Absorbable Hemostatic Gelatin Sponge Research Articles

S2550 EUS-Guided Coil Embolization and Absorbable Hemostatic Gelatin Sponge Is a Safe and Efficacious Treatment of Rectal Varices

S2550 EUS-Guided Coil Embolization and Absorbable Hemostatic Gelatin Sponge Is a Safe and Efficacious Treatment of Rectal Varices

Minimizing Post-Infusion Portal Vein Bleeding during Intrahepatic Islet Transplantation in Mice.

Although the liver is currently accepted as the primary transplantation site for human islets in clinical settings, islets are transplanted under the kidney capsule in most rodent preclinical islet transplantation studies. This model is commonly used because murine intrahepatic islet transplantation is technically challenging, and a high percentage of mice could die from surgical complications, especially bleeding from the injection site post-transplantation. In this study, two procedures that can minimize the incidence of post-infusion portal vein bleeding are demonstrated. The first method applies an absorbable hemostatic gelatin sponge to the injection site, and the second method involves penetrating the islet injection needle through the fat tissue first and then into the portal vein by using the fat tissue as a physical barrier to stop bleeding. Both methods could effectively prevent bleeding-induced mouse death. The whole liver section showing islet distribution and evidence of islet thrombosis post-transplantation, a typical feature for intrahepatic islet transplantation, were presented. These improved protocols refine the intrahepatic islet transplantation procedures and may help laboratories set up the procedure to study islet survival and function in pre-clinical settings.

A comparison of the early therapeutic effects of allogeneic bone marrow-derived mesenchymal stem cells and calcitonin on the healing of surgically induced mandibular bone defects in osteoporotic rats

ObjectivesThis study aimed to evaluate and compare the early biological effects of allogeneic bone marrow-derived mesenchymal stem cells (BMSCs) versus salmon calcitonin (SC) on healing of surgically induced mandibular bone defects in osteoporotic rats. MethodsSixty-one female albino rats were included in this study, four of them were used for BMSCs isolation. The remaining 57 rats were divided into 4 groups. Group I (negative control), 12 rats received a vehicle injection after which a unilateral mandibular defect was created in each rat. Osteoporosis was induced in the remaining 45 rats then rats were randomly allocated into 3 equal groups (15 each). Surgical defects were created as in group I. The defects were left to heal spontaneously in group II; positive control. While in group III each defect was filled with an absorbable hemostatic gelatin sponge loaded by 10 IU of injectable SC and in group IV the sponge was seeded by 0.5 × 106 BMSCs. Rats were euthanized at 1st, 2nd, and 4th week postsurgically. Hematoxylin and eosin, Masson’s trichrome, picrosirius, and alizarin red s stains were used, followed by statistical analysis. ResultsBMSCs-treatment showed marked enhanced bone healing. Moreover, collagen fibers and calcium deposits area percentages were statistically significantly higher when compared to the other groups particularly at 2 and 4 weeks. ConclusionsLocal application of bone marrow-derived mesenchymal stem cells and salmon calcitonin may be an effective therapy for treatment of osteoporotic bone defects, with privilege to the stem cells in terms of quantity and quality of regenerated bone.

Endoscopic ultrasound-guided treatment of gastric varices with coil embolization and absorbable hemostatic gelatin sponge: a novel alternative to cyanoacrylate.

Background and study aims Bleeding from gastric varices (GV) carries high morbidity and mortality. Current endoscopic therapies are premised on cyanoacrylate injection which is technically challenging and carries risk of embolization. We present a case series of endoscopic ultrasound (EUS)-guided coil injection in combination with hemostatic absorbable gelatin sponge (AGS) for treatment of bleeding gastric varices. Patients and methods This was a retrospective review of EUS-guided coil injection for bleeding GV since November 2017. After EUS-guided needle puncture, hemostatic coils were serially injected until significant reduction of Doppler flow. Under fluoroscopic guidance, test contrast was injected to confirm absence of run-off, at which time AGS, converted into a liquid slurry, was injected as hemostatic reinforcement. Results Ten consecutive patients underwent EUS-guided coil embolization reinforced by AGS. Technical success, defined as uncomplicated injection of coils and sponge was achieved in 100 % (10/10). Mean follow-up was 6 months 73–397 days; No patients rebled or required reintervention on GV. The complication rate was 10 % (1/10; severe abdominal pain without radiographic findings); otherwise, there were no cases of systemic embolization. Nine of 10 patients (90 %) had follow-up EUS (mean 80 days); 100 % (9/9) revealed near-obliteration of GV. Conclusion EUS-guided coil embolization in combination with hemostatic AGS is a novel method for management of bleeding GV with high clinical and technical success rates, low risk for complications and favorable safety profile when compared to cyanoacrylate. This technique theoretically minimizes embolic complications and need for re-intervention. Further studies are required to compare this modality.

The Use of Three Different Hemostatic Agents during Laparoscopic Partial Nephrectomy: A Comparison of Surgical and Early Renal Functional Outcomes.

This study aimed to compare the effects of three different hemostatic agents on surgical and early renal functional outcomes after laparoscopic partial nephrectomy (LPN). A total of 126 cases of LPN performed between November 2008 and September 2016 were enrolled in this study. Spongostan™ Absorbable Hemostatic Gelatin Sponge (Ethicon, Somerville, NJ, USA) or Surgicel® Original Absorbable Hemostat (Ethicon, Somerville, NJ, USA), or a total of 5 mL of Floseal® Hemostatic Matrix (Baxter Healthcare, Deerfield, IL) was used for additional hemostasis. According to the hemostatic agent used, patients were divided into three groups; and patient characteristics, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor characteristics, perioperative parameters, serum creatinine levels, and complications were compared among these three groups. Age, BMI, ASA score, tumor characteristics, operative time, warm ischemia time, complication rates, and length of hospital stay were similar among the groups, whereas estimated blood loss was significantly lower in the Floseal Group (p=0.01). Postoperative serum creatinine levels and differences between preoperative and postoperative serum creatinine levels were also similar among the groups. The type of hemostatic agent used in LPN may affect the estimated blood loss. However, it has no substantial effect on other surgical parameters and early renal functional outcomes.

EUS-Guided Coil Embolization with Absorbable Hemostatic Gelatin Sponge vs. Cyanoacrylate Injection for Treatment of Gastric Varices: Comparison of Clinical Outcomes and Health Care Utilization Presidential Poster Award

Introduction: Gastric variceal bleeding is an uncommon complication of cirrhosis but is associated with high rates of mortality and morbidity. Traditional endoscopic treatment options involve cyanoacrylate (CYA) injection which can be technically challenging. Coil embolization and absorbable gelatin sponge (Gelfoam®) are frequently used by interventional radiology for hemostasis. Recently, we have applied this combination therapy in EUS-guided management of gastric varices (GV) with high therapeutic success. We compared the outcome and health care utilization of endoscopic coil embolization with Gelfoam therapy versus CYA injection for treatment of GV.542_A Figure 1. Demographics and Patient Characteristics. Data are presented as number of cases (percentage) OR mean ± S.D. [ ] signify range of values. Abbreviations: NAFLD = non-alcoholic fatty liver disease; MELD = Model for End-stage Liver Disease; IGV = isolated gastric varices; GOV = gastroesophageal varices; UGIB = upper gastrointestinal bleed.542_B Figure 2. Comparison of Primary and Secondary Outcomes. *Two patients passed away prior to adequate follow-up evaluation of need for re-intervention (both due to HCC progression). Data are presented as number of cases (percentage) OR mean ± S.D. [ ] signify range of values. Abbreviations: CYA = cyanoacrylate; BRTO = balloon-occluded retrograde transvenous obliteration; HCC = hepatocellular carcinoma; HD = hemodynamic.Methods:Study Design: Matched cohort study using a prospective registry of over 10 yearsMatching: 5 consecutive patients undergoing EUS coil embolization with Gelfoam therapy for bleeding GV (10/2017-6/2018) were matched in 1:4 fashion to 20 patients who underwent cyanoacrylate injection. Matching criteria included age, Child-Pugh class, variceal type, and bleeding severity on admission. Primary outcome: Need for re-intervention at 3 months Secondary outcomes: All-cause mortality at 3 months, time spent in hospital post procedure, and post-procedural transfusion requirements Statistics: Student t-test and Fisher's exact test Results: 0% (0/5) patients in the coil embolization with Gelfoam cohort required re-intervention at 3-months, as compared to 56% (10/18) in the CYA cohort (p=0.046). Mortality at 3 months was 0% (0/5) for coil with Gelfoam versus 20% (4/20) for CYA (p=0.55), with 1 death directly attributed to ineffective intervention and uncontrolled GV bleeding. Post procedural hospitalization was higher for the CYA cohort (8.6±9.9 vs. 3.4±2.2 days; p=0.26). Post procedure transfusion requirements on average was higher for the CYA cohort (1.95±2.70 vs. 0.2±0.4 units of blood; p=0.17). Conclusion: EUS guided coil embolization with absorbable gelatin sponge therapy is a novel technique that appears to be highly effective in treating bleeding gastric varices. This technique lend itself to effective and sustained hemostasis compared to cyanoacrylate injection which requires re-intervention. There was a trend toward significance with post-procedural time spent in the hospital and transfusion requirements; larger studies in the future should help elucidate additional benefits and risks from this novel approach.

Endoscopic Ultrasound-Guided Treatment of Gastric Varices With Coil Embolization and Absorbable Hemostatic Gelatin Sponge

Endoscopic Ultrasound-Guided Treatment of Gastric Varices With Coil Embolization and Absorbable Hemostatic Gelatin Sponge

Use of absorbable hemostatic gelatin sponge in postoperative care of the vascular pedicle of interpolated flaps

Use of absorbable hemostatic gelatin sponge in postoperative care of the vascular pedicle of interpolated flaps

Modified Evisceration in a Blue-Fronted Amazon (Amazona aestiva) as AN Ocular Treatment Option in Parrots

A 39-year-old blue-fronted Amazon parrot (Amazona aestiva) was presented with a traumatic corneal perforation (2mm × 0.1mm) with gelatinous material protruding from the defect and a severely edematous moderately vascularized cornea. A surgical repair of the perforation was attempted but was unsuccessful. Following the surgical effort, an evisceration was performed. The evisceration technique used for the parrot was originally described in raptor species; however, modifications were required for the smaller-eyed patient. After executing a lateral canthotomy, a stab incision into the cornea was made at the limbus and a full-thickness 360° keratectomy was performed. This was followed by stepwise removal of uvea, lens, vitreous body, conjunctiva, nictitating membrane, and eyelids. Absorbable hemostatic gelatin sponge and cold fluids were used to reduce hemorrhage. Periorbital subcutaneous tissues and skin were closed with continuous and simple interrupted sutures, respectively. Antibiotic, antimycotic, and analgesic treatments were administered to the parrot for 2 weeks following the surgical procedure. Over a follow-up period of 12 months, the bird was in good general condition and achieved a satisfactory cosmetic result over the orbit from which the eye was removed. Alterations in normal behaviors such as flying, preening, feeding, and social interactions were not observed. Therefore, the authors conclude that this modified evisceration technique is a faster and less invasive surgical technique with reduced manipulation of the optic nerve and has a lower risk of orbital bone fracture and hemorrhage compared to previously reported enucleation procedures for parrot species. This modified ocular evisceration technique is a treatment option for inoperable ocular trauma in psittacine cases deemed appropriate.

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.

Comparison of the Wound Healing Effect of Cellulose and Gelatin: An In Vivo Study

Many topical hemostatics are widely applied for bleeding control. They can be classified into two categories according to their mechanism of action on the clotting cascade in a biologically active or passive manner. Passive hemostatics include cellulose and gelatin. We performed an experimental study to compare the effect of passive hemostatics in wound healing by applying them to a rectus abdominis muscle defect of white mice. Surgicel is a sterile absorbable knitted fabric prepared by the controlled oxidation of regenerated cellulose. Spongostan is an absorbable hemostatic gelatin sponge. In 30 mice, a 1×1 cm defect was created on the rectus abdominis muscle and the materials were applied in three ways: control group, cellulose (Surgicel) group, gelatin (Spongostan) group. For the histologic analysis, biopsies were performed at 3 and 28 days. After 3 days, the cellulose group showed limited granulation formation with acute inflammatory reactions similar to the control group. At the 28th day, moderate amounts of granulation tissue formation was observed with milder inflammatory reactions than the control group. In the gelatin group, after 3 days, gelatin remnants were observed surrounded by severe inflammatory changes. After 28 days, the same quantity of gelatin remnants could be still observed. This study suggests that cellulose is associated with minimal morbidity in wound healing, while the use of gelatin shows severe adverse tissue reactions with delayed wound healing. Consequently, cellulose is better than gelatin when considering wound healing.

Comparision of Wound Healing Effect of Cellulose and Gelatin: An In Vivo Study

BackgroundMany topical hemostatics are widely applied for bleeding control. They can be classified into two categories according to their mechanism of action on the clotting cascade in a biologically active or passive manner. Passive hemostatics include cellulose and gelatin. We performed an experimental study to compare the effect of passive hemostatics in wound healing by applying them to a rectus abdominis muscle defect of white mice.MethodsSurgicel is a sterile absorbable knitted fabric prepared by the controlled oxidation of regenerated cellulose. Spongostan is an absorbable hemostatic gelatin sponge. In 30 mice, a 1×1 cm defect was created on the rectus abdominis muscle and the materials were applied in three ways: control group, cellulose (Surgicel) group, gelatin (Spongostan) group. For the histologic analysis, biopsies were performed at 3 and 28 days.ResultsAfter 3 days, the cellulose group showed limited granulation formation with acute inflammatory reactions similar to the control group. At the 28th day, moderate amounts of granulation tissue formation was observed with milder inflammatory reactions than the control group. In the gelatin group, after 3 days, gelatin remnants were observed surrounded by severe inflammatory changes. After 28 days, the same quantity of gelatin remnants could be still observed.ConclusionsThis study suggests that cellulose is associated with minimal morbidity in wound healing, while the use of gelatin shows severe adverse tissue reactions with delayed wound healing. Consequently, cellulose is better than gelatin when considering wound healing.

Gelatin sponge mimicking left atrial clot in rheumatic mitral stenosis

We report the case of a 23-year-old female who underwent balloon mitral valvotomy for severe symptomatic mitral stenosis. Following septal puncture, the patient developed cardiac tamponade, which warranted sternotomy to suture the rent in the inferior vena cava-right atrial junction. The postoperative echocardiogram revealed nonhomogenous irregular opacities within the left atrium suggesting the possibility of thrombus formation. As the patient was in sinus rhythm and peri-procedural activated clotting time was in therapeutic range, clot formation was unlikely. A review of operative notes revealed placement of absorbable hemostatic gelatin sponge within the pericardium, which was mimicking left atrial clot. This potential pitfall has to be recognized in echocardiograms, as it will avoid inappropriate anticoagulant therapy.