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Franceschini G. Commentary: A lymph node mediastinal foreign body reaction mimicking nodal metastasis: a case series. Front Med (Lausanne) 2023; 10:1259819. [PMID: 37822470 PMCID: PMC10562627 DOI: 10.3389/fmed.2023.1259819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Gianluca Franceschini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Woman and Child Health and Public Health, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Dolcetti V, Lori E, Fresilli D, Del Gaudio G, Di Bella C, Pacini P, D'Andrea V, Frattaroli FM, Vallone GG, Liberatore P, Pironi D, Canu GL, Calò PG, Cantisani V, Sorrenti S. US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy. Cancers (Basel) 2023; 15:cancers15092644. [PMID: 37174110 PMCID: PMC10177612 DOI: 10.3390/cancers15092644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND the aim of this study was to describe the ultrasound appearance of topical hemostatics after thyroidectomy. METHODS we enrolled 84 patients who were undergoing thyroid surgery and were treated with two types of topical hemostats, 49 with an absorbable hemostat of oxidized regenerated cellulose (Oxitamp®) and 35 with a fibrin glue-based hemostat (Tisseel®). All patients were examined using B-mode ultrasound. RESULTS In 39 patients of the first group (approximately 80%), a hemostatic residue was detected and in some cases confused with a native gland residue, or with cancer recurrence in oncological patients. No residue was detected in patients in the second group. The main ultrasound characteristics of the tampon were analyzed and arranged according to predefined patterns, and suggestions to recognize it and avoid wrong diagnoses were provided. A part of the group of patients with tampon residue was re-evaluated after 6-12 months, ensuring that the swab remained for months after the maximum resorption time declared by the manufacturer. CONCLUSIONS with equal hemostatic effectiveness, the fibrin glue pad is more favorable in the ultrasound follow-up because it creates reduced surgical outcomes. It is also important to know and recognize the ultrasound characteristics of oxidized cellulose-based hemostats in order to reduce the number of diagnostic errors and inappropriate diagnostic investigations.
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Affiliation(s)
- Vincenzo Dolcetti
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Eleonora Lori
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Daniele Fresilli
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Chiara Di Bella
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Patrizia Pacini
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Vito D'Andrea
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Fabrizio Maria Frattaroli
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giulia Giordana Vallone
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Piero Liberatore
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Daniele Pironi
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato (Cagliari), Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato (Cagliari), Italy
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Romero-López C, Butrón CG, Torri JA, Cárdenas E, Ros J, Martín I. Intraoperative ultrasound appearance of PAHACEL ® Absorbable Hemostat (oxidised regenerated cellulose) in small to medium size intraaxial lesions localization. Neurochirurgie 2023; 69:101405. [PMID: 36680852 DOI: 10.1016/j.neuchi.2023.101405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 01/21/2023]
Affiliation(s)
- C Romero-López
- Department of Neurosurgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain.
| | - C G Butrón
- Department of Neurosurgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - J A Torri
- Department of Neurosurgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - E Cárdenas
- Department of Neurosurgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - J Ros
- Department of Neurosurgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain
| | - I Martín
- Chief of department of Neurosurgery, Hospital Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain
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Franceschini G. Breast conserving surgery using oxidized regenerated cellulose as filling biomaterial: recommendations to improve clinical outcomes. BMC WOMENS HEALTH 2021; 21:281. [PMID: 34348697 PMCID: PMC8336085 DOI: 10.1186/s12905-021-01436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/29/2021] [Indexed: 11/10/2022]
Abstract
Oxidized regenerated cellulose is considered an optimal local hemostatic agent thanks to its favorable biocompatibility, absorption characteristics and ease-of-use. Recently, oxidized regenerated cellulose has also been used as a filler in breast conserving surgery with a reconstructive purpose in order to repair partial breast defects and improve aesthetic outcomes. However, some postoperative problems due to its use, such as allergic reactions, seroma, foreign-body reaction and misdiagnosis during the follow-up of breast cancer patients, have been shown. These possible surgical complications can undermine clinical outcomes and lead to delay the beginning of oncological treatments with a negative impact on patient quality of life and survival. An adequate surgical expertise and the compliance with some specific recommendations are crucial in order to minimize postoperative issues and optimise aesthetic outcomes.
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Affiliation(s)
- Gianluca Franceschini
- Multidisciplinary Breast Unit, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy. .,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
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Franceschini G. Use of Oxidized Regenerated Cellulose as a Hemostatic Agent in Neurosurgery: Appraisals and Recommendations to Prevent Postoperative Complications and Facilitate Follow-Up. Surg Technol Int 2021; 38:481-485. [PMID: 33592670 DOI: 10.52198/21.sti.38.ns1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neurosurgical hemostasis can be performed with bipolar coagulation and with the support of several dedicated biomaterials including oxidized regenerated cellulose (ORC; e.g., Surgicel®, Johnson & Johnson, New Brunswick, NJ, USA). Oxidized regenerated cellulose is a sterile absorbable fibrous biomaterial that has become a major local hemostatic agent thanks to its ease of use, favorable biocompatibility and bioabsorption characteristics. However, some postoperative issues associated with its use, such as allergic reaction, seroma, foreign-body reaction with compressive neuropathies and misdiagnosis during follow-up, have been reported. These complications could compromise clinical outcomes with a negative impact on patient quality of life and sometimes require risky major surgical procedures. An understanding of the specific properties of ORC combined with adequate surgical expertise and compliance with some basic rules are needed to optimize clinical outcomes and minimize postoperative issues.
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Affiliation(s)
- Gianluca Franceschini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS; Università Cattolica del Sacro Cuore Multidisciplinary Breast Unit, Department of Woman and Child Health and Public Health. Largo Agostino Gemelli, Rome, Italy
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Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose. Carbohydr Polym 2019; 216:213-216. [DOI: 10.1016/j.carbpol.2019.04.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 11/19/2022]
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Piozzi GN, Reitano E, Panizzo V, Rubino B, Bona D, Tringali D, Micheletto G. Practical Suggestions for Prevention of Complications Arising from Oxidized Cellulose Retention: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:812-819. [PMID: 29991675 PMCID: PMC6066980 DOI: 10.12659/ajcr.910060] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature. CASE REPORT A 51-year-old male patient presented in our emergency department with acute abdominal pain, nausea, and vomiting. The patient had been admitted in our department for laparoscopic cholecystectomy for acute cholecystitis 25 months previously. Abdominal ultrasound and CT scan showed the presence of a cystic circular mass, with homogeneous fluid content, close to the surgical clips of the previous surgery, resembling a "neogallbladder". Laparoscopic abdominal exploration and drainage were performed. Histological examination reported protein-based amorphous material with rare lymphocytes and macrophages. Culturing was negative for bacterial growth. The patient was discharged uneventfully on the 4 th postoperative day. The primary surgical report was evaluated with evidence of application of Gelita-Cel ® Standard for hemostatic purposes. Results of 12-month follow-up were normal. CONCLUSIONS Herein, we report the first case of a complication associated with the use of Gelita-Cel ® Standard. We reviewed the literature to better define the purpose and limits of oxidized cellulose use as a hemostatic agent. Despite the fundamental role of oxidized cellulose as a hemostatic agent, we provide some practical suggestions to prevent the reported severe complications and surgical overtreatments.
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Affiliation(s)
| | - Elisa Reitano
- Department of General Surgery, University of Milan, Milano, Italy
| | - Valerio Panizzo
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Barbara Rubino
- Department of Pathology, IRCCS Policlinico San Donato Hospital, San Donato Milanese, Italy
| | - Davide Bona
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Domenico Tringali
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Giancarlo Micheletto
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
- Department of Medical and Surgical Pathophysiology and Transplantation, Policlinico Hospital, Milano, Italy
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Lee J, Jung JH, Kim WW, Yang JD, Lee JW, Li J, Park HY. Comparison of two different types of oxidized regenerated cellulose for partial breast defects. J Surg Res 2017. [PMID: 28624048 DOI: 10.1016/j.jss.2017.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A defect after partial mastectomy, sometimes, is hard to be filled with patient's own breast tissue. Two different types of oxidized regenerated cellulose (ORC) for filling of partial defects in small-sized breasts were compared with respect to clinicopathologic factors and outcomes. METHODS A total of 45 patients with breast cancer underwent conventional partial mastectomy with insertion of an ORC filling material. The two filling materials used were a hemostasis-purposed ORC and adhesion barrier-purposed ORC. Clinical factors were compared between these two ORC materials. Both the surgeon and patient assessed the cosmetic outcomes using the Harvard/NSABP/RTOG Breast Cosmesis Grading Scale. RESULTS Partial mastectomy with filling material insertion technique was not inferior to partial mastectomy-only technique in many clinical aspects. And most of the clinicopathologic factors showed no significant difference between the two groups. However, the mean operation time was significantly shorter in the hemostasis-purposed ORC group (P = 0.027). In addition, the infection rate was significantly higher in the adhesion barrier-purposed ORC group (P = 0.040). CONCLUSIONS Reconstructive surgery using a hemostasis-purposed ORC was associated with a shorter operation time and lower incidence of postoperative infection than that using an adhesion barrier-purposed ORC. However, both types of ORC were feasible as filling compounds for partial defects of the breast.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jeong Woo Lee
- Department of Plastic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Junjie Li
- Department of Surgery, Sichuan Province Cancer Hospital, Chengdu, China
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
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Kim SH, Kim SH, Yoon HS, Kim HK, Kim KS. Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery. Yonsei Med J 2017; 58:195-205. [PMID: 27873514 PMCID: PMC5122638 DOI: 10.3349/ymj.2017.58.1.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/10/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Adequate hemostasis is important for postoperative outcomes of abdominal surgery. This study evaluated the hemostatic effects and accompanying histopathological changes of a novel oxidized regenerated cellulose, SurgiGuard®, during abdominal surgery. MATERIALS AND METHODS Ten pigs underwent wedge resection of the spleen (1×1 cm) and liver (1.5×1.5 cm). The resected surface was covered with Surgicel® fabric or fibril type (Group A) or SurgiGuard® fabric or fibril type (Group B). Surgicel® and SurgiGuard® were randomized for attachment to the resected surface by fabric type (n=5) or fibril type (n=5). Blood loss was measured 5, 7, and 9 min after resection. Pigs were necropsied 6 weeks postoperatively to evaluate gross and histopathological changes. RESULTS There was no significant difference in total blood loss between groups [spleen fabric: Group A vs. Group B, 4.38 g (2.74-6.43) vs. 3.41 g (2.46-4.65), p=0.436; spleen fibril: Group A vs. Group B, 3.44 g (2.82-6.07) vs. 3.60 g (2.03-6.09), p=0.971; liver fabric: Group A vs. Group B, 4.51 g (2.67-10.61) vs. 6.93 g (3.09-9.95), p=0.796; liver fibril: Group A vs. Group B, 3.32 g (2.50-8.78) vs. 3.70 g (2.32-5.84), p=0.971]. Histopathological analysis revealed no significant difference in toxicities related to Surgicel® or SurgiGuard® [inflammation, fibrosis, foreign bodies, and hemorrhage (spleen: p=0.333, 0.127, 0.751, and 1.000; liver: p=0.155, 0.751, 1.000, and 1.000, respectively)]. CONCLUSION SurgiGuard® is as effective and non-toxic as Surgicel® in achieving hemostasis after porcine abdominal surgery.
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Affiliation(s)
- Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sung Yoon
- Department of Quality Assurance, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Hyun Kyoon Kim
- Department of Research and Development, Medical Device Program, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Kyung Sik Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Magnetic resonance imaging appearance of oxidized regenerated cellulose in breast cancer surgery. Radiol Med 2016; 121:688-95. [PMID: 27262578 DOI: 10.1007/s11547-016-0656-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe magnetic resonance imaging (MRI) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in surgical cavity. MATERIALS AND METHODS We retrospectively reviewed 51 MRI examinations performed between January 2009 and January 2014 in 51 patients who underwent BCS with ORC implantation. RESULTS In 29/51 (57 %) cases, MRIs showed abnormal findings with three main MRI patterns: (1) complex masses: hyperintense collections on T2-weighted (w) images with internal round hypointense nodules without contrast enhancement (55 %); (2) completely hyperintense collections (17 %); and (3) completely hypointense lesions (28 %). All lesions showed rim enhancement on T1w images obtained in the late phase of the dynamic study with a type 1 curve. Diffusion-weighted imaging was negative in all MRIs and, in particular, 22/29 (76 %) lesions were hyperintense but showing ADC values >1.4 × 10(-3) mm(2)/s, while the remaining 7/29 (24 %) lesions were hypointense. In four cases, linear non-mass-like enhancement was detected at the periphery of surgical cavity; these patients were addressed to a short-term follow-up, and the subsequent examinations showed the resolution of these findings. CONCLUSION When applied to surgical residual cavity, ORC can lead alterations in surgical scar. This could induce radiologists to misinterpret ultrasonographic and mammographic findings, addressing patients to MRI or biopsy; so knowledge of MRI specific features of ORC, it is essential to avoid misdiagnosis of recurrence.
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