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PubMed1980

Caloric testing by continuous automatic alternating irrigation.

Quantitative caloric test results show a high variability. They were described as questionable by Frenzel (1955) and a review of the test was recommended by Hood (1973). Thus, we developed a new method: continuous automatic alternating irrigation. An irrigator is connected to two water-baths of 30 degrees C and 44 degrees C. A time-relays switches over from one bath to the other every 60 s. The continuous, but alternating, irrigations produce subsequently alternating exponential temperature waves in the temporal bone. The mathematical model shows a quasi-periodicity and sufficient symmetry of the alternating thermal gradient across the canal, except for the first stimulus. After 11 irrigations of 60 s, a short (20 s) "washout" irrigation terminates the sequence. By the five repetitions of each stimulus and the additional possibility of correlating the response to the paper-marked stimulus periodicity the judgement is far more reliable and therefore, in doubtful cases, despite the five-fold data, quicker. The technical device is simple enough for routine use and inexpensive. The results of the caloric test are now much more clear-cut and the correlation to a known clinical pathology is remarkably high.

Body Temperature↗
PubMed1995

Fluctuation of blood pressure and pulse rate during colostomy irrigation.

PURPOSE: The aim of this study was to determine the effects of colostomy irrigation on the vital signs of patients with left colostomy. METHODS: Twenty-two consecutive patients who underwent abdominoperineal resection for cancer of the lower rectum and had left lower quadrant end colostomy were included in this study. Subjective symptoms, blood pressure, and pulse rate during the first irrigation were investigated. RESULTS: Fluctuation of blood pressure during instillation was 8.0/8.5 mmHg (average) and 25.0/17.9 mmHg during evacuation. Fluctuation of pulse rate was 5.5 per minute (average) during instillation and 11.5 per minute during evacuation. The number of subjects who showed more than 20% fluctuation of systolic pressure was 12 (54.5 percent) and that of diastolic pressure was 14 (63.6 percent). One of 22 patients complained of illness during irrigation. CONCLUSION: Although colostomy irrigation showed no significant effects on vital signs in the majority of patients, it caused a significant reduction in both blood pressure and pulse rate in a small number of patients. Careful attention should be paid to vital signs considering the possibility of such effects, especially on the initial irrigation.

Aged↗
PubMed1990

Colostomy irrigation in the elderly. Effective recovery regardless of age.

One hundred forty elderly cancer outpatients with colostomy in the authors' rehabilitation department were included in an analysis of the feasibility, effectiveness, and safety of periodic irrigation of remaining colon with lukewarm tap water with the aim of regaining full continence. Sixteen patients did not have a sufficiently long remaining bowel (cecostomy, transverse colostomy) and 17 were considered unsuitable to learn the technique because of advanced neoplastic disease with poor life expectancy, intercurrent disease, or stomal problems. One hundred seven patients were proposed to perform the irrigation: 17 refused to do so with the remaining 90 able to learn the method without problems. Nearly all patients achieved full continence for at least 24 hours. Three patients refused to continue, and nine interrupted for minor complications. The median duration of irrigation in the whole group is 257 days (range, 1 to 2669 days): 32 patients have been irrigating from one to five years, and 9 patients for more than 5 years. Based on these results, we recommend irrigation as standard rehabilitative treatment for elderly patients.

Age Factors↗
PubMed2002

The use of detergent irrigation for musculoskeletal wounds.

The primary purpose of irrigation is to remove bacterial contaminants from the wound. Surfactants do that by disrupting the bonds of the organism to the surface. The use of this wound care strategy was studied in a series of investigations spanning several years. In vitro experiments revealed that surfactant irrigation was superior to saline or antibiotic solutions for removal of adherent bacteria from metallic surfaces, from bone, and from bovine muscle. An in vivo model of the complex orthopedic wound was developed. The superiority of surfactant irrigation over saline or antibiotic solution was demonstrated in animal wounds containing metal, bone injury, and soft tissue damage. Specificity of different surfactant irrigations for various bacterial species was demonstrated. A sequential surfactant irrigation protocol was developed and shown effective in the polymicrobial wound with established infection.

Animals↗
PubMed2004

Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer.

BACKGROUND AND AIMS: Recently there has been growing acceptance of the one-stage resection and primary anastomosis with intraoperative antegrade irrigation. This study evaluated the efficacy of a newly developed device for performing a single-stage procedure in patients with obstructing left-sided colon cancer. PATIENTS AND METHODS: A series of 151 consecutive patients with obstructing left-sided colonic cancer underwent on-table irrigation, resection, and primary anastomosis with the use of a newly developed device; 75 patients on-table colonoscopy. The study spanned a 3 years from September 1999 to August 2002. The observed variables were the volume of irrigated saline, time for irrigation and colonoscopic examination, synchronous pathology, operative mortality and morbidity, time to passage of flatus, restarting day of oral intake, and length of hospital stay. RESULTS: The mean volume of irrigated saline was a mean of 12.5 l (range 1-32) over a mean of 14.2 min (range 1-45). Subsequent colonoscopic examination added a mean of 10.7 min (range 3-15). The incidence of synchronous polyps was 47% (35 of 75 cases) in performing the on-table colonoscopic investigations. On-table colonoscopy induced surgeons to extend resection because of synchronous malignancy attested by frozen biopsy specimen in ten patients and because of mucosal necrosis of the proximal colon in three. There were two anastomotic leakages, six wound infections, and one operative mortality. The time to passage of flatus was an average of 3.6 days (range 1.0-7). The time to oral intake was an average of 4.3 days (range 3-8). The length of hospital stay was 11.7 days (range 6-43). CONCLUSION: These findings suggest that our device is an effective tool to facilitate acceptance of the one-stage procedure in patients with obstructing left-sided colonic cancer. Specifically, our device enables quick and easy on-table colonoscopy.

Adult↗
PubMed2000

Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease.

In a prospective, randomized, controlled, double-blind trial we compared the effectiveness of endonasal irrigations with Ems salt solution to that with sodium chloride solution in the treatment of adult patients with chronic paranasal sinus disease. Subjects (n = 40) were randomly allocated to treatment either with isotonic Ems salt solution or with isotonic sodium chloride solution. The treatment consisted of endonasal irrigation twice daily and additional nasal spray as required. Nasal endoscopy, plain radiography of the paranasal sinuses, olfactometry, anterior rhinomanometry, and a saccharin-clearance test were carried out on days 1 and 7. Patients recorded rating scales of general discomfort, nasal airway obstruction, agreeableness of the irrigation, duration of improved nasal resistance after each irrigation, and the amount of additional nasal spray in a diary. Nasal air flow was not improved significantly. Subjective complaints, endonasal endoscopy, and radiography results revealed a significant improvement in both groups (P = 0.0001). In comparison, the two groups were not significantly different in outcome. Endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis, and a significant difference between Ems salt and sodium chloride was not observed.

Adult↗
PubMed1999

Burr hole evacuation of chronic subdural haematomas followed by continuous inflow and outflow irrigation.

Chronic subdural haematomas are prone to recollect, increasing the risk of further complications and death. Burr hole evacuation followed by continuous irrigation of a Ringer solution into the remaining subdural cavity, allows remaining blood to be washed out and the brain to re-expand. This technique was compared with burr hole evacuation either without or with a passive drainage and craniotomy, respectively. Reformation of haematomas after continuous irrigation occurred in 2.6% (2/77); more than a twelve (32.6%; 15/46) and a nine (23.8%; 5/21) times rate reduction compared to burr hole evacuation without and with passive drainage, respectively. Compared to the craniotomy results, the rate dropped seventeen times (44.4%; 4/9). Expect from the two rebleedings in 77 haematomas operated on through burr holes followed by irrigation, all patients recovered including nine recurrent haematomas re-operated on by this method. Recurrent haematomas operated on through burr hole evacuation alone or with insertion of a passive drainage, recollected in 50% (2/4) and 33.3% (2/6). Similar rate after craniotomies was 11.1% (1/9). Neither infections nor deaths followed burr hole evacuation combined with continuous irrigation, whereas 5.3% (2/38) and 5.9% (1/17) suffered from empyema after burr hole evacuation alone or combined with a passive drainage, respectively. Five (9.1%) of these 55 patients died either from empyemas (three) or rebleedings (two). Recurrent haematomas evacuated through a craniotomy had no complications from infections. Compared to other methods, continuous irrigation reduces the need for re-operation significantly by preventing haematoma recurrence and empyema formation. Contrary to other surgical techniques, haematoma recurrence after second time surgery did not occur.

Adult↗
PubMed2004

Improvement of colonic healing by preoperative rectal irrigation with short-chain fatty acids in rats given radiotherapy.

BACKGROUND: We investigated the effect of preoperative rectal irrigation with short-chain fatty acids on irradiated colonic anastomosis in rats. METHODS: Sixty male Wistar rats were divided into four groups. Group I (control group, n = 15) underwent left colon resection and primary anastomosis. Group II (Short-chain fatty acids pretreatment group, n = 15) had short-chain fatty acids rectal irrigation for five days preoperatively. Group III (preoperative radiotherapy group, n = 15) underwent irradiation to the whole pelvis eight and four days before the operation, for a total dose of 20 Gy. Group IV (preoperative radiotherapy group + short-chain fatty acids pretreatment group, n = 15) had rectal irrigation with short-chain fatty acids for five days after the second irradiation. Within each group, animals were anesthetized to assess the clinical, mechanical, histologic, and biochemical parameters of anastomotic healing on either the third or seventh postoperative days. RESULTS: The mean bursting pressure was significantly low in Group III on Day 3 and was significantly high in Group IV on Day 7 (P = 0.001, P = 0.021). The burst occurred at the anastomoses in all animals tested on the third postoperative day, and outside of the anastomoses in all animals tested on the seventh postoperative day. The histologic parameters of anastomotic healing, such as epithelial regeneration and formation of granulation tissue, were significantly improved by use of preoperative rectal irrigation with short-chain fatty acids on Day 7. The amount of total and salt-soluble collagen concentrations significantly increased in Group IV compared with the control group on Day 3 (P = 0.008, P = 0.004). CONCLUSION: Some mechanical and histologic aspects of colonic anastomotic healing can be adversely affected by preoperative radiotherapy, but rectal irrigation with short-chain fatty acids may improve anastomotic healing.

Anastomosis, Surgical↗
PubMed1985

Antibiotic irrigation prophylaxis in the high-risk cesarean section patient.

Two hundred twenty-three women who underwent cesarean section delivery were studied to assess the effectiveness of operative antibiotic irrigation in preventing postoperative uterine infection. Patients were prospectively randomized into high-risk and low-risk groups according to length of labor, and received irrigation with either a 2 gm solution of cefamandole or normal saline solution, or no irrigation. Infection rates of 48.6% and 54.8% were observed in high-risk patients given either saline solution or no irrigation, respectively. Three of 27 high-risk patients (11.1%) given antibiotic irrigation developed metritis. The authors find this method of preventing infection to be advantageous in terms of both efficacy and minimization of antibiotic exposure.

Anti-Bacterial Agents↗
PubMed1992

Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations.

To investigate the effects of the hair removal methods and intraoperative irrigation on suppurative mediastinitis after cardiopulmonary bypass operations, 1,980 consecutive adult patients over a 2-year period in our institution were prospectively randomized to manual shaving versus electrical clipping of hair before the skin incision, and to povidone-iodine solution (0.5%) versus saline solution mediastinal and subcutaneous irrigation before wound closure. The overall incidence of suppurative mediastinitis was 0.86% (17/1,980). The infectious rate was significantly higher in the manually shaven (13/990) than in the electrically clipped patients (4/990) with an odds ratio of 3.25 (95% confidence interval, 1.11 to 9.32; p = 0.024). It was also higher in the povidone-iodine group (11/990) than in the saline group (6/990), although the difference was not statistically significant (p = 0.16). Fourteen patients were treated with operative debridement with closed tube irrigation, with one failure requiring a conversion to an open wound. Two patients were successfully treated with primary open wound procedures followed by delayed muscular flap closures, and 1 patient succumbed to rapid and profound sepsis soon after open drainage. We conclude that electrical clipping is superior to manual shaving in the prevention of suppurative mediastinitis. The routine use of povidone-iodine (0.5%) irrigation was of no benefit in this study and may increase the incidence of infection due to its known suppressive effects on local leukocytes and fibroblasts. Furthermore, operative debridement with closed tube irrigation was successful in treating the majority of cases in this series.

Cardiopulmonary Bypass↗
PubMed1985

Acid phosphatase levels of irrigant solution during transurethral prostatectomy.

The acid phosphatase level of irrigant solution used during transurethral prostate resections was measured in 20 patients. The mean acid phosphatase of the irrigant solution was 45.3 IU/L (S.D. 50.7). The degree of elevation of irrigant acid phosphatase was related to the weight of tissue resected, the duration of the resection, and the total volume of irrigant used. A transient elevation of serum acid phosphatase occurred postoperatively which was associated with the level of urinary acid phosphatase elevation and the amount of absorbed irrigant solution based on changes in serum sodium.

Acid Phosphatase↗
PubMed1993

The effect of scrubbing and irrigation with normal saline, povidone iodine, and cefazolin on wound bacterial counts in a guinea pig model.

This study examines the effects of povidone iodine, normal saline, and cefazolin alone and after scrubbing on bacterial counts in contaminated animal lacerations. Twelve albino guinea pigs each received four lacerations inoculated with a standard inoculum of Staphylococcus aureus. Twelve hours after inoculation, each wound was biopsied to ensure contamination and then either treated or left as an untreated control. One wound on each animal was an untreated control. The remaining three lacerations on six pigs were irrigated with cefazolin (CZ) solution, normal saline, or 1% (wt/vol) povidone iodine solution (PI). Three lacerations on another six pigs were treated with 20% poloxamer 188 scrub (scrub) alone, scrub followed by PI irrigation (SCR/PI), or scrub followed by CZ irrigation (SCR/CZ). Quantitative bacteriology was performed on tissue biopsies 2 hours (time 1), 7 hours (time 2), and 12 hours (time 3) after irrigation. Posttreatment counts for PI, CZ, and normal saline irrigation were not different from control or one another (P > .05). Bacterial counts for SCR/PI were significantly lower than control (P < .05) for all posttreatment biopsies (1.8 to 2.9 mean log(10) decrease). SCR/CZ was significantly lower than control (P < .05) at times 2 and 3 only (1.7 to 2.0 mean log(10) decrease). In this guinea pig model, cleansing 12-hour-old lacerations contaminated with S aureus using SCR/PI or SCR/CZ significantly reduced bacterial counts over 12 hours.

Animals↗
PubMed2004

Impact on active scope deflection and irrigation flow of all endoscopic working tools during flexible ureteroscopy.

OBJECTIVE: Flexible ureteroscopy is nowadays an alternative effective option for treatment of upper urinary tract stones, especially in the lower renal pole. Access in this case is often limited by active deflection capabilities of the instrument which is always deteriorated by the passage of different tools through the working channel. Insertion of them limits also the irrigation flow and so that the visibility. These deteriorations vary largely following the tool inserted. We performed an in vitro evaluation of deterioration of active deflection, possibility of tool insertion in maximal active deflection and irrigation flow in 6 different flexible ureteroscopes with almost all of tools available. METHODS: A total of 546 measures of maximal deflection, test of passage of tools in maximal deflection and measures of irrigation flow passage through the working channel were made on 6 different ureteroscopes, the ACMI DUR-8, the ACMI DUR-8 "Elite", the Karl Storz 11274 AA, the Karl Storz 11278 AU1 "Flex-X", the Wolf 7325.172 and the Olympus URF/P-3 without any tool inserted and with 22 different tools (14 extraction devices and 8 lithotripsy probes). RESULTS: Larger caliber tools resulted in more deflection degradation than smaller ones but it is more evident in case of use of non-nitinol tools instead of the nitinol ones. Generally lithotripsy probes affected active deflection more than nitinol extractions tools but different brand laser fibres present different results. Usually 1.6 and 1.9F electro hydraulic probes offer a slightly better deflection than does the 200micro laser fibre. Ballistic shock probes are so stiff that can not be used for treating lower renal pole stones. CONCLUSIONS: An array of different instruments are nowadays available for upper renal endoscopic treatment but they differ largely on stiffness and on obstruction to irrigation flow. Laser probes are very problematic to insert in the already deflected instruments, something that is less evident with the EHL probes and the smaller nitinol extraction tools. Irrigation flow is inversely proportional to the diameter of the tool inserted. Tools with a diameter of 3 French or more block totally the flow.

Equipment Design↗
PubMed2006

After-cataract evaluation after using balanced salt solution, distilled deionized water, and 5-fluorouracil with a sealed-capsule irrigation device in the eyes of 4-week-old rabbits.

PURPOSE: To evaluate the Perfect Capsule sealed-capsule irrigation device (Milvella Pty., Ltd.) using 3 substances in young rabbit eyes. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Thirty 4-week-old rabbits had clear lens extraction in both eyes. In 1 randomly selected eye, the Perfect Capsule was applied and the lens capsule was irrigated for 5 minutes with 1 of 3 substances: balanced salt solution (BSS), distilled deionized water (DDW), or 5-fluorouracil (5-FU) 50 mg/mL. In the other eye, no sealed capsule irrigation was used. Forty days postoperatively, the animals were killed and the eyes fixed in formalin for histologic analysis. After-cataract was evaluated in 3 ways: clinically, from photographs, and histologically. Central posterior capsule thickness was evaluated using a microscope, camera, and computer. RESULTS: The Perfect Capsule sealed-capsule irrigation system could be used in all selected eyes. The vacuum to the anterior capsule was tight, and the system was sealed in all eyes. After-cataract developed in the BSS group and DDW group, but not in the 5-FU group. The 5-FU group had significantly less after-cataract than the other 2 groups (P<.05). There was no difference between the groups in capsule thickness. CONCLUSIONS: The Perfect Capsule sealed-capsule irrigation system could be used in small eyes. Distilled deionized water did not prevent after-cataract in rabbit eyes with highly proliferative cells, but 5-FU was effective in preventing after-cataract.

Acetates↗
PubMed2026

Agricultural sprinkler irrigation systems as environmental reservoirs and airborne dissemination sources of Legionella pneumophila.

Sprinkler irrigation systems are critical for modern agriculture but represent largely unrecognized aquatic environments capable of sustaining opportunistic human pathogens. Among them, Legionella pneumophila is of particular concern due to its ability to colonize engineered water systems, persist under fluctuating environmental conditions, and be transmitted through aerosols. In this study, we conducted a comprehensive microbiological and genomic investigation of irrigation ponds and ditches in a rural area of north-east Spain where two zones were sampled. Metagenomic profiling revealed highly diverse microbial communities encompassing more than 20,000 species, including 21 airborne-transmissible bacterial pathogens of clinical relevance. Notably, L. pneumophila was detected in both zones, with a relative abundance of up to 4.6&#x202f;%. Culture-based isolation confirmed the presence of L. pneumophila serogroup 1, Pontiac group, Benidorm subgroup, sequence type 15. Phylogenetic analysis demonstrated a close relationship between this environmental strain and clinical isolates obtained during a Legionnaires' disease outbreak occurred in 2015, which had remained without a confirmed environmental source. Meteorological data from the exposure period revealed wind conditions favouring long-distance aerosol dispersion from irrigated fields toward residential areas. Our findings provide evidence that irrigation infrastructures can act as environmental reservoirs and dissemination routes of L. pneumophila among other airborne pathogens. These results underscore the need to incorporate agricultural irrigation systems into routine environmental surveillance, outbreak investigations, and public health risk assessments.

Legionella pneumophila↗
PubMed2006

Ultramorphological and histochemical changes after ER,CR:YSGG laser irradiation and two different irrigation regimes.

The purpose of this study was to evaluate the ultramorphological and chemical changes in Er,Cr:YSGG laser-treated radicular dentin in comparison with two different irrigation regimes. Extracted human premolars were assigned into three experimental groups. Group 1: After each file size, root canals were irrigated with 5.25% NaOCL, followed by a final irrigation with 5.25% NaOCL. Group 2: At each file size, biomechanical preparation was performed in conjunction with Rc-Prep, followed by 5.25% NaOCL irrigation; and 5.25% NaOCL for the final flush. Group 3: 5.25% NaOCL was used after each file size, followed by Er,Cr:YSGG laser irradiation; and a final flush with 5.25% NaOCL. Scanning electron microscopic (SEM) evaluations revealed failure of smear removal in NaOCL-irrigated specimens. RC-Prep + NaOCL-treated dentin revealed moderate-to-total presence of the smear layer with distinct areas of exposed collagen. Er,Cr:YSGG laser irradiation of radicular dentin also resulted in partial or total removal of the smear associated with a few small regions of thermal injury, including carbonization and partial melting. Energy dispersive X-ray analysis (SEM-EDX) showed no significant difference between the Ca/P ratios of the test groups, suggesting absence of changes at the molecular level.

Bicuspid↗
PubMed2006

Root canal irrigants.

Local wound debridement in the diseased pulp space is the main step in root canal treatment to prevent the tooth from being a source of infection. In this review article, the specifics of the pulpal microenvironment and the resulting requirements for irrigating solutions are spelled out. Sodium hypochlorite solutions are recommended as the main irrigants. This is because of their broad antimicrobial spectrum as well as their unique capacity to dissolve necrotic tissue remnants. Chemical and toxicological concerns related to their use are discussed, including different approaches to enhance local efficacy without increasing the caustic potential. In addition, chelating solutions are recommended as adjunct irrigants to prevent the formation of a smear layer and/or remove it before filling the root canal system. Based on the actions and interactions of currently available solutions, a clinical irrigating regimen is proposed. Furthermore, some technical aspects of irrigating the root canal system are discussed, and recent trends are critically inspected.

Anti-Infective Agents, Local↗
PubMed2006

Ultrastructure of intraradicular dentin after irrigation with BioPure MTAD. II. The consequence of obturation with an epoxy resin-based sealer.

In addition to an initial report on the creation of thick demineralized collagen matrices in root dentin that were irrigated with BioPure MTAD or EDTA as final rinses for 5 minutes, this study examined the effect of a 2-minute irrigation time of these final irrigants on the extent of demineralization of intact intraradicular dentin and on interfacial nanoleakage after obturation with AH Plus and gutta-percha using warm vertical compaction. Transmission electron microscopy confirmed that the reduction in irrigation time did not compromise the smear layer removing capacity of these two irrigants when 1.3% NaOCl was employed as the initial rinse. BioPure MTAD created 5 to 6 microm thick demineralized dentin matrices, while 17% EDTA produced 1 to 2 microm thick matrices that were suboptimally infiltrated by the epoxy resin-based sealer, as manifested by the occurrence of silver tracer deposits within the hybrid layers.

Chelating Agents↗