[Clinical observation of gelfoam in preventing cement leakage via the anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty].

OBJECTIVE: To evaluate the efficacy of gelfoam granules application in prevention of cement leakage via anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty (PKP). METHODS: From June 2017 to December 2019, 13 patients with Kümmell disease were treated with PKP, and gelatin sponge was inserted into the anterior wall of vertebral body to prevent bone cement leakage. There were 3 males and 10 females, with an average age of (73.84±8.44) years. The visual analogue scale (VAS) was used to record the degree of pain before treatment and 1 day and 3 months after treatment; Oswestry Disability Index (ODI) was used to evaluate the thoracolumbar function before treatment and 3 monthsafter treatment;X-ray was used to observe the bone cement leakage after operation. RESULTS: The VAS scores were 7.31±0.83, 2.92±1.13 and 1.69±1.11 before treatment and 1 day and 3 months after treatment, respectively. The VAS scores on the 1st day and 3 months after treatment were lower than those before treatment (P<0.05), and the postoperative pain was significantly relieved. The ODI before treatment and 3 months after treatment were (71.08±9.46)%, (17.85±7.82)%, respectively. The ODI at 3 months after treatment was improved compared with that before treatment (P<0.05), and the postoperative thoracolumbar function was significantly improved compared with that before treatment. Postoperative X-ray showed no leakage of bone cement in the anterior wall of vertebral body. CONCLUSION: The application of gelfoam granules in PKP can effectively prevent the leakage of bone cement via the anterior vertebral wall of Kümmell patients, and reduce the risk of thermal and mechanical injury of soft tissues such as the aorta in front of the vertebral body, and does not affect the postoperative pain relief and the recovery of thoracolumbar function.

Comparison of three embolic materials at partial splenic artery embolization for hypersplenism: clinical, laboratory, and radiological outcomes.

PURPOSE: To compare effectiveness of three widely used embolic agents in partial splenic embolization (PSE) by analyzing their clinical, laboratory, and radiological outcomes within one year of follow-up. MATERIALS AND METHODS: This retrospective study examined 179 patients who underwent PSE to manage hypersplenism secondary to cirrhosis. Patients were divided into 3 groups according to embolic agent used. Group 1 (gelatin sponge) included 65 patients, group 2 (embospheres) included 58 patients, and group 3 (PVA) included 56 patients. Clinical, laboratory, and radiological outcomes were compared between groups. RESULTS: The technical success rate was 100% in all groups. Pain as a major complication was lower in the gelatin sponge group (20%) compared to the embosphere group (31%) and PVA group (32.3%). Major complications other than pain were found in 20.1%; 24.6% in gelatin sponge group, 15.5% in embosphere group and 19.6% in PVA group (p = 0.045). WBCs and platelet counts showed a significant increase after PSE in all groups. Entire splenic volume as measured by computed tomography after PSE showed no significant difference among the 3 groups; however, the volume of infarcted spleen was significantly lower in the gelatin sponge group compared to other two groups (p = 0.001). The splenic span was significantly reduced one-year post-procedure in three groups (p = 0.006), and it was significantly less in embosphere and PVA groups compared to gelatin sponge group (p < 0.05). Recurrent bleeding was higher in gelatin sponge group (p < 0.05). CONCLUSIONS: Permanent embolic materials achieved better laboratory and radiological outcomes than gelatin sponge particles in PSE of cirrhotic hypersplenism patients. However, permanent particles were associated with greater abdominal pain.

Clinical observation of gelfoam in preventing cement leakage via the anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty / 中国骨伤

OBJECTIVE@#To evaluate the efficacy of gelfoam granules application in prevention of cement leakage via anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty (PKP).@*METHODS@#From June 2017 to December 2019, 13 patients with Kümmell disease were treated with PKP, and gelatin sponge was inserted into the anterior wall of vertebral body to prevent bone cement leakage. There were 3 males and 10 females, with an average age of (73.84±8.44) years. The visual analogue scale (VAS) was used to record the degree of pain before treatment and 1 day and 3 months after treatment; Oswestry Disability Index (ODI) was used to evaluate the thoracolumbar function before treatment and 3 monthsafter treatment;X-ray was used to observe the bone cement leakage after operation.@*RESULTS@#The VAS scores were 7.31±0.83, 2.92±1.13 and 1.69±1.11 before treatment and 1 day and 3 months after treatment, respectively. The VAS scores on the 1st day and 3 months after treatment were lower than those before treatment (@*CONCLUSION@#The application of gelfoam granules in PKP can effectively prevent the leakage of bone cement via the anterior vertebral wall of Kümmell patients, and reduce the risk of thermal and mechanical injury of soft tissues such as the aorta in front of the vertebral body, and does not affect the postoperative pain relief and the recovery of thoracolumbar function.

[Application of absorbable hemostatic fluid gelatin in anterior cervical subtotal vertebral resection and fusion].

OBJECTIVE: To explore the hemostatic effect of absorbable hemostatic fluid gelatin in single anterior cervical subtotal corpectomy and decompression fusion (ACCF) . METHODS: From August 2014 to February 2018, 44 patients with single anterior cervical corpectomy decompression and fusion were selected and divided into two groups：22 cases in experimental group including 10 males and 12 females with an average age of (55.6±9.7) years old, were treated by hemostasis with absorbable hemostasis fluid gelatin; 22 cases in control group including 11 males and 11 females with an average age of (54.4± 11.1) years old were treated by hemostasis with traditional hemostasis method. The operation time, decompression time, intraoperative hemorrhage, postoperative negative pressure drainage, postoperative neurological improvement rate (JOA%) , postoperative bone fusion time, postoperative titanium mesh subsidence rate, postoperative hematoma and other postoperative complications were compared between the two groups. RESULTS: The operative time of the experimental group (83.1±19.2) min was significantly shorter than that of the control group (89.5±17.0) min (P<0.05) ; the decompression time of the spinal canal in the two groups was (52.4±13.7) , (56.1±14.6) min, with a statistically significant difference (P=0.001) ; the amount of bleeding in the two groups was (49.9±12.4) , (90.6±36.7) ml, with a statistically significant difference (P<0.05) ; the total amount of drainage in the negative pressure drainage ball after operation in the two groups was (42.5±18.3) , (60.0±22.8) ml, the difference was statistically significant (P<0.05) . There was no statistically significant difference in the improvement rate of nerve function between the two groups at 1 week after operation, and the improvement rate of nerve function in the experimental group was better than that in the control group at 3 and 6 months after operation. In the two groups, bone fusion was obtained 6 months after operation, no obvious titanium mesh subsidence was found in 3 months after operation, no acute hematoma, CSF leakage and other postoperative complications were found. CONCLUSION: Absorbable hemostatic fluid gelatin has a significant hemostatic effect in ACCF operation, can maintain a good operation field, can reduce the decompression time of spinal canal, reduce the amount of bleeding during operation and the amount of bleeding after operation. It is a more effective and safe hemostatic material than the traditional hemostatic method.

Ultraselective conventional transarterial chemoembolization: When and how?

Ultraselective conventional transarterial chemoembolization (cTACE), defined as cTACE at the most distal portion of the subsubsegmental hepatic artery, is mainly performed for hepatocellular carcinoma (HCC) ≤5 cm. Distal advancement of a microcatheter enables injection of a larger volume of iodized oil into the portal vein in the limited area under non-physiological hemodynamics. As a result, the reversed portal flow into the tumor through the drainage route of the tumor that occurs when the hepatic artery is embolized is temporarily blocked. By adding gelatin sponge slurry embolization, both the hepatic artery and portal vein are embolized and not only complete necrosis of the tumor but also massive peritumoral necrosis can be achieved. Ultraselective cTACE can cure small HCCs including less hypervascular tumor portions and replace surgical resection and radiofrequency ablation in selected patients.

Application of gelatin sponge debris pre-perfusion in percutaneous kyphoplasty for vertebral fracture with cortical rupture / 中华骨科杂志

Objective@#To investigate the preventive effects of gelatin sponge debris pre-filling on bone cement leakage during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture with cortical bone rupture.@*Methods@#The data of 256 cases (294 segments) of osteoporotic vertebral compression fracture (OVCF) treated with PKP from January 2014 to July 2016 were retrospectively analyzed. There were 106 segments in 92 males and 188 segments in 164 females. In 119 cases, a total of 132 segments were pre-filled with gelatin sponge debris before bone cement injection. The average age was 74.4±7.7 years. In 137 cases, 162 segments were not pre-filled with gelatin sponge debris, with average age of 73.3±6.4 years. The incidences of cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), the change of anterior vertebral height and kyphosis angle before and after operation were compared between the two groups.@*Results@#In gelatin sponge group, the incidence of cement leakage was 12.6% (15/119), including 3.4% (4/119), 0.8% (1/119), 1.7% (2/119), 5.0% (6/119) and 1.7% (2/119) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The incidence of cement leakage in non-gelatin sponge group was 23.4% (32/137), including 4.4% (6/137), 5.1% (7/137), 5.1% (7/137), 5.8% (8/137) and 2.9% (4/137) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The difference of total cement leakage rate between the two groups was significant (χ2=4.912, P=0.027). There was no significant difference in leakage rates among different types (P>0.05). Postoperative symptoms were improved in both groups. VAS score and ODI index were improved at 1, 3 and 6 months after operation (P<0.05). However, there was no significant difference in VAS score and ODI index at preoperative and post-operative follow-up between groups. There were no significant difference between the two groups in the height of the anterior edge of the injured vertebra before operation (17.3±3.2 mm, 17.5±5.4 mm), the kyphosis angle before operation (18.9°±2.0°, 18.7°±2.3°), the height of the anterior edge of the injured vertebra after operation (22.7±3.6 mm, 22.4±5.4 mm), and the kyphosis angle after operation (11.2°±1.4°, 11.9°±1.8°).@*Conclusion@#Gelatin sponge debris pre-filling can effectively reduce bone cement leakage after PKP in patients with vertebral cortical bone rupture. There was no significant effect on the improvement of symptoms after PKP.

Ultraselective conventional transarterial chemoembolization: When and how?

Ultraselective conventional transarterial chemoembolization (cTACE), defined as cTACE at the most distal portion of the subsubsegmental hepatic artery, is mainly performed for hepatocellular carcinoma (HCC) ≤5 cm. Distal advancement of a microcatheter enables injection of a larger volume of iodized oil into the portal vein in the limited area under non-physiological hemodynamics. As a result, the reversed portal flow into the tumor through the drainage route of the tumor that occurs when the hepatic artery is embolized is temporarily blocked. By adding gelatin sponge slurry embolization, both the hepatic artery and portal vein are embolized and not only complete necrosis of can be achieved. Ultraselective cTACE can cure small HCCs including less hypervascular tumor portions and replace surgical resection and radiofrequency ablation in selected patients.

Efficacy evaluation of gelatin sponge in percutaneous vertebroplasty for lumbar osteoporosis compression fractures / 中华创伤杂志

Objective To evaluate the feasibility of using gelatin sponge to reduce bone cement leakage in percutaneous vertebroplasty (PVP).Methods A retrospective case control study was conducted to analyze the 191 patients (191 vertebrae) with lumbar osteoporosis vertebrae compression fractures (OVCF) who were treated by PVP from October 2014 to October 2017 in Xi'an Honghui Hospital.There were 52 males and 139 females,aged 65-91 years,with an average of 75.1 years.A total of 48 patients were treated with routine PVP,and bone cement was injected directly after puncture (Group A).A total of 47 patients,49 patients and 47 patients were injected with 1/4,1/3 and 1/2 gelatin sponge before bone cement injection respectively (Group B,Group C and Group D).Postoperative routine X-ray and CT scans were used to compare the amount of bone cement injection,the leakage of bone cement,the visual analogue score (VAS),neurological symptoms and complications before and after operation.Results All patients were followed up for 1-12 months,with an average of 3.6 months.There were no significant differences in the amount of bone cement injection after operation between groups (P ＞ 0.05).There was a significant difference in the cement leakage rate among the groups after operation [Group A:42％ (20/48);Group B:40％ (19/47);Group C:14％ (7/49);Group D:13％ (6/47)] (P ＜ 0.05).The results of pairwise comparison of bone cement leakage rate were as follows:significant differences were found between Group A and Group C as well as between Group A and Group D (P ＜ 0.008 3),but no significant difference was found between Group A and Group B (P ＞ 0.008 3);significant differences were found between Group B and Group C as well as between Group B and Group D (P ＜ 0.008 3),but no significant difference was found between Group C and Group D (P ＞ 0.05).There were no significant differences in VAS among the groups (P ＞ 0.05);VAS was significantly improved after operation within each group (P ＜ 0.05).After operation,two patients had persistent lower back pain and one patient had intraspinal leakage.Wound healing was found in all patients,with no neurological symptoms.Conclusion For OVCF,use of 1/3 or 1/2 gelatin sponge in PVP can reduce bone cement leakage.

Comparative analysis of two methods for the treatment of ear mycosis with pevison / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare two administration methods of triamcinolone acetonide cream for the treatment of ear mycosis with pevison. METHODS Eighty-six cases diagnosed as the external auditory canal fungal infections with tympanic membrane perforation were randomly divided into observation group and control group, with 43 cases in each group. All the selected patients were positive in the external auditory meatal secretions fungus detection test, fungi and secretions of the external auditory canal are thoroughly cleaned under the endoscope. After ear canal cleaning, the obervation group was treated with Pevisone smeared on gelatin sponge which was evenly placed on the external auditory canal with fungal infection. The control group was treated with Pevisone smearing on external auditory canal by the patients themselves, twice a day. Two groups of patients come to the hospital every 3 days for review. After 2 weeks of treatment, the patients were followed up for 3 months, and the clinical efficacy of each group was compared. RESULTS The observation group was cured in 39 cases(90.7％), effective in 2 cases(4.7％), and ineffective in 2 cases(4.7％), The total efficiency rate is 95.3％.1 case recurred at 3 months of follow-up(2.4％). While in the control group, it was cured in 26 cases(60.5％), effective in 1 cases(2.3％), and ineffective in 16 cases(37.2％), the total efficiency rate is 62.8％.9 cases recurred at 3 months of follow-up(31.0％). The effect of the observation group was significantly higher than that of the control group(x2=14.508, P<0.05). CONCLUSION The ear endoscope can be used to remove the external auditory canal fungus thoroughly and has good visibility. Treating external auditory canal fungi disease with tympanic membrane perforation with gelatin sponge coated with triamcinolone acetonide cream has better clinical efficacy.

Efficacy of intranasal corticosteroids-gelatin sponge in the treatment of nasal adhesion after nasal endoscopic sinus surgery / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare the effect of intranasal corticosteroids-gelatin sponge and saline-gelatin sponge in the treatment of nasal adhesion.METHODS A total of 208 noses(170 patients) with nasal adhesions after receiving the endoscopic sinus surgeries from July,2012 to December,2015 were selected.All the cases were divided randomly into two groups:the treatment group and the control group.Both groups received separation treatments of the nasal adhesions.The intranasal corticosteroidsgelatin sponges were used as the separation material for the treatment group,while saline-gelatin sponges for the control group.The severity score and the time of treatment were evaluated as the indicators for curative efficacy of the treatment in each case.The differences of efficacy between two groups were analysed statistically.RESULTS The severity scores of the two groups after the treatment were both substantially lower than those before the treatment;The after-treatment severity scores of the treatment group were significantly lower than those of the control group;the times of treatment in the treatment group were substantially lower than those of the control group.The differences stayed for 3 months,and they became insignificant after 3 months.CONCLUSION The intranasal corticosteroids-gelatin sponge can be a quicker and more effective treatment of nasal adhesion in comparison with saline-gelatin sponge.

Esponja estéril de gelatina comprimida (GELFOAMMR) simulando tejido tiroideo en ecografía de paciente con tiroidectomía. Reporte de un caso / A compressed sterile gel sponge (GELFOAMMR) simulating thyroid tissue in an ultrasound examination of a patient who underwent a thyroidectomy. Report of a case

El cáncer de tiroides es la neoplasia endocrina más usual, el carcinoma papilar de tiroides el subtipo más prevalente representando el 75 al 80% de los casos. Se presenta por lo general como nódulo tiroideo único, el uso de la ecografía ha aumentado su detección. El tratamiento recomendado es la tiroidectomía total evidenciando menor número de recurrencias y complicaciones. Se presenta el caso de una paciente femenina de 54 años de edad, quien en el control postquirúrgico por tiroidectomia refiere aparición de nódulos en hemicuello izquierdo. Se realiza biopsia sugestiva de respuesta inflamatoria. La evaluación postiroidectomía tiene como objetivo la identificación temprana de las recurrencias, existen diferentes situaciones clínicas que pueden simular una recurrencia, como se evidencia en el caso presentado, donde las imágenes simulantes de tejido tiroideo correspondían al material hemostático GelfoamMR, el cual es ampliamente empleado en el campo quirúrgico, la respuesta nodular corresponde a una hiperplasia linfoide atípica

Thyroid cancer is the most common endocrine neoplasm, and papillary thyroid carcinoma is the most prevalent subtype, representing 75 to 80% of all cases. This condition usually appears as a single thyroid nodule, and the use of ultrasound has increased its detection. The recommended treatment is total thyroidectomy, which leads to fewer recurrences and complications. We present the case of a 54-year old female patient who reported the appearance of nodular structures on the left side of her neck in a control after a thyroidectomy. A biopsy was taken, and it was reported as suggestive of an inflammatory response. The assessment after a thyroidectomy aims to identify early recurrences, as it was described in this case, where the images resembling thyroid tissue corresponded to a hemostatic material (GelfoamTM), which is widely used in the surgical field, and the nodular response described corresponded to a case of atypical lymphoid hyperplasia

Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

Objectives To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy. Subjects and Methods The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants) and to the non-insertion group (group B: 130 participants). In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy. Results Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0%) vs. 11 (8.5%), P=0.029). The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis. Conclusion Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort. .

Dexamethasone-soaked gelatin sponges prevent epidural adhesion / 中国组织工程研究

BACKGROUND:Clinicaly, dexamethasone-soaked gelatin sponges that are placed around the nerve root and spinal dura mater in lumbar disc excision have achieved good results. OBJECTIVE: To understand the effect of dexamethasone-soaked gelatin sponges in prevention of epidural adhesion in animals. METHODS:Forty New Zealand white rabbits were randomly divided into four groups folowed by removal of L4, L7 laminae, and a 1.0 cm×0.5 cm lamina dura area was exposed in each group. Then, the dura and nerve root were covered with dexamethasone-soaked gelatin sponges, dexamethasone, gelatin sponge and nothing (blank group), respectively. At 2, 4, 6, 8, 12 weeks after surgery, the entire operated vertebral segment and its accessories and paraspinal muscles were taken for gross and microscopic observation of nerve root and dural tissue adhesions. RESULTS AND CONCLUSION:At 12 weeks postoperatively, new bone tissue formed generaly at the site of laminectomy defect in the dexamethasone-soaked gelatin sponge group, with separable yelow-white membranous tissue around the dura; histological results showed the complete structure of fat cels, clearly distinct from the dura; there was no scar cel formation, no adhesions, no trabecular bone cartilage cels and hyperplasia. In the other three groups, a large number of peripheral epidural scar tissues were generaly seen, epidural adhesions were serious that could not be separated bluntly, and histological results showed colagenization of granulation tissue, dural thickening and serious adhesions. The findings indicate that dexamethasone-soaked gelatin sponges can synergisticaly prevent epidural adhesions.

Ultrasound-guided plugged percutaneous biopsy of solid organs in patients with bleeding tendencies.

OBJECTIVE: To establish and verify the utility of plugging biopsy tracts, using a combination of Gelfoam slurry and torpedo in the prevention of post-biopsy bleeding in patients at high risk of post-procedure haemorrhage following ultrasound-guided percutaneous biopsy of solid organs. DESIGN: Case series. SETTING: Radiology Department of a regional hospital in Hong Kong. PATIENTS: In our unit, all patients considered to be at high risk of post-biopsy haemorrhage of a solid organ underwent ultrasound-guided plugged percutaneous biopsy from year 2005 to 2012. INTERVENTIONS: All the included patients had undergone real-time ultrasound-guided biopsy of solid organs (liver in 10 and spleen in one patient). In all cases, a combination of a coaxial introducer needle and Temno needle were used. After adequate specimens were obtained, Gelfoam slurry (for distal embolisation) followed by Gelfoam torpedo (for proximal embolisation) were used to plug the biopsy tract. MAIN OUTCOME MEASURES: Technical success, any post-biopsy haemorrhage treated by transfusion or other intervention, and plugging-related complications were reviewed for each patient. RESULTS: Technical success was achieved in all patients and none experienced post-biopsy haemorrhage treated by blood transfusion or any other intervention. CONCLUSION: Plugging of the biopsy tract with Gelfoam slurry followed by Gelfoam torpedo is a direct and simple procedure that can safely and effectively prevent haemorrhage in patients at high risk of post-biopsy haemorrhage.

Clinical study on the treatment of ectopic pregnancy by methotrexate and the particle of gelatin sponge with uterine artery embolization / 中国医师杂志

Objective To investigate the clinical application value of methotrexate and the particle of gelatin sponge treat ec -topic Pregnancy .Methods A total of 48 cases of ectopic pregnancy was analyzed retrospectively .Methotrexate and gelatin sponge particles were injected into the uterine artery embolization for the method of intervention , and its clinical application value was evalua-ted.Results All 48 patients were embolized uterine artery successfully .It treated successfully ectopic pregnancy 44 cases (92%), including 38 cases of tubal pregnancy and other parts of the 6 cases.All patients were detected in β-human chorionic gonadotropin (β-HCG) until normal about 3 weeks.No serious postoperative complications were found , only 30 patients with abdominal pain, 16 cases of patients with nausea and vomiting , 9 patients with low-grade fever were found .After four months , 29 patients were recanalizated successfully .Conclusions Treatment of ectopic pregnancy can kill embryos efficiently , stanch the bleeding rapidly , and have small operation wound .It is safe and reliable method and is worth populating .

Gelatin sponge impregnated with hemocoagulase reduces postoperative blood loss of patients with lumbar fractures undergoing posterior spinal decompression / 中国组织工程研究

BACKGROUND:A single hemostatic material has been proved not to facilitate wound healing or to produce certain adverse reactions; while composites composed of two or three different materials can improve the advantage and histocompatibility of hemostatic materials. OBJECTIVE:To investigate the effect of gelatin sponge impregnated with hemocoagulase solution on amount of bleeding in patients with lumbar fractures undergoing posterior spinal decompression. METHODS: Fifty patients with lumbar fractures who were scheduled for open reduction, pedicle screw fixation and laminectomy were enroled, including 25 cases treated with gelatin sponge impregnated with hemocoagulase before surgical incision closure as test group and 25 cases treated with single gelatin sponge before surgical incision closure as control group. Postoperative drainage volume, drainage time, length of stay, number of re-admissions and postoperative complications were compared between the two groups. RESULTS AND CONCLUSION:The postoperative drainage volume, drainage time and length of stay in the test group were significantly less than those in the control group (P re-admission of patients was found, and there was no hemocoagulase-impregnated absorbable gelatin sponge- related adverse reaction. These findings indicate that posterior laminectomy with hemocoagulase-impregnated gelatin sponge can significantly reduce patients’ postoperative wound drainage and shorten the length of stay.

Autologous bone marrow aspirate concentrate repairs peri-implant bone defect / 中国组织工程研究

BACKGROUND:Autologous bone marrow aspirate concentrate is often applied in patients from Department of Orthopedics and those with severe limb ischemia, but rarely applied in Department of Oral and Maxil ofacial Surgery, especial y in Department of Oral Implantology. The effect of autologous bone marrow aspirate concentrate on promoting peri-implant bone regeneration deserves further studies. OBJECTIVE:To evaluate the effect of bone marrow aspirate concentrate in the repair of peri-implant bone defect. METHODS:Bone marrow 5 mL was extracted from posterior superior iliac spine of experimental dogs and bone marrow cel s were counted before and after concentration. Bone defect (4 mm × 4 mm × 4 mm) was prepared in the middle of bilateral mandibular premolar, which was randomly implanted with gelatin sponge plus bone marrow aspirate concentrate, autologous bone and gelatin sponge. At 4 and 12 weeks after surgery, bone defect specimens were histological y observed. The new bone formation rate and new bone mineral density were calculated. RESULTS AND CONCLUSION:After centrifugation, the concentrations of nucleated cel s in bone marrow aspirate concentrate were increased by (2.78±0.22) times. More colony-forming units were found after cel culture. Histological analysis showed that, significantly higher new bone formation rate and new bone mineral density occurred in gelatin sponge plus bone marrow aspirate concentrate group, compared with autologous bone group and gelatin sponge group at 4 weeks (P0.05). Autologous bone marrow aspirate concentrate can significantly improve new bone mineral density and quantity in the pre-implant bone defect.

Huaier granules combined with intraarterial chemoembolization for the treatment of hepatocellular carcinoma / 中华普通外科杂志

Objective To evaluate the safety and efficacy of combined transcatheter intraarterial chemoembolization with 350-560 μm gelatin sponge particles and lobaplatin (GSPs-TACE) and oral Chinese herb medication Huaier granules in patients with hepatocellular carcinoma (HCC).Methods This is a case-control,single-institution clinical trial.31 HCC patients receiving GSPs-TACE (group A) were matched with 31 patients receiving GSPs-TACE and Huaier granules (group B).Tumor response was evaluated by CECT using response evaluation criteria in solid tumors at 1 month after initial GSPs-TACE.The overall survival was calculated from the data of initial GSPs-TACE using the Kaplan-Meier method.Results The overall mean follow-up period was 28.7 (range 12-42) months.The overall 6-and 12-month survival rates in group A and group B were 90.3％ and 80.6％ vs 100％ and 93.5％,respectively.There was statistically significant difference in 12-month survival rates (x2 =5.213,P ＜0.05).Median survival time respectively was 17.1 and 20.6 months(x2 =0.745,P ＞0.05).The average TACE times were (4.1 ±7.3) and (2.9 ±8.7) respectively in group A and group B (P =0.01).Tumor objective response rate was statistically different in 6-and 12-month in two arms(x2 =5.945,6.384,P ＜0.05).There was no statistically significant difference in complications (respectively x2 =0.435,0.485,2.037,0.137,0.325,all P ＞ 0.05).Conclusions Huaier granules combined with transcatheter intraarterial chemoembolization with 350-560 μm gelatin sponge particles and carboplatin for HCC is safe and effectively prolongs patients' survival.

Avaliação da eficácia de bupivacaína embebida em Gelfoam® no local do enxerto ósseo de crista ilíaca / Evaluation of the efficacy of bupivacaine soaked in Gelfoam® at the iliac crest bone graft site / Evaluación de la eficacia de la bupivacaina empapada en Gelfoam® en la región del injerto óseo de la cresta ilíaca

JUSTIFICATIVA E OBJETIVOS: Um número considerável de pacientes relata dor após coleta de enxerto da crista ilíaca anterior. Este estudo avaliou a eficácia da aplicação de bupivacaína embebida em uma esponja de gelatina absorvível (Gelfoam®) no local doador de osso e do uso parenteral de opioides no controle da dor pós-operatória. MÉTODO: Estudo prospectivo, duplo-cego, randomizado e controlado por placebo comparando a infiltração no período intraoperatório de 20 mL de bupivacaína (tratamento, grupo B) versus soro fisiológico (placebo) com Gelfoam embebida no local de coleta óssea da crista ilíaca em pacientes submetidos à cirurgia eletiva de coluna cervical. No período pós-operatório, a administração de cloridrato de hidromorfona (na sala de recuperação pós-anestésica e analgesia controlada pelo paciente) foi padronizada. Um escore de dor com base em escala visual analógica (EVA) com pontuação de zero a 10 foi usado para avaliar a intensidade da dor associada ao local doador. Os escores de dor e uso/frequência de narcóticos foram registrados 24 e 48 horas após a operação. Os médicos, pacientes, a equipe de enfermagem e os estatísticos desconheciam o tratamento usado. RESULTADOS: Os grupos eram semelhantes em idade, gênero e comorbidades. Não houve diferença significativa entre os grupos nos escores da EVA. As doses de narcótico foram significativamente menores no grupo B nos tempos de 24 e 48 horas (p < 0,05). CONCLUSÃO: Este estudo demonstrou que bupivacaína embebida em esponja de gelatina absorvível no local de coleta do enxerto ósseo de crista ilíaca (EOCI) reduziu o uso parenteral de opioides no pós-operatório.

BACKGROUND AND OBJECTIVE: A substantial number of patients report pain after graft harvest from the anterior iliac crest. This study examined the efficacy of local application of bupivacaine soaked in a Gelfoam® at the bone donor site in controlling postoperative pain and parenteral opioid use. METHOD: We performed a prospective, double-blind, randomized, placebo-controlled study comparing intraoperative infiltration of 20 mililiters of bupivacaine (treatment, group B) versus saline (placebo), with Gelfoam® soaked into the iliac crest harvest site for patients undergoing elective cervical spinal surgery. Postoperative administration of dihydromorphinone hydrochloride (post anesthesia care unit and patient-controlled analgesia) was standardized. A pain score based on a 10-point visual analog scale (VAS). was used to assess the severity of pain associated with donor site. Pain scores and narcotic use/frequency were recorded at the twenty-four and forty-eighth hour after the operation. Physicians, patients, nursing staff, and statisticians were blinded to the treatment. RESULTS: The groups were similar in baseline age, gender, and comorbidities. There was no significant difference between groups in VAS scores. Narcotic dosage, were significantly less in the Group B at 24 and 48 hours (p < 0.05). CONCLUSION: This study has demonstrated that bupivacaine soaked in gelfoam at the iliac bone graft harvest site reduced postoperative parenteral opioid usage.

JUSTIFICATIVA Y OBJETIVOS: Un número considerable de pacientes relata sentir dolor después de la recolección del injerto de la cresta ilíaca anterior. Este estudio evaluó la eficacia de la aplicación de bupivacaina empapada en una esponja de gelatina absorbible (Gelfoam®) en la región donadora del hueso y el uso parenteral de opioides en el control del dolor postoperatorio. MÉTODO: Realizamos un estudio prospectivo, doble ciego, aleatorio y controlado por placebo, comparando la infiltración en el período intraoperatorio de 20 mL de bupivacaina (tratamiento, grupo B) versus suero fisiológico (placebo) con Gelfoam empapado dentro de la región de la recolección ósea de la cresta ilíaca, en pacientes sometidos a la cirugía electiva de la columna cervical. En el período postoperatorio, la administración de clorhidrato de hidromorfona (unidad de recuperación y analgesia controlada por el paciente) se estandarizó. Un puntaje de dolor con base en la escala visual analógica (EVA) y un puntaje de 0 a 10 fueron usados para evaluar la intensidad del dolor asociada con la región donadora. Los puntajes de dolor y el uso/frecuencia de narcóticos se registraron 24 y 48 horas después de la operación. Los médicos, pacientes, el equipo de enfermería y los estadísticos no conocían el tratamiento usado. RESULTADOS: Los grupos eran similares en edad, sexo y comorbilidades. No hubo diferencia significativa entre los grupos en los puntajes de la EVA. Las dosis de narcótico fueron significativamente menores en el grupo B en los tiempos de 24 y 48 horas (p < 0,05). CONCLUSIONES: Este estudio demostró que la bupivacaina empapada en esponja de gelatina absorbible en la región de recolección del injerto óseo de la cresta ilíaca (EOCI) redujo el uso parenteral de opioides en el postoperatorio.

"Use of gelatin sponge in ""sandwich"" method for prevention of cerebrospinal fluid leakage after repair of spinal dura mater" / 中华骨科杂志

Objective To investigate the therapeutic effect of the sandwich method (medical glue +gelatin sponge+medical glue) in the repair of spinal dura mater to prevent the cerebrospinal fluid leakage.Methods From February 2007 to June 2011,54 patients with spinal subdural tumors underwent excision of tumor in our hospital.According to manner of repairing spinal dura mater,all patients were classified into two groups:routine group and sandwich group.There were 16 males and 7 females with an average age of 45.2±7.2 years in the routine group,while 19 males and 12 females with an average age of 44.2±6.4 years in sandwich group.In routine group,the spinal dura mater was repaired through running locked suture.In sandwich group,the spinal dura mater was repaired through running locked suture,painting medical glue around the dural incision,covering with gelatin sponge,and painting medical glue on the surface and margin of gelatin sponge successively.Results Compared with the routine group,the total volume of postoperative drainage in sandwich group decreased significantly on the very day,the first day,the second day,and the third day,and the incidence of cerebrospinal fluid leakage decreased significantly.Before discharge,hydrops happened in 3 cases in the routine group,and got well through aspiration,continuous pressure by sandbag,and prone position.Three months after operation,5 cases from the routine group got deep hydrops under the incision and no treatment was applied to them.There was no obvious abnormality in the sandwich group.Conclusion The sandwich method can improve the repair effect of spinal dura mater injury,reduce the volume of postoperative drainage,and decrease the incidence of cerebrospinal fluid leakage