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Introduction: The aim of this study is to examine the analgesic efficacy of varying doses of hydromorphone hydrochloride in conjunction with absorbable gelatin sponge for postoperative pain management in elderly individuals undergoing lumbar fusion surgery. Additionally, the study aims to assess the sustained release analgesic properties of this combination and to determine the optimal dosage of hydromorphone hydrochloride for effective pain relief. Methods: A total of 113 elderly patients (aged ≥ 65 years old) meeting the criteria for 1-2-level posterior lumbar fusion surgery at Ganzhou City People's Hospital between July 2022 and August 2023 were randomly assigned to four groups: group A (0.2 mg hydromorphone hydrochloride 1 ml), group B (0.3 mg hydromorphone hydrochloride 1.5 ml), group C (0.4 mg hydromorphone hydrochloride 2 ml), and group D (0.9% normal saline 2 ml) for standard anesthesia induction and maintenance. Prior to suturing the incision, gelfoam was utilized to administer epidural analgesia to each group. Following the surgical procedure, an intravenous analgesia pump was utilized for pain management. The baseline infusion rate was set at 0.5 ml/h. Patient-controlled analgesia (PCA) was administered at a dose of 2 ml, with a lockout interval of 20 min, allowing the patient to self-administer as needed. Pain relief was assessed using the visual analogue scale (VAS) prior to surgery, as well as at 1 day and 3 days post-operation. The frequency of PCA requests within the initial 48-h postoperative period, the remedial analgesia with dezocine, postoperative adverse reactions, and duration of hospitalization were documented for analysis. Results: The VAS scores of groups B and C were found to be significantly lower than those of group D 1 day after the operation. Additionally, VAS scores at 3 days post-operation, remedial rate of dezocine and PCA follow-up times at 48 h in groups A, B, and C were significantly lower compared to group D (P < 0.001). There was no statistically significant difference between group B and group C in VAS scores at 1 day and 3 days post-operation, as well as PCA follow-up times at 48 h post-operation (P < 0.001). Furthermore, the VAS scores of groups B and C were lower than those of group A at 1 day and 3 days post-operation (P < 0.05). The PCA frequency of group C was also lower than that of group A at 48 h post-operation (P < 0.05). Conclusion: The combination of hydromorphone hydrochloride and absorbable gelatin sponge epidural analgesia has been shown to enhance postoperative pain management. A dosage of 0.4 mg of hydromorphone hydrochloride may be considered an appropriate analgesic dose, as it can provide effective pain relief without eliciting adverse reactions. Trial Registration: ChiCTR.org.cn(ChiCTR2200064863). Registered on October 20, 2022. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal fixation surgeries play a pivotal role in addressing pain which can be nociceptive, neuropathic, mixed, and nociplastic; however, these surgeries can also cause significant postoperative pain and discomfort, leading to prolonged hospital stays and delayed return to normal activity. Aims and Objectives: The aim of the study was to provide effective postoperative analgesia and to compare the analgesic efficacy by application of Gelfoam-soaked morphine sulfate placed in the epidural space and direct instillation of morphine sulfate in the epidural space in patients undergoing lumbar spinal fixation surgery under general anesthesia. Materials and Methods: A total of 60 patients planned for Lumbar spinal fixation surgeries were selected and sorted into two groups of 30 each after a computer-based randomization. In Group G, a 5 cm × 1 cm piece of absorbable gelatin sponge soaked in 5 mg of morphine sulfate diluted in 0.9% normal saline up to 5 mL was placed in the epidural space. In Group I, 5 mg of morphine sulfate diluted in 0.9% normal saline 5 mL was instilled over the intact epidural space. Pulse rate, mean arterial pressure (MAP), respiratory rate (RR), and peripheral oxygen saturation (SpO2) were observed hourly for the first 6 h, then at 2 hourly intervals till 12 h, and at 4 hourly intervals till 48 h. Postoperatively, pain intensity is assessed by the Visual Analog Scale (VAS) for 24 h, and the time of the first analgesic dose is noted. VAS ranges from 0 (no pain) to 10 (severe pain). Preoperative instructions were given to the patients about the use of VAS. Results: In this study, Group G demonstrated lower postoperative VAS scores and delayed need for rescue analgesia compared to Group I (P < 0.05, P < 0.0001, respectively). Group I had a higher total analgesic requirement (P < 0.0001) and consistently higher heart rates (P < 0.0001) compared to Group G. MAPs were lower in Group G compared to Group I (P < 0.0001). RRs, SpO2, sedation scores, and incidence of nausea and pruritus were similar between the two groups (P > 0.05). Conclusion: Epidural administration of morphine using Gelfoam as a vehicle for sustained release of morphine is a safe and effective method of postoperative analgesia in lumbar spinal fixation surgeries and results in better hemodynamics, prolonged duration of analgesia, and reduced requirement of rescue analgesics, compared to epidural instillation of morphine.

Abstract Introduction The aim of this study is to examine the analgesic efficacy of varying doses of hydromorphone hydrochloride in conjunction with absorbable gelatin sponge for postoperative pain management in elderly individuals undergoing lumbar fusion surgery. Additionally, the study aims to assess the sustained release analgesic properties of this combination and to determine the optimal dosage of hydromorphone hydrochloride for effective pain relief. Methods A total of 113 elderly patients (aged ≥ 65 years old) meeting the criteria for 1-2-level posterior lumbar fusion surgery at Ganzhou City People’s Hospital between July 2022 and August 2023 were randomly assigned to four groups: group A (0.2 mg hydromorphone hydrochloride 1 ml), group B (0.3 mg hydromorphone hydrochloride 1.5 ml), group C (0.4 mg hydromorphone hydrochloride 2 ml), and group D (0.9% normal saline 2 ml) for standard anesthesia induction and maintenance. Prior to suturing the incision, gelfoam was utilized to administer epidural analgesia to each group. Following the surgical procedure, an intravenous analgesia pump was utilized for pain management. The baseline infusion rate was set at 0.5 ml/h. Patient-controlled analgesia (PCA) was administered at a dose of 2 ml, with a lockout interval of 20 min, allowing the patient to self-administer as needed. Pain relief was assessed using the visual analogue scale (VAS) prior to surgery, as well as at 1 day and 3 days post-operation. The frequency of PCA requests within the initial 48-h postoperative period, the remedial analgesia with dezocine, postoperative adverse reactions, and duration of hospitalization were documented for analysis. Results The VAS scores of groups B and C were found to be significantly lower than those of group D 1 day after the operation. Additionally, VAS scores at 3 days post-operation, remedial rate of dezocine and PCA follow-up times at 48 h in groups A, B, and C were significantly lower compared to group D (P

Epistaxis, defined as bleeding from the nose, is one of the common ENT cases coming to emergency department. Epistaxis is experienced by at least 60% of the population once in their life time and about 6% of them will require medical attention. The different treatment modalities include: local pressure, application of topical vasoconstrictor substances, or nasal packing depending on personal physician preference. Tranexamic acid (TXA), a synthetic analogue of the amino acid lysine, belongs to a class of drugs known as antifibrinolytics. It acts by reversibly binding four to five lysine receptor sites on plasminogen and can be used in emergency department for reducing the bleeding time in epistaxis. To evaluate the efficacy of topical application of injection TXA compared to cases managed with anterior nasal packing for the treatment of patients with epistaxis. 100 patients presenting with epistaxis in emergency department, above the age of 18 years were randomly divided into two groups with 50 patients each. Group 1 were managed with anterior nasal packing with gel foam and Group 2 with topical application of injection TXA. Causes,duration to control epistaxis, and occurrence of rebleeding were recorded. Our study showed homogenous distribution of age and sex among the patients. Bleeding stopped within 10 min in 38 patients in group 2 compared to 17 patients in group 1. For 31 patients in group 1, bleeding stopped between 10 and 15 min compared to 12 in group 2. In group 1, 8 patients had rebleeding compared to 2 patients in group 2. Our study showed that topical application of TXA reduces the bleeding time and number of rebleeds compared to anterior nasal packing with gelfoam. Since it is easily available in an emergency setup and cheaper compared to gelfoam, it can be used as an elective method in managing epistaxis in emergency department. [ABSTRACT FROM AUTHOR]

Background: Sudden sensorineural hearing loss (SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy (IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy (SST). Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors. Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group (n = 25) or the treatment group (n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST. Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies (250-8000 Hz) compared with the control group (P 0.05). Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

Abstract Background To assess the feasibility and safety of a gelfoam torpedo plugging technique for embolization of the transsplenic access channel in adult patients following transvenous portal vein interventions. Materials and methods Between 09/2016 and 08/2021, an ultrasound guided transsplenic portalvenous access (TSPVA) was established in twenty-four adult patients with a 21-G needle and 4-F microsheath under ultrasound guidance. Afterwards, sheaths ranging from 4-F to 8-F were inserted as needed for the procedure. Following portal vein intervention, the splenic access tract was embolized with a gelfoam-based tract plugging (GFTP) technique. TSPVA and GFTP were performed twice in two patients. Patients’ pre-interventional and procedural characteristics were analyzed to assess the feasibility and safety of the plugging technique according Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. Values are given as median (minimum;maximum). Subgroup analysis of intercostal vs. subcostal puncture site for TSPVA was performed using the two-sided Mann–Whitney-U test or Student’s t-test and Fisher’s exact test. Level of significance was p

Purpose: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the surgical outcomes of type-1 tympanoplasty with and without gelfoam middle ear packing. Methods: PubMed, CENTRAL, Scopus, Web of Science, and Google Scholar databases were screened from inception until October 2022. The included RCTs were evaluated for risk of bias, and the quality of each outcome was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Nine RCTs with 773 participants (gelfoam = 381 and non-gelfoam = 392) were analyzed. The overall study quality varied: low risk (n = 4 RCTs), some concerns (n = 3 RCTs), and high risk (n = 2 RCTs). There were no significant differences between both arms regarding the graft uptake rate (moderate certainty), hearing improvement rate (moderate certainty), type of impedance audiometry (moderate certainty), and ear discharge (low certainty). The mean change in air–bone gap was significantly higher in the non-gelfoam arm compared with the gelfoam arm (low certainty). However, the non-gelfoam group had superior hearing improvement in only the early postoperative period (i.e., one month); however, after two, three, and six months, there were no significant differences between both arms. The rate of ear fullness was significantly higher in the gelfoam arm compared with the non-gelfoam arm (moderate certainty). Conclusion: Among patients undergoing type-1 tympanoplasty, the surgical outcomes did not significantly differ between both arms. The practice of middle ear packing with gelfoam needs to be standardized. [ABSTRACT FROM AUTHOR]

Background: To assess the feasibility and safety of a gelfoam torpedo plugging technique for embolization of the transsplenic access channel in adult patients following transvenous portal vein interventions. Materials and methods: Between 09/2016 and 08/2021, an ultrasound guided transsplenic portalvenous access (TSPVA) was established in twenty-four adult patients with a 21-G needle and 4-F microsheath under ultrasound guidance. Afterwards, sheaths ranging from 4-F to 8-F were inserted as needed for the procedure. Following portal vein intervention, the splenic access tract was embolized with a gelfoam-based tract plugging (GFTP) technique. TSPVA and GFTP were performed twice in two patients. Patients' pre-interventional and procedural characteristics were analyzed to assess the feasibility and safety of the plugging technique according Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. Values are given as median (minimum;maximum). Subgroup analysis of intercostal vs. subcostal puncture site for TSPVA was performed using the two-sided Mann–Whitney-U test or Student's t-test and Fisher's exact test. Level of significance was p < 0.05. Results: The study population's age was 56 (29;71) years and 54% were female patients. Primary liver disease was predominantly liver cirrhosis with 62% of the patients. Pre-interventional model for end-stage liver disease score was 9 (6;25), international normalized ratio was 1.15 (0.86;1.51), activated partial thromboplastin time was 33s (26s;52s) and platelet count was 88.000/µL (31.000;273.000/µL). Ascites was present in 76% of the cases. Craniocaudal spleen diameter was 17cm (10cm;25cm). Indication for TSPVA was assisted transjugular intrahepatic portosystemic shunt placement in 16 cases and revision in two cases, portal vein stent placement in five cases and variceal embolization in three cases. TSPVA was successfully established in all interventions; interventional success rate was 85% (22/26). The splenic access time was 33min (10min;133min) and the total procedure time was 208min (110min;429min). Splenic access was performed with a subcostal route in 11 interventions and with an intercostal route in 15 interventions. Final sheath size was 4-F in 17 cases, 5-F in three cases, 6-F in five cases, 7-F in two cases and 8-F in one case. A median of two gelfoam cubes was used for GFTP. TSPVA- and GFTP-related complications occurred in 4 of 26 interventions (15%) with a subcapsular hematoma of the spleen in two patients (CIRSE grade 1), access-related infection in one patient (CIRSE grade 3) and both in one patient (CIRSE grade 3). In detail, one access-related complication occurred in a patient with subcostal TSPVA (CIRSE grade 1 complication) and the other three complications occurred in patients with intercostal TSPVA (one CIRSE grade 1 complication and two CIRSE grade 3 complication) (p = 0.614). No patient required interventional or surgical treatment due to puncture tract bleeding. Conclusion: Gelfoam-based plugging of the puncture tract was feasible and safe for transsplenic access in adult patients undergoing percutaneous portal vein interventions. The lack of major bleeding complications and complete absorption of the gelatine sponge make it a safe alternative to transjugular and transhepatic access and re-interventions via the splenic route. [ABSTRACT FROM AUTHOR]

Abstract Background CT-guided percutaneous transthoracic biopsy has become a widely accepted safe method in establishing the etiology of lung masses. Pneumothorax is the most commonly faced complication requiring further therapeutic intervention for treatment with chest tube drainage adding to the time of hospital stay. Aim of work We aim to evaluate the effect of Gelfoam mixture biopsy tract embolization as a minimal added cost in reducing the overall rate of complications, the need of chest tube placement, and hospital stay. Patient and methods A total of 138 transthoracic CT-guided lung biopsies were randomized to 70 track embolized patients and 68 control. The study protocol was approved from the National Cancer Institute ethical committee review board. Data were collected from the local PACS system and analyzed, reviewed and performed by one of three interventional radiologists. Patient records were analyzed for primary health risks, pre-procedural CT was analyzed for lesion-related risk factors, and intra-procedural CTs were analyzed for procedure-related risk factors. Outcome measures include incidence of pneumothorax, pneumothoraxes requiring chest tube insertion and hospital admission rates. Results Marked pneumothorax requiring chest tube insertion and hospital admission were significantly reduced in the embolized group as 7.1% compared to 19% in the non-embolized group with significant p value of 0.037. Hospital admissions reduced from 19% down to 4.3% in embolized cases with a significant p value of 0.007. On univariate regression analysis, embolization reduced chest tube placement odds by 68% (OR = 0.32, 95% CI 0.109–0.97, p = 0.044). The only significant procedural-related factor was needle pleural angle > 70° where it increased the risk of pneumothorax by 2.85 times and chest tube placement by 3.10 times. Gelfoam embolization significantly reduces the odds of post-procedural hospital admission by 81% (OR = 0.189, 95% CI 0.051–0.699, p = 0.012). In multivariate regression analysis, Gelfoam was significantly protective against chest tube insertion and prolonged hospital stay, by reducing the odds 74.3% (OR = 0.257, 95% CI 0.082–0.808, p = 0.020) and 86% (OR = 0.133, 95% CI 0.027–0.662, p = 0.014), respectively. Needle pleural angle more than 70° increased odds of chest tube insertion by 252%. Lesions that were in very low position related to the diaphragm and just behind ribs were less prone to chest tube insertion by 83% (OR = 0.164, 95% CI 0.035–0.779, p = 0.02), while those showing mediastinal invasion and central lung lesions had increased odds by 6.812 times (95% CI 1.452–31.958, p = 0.015) for longer hospital stays. Conclusions Gelfoam embolization post-CT-guided lung biopsy has proven to statistically reduce large pneumothoraces requiring chest tube insertion, longer hospital stay, and reduced unnecessary expenses.

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.

Objective To study the incidence, risk factors, surgical outcomes of accidental durotomies (ADT) in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperative patient mobilization protocol. Methods A total of 550 patients who underwent MLDS from January 2012 to march 2020 under single surgeon and single institute were included in the study and incidence of ADT risk factors like age, BMI, smoking status, diabetes mellitus, surgeon’s experience were studied for the same and early mobilization protocol for all the patients was followed. Results Age >60 years (p=0.0062), bilateral decompression with unilateral approach, surgeons experience in the first 3 years over next 5 years (p=0.037) were the statistically significant risk factors for increased incidence of ADT. Most of the ADT were small which did not require primary repair and managed with sealants like gelfoam and fibrin glue. Postoperative recovery in JOA and ODI scores in both ADT and non ADT cohorts were same. Conclusion MISS has low incidence of ADT and age >60 years and surgical technique of bilateral decompression with unilateral approach and surgeons expertise are the significant risk factors. MISS also has less risk of CSF leak symptoms and pseudomeningocele formation because of limited dead space formation in the soft tissue which helps in early postoperative mobilization and reduces the duration of hospital stay.

Abstract Background Embolisation of the parenchymal tract is a key step after any other transhepatic or transplenic percutaneous portal vein catheterization since eventual venous bleeding is difficult to control and may require surgical management. Different techniques have been proposed to perform tract embolisation. The aim of this study is to compare the safety and efficacy of different techniques of haemostasis of the parenchymal tract. Materials and methods All the interventional procedures with percutaneous transhepatic or transplenic access to the portal vein (excluding ipsilateral portal vein embolisation) from January 2010 to July 2020, in two tertiary hospitals, were retrospectively analyzed. The following data were evaluated: access site, the technique of embolisation, technical success in terms of immediate thrombosis of the tract, safety and clinical efficacy in terms of the absence of hemorrhagic and thrombotic complications. Results One-hundred-sixty-one patients underwent 220 percutaneous transhepatic or transplenic portal vein catheterization procedures. The main indications were pancreatic islet transplantation, portal anastomotic stenosis after liver transplantation, and portal vein thrombosis recanalization. As embolic materials gelfoam was used in 105 cases, metallic micro-coils in 54 cases, and cyanoacrylic glue in 44 cases; in 17 cases the parenchymal tract was not embolized. Technical success was 98% without significant difference among groups (p-value = 0.22). Eighteen post-procedural abdominal bleedings occurred, all grade 3 and were managed conservatively; difference among groups was not significant (p-value = 0.25). We detected 12 intrahepatic portal branch thromboses not related to the embolisation technique; only one case of non-target embolisation was documented after liver tract embolisation with glue, without clinical consequences. Conclusion Embolisation of the parenchymal tract after percutaneous portal vein catheterization is technically safe and effective. No significant differences were found between coils, glue, and gelfoam in effectiveness and complications rate. Level of evidence Level 3, Cohort study.

Study Design Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively. Purpose To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery. Overview of Literature EF is a possible sequelae of lumbar disc surgery. Different treatments and surgical strategies have been attempted to prevent postoperative fibrosis without providing consistent long-term results. Methods The study was conducted on 100 adult patients. The patients were randomly allocated into two groups of 50 patients each: group A, autologous fat group, and group B, Gelfoam group. The postoperative follow-up was conducted at intervals of 6 weeks, 3 months, 6 months, and 12 months. Both groups were evaluated clinically (Oswestry Low Back Pain Disability Questionnaire [ODI], Visual Analog Scale [VAS], Straight Leg Raising Test [SLRT]) and radiologically (using Ross grading by contrast magnetic resonance imaging [MRI]) for development of radicular pain and hence EF. Results Based on the analysis, improvement in mean values of ODI score, VAS score, and SLRT were found to be statistically significant postoperatively at intervals of 6 weeks, 3 months, 6 months, and 12 months when compared individually in both groups. However, improvement was greater in the autologous fat group than in the Gelfoam group. Based on contrast-enhanced MRI, the number of patients who developed EF was smaller in the autologous fat group than in the Gelfoam group. Conclusions In the present study, on clinical and radiological assessment, we conclude that both groups prevent radicular pain and postoperative EF individually but relatively autologous fat was found to be more effective than Gelfoam in the prevention of EF and hence radicular pain.

Background: CT-guided percutaneous transthoracic biopsy has become a widely accepted safe method in establishing the etiology of lung masses. Pneumothorax is the most commonly faced complication requiring further therapeutic intervention for treatment with chest tube drainage adding to the time of hospital stay. Aim of work: We aim to evaluate the effect of Gelfoam mixture biopsy tract embolization as a minimal added cost in reducing the overall rate of complications, the need of chest tube placement, and hospital stay. Patient and methods: A total of 138 transthoracic CT-guided lung biopsies were randomized to 70 track embolized patients and 68 control. The study protocol was approved from the National Cancer Institute ethical committee review board. Data were collected from the local PACS system and analyzed, reviewed and performed by one of three interventional radiologists. Patient records were analyzed for primary health risks, pre-procedural CT was analyzed for lesion-related risk factors, and intra-procedural CTs were analyzed for procedure-related risk factors. Outcome measures include incidence of pneumothorax, pneumothoraxes requiring chest tube insertion and hospital admission rates. Results: Marked pneumothorax requiring chest tube insertion and hospital admission were significantly reduced in the embolized group as 7.1% compared to 19% in the non-embolized group with significant p value of 0.037. Hospital admissions reduced from 19% down to 4.3% in embolized cases with a significant p value of 0.007. On univariate regression analysis, embolization reduced chest tube placement odds by 68% (OR = 0.32, 95% CI 0.109–0.97, p = 0.044). The only significant procedural-related factor was needle pleural angle > 70° where it increased the risk of pneumothorax by 2.85 times and chest tube placement by 3.10 times. Gelfoam embolization significantly reduces the odds of post-procedural hospital admission by 81% (OR = 0.189, 95% CI 0.051–0.699, p = 0.012). In multivariate regression analysis, Gelfoam was significantly protective against chest tube insertion and prolonged hospital stay, by reducing the odds 74.3% (OR = 0.257, 95% CI 0.082–0.808, p = 0.020) and 86% (OR = 0.133, 95% CI 0.027–0.662, p = 0.014), respectively. Needle pleural angle more than 70° increased odds of chest tube insertion by 252%. Lesions that were in very low position related to the diaphragm and just behind ribs were less prone to chest tube insertion by 83% (OR = 0.164, 95% CI 0.035–0.779, p = 0.02), while those showing mediastinal invasion and central lung lesions had increased odds by 6.812 times (95% CI 1.452–31.958, p = 0.015) for longer hospital stays. Conclusions: Gelfoam embolization post-CT-guided lung biopsy has proven to statistically reduce large pneumothoraces requiring chest tube insertion, longer hospital stay, and reduced unnecessary expenses. [ABSTRACT FROM AUTHOR]

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]

Gelfoam® is a temporary embolization agent often used in trauma where permanent arterial occlusion is not desired. Gelfoam occlusions have been shown to resolve by 2 weeks, but shorter intervals have not been studied. We report a case of spontaneous arterial hemorrhage due to ruptured hepatic malignancy where treatment was Gelfoam slurry occlusion of the right hepatic artery. Repeat hemorrhage resulted in repeat CT and hepatic arteriography, which showed that recanalization of the occluded artery had occurred in less than 48 hours. Gelfoam arterial occlusion in some cases may last less than 2 weeks.

Introduction: One of the most common causes of maternal death worldwide is postpartum hemorrhage (PPH). So far, no study has been performed in Iran to compare the effects of polyvinyl alcohol and foam gel embolizers on menstrual pattern after uterine artery embolization. Therefore, this study was performed with aim to evaluate the efficacy and complications of uterine artery embolization (UAE) in patients with late PPH. Methods: This quasi-experimental study was performed on 70 patients with late postpartum hemorrhage referred to the Isfahan Educational and Medical Centers, Al-Zahra and Khorshid hospitals in 2019-2020. In this study, 30 patients with foam gel embolizer and 40 patients with polyvinyl alcohol embolizer underwent uterine artery embolization. Patients were followed for 6 months; menstrual pattern and complications of UAE were compared in the two groups. Data were analyzed by SPSS statistical software (version 22) and Independent t-test, Chi-square and Fisher's exact test. P

Background : Plugged percutaneous liver biopsy, though has been in use for many years, is being used more frequently in patients in whom percutaneous liver biopsy is contraindicated due to proven or probable bleeding tendencies. We report our experience with this procedure, its indications, efficacy, and complications in Indian population over 2 years. Methods: A retrospective study of 127 consecutive patients who had undergone plug liver biopsy from April 2017 to May 2019 was done from the database maintained in our department. The indications, technical success, complications, and impact of histological diagnosis on the management of those patients were evaluated. Results: A total of 127 biopsies were performed of which 68 were males and 59 were females, aged between 7 and 73 years. No procedures were abandoned; however, 13 cases needed ultrasonography (USG) guidance because of small size of the liver or presence of right perihepatic fluid. Out of 127 biopsies, none of the samples was inadequate and yielded adequate tissue for histopathological diagnosis. Seven patients required repeat study only because underlying liver disease was suspected clinically and the previous biopsy report had turned out to be normal. Histopathological examination in our study showed autoimmune hepatitis in 61, cirrhotic changes either hepatitis B virus (HBV) or hepatitis C virus (HCV) related in 40, veno-occlusive disease in 3, cholestatic disease in 2, and Wilson's disease in 2 patients. The remaining 19 were normal. Complications occurred in 3 patients — arterioportal fistula, pneumothorax, and inadequate coiling causing mild hemoperitoneum. Conclusion: Percutaneous liver biopsy followed by plugging of the tract with coils is a safe, easy, and effective method in patients with underlying bleeding tendencies, minimal ascites, and small liver. [ABSTRACT FROM AUTHOR]

Background: Embolisation of the parenchymal tract is a key step after any other transhepatic or transplenic percutaneous portal vein catheterization since eventual venous bleeding is difficult to control and may require surgical management. Different techniques have been proposed to perform tract embolisation. The aim of this study is to compare the safety and efficacy of different techniques of haemostasis of the parenchymal tract. Materials and methods: All the interventional procedures with percutaneous transhepatic or transplenic access to the portal vein (excluding ipsilateral portal vein embolisation) from January 2010 to July 2020, in two tertiary hospitals, were retrospectively analyzed. The following data were evaluated: access site, the technique of embolisation, technical success in terms of immediate thrombosis of the tract, safety and clinical efficacy in terms of the absence of hemorrhagic and thrombotic complications. Results: One-hundred-sixty-one patients underwent 220 percutaneous transhepatic or transplenic portal vein catheterization procedures. The main indications were pancreatic islet transplantation, portal anastomotic stenosis after liver transplantation, and portal vein thrombosis recanalization. As embolic materials gelfoam was used in 105 cases, metallic micro-coils in 54 cases, and cyanoacrylic glue in 44 cases; in 17 cases the parenchymal tract was not embolized. Technical success was 98% without significant difference among groups (p-value = 0.22). Eighteen post-procedural abdominal bleedings occurred, all grade 3 and were managed conservatively; difference among groups was not significant (p-value = 0.25). We detected 12 intrahepatic portal branch thromboses not related to the embolisation technique; only one case of non-target embolisation was documented after liver tract embolisation with glue, without clinical consequences. Conclusion: Embolisation of the parenchymal tract after percutaneous portal vein catheterization is technically safe and effective. No significant differences were found between coils, glue, and gelfoam in effectiveness and complications rate. Level of evidence: Level 3, Cohort study. [ABSTRACT FROM AUTHOR]

BACKGROUND: We aimed to investigate platelet-rich fibrin's potential role as packing material in both the middle ear and external auditory canal. METHODS: Twenty-nine patients undergoing transcanal endoscopic type 1 cartilage tympanoplasty were included in this controlled prospective clinical study. Patients were randomly assigned to platelet-rich fibrin (n = 14) or absorbable gelatine (n = 15) groups. Preoperative and postoperative pure-tone audiometry results, graft healing rates, tympanometry values, and Glasgow Benefit Inventory scores were compared. RESULTS: No significant postoperative complications were observed and the graft intake rate was 100% in both groups. Mean air-bone gap gain was 9.82 ± 4 dB HL in the postoperative first month and 10.08 ± 4.91 dB HL in the sixth postoperative month in the platelet-rich fibrin group. There was no statistically significant difference between the postoperative air-bone gap gains of the groups in the first (P = .537) and sixth month (P = .723) controls. There was no statistically significant difference in compliance (P = .453) between groups. The physical benefit scores of the Glasgow Benefit Inventory were significantly higher in the platelet-rich fibrin group (P = .01). There was no difference in general and social benefit scores (P > .05). CONCLUSION: As a middle and external auditory canal packing agent, platelet-rich fibrin was as successful as absorbable gelatine in transcanal endoscopic cartilage tympanoplasty with similar functional results and graft healing rate. [ABSTRACT FROM AUTHOR]

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection. Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE). Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis. Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery. Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate. [ABSTRACT FROM AUTHOR]

Background: With the widespread adoption of computed tomography (CT) technology, the number of detected pulmonary nodules has gradually increased. CT-guided percutaneous needle biopsy has become the primary method for qualitative diagnosis of pulmonary nodules. Benefiting from its three-dimensional (3D) reconstruction capability, cone-beam CT (CBCT) technology has also been widely adopted. Nevertheless, pneumothorax remains the most common complication of these diagnostic and therapeutic procedures. This study assessed the diagnostic accuracy of conventional CT (CCT)- and CBCT-guided coaxial core needle biopsy (CCNB) and the effectiveness of gelfoam particle suspension in reducing complications through tract embolization., Methods: A retrospective analysis was conducted on 320 patients who had undergone CCNB for nodules ≤3 cm from January 2020 to June 2022 at Zhongshan People's Hospital, comprising 325 biopsies (145 CCT-guided and 180 CBCT-guided). Gelfoam tract embolization was specifically used in biopsies of patients identified with a high risk of complications. Comparative statistics involved diagnostic outcomes (sensitivity, specificity, accuracy), procedural lengths, complication occurrences, and radiation doses., Results: Diagnostically, both CCT (sensitivity 93.3%, specificity 100%, accuracy 94.1%) and CBCT (sensitivity 92.8%, specificity 100%, accuracy 93.8%) offered a similarly high performance. The CCT technique was preferable in terms of shorter median operational times (19 vs. 24 minutes; P<0.001) and greater radiation exposure (13.9 vs. 10.1 mSv; P<0.001). The complication rates of CBCT and CCT, such as those of pneumothorax (18.9% vs. 20.7%; P=0.69) and hemorrhage (23.9% vs. 18.6%; P=0.25), were comparable. Of note, the comparison of biopsies with and without gelfoam embolization revealed a marked reduction in postoperative pneumothorax incidence (1.24% vs. 7.9%; P=0.004) and the requirement for drainage (0% vs. 4.27%; P=0.02), indicating the effectiveness of this procedure., Conclusions: CCT- and CBCT-guided lung biopsies demonstrate equivalent diagnostic capacities, with CCT providing shorter median operational times. Importantly, gelfoam embolization substantially diminishes the risk of postoperative pneumothorax, underscoring its value in high-risk patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-342/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Introduction: Embolisation is defined as the therapeutic introduction of Gelfoam or Poly-Vinyl Alcohol (PVA) particles into the circulation to occlude vessels. Selective embolisation of the bronchial arteries feeding the affected areas could be more effective than surgical intervention which is more hazardous leading to prolong Intensive Care Unit (ICU) stay, air leaks, stump infection. Aim: To study various indications, success rate, complications, and recurrence after Bronchial Artery Embolisation (BAE). Materials and Methods: The present longitudinal study was conducted in the Department of Pulmonary Medicine in collaboration with the Department of Interventional Radiology in Grant Medical College and JJ hospital, Mumbai, Maharashtra, India from December 2016 to December 2017. The study was done on 50 patients admitted in view of moderate to massive haemoptysis. Common indications requiring BAE, success rate with gelfoam or PVA particles, and common complications of the procedure were studied. Mean age of presentation with haemoptysis, co-morbidities associated with the disease were also studied. The patients were followed-up for six months. Repeat BAE was done in patients with PVA particles before referring for surgical intervention in cases with recurrent haemoptysis. Results: The mean age of patients requiring BAE was 37.98 years, with male predominance. Most common indication was pulmonary tuberculosis followed by post-tuberculosis sequelae. The overall success rate of the procedure was 88% at six months follow-up.BAE done with PVA (10/10) particle showed a better outcome as compared to gelfoam (34/40). The most common complication related to the procedure was puncture site pain. Three patients out of six with recurrent haemoptysis required repeat BAE within three months, out of which only one required surgery. Conclusion: The most common indication for BAE in this study was pulmonary tuberculosis. There were no major complications, even with repeat BAE. Hence, BAE should be the procedure of choice for moderate to massive haemoptysis despite of previous history of BAE, before considering for surgical intervention. BAE with PVA is associated with better success rate.

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgeries. It not only provides support to the graft and ossicular reconstruction materials but also helps in haemostasis and aeration of the middle ear. Although gelfoam is generally well tolerated but fibrosis and granulations in the mesotympanum have been attributed to its usage in some studies. This study was conducted to compare the results of middle ear surgeries with and without gel foam in terms of both objective and subjective improvements of symptoms. To study the outcome of tympanoplasty with and without gel foam in the middle war by measuring following attributes (for measuring outcomes) at an intervals of 6 weeks, 12 weeks and 6 months after surgery. (a) Graft take up rate as evaluated by otoscopy. (b) Pre and post-operative hearing levels as measured on Pure Tone Audiogram. (c) Subjective improvement in symptoms of ear discharge, heaviness in ears, hearing loss and tinnitus. Study design-prospective clinical study. patients undergoing tympanoplasty type 1 between August 2018 to July 2019 were included in the study. Group A (n = 36) consisted of patients who underwent tympanoplasty with gel foam in the middle ear and Group B (n = 36) consisted of patients who underwent tympanoplasty without any gel foam inside the middle ear. The uptake of graft after tympanoplasty was almost similar in the patients using gelfoam (89%) and those without gelfoam (84%) at the end of 6 months. The improvement in the subjective symptoms of ear discharge and hearing loss at 6 weeks following the surgery was better in patients without gelfoam whereas, at the end of 6 months the improvement in these symptoms was similar in both the groups. The improvement in hearing 6 months following tympanoplasty as assessed by pure tone audiometry and was found to be the same in both the groups. Tympanoplasty can be performed safely without using any gelfoam in the ear. This not only makes patients comfortable early but also avoids any gelfoam induced fibrosis or granulations in the middle ear. [ABSTRACT FROM AUTHOR]

Study Design: Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively. Purpose: To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery. Overview of Literature: EF is a possible sequelae of lumbar disc surgery. Different treatments and surgical strategies have been attempted to prevent postoperative fibrosis without providing consistent long-term results. Methods: The study was conducted on 100 adult patients. The patients were randomly allocated into two groups of 50 patients each: group A, autologous fat group, and group B, Gelfoam group. The postoperative follow-up was conducted at intervals of 6 weeks, 3 months, 6 months, and 12 months. Both groups were evaluated clinically (Oswestry Low Back Pain Disability Questionnaire [ODI], Visual Analog Scale [VAS], Straight Leg Raising Test [SLRT]) and radiologically (using Ross grading by contrast magnetic resonance imaging [MRI]) for development of radicular pain and hence EF. Results: Based on the analysis, improvement in mean values of ODI score, VAS score, and SLRT were found to be statistically signifi- cant postoperatively at intervals of 6 weeks, 3 months, 6 months, and 12 months when compared individually in both groups. However, improvement was greater in the autologous fat group than in the Gelfoam group. Based on contrast-enhanced MRI, the number of patients who developed EF was smaller in the autologous fat group than in the Gelfoam group. Conclusions: In the present study, on clinical and radiological assessment, we conclude that both groups prevent radicular pain and postoperative EF individually but relatively autologous fat was found to be more effective than Gelfoam in the prevention of EF and hence radicular pain. [ABSTRACT FROM AUTHOR]

Gelfoam, an absorbable gelatin material that can carry thrombin and provide a matrix for the clotting cascade, is commonly used in dermatologic surgery to obtain hemostasis. Gelfoam application is often well tolerated, with minimal surgical site reaction. Gelfoam may be an incidental histopathologic finding following cutaneous surgery, typically without any clinical sequelae. Both dermatologic surgeons and pathologists should be familiar with this histopathologic finding to eliminate confusion and to avoid additional intervention. We present a case of a 76-year-old man with an interesting histopathologic finding of basophilic material predominantly overlying and among keratinocytes in an epithelializing surgical defect that was covered with Gelfoam.

BackgroundFrontal 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.ObjectiveThis article describes a new technique to reconstruct the exposed frontal sinus cavity with the combined application of gelatin sponge and a vascularized pericranial flap.MethodsA 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.ResultsPostoperative cerebrospinal fluid leakage and infection did not occur in any patient.ConclusionOur results validated the effectiveness of our technique in the prevention of exposed frontal sinus-related postoperative complications.

Hemoptysis, the coughing out of blood, is a fear-provoking symptom with possible life-threatening implications such as hypotensive shock, asphyxia and, myocardial stunning. The severity of hemoptysis can range from streaky episodes to massive episodes (> 500 ml/day or > 150 ml/hour). The etiology of hemoptysis varies from lower respiratory causes such as tuberculosis, lung cancer, bronchiectasis, lung abscess, and pulmonary thromboembolism. The usual line of management is detailed history, imaging studies such as chest X-ray and CT thorax and excluding drugs affecting bleeding and clotting. Treating the underlying cause and including procoagulants usually helps to control moderate bleeding. Swift and effective management is important, especially in life-threatening cases as patients deteriorate fast. Bronchial artery embolization is indicated when conventional medical management fails and the patient is hemodynamically unstable to undergo emergency lobe/lung resection surgeries. We report our experience with four patients who presented to us with massive hemoptysis in whom superselective bronchial artery embolization (SBAE) was carried out successfully with gel-foam and coil. These patients were meticulously followed up for possible complications for one year.

Introduction: Current agents for the intravascular embolization of traumatic hemorrhage are used off-label and have been minimally studied with respect to their performance under differing coagulation conditions. We studied the hemorrhage control efficacy of a novel, liquid, polyethylene glycol-based hydrogel delivered as two liquid precursors that polymerize within the target vessel in a unique animal model of severe solid organ injury with and without dilutional coagulopathy. Methods: Anesthetized swine (n = 36, 45 ± 3 kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33°C-35°C (coagulopathic group). All animals had controlled 20 mL/kg hemorrhage and endovascular proximal splenic artery access with a 4F catheter via a right femoral sheath. Splenic transection and 5-minute free bleeding were followed by treatment (n = 5/group) with 5 mL of gelfoam slurry, three 6-mm coils, up to 6 mL of hydrogel, or no treatment (n = 3, control). Animals received 15 mL/kg plasma and were monitored for 6 hours with continuous blood loss measurement. Results: Coagulopathy was successfully established, with coagulopathic animals having greater pretreatment blood loss and earlier mean time to death regardless of the treatment group. All control animals died within 100 minutes. Overall survival without coagulopathy was 5/5 for hydrogel, 4/5 for coil, and 3/5 for gelfoam. With coagulopathy, one hydrogel animal survived to the end of the experiment, with 2/4 hydrogel deaths occurring in the final hour of observation. In noncoagulopathic animals, hydrogel demonstrated improved survival time (P < .01) and post-treatment blood loss (1.46 ± 0.8 mL/kg) over controls (18.8 ± 0.7, P = .001), gelfoam (4.7 ± 1.3, P > .05), and coils (4.6 ± 1.5, P > .05). In coagulopathic animals, hydrogel had improved survival time (P = .003) and decreased blood loss (4.2 ± 0.8 mL/kg) compared with control (20.4 ± 4.2, P = .003). Conclusions: The hydrogel demonstrated equivalent hemorrhage control performance to standard treatments under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent should be explored as a potential preferable treatment for the embolization of traumatic solid organ and other injuries. (JVS–Vascular Science 2021;2:43-51.) Clinical Relevance: In a translational model of severe solid organ injury hemorrhage with and without coagulopathy, a novel hydrogel transarterial embolization agent demonstrated equivalent hemorrhage control performance to standard agents under noncoagulopathic conditions and improved performance in the face of dilutional coagulopathy. This agent represents a promising future treatment for the embolization of traumatic solid organ and other injuries.

We report a rare case of inadvertent distal small diagonal branch perforation noted postleft anterior descending coronary artery revascularization, rescued by Gelfoam closure in a 43-year diabetic male presenting with acute anterior wall ST elevated myocardial infarction. Intermittent balloon inflation for 30 min was not able to seal off the perforation; because of impending late (3–6 h) cardiac tamponade, we closed the perforation with Gelfoam embolization through Caravel microcatheter. Although rarely practiced, this armamentarium should be there in the interventional cardiology laboratory to deal with small vessel perforation (

Abstract Purpose To evaluate the feasibility, safety and long-term efficacy of super-selective trans-catheter arterial embolization for the management of intractable bladder bleeding. Materials and methods The records of 20 patients with intractable haematuria referred urgently for selective arterial embolization after failed conventional therapy, between 2013 and 2018, were retrospectively analyzed. Primary outcomes were technical (cessation of extravasation and/or stasis of flow within the target vessel) and clinical (bleeding control) success. Secondary outcomes included complication and re-intervention rates. Results Technical success was 90% (18/20 cases), as in 2 cases, embolization was not feasible. Super-selective embolization of the vesical arteries was feasible in 15/18 cases (83.3%). Selective proximal occlusion of the anterior division of the internal iliac artery was performed in two cases (11%) and embolization of the anterior division after coil blockage of the posterior division was performed in one case (5%). Bilateral and unilateral embolization was performed in 10 and 8 cases, respectively. Peri-procedural mortality rate was 5% (1/18 patients). One possible procedure-related death occurred due to myocardial infarction ten days following non-target embolization of the buttocks and the anterior abdominal wall. Mean time follow up was 35 ± 15 months. Bleeding reoccurred in three patients (16.6%), all successfully managed (one conservatively and two with further embolization). Clinical success was 85% (17/20 cases). During follow up 11 more patients died, due to underlying conditions not related to bleeding or the procedure. Conclusions Super-selective angiographic embolization is feasible, safe and effective to control refractory, life threatening bladder bleeding and should be considered as a first line treatment, as to obviate the need for emergency surgery.

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]

Background and Objectives Chronic rhinosinusitis with nasal polyps (CRSwNP) recurs frequently after endoscopic sinus surgery (ESS). The aim of study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurred polypoid changes after ESS. Subjects and Method A total of 35 patients and 57 nasal cavities was retrospectively reviewed. All patients underwent triamcinolone-infused gelfoam packing for 1 week under nasal endoscopic guidance. Endoscopic scores were evaluated at 1 week, 1 month, and 3 months. We analyzed clinical characteristics between success and failure groups. Results Endoscopic scores were significantly improved after triamcinolone-soaked gelfoam packing, and the effects were maintained at 3-month follow-up (1.85±0.61 vs. 0.82±0.77, p

Background: An under‐recognized complication of gelatin‐based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in the literature of intraoperative anaphylaxis secondary to locally applied haemostatic agents. Methods: An electronic search was performed on databases Medline, Embase, Pubmed and ProQuest. A total of 7671 articles were reviewed from title and abstract. After exclusion criteria and duplicates removed, 19 articles with 21 cases were included for analysis. Data extracted from each of the articles included patient demographics, haemostatic agent used, surgery type, known allergies and any objective evidence of hypersensitivity post anaphylactic episode, that is tryptase levels, IgE levels, skin prick testing. Results: Fifty‐seven percent of cases involved patients <18 years of age; 57% of cases involved spinal surgery; 100% of cases displayed objective evidence of hypersensitivity (tryptase levels, bovine or porcine IgE levels, or skin prick testing). Thirty‐three percent of patients had exposure preoperatively to a known agent causing anaphylaxis or allergy which would preclude the use of a gelatin‐based haemostat. These products included vaccines, spam meats, red meat, Jell‐O and CollaPlug. Gelatin‐based haemostat agents included Floseal, Gelfoam, Surgiflo, fibrin glue, Avitene, haemofibrine sponge, topical bovine thrombin and thrombin‐soaked gelatin. Conclusion: Increased awareness of allergy to gelatin‐based haemostats for surgical and anaesthetic is imperative, with 33% of cases having a known contraindication to gelatin‐based haemostat. This review highlights important aspects in the pre‐operative patient history and post‐event patient investigation that could assist anaesthetists and surgeons in the prevention of future events. [ABSTRACT FROM AUTHOR]

Objective: A prospective randomised study was undertaken to compare the results of type 1 tympanoplasty with and without middle-ear packing with gelfoam. Method: Eighty patients undergoing type 1 tympanoplasty were randomised into two groups according to packing in the middle ear: with gelfoam and without gelfoam. The data in terms of graft uptake rate, hearing gain and subjective improvement were analysed at one and three months. Results: The graft uptake rate between both groups did not show a statistically significant difference. There was conductive hearing loss in the gelfoam group in the early post-operative period. Subjectively, patients were more comfortable with respect to heaviness and hearing gain than in the non-gelfoam group. Conclusion: Gelfoam use in middle-ear packing is not an essential step and causes more discomfort in patients during the early post-operative period. It should be a surgeon's choice to use it when and where it is necessary. [ABSTRACT FROM AUTHOR]

We report a rare case of inadvertent distal small diagonal branch perforation noted postleft anterior descending coronary artery revascularization, rescued by Gelfoam closure in a 43-year diabetic male presenting with acute anterior wall ST elevated myocardial infarction. Intermittent balloon inflation for 30 min was not able to seal off the perforation; because of impending late (3-6 h) cardiac tamponade, we closed the perforation with Gelfoam embolization through Caravel microcatheter. Although rarely practiced, this armamentarium should be there in the interventional cardiology laboratory to deal with small vessel perforation (<2 mm), for which traditionally covered stents are not available in size. [ABSTRACT FROM AUTHOR]

The phase of the cell cycle can determine whether a cancer cell can respond to a given drug. We previously reported monitoring of real-time cell cycle dynamics of cancer cells throughout a live tumor, intravitally in live mice, using a fluorescence ubiquitination-based cell-cycle indicator (FUCCI). Approximately 90% of cancer cells in the center and 80% of total cells of an established tumor are in G0/G1 phase. Longitudinal real-time imaging demonstrated that cytotoxic agents killed only proliferating cancer cells at the surface and, in contrast, had little effect on quiescent cancer cells, which are the vast majority of an established tumor. Moreover, resistant quiescent cancer cells restarted cycling after cessation of chemotherapy. These results suggested why most drugs currently in clinical use, which target cancer cells in S/G2/M, are mostly ineffective on solid tumors. In the present report, we used FUCCI imaging and Gelfoam® collagen-sponge-gel histoculture, to demonstrate in real time, that the cell-cycle phase distribution of cancer cells in Gelfoam® and in vivo tumors is highly similar, whereby only the surface cells proliferate and interior cells are quiescent in G0/G1. This is in contrast to 2D culture where most cancer cells cycle. Similarly, the cancer cells responded similarly to toxic chemotherapy in Gelfoam® culture as in vivo, and very differently than cancer cells in 2D culture which were much more chemosensitive. Gelfoam® culture of FUCCI-expressing cancer cells offers the opportunity to image the cell cycle of cancer cells continuously and to screen for novel effective therapies to target quiescent cells, which are the majority in a tumor and which would have a strong probability to be effective in vivo.

Purpose: To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA). Materials and Methods: In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. Results: This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02). Conclusion: Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique. [ABSTRACT FROM AUTHOR]

Gelfoam, an absorbable gelatin material that can carry thrombin and provide a matrix for the clotting cascade, is commonly used in dermatologic surgery to obtain hemostasis. Gelfoam application is often well tolerated, with minimal surgical site reaction. Gelfoam may be an incidental histopathologic finding following cutaneous surgery, typically without any clinical sequelae. Both dermatologic surgeons and pathologists should be familiar with this histopathologic finding to eliminate confusion and to avoid additional intervention. We present a case of a 76-year-old man with an interesting histopathologic finding of basophilic material predominantly overlying and among keratinocytes in an epithelializing surgical defect that was covered with Gelfoam. [ABSTRACT FROM AUTHOR]

We previously described a color-coded imaging model that can quantify the length of nascent blood vessels using Gelfoam® implanted in nestin-driven green fluorescent protein (ND-GFP) nude mice. In ND-GFP mice, nascent blood vessels are labeled with GFP. We report here that osteosarcoma cells promote angiogenesis in the Gelfoam® angiogenesis assay in ND-GFP mice. Gelfoam® was initially transplanted subcutaneously in the flank of transgenic ND-GFP nude mice. Seven days after transplantation of Gelfoam®, skin flaps were made and human 143B osteosarcoma cells expressing green fluorescent protein (GFP) in the nucleus and red fluorescent protein (RFP) in cytoplasm were injected into the transplanted Gelfoam®. The control-group mice had only implanted Gelfoam®. Skin flaps were made at days 14, 21, and 28 after transplantation of the Gelfoam® to allow imaging of vascularization in the Gelfoam® using a variable-magnification small animal imaging system and confocal fluorescence microscopy. ND-GFP expressing nascent blood vessels penetrated and spread into the Gelfoam® in a time-dependent manner in both control and osteosarcoma-implanted mice. ND-GFP expressing blood vessels in the Gelfoam® of the osteosarcoma-implanted mice were associated with the cancer cells and larger and longer than in the Gelfoam®-only implanted mice (P

Abstract Background Myringotomy with ventilation tube (VT) insertion to treat recurrent acute otitis media and chronic secretory otitis media has become one of the most common surgical procedures performed in children. Although contemporary literature has detailed the various patient and perioperative factors that affect successful pediatric myringoplasty, there is still limited evidence surrounding the increasing number of graft material options. In particular, gelfoam patching has arisen as a simple and efficient modality for perforation closure, but has a paucity of evidence particularly in pediatric cohorts. Our study aims to evaluate the clinical and audiometric outcomes following gelfoam myringoplasty for TMP following prolonged VT insertion in an urban pediatric population. Methods A retrospective review of pediatric patients who underwent myringoplasty between 2013 and 2018 following ventilation tube insertion. Patient demographics, comorbidities, and graft material were correlated with audiometric and clinical outcomes on follow up examination. Results One hundred twenty patients underwent myringoplasty, with 61 (50.8%) males with a mean age of 8.9 years old. 101 (84.2%) of patients eventually underwent successful tympanic membrane (TM) closure, with 93 (77.5%) demonstrating closure at initial follow up. In the gelfoam cohort, 77 (90.6%) of patients demonstrated successful TM closure at initial follow up. Overall mean time to closure was 5.6 (standard error (SE) 0.9) months. A multivariate Cox proportional hazards model demonstrated none of the covariates including graft material significantly affected TM closure. Mean change in air conduction threshold were comparable between graft materials. Conclusions Pediatric myringoplasty with gelfoam graft material is a safe and viable alternative with favorable short and long term clinical and audiometric outcomes.

Introduction: This study evaluated the effect of gelfoam impregnated with botulinum toxin on the symptoms induced by allergic rhinitis. Materials and Methods: In total, 30 patients with allergic rhinitis who did not respond to common therapies were included in this clinical trial study. All patients were treated with intranasal gelfoam impregnated with botulinum toxin type a (40 unit in each side) placed in the middle meatus of each nostril. The main symptoms of allergic rhinitis were scored from zero to three by the patients. Symptoms recorded and compared before and two months after the treatment. Result: The mean age of patients was 31.03±6.9 years. The mean score for sneezing was 2.23 before the treatment which significantly decreased to 1.06 after the treatment (P Conclusion: According to the results, treatment with gelfoam impregnated with botulinum toxin is an effective and safe method in patients who have not responded to common therapies for allergic rhinitis. Accordingly, it is recommended to relieve symptoms in patients with seasonal allergic rhinitis in order to maintain the effectiveness of this treatment at least 8 weeks.

Aims : This study aims to estimate the efficacy of Ostene as bone hemostatic agent clinically and experimentally and their effect on the ease of operation in clinical dental practice. Materials and Methods: For experimental part: Fifteen males rabbits were divided into three groups according to the time interval for hemostasis measurement, five rabbits in each group. Each group subdivides into other three groups according to study material "ostene, gelfoam, control". On femoral bone, three holes were made. After bleeding started, study material was placed inside holes, then a uniform piece of cotton was applied with gentle pressure, then hemostasis measured using the gravimetric method. For the clinical part: after complete extraction, a piece of study material was implanted inside the tooth socket and covered with uniform cotton for hemostasis, then hemostasis measured using the gravimetric method. Results and Discussion: For experimental part: study result revealed that the comparison between two local hemostatic agents (ostene and gelfoam) groups for hemostatic effect show Ostene has superiority effect over gelfoam in control bleeding at all interval times. Friedman test revealed a significant difference between study materials P =0.00 (P ≤ 0.05). For the clinical part: clinical measurement, ostene showed significant over gelfoam at 1min, 30 min While there were no significances between ostene and gelfoam at 5min,10min. Regarding visual analog scales for assessing bleeding and ease of operation, ostene, when comparing it with gelfoam, appeared better than gelfoam. Conclusion: Hemostatic effect of ostene is superior to gelfoam experimentally and after tooth extraction.

OBJECTIVES: (1) To test the effect of local administration of insulin-like growth factor-1 (IGF-1) in patients with sensorineural hearing loss (SNHL). (2) To test the effect of local administration of IGF-1 in patients with ototoxicity. METHODS: Forty patients with SNHL were included in the study. Their hearing thresholds at different frequencies (0.5, 1, 2, and 4 kHz) along with the average hearing threshold were noted. The patients were then randomly allocated to 2 groups and were treated with IGF-1 via one of the following routes: (1) intratympanic injection and (2) Gelfoam. Patients were followed-up at weekly intervals for 6 weeks but follow-up PTA was done at 3 weeks, 6 weeks, and 6 months only. RESULTS: Forty patients (25 male, 15 female) participated in the study. Their age ranged from 13 to 63 years, with a mean of 31.3 years. Nineteen (47.5%) patients exhibited some degree of recovery after 6 months of follow-up, while 21 (52.5%) did not exhibit any recovery. Fourteen (35%) patients showed slight recovery (SR), 1 (4%) patient showed marked recovery, and complete recovery was observed in 4 (10%) patients. Twelve of the 20 patients who underwent treatment using Gelfoam showed improvement in hearing (measured as a reduction in hearing threshold), while only 7 of the 20 patients who underwent intratympanic injection showed such improvement. Among adverse reactions, the most common was pain (88%) which typically did not last beyond 3 days. Other adverse reactions observed were dizziness (24%) and headache (20%). One patient suffered from acute suppurative otitis media (ASOM) and had a perforation in the tympanic membrane. However, this was treated successfully with medications. [ABSTRACT FROM AUTHOR]

Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. To analyse the effect of using or not using Gelfoam® as a sealing material. A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. The patients' mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p =.049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p =.634). No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear. [ABSTRACT FROM AUTHOR]