Gelatine-Thrombin-Matrix zur Blutstillung: Einsatz bei der Tonsillektomie

Preparation and application of quick hemostatic gauze based on biomimetic mineralized thrombin

Thrombin is a serine protease known as activated coagulation factor II and is primarily applied as an effective local hemostatic agent. However, its clinical application is hindered by drawbacks, such as high sensitivity to the surrounding environment, instability and poor storage stability, easy inactivation, and low bioavailability. The biological functions of biomacromolecules in harsh environments can be preserved through biomineralization. Despite the success of biomimetic mineralization, limited consideration has been given to the mineral-based methods and the effect of various metal ions on enzyme activity. To explore an efficient technique for biomimetic mineralized thrombin, six kinds of ion/thrombin hybrid microflowers and two kinds of thrombin/MOF were synthesized in this work. The results showed that Zn-HNFs-G exhibits good hemostatic effect and maintains high enzymatic activity when exposed to high-temperature conditions. Meanwhile, Fe-HNFs-G, Thrombin@ZIF-8-G and Thrombin@MAF-7-G possess negligible enzyme protection.

[In vivo-efficacy of an ear medication using gelatin powder as a vehicle for the therapy of canine otitis externa]

OBJECTIVE

Otitis externa is normally treated with daily topical medication. Longer application intervals may be useful to facilitate therapy. In this study, the in vivo efficacy of a gel preparation containing marbofloxacin, dexamethasone and enilconazole was compared to that of a commercial otologic agent containing marbofloxacin, dexamethasone and clotrimazole based on clinical signs, ear cytology and bacterial/fungal cultures.

MATERIAL AND METHODS

A gel preparation (group A) or a registered otologic agent (group B), respectively, was applied to 41 dogs. A total of 50 ears (25 per group) were analysed. The gel preparation was administered on days 0 and 5; the combination preparation was administered daily according to the manufacturer's recommendations. Dogs were reevaluated clinically and cytologically after 5 and 10 days. Initially and after 10 days, ear swabs were taken for bacterial and fungal cultures.

RESULTS

No significant clinical or cytological differences were found between the groups. Significantly more isolates resistant to marbofloxacin were identified in group A after 10 days, although >98% of marbofloxacin was still detectable in vitro after 15 days.

CONCLUSION

The clinical and cytological efficacy of a gel containing defined active agents applied twice 5 days apart was comparable to that of an authorised otologic agent applied once daily. There appears to be an increased risk with the gel in that a resistance to fluoroquinolones develops. Local adverse effects are also possible.

CLINICAL RELEVANCE

A gelatine preparation containing active agents may be an alternative to daily topical therapy of canine otitis externa. The development of resistances is possible.

Hemostatic glues in tonsillectomy: A systematic review

OBJECTIVES/HYPOTHESIS

The aim of this study was to compare use of hemostatic glues to conventional techniques of intraoperative hemostasis for tonsillectomy.

STUDY DESIGN

A systematic review of the literature and meta-analysis.

METHODS

All published prospective controlled trials that compared hemostatic glues to conventional techniques of hemostasis were identified. We performed a meta-analysis of articles comparing fibrin sealant to electrocautery, and of those comparing electrocautery to electrocautery plus fibrin hemostasis.

RESULTS

Seven studies were identified that made qualifications for review, with a total of 748 patients. Outcome measures were postoperative hemorrhage recorded by investigators, and visual analogue scores of pain for day 1, day 3, and day 10 postoperatively. Use of fibrin sealant was not associated with a reduction in hemorrhage rates following tonsillectomy when compared to electrocautery (pooled relative risk [RR] 0.315; 95% confidence intervals [CI]: 0.047-2.093, 224 patients). No statistical difference in bleeding rate was seen between electrocautery hemostasis alone, compared to electrocautery with fibrin sealant (pooled RR 1.742; 95% CI: 0.433-7.005, 108 patients). No statistically significant difference in pain was identified.

CONCLUSIONS

Pain and bleeding are significant causes of morbidity post-tonsillectomy. We conclude that there is no significant evidence to support hemostatic glues over current techniques for reducing severity of these outcomes. Consequently, we do not recommended hemostatic glues for routine use in current clinical practice. Studies were generally of low quality and inadequately powered to detect a statistical difference, even when pooled. We advocate further research to facilitate future meta-analysis.