A new packing and spacing material for use in carcinoma of the cervix uteri. Preliminary report.

Abstract

Ever since radioactive sources have been in use for the local treatment of carcinoma of the cervix uteri, it has been customary to use one-inch gauze packing to retain the sources in position and to hold them at a maximum distance from the mucosa of the urinary bladder and rectum. If such spacing is to be adequate, the gauze must be firmly packed against sensitive and often bleeding or eroded mucosa. Removal of the packing after seventy-two to ninety-six hours is associated with extreme pain and bleeding. Erosion is produced by pressure, with resultant infection. The odor due to retained secretions is offensive to the patient as well as to attending personnel. No matter how expertly it is placed, the moist gauze contracts, with a reduction of the estimated spacing and often a change in the position of the radium applicator. This results in uneven distribution of radiation and the production of unwanted hot spots. After a number of inquiries for a gauze substitute, the writer was directed to the O-Cel-O Corporation2 which makes a polyurethane foam material which seems to be ideal for the above purpose. This is a polymer of high molecular weight, made by the reaction of tolylene diisocyanate to a polyester resin (polydiethylene adipate) in the presence of water, catalyst (N-methyl morpholine), tricresyl phosphate, and emulsifier. The material is apparently neutral chemically. It has a flesh-soft texture and is resilient and absorptive, with a tendency to retain its original shape after compression in the dry or moist state. It is inert to most solvents, such as alcohol, ether, and benzene, but is subject to either alkaline or acid hydrolysis. Strips of this material 1 inch in width and 1/4 inch in thickness were kindly furnished by the manufacturer for this study. When these foam strips were packed in glass jars and autoclaved, the original properties were well preserved, although, after being autoclaved more than once or twice, they suffered some loss of resiliency and underwent a change in color to a light brown. Figure 1 illustrates the resilient property of the foam strip packing. The glass on the left contains 5 yards of 1-inch gauze packing compressed by a small lead wafer weighing a few ounces; that on the right contains 1 1/2 yards of foam strip packing compressed by a similar lead weight. The edges of the foam packing have been tinted for better clarity. Note its obvious advantages for spacing. The packing is carried out by conventional methods; the vagina is ballooned out readily for insertion of the foam strip with a long forceps. Removal seventy-two or ninety-six hours later is simple. The strip of packing bulges and is easily picked up. The patient is agreeably surprised at the lack of pain. There is less odor and discharge, since the foam permits interstices for drainage.