In-vivo wound healing activity of a novel composite sponge loaded with mucilage and lipoidal matter of Hibiscus species.

Many researches have been undergone to hasten the natural wound healing process. In this study, several Hibiscus species (leaves) were extracted with petroleum ether, methanol, and their mucilage was separated. All the tested species extracts were assessed for their viability percentage using the water-soluble tetrazolium. H.syriacus was the plant of choice to be incorporated in a new drug delivery system and evaluated for its wound healing activity. H.syriacus petroleum ether extract (PEE) showed a high percentage of palmitic and oleic acids while its mucilage demonstrated high glucosamine and galacturonic acid. It was selected to be formulated and pharmaceutically evaluated into three different composite sponges using chitosan in various ratios. Fourier-transformed infrared spectroscopy investigated the chemical interaction between the utilized sponges' ingredients. Morphological characteristics were evaluated using scanning electron microscopy. H.syriacus composite sponge of mucilage: chitosan (1:5) was loaded with three different concentrations of PEE. Medicated formulations were assessed in rat model of excision wound model. The wound healing ability was clearly proved by the clinical acceleration, histopathological examination, and modulation of correlated inflammatory parameters as tumor necrosis factor in addition to vascular endothelial growth factor suggesting a promising valuable candidate that supports the management of excision wounds using single-dose preparation.

Antibacterial and Hemostatic Thiol-Modified Chitosan-Immobilized AgNPs Composite Sponges.

Wound bleeding and infection are two of the major threats to patients' lives, but developing safe materials with high hemostasis efficiency and antibacterial activity remains a major challenge. Silver nanoparticles (AgNPs) are suitable as antibacterial agents in the hemostatic process, but the application is hampered because of easy accumulation of toxicity. Herein, thiol-modified chitosan (TMC) was prepared by modifying with mercaptosuccinic acid and then was used to immobilize AgNPs to obtain composite sponges (TMC/AgNPs) for stemming the bleeding and preventing infection. TMC/AgNPs sponges had complex interlaced tubular porous structure with high porosity (99.42%), indicating high absorption. TMC had high immobilization efficiency for AgNPs-the release rate of AgNPs was 14.35% after 14 days-but the TMC/AgNPs sponge still had excellent antibacterial activity against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. In vitro and in vivo experiments confirm that the TMC/AgNPs sponge had fast and efficient hemostatic performance in comparison with the PVF sponge, and its possible mechanism was the synergistic effect of high blood absorption capacity and the interaction between amino, sulfydryl, and blood cells. Furthermore, the TMC/AgNPs sponge can promote wound healing by preventing wound infection, while the PVF sponge cannot. More importantly, the sponges had good safety due to the immobilization of TMC for AgNPs.

Fabricating antimicrobial peptide-immobilized starch sponges for hemorrhage control and antibacterial treatment.

It is important to control immediate hemorrhage and prevent infection simultaneously in the wound management. However, most of hemostatic materials are associated with low efficiency of hemostasis, poor biocompatibility and lack of antimicrobial properties. A kind of starch-based macroporous sponges (KR-Sps) immobilized covalently with antimicrobial peptide KR12 using highly efficient thiol-ene photo click reaction were developed. The physical properties of these sponges could be fine-tuned by varying the ratio of modified starch/HS-PEG-SH and the polymer concentration. The in vitro and vivo results demonstrated that KR-Sps induced thrombosis, shortened clotting time and reduced the blood loss at bleeding site. Besides, KR12 immobilized sponge exhibited inherent antimicrobial properties against Gram (+) and (-) bacteria and methicillin-resistant Staphylococcus aureus (MRSA), which could maintain at least 5 days. Therefore, KR-Sps were believed to be an excellent candidate as hemostatic and antimicrobial product for the intraoperative wound management.

Effect of red propolis on hamster cheek pouch angiogenesis in a new sponge implant model.

PURPOSE: To evaluate the effects of red propolis on cheek pouch angiogenesis in a hamster new model sponge implant. METHODS: Forty eight animals divided into eight groups. (Groups I-IV), the animals were treated for 15 days before and 10 days after sponge implantation. (Groups V-VIII), the animals were treated for 10 days after sponge implantation (GI and GV: red propolis 100 mg/kg, GII and GVI: celecoxib 20 mg/kg, GIII and GVII: 1% gum arabic 5 mL/kg, GIV and GVIII: distilled water 5 mL/kg). On the 11th day of implantation, the animals were anesthetized for stereoscopic microscopic imaging and morphometric quantification of angiogenesis (SQAN), followed by histopathological evaluation (H&E). RESULTS: In the SQAN analysis, no significant difference was found between the groups. However, on histology, propolis was found reduce the population of mastocytes in the qualitative analyses (p = 0,013) in the quantitative analyses to reduce the number of blood vessels (p = 0,007), and increase the macrophage count (p = 0,001). CONCLUSION: Red propolis inhibited inflammatory angiogenesis when administered before andcontinuously after sponge implant, and was shown to have immunomodulating effects on inflammatory cells (mastocytes and macrophages) in a new sponge implant hamster model.

Effect of red propolis on hamster cheek pouch angiogenesis in a new sponge implant model

Abstract Purpose: To evaluate the effects of red propolis on cheek pouch angiogenesis in a hamster new model sponge implant. Methods: Forty eight animals divided into eight groups. (Groups I-IV), the animals were treated for 15 days before and 10 days after sponge implantation. (Groups V-VIII), the animals were treated for 10 days after sponge implantation (GI and GV: red propolis 100 mg/kg, GII and GVI: celecoxib 20 mg/kg, GIII and GVII: 1% gum arabic 5 mL/kg, GIV and GVIII: distilled water 5 mL/kg). On the 11th day of implantation, the animals were anesthetized for stereoscopic microscopic imaging and morphometric quantification of angiogenesis (SQAN), followed by histopathological evaluation (H&E). Results: In the SQAN analysis, no significant difference was found between the groups. However, on histology, propolis was found reduce the population of mastocytes in the qualitative analyses (p = 0,013) in the quantitative analyses to reduce the number of blood vessels (p = 0,007), and increase the macrophage count (p = 0,001). Conclusion: Red propolis inhibited inflammatory angiogenesis when administered before andcontinuously after sponge implant, and was shown to have immunomodulating effects on inflammatory cells (mastocytes and macrophages) in a new sponge implant hamster model.

Surgical sponge blood salvage spinning device design and testing.

One method to clear intraoperative blood from the surgical field is to remove blood with surgical sponges. Currently, absorbed blood cannot be retrieved effectively and is lost. A spinning device was created to salvage red blood cells from the sponges. With this device the sponges are gently washed with saline and the resultant bloody fluid can be delivered to a cell saver to prepare it for autologous blood transfusion. In this article, we demonstrate how a novel sponge extractor can be used to extract blood from sponges. Several tests were conducted with porcine blood to optimise viable blood salvage by varying spin speed, and spin time of the device. At spin speeds greater than 1000 RPM, the blood salvaged from the device was similar to blood volumes obtained by hand wringing sponges. Cell viability testing yielded no significant differences in haemolysis for device trials compared to gently hand wringing. Spin time testing showed no significant differences in the blood salvaged at times greater than one minute. Optimal parameters for the device were determined to be a one-minute spin time at 1500 RPM.

Brazilian green propolis modulates inflammation, angiogenesis and fibrogenesis in intraperitoneal implant in mice.

BACKGROUND: Chronic inflammatory processes in the peritoneal cavity develop as a result of ischemia, foreign body reaction, and trauma. Brazilian green propolis, a beeswax product, has been shown to exhibit multiple actions on inflammation and tissue repair. Our aim was to investigate the effects of this natural product on the inflammatory, angiogenic, and fibrogenic components of the peritoneal fibroproliferative tissue induced by a synthetic matrix. METHODS: Chronic inflammation was induced by placing polyether-polyurethane sponge discs in the abdominal cavity of anesthetized Swiss mice. Oral administration of propolis (500/mg/kg/day) by gavage started 24 hours after injury for four days. The effect of propolis on peritoneal permeability was evaluated through fluorescein diffusion rate 4 days post implantation. The effects of propolis on the inflammatory (myeloperoxidase and n-acetyl-ß-D-glucosaminidase activities and TNF-α levels), angiogenic (hemoglobin content-Hb), and fibrogenic (TGF-ß1 and collagen deposition) components of the fibrovascular tissue in the implants were determined 5 days after the injury. RESULTS: Propolis was able to decrease intraperitoneal permeability. The time taken for fluorescence to peak in the systemic circulation was 20±1 min in the treated group in contrast with 15±1 min in the control group. In addition, the treatment was shown to down-regulate angiogenesis (Hb content) and fibrosis by decreasing TGF-ß1 levels and collagen deposition in fibroproliferative tissue induced by the synthetic implants. Conversely, the treatment up-regulated inflammatory enzyme activities, TNF-α levels and gene expression of NOS2 and IFN-γ (23 and 7 fold, respectively), and of FIZZ1 and YM1 (8 and 2 fold) when compared with the untreated group. CONCLUSIONS: These observations show for the first time the effects of propolis modulating intraperitoneal inflammatory angiogenesis in mice and disclose important action mechanisms of the compound (downregulation of angiogenic components and activation of murine macrophage pathways).

Blue-violet light-emitting diode irradiation in combination with hemostatic gelatin sponge (Spongel) application ameliorates immediate socket bleeding in patients taking warfarin.

OBJECTIVE: The control of bleeding after tooth extraction is a major concern in patients taking warfarin. Light-emitting diode (LED) irradiation with hemostatic gelatin sponge application was investigated. STUDY DESIGN: Patients who took warfarin and required tooth extraction were divided randomly into 3 groups. The first group was irradiated with blue-violet LED after tooth extraction. The second group was treated with a hemostatic gelatin sponge and LED irradiation. The third group was treated with only hemostatic gelatin sponges. Hemostasis was evaluated at 30 seconds after treatment. RESULTS: Less than 30% of the patients achieved hemostasis within 30 seconds in the hemostatic sponge group; approximately 50% of the patients in the simple LED irradiation group achieved hemostasis within 30 seconds; and 86.7% of the patients in the LED and hemostatic sponge combined group achieved hemostasis within 30 seconds, indicating that combined treatment with LED and hemostatic sponges provided a significantly higher hemostasis than in the hemostatic sponge group (P < .01). CONCLUSIONS: Blue-violet LED irradiation combined with hemostatic gelatin sponge treatment yielded hemostasis of the extraction socket within 30 seconds without suture in most cases.

Standardization of a method to study angiogenesis in a mouse model.

In the adult organism, angiogenesis is restricted to a few physiological conditions. On the other hand, uncontrolled angiogenesis have often been associated to angiogenesis-dependent pathologies. A variety of animal models have been described to provide more quantitative analysis of in vivo angiogenesis and to characterize pro- and antiangiogenic molecules. However, it is still necessary to establish a quantitative, reproducible and specific method for studies of angiogenesis factors and inhibitors. This work aimed to standardize a method for the study of angiogenesis and to investigate the effects of thalidomide on angiogenesis. Sponges of 0.5 x 0.5 x 0.5 cm were implanted in the back of mice groups, control and experimental (thalidomide 200 mg/K/day by gavage). After seven days, the sponges were removed. The dosage of hemoglobin in sponge and in circulation was performed and the ratio between the values was tested using nonparametric Mann-Whitney test. Results have shown that sponge-induced angiogenesis quantitated by ratio between hemoglobin content in serum and in sponge is a helpful model for in vivo studies on angiogenesis. Moreover, it was observed that sponge-induced angiogenesis can be suppressed by thalidomide, corroborating to the validity of the standardized method.

Use of gentamicin collagen sponges for the treatment of periprosthetic breast implant infection.

The infection of a breast implant or tissue expander is a major complication with significant psychological and medical ramifications. The incidence has been reported to range from 1.1% in cosmetic augmentations to as high to 24% in a series of reconstructive cases. Gentamicin Surgical Implant is a surgical implant comprised of a lyophilised collagen matrix impregnated with a broad-spectrum antibiotic. When placed in the operative field, it achieves very high local concentrations of drug several fold above the minimal inhibitory concentrations; and the collagen carrier is absorbed. Its beneficial use has been reported in other fields of surgery. Gentamicin sponges were used in four cases of periprosthetic infections. The implants were removed, the pockets cleaned with pulse lavage and the implants were replaced, together with a gentamicin collagen implant. This was followed by a 6-week systemic antibiotic regimen. The patients had uneventful recovery and have not developed capsular contracture. Gentamicin collagen sponges may be used as an adjunct in the salvage of infected breast implants. Periprosthetic infections, as well as the use of gentamicin, are reviewed.

[Enteric anastomosis and Tachosil®]. / Anastomosi enteriche e Tachosil®.

AIM: Anastomotic leakage is a common complication of colorectal surgery. To date, no clinical study exists showing a significant effect in reducing its frequency by sealing the anastomosis with a fibrin glue-coated collagen patch; the aim of this study was to demonstrate the efficacy of Tachosil®. METHODS: We considered patients undergoing open resective colorectal surgery. In selected cases, the Tachosil® patches were wrapped around the anastomotic line. The onset of anastomotic leakage was either defined clinically and investigated by contrast enema and CT scan. RESULTS: From January 2010 to February 2011, 63 patients underwent colorectal surgery at our Institute. Tachosil® was used in 24 cases. We recorded six major surgical complications; all complicated cases were in the no-Tachosil® group. A shorter mean postoperative stay of 7.2 days was observed for patients where Tachosil® was applied compared to 9.3 days for patients of no- Tachosil® group. These difference was mainly related to anastomotic insufficiencies recorded in the no-Tachosil®, group. Fibrin-coated collagen glue is used in different fields of surgery to improve hemostasis and anastomotic healing. Our experience confirmed its safety with a low incidence of anastomotic leak. These experience is based on few, non-randomized cases and therefore cannot demonstrate a real efficacy of Tachosil® in anastomotic leak prevention. CONCLUSION: Anastomotic leakage is a relatively common and potentially catastrophic complication after gastrointestinal surgery. Our initial experience with Tachosil® has confirmed the safety of this patch and we can therefore suggest a possible positive effect on anastomotic healing.

Metformin inhibits inflammatory angiogenesis in a murine sponge model.

To investigate the effects of metformin on angiogenesis, on inflammatory cell accumulation and on production of endogenous cytokines in sponge implant in mice. Polyester-polyurethane sponges were implanted in Swiss mice and metformin (40 or 400mg/kg/day) was given orally for six days. The implants collected at day 7 postimplantation were processed for the assessment of hemoglobin (Hb), myeloperoxidase (MPO), N-acetylglucosaminidase (NAG) e collagen used as indexes for angiogenesis, neutrophil and macrophage accumulation and extracellular matrix deposition, respectively. Relevant inflammatory, angiogenic and fibrogenic cytokines were also determined. Metformin treatment attenuated the main components of the fibrovascular tissue, wet weight, vascularization (Hb content), macrophage recruitment (NAG activity), collagen deposition and the levels of transforming growth factor (TGF-beta1) intraimplant. A regulatory function of metformin on multiple parameters of main components of inflammatory angiogenesis has been revealed giving insight into the potential therapeutic underlying the actions of metformin.

Lidocaine spray vs tetracaine solution for transnasal fiber-optic laryngoscopy.

STATEMENT OF PROBLEM: The aim of this study was to evaluate the efficacy of lidocaine spray 10%, compared with tetracaine 2% solution, as a local anesthetic for patients undergoing transnasal fiber-optic laryngoscopy. METHOD OF STUDY: A prospective study was conducted on patients undergoing transnasal fiber-optic laryngoscopy. Microsurgical sponges were applied in each side of the nose for 10 minutes before laryngoscopy. Patients were randomly classified into group A and group B, in which tetracaine 2% solution and lidocaine spray 10% were used, respectively. Patients were asked to evaluate the severity of pain during the procedure by a visual analog scale. Patients data, pain score, and potential complications were placed in a database and statistically assessed. MAIN RESULTS: Our series consisted of 48 patients. Statistical analysis showed significant lower mean nasal discomfort score in favor of the tetracaine group (2.29 vs 3.04 [P < .001]). No tetracaine complications or side effects occurred. PRINCIPAL CONCLUSION: Neurosurgical sponge application of tetracaine 2% solution is an easy, safe, inexpensive, and effective analgesia for transnasal fiber-optic laryngoscopy.

Effectiveness of Ankaferd blood stopper in the topical control of active bleeding due to cutaneous-subcutaneous incisions.

OBJECTIVE: To assess the effectiveness of Ankaferd blood stopper (ABS) in the topical control of bleeding due to cutaneous/subcutaneous incisions. METHODS: We included in this study, 69 patients with cancer that were admitted for port insertion to the Emergency Department of Gaziantep University Hospital, Gaziantep, Turkey, between May and July 2008. We used the wet compress form of ABS in 37 patients (group I), and regular dry sterile sponges in 32 patients (group II), to stop the bleeding that occurs during the clinically indicated vascular port insertion in patients with cancer. The success rate in terms of bleeding control, time needed to stop the bleeding, recurrence of bleeding, and complications were recorded. RESULTS: A total of 69 patients were included in this study. The average time needed to stop the bleeding was 32.97 +/- 29.9 seconds for group I, and 123.75 +/- 47.5 seconds for group II. Bleeding restarted in 24% in group I, and in 50% in group II. Among the patients in group I, 13.5% developed localized redness, and 8.1% minor swelling, while 8.1% reported local pain at the wound site; in 5.4% of the patients, the sutures at the wound site opened. The same parameters were recorded for group II; 9.4% for localized redness, 0.0% for minor swelling, 6.2% reported local pain, and the sutures at the wound site opened in 3.2% (p=0.592). CONCLUSION: The Ankaferd blood stopper was proven to stop local bleeding in a shorter time, with a lower recurrence rate in comparison with the sterile sponge.

Cuerpos extraños en abdomen: presentación de casos y revisión bibliográfica / Foreign bodies in the abdomen: case presentations and literature review

Los cuerpos extraños en abdomen constituyen un grupo de pseudotumores que corresponden a material no absorbible que, a diferencia de otros, no cumple ningún efecto terapéutico. Constituyen una complicación de un procedimiento quirúrgico o una nueva patología para el paciente, que obedece a un suceso iatrogénico de gran morbimortalidad y causan dificultades diagnósticas, sobrecostos y posibles problemas médico-legales. Con el advenimiento de la cirugía por laparoscopia (cirugía mínimamente invasiva), su incidencia ha descendido en forma importante. Se presenta un reporte de 6 casos cuyos curso clínico, complicaciones, estudios diagnósticos y tratamiento describen ampliamente las características de esta patología.

Comparison of the efficacy and safety of contact versus peribulbar anaesthesia in combined eye surgery.

PURPOSE: To compare the combined levels of comfort, the presence of complications and the results of phacotrabeculectomy surgery obtained with 2 different forms of anaesthesia: topical contact anaesthesia and peribulbar injected anaesthesia. PROCEDURES: In total, 120 consecutive patients undergoing phacotrabeculectomy were randomly assigned to each anaesthesia group. The patients were asked to rate their pain level on a 5-point scale at 3 time points during the procedure. Early and late surgical complications and clinical parameters of success were evaluated. RESULTS: Administration of contact anaesthesia was clearly associated with less pain than injection of peribulbar anaesthesia. The amount of pain or discomfort experienced during or following surgery did not differ between the patient groups. No long-term differences in the tensional results were observed between the groups of the study. CONCLUSION: The application of contact anaesthesia in the phacotrabeculectomy procedure provides a level of comfort and safety that is comparable to that achieved with peribulbar anaesthesia. Likewise, patients that received contact anaesthesia were as comfortable as patients that received the peribulbar injection of anaesthesia, not only during the immediate postoperative period, but also in terms of their tensional results and their visual acuity in the mid and long term.

An alternative dressing material for the split-thickness skin graft donor site: oxidized regenerated cellulose.

The split-thickness skin graft (STSG) donor sites have been treated with various and plenty of dressing techniques and materials. An ideal STSG donor site dressing should have antibacterial, hemostatic, and promoting epidermal healing properties. We have performed a prospective study to evaluate the effect of the oxidized regenerated cellulose on STSG donor site healing. Between January 2002 and January 2005, 40 patients who were operated in any kind of reconstructive operations with STSG donor sites were included in the study. One half of the wound was covered with oxidized regenerated cellulose and the other half of the same wound of the same patient was covered with fine mesh gauze treated with Furacin (nitrofurazone). The patients were grouped into 2 depending on the dressing technique: group I, semiclosed and group II, closed. The wounds were evaluated for healing time, infection, pain perception of the patient, and final esthetic results. The oxidized regenerated cellulose side of the group I was healed in a mean of 6.5 +/- 0.51 days; in group II, 5.4 +/- 0.50 days (range, 5-6 days). The fine mesh gauze treated with Furacin in group I was healed in a mean of 9.9 +/- 0.97 days (range, 8-11 days); in group II, 8.4 +/- 0.99 days (range, 7-10 days). There was a statistical significance between the oxidized regenerated cellulose side and the fine mesh gauze side (P < 0.001) in group I and group II separately. The difference between group I and group II was statistically significant in the oxidized regenerated cellulose side (P < 0.001), and the difference between group I and group II was statistically significant in the fine mesh gauze side (P < 0.005). The antibacterial, hemostatic, and absorbable property of the oxidized regenerated cellulose could ensure the utilization as an alternative STSG donor site dressing, especially because the positive influence over the wound healing was proven.

Lost 'swab' at inguinal hernioplasty under local anaesthesia.

Small surgical swabs should not be placed adjacent to polypropylene mesh prosthetics.