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Introduction: Endo-periodontal lesions can lead to the formation of severe intraosseous defects in the periodontium; which can lead to tooth loss. Objective: Demonstrate that surgical periodontal therapy with the help of gelatin sponges, with colloidal silver nanoparticles, restores bone tissue lost in endo-periodontal lesions. Case presentation: 55-year-old male patient without systemic alterations, diagnosed with grade 3 endo-periodontal lesion in patients with periodontitis. It was treated first with ducts and then with periodontal surgery combined with gelatin sponges, which contain colloidal silver nanoparticles, and were placed filling the 2-wall bone defect involving > 80 percent of the root length, with 24 months of radiographic and clinical follow-up. Conclusions: Based on the case report, surgical periodontal therapy and filling of bone defects with gelatin sponges, which contain colloidal silver nanoparticles, were sufficient to restore the lost bone at a 24-month follow-up. However, further studies are needed to assess the clinical benefit of this material for the treatment of intraosseous defects(AU)
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Humanos , Masculino , Persona de Mediana Edad , Periodontitis/diagnóstico , Pérdida de Hueso Alveolar/terapia , Esponja de Gelatina Absorbible/efectos adversosRESUMEN
OBJECTIVE: Tranexamic acid (TXA) and the hemostatic agent Floseal® have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS: We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal® and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS: The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseal® (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseal® and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseal® group. Both TXA and Floseal® had significantly less output than the control group, and Floseal® had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION: The use of TXA or Floseal® was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal® showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal® group.
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Artroplastia de Reemplazo de Rodilla/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Esponja de Gelatina Absorbible/administración & dosificación , Hemostáticos/administración & dosificación , Ácido Tranexámico/administración & dosificación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Embarazo , Estudios Prospectivos , Adulto JovenRESUMEN
Abstract Introduction: In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. Objective: This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. Methods: In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n = 57) and Gelfoam patch-treated group (n = 57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. Results: Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p > 0.05). However, the total average closure time was significantly different between the two groups (26.8 ± 9.1 days in the spontaneous healing group vs. 14.7 ± 9.1 days in the Gelfoam patch-treated group, p < 0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1 ± 1.6 days vs. 12.6 ± 3.9, medium-sized perforations: 13.3 ± 2.2 days vs. 21.8 ± 4.2 days, and large perforations: 21.2 ± 4.7 days vs. 38.4 ± 5.7 days; p < 0.01). Conclusion: In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.
Resumo Introdução: Na última década, houve um uso crescente de placas biomateriais na regeneração de perfurações traumáticas da membrana timpânica. As principais vantagens das placas de biomateriais são restaurar provisoriamente a função fisiológica da orelha média, assim melhoram imediatamente os sintomas da orelha e atuam como um suporte para a migração do epitélio. No entanto, não se sabe se há efeitos clínicos adicionais na regeneração do tímpano em relação ao fragmento de material biológico. Objetivo: Avaliar a resposta de cicatrização para diferentes padrões de reparo em perfurações de membrana timpânica traumáticas humanas por meio de observação endoscópica. Método: Foram alocados 114 pacientes com perfurações de membrana timpânica traumáticas sequencialmente para dois grupos: o de cicatrização espontânea (n = 57) e o tratado com esponja de Gelfoam (n = 57). A velocidade de fechamento, o tempo de fechamento e a taxa de otorreia foram comparados entre os grupos aos três meses. Resultados: Foram analisados 107 pacientes nos dois grupos (52 no de cicatrização espontânea e 55 no tratado com esponja de Gelfoam). A velocidade global de fechamento no fim do período de seguimento de três meses foi de 90,4% no grupo de cicatrização espontânea e de 94,5% no grupo tratado com esponja de Gelfoam; a diferença não foi estatisticamente significativa (p > 0,05). No entanto, o tempo total médio de fechamento foi significativamente diferente entre os dois grupos (26,8 ± 9,1 dias no de cicatrização espontânea versus 14,7 ± 9,1 dias no tratado com esponja de Gelfoam, p < 0,01). Além disso, a velocidade de fechamento não foi significativamente diferente entre o grupo de cicatrização espontânea e o grupo tratado com esponja de Gelfoam, independentemente do tamanho da perfuração. O tempo de fechamento no grupo tratado com esponjas de Gelfoam foi significativamente menor do que no grupo de cicatrização espontânea, independentemente do tamanho da perfuração (pequenas perfurações: 7,1 ± 1,6 dias vs. 12,6 ± 3,9, perfurações de tamanho médio: 13,3 ± 2,2 dias vs. 21,8 ± 4,2 dias e grandes perfurações: 21,2 ± 4,7 dias vs. 38,4 ± 5,7 dias; p < 0,01). Conclusão: Na regeneração de PMT traumáticas, a esponja de Gelfoam não só desempenha um papel de estrutura para a migração epitelial, mas também promove edema e hiperplasia de tecido de granulação nas bordas da perfuração e acelera a cicatrização do tímpano.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Cicatrización de Heridas , Perforación de la Membrana Timpánica/diagnóstico por imagen , Estudios Prospectivos , Resultado del Tratamiento , Perforación de la Membrana Timpánica/terapia , Oído Medio , Endoscopía , Esponja de Gelatina Absorbible/uso terapéuticoRESUMEN
INTRODUCTION: In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. OBJECTIVE: This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. METHODS: In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n=57) and Gelfoam patch-treated group (n=57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. RESULTS: Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p>0.05). However, the total average closure time was significantly different between the two groups (26.8±9.1 days in the spontaneous healing group vs. 14.7±9.1 days in the Gelfoam patch-treated group, p<0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1±1.6 days vs. 12.6±3.9, medium-sized perforations: 13.3±2.2 days vs. 21.8±4.2 days, and large perforations: 21.2±4.7 days vs. 38.4±5.7 days; p<0.01). CONCLUSION: In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.
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Perforación de la Membrana Timpánica/diagnóstico por imagen , Cicatrización de Heridas , Adolescente , Adulto , Oído Medio , Endoscopía , Femenino , Esponja de Gelatina Absorbible/uso terapéutico , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Perforación de la Membrana Timpánica/terapiaRESUMEN
Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery, <30-day follow-up, immunosuppressive state, and diagnosis of Treacher-Collins or Apert Syndrome. Demographic data include age, sex, cleft laterality, prior surgeries, Veau classification, Pierre Robin status, and tracheostomy dependence. Primary outcome was fistula formation. Secondary outcomes included perioperative metrics and AAE.One hundred subjects met criteria, 45% female. Average age was 14.6 months. Subjects with syndromes comprised 28%, with 16% diagnosed with Pierre Robin. Two subjects were tracheostomy-dependent. Prior cleft and mandibular procedures were performed in 55%. Isolated palatal defects were seen in 46%, unilateral lip and palate in 41%, and bilateral lip and palate in 13%. The majority of defects were Veau II and III (35% and 34%, respectively). Adverse airway events occurred in 2%, one of which resulted in reintubation. One subject (1%) was found to have a postoperative fistula.The incorporation of Gelfoam in the modified-Furlow palatoplasty results in a low rate of oronasal fistula (1%) and low perioperative risk of AAE. Further prospective comparison of this method to others will be the focus of future work.
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Fisura del Paladar/cirugía , Esponja de Gelatina Absorbible/uso terapéutico , Hemostáticos/uso terapéutico , Enfermedades Nasales/prevención & control , Fístula Oral/prevención & control , Procedimientos de Cirugía Plástica/métodos , Hemorragia Posoperatoria/prevención & control , Preescolar , Femenino , Humanos , Lactante , Masculino , Procedimientos de Cirugía Plástica/efectos adversos , Estudios RetrospectivosRESUMEN
OBJECTIVES: This study aimed to evaluate the potential of adipose-derived stem cells (ASCs) combined with a modified α-tricalcium phosphate (α-TCP) or gelatin sponge (GS) scaffolds for bone healing in a rat model. MATERIAL AND METHODS: Bone defects were surgically created in the femur of adult SHR rats and filled with the scaffolds, empty or combined with ASCs. The results were analyzed by histology and histomorphometry on days seven, 14, 30, and 60. RESULTS: Significantly increased bone repair was observed on days seven and 60 in animals treated with α-TCP/ASCs, and on day 14 in the group treated with GS/ASCs, when compared with the groups treated with the biomaterials alone. Intense fibroplasia was observed in the group treated with GS alone, on days 14 and 30. CONCLUSIONS: Our results showed that the use of ASCs combined with α-TCP or GS scaffolds resulted in increased bone repair. The higher efficacy of the α-TCP scaffold suggests osteoconductive property that results in a biological support to the cells, whereas the GS scaffold functions just as a carrier. These results confirm the potential of ASCs in accelerating bone repair in in vivo experimental rat models. These results suggest a new alternative for treating bone defects.
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Tejido Adiposo/citología , Materiales Biocompatibles/farmacología , Regeneración Ósea/efectos de los fármacos , Fosfatos de Calcio/farmacología , Esponja de Gelatina Absorbible/farmacología , Trasplante de Células Madre/métodos , Andamios del Tejido , Animales , Materiales Biocompatibles/uso terapéutico , Fosfatos de Calcio/uso terapéutico , Adhesión Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Células Cultivadas , Fémur/patología , Fémur/cirugía , Fibroblastos/efectos de los fármacos , Formazáns , Esponja de Gelatina Absorbible/uso terapéutico , Masculino , Modelos Animales , Osteogénesis/efectos de los fármacos , Ratas Endogámicas SHR , Reproducibilidad de los Resultados , Sales de Tetrazolio , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Abstract Objectives This study aimed to evaluate the potential of adipose-derived stem cells (ASCs) combined with a modified α-tricalcium phosphate (α-TCP) or gelatin sponge (GS) scaffolds for bone healing in a rat model. Material and Methods Bone defects were surgically created in the femur of adult SHR rats and filled with the scaffolds, empty or combined with ASCs. The results were analyzed by histology and histomorphometry on days seven, 14, 30, and 60. Results Significantly increased bone repair was observed on days seven and 60 in animals treated with α-TCP/ASCs, and on day 14 in the group treated with GS/ASCs, when compared with the groups treated with the biomaterials alone. Intense fibroplasia was observed in the group treated with GS alone, on days 14 and 30. Conclusions Our results showed that the use of ASCs combined with α-TCP or GS scaffolds resulted in increased bone repair. The higher efficacy of the α-TCP scaffold suggests osteoconductive property that results in a biological support to the cells, whereas the GS scaffold functions just as a carrier. These results confirm the potential of ASCs in accelerating bone repair in in vivo experimental rat models. These results suggest a new alternative for treating bone defects.
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Animales , Masculino , Materiales Biocompatibles/farmacología , Regeneración Ósea/efectos de los fármacos , Fosfatos de Calcio/farmacología , Tejido Adiposo/citología , Trasplante de Células Madre/métodos , Andamios del Tejido , Esponja de Gelatina Absorbible/farmacología , Osteogénesis/efectos de los fármacos , Ratas Endogámicas SHR , Sales de Tetrazolio , Factores de Tiempo , Cicatrización de Heridas/efectos de los fármacos , Materiales Biocompatibles/uso terapéutico , Fosfatos de Calcio/uso terapéutico , Adhesión Celular/efectos de los fármacos , Células Cultivadas , Reproducibilidad de los Resultados , Resultado del Tratamiento , Modelos Animales , Proliferación Celular/efectos de los fármacos , Fémur/cirugía , Fémur/patología , Fibroblastos/efectos de los fármacos , Formazáns , Esponja de Gelatina Absorbible/uso terapéuticoRESUMEN
Objetivo: Describir los resultados de la embolización portal hepática (EPH) preoperatoria con lipiodol y gelatina absorbible para generar hipertrofia hepática y permitir la hepatectomía derecha en pacientes con tumores hepáticos e hígado remanente futuro insuficiente. Materiales y métodos: Entre marzo de 2002 y abril de 2014, en 18 pacientes candidatos a hepatectomía derecha se realizó EPH con lipiodol y esponja de gelatina absorbible mezclada con contraste yodado. La estimación de los volúmenes hepáticos preembolización se hizo por tomografía computada con contraste endovenoso. Los pacientes fueron abordados mediante punción percutánea bajo guía ecográfica, seguida de angiografía. El control de la hipertrofia con estimación del volumen se realizó a la cuarta semana posembolización y el seguimiento se llevó a cabo ambulatoriamente o mediante historia clínica. Resultados: La mediana de edad fue de 58 años (relación hombre/mujer de 1:0,8) y el volumen hepático total estimado (mediana) de 1587,75 cm³. La estimación previa del volumen hepático y su relación con la porción futura remanente pre-EPH fue de 19,9%, mientras que el promedio absoluto de crecimiento del parénquima hepático remanente futuro pos-EPH se encontró entre los 306,2 y 475,2 cm³, con un 43,5% de aumento. La mediana de incremento de la relación volumen hepático total y la porción remanente pos-EPH fue de 8,5% (p< 0,001). Como complicaciones, se registró un hematoma y una necrosis aséptica. Conclusión: La EPH con lipiodol y esponja de gelatina absorbible es un procedimiento seguro y efectivo, que surge como alternativa a otros materiales de embolización.
Objective: To evaluate outcomes of preoperative hepatic portal vein embolisation with lipiodol and absorbable gelatin in order to generate liver hypertrophy and enable right hepatectomy in selected patients with liver tumours and future insufficient residual liver. Materials and methods: Portal vein embolisation (PVE) with lipiodol and absorbable gelatin sponge mixed with iodine based contrast was performed in 18 patient candidates for right hepatectomy between March 2002 and April 2014. The preembolisation liver volume evaluations were performed by computed tomography with intravenous contrast. Patients underwent an ultrasound-guided percutaneous puncture, followed by angiography. The controls of hypertrophy and volume estimation were performed in the 4 th week after portal embolisation. The patients were followed-up on an outpatient basis or by using their medical records. Results: The median age was 58 years, with a 1:0.8 male: female ratio. The total estimated liver volume, excluding the tumour, of all patients evaluated prior to surgery was 1587.75 cm³ (median). The previous estimated liver volume and its relation to the future remaining portion before PVE was 19.9%. The absolute median growth of future residual liver parenchyma post-PVE was 306.2 to 475.2 cm³, being an increase of 43.5%, and the mean growth of liver volume and remaining portion ratio post-PVE was 8.5% (P<.001). Complications were one haematoma and one aseptic necrosis. Conclusión: The selection of patients is of paramount importance, and PVE with lipiodol and absorbable gelatin in our environment is a safe and effective procedure.
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Humanos , Masculino , Femenino , Embolia , Aceite Etiodizado , Neoplasias Hepáticas , Esponja de Gelatina Absorbible , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Splenic involvement secondary to blunt abdominal trauma is often treated by performing a splenectomy. The severity of the post-splenectomy syndrome is currently well known (blood loss, sepsis), so there is an increasing tendency to preserve the spleen. The case is presented of splenic preservation after blunt abdominal trauma with hilum involvement, emphasising the role of Floseal as a haemostatic agent, as well as the use of resorbable meshes to preserve the spleen. CLINICAL CASE: A 22-year-old woman presenting with a grade IV splenic lesion secondary to a blunt abdominal trauma after a traffic accident. Partial splenic resection was performed and bleeding was controlled with Floseal and use of a reinforcing polyglycolic acid mesh. No postoperative complications occurred, being discharged on day 5. The long-term follow-up has been uneventful. CONCLUSION: The use of haemostatic agents such as thrombin and the gelatine gel (FloSeal) and the use of polyglycolic acid meshes enable spleen-preserving surgery, making it a feasible and reproducible procedure and an alternative to classical splenectomy.
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Traumatismos Abdominales/cirugía , Tratamientos Conservadores del Órgano/métodos , Bazo/cirugía , Esplenectomía/métodos , Heridas no Penetrantes/cirugía , Accidentes de Tránsito , Electrocoagulación , Urgencias Médicas , Femenino , Esponja de Gelatina Absorbible , Hemorragia/etiología , Hemorragia/cirugía , Hemostasis Quirúrgica , Técnicas Hemostáticas , Humanos , Laceraciones/cirugía , Ácido Poliglicólico , Bazo/lesiones , Mallas Quirúrgicas , Adulto JovenRESUMEN
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.
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Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Hemorragia Gastrointestinal/prevención & control , Esponja de Gelatina Absorbible/uso terapéutico , Hemostasis/fisiología , Hemostáticos/uso terapéutico , Próstata/patología , Anciano , Anciano de 80 o más Años , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Métodos Epidemiológicos , Hemorragia Gastrointestinal/etiología , Técnicas Hemostáticas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Neoplasias de la Próstata/patología , Recto/cirugía , Valores de Referencia , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
INTRODUCTION: Several biomaterials can be used in ear surgery to pack the middle ear or support the graft. The absorbable gelatin sponge is the most widely used, but it may produce fibrosis and impair ventilation of the middle ear. OBJECTIVE: This experimental study aimed to investigate the inflammatory effects of the sugarcane biopolymer sponge (BP) in the rat middle ear compared with absorbable gelatin sponge (AGS). MATERIALS AND METHODS: Prospective experimental study design. Thirty adult female Wistar rats were allocated to receive the BP sponge into the right ear and AGS into the left ear. Animals were randomly killed at 4 and 12 weeks post-procedure. Qualitative histological assessments were performed to evaluate the inflammatory reaction in the tympanic bullae. RESULTS: The BP sponge caused inflammation more intense and persistent than AGS. The BP was not absorbed during the experiment. Fibrosis was observed only in the ears with AGS. There were thickening of the mucosa and neoangiogenesis in the group of AGS. CONCLUSION: Despite inflammation, the BP sponge produced less fibrosis and neoangiogenesis compared to AGS. The sponge BP appeared to be a non-absorbable biomaterial in the middle ear.
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Materiales Biocompatibles/uso terapéutico , Biopolímeros/uso terapéutico , Oído Medio/cirugía , Esponja de Gelatina Absorbible/uso terapéutico , Poríferos , Saccharum , Animales , Oído Medio/patología , Femenino , Membranas Artificiales , Estudios Prospectivos , Ratas WistarRESUMEN
INTRODUCTION: Several biomaterials can be used in ear surgery to pack the middle ear or support the graft. The absorbable gelatin sponge is the most widely used, but it may produce fibrosis and impair ventilation of the middle ear. OBJECTIVE: This experimental study aimed to investigate the inflammatory effects of the sugarcane biopolymer sponge (BP) in the rat middle ear compared with absorbable gelatin sponge (AGS). MATERIALS AND METHODS: Prospective experimental study design. Thirty adult female Wistar rats were allocated to receive the BP sponge into the right ear and AGS into the left ear. Animals were randomly killed at 4 and 12 weeks post-procedure. Qualitative histological assessments were performed to evaluate the inflammatory reaction in the tympanic bullae. RESULTS: The BP sponge caused inflammation more intense and persistent than AGS. The BP was not absorbed during the experiment. Fibrosis was observed only in the ears with AGS. There were thickening of the mucosa and neoangiogenesis in the group of AGS. CONCLUSION: Despite inflammation, the BP sponge produced less fibrosis and neoangiogenesis compared to AGS. The sponge BP appeared to be a non-absorbable biomaterial in the middle ear. .
INTRODUÇÃO: Existem diversos biomateriais que podem ser utilizados na cirurgia otológica para preencher a cavidade da orelha média ou dar suporte a enxertos. A esponja de gelatina absorvível é a mais utilizada, mas pode provocar fibrose e prejudicar a ventilação da orelha média. OBJETIVO: Investigar os efeitos da reação inflamatória provocada pela esponja do biopolímero da cana-de-açúcar (BP) comparada a esponja de gelatina absorvível (EGA) na mucosa da orelha média de ratos. MATERIAIS E MÉTODOS: Estudo experimental prospectivo. A esponja do BP foi implantada na orelha direita e a EGA na orelha esquerda de 30 ratos Wistar fêmeas. Os animais foram sacrificados com 4 e 12 semanas após o procedimento. Avaliação histológica qualitativa foi realizada para verificar a reação inflamatória na bula timpânica. RESULTADOS: A esponja do BP provocou exsudato inflamatório mais intenso e persistente que a EGA. O BP não foi absorvido durante o tempo de observação. Traves de fibrose foram observadas apenas nos ouvidos com a EGA. Houve espessamento da mucosa e neoangiogênese no grupo da EGA. CONCLUSÃO: Apesar da reação inflamatória, a esponja do BP provocou menos fibrose e neoangiogênese quando comparada a EGA. A esponja do BP comportou-se como um biomaterial não absorvível na orelha média. .
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Animales , Femenino , Materiales Biocompatibles/uso terapéutico , Biopolímeros/uso terapéutico , Oído Medio/cirugía , Esponja de Gelatina Absorbible/uso terapéutico , Poríferos , Saccharum , Oído Medio/patología , Membranas Artificiales , Estudios Prospectivos , Ratas WistarRESUMEN
INTRODUCTIONS: There are several materials for reconstruction of nasal dorsum deformities, which are divided into four categories: autologous, homologous, heterologous, and alloplastic grafts. OBJECTIVE: To compare experimental conditions through inflammatory time reactions in ear cartilage grafts with and without Gelfoam® when grafted on the nasal dorsum of rabbits. METHODS: This study included 30 rabbits, divided into two groups of 15 rabbits each (Gelfoam® and cartilage group and cartilage group), and then divided into three sub-groups of 7, 30, and 60 days of follow-up, where the 1.5 cm long and 0.5 wide grafts were placed in the stock grafting on the nasal dorsum of rabbits, half with and half without Gelfoam®. After the specified period, the rabbits in each group were euthanized, and the grafts were then submitted to a histological study. RESULTS: The experimental group revealed more neovascularization and granulation tissue formation; in terms of the presence of acute and chronic inflammatory process, the results were virtually identical in rabbits from both the control and experimental models in all three groups. CONCLUSION: There was no statistical difference to justify the use of Gelfoam® surrounding cartilage graft for nasal dorsum reconstruction.
Asunto(s)
Cartílago Auricular/trasplante , Esponja de Gelatina Absorbible/uso terapéutico , Tabique Nasal/cirugía , Animales , Conejos , Trasplante AutólogoRESUMEN
Introdução: Existem inúmeros materiais para reconstrução de deformidades do dorso nasal que Orelha são divididos em quatro categorias: enxertos autólogos, homólogos, heterólogos e aloplásticos. Objetivo: Comparar as condições através do tempo das reações inflamatórias do enxerto de cartilagem auricular com e sem Gelfoam® quando colocadas no dorso nasal de coelhos. Método: Foram estudados 30 coelhos, em dois grupos de 15 coelhos cada (Grupo com cartilagem e Grupo com cartilagem mais Gelfoam®) e em seguida subdivididos em três sub grupos de 7, 30 e 60 dias de seguimento onde os enxertos de 1,5 centímetro de comprimento e 0,5 de largura eram colocados metade com Gelfoam® e outra metade sem Gelfoam® na bolsa de enxertia sobre o dorso nasal de coelhos. Após o período determinado, os coelhos de cada grupo foram submetidos à eutanásia e a seguir os enxertos foram submetidos a estudo histológico. Resultados: O grupo experimental foram os que mais apresentaram neovascularização e formação de tecido de granulação e em relação a presença de processo inflamatório agudo e crônico, os resultados se mostraram praticamente iguais tanto nos coelhos do modelo controle quanto no experimental em todos os três grupos. Conclusão: Não há diferença estatística entre os grupos. .
Introductions: There are several materials for reconstruction of nasal dorsum deformities, which are divided into four categories: autologous, homologous, heterologous, and alloplastic grafts. Objective: To compare experimental conditions through inflammatory time reactions in ear cartilage grafts with and without Gelfoam® when grafted on the nasal dorsum of rabbits. Methods: This study included 30 rabbits, divided into two groups of 15 rabbits each (Gelfoam®and cartilage group and cartilage group), and then divided into three sub-groups of 7, 30, and 60 days of follow-up, where the 1.5 cm long and 0.5 wide grafts were placed in the stock grafting on the nasal dorsum of rabbits, half with and half without Gelfoam®. After the specified period, the rabbits in each group were euthanized, and the grafts were then submitted to a histological study. Results: The experimental group revealed more neovascularization and granulation tissue formation; in terms of the presence of acute and chronic inflammatory process, the results were virtually identical in rabbits from both the control and experimental models in all three groups. Conclusion: There was no statistical difference to justify the use of Gelfoam® surrounding cartilage graft for nasal dorsum reconstruction. .
Asunto(s)
Animales , Conejos , Cartílago Auricular/trasplante , Esponja de Gelatina Absorbible/uso terapéutico , Tabique Nasal/cirugía , Trasplante AutólogoRESUMEN
OBJECTIVE: The aim of this study was to evaluate otoscopic and microscopic changes produced on the healthy mucosa of the middle ear (ME) and tympanic membrane (TM) of guinea pigs after packing with a collagen polyvinylpyrrolidone (CPVP) sponge soaked in hyaluronic acid (HA). MATERIAL AND METHODS: In 24 guinea pigs, myringotomy on the right side was created and the ME was packed as follows: Group I (n = 6): Absorbable gelatin sponge (AGS) soaked in saline solution; Group II (n = 6): AGS sponge soaked in HA, Group III (n = 6): CPVP sponge soaked in saline solution, Group IV (n = 6): CPVP sponge soaked in HA. Four weeks after miringotomy, the ME and TM integrity and residual packing material were evaluated otoscopically. Histologically, we evaluated inflammatory changes on the ME mucosa. RESULTS: All animals in Groups I and II showed residual packing material (p < .001 ANOVA, TUKEY). Histologically, more inflammation was observed in Groups I, II, and III than in Group IV (p < .001 ANOVA, TUKEY). Group IV showed greater fibroblastic reaction (p < .02, ANOVA, TUKEY) versus other groups. CONCLUSION: The CPVP sponge soaked in HA used as ME packing material is biocompatible and nontoxic, because it produces minimal inflammatory changes on the healthy mucosa of the ME and TM of guinea pigs. However, more research with injured mucosa is needed to validate its usefulness in otosurgery.
Asunto(s)
Colágeno/farmacología , Oído Medio/cirugía , Ácido Hialurónico/farmacología , Membrana Mucosa/efectos de los fármacos , Povidona/farmacología , Animales , Femenino , Esponja de Gelatina Absorbible , Cobayas , Masculino , Ensayo de Materiales , Modelos Animales , Membrana Mucosa/patología , Otoscopía , Membrana Timpánica/efectos de los fármacos , Membrana Timpánica/patologíaRESUMEN
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.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Esponja de Gelatina Absorbible , Hemostáticos , Ilion/efectos de los fármacos , Ilion/trasplante , Bupivacaína/farmacología , Método Doble Ciego , Sistemas de Liberación de Medicamentos , Estudios ProspectivosRESUMEN
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.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Esponja de Gelatina Absorbible , Hemostáticos , Ilion/efectos de los fármacos , Ilion/trasplante , Adulto , Bupivacaína/farmacología , Método Doble Ciego , Sistemas de Liberación de Medicamentos , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
Recurrent, spontaneous bleeding is common in patients with hemophilia. The joints are commonly and repeatedly affected, and this can result in chronic synovitis and joint damage. Synoviorthesis or synovectomy are indicated after failure of appropriate medical management. Hemostasis in the perioperative period is paramount in these patients. We report a case study of a patient with hemophilia A inhibitors undergoing open synovectomy complicated by postoperative bleeding. In addition to an infusion of bypassing agents due to the presence of inhibitors, a topical hemostatic agent, FLOSEAL, and absorbable Gelfoam were applied. Hemostasis was achieved rapidly. The patient recovered without complications.
Asunto(s)
Esponja de Gelatina Absorbible/uso terapéutico , Hemartrosis/cirugía , Hemofilia A/cirugía , Hemostáticos/uso terapéutico , Hemorragia Posoperatoria/prevención & control , Sinovitis/cirugía , Adolescente , Hemartrosis/etiología , Hemofilia A/complicaciones , Humanos , Masculino , Sinovitis/etiología , Resultado del TratamientoRESUMEN
O infarto agudo do miocárdio resulta da obstrução temporária de uma coronária com redução de sangue para parte do miocárdio, bastando alguns minutos de interrupção do fluxo sanguíneo para estabelecer a injúria. Foi cateterizado a porção distal da origem do 1° ramo diagonal da artéria coronária interventricular esquerda de dois suínos e infundida solução de esponja hemostática de gelatina. Pós um período de 21 dias os animais foram eutanasiados e o coração foi processado para microscopia de luz, revelando expressiva cicatriz na região apical do ventrículo esquerdo em um animal enquanto que no outro, a lesão estava localizada na parede ventricular esquerda, e com menor extensão. Foi possível observar também a presença de áreas não pertencentes à região infartada, com grande depósito de colágeno, sugerindo um processo bastante heterogêneo. Desta forma, podemos concluir que esta técnica não é interessante para o desenvolvimento de modelo experimental de infarto agudo do miocárdio.
The acute infarction of myocardium results of the temporary blockage of coronary with reduction of blood for part of the myocardium, some minutes of interruption of the sanguineous flow are sufficient for the establishment of injury. Was catheterized the distal portion of the origin of the first diagonal branch of coronary interventricular left artery from two swine and a solution of haemostatic gelatin sponge was infused. After a period of 21 days the animals had been euthanized and the heart was processed for light microscopy, show an expressive scar in the apical region of the left ventricle in an animal whereas in the other, the injury was located in the left ventricular wall, and with lesser extension. It was possible also to observe the presence of areas not pertaining to the infarction region, with great collagen deposit, suggesting a heterogeneous process. In such a way, we can conclude that this technique is not interesting for the development of acute experimental model of infarction of the myocardium.
Asunto(s)
Animales , Porcinos , Esponja de Gelatina Absorbible/uso terapéutico , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/veterinaria , Modelos Animales de EnfermedadRESUMEN
PURPOSE: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction. METHODS: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist. RESULTS: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001). CONCLUSIONS: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.