentional embolization of nontarget organs. [ABSTRACT FROM AUTHOR]

Transcatheter vessel occlusion (TCVO) is increasingly used for control of hemorrhage, palliative and preoperative tumor embolization, organ function ablation, and obliteration of arteriovenous fistulae and malformations. Methods for TCVO include transcatheter electrocoagulation, "staining" with contrast, the use of balloon-tipped catheters, and embolization. The choice of method and material depends on whether proximal occlusion of feeding vessels or arteriocapillary occlusion is desired, the vascular anatomy of the lesion, the safety with which the lesion can be embolized, and the type of lesion being treated. Embolization is the most frequently employed modality. Available materials include autologous tissue, absorbable hemostatics, synthetic particulates, and liquid polymers. Each material has advantages and disadvantages that make it desirable in certain situations and less useful in others. Complications of TCVO may be disastrous, but can be avoided with careful attention to detail. The specific features of the lesion determine the choice of materials and techniques. [ABSTRACT FROM AUTHOR]

Percutaneous transhepatic embolization of varices (PTEV) has proved to be effective in the control variceal bleeding, particularly in Child's Class C Category patients whose bleeding was not adequately controlled by pitressin perfusions. PTEV, using Gel-Foam soaked in sodium tetradecyl sulfate, controlled acute variceal bleeding in 71--95% of patients and appears to be more effective as an embolizing agent than bucrylate, which controlled 43--57%. Considering the poor condition of the patients particularly during acute bleeding episodes, PTEV is a relatively safe therapeutic procedure that buys time for the surgeons to perform a decompressive shunt electively as definitive surgery. A one-year recurrent bleeding rate of 30% and a two year recurrence of 37.5% was noted. Thus, for long term control of variceal bleeding, a surgical decompressive shunt is recommended in addition to PTEV. [ABSTRACT FROM AUTHOR]

Gelfoam embolization of parathyroid adenomas causes temporary remission of hypercalcemia, but collateral circulation revascularizes the gland. Embolization with silicone permanently infarcts the gland, but is associated with all the risks of capillary bed occlusion. The staining of parathyroid adenomas with contrast material avoids the risks of particulate embolization and appears to produce permanent ablation. We carried out embolization or staining procedures in 14 parathyroid adenomas. In three of the four cases in which Gelfoam embolization was performed, hypercalcemia recurred within six months to two years; in the fourth case, in which persistent normocalcemia has been found, intense staining had been demonstrated before embolization. In eight of the remaining 10 cases, adequate staining was achieved, and normocalcemia has been maintained in all up to 36 months. [ABSTRACT FROM AUTHOR]