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PubMed2003

A comparison of the cleaning efficacy of short-term sonic and ultrasonic passive irrigation after hand instrumentation in molar root canals.

A total of 100 maxillary molar canals were hand instrumented to a master apical file size #35 and flared to a size #60 file. The canals were randomly divided into 5 groups of 20 each. Group 1 received no further treatment. Groups 2 and 3 received passive sonic irrigation for 30 and 60 s, respectively. Groups 4 and 5 received passive ultrasonic irrigation for 30 and 60 s, respectively. The roots were split longitudinally and photographed with a digital camera. The apical portion of the root was magnified to 100x. A debris score was calculated for the apical 3 and 6 mm. The debris score was calculated as a percentage of the total area of the canal that contained debris as determined by pixels in Adobe Photoshop 5.0. Passive sonic or ultrasonic irrigation, for as little as 30 s, resulted in significantly cleaner canals than hand filing alone. Ultrasonic passive irrigation produced significantly cleaner canals than passive sonic irrigation, when sonic and ultrasonic passive irrigation were compared with only each other.

Analysis of Variance↗
PubMed2004

The efficacy of ultrasonic irrigation to remove artificially placed dentine debris from different-sized simulated plastic root canals.

AIM: To investigate the influence of diameter and taper of root canals on the effectiveness of ultrasonic irrigation to remove artificially placed dentine debris from simulated uninstrumented extensions in simulated root canals. METHOD: Three groups of standard canals were cut in resin blocks using either size 20, .04 taper ProFile instruments, size 20, .06 Greater Taper (GT) rotary instruments or size 20, .08 GT instruments, respectively. Each resin block was then split longitudinally through the canal, forming two halves. In one canal wall, a standard groove 4 mm in length was cut 2-6 mm from the apical end of the canal, to simulate uninstrumented canal extensions. Each groove was filled with dentine debris mixed with 2% NaOCl to simulate a situation when dentine debris accumulates in the uninstrumented canal extensions. Each canal was reassembled by joining the two halves of the resin block by means of wires and sticky wax. In each canal ultrasonic irrigation was performed for 3 min using 2% NaOCl as irrigant. Before and after irrigation, images of each half of the canal with a groove were taken using a microscope and a digital camera, after which they were scanned into a PC as TIFF images. The quantity of dentine debris in the groove was evaluated using a scoring system: the higher the score, the larger the amount of debris remaining. The score data were analysed by means of Kruskal-Wallis and Mann-Whitney U-tests. RESULTS: After ultrasonic irrigation, the debris score for the size 20,.04 taper group was significantly higher than that for the size 20,.06 group (P = 0.040) and the size 20,.08 group (P = 0.006) groups. However, no significant difference was found between the size 20,.06 and the size 20,.08 groups (P = 0.320). CONCLUSION: In simulated plastic root canals, the diameter and taper of root canal influenced the effectiveness of ultrasonic irrigation to remove artificially placed dentine debris.

Dental Instruments↗
PubMed1991

[High volume vs. activated root canal irrigation].

Irrigation of the root canal is carried out to remove the smear layer and the overlying pulp tissue remnants and dentin chips left by preparation. Our results show that even high volume irrigation is less effective in the apical section than towards cervical. A positive effect of activated continuous irrigation was demonstrated above all in the apical third of the root canal. Almost complete removal of both the smear layer and the overlying debris was achieved. Since high volume, continuous activated irrigation is superior to any other form of irrigation, particularly in the apical section, the results of our studies suggest that further efforts to develop such a root canal irrigation system to the state in which it can be clinically used are necessary.

Dental Cavity Preparation↗
PubMed1991

An evaluation of saline irrigation and comparison of povidone-iodine and antibiotic in the surface decontamination of donor eyes.

We evaluated the effect of saline irrigation on 38 pairs of donor eyes and determined the relative efficacy of antibiotic rinse/storage (neomycin-polymyxin B-gramicidin) and povidone-iodine immersion. Microbial growth was found in 49 (64.5%) of 76 eyes from which cultures were taken before irrigation, and only four (8.2%) became culture negative after irrigation. Of 27 eyes culture negative before irrigation, 15 (55.6%) became positive after irrigation. One eye of each pair was then assigned randomly to antibiotic rinse/storage and the other eye to 3-minute immersion in 1% povidone-iodine. Both antimicrobial treatments decreased the numbers of positive cultures, with povidone-iodine showing an advantage that did not reach significance. These results demonstrate that saline irrigation of donor eyes in situ does not reduce surface contamination and that povidone-iodine immersion should be considered as an alternative for donor eye decontamination.

Anti-Bacterial Agents↗
PubMed1980

Bladder cancer diagnosis by flow cytometry. Correlation between cell samples from biopsy and bladder irrigation fluid.

Results of flow cytometry (FCM) examinations of bladder irrigation specimens were compared with those of FCM examinations of cell suspensions from bladder biopsies of 44 urologic patients. The fluorescent dye, acridine orange (AO), was used to stain DNA and RNA differentially and abnormal urothelial cells were identified by their relative content of nucleic acids. Granulocytes and squamous cells could be distinguished from transitional cells in this procedure, and did not interfere with the analyses. Of 28 patients with papillary carcinoma, carcinoma in situ, and invasive carcinoma 27 were identified through FCM examination of irrigation cytology specimens; the one false-negative result was from a low-grade papillary carcinoma. Of 7 patients with papilloma, FCM examinations of irrigation specimens were positive in 4 and negative in 3. Results of FCM studies of biopsy specimens were in good but not complete agreement with those of irrigation specimens. In several cases, irrigation FCM disclosed tumor stemlines that were not identified in biopsy specimens. Discrepancies of this kind seemed most likely due to differences in sampling. Irrigation FCM seems to be a sensitive method for assessing multiple-site bladder tumors, and may be a useful technique for monitoring the course of conservatively managed bladder tumors.

Acridine Orange↗
PubMed1985

Flow cytometric analysis of DNA content in human bladder tumors and irrigation fluids.

Flow cytometry (FCM) was used to study the DNA distribution of 99 tumor biopsy specimens and 41 bladder irrigation samples from patients with transitional cell carcinoma of the bladder. For tumor biopsy and cystectomy specimens, the frequency of aneuploidy increased with advancing tumor stage and grade. All T0 tumors were diploid. Twenty-seven percent of T1, 71.4% of T2, and 75% of T3 and T4 tumors were aneuploid. All Grade I tumors were diploid. Thirty percent of Grade II and 76.9% of Grade III tumors were aneuploid. The frequency of aneuploidy of tumors in the early stages (Ta, T1) is similar to the incidence of subsequent progression by these tumors described in the literature. For irrigation fluids, the relationship between grade and stage and the frequency of aneuploidy was similar to the relationship seen with tumor specimens. All four patients with only carcinoma in situ had aneuploid cells in their irrigations. The comparison of FCM data of bladder biopsy and bladder irrigation from the same cystoscopic evaluation suggests adequate representation of tumor cells in the irrigation fluids for almost all cases. The authors conclude that DNA ploidy analysis by FCM appears useful in a clinically important group of patients with aneuploid superficial tumors of moderate or high grade. Bladder irrigation analysis appears useful in the follow-up of patients with a history of carcinoma in situ and those with aneuploid tumors.

Carcinoma, Transitional Cell↗
PubMed1990

Whole gut irrigation and Prepacol laxative preparation for colonoscopy: a comparison.

Two techniques for preparation of the colon for colonoscopy were compared in a controlled trial. Fifty patients given a low residue diet and the laxative Prepacol were compared with 50 patients given whole gut irrigation. Significantly more patients suffered from vomiting (P = 0.0005), shivering (P = 0.0062) and nausea (P = 0.031) following irrigation; in two cases the procedure had to be abandoned because of profuse vomiting. Irrigation was less well tolerated by the patients (P = 0.00002) than preparation with Prepacol. On the other hand, the quality of bowel preparation was found to be better (P = 0.0005) after irrigation. On two occasions colonoscopy was not possible following Prepacol preparation because of faecal residue. Patients with a previous colorectal resection showed a similar quality of cleansing to those patients prepared with irrigation. We conclude that Prepacol is as efficient as irrigation for patients who have had a previous colorectal resection because the quality of bowel preparation is as good and the associated patient discomfort is small.

Adolescent↗
PubMed1987

Effects of intraocular irrigation with melatonin on the c-wave of the direct current electroretinogram and on the standing potential of the eye in albino rabbits.

The direct current electroretinogram (ERG) and the standing potential (SP) were recorded from both eyes of 14 albino rabbits during intraocular perfusion of one of the eyes, which was vitrectomized, with a recently developed eye irrigation solution (PHS) produced by Pharmacia Ophthalmics. PHS was then replaced by a test solution containing melatonin dissolved in PHS (0.002 microM-200 microM). The fluids were subsequently alternated (PHS - melatonin - PHS). During uniocular irrigation with melatonin the mean c-wave amplitude and SP level of the intact control eye were increased (c-wave +24%, p less than 0.01; SP +0.65 mV, p less than 0.05) compared with the values during the initial perfusion with PHS. In contrast, the c-wave amplitude of the irrigated eye was markedly decreased in many rabbits during perfusion with melatonin compared with the initial PHS, but the mean reduction was small and not statistically significant. The mean SP level was reduced (-1.54 mV, p less than 0.001). This difference between the eyes probably depends on the route by which melatonin reaches the retinal pigment epithelium and thus whether it primarily affects the apical (as in the irrigated eye) or the basal (as in the control eye) pigment epithelial membrane. A peak in the b-wave amplitude was observed in both eyes during uniocular irrigation with melatonin when compared with the amplitude measured during the initial perfusion with PHS (irrigated eye: +27%, p less than 0.001; control eye +18%, p less than 0.002).

Animals↗
PubMed1992

Estimation of irrigant absorption during transurethral resection of the prostate. Assessment of fluorescein as a marker.

Absorption of irrigating solution may complicate transurethral resection of the prostate (TURP), and a system which warns of fluid overload reliably would be of benefit in the prevention of these complications. Fluorescein can easily be detected at very low concentrations in blood and can be added to the irrigating solution in amounts invisible to the naked eye, providing a possible means of easily monitoring the absorption of irrigant solution during TURP. To test this hypothesis, the plasma concentration of fluorescein was determined at intervals after intraperitoneal injection in rats. Although the published data on fluorescein suggest that it meets the criteria for a suitable marker substance to be introduced into the irrigant solution, the results show that plasma fluorescein is constant and not dose related. The addition of fluorescein to the irrigant solution would not provide a quantitative means of determining the volume of irrigant absorbed. The use of other substances may provide the answer to this major clinical problem. We have defined a set of criteria which such a substance should fulfil.

Absorption↗
PubMedDate not supplied

Clearance of Candida colonizing the urinary bladder by a two-day amphotericin B irrigation.

The minimum duration of continuous amphotericin B irrigation (50 mg/liter/day) required to clear the candida colonizing the urinary bladder was investigated. Eleven in vitro experiments revealed a consistent candidicidal effect within 48 hours with 25 and 5 mg/l of amphotericin B concentrations attainable in the bladder. Hospitalized nursing home patients with candiduria were treated with two-day irrigation according to the protocol. The protocol consists of the use of a newly inserted catheter for the irrigation, subsequent washout of the residual drug, and immediate sampling of urine for microscopic examination and culture after the procedure. In 47 of 65 (72.3%) cases yeast was cleared. In the remaining 18 the candida persisted. Of the latter, ten received additional irrigation for an average of 7.3 days (range: 4-12 days). In all ten cases funguria continued. Two-day irrigation saves time and expense, and is as effective as the five-day procedure in eradicating the yeast on bladder mucosa. Because of the relatively short irrigation time, the protocol may be useful in clinical evaluation of the site of urinary candidiasis.

Amphotericin B↗
PubMed1998

Subtotal colectomy vs. intraoperative colonic irrigation in the management of obstructed left colon carcinoma.

PURPOSE: Whether primary anastomosis should be performed after segmental resection with intraoperative colonic irrigation or subtotal colectomy is not yet established in the surgical treatment of obstructive left colon carcinoma. In this prospective, nonrandomized study, we present the results of 66 patients undergoing one-stage surgery for obstructed left colon carcinoma. PATIENTS AND METHODS: We compared two techniques, subtotal colectomy (35 patients) and intraoperative colonic irrigation with segmental resection and immediate anastomosis (31 patients). RESULTS: The mortality rate was similar in both groups, 8.5 percent in the subtotal colectomy group and 3.2 percent in the intraoperative colonic irrigation group. The surgical complication rate was significantly higher in the intraoperative colonic irrigation group (41.9 percent) than in the subtotal colectomy group (14.2 percent; P < 0.05). Mean operating time was significantly lower in the subtotal colectomy group than in the intraoperative colonic irrigation group (P < 0.05). Both groups had a similar mean duration of hospital stay. Ten patients who underwent subtotal colectomy (31.2 percent) presented with diarrhea in the immediate postoperative period, which disappeared spontaneously or with antidiarrheal medication; a disabling diarrhea persisted in two patients only (6.2 percent). CONCLUSION: We believe that subtotal colectomy is the treatment of choice for obstructed left-sided colonic carcinoma. Segmental resection with intraoperative colonic irrigation is more appropriate than subtotal colectomy only in patients with carcinomas of the rectosigmoid junction or with previous anal incontinence to avoid the appearance of postoperative diarrhea.

Adult↗
PubMed1985

Is prophylactic abdominal irrigation with polyvinylpyrrolidone iodine (PVPI) safe?

In order to investigate the safety of abdominal irrigation with polyvinylpyrrolidone iodine (PVPI), the abdominal cavities of normal rats were irrigated with the highest nonlethal dose. Samples of the peritoneal fluid were taken before and 1, 2, and 4 hours after irrigations. Control studies were done with saline. After irrigation with PVPI, the protein concentration in the peritoneal fluid showed a 40-fold increase, compared with only a doubling after saline irrigations. Irrigation with PVPI causes serious peritoneal damage, and should therefore not be performed as a prophylactic procedure.

Abdomen↗
PubMedDate not supplied

Irrigation vs. natural evacuation of left colostomy: a comparative study of 340 patients.

A comparative study of two methods of managing left colostomy (irrigation and natural evacuation) was carried out on 340 patients who were examined and interviewed at the Stoma Rehabilitation Clinic of the Institute of Surgical Pathology of the University of Padua. Ninety-two per cent of patients who irrigated their colostomies gained fecal continence. No patient who irrigated his colostomy had any cutaneous problem, and this group had significantly better results in preventing leakage of gas and odors compared with those patients using natural evacuation. For most patients who irrigated, the ability to predict or control bowel movements overcame fears of "being dirty" and related psychological problems. These patients also had more normal social and working lives than did those patients not irrigating their colostomies. Only one patient in our series had a colonic perforation, and any chance of a repeat incident will probably disappear with the cone-shaped catheters now available. The authors conclude that in properly selected patients, irrigation is the method of choice for management of left colostomy.

Aged↗
PubMedDate not supplied

Whole-gut irrigation versus enema in elective colorectal surgery: a prospective, randomized study.

Whole-gut irrigation was compared with conventional mechanical bowel preparation in a prospective, randomized study. All 100 patients had a combination of ampicillin and metronidazole during and after colorectal surgery. Patients' complaints were equally frequent during the two preparations and were severe in 15 per cent. Gastric position of the tube for irrigation resulted in severe complaints in 3 of 26 patients and in the duodenal position, in severe complaints in five of 24. The time for irrigation was shorter than that for conventional preparation. Deep wound infection were equally frequent after irrigation (3/46) and conventional preparation (4/47). Seven patients were excluded, since no bowel resection had been performed. Collapse of the small and large intestine, as evaluated blindly during surgery, was more frequent after irrigation (P less than 0.05). Anastomotic leaks after left side resections were less frequent in patients with collapse of the small (P less than 0.001) and large (P less than 0.05) intestine. Five leakages among 29 patients after conventional preparation in contrast to one among 22 after whole-gut irrigation favor the latter, even if this difference did not reach statistical significance (0.05 less than P less than 0.10), since anastomotic leakage is lethal in a high number of patients.

Adolescent↗
PubMed1995

[Continuous breath alcohol analysis. Monitoring of irrigation absorption syndrome in transurethral prostate resection].

The absorption of large volumes of irrigation fluid is a major problem in transurethral prostatic surgery (TUR-P). Various indicators have been tested to monitor fluid absorption with regard to continuous registration and sufficient accuracy. The volumetric fluid balance is not suitable as a routine method because of its inaccuracy. Easily accessible parameters are unspecific because of surgical bleeding (haematocrit [Hct]), or are interfered with by physiological counter-regulatory actions (serum sodium [Na] concentration). In 1986 Hulten et al. suggested adding 2% ethanol to the irrigation fluid as a marker and investigated it intermittently in the expired air with an alcohol-test appliance. In a prospective clinical study of 17 patients undergoing TUR-P under spinal anaesthesia, expiratory concentrations of alcohol that was added to the irrigation fluid (2% ethanol in Purisole, Fresenius, Bad Homburg) were monitored. Gas was continuously sampled from the nasopharynx through a nasal cannula and the ethanol concentration was measured using a modified diverting anaesthetic gas monitor (Normac, Datex, Helsinki) that allows continuous as well as early detection of the absorbed irrigation fluid with reliable accuracy for clinical use. In addition, at intervals of 10 minutes we measured blood alcohol, end-tidal alcohol (Alcotest 7110, Dräger, Lübeck), haematocrit, serum Na concentration, and blood gases. Sixty-eight measurements were obtained from the 17 patients. As shown in other studies, serum Na (r2 = 0.68) and Hct (r2 = 0.39) correlated poorly with the irrigation fluid as determined by serum alcohol levels. In contrast, the expiratory alcohol measurements with the Alcotest 7110 (r2 = 0.93) and Normac devices (r2 = 0.85) were closely related. Continuous monitoring of the expiratory alcohol concentration with a Normac monitor closely reflects blood alcohol concentration, and may hence serve as a useful semiquantitative monitor of irrigation fluid absorption during TUR-P.

Absorption↗
PubMed2004

Randomized cross-over trial of polyethylene glycol electrolyte solution and water for colostomy irrigation.

PURPOSE: Water for colostomy irrigation is largely absorbed by the colon, which may result in less efficient expulsion of stool. This study compared the outcome of colonic cleansing with water and polyethylene glycol solution. METHODS: In a cross-over study, 41 colostomy irrigators were randomly assigned to water or polyethylene glycol solution irrigation first and then the other regimen, each for one week. Patients recorded fluid inflow time, total washout time, cramps, leakage episodes, number of stoma pouches used, and satisfaction scores (Visual Analog Scale, 1-10: 1 = poor, and 10 = excellent). The median and interquartile range for each variable was calculated, and the two treatments were compared (Wilcoxon's test). RESULTS: Eight patients failed to complete the study. Thirty-three patients (20 females; mean age, 55 (range, 39-73) years) provided 352 irrigation sessions: water (n = 176), and polyethylene glycol solution (n = 176). Irrigation was performed every 24, 48, and 72 hours by 17, 9, and 7 patients respectively, using 500 ml (n = 1), 750 ml (n = 2), 1,000 ml (n = 16), 1,500 ml (n = 11), 2,000 ml (n = 2), and 3,500 ml (n = 1) of fluid. The median and interquartile range for water vs. polyethylene glycol solution were: fluid inflow time (6 (range, 4.4-10.8) vs. 6.3 (range, 4.1-11) minutes; P = 0.48), total washout time (53 (range, 33-69) vs. 38 (range, 28-55) minutes; P = 0.01), leakage episodes (2.3 (range, 1.7-3.8) vs. 0.7 (range, 0.2-1); P < 0.001), satisfaction score (5.8 (range, 4-7.5) vs. 8.8 (range, 8.3-10); P < 0.001), and stoma pouch usage per week (75 (range, 45-80) vs. 43 (range, 0-80); P = 0.008). No difference was demonstrated for frequency of cramps ( P = 0.24). CONCLUSIONS: Polyethylene glycol solution performed significantly better than water and may be a superior alternative fluid regimen for colostomy irrigation.

Adult↗
PubMed1981

Febrile morbidity following cefamandole nafate intrauterine irrigation during cesarean section.

The effectiveness of intrauterine irrigation during cesarean section with a solution of cefamandole nafate in reducing febrile morbidity was studied in a prospective double-blind fashion. Ninety patients who were undergoing cesarean section at Tripler Army Medical Center were randomized into three groups: (1) intrauterine irrigation with cefamandole nafate solution, (2) intrauterine irrigation with normal saline solution, and (3) no irrigation. Febrile morbidity was evaluated by means of a fever index. There was a statistically significant reduction in the fever index in the group that received intrauterine irrigation with cefamandole nafate. The incidences of clinically diagnosed endomyometritis in the three groups were 0%, 26.7%, and 23.3%, respectively. Prophylactic intrauterine irrigation with cefamandole nafate during cesarean section markedly reduces febrile morbidity, primarily by reducing the incidence of endomyometritis.

Cefamandole↗
PubMed1983

Mechanical effectiveness of closed peritoneal irrigation in peritonitis.

Peritonitis was produced in rabbits using a human fecal suspension. Catheters for multiple peritoneal lavage then were inserted and continuous irrigation was performed. Contrast material was injected on day 1, 2, or 3 to evaluate the mechanical effectiveness of irrigation. Radiologic studies revealed that contrast material penetrated most or all six regions in all animals. The addition of heparin to the irrigant did not alter the number of regions irrigated. It has been concluded the peritoneal irrigation effectively irrigates most of the peritoneal cavity for up to 3 days.

Animals↗