Gelfoam Group Research Articles

Efficacy of topical tranexamic acid soaked absorbable gelfoam in relieving post-extraction pain in warfarin patients: a randomized, triple-blinded, split-mouth, active-controlled clinical trial

BackgroundWarfarin patients who need dental extraction face the problem of bleeding and no sufficient hemostasis results in dry socket and postoperative pain. This study aimed to evaluate and compare the efficacy of the topical application of tranexamic acid-soaked absorbable Gelfoam (TXA-Gel) and saline-soaked absorbable Gelfoam (saline-Gel) in relieving postoperative pain following bilateral simple extraction of permanent mandibular molars in warfarin patients.MethodsThis was a randomized, triple-blinded, split-mouth, active-controlled clinical trial. It was performed at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Damascus University, between November 2021 and October 2023. 60 bilateral permanent mandibular molars, which were indicated for simple extraction in 30 warfarin patients randomly assigned into two groups according to the topical hemostatic agents after extraction used: Group 1: control group, saline-Gel (n = 30). Group 2: TXA-Gel (n = 30). A simple randomization method was performed by flipping a coin. The primary outcome measure was the visual analogue scale (VAS). The intensity of pain was evaluated at the baseline (t0), and on the 1st (t1), 2nd (t2), 3rd (t3), 4th (t4), 5th (t5), 6th (t6), and 7th (t7) days following extraction. The Kolmogorov–Smirnov test and the Mann-Whitney U test were performed. The level of significance was set at 0.05 (p < 0.05).ResultsThe mean vas scores was 4.17 ± 1.76 at t1 and decreased to 0.73 ± 0.78 at t7 in the TXA-Gel group. However, in the Gelfoam group, the mean vas scores was 4.83 ± 2.18 at t1 and decreased to 1.80 ± 1.00 at t7. The results of the Mann-Whitney U test showed that there was no statistically significant difference between the two groups at t1 (p = 0.236) and t2 (p = 0.155). However, there was a statistically significance difference at the rest time points (p < 0.05).ConclusionsTXA-Gel played a prominent role in alleviating post-extraction pain in warfarin patients.Trial registrationThe trail was retrospectively registered at the ISRCTN registry (ISRCTN71901901).

Gelfoam slurry tract occlusion after computed tomography-guided percutaneous lung biopsy: Does it prevent major pneumothorax?

Computed tomography (CT)-guided lung biopsy is a frequently performed procedure in the diagnostic workup for suspicious lung nodules that can be complicated by pneumothorax. This retrospective study assessed the efficacy of biopsy tract occlusion with a gelatin sponge slurry for preventing post-biopsy pneumothorax. Retrospective analysis was conducted on consecutive adult patients who underwent CT-guided lung biopsy over a 10-year period. Age, gender, existing chronic obstructive pulmonary disease (COPD), evidence of emphysema on CT, location of the lesion and the presence of pneumothorax on post-procedure CT and 4-h chest radiograph were recorded. Two hundred and ninety-six patients were included (126 patients in the non-gelfoam group and 170 in the gelfoam group). When gelfoam was used, risk of developing an immediate pneumothorax was lower (P=0.032). Patients with emphysema were 2.4 times more likely to develop a delayed pneumothorax without gelfoam (P=0.034). There was a significantly higher risk of both immediate and delayed pneumothorax in non-peripheral lesions without gelfoam (P=0.001 and P=0.002, respectively). The frequency of requiring a chest tube to treat a pneumothorax was 86% lower when gelfoam was used (P=0.012). Gelfoam is effective in preventing immediate pneumothorax. In patients with emphysema, there was a significantly higher risk of delayed pneumothorax without gelfoam. Additionally, non-peripheral lesions were more likely to develop pneumothorax when gelfoam was not used. The use of gelfoam was especially important in preventing the development of major pneumothoraces that would require drainage with a chest tube.

Postoperative Epidural Fibrosis Prevention: Which Is Better-Autologous Fat versus Gelfoam.

Study DesignProspective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively.PurposeTo compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery.Overview of LiteratureEF 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.MethodsThe 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.ResultsBased 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.ConclusionsIn 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.

Effect of Gelfoam Soaked Epidural Dexmedetomidine or Bupivacaine for Postoperative Analgesia in Lumbar Laminectomy: A Prospective Randomized Clinical Study.

Background and Aims:Postoperative pain is spine surgery can last for an average of two to three days. Epidural catheter management are difficult in spine surgery for postoperative pain. Still, there have been not much studies on epidural administered gelfoam soaked dexmedetomidine or bupivacaine, to enhance postoperative analgesia.Methods:Ninety six adult patients were randomized into three groups. Gelfoam soaked in 0.1 mg dexmedetomidine (0.02 mg. mL-1) in group D, 0.25% isobaric bupivacaine (5 mL) in group B and gelfoam soaked in 0.9% normal saline (5 mL) in group C. The Primary outcome was to compare the total amount of rescue analgesic consumption till 48 hours. The Secondary outcome was to compare time to first dose of rescue analgesia (duration of analgesia), the visual analogue scale and side effects up to 48 hours. Chi-square test, independent t test and analysis of variance test were used, and P < 0.05 was considered significant.Results:Ninety patients completed the study. Total dose of rescue analgesic consumed in 48 hours was significantly higher in control group (paracetamol 4.17 ± 0.75 gm with tramadol 205 ± 37.94 mg). Bupivacaine soaked gelfoam group (paracetamol 3.04±0.71 gm with tramadol 151.85 ± 35.31 mg) had more rescue analgesic consumption than dexmedetomidine soaked gelfoam group (paracetamol 1.72 ± 0.57 gm with tramadol 86.11 ± 28.73 mg). Time for first rescue analgesic requirement with dexmedetomidine soaked gelfoam group was significantly longer (14.67 ± 7.76 hours) than in bupivacaine soaked gelfoam group (11.33 ± 6.08 hours) and control group (6.40 ± 2.77 hours). Postoperative mean VAS scores were lower in group D and group B compared with group C along with no significant adverse effects.Conclusion:Patients undergoing lumbar laminectomy with gelfoam soaked epidural dexmedetomidine or bupivacaine decreases rescue analgesic consumption, prolongs the duration of analgesia and decreases mean VAS score postoperatively.

Is gelfoam sealing necessary in stapes surgery?

Background Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. Objectives To analyse the effect of using or not using Gelfoam® as a sealing material. Methods 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. Results 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). Conclusion and significance No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear.

Comparison of biodegradable synthetic polyurethane foam versus Gelfoam packing in cartilage graft myringoplasty procedures

ObjectiveTo compare cartilage graft rates and graft morphologies when biodegradable Synthetic Polyurethane Foam (BSPF) and Gelfoam are used to pack the EAC after cartilage graft myringoplasty. MethodsEighty-two patients with chronic perforations underwent endoscopic myringoplasty and were randomized to receive Gelfoam or BSPF packing of the middle ear and EAC.The groups were compared with respect to the pre- and postoperative air-bone gap (ABG), graft integrity, graft epithelialization, graft lateralization, and exudate. ResultsGraft success rate was 87.8% in postoperative 3rd month and 87.8% in postoperative 12th month in the Gelfoam group, whereas graft success rate was 97.6% in postoperative 3rd month and 95.1% in postoperative 12th month in the BSPF group, with no statistical significance between two groups in the 3rd (P = 0.089) and 12th (P = 0.236) month after surgery. Comparing the two groups, there was no difference in preoperative or postoperative mean ABG and ABG closure. Graft lateralization or medialization was evident in 6 patients in the Gelfoam group and one in the BSPF group. Re-peroration occured in one patient in the BSPF group. ConclusionsAlthough cartilage graft myringoplasty between Gelfoam packing and BSPF packing of EAC achieve similar graft success rate and ABG closure, BSPF packing afford better graft support and less exudation than did Gelfoam, well prevent graft lateralization and promote earlier graft epithelialization.

Endovascular Embolization Techniques in a Novel Swine Model of Fatal Uncontrolled Solid Organ Hemorrhage and Coagulopathy

Endovascular embolization is increasingly used in treating traumatic hemorrhage and other applications. No endovascular-capable translational large animal models exist and coagulopathy's effect on embolization techniques is unknown. We developed a coagulation-adaptable solid organ hemorrhage model in swine for investigation of embolization techniques. Anesthetized swine (n=26, 45±3kg) had laparotomy and splenic externalization. Half underwent 50% isovolemic hemodilution with 6% hetastarch and cooling to 33-35°C (COAG group). All had controlled 20mL/kg hemorrhage and endovascular access to the proximal splenic artery with a 4F catheter via a right femoral sheath. Splenic transection and 5min free bleeding were followed by treatment (n=5/group) with 5mL gelfoam slurry, three 6-mm coils, or no treatment (n=3, control). Animals received 15mL/kg plasma resuscitation and were monitored for 6hr. Splenic blood loss was continuously measured and angiograms were performed at specified times. Coagulopathy was successfully established in COAG animals. Pre-treatment blood loss was greater in COAG (11±6mL/kg) than non-COAG (7±3mL/kg, P=0.04) animals. Splenic hemorrhage was universally fatal without treatment. Non-COAG coil survival was 4/5 (326±75min) and non-COAG Gelfoam 3/5 (311±67min) versus non-COAG Control 0/3 (82±18min, P<0.05 for both). Neither COAG Coil (0/5, 195±117min) nor COAG Gelfoam (0/5, 125±32min) treatment improved survival over COAG Control (0/3, 56±19min). Post-treatment blood loss was 4.6±3.4mL/kg in non-COAG Coil and 4.6±2.9mL/kg in non-COAG Gelfoam, both lower than non-COAG Control (18±1.3mL/kg, P=0.05). Neither COAG Coil (8.4±5.4mL/kg) nor COAG Gelfoam (15±11ml/kg) had significantly less blood loss than COAG Control (20±1.2mL/kg). Both non-COAG treatment groups had minimal blood loss during observation, while COAG groups had ongoing slow blood loss. In the COAG Gelfoam group, there was an increase in hemorrhage between 30 and 60min following treatment. A swine model of coagulation-adaptable fatal splenic hemorrhage suitable for endovascular treatment was developed. Coagulopathy had profound negative effects on coil and gelfoam efficacy in controlling bleeding, with implications for trauma and elective embolization procedures.

Topical Injection of Tranexamic Acid via a Drain Plus Drain‐Clamping to Reduce Blood Loss in Degenerative Lumbar Scoliosis Surgery

ObjectiveThe aim of the present study was to investigate whether an innovative way of administering tranexamic acid (TXA), that is, injecting it retrogradely through the drain and clamping it for 1 h, can reduce postoperative bleeding after degenerative lumbar scoliosis surgery.MethodsSixty degenerative lumbar scoliosis patients who underwent posterior lumbar decompression with fusion of three or more levels were retrospectively enrolled and categorized into three groups (TXA, Gelfoam, and control groups). The demographic distribution, operative parameters, length and amount of Hemovac drainage, blood transfusion rate, length of stay, laboratory results (complete blood count and coagulogram), and the postoperative complications were collected and analyzed.ResultsThe age of patients in the Gelfoam group was significantly younger than in the TXA and control groups (59.75 ± 6.95 vs 66.10 ± 8.80, P = 0.016 and 59.75 ± 6.95 vs 67.90 ± 5.33, P = 0.000, respectively). There were no significant differences in sex, body mass index, comorbid medical status, and operation level between each of the two groups. The three groups did not differ significantly in estimated blood loss during surgery, the mean red blood cell transfusion requirement during hospitalization, and the entire perioperative allogenic blood transfusion rate. The postoperative total blood loss and total drainage were lower in the TXA group than in the control group (1027.14 ± 466.56 vs 1390.07 ± 314.85 mL, P = 0.006; 322.20 ± 187.32 vs 605.50 ± 184.70 mL, P = 0.000, respectively). The length of drainage retention in the TXA group was significantly shorter than in the Gelfoam and control groups (46.10 ± 9.00 vs 68.00 ± 12.31 h, P = 0.000 and 46.10 ± 9.00 vs 76.40 ± 10.97 h, P = 0.000, respectively). The TXA and Gelfoam groups also had significantly shorter hospital stays than the control group (7.50 ± 0.95 vs 9.80 ± 2.44 days, P = 0.000, and 7.90 ± 1.16 vs 9.80 ± 2.44 days, P = 0.003, respectively). At discharge, the mean hemoglobin and hematocrit level were significantly higher in the TXA group compared with the control group (11.77 ± 1.78 g/dL vs 10.67 ± 0.94 g/dL, P = 0.002; 34.82 ± 3.57% vs 31.79 ± 3.85%, P = 0.014). No significant difference was identified with respect to prothrombin time, activated partial thromboplastin time, and D‐dimmer among groups (P > 0.05). The three groups were comparable in wound problem incidences. Symptomatic deep vein thrombosis and pulmonary embolism were not observed in this study.ConclusionTopical injection of TXA retrogradely via a drain at the end of a degenerative lumbar scoliosis operation and clamping the drain for an hour can effectively decrease the postoperative blood loss and the length of hospitalization without increasing the complication rate.

Comparing Gelfoam vs fat as a sealing material in stapedotomy: A prospective double-blind randomised clinical trial.

One research aspect of stapes surgery is various materials that are used to seal the oval window. Several materials are used to seal the oval window, for example adipose tissue, perichondrium, vein graft, gelatin sponge (Gelfoam), blood clot and soft connective tissue. Up to now, there has been no randomised clinical trial that has evaluated the effects of different types of sealing material on hearing outcomes after stapedotomy. Hence, the present study aimed to find out which of these materials; fat or Gelfoam was associated with better hearing outcome, when used as a sealing material. This prospective, double-blind, randomised clinical trial was carried out on ears that had undergone stapedotomy. Dastgheib Hospital affiliated to Shiraz University of Medical Sciences, a referral otology centre in southern Iran. A total of 176 primary stapedotomies were analysed. Fat harvested from the ear lobule was used in 86 ears and Gelfoam in 90 ears. Preoperative and postoperative pure tone audiometric data and incidence of sensorineural hearing loss were evaluated. Total of 90.7% of all ears in the fat group and 87.8% of ears in Gelfoam group achieved postoperative air-bone gap (ABG) within 20dB, and this difference was not significant. There was no case of sensorineural hearing loss (defined as 10dB or more reduction in BC threshold) in both groups in mean frequencies of 0.5-3kHz. There were 9 cases of sensorineural hearing loss at 4kHz in the fat group vs 4 in the Gelfoam group. The occurrence of sensorineural hearing loss in different frequencies was not significant between the two groups (P>0.05). In addition, there was no case of dead ear in either group. We found similarity between hearing outcome in the Gelfoam and fat as sealing materials in stapedotomy. We believe that the first limitation of this study was the short-term follow-up in stapedotomy. The other issue is that one has to be cautious when using our result, which might not be applicable in larger fenestra stapedectomy.

Gel foam or microsphere particles for partial splenic artery embolization in managing patients with hypersplenism

Background and aim of studySpleen is the largest lymphoid organ on the human body, it has a very important immunological functions. Portal hypertension accompanied liver cirrhosis commonly leads to splenomegaly which may be complicated by hypersplenism. Also liver cirrhosis is frequently associated with decreased hematological indices with subsequent anemia, thrombocytopenia and leucopenia. Spontaneous bleeding can delay any surgical or endovascular intervention. Leucopenia with decreased immunity may interfere with treatment of cancer patients using chemotherapy. The objective of this prospective study is to achieve the maximum splenic tissue infarction with the least possible complications by performing partial splenic artery embolization in cases of hypersplenism through comparing two materials; gel foam in one group and microspheres in another group. Patients and methodsThe study was conducted from October 2014 to September 2015. Thirty patients included in this study were presented by hypersplenism. They were 14 males and 16 females with mean age of 51 years. All patients were subjected to full history taking, clinical examination, laboratory investigations, pelvi-abdominal US and interventional procedure (transcatheter partial splenic artery embolization). The patients were divided into two groups, group (1): Fifteen patients were subjected to partial splenic embolization (PSE) using gel foam, group (2): Fifteen patients were subjected to partial splenic embolization (PSE) using microspheres. ResultsMultiple complications appeared after the procedure some of them were of minor importance as post embolization syndrome (fever, pain and nausea) that continued for two days and disappeared in five patients. Haematemesis occurred in one patient of the first group. One case in the first group showed abscess formation after the procedure and this patient underwent the procedure using gel foam particles, four cases showed portal vein thrombosis, two in each group, Pleural effusion appeared in two patients of first group. Regarding the efficacy of the procedure, improvement in laboratory tests were nearly the same in both groups. However, regarding the occurrence of serious complications, the microsphere particles group show fewer complications than gel foam group. ConclusionPSE using gel foam or microsphere showed nearly the same efficacy with no significant difference between the improvement in laboratory tests. However, using microsphere particles was associated with fewer occurrences of serious complications when compared with using gel foam.

Prospective Randomized Comparative Study to Evaluate Epidural Fibrosis and Surgical Outcome in Patients Undergoing Lumbar Laminectomy with Epidural Autologous Free Fat Graft or Gelfoam: A Preliminary Study.

Introduction:Epidural fibrosis (EF) contributes to unsatisfactory relief of symptoms and failed back syndrome after spine surgery. EF around the nerve root can be more refractory to treatment than the original disc herniation itself. Reoperation on the scar can produce more scarring. Few studies have been conducted regarding the type of material to be used for decreasing EF.Materials and Methods:The prospective randomized comparative study was conducted in the Department of Neurosurgery and Radiodiagnosis, of a tertiary care hospital. Informed and written consent was obtained. Patients previously unoperated with symptoms and radiological features of lumbar spinal canal stenosis were included in the study. Fifteen patients were assigned to Group A (free fat graft) and 15 patients in Group B (Gelfoam group). Postoperatively, at 3 and 6 months, clinical outcome was evaluated and EF was assessed on CE-MRI.Results:Age and sex were comparable in both groups. The pain relief at 3 and 6 months was more in Group A as compared to Group B. In Group A, on CEMRI at 3 months, 87% of patients had none to mild fibrosis, with none had extensive fibrosis. The CEMRI at 6 months showed no increase in fibrosis. In Group B, 80% of patients had none to mild fibrosis at the end of 3 months. At 6 months, 13.3% patients had extensive fibrosis. The extent of EF was found to be statistically significant at 6 months postsurgery.Conclusion:Use of free fat graft at laminectomy site helps in reducing EF.

Secondary Degeneration of Auditory Neurons after Topical Aminoglycoside Administration in a Gerbil Model.

Hair cells in the cochlea can be damaged by various causes. Damaged hair cells can lead to additional destruction of parts of the auditory afferent pathway sequentially, which is called secondary degeneration. Recently, researches regarding cochlear implants have been actively carried out for clinical purposes; secondary degeneration in animals is a much more practical model for identifying the prognosis of cochlear implants. However, an appropriate model for this research is not established yet. Thus, we developed a secondary degeneration model using an ototoxic drug. 35 gerbils were separated into four different groups and kanamycin was applied via various approaches. ABR was measured several times after drug administration. SGCs were also counted to identify any secondary degeneration. The results showed that outer and inner HCs were damaged in all kanamycin-treated groups. Twelve weeks after kanamycin treatment, the round window membrane injection group showed severe subject differences in hair cells and SGC damage, whereas the gelfoam group showed consistent and severe damage in hair cells and SGCs. In this study, we successfully induced secondary degeneration in hair cells in a gerbil model. This model can be used for various purposes in the hearing research area either for treatment or for preservation.

Partial splenic embolization using polyvinyl alcohol and gelfoam to treat hypersplenism in cirrhotic patients: a Meta-analysis

Objective To evaluate the effectiveness and safety of partial splenic embolization using polyvinyl alcohol versus gelfoam to treat hypersplenism in cirrhotic patients. Methods A literature search was performed in databases which included PubMed, Embase, Cochrane library, Sinomed, CNKI, Wangfang data and VIP for trials on partial splenic embolism using PVA or gelfoam to treat hypersplenism in cirrhotic patients. The study was censored in May 2016. After data extraction and assessment of quality, a meta-analysis was performed using the RevMan 5.3 software. Results Five studies which involved 197 patients were selected in this study. Included into the PVA group were 92 patients and the gelfoam group 105 patients. On Meta-analysis, the PVA group had a higher value of WBC a month after PSE (WMD=0.4, 95%CI: 0.05~0.75, P 0.05). Conclusions PSE using PVA achieved better short-term and long-term results in hematological indicators than gelfoam. However, the degree and extent of duration of pain were significantly longer. Key words: Partial splenic embolization; Polyvinyl alcohol; Gelfoam; Cirrhosis; Hypersplenism

Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model

Objectives: To investigate the efficacy of chitosan-dextran hydrogel (CDH) in preventing postoperative adhesions between the tympanic membrane (TM) and intratympanic structures, and to evaluate its ototoxicity in an animal study. Methods: In the first step, ototoxicity was evaluated with 7 male albino guinea pigs (GPs) via auditory brainstem responses (ABR) before and 4 weeks after unilateral intratympanic injection of CDH and saline solution contralaterally. In the second step, 12 GPs underwent bilateral ear surgery. The middle ear (ME) mucosa was abraded, and the cavity was filled with CDH on one side and packed with Gelfoam on the contralateral side. A control group of 6 GPs underwent the same procedure except that no material was applied in the ME. The animals were euthanized at the end of the 7th week, and otomicroscopic findings were noted and the temporal bones harvested for the histologic examination. The findings were scored and compared. Results: There was no statistically significant difference between the pre- and postoperative ABR thresholds. In the otomicroscopic findings, the most prominent difference between the two groups was the presence of retraction of the TM in the Gelfoam group. The histopathologic findings revealed a higher degree of inflammation in the Gelfoam group compared with the CDH group. Conclusion: This study demonstrated that CDH has no ototoxic effects in GPs. Its use as an ME packing material revealed significantly less TM retraction and inflammatory reaction compared with Gelfoam.

Using tranexamic acid soaked absorbable gelatin sponge following complex posterior lumbar spine surgery: A randomized control trial

ObjectivesThis paper aims to determine whether the use of Tranexemic Acid (TXA) – soaked absorbable gelatin sponge could more effectively reduce post-operative blood loss and blood transfusion requirements among low-risk adult patients undergoing lumbar spine surgery. MethodsA total of 90 consecutive patients undergoing surgery for multilevel posterior lumbar degenerative procedures were prospectively randomized into one of three groups: – TXA Soaked Gelfoam group, absorbable gelatin sponge group or control group. Demographic distribution, total drain output, blood transfusion requirement, length of hospital stay, the number of readmissions, and postoperative complications were analyzed. ResultsIn the TXA Soaked Gelfoam, Gelfoam, and control groups, the respective hemovac drainage at the first 8h postoperatively was 81.06±61.21, 166.73±76.76, and 155.67±92.94ml respectively. The second 8h period drainage for the same groups postoperatively was 46.67±40.09, 55.10±43.43, and 82.50±56.67ml and 23.73±25.56, 32.43±25.81 and 44.20±32.44ml for the third 8h period postoperatively. The duration of the post-operative drain left in the TXA Soaked Gelfoam group was significantly shorter than the Gelfoam and control groups (p=0.019 and 0.000, respectively). The TXA Soaked Gelfoam and Gelfoam also had a significantly shorter hospital stay than the control group (p=0.014, and 0.036, respectively). No patient developed adverse reactions attributable to the tranexamic acid soaked absorbable gelatin sponge. ConclusionsTXA-soaked absorbable gelatin sponge is a safe, effective treatment for reduction of post-operative blood loss and blood transfusions among low-risk adult patients undergoing lumbar spine surgery.

The Effectiveness of Gelfoam Technique before Percutaneous Vertebroplasy: Is It Helpful for Prevention of Cement Leakage? A Prospective Randomized Control Study.

ObjectivePreinjection gelfoam embolization during percutaneous vertebroplasty (PVP) has been thought alternative technique to prevent the leakage of bone cement. The goal of this study was to evaluate whether the gelfoam techniques are useful to reduce bone cement leakage.MethodsTotal 100 PVPs of osteoporotic spine compression fractures were performed by 1 spine surgeon who experienced more than 500 PVP cases under prospective control study. Operation was done in T-L junction (T10-L2) fractures with bi-transpedicular approach. Preinjection gelfoam PVP was done in the 50 levels. As control group, PVP without gelfoam was done in the 50 levels. We did not perform preoperative venography. We inserted normal saline-mixed gelfoam to the anterior third of vertebral body via PVP needle, and then 3mL of polymethylmetacrylate (PMMA) was injected. We prospectively evaluated the incidence and leakage pattern of PMMA by postoperative computed tomography.ResultsBetween gelfoam and control groups, there were 11 leaks (22%) versus 12 leaks (26%). The mean operation time was 7.00 minutes versus 6.30 minutes. In gelfoam group, there were 6 spinal canal leaks, 4 paravertebral venous leaks, and 1 soft tissue leaks. In control group, there were 4 spinal canal leaks, 8 paravertebral venous leaks, and 1 disc space leak. In spite of cement leakage, there was no symptomatic case in both groups. Statistically, gelfoam technique was not related to decrease the incidence of leakage (p=0.64).ConclusionOur prospective study showed that it did not significantly decrease cement leakage when vertebroplasty is performed by experienced spine surgeon.

Histologic Analysis of the Influence of a Gelatin-based Scaffold in the Repair of Immature Dog Teeth Subjected to Regenerative Endodontic Treatment

IntroductionRegenerative endodontic treatment is a new and promising approach to manage immature teeth with necrotic pulps and apical periodontitis. The use of scaffolds is essential to treatment success, but many materials are difficult to acquire and have a high cost. This study assessed tissue repair in immature dog teeth with necrotic pulps and apical periodontitis after using a gelatin-based scaffold (Gelfoam; Pharmacia & Upjohn Co, Kalamazoo, MI). MethodsApical periodontitis was induced in 20 immature dog teeth. After disinfection with triple antibiotic paste for 2 weeks, canals were irrigated, dried, and filled with a blood clot alone (10 teeth) or combined with Gelfoam (10 teeth). Another 10 teeth were used as negative controls (no intervention). After 7 months, the dogs were euthanized. Histologic sections were stained with hematoxylin-eosin and analyzed in relation to tissue repair. Categoric data were analyzed using the Fisher exact test (P < .05), numeric data (histomorphometric analysis), and the Mann-Whitney U test. ResultsHistologic analysis revealed a higher percentage of roots with new cementumlike mineralized tissue and connective tissue inside the canal in the blood clot + Gelfoam group (P < .001). Histomorphometric analysis showed a higher area of mineralized tissue in the same group (P = .029). Apical extension of root and inflammation were similar between the experimental groups. The new tissue formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. ConclusionsThe use of a gelatin-based scaffold (Gelfoam) combined with a blood clot improved repair in immature dog teeth with apical periodontitis subjected to regenerative endodontic treatment.

Can (1)H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?

Absence of contrast on contrast enhanced MRI (CEMRI) and reduction in uterine volume at 6months post-uterine artery embolisation (UAE) currently indicate the successful disruption of the fibroid blood supply by UAE. This study assesses whether (1)H MR spectroscopy ((1)H MRS) can also indicate the success of UAE. 20 patients with symptomatic fibroids were randomised 1:1 to undergo UAE with either Gelfoam or Embospheres. CEMRI and spectra (1.5T) were acquired pre-, 24-h and 6months post-UAE. LCModel was used to detect significant levels of choline, creatine and lactate in fibroid spectra. Uterine volumes were measured and paired t tests (p<0.05) assessed volume reduction over time. Qualitative assessments of CEMRI were performed. Choline was detected in 17/18 spectra pre-UAE, 12/14 at 24-h and 6/16 at 6months post-UAE. Choline was not detected in the 7/7 spectra available for the Embospheres group at 6months. These fibroids were non-enhancing on CEMRI and associated with a significant reduction in mean uterine volume at 6months (mean/min/max 396.5/84.1/997.5cm(3), p=0.003). Choline was detected in 6/9 fibroid spectra available for the Gelfoam group at 6months. Of these fibroids, four demonstrated persistent enhancement on CEMRI and two were non-enhancing. This group did not demonstrate significant uterine volume reduction (mean/min/max 117.2/-230.6/382.6cm(3), p=0.15). The negative minimum value indicates fibroid growth. This study has demonstrated the potential of (1)H MRS to provide an additional marker of the success of UAE.

Hemostatic Techniques Following Multilevel Posterior Lumbar Spine Surgery

This was a prospective, randomized controlled clinical study. To determine the efficacy of absorbable gelatin sponge in reducing blood loss, as well as shortening the length of hospital stay in patients undergoing multilevel posterior lumbar spinal surgery. Absorbable gelatin sponge is reported to decrease postoperative drain output and the length of hospital stay after multilevel posterior cervical spine surgery. However, there is a dearth of literature on prospective study of the efficacy of absorbable gelatin sponge in reducing postoperative blood loss, as well as shortening the length of hospital stay in patients undergoing multilevel posterior lumbar spinal surgery. A total of 82 consecutive patients who underwent multilevel posterior lumbar fusion or posterior lumbar interbody fusion between June 2011 and June 2012 were prospectively randomized into one of the 2 groups according to whether absorbable gelatin sponge for postoperative blood management was used or not. Demographic distribution, total drain output, blood transfusion rate, the length of stay, the number of readmissions, and postoperative complications were analyzed. Total drain output averaged 173 mL in the study group and 392 mL in the control group (P=0.000). Perioperative allogeneic blood transfusion rate were lower in the Gelfoam group (34.1% vs. 58.5%, P=0.046); moreover, length of stay in patients with the use of absorbable gelatin sponge (12.58 d) was significantly shorter (P=0.009) than the patients in the control group (14.46 d). No patient developed adverse reactions attributable to the absorbable gelatin sponge. Application of absorbable gelatin sponge at the end of multilevel posterior lumbar fusion can significantly decrease postoperative drain output and length of hospital stay.

Post-Uterine Artery Embolization Pain and Clinical Outcomes for Symptomatic Myomas Using Gelfoam Pledgets Alone Versus Embospheres Plus Gelfoam Pledgets: A Comparative Pilot Study

BackgroundTo evaluate the efficacy and post-procedural pain associated with uterine artery embolization (UAE) using Gelfoam alone versus Embospheres plus Gelfoam in women with symptomatic uterine fibroids. MethodWe conducted a prospective, non-randomized pilot study. Fluoroscopy-guided trans-femoral artery UAE was performed using Gelfoam pledgets alone or Embospheres (500 to 700mg) plus Gelfoam under conscious sedation and local anaesthesia. This was followed by patient-controlled analgesia (PCA) using a morphine pump overnight.Post-procedural pain was assessed by the mean amount of self-administered morphine delivered by PCA pump (mL) from 0 to 19hours in each group. The mean volumes of the uterus and the dominant fibroid were calculated by ultrasound at baseline, three months, six months, and 12months. ResultsA total of 17 women participated in the study. Bilateral uterine artery occlusion was performed in eight women using Gelfoam alone, and in nine women using Embosphere+Gelfoam. One woman in the Embosphere+Gelfoam group developed a puncture-site hematoma requiring further intervention one week later. The mean (SD) amount of morphine self-administered by PCA pump at time 0, 1, and 2hours was 3.4mg (3.1), 2.9mg (2.2), and 2.4mg (3.3) in the Gelfoam-only group and 6.1mg (3.0), 9.6mg (7.1), and 5.3mg (4.4) in the Embosphere+Gelfoam group, respectively. After three hours, the amount of morphine used was equal in both groups. The mean (SD) total dose of morphine used was 29.5mg (18.6) in the Gelfoam group and 41.1mg (19.3) in the Embosphere+Gelfoam group (P=0.228). At 12months, the reduction in median total uterine volume and median dominant fibroid volume in each group was equal. ConclusionClinical outcomes were equivalent after uterine artery embolization using Gelfoam alone versus Gelfoam+Embospheres. Although the amount of immediate post-procedure pain may be less with Gelfoam alone, we could not demonstrate this objectively using morphine use as a measure of pain.