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PubMed1991

Irrigation for colostomized cancer patients: a rational approach.

Management of a colostomy by irrigation is simple and effective. Five hundred and nine patients having a colostomy for rectal cancer during the last 10 years were assessed by our Rehabilitation Department as potential candidates for irrigation. Fifty-two patients were considered unsuitable and 40 refused to learn the technique. The remaining 417 (82%) patients adopted the irrigation method. Of these, 97% achieved full continence of periods of 24 to 48 h. There was no case of colonic perforation. The median duration of irrigation was 230 days; 31.6% had been irrigating from 1 to 5 years and 10.3% for more than 5 years. There was a reduction of more than 50%/24 h in the number of appliances used by patients. Irrigation is a simple, safe and cost-effective means of managing a colostomy. With careful selection of patients, irrigation should be recommended as a routine part of rehabilitation.

Colostomy↗
PubMed1982

Bacterial adherence to urothelium following bladder irrigation in the rat.

We investigated the effects of bladder irrigation with various irrigation fluids at various temperatures and irrigation pressures on the adherence of 3H-labeled Escherichia coli O6 to bladder urothelium in a rat model. Sixty-four control and 108 experimental animals were studied. The latter were divided into five groups according to type of irrigation fluid (glycine 1.5%, sorbitol 2.7%, mannitol 0.54%, and H2O), fluid temperature, and intravesical pressure during irrigation. Only rats undergoing high pressure (60 cm H2O) bladder irrigation demonstrated significant increases in bacterial adherence compared to controls. No differences were found with the different irrigation fluids. This study suggests that high intravesical pressure during transurethral surgery might enhance bacterial adherence to urothelium and thereby increase the risk of manifest infection in the postoperative course.

Animals↗
PubMed1996

Absorption of glycine irrigating solution during endoscopic transanal resection of rectal tumors.

PURPOSE: This study was undertaken to evaluate the potential metabolic complications of 1.5 percent glycine irrigating solution during endoscopic transanal resection (ETAR) of rectal tumors. METHODS: Thirteen consecutive frail patients (mean age, 81 (range, 57-91) years) undergoing 18 ETAR were prospectively studied from July 1993 to January 1995. Indications for ETAR included palliation of advanced rectal cancer (12 patients) and an extensive villous tumor (1 patient). A 27-French two-way Iglesias resectoscope was used. Packed cell volume, blood glucose, and serum concentrations of sodium, potassium, and creatinine were measured before, during (at 45 minutes), and after (at 6 and 24 hours) ETAR. Plasma concentration of glycine and hemoglobin levels were both measured preoperatively and at 45 minutes and 24 hours, respectively. Variables studied included resection time, volume and rate of irrigating fluid, height of irrigating fluid bag above operating table, resectate weight, occurrence of intraperitoneal and extraperitoneal perforation, blood loss, and clinical symptoms. RESULTS: Two patients were excluded. Mean operating time was 456 minutes. A mean of 192.3 liters of irrigant was infused into the rectum. Mean irrigation rate was 43,330 ml/minutes. Mean height of irrigating fluid bag was 692 cm. Extraperitoneal perforation occurred in two patients. Blood loss exceeded 200 ml in four patients, one of whom complained of nausea (operating time, 110 minutes). Mean rise in p-glycine at 45 minutes (10,028 mol/l; 387 percent of preoperative values) was significant (P = 0.006). Changes in packed cell volume, b-hemoglobin, b-glucose, s-sodium, and s-creatinine levels were not significant. There was significant correlation between p-glycine and s-creatinine levels at six hours (P = 0.033), between p-glycine levels and fall in s-sodium at 24 hours (P = 0.037), and between levels of b-hemoglobin and packed cell volume at 24 hours (P = 0.0004). There was a positive linear correlation between p-glycine and operating time (r = 0.7; P = 0.0026) and between p-glycine and volume of irrigating fluid (r = 0.5; P = 0.0386). CONCLUSIONS: Operating time best predicts increase of p-glycine in ETAR.

Adsorption↗
PubMed2001

Chemical colostomy irrigation with glyceryl trinitrate solution.

PURPOSE: Colostomy irrigation may improve patient quality of life, but is time consuming. This study tests the hypothesis that irrigation with glyceryl trinitrate solution, by inducing gastrointestinal smooth muscle relaxation, may accelerate expulsion of stool by passive emptying, thereby reducing irrigation time. METHODS: Fifteen colostomy irrigators(with more than 3 years' experience) performed washout with tap water compared with water containing 0.025 mg/kg glyceryl trinitrate. Fluid inflow time, total washout time, and hemodynamic changes occurring during glyceryl trinitrate irrigation were documented by an independent observer. Subjects recorded episodes of fecal leakage and overall satisfaction on a visual analog scale. Cramps, headaches, and whether or not a stoma bag was used were expressed as a percentage of number of irrigations. Comparison of fluid inflow time, total washout time, leakage, and satisfaction was by Wilcoxon's signed-rank test and headaches, cramps, and stoma bag use was by McNemar's test. Pulse rate (paired t-test), systolic and diastolic blood pressures (Wilcoxon's test) at 20 and 240 minutes after washout with glyceryl trinitrate solution were compared with baseline. RESULTS: Fifteen patients (9 female), with a mean age of 53 (31-73) years, provided 30 sessions (15 with water and 15 with glyceryl trinitrate). Medians (interquartile ranges) for water vs. glyceryl trinitrate were fluid inflow time 7 (4-10) vs. 4, (3-5; P = 0.001); total washout time 40 (30-55) vs. 21, (15-24; P < 0.001); leakage 0 (0-1) vs. 0, (0-0; P = 0.02), satisfaction 10 (8-10) vs. 10 (9-10; P = 0.31). The number (percentage) of stoma bags, cramps, and headaches with water vs. glyceryl trinitrate were 7 (47 percent) vs. 7 (47 percent), P = 1; 1 (7 percent) vs. 14 (93 percent), P < 0.001; and 0(0 percent) vs. 14 (93 percent), P < 0.001, respectively. Changes in pulse (increase) and systolic and diastolic blood pressures (decrease) from baseline were maximal at 20 minutes (P < 0.001, P = 0.001, and P = 0.002, respectively) and had returned to baseline by 240 minutes (P = 0.52, P = 0.08, and P = 1, respectively). CONCLUSION: Glyceryl trinitrate solution significantly reduces colostomy irrigation time compared with the generally recommended tap water. Patients suffer fewer leakages and are highly satisfied, but side effects are potential drawbacks. Other colonoplegic agent solutions should now be evaluated.

Adult↗
PubMed2000

Iodine absorption after intraoperative bowel irrigation with povidone-iodine.

PURPOSE: Povidone-iodine is a commonly used intrarectal tumoricidal agent in patients undergoing colorectal surgery. The aim of this study was to assess systemic absorption of total iodine and its effect on thyroid function after intrarectal application. METHODS: Twenty patients with carcinoma of the rectum received intraoperative irrigation with either povidone-iodine (Group A; n = 10) or physiologic saline (Group B; n = 10). Ten patients with carcinoma of the sigmoid colon (group C) were treated the same as Group A. Electrolyte, total iodine, triiodothyronine, thyroxine, and thyroid-stimulating hormone values were measured in serum preoperatively and before intraoperative irrigation and immediately, ten minutes, 1 hour, 6 hours, 24 hours, and two weeks after irrigation. RESULTS: No significant changes occurred in serum electrolytes. A significant uptake of the total iodine was demonstrated in each group. Total iodine levels examined immediately, ten minutes, and one hour after irrigation in Group C were significantly higher than those examined in Group B. Maximum values were obtained one hour after irrigation in Groups A and B and six hours after irrigation in Group C. No significant changes occurred in triiodothyronine, thyroxine, and thyroid-stimulating hormone levels among the three groups. The decrease in triiodothyronine levels after surgery was demonstrated in each group. We noted a decrease after surgery in thyroxine levels for Groups A and B and in thyroid-stimulating hormone levels for Group B. Those hormones were not affected by the administration of povidone-iodine. CONCLUSION: High serum levels of iodine did not cause organ toxicity, suggesting that a single use of intraoperative bowel irrigation with povidone-iodine may be performed with practically negligible risk.

Adult↗
PubMed2006

Size does matter: 1.5 Fr. stone baskets almost double irrigation flow during flexible ureteroscopy compared to 1.9 Fr. stone baskets.

With a new generation of flexible ureterorenoscopes, a new area in stone management is emerging. Limitation of vision with these new instruments is often caused by insufficient irrigation flow, especially when using instruments like stone baskets, resulting from partial obstruction of the working and irrigation channel with these instruments. Empirically, new available smaller stone baskets seem to dramatically improve irrigation and therefore vision in clinical use. The goal of this study was to show objective differences in basket diameters and flow rates in an in vitro setting. Diameters and irrigation flows in flexible ureterorenoscopes depending on different sizes of stone baskets (Fr. 1.5-1.7-1.9-2.2-2.4-3.0) and different deflections were measured. The measured diameter of the baskets varied within the first 20 cm and the true measured size varied from the manufacturer's specified size to a different extent. The new generation of 1.5 and 1.7 Fr. baskets improved irrigation flow, even compared to the smallest commonly used baskets, up to 68%. Interestingly, deflection did not influence irrigation flow. This study confirmed the subjective impression of inadequate description of relevant basket diameters as well as that of a significant improvement of irrigation flow with the newest generation of stone baskets with smaller diameters.

Calibration↗
PubMed2004

Does professional preventive care benefit from additional subgingival irrigation?

The effect of an oral irrigator (Water Pik, Intersante) with a subgingival tip (Pik Pocket Subgingival Tip, Intersante) in the reduction of gingivitis was investigated in a single-blind three-group study involving 45 volunteers (age 46.2+/-10.2). All volunteers (inclusion criteria: gingivitis or a superficial periodontitis) were examined and underwent professional tooth cleaning at the first appointment. They were then randomly distributed in three groups: one group used the irrigator with the subgingival tip once daily with just tap water, in addition to their regular oral hygiene; another group also used an herbal-based mouth rinse (Parodontax, GlaxoSmithkline) in the water of the irrigator; a third group did not use an irrigator or any irrigant and therefore served as control. All groups received professional oral care education at each appointment. The investigation period was 3 months. At baseline and after 4, 8, and 12 weeks, the plaque index (PI, scores 0-5), gingival index (GI, scores 0-3), bleeding index (BI scores 0-5), and sulcus fluid flow rate (SFFR, Periotron 6000) at the Ramfjord teeth were scored. At baseline and after 3 months, the probing depth (millimeters) was measured at six surfaces of all teeth. A significant reduction in BI, PI, GI, probing depth, and SFFR was observed within 3 months. With all volunteers, however, there was no statistically significant difference ( p>/=0.05, Wilcoxon-test, SAS 6.04) between the three groups at any time. The additional use of the Water Pik irrigator with the Pik Pocket subgingival irrigation device with or without an herbal mouth rinse showed no clinical benefit over professional education in oral hygiene alone.

Dental Calculus↗
PubMed2005

Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer.

BACKGROUND: This is a prospective, randomized, controlled trial comparing the outcome of intraoperative colonic irrigation with that of manual decompression for acutely obstructing colorectal cancers distal to the splenic flexure. METHODS: All patients admitted to our department from June 1999 to August 2002 with obstructing left-sided colorectal cancers were recruited. Patients were randomized intraoperatively and were excluded if deemed unsuitable for segmental resection and primary anastomosis. Twenty-five patients were randomized to receive colonic irrigation and twenty-eight to receive manual decompression. Perioperative parameters and outcome including mortality and anastomotic leak were recorded. RESULTS: Both groups of patients were comparable in terms of gender and age. The time taken for mobilization, decompression, and irrigation in the colonic irrigation group (median, 31 minutes) was significantly longer than that for the manual decompression group (median, 13 minutes) (P; = 0.0005). However, the total time of the operation was similar for both groups. Times for recovery of bowel function, of wound infection, and until discharge from the hospital were also similar. In the manual decompression group there were two cases of anastomotic leak (8 percent, 2/25) requiring reoperation but none (0/24) in the colonic irrigation group. However, this difference was not statistically significant. CONCLUSION: Manual decompression of proximal colon without irrigation is as safe as colonic irrigation in one-stage surgical management of obstructing left-sided colorectal cancer.

Adult↗
PubMed2003

Management with closed irrigation for post-sternotomy mediastinitis: experience with the use of electrolyzed strong acid aqueous solution.

OBJECTIVE: The aim of this study was to assess the adequacy of our treatment strategy for patients with post-sternotomy mediastinitis. METHODS: Between May 1997 and December 2000, 1,045 consecutive adult cardiac operations were performed at our center. Mediastinitis occurred in 8 patients (0.77%) and as treatment, they underwent (1) aggressive debridement, (2) closed irrigation and drainage, and (3) transvenous administration of antibiotics. We irrigated the mediastinum with 0.1-1.0% povidone-iodine solution, alternating with electrolyzed strong acid aqueous solution. We subsequently reviewed the outcome after the closed irrigation treatment for patients with post-sternotomy mediastinitis. RESULTS: In four of the 8 patients, the culture specimen grew Methicillin-resistant Staphylococcus aureus. In the others, Serratia marcescens, Staphylococcus epidermidis, Pseudomonas aeruginosa and Gram-negative rods were cultured. The mean period between primary surgery and the diagnosis of mediastinitis was 16.3 (8 -57) days. The mean period between diagnosis of mediastinitis and the start of the irrigation treatment was 0.8 (0-3) days. The mean irrigation period was 30.0 (14-47) days. The irrigation complications were mild hepatic dysfunction in 2 patients, hyponatremia in 2 and protracted wound infection in 1. The hospital mortality was 1/8 (12.5%). Seven survivors are free from recurrent mediastinitis. CONCLUSIONS: Our experience of closed irrigation and drainage suggests that it can yield satisfactory results after post-sternotomy mediastinitis, comparable to other reported results with or without muscle flaps.

Adolescent↗
PubMed1990

Effect of various irrigating fluids on the ultrastructure of articular cartilage.

The effect of five different irrigating fluids on the ultrastructure of articular cartilage was studied utilizing the scanning electron microscope. Gross histologic studies have shown no significant difference amongst commonly used irrigating fluids on the surface or matrix composition of articular cartilage. Recent in vivo and in vitro biochemical studies, in addition, have shown no significant deleterious effects of irrigating fluids on articular cartilage composition. This study was prospectively undertaken to assess the effect of irrigating fluids on the ultrastructure of articular cartilage. When comparing five irrigating solutions utilizing the scanning electron microscope, specimens irrigated with 1.5% glycine seemed to show a more consistently smooth appearance. Ultrastructural changes were noted with the other four irrigating solutions tested.

Adult↗
PubMedDate not supplied

Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations.

INTRODUCTION: Chronic rhinosinusitis (CRS) exacerbations due to methicillin-resistant Staphylococcus aureus (MRSA) are routinely encountered. Treatment often involves intravenous antibiotics that provide only transient benefits. Mupirocin has well-recognized antistaphylococcal activity, and its nasal formulation is approved by the Food and Drug Administration for the eradication of nasal colonization with MRSA. OBJECTIVE: The aim of this study was to describe the use of mupirocin nasal irrigations for the treatment of CRS exacerbations due to MRSA. MATERIALS AND METHODS: Charts of patients who received mupirocin nasal irrigations for MRSA exacerbations of CRS between January 2000 and October 2003 were reviewed. RESULTS: Forty-two MRSA-positive cultures were obtained from 24 patients (mean age, 61 years; range, 38-82 years; 15 women and 6 men). Twenty-eight episodes were treated with mupirocin nasal irrigations and doxycycline; 4 were treated with mupirocin nasal irrigations and trimethoprim-sulfamethoxazole, and 7 episodes were treated with mupirocin nasal irrigations alone. Patients were reevaluated at approximately 4 to 6 weeks. Repeat cultures were not obtained in 12 patients (because of clinical and endoscopic resolution). Adequate follow-up was unavailable for 3 patients, and of the 27 repeat cultures, only 1 grew MRSA. Twelve patients had at least one recurrence, with a mean number of episodes of 1.75 (range, 1-8 episodes). The mean follow-up was 11.8 months (range, 3-27 months). CONCLUSIONS: Mupirocin nasal irrigations may avoid the need for intravenous antibiotics, which often provide temporary benefits and entail greater cost and morbidity. Thus, mupirocin nasal irrigations may provide a relatively simple means for the management of MRSA exacerbations of CRS.

Administration, Intranasal↗
PubMed1986

Empyema thoracis and infected pneumonectomy space: case for cyclical irrigation.

Between January, 1974, and July, 1984, 63 cases of pleural empyema were treated at Papworth Hospital, Cambridge. Twenty-one of these patients had cyclical irrigation of the empyema cavity, and 23 patients underwent decortication. The two groups were comparable in age and sex distribution. There was no significant difference in the duration of empyema between the two groups (7 and 10.4 weeks for the patients having irrigation and decortication, respectively) (p greater than 0.05). There was no correlation between the duration of empyema and the length of hospital stay in either group (r = 0.007 and 0.005 for the irrigation and decortication groups, respectively). However, both the mean duration of tube drainage (7 and 13.5 days) and the length of hospital stay (12.3 and 17.3 days) were significantly shorter in the irrigation than in the decortication group (p less than 0.01). There were two failures in the decortication group and three in the irrigation group. Cyclical irrigation was also used in 4 patients with infected pneumonectomy space with satisfactory results. We conclude that cyclical irrigation is an effective, simple, and time-saving technique that does not preclude the use of other procedures if it fails.

Adolescent↗
PubMed1997

Loss of the CDKN2A/p16 locus detected in bladder irrigation specimens by fluorescence in situ hybridization.

PURPOSE: We measured the CDKN2A/p16 tumor suppressor gene locus in bladder irrigation specimens and correlated the measurement with the clinical status of patients with bladder cancer. MATERIALS AND METHODS: Irrigation specimens were obtained at cystoscopy from 10 normal controls, 21 patients with bladder cancer in whom no concurrent bladder tumor was seen and 23 patients with bladder tumors. Deoxyribonucleic cytometry and fluorescence in situ hybridization measurements were made. One fluorescence in situ hybridization probe was specific to the chromosome 9 centromere and the other, COSp16, targeted the CDKN2A/p16 region on chromosome 9p21. Three rates were calculated, including the hyperdiploid fraction from deoxyribonucleic acid cytometry, disomic fraction from the 9 centromere count and COSp16F, the frequency of COSp16 in association with 9 centromere. Specimens were classified as positive or negative for each of these rates using cutoff points based on previous studies and the distribution of values obtained for the normal control specimens. RESULTS: Hyperdiploid fraction values were positive (greater than 8%) in 1 normal and 1 nontumor specimen. Ten specimens from patients with tumor showed elevated hyperdiploid fraction values. In 4 nontumor and 13 tumor irrigation specimens the chromosome 9 disomic fraction values were positive (less than 80%). COSp16F was positive (less than 83%) for 18 nontumor irrigation specimens and 18 tumor irrigation specimens. One normal, and 39 of 44 nontumor and tumor irrigation specimens were positive by at least 1 test. CONCLUSIONS: COSp16 loss is measurable in irrigation specimens and it correlates with clinical status. This assay may prove useful in screening for and managing bladder cancer.

DNA, Neoplasm↗
PubMed1998

Treatment of chronic subdural hematoma by closed-system drainage without irrigation.

BACKGROUND: Recurrence of chronic subdural hematoma after surgery has not been eliminated. We sought to determine whether irrigation influences recurrence rate. METHODS: Patients who had undergone surgery for chronic subdural hematoma were reviewed retrospectively. RESULTS: Between 1986 and 1993, 186 cases of chronic subdural hematoma were treated surgically at Mito National Hospital. Recurrence was limited to six cases (3.2%). A closed drainage system without irrigation has been used since 1988 in 119 patients. Before 1988, 67 cases were treated with single burr hole irrigation and drainage. The rate of recurrence with the closed drainage system was 3.4% (four cases), compared with 3.0% (two cases) for irrigation and drainage. CONCLUSION: Compared with irrigation and drainage, the closed drainage system without irrigation was safe and effective, and recurrence of chronic subdural hematoma is not influenced by irrigation.

Adult↗
PubMed1985

Randomised trial of intraperitoneal irrigation with low molecular weight povidone-iodine solution to reduce intra-abdominal infectious complications.

A prospective randomized trial was performed comparing the efficacy of intraperitoneal irrigation with low molecular weight povidone-iodine solution ('Betadine LMW') (PVP-I LMW) in reducing the risk of intra-abdominal infectious complications. Seventy-five patients who were undergoing surgical procedures in the face of bacterial contamination were studied. Patients were intra-operatively randomized to receive intraperitoneal irrigation prior to abdominal closure with PVP-I LMW or with saline. Patients were maintained on peri-operative systemic antibiotics, and surgical incisions were drained and were closed primarily or left open according to the practice of the surgeon responsible. If incisions were closed, the subcutaneous tissue was irrigated prior to skin closure with the same irrigant as used intraperitoneally, PVP-I LMW or saline. Patients were followed for abnormal wound healing, peritonitis, intra-abdominal abscesses, or other infectious complications. Serum iodine levels were monitored in some patients. Intra-abdominal infectious complications developed in two of 37 patients receiving PVP-I LMW irrigation as compared to complications in nine of 38 patients receiving saline irrigation (P less than 0.05). When infectious complications were excluded that were possibly due to surgical technical failures (such as anastomotic leakage), peritonitis or intra-abdominal abscesses were observed in one of 37 PVP-I LMW patients and in seven of 38 saline control patients (P less than 0.05). Wound infections developed in one of 37 PVP-I LMW patients and in three of 38 control patients. A broad range of serum iodine levels were observed in control patients preoperatively and at 24 h and 7 days postoperatively. Serum iodine levels in 'Betadine LMW' patients rose approximately nine-fold by 24 h postoperatively and returned to pre-operative levels by 7 days. It was concluded that PVP-I LMW solution can reduce the incidence of intra-abdominal infectious complications when used as an intraperitoneal irrigant in patients undergoing bacterially-contaminated surgical procedures.

Abdomen↗
PubMed1998

Irrigation in facial and scalp lacerations: does it alter outcome?

STUDY OBJECTIVE: Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for "clean" lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation. METHODS: We performed a cross-sectional study of consecutive patients presenting to a suburban, academic emergency department between October 1992 and August 1996. Patients with nonbite, noncontaminated facial skin or scalp lacerations who presented less than 6 hours after injury were included. Structured, closed-question data collection instruments were completed at the time of laceration repair and at suture removal. The primary outcome parameters were the incidence of wound infection and the short-term cosmetic appearance of lacerations in patients who did or did not receive irrigation. RESULTS: A total of 1,923 patients were included in the study group; 1,090 patients received saline irrigation, and 833 patients did not. The irrigation and nonirrigation groups were similar with regard to time from injury to presentation (1.56 versus 1.42 hours, respectively), frequency of linear wound morphology (82% versus 88%), frequency of smooth wound margins (72% versus 82%), number of layers of closure (1.14 versus 1.26), number of skin sutures applied (4.98 versus 4.65), number of deep sutures applied (.70 versus 1.05), and use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect to outcomes, the incidence of wound infection was not significantly different between the two treatment groups (.9% versus 1.4%, respectively; P = .28). Likewise, the percentage of patients who had an "optimal" cosmetic appearance was similar in the two groups (75.9% versus 81.7%, respectively; P = .07). CONCLUSION: Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations.

Adolescent↗
PubMed2001

[Evaluation of the anatomopathological characteristics and the safety of radiofrequency lesions at the atrial level with two different systems of irrigated tip catheters on an experimental level].

INTRODUCTION AND OBJECTIVES: We performed this study to evaluate the security and efficacy in the lesions produced on the atrial wall by different irrigated catheters in an experimental model. We evaluated the anatomopathologic characteristics of the lesions produced by two different systems of irrigated tip catheters, with opened or closed circuit. METHODS: This study was performed in 16 pigs applying 60 sec radiofrequency pulses with three different energy levels (15, 25 y 50 Watts). Two different systems of radiofrequency ablation irrigated catheters were used, opened and closed. We used 4 pigs in which we performed ablation with a standard catheter as a control group. Under fluoroscopic guidance, catheters were placed on the high and low right atrial lateral wall, where lesions were produced. After 7 days, animals were sacrificed for anatomopathological study. RESULTS: A total of 27 lesions were performed with irrigated catheters (11 closed circuit and 16 opened) and 6 with standard catheters in the control group. We did not find significant differences in the lesion characteristics between the two different systems of irrigated tip catheter used, nevertheless lesions performed with the closed system were slightly greater. Th lesions produced with irrigated catheters were always superior in the control group. Transmurality in the free atrial wall is frequent with both systems. We did not see any perforation in the atrial wall. CONCLUSIONS: We did not find significant differences in the size of the lesions produced with the two systems of irrigated catheters used. These data from an experimental model can provide useful information for atrial tachycardia radiofrequency ablation procedures in humans.

Animals↗
PubMed1999

Efficacy of irrigation for removal of particulate debris after cemented total knee arthroplasty.

We studied the amount of particulate debris removed with pulsatile lavage irrigation before and after component implantation in 13 consecutive patients undergoing primary cemented total knee arthroplasty (TKA) done by a single surgeon. Before component implantation, the knees were copiously lavaged with 3 L of pressurized irrigant; all fluid was collected in 1 aliquot using standard wall suction canisters. After cementing the components in place, another 3 L of pressurized irrigant was used; this fluid was collected in 3 sequentially labeled 1-L aliquots. Collected fluids were centrifuged, and the residue was washed, recentrifuged, and dried. Residual particulate debris was quantitated by weight. An average of 537 mg/L (range, 16-1,406 mg/L) of debris were removed before implantation with 3 L of irrigation. An average of 217 mg/L (range, 31-999 mg/L), 52 mg/L (range, 0-189 mg/L), and 49 mg/L (range, 1-185 mg/L) of debris was removed after implantation with each of the additional liters. Using analysis of variance testing, there was a statistically significant difference between the amount of debris removed with 3 L and after 4 L (P = .02) and 5 L (P = .03) of irrigant. There was no statistical difference between irrigation with 5 L and 6 L of irrigation (P = .92). The residua particulate debris was also analyzed to determine the relative amounts of bone-soluable organics and polymethyl methacrylate (PMMA). Before implantation, the residual debris, by weight, consisted of 79% bone and 21% soluable organics. We found on average that after implantation of components the specimens contained 53% bone and 47% PMMA and soluable organics by weight. We believe that despite careful implantation and meticulous cement technique, large amounts of debris, including bone and PMMA, remain after TKA, which require at least several liters of pulsatile lavage to remove. Removal of this particulate debris may decrease third-body polyethylene wear.

Aged↗