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An Insight into Advanced Nanoparticles as Multifunctional Biomimetic Systems in Tissue Engineering
Published in Harishkumar Madhyastha, Durgesh Nandini Chauhan, Nanopharmaceuticals in Regenerative Medicine, 2022
Kusha Sharma, Abhay Tharmatt, Pooja A Chawla, Kamal Shah, Viney Chawla, Bharti Sapra, Neena Bedi
The first tissue-engineered skin products that were developed for the treatment of burns include Integra (Integra Lifesciences Corporation, USA), Epicel (Genzyme Biosurgery, USA), and TransCyte (Smith and Nephew, UK). Several products are available for chronic skin ulcer management, such as Apligraf (Organogenesis, USA), Dermagraft (Smith and Nephew, UK and Advanced Tissue Sciences, USA), EpiDex (Euroderm, Germany), Epibase (Laboratories Genévrier, France), and BioSeed-S (BioTissue Technologies, Germany). The tissue-engineered products are also commercially available for cosmetic surgery applications such as BioSeed-M and MelanoSeed (BioTissue Technologies AG, Germany) (Law et al., 2017). Several stem cell engineered products are currently in development and are being tested in clinical and preclinical trials (Wang et al., 2017). Nanoparticles (NP) are solid colloidal particles, and their size range is 10–200 nm. Their small size provides a high surface to volume ratio, one of their most attractive intrinsic properties (Acharya and Sahoo, 2011). Due to their size and surface properties, NPs can be exploited as theranostic agents, drug delivery systems, genetic material, and growth factors. NPs used in biomedicine must be biocompatible, and the stability of nanocarriers in biological media is crucial when formulating nanomedicines (Figure 1.1).
Surgical Management of Placenta Accreta
Published in Robert M. Silver, Placenta Accreta Syndrome, 2017
William M. Burke, Annette Perez-Delboy, Jason D. Wright
A number of topical hemostatic agents are currently available in the United States to promote hemostasis.43 While data are predominately based on small studies, these agents are being employed in a number of surgical disciplines and may be used as an adjunct to control bleeding in women who undergo peripartum hysterectomy. Topical absorbable agents include microfibrillar collagens, gelatins, and oxidized cellulose. The gelatin-based products including Gelfoam (Pharmacia, Kalamazoo, MI) and Surgifoam (Ethicon, Somerville, NJ) are porcine gelatin sponges that can be placed on surgical surfaces. These products cause platelet adherence and clot formation and can be soaked in thrombin prior to placement. Oxidized regenerated cellulose (Surgicel, Ethicon, Somerville, NJ) also consists of a matrix to facilitate clotting. Flowable matrix agents such as FloSeal (bovine gelatin and thrombin) (Baxter BioSurgery, Fremont, CA) and SurgiFlo (porcine gelatin) (Ethicon, Somerville, NJ) contain granules of collagen or gelatin that expand upon contact with blood to promote tamponade. Fibrin sealants provide fibrin and thrombin to promote the clotting cascade. Tisseel (Baxter BioSurgery, Fremont, CA) is composed of human fibrinogen and thrombin from pooled plasma with bovine aprotinin. Evicel (Ethicon, Somerville, NJ) is a similar product that contains fibrinogen and human thrombin. Synthetic, recombinant activated factor VII (rFVIIa) promotes coagulation in the presence of tissue factor at sites of active bleeding. While rFVIIa is approved in the United States for bleeding associated with hemophilia A and in patients with inhibitors of coagulation, the drug is being increasingly used for other causes of hemorrhage. Although publication bias is likely, rFVIIa has been used in a number of cases of postpartum hemorrhage with reported success rates of >70%.44 The cost of rFVIIa is often tens of thousands of dollars per patient and should only be used in cases of intractable hemorrhage.
Myiasis (Invasion of Human Tissues by Fly Larvae)
Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Physicians occasionally utilize fly maggots (primarily blow fly larvae) for the debridement of wounds and ulcers both in the United States and internationally.10–12 Historically, maggot therapy was commonly used in medicine until the advent of antibiotics in the 1940s, but lately the practice is increasingly being used again, especially in cases where antibiotics are ineffective or surgery is not possible.11 When raised on sterile media and properly handled, blow fly maggots are capable of debriding a wound without spreading further infection or feeding on living tissues. The most commonly used species of larvae for maggot debridement therapy (MDT) is Lucilia sericata in the family Calliphoridae.13,14 These sterile, live, medical-grade “biosurgery” maggots can be applied using a special “maggot cage” dressing that confines larvae to the wound site and prevents escape. The maggots are able to dissolve necrotic tissue and bacterial biofilms.15 Their excretions kill bacteria, dissolve old tissue, and stimulate generation of granulation tissue—a type of new, healthy tissue that forms in healing wounds.16 Once the maggots have been applied (dosing range for maggots per square centimeter varies from 4–10 maggots depending on healthcare provider and maggot type being used). Once they are sealed against the wound with dressings, they must be checked every 2–4 hours to ensure that the outer dressing is dry, the seal is strong, and that there are no openings from which the maggots can escape. Maggots can be left in the wound until the area has been debrided. Once necrotic tissue has been dissolved and ingested, the maggots will cease feeding, leaving only healthy tissue; they are not intended to harm the patient. After treatment is completed, the maggots can be disposed of with normal medical waste after flushing the wound thoroughly with sterile fluid to remove any residual maggots or excretions. Besides chronic wounds, MDT can be used for patients with malignant wounds, venous wounds, and burns.15 MDT may also be prescribed for patients whose condition is not stable enough to undergo surgical debridement. Patients with rapidly advancing infections or a deteriorating condition should not undergo MDT. The entire treatment can take anywhere from 4 days to several weeks to completely debride a wound, depending on the extent of the injury. Wounds must be open to the outside of the body, not completely dry, not near major blood vessels, and cannot include bone or tendon tissues.
Fluoroless endourological surgery for high burden renal and proximal ureteric stones: A safe technique for experienced surgeons
Published in Arab Journal of Urology, 2021
Elias M. Ayoub, Ali Bourgi, Josee Alsouki, Sleiman Merhej, Pierre Conort
When a high stone burden is confirmed, after an attempt at lasering, it is decided whether the mini-PCNL approach should be implemented, as explained to the patient before the procedure. In these cases, preoperative CT was suspicious of this situation and the patient was installed in a GMSV position. Percutaneous access is performed under double simultaneous control: ultrasonography (US) and retrograde fURS. US can detect the fURS tip moving in the ideal calyx to be punctured. When the needle is introduced under US-guidance, the fURS is monitored during all the different steps, from needle insertion to the 16-F mini-PCNL sheath introduction in the calyx. A wire (Sensor; Boston Scientific) is introduced percutaneously, retrieved with the fURS down to the bladder using a tipless basket as a grasper. Successive dilatations are then performed over the guidewire under fURS control. The mini-nephroscope (Karl-Storz Endoskope) is then introduced to complete stone fragmentation and extraction. The aim is to remove all fragments of >1 mm. The fURS is used to review all the calyces and check the stone-free status. The mini-nephroscope ensures the position of a 7-F ureteric catheter introduced in the Flexor sheath and fixed to a Foley catheter for few hours. The mini-nephroscope is retrieved just behind the papilla and a haemostatic matrix (Floseal™, Baxter BioSurgery, Vienna, Austria) is used to close the percutaneous tract.
Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes
Published in Hospital Practice, 2018
Manuel G Ramirez, Harel Deutsch, Nitin Khanna, Donald Cheatem, Dongyan Yang, Erik Kuntze
The gelatin-thrombin hemostatic matrix, Floseal® (F, Baxter BioSurgery, Vienna, Austria), is an active flowable topical hemostat that combines two independent hemostatic agents: patented bovine-derived gelatin granules and human thrombin that work in combination to form a stable clot at the bleeding site [16–18]. An advantage to the use of flowable hemostats is that they exhibit both passive and active mechanisms of action on the blood clotting cascade. The gelatin granules passively swell to produce a tamponade effect and the high concentrations of human thrombin component actively convert fibrinogen into fibrin monomers, accelerating clot formation [14,17,18]. F is currently approved by the US Food and Drug Administration for use in surgical procedures other than ophthalmologic, as an adjunct to hemostasis when control of bleeding by ligature or conventional procedures is ineffective or impractical.
Epidural multi-slitted microporous non-absorbable patch in decompressive craniectomy to facilitate cranioplasty: a preliminary study
Published in British Journal of Neurosurgery, 2018
Sui-To Wong, Wan-Nok Ho, Zhexi He, Kwong-Yui Yam
Concerning the use of synthetic absorbable patches, 2 reports have been published (Table 3). Oladunjoye et al used a gelatin film barrier (Gelfilm, Pfizer) placed epidurally in 62 patients during craniectomy.9 All patient underwent cranioplasty between 19 and 262 days (mean 54 days) after craniectomy. The post-craniectomy wound infection rate and post-cranioplasty wound infection rate were both 6.5%. Eight patients developed extra-axial fluid collections after cranioplasty; all were managed conservatively. Mumert et al used another synthetic absorbable patches – a chemically modified sodium hyaluronate plus carboxymethylcellulose sheet (Seprafilm, Genzyme Biosurgery).8 However, they described its use in only 3 patients, and cranioplasty was done shortly after craniectomy in 2 patients - 10 days, and 5 weeks respectively.