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PubMed2005

Tubal flushing for subfertility.

BACKGROUND: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. Historically a variety of agents have been used to 'flush' the fallopian tubes, although tubal flushing does not currently form part of routine practice in the treatment of fertility delay. OBJECTIVES: To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 2 March 2004), MEDLINE (1966 to Mar 2004), EMBASE (1980 to Mar 2004), Biological Abstract (1980 to Mar 2004) and reference lists of articles. SELECTION CRITERIA: All randomised trials where tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media was compared with one another or with no treatment were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Eleven randomised controlled trials were identified and included in this review. All trials were assessed for quality criteria. The studied primary outcome was live birth (and ongoing pregnancy), with secondary outcomes pregnancy, miscarriage, ectopic pregnancy, treatment complications including pain, intravasation of contrast medium, infection and haemorrhage, and image quality. MAIN RESULTS: Tubal flushing with oil-soluble media versus no intervention (three trials including 381 participants) was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95%CI 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95%CI 2.00 to 5.43). There were no data from RCTs to assess tubal flushing with water-soluble media versus no intervention. For the comparison of tubal flushing with oil-soluble media versus tubal flushing with water-soluble media (six trials including 1,483 participants), the increase in the odds of live birth for tubal flushing with oil-soluble versus water-soluble media (Peto OR 1.49, 95%CI 1.05 to 2.11) was based on two trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.24, 95%CI 0.97 to 1.57). The addition of oil-soluble media to flushing with water-soluble media (water-soluble plus oil-soluble media versus water-soluble media alone; three trials including 555 participants) showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.18, 95%CI 0.82 to 1.70) or live birth (Peto OR 1.06, 95%CI 0.64 to 1.77). Adverse event data were only available for the comparison OSCM versus WSCM: OSCM carried a significantly higher chance of intravasation (Peto OR 5.41, 95%CI 2.57 to 11.37) but a significantly lower chance of immediate pain (Peto OR 0.53, 95%CI 0.34 to 0.84), prolonged pain (Peto OR 0.26, 95%CI 0.15 to 0.45) and post-procedure bleeding (Peto OR 0.22, 95%CI 0.15 to 0.31), and no serious adverse events were reported. AUTHORS' CONCLUSIONS: There is evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention. The limited evidence of an increase in the odds of live birth from tubal flushing with oil-soluble contrast media versus water-soluble contrast media must be interpreted cautiously. Further robust randomised trials, comparing oil-soluble versus water-soluble media and comparing water-soluble media versus no intervention, would be a useful further guide to clinical practice. Further research is merited to ascertain the mechanism of the fertility enhancing effect of oil-soluble media, as to whether this is a 'tubal flushing' phenomenon, an effect on the intraperitoneal environment, or an implantation enhancing effect on the endometrium.

Contrast Media↗
PubMed1997

Effects of daily alcohol intake on the blood pressure differ depending on an individual's sensitivity to alcohol: oriental flushing as a sign to stop drinking for health reasons.

OBJECTIVE: To determine whether flushing of the facial skin in response to alcohol consumption (alcohol flushing) is a warning sign of hypertension. We also sought the relationship between alcohol flushing and other risk factors that may contribute to the development of hypertension. METHODS: We first investigated the relationship of the aldehyde dehydrogenase 2 (ALDH2) genotype to alcohol flushing for 53 normal volunteers. We evaluated the relationships among hypertension, alcohol consumption, and facial flushing for 1011 middle-aged Japanese men (aged 40-68 years; mean 51.6 +/- 5.5 years), on the basis of their responses to questionnaires and health records. RESULTS: The first examination of 53 normal volunteers showed that there were differences in the degree of alcohol flushing between the ALDH2 genotypes (P < 0.01). Hypertension was observed in 27.4% of the study population (277 of 1011), and was correlated positively to alcohol consumption (P < 0.01). The prevalence of hypertension differed significantly among these four groups: there was a 22.4% prevalence (70 of 312) among subjects with no flushing, a 33.8% prevalence (113 of 334) among those with slight flushing, a 27% prevalence (84 of 311) among those with visible flushing, and an 18.5% prevalence (10 of 54) among subjects who were almost completely intolerant to alcohol (P < 0.05). In particular, heavy drinkers who consumed > or = 1.5 Go (a traditional Japanese unit equivalent to 27 g ethanol) a day had a high prevalence of hypertension with slight and visible skin flushing [42% (63 of 150) and 40.7% (24 of 59), respectively]. That a family history of hypertension, greater age, heavy alcohol consumption, obesity, and symptoms of intoxication including flushing were correlated significantly to the prevalence of hypertension for all groups was demonstrated by multiple logistic regression analysis (P < 0.05). CONCLUSIONS: A repeated heavy alcohol intake could increase the risk of hypertension for Japanese subjects who exhibit skin flushing in response to alcohol consumption. Chronic alcohol intake by subjects with alcohol flushing might bring about a significant increase in blood acetaldehyde levels and cause an additional rise in the blood pressure.

Adult↗
PubMed2006

Retrograde blood flow in the brachial and axillary arteries during routine radial arterial catheter flushing.

BACKGROUND: Flushing of radial arterial catheters may be associated with retrograde embolization of air or thrombus into the cerebral circulation. For embolization into the central circulation to occur, sufficient pressure must be generated during the flushing process to reverse antegrade blood flow in the arterial blood vessels of the upper extremity. This ultrasound study was designed to examine whether routine radial catheter flushing practices produce retrograde blood flow patterns in the brachial and proximal axillary arteries. METHODS: Duplex ultrasound examinations of the brachial and axillary arteries were conducted in 100 surgical patients to quantify direction and velocity of blood flow during catheter flushing. After obtaining Doppler spectral images of brachial and axillary arterial flow patterns, manual flushing was performed by injecting 10 ml flush solution using a syringe at a rate reflecting standard clinical practices. The flow-regulating device on the pressurized (300 mmHg) arterial flushing-sampling system was then opened for 10 s to deliver a rapid bolus of fluid (flush valve opening). RESULTS: The rate of manual flush solution injection through the radial arterial catheter was related to the probability of retrograde flow in the axillary artery (P < 0.001). Reversed arterial flow was noted in the majority of subjects (33 of 51) at a manual flush rate of less than 9 s and in no subjects (0 of 48) at a rate 9 s or greater. Retrograde flow was observed less frequently during flush valve opening (2 of 99 patients; P < 0.001 vs. manual flushing). CONCLUSIONS: Rapid manual flushing of radial arterial catheters at rates faster than 1 ml/s produces retrograde flow in the proximal axillary artery.

Adult↗
PubMed2005

Cytochrome gene polymorphisms, serum estrogens, and hot flushes in midlife women.

OBJECTIVE: The purpose of this study was to evaluate whether genetic polymorphisms in selected cytochrome P450 enzymes (CYPc17alpha, CYP1A1, and CYP1B1), estradiol (E2) levels, and estrone levels were associated with hot flushes. METHODS: Women with hot flushes were those aged 45-54 years who reported ever experiencing hot flushes (n = 354). Women without hot flushes were those aged 45-54 years who reported never experiencing hot flushes (n = 258). Each participant completed a questionnaire and provided a blood sample for determination of genotypes, E2 levels, and estrone levels. RESULTS: Carriers of the CYP1B1 (Val432Leu) polymorphism were more likely to report having any hot flushes (risk ratio [RR] 1.16, 95% confidence interval (CI) 0.98-1.37) and at least weekly hot flushes (RR 1.29, 95% CI 0.98-1.70) than women without the polymorphism, although these associations were of borderline statistical significance. In addition, carriers of the CYP1B1 polymorphism were likely to have a statistically significant 30% increased risk of reporting moderate to severe hot flushes (RR 1.30, 95% CI 1.02-1.67) and a statistically significant 27% increased risk of reporting hot flushes lasting a year or more (RR 1.27, 95% CI 1.00-1.61) compared with women without the polymorphism. There were no associations between CYP1A1 or CYPc17alpha polymorphisms and hot flushes. Low E2 and estrone levels were associated with hot flushes, but they did not alter the association between the CYP1B1 polymorphism and hot flushes. CONCLUSION: These data suggest that a CYP1B1 polymorphism may be associated with severe and persistent hot flushes, independent of E2 and estrone levels.

Cohort Studies↗
PubMedDate not supplied

Effect of flushing pressure on rat small bowel transplants.

Excessive flushing pressure in rat small bowel transplants may cause graft failure, but the optimal pressure for manual flushing has not been established. The goal of this study was to determine a safe yet effective pressure for intravascular graft flushing and to evaluate the consequences of higher pressures. The "usual" manual flush was found to be at a pressure of approximately 40 mm Hg. After harvest, grafts were flushed manually with heparinized normal saline solution while connected to a transducer. Two groups of 25-cm jejunal grafts (n = 5 each) were harvested from Lewis rats (200 g) on a pedicle of superior mesenteric artery and vein. Group 1 grafts underwent 3 successive flushes at 50, 100, 200 mm Hg, respectively. After each flush, full-thickness biopsies were obtained for light and transmission electron microscopy. Two grafts underwent syngeneic small bowel transplantation (SBTx), and biopsies were taken after reperfusion. Group 2 grafts were flushed at 50 mm Hg and biopsies were obtained. All grafts underwent SBTx and biopsies as in group 1. After flushing at 50 mm Hg. biopsies were essentially normal. When flushed at 100 mm Hg, there was pronounced epithelial separation with dilatation of the core of the villus. Flushing at 200 mm Hg resulted in complete separation of the villi, with occasional disruption in the crypts. All group 1 transplanted grafts were grossly nonviable immediately after reperfusion, while transplanted grafts in group 2 were grossly normal. The findings were consistent within each group and the difference between groups was statistically significant (0 vs. 100%). The results suggest that flushing pressures of 50 mm Hg in rat SBTx provide optimal evacuation of blood with minimal, reversible tissue injury. Higher pressures cause progressive histologic damage and may produce nonviable grafts. Flushing pressures in the rat model of SBTx should therefore be maintained at approximately 50 mm Hg.

Animals↗
PubMed2002

Tubal flushing for subfertility.

BACKGROUND: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. Historically a variety of agents have been used to 'flush' the fallopian tubes, although tubal flushing does not currently form part of routine practice in the treatment of fertility delay. OBJECTIVES: To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent pregnancy outcomes in couples with infertility. SEARCH STRATEGY: The search strategy of the Menstrual Disorders and Subfertility Group and a recent search of electronic databases completed in December 2001 was used for the identification of relevant randomised controlled trials. SELECTION CRITERIA: All randomised trials where tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media was compared with one another or with no treatment were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Eight randomised controlled trials were identified and included in this review. A further one randomised controlled trial is ongoing. All trials were assessed for quality criteria. The studied outcomes were pregnancy, live birth (and ongoing pregnancy), miscarriage, ectopic pregnancy, treatment complications including pain, intravasation of contrast medium, infection and haemorrhage, and image quality. MAIN RESULTS: Tubal flushing with oil-soluble media versus no intervention was associated with a significant increase in the odds of pregnancy (OR 3.57, 95%CI 1.76-7.23). There were no data from RCTs to assess tubal flushing with water-soluble media versus no intervention. Tubal flushing with oil-soluble media was associated with a significant increase in the odds of live birth versus tubal flushing with water-soluble media (OR 1.49, 95%CI 1.05-2.11) but the odds of pregnancy showed no significant difference (OR 1.23, 95%CI 0.95-1.60) and there was evidence of statistical heterogeneity for these two outcomes. The addition of oil-soluble media to flushing with water-soluble media (water-soluble plus oil-soluble media versus water-soluble media alone) showed no significant difference in the odds of pregnancy (OR 1.16, 95%CI 0.78-1.70) or live birth (OR 1.06, 95%CI 0.64-1.77). REVIEWER'S CONCLUSIONS: There is some evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy versus no intervention. The limited evidence of an increase in the odds of live birth from tubal flushing with oil-soluble contrast media versus water-soluble contrast media must be interpreted cautiously. Further robust randomised trials, comparing oil-soluble versus water-soluble media and comparing each versus no intervention, are required to provide convincing evidence as to whether the technique should be accepted into widespread clinical practice.

Contrast Media↗
PubMed2002

Pressurized bag pump and syringe pump arterial flushing systems: an unrecognized hazard in neonates?

OBJECTIVE: Hand-held flushing of radial arterial lines at 0.5 ml/s in neonates can result in retrograde embolization of flush solution into the central arterial circulation. We studied flush flow velocities during intermittent arterial line purging using a flow regulating device with an infusion bag pump and a syringe pump system. MEASUREMENTS AND INTERVENTIONS: In this in vitro experiment we simulated flushing of a 24- and a 22-G cannula against a mean arterial pressure of 45 mmHg. Fluid flow velocities were gravimetrically measured during flushing from an infusion bag system pressurized to 100, 200, and 300 mmHg and from a syringe pump flush system after initialization of boluses of 0.5, 1.0, 1.5, 2.0, and 2.5 ml. The flow regulating device was opened for 1, 2, and 5 s. RESULTS: Both flush systems tested allowed delivery of flush flow velocities exceeding 0.5 ml/s (e.g., 22-G cannula; bag system, pressure 300 mmHg up to 0.64+/-0.08 ml/s; syringe pump, 2 ml bolus up to 0.74+/-0.05 ml/s). In syringe pump systems the main determinant of flow velocity was bolus size, in bag pump systems flushing time and bag pressure. CONCLUSIONS: Based on data about critical flow velocities through an radial arterial cannula in neonates, both tested flushing systems carry the risk of exceeding the critical value of 0.5 ml/s. They are likely to cause retrograde embolization of flushing solution into the central arterial circulation with the associated risk of clot and air embolization. In vivo studies should identify margins of safety to minimize the risk of retrograde flushing into the central arterial circulation.

Catheters, Indwelling↗
PubMed2004

Raloxifene is not associated with biologically relevant changes in hot flushes in postmenopausal women for whom therapy is appropriate.

OBJECTIVES: Raloxifene is approved for the treatment and prevention of postmenopausal osteoporosis. Previous studies have described a raloxifene-associated increase in hot flushes, reported as adverse events. This study was undertaken to provide a detailed evaluation of the potential of raloxifene to induce or exacerbate hot flushes in postmenopausal women. STUDY DESIGN: In this double-blind, placebo-controlled, parallel group multicenter study, 487 postmenopausal women were randomized to receive 8 months of treatment with either raloxifene (RLX) at the recommended dose of 60 mg/day, or by slow-dose escalation for the first 2 months, followed by the standard dose for the rest of the study (SDE), or placebo (PL). The frequency, duration, intensity, severity, and impact of hot flushes were measured. RESULTS: With 3-5 hot flushes per week, the mean number at baseline was low. During treatment, it increased by <1 hot flush/week in both active treatment groups and decreased by <1 hot flush/week with PL. The high proportion ( approximately 60%) of asymptomatic patients at baseline had increased further by the end of treatment in all groups. The proportion of women whose pre-existing hot flushes abated during treatment was significantly greater with SDE (P=.005) and PL (P=.050), but not with RLX, when compared with the proportion with treatment-emergent flushes. There were no statistically significant between-group differences in the distribution of the number of hot flushes after 2 months of treatment. At end point, there were no significant differences between SDE and either RLX or PL, but the difference between RLX and PL was statistically significant (P=.035). There were no significant between-group differences in the hot flush impact scores, in treatment satisfaction, and in the proportion of patients requesting symptomatic treatment to alleviate hot flushes. CONCLUSION: In a postmenopausal population meeting the criteria for the prescription of RLX, the overall effect of the drug on hot flushes is low. Previous studies using adverse event reports have overestimated the importance of hot flushes in postmenopausal women during treatment with RLX. Slow-dose escalation seems to decrease the number of symptomatic patients further and may be a useful strategy in women reporting flushes when starting RLX.

Aged↗
PubMed2006

Isoflavone therapy for menopausal flushes: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis of all randomized, controlled trials of isoflavone supplementation to determine the efficacy of isoflavone therapy in reducing the number of daily menopausal flushes. METHODS: A comprehensive search of published studies of isoflavone treatment and menopausal flushing was undertaken. Studies were selected if they were randomized, were placebo controlled, provided the number of baseline flushes, the variance in flushes and the reduction in flushes. Effects for isoflavone treatment compared to control were calculated and a meta-analysis was performed. Regression analysis, weighted for the size of the study was performed to investigate the relationship between the dose of isoflavone, or number of baseline flushes and the reduction in flushes achieved compared to control. RESULTS: Isoflavone supplementation was found to be associated with a significant reduction in flushes (effect size -0.28, 95% confidence intervals -0.39 to -0.18, P < 0.0001). Marked heterogeneity was found between the studies, but the effect remained significant when analyzed using a random effects model (delta = -0.49, 95% confidence intervals -0.81 to -0.17, P = 0.001). The percentage reduction in flushes was significantly related to the number of baseline flushes per day and the dose of isoflavone studied (beta = -0.49 and -0.26, respectively, both P < 0.0001). CONCLUSIONS: These results suggest that isoflavone supplementation may produce a slight to modest reduction the number of daily flushes in menopausal women and that the benefit may be more apparent in women experiencing a high number of flushes per day.

Clinical Trials as Topic↗
PubMed2006

Hormonal control of second flushing in Douglas-fir shoots.

Spring-flushing, over-wintered buds of Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) produce new buds that may follow various developmental pathways. These include second flushing in early summer or dormancy before flushing during the following spring. Second flushing usually entails an initial release of apical dominance as some of the current-season upper lateral buds grow out. Four hypotheses concerning control of current bud outgrowth in spring-flushing shoots were tested: (1) apically derived auxin in the terminal spring-flushing shoot suppresses lateral bud outgrowth (second flushing); (2) cytokinin (0.5 mM benzyladenine) spray treatments given midway through the spring flush period induce bud formation; (3) similar cytokinin spray treatments induce the outgrowth of existing current lateral buds; and (4) defoliation of the terminal spring-flushing shoot promotes second flushing. Hypothesis 1 was supported by data demonstrating that decapitation-released apical dominance was completely restored by treatment with exogenous auxin (22.5 or 45 mM naphthalene acetic acid) (Thimann-Skoog test). Hypothesis 2 was marginally supported by a small, but significant increase in bud number; and Hypothesis 3 was strongly supported by a large increase in the number of outgrowing buds following cytokinin applications. Defoliation produced similar results to cytokinin application. We conclude that auxin and cytokinin play important repressive and promotive roles, respectively, in the control of second flushing in the terminal spring-flushing Douglas-fir shoot.

Cytokinins↗
PubMed1996

Influence of pulmonary arterial pressure during flushing on lung preservation.

The effect of changing pulmonary artery pressure during flushing (flushing pressure) on lung preservation was examined in an ex vivo rabbit lung perfusion model. Both lungs were flushed in situ with 200 ml of a preservation solution (extracellular fluid [ECF] type) at 8 degrees C, at a constant flushing pressure maintained by regulating the flushing flow rate from 20 to 120 ml/min. In the controls, the flushing pressure was maintained at 15 mmHg and the lungs were assessed without storage. In the other 5 groups (n = 7 in each group), the lungs were flushed at pressures of 5, 10, 15, 20, and 25 mmHg, respectively. The heart-lung block was then harvested, and immersed in the same solution at 8 degrees C for 24 hr. After 24 hr of storage, the block was reperfused with pooled venous blood for 10 min, and then with oxygenated blood for another 60 min in a closed circuit. Assessment of lung function included blood gas analysis of effluent blood, pulmonary artery pressure, airway pressure, wet:dry weight ratio, and histologic study. At flushing pressures of 5, 20, and 25 mmHg, uniform and clear flushing out of the pulmonary vascular beds was not obtained, resulting in postperfusion pulmonary hypofunction and a high incidence of pulmonary edema. However, at flushing pressures of 10-15 mmHg, we succeeded in completely flushing out the pulmonary vascular beds, and managed to preserve good pulmonary function. In conclusion, we determined the optimal flushing pressure for rabbit lung preservation to be 10-15 mmHg.

Animals↗
PubMed2005

The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet.

AIMS: To determine the level of aerosol formation and fallout within a toilet cubicle after flushing a toilet contaminated with indicator organisms at levels required to mimic pathogen shedding during infectious diarrhoea. METHODS AND RESULTS: A semisolid agar carrier containing either Serratia marcesens or MS2 bacteriophage was used to contaminate the sidewalls and bowl water of a domestic toilet to mimic the effects of soiling after an episode of acute diarrhoea. Viable counts were used to compare the numbers of Serratia adhering to the porcelain surfaces and those present in the bowl water before and after flushing the toilet. Air sampling and settle plates were used to determine the presence of bacteria or virus-laden aerosols within the toilet cubicle. After seeding there was a high level of contamination on the porcelain surfaces both under the rim and on the sides of the bowl. After a single flush there was a reduction of 2.0-3.0 log cycles cm(-2) for surface attached organisms. The number of micro-organisms in the bowl water was reduced by 2.0-3.0 log cycles ml(-1) after the first flush and following a second flush, a further reduction of c. 2.0 log cycles ml(-1) was achieved. Micro-organisms in the air were at the highest level immediately after the first flush (mean values, 1370 CFU m(-3) for Serratia and 2420 PFU m(-3) for MS2 page). Sequential flushing resulted in further distribution of micro-organisms into the air although the numbers declined after each flush. Serratia adhering to the sidewalls, as well as free-floating organisms in the toilet water, were responsible for the formation of bacterial aerosols. CONCLUSIONS: Although a single flush reduced the level of micro-organisms in the toilet bowl water when contaminated at concentrations reflecting pathogen shedding, large numbers of micro-organisms persisted on the toilet bowl surface and in the bowl water which were disseminated into the air by further flushes. SIGNIFICANCE AND IMPACT OF THE STUDY: Many individuals may be unaware of the risk of air-borne dissemination of microbes when flushing the toilet and the consequent surface contamination that may spread infection within the household, via direct surface-to-hand-to mouth contact. Some enteric viruses could persist in the air after toilet flushing and infection may be acquired after inhalation and swallowing.

Acute Disease↗
PubMed2003

[Clinical evaluation of hot flushes developing during endocrine therapy for prostate carcinoma].

OBJECTIVE: There are few clinical investigations on the hot flushes that develop during endocrine therapy for prostate cancer in Japan, although there are many reports in the Western countries. Therefore, we evaluated the incidence of hot flushes and the association between hot flushes and clinical characteristics of prostate cancer patients receiving endocrine therapy. PATIENTS AND METHODS: Sixty-eight prostate cancer patients receiving endocrine therapy (LH-RH analog (group LH-RHA); 22 patients, LH-RHA + non-steroidal antiandrogen (group LH-RHA + NSAA); 20 patients, LH-RHA + steroidal antiandrogen (group LH-RHA + SAA); 8 patients, LH-RHA + estramustine phosphate (group LH-RHA + EP); 1 patient, bilateral orchiectomy (group O); 5 patients, O + non-steroidal antiandrogen (group O + NSAA); 11 patients, and O + steroidal antiandrogen (group O + SAA); 1 patient) were evaluated by a fixed questionnaire. The incidence of the hot flush, the association between hot flushes and the clinical factors, as well as the therapy of hot flushes including SAA and Kampo therapy were analyzed. RESULTS: The overall incidence of hot flushes was 37% (36% in group LH-RHA, 45% in group LH-RHA + NSAA, 13% in group LH-RHA + SAA, 0% in group LH-RHA + EP, 20% in group O, 45% in group O + NSAA, 100% in group O + SAA). No significant association between the hot flushes and the clinical factors of the patients was observed. On the other hand, in 3 of 4 patients treated by SAA, hot flushes improved after 4 weeks. In 2 of 3 patients treated by Kampo, hot flushes improved after 4 weeks. CONCLUSION: Hot flushes are the major side effect of endocrine therapy for Japanese prostate cancer patients. SAA and Kampo are thought to be effective for treatment of hot flushes.

Aged↗
PubMed1996

The effects of heparin flush on patency of the Groshong catheter: a pilot study.

PURPOSE/OBJECTIVES: To determine whether the addition or a heparinized saline flush would decrease clot formation and persistent withdrawal occlusion (PWO) in Groshong (Bard Access Systems, Salt Lake City, UT) catheters. DESIGN: A prospective, nonrandomized study using a historical control group of patients with Groshong catheters that had been flushed weekly with 5 ml normal saline compared to data from patients with Groshong catheters flushed weekly with 2.5 ml heparinized saline (100 U/ml). A retrospective chart review was performed to determine the incidence of PWO. In both groups, the presence of liquid blood and adherent or nonadherent clot in explanted catheters was recorded. SETTING: Oncology inpatient and outpatient units of a cancer research center located in a mid-Atlantic city in the United States. SAMPLE CONTROL GROUP: Twenty-eight 9.5 Fr. double-lumen Groshong catheters maintained with a saline flush. Experimental group: Twenty-three double-lumen Groshong catheters maintained with a heparin flush. At the time of this report, 12 of these 23 catheters had been explanted and 11 remained in place. METHODS: The frequency of PWO was measured in a retrospective chart review and determined by the number of urokinase instillations required for each catheter. All 28 catheters in the saline flush group and 8 catheters in the heparin flush group were examined immediately after removal for intraluminal liquid blood and adherent or nonadherent clot. MAIN RESEARCH VARIABLES: Urokinase usage, intra-luminal blood or clot, and PWO. FINDINGS: PWO occurred less frequently in the heparin flush group (p = 0.006) than in the saline fush group. All 28 of the saline flush catheters developed an adherent clot in one or both lumens, whereas no adherent clots were found in the heparin flush catheters (p < 0.0001). CONCLUSIONS: The addition of a heparinized saline weekly flush to maintain Groshong catheters decreased the presence of intraluminal adherent clots and improved the catheter function. IMPLICATIONS FOR NURSING PRACTICE: The safe delivery of medication and the ability to obtain blood specimens are vital for patients who depend on functioning venous access catheters. Flushing Groshong catheters with heparinized saline decreases the likelihood of intraluminal clot formation and catheter malfunction.

Adult↗
PubMed2007

Urotensin-II induces ear flushing in rats.

BACKGROUND AND PURPOSE: While investigating the effects of systemic urotensin II (U-II), a potent vasoactive peptide acting at the UT receptor, we observed ear pinna flushing after systemic administration to conscious rats. In the present study, U-II-induced ear flushing was quantified in terms of ear pinna temperature change and potential mechanisms were explored. EXPERIMENTAL APPROACH: U-II-induced ear flushing was quantified by measuring lateral ear pinna temperature changes and compared to that of calcitonin gene-related peptide (CGRP), a known cutaneous vasodilator. Further, the effects of a variety of pharmacological agents on U-II-induced ear flushing were explored. KEY RESULTS: Subcutaneous injection of U-II (9 microg kg(-1))produced localized ear pinna flushing with an onset of approximately 15 min, a duration of approximately 30 min and a maximal temperature change of 9 degrees C. In contrast, CGRP caused cutaneous flushing within multiple cutaneous beds including the ear pinna with a shorter onset and greater duration than U-II. A potent UT receptor antagonist, urantide, blocked U-II-induced ear flushing but did not affect CGRP-induced ear flushing. Pretreatment with indomethacin or L-Nomega-nitroarginine methylester (L-NAME) abolished U-II-induced ear flushing. Mecamylamine or propranolol did not affect this response to U-II. Direct intracerebroventricular injection studies suggested that the ear flushing response to U-II was not mediated directly by the CNS. CONCLUSION AND IMPLICATIONS: Our results suggest that U-II-induced ear flushing and temperature increase is mediated by peripheral activation of the UT receptor and involves prostaglandin- and nitric oxide-mediated vasodilation of small capillary beds in the rat ear pinna.

Adrenergic beta-Antagonists↗
PubMed1984

The flushing response to alcohol use among Koreans and Taiwanese.

Alcohol use, the existence of a flushing response to alcohol and the amount of alcohol required to evoke flushing were studied by questionnaire in 87 homeland Korean and 101 Taiwan Chinese families. SFs (slow flushers--flush after two or more drinks) and FFs (fast flushers--flush after one drink or less) were compared. Despite the similarity in the proportions of subjects who reported flushing, Koreans reported very heavy and Taiwanese very light alcohol use. The two groups differed substantially in the proportions of SFs and FFs. Five ethnic groups in Hawaii were compared with the Koreans and Taiwanese. It appears that fast flushing, but not slow flushing, leads to substantial decreases in alcohol use among all seven groups. The association of flushing type with the extent and duration of flushing and with the frequency of other alcohol-related symptoms may be dose-dependent. For both Koreans and Taiwanese, family resemblances in flushing are substantial but not supportive of the belief that flushing is dominant and results from the influence of a single autosomal gene pair. Of the large groups of subjects from whom data were obtained (Caucasians, Chinese, Filipinos, Hawaiians or part Hawaiians, and Japanese in Hawaii; homeland Koreans; and Taiwan Chinese), the Koreans and Taiwanese differ the most from one another in alcohol consumption. In summary, there is substantial diversity among groups frequently lumped together as "Mongoloid."

Adult↗
PubMed2003

Alcohol flushing, alcohol and aldehyde dehydrogenase genotypes, and risk for esophageal squamous cell carcinoma in Japanese men.

Alcohol flushing after light drinking is triggered mainly by severe acetaldehydemia in individuals possessing inactive aldehyde dehydrogenase (ALDH)-2. Inactive ALDH2 encoded by ALDH2*1/2*2 and the low-activity form of alcohol dehydrogenase (ADH)-2 encoded by ADH2*1/2*1 enhance the risk for esophageal cancer in Japanese light to heavy drinkers, a significant association that emphasizes the importance of screening tests for inactive ALDH2 based on alcohol flushing. The objectives of the present report were (a). to evaluate the reliability of a simple questionnaire that asks about both current and past flushing for detecting inactive ALDH2 and (b). to predict cancer risk based on flushing in a case-control manner. The study subjects consisted of 233 Japanese men with esophageal squamous cell carcinoma and 610 cancer-free Japanese men. When current or former flushing individuals were considered to have inactive ALDH2, the sensitivity and specificity of the test were 84.8% and 82.3%, respectively, for the cases and 90.1% and 88.0%, respectively, for the controls. To clarify the characteristics of men who had genetically inactive ALDH2 but did not report alcohol flushing, we analyzed individuals possessing the ALDH2*1/2*2 genotype and found that those who also had ADH2*1/2*1 (both cases and controls) tended not to report current flushing, and those who did not report current flushing (controls only) tended to be heavier drinkers. As compared with overall never or rare drinking, the cancer risks for light (1-8.9 units/week; 1 unit = 22 g of ethanol), moderate (9-17.9 units/week), and heavy (18+ units/week) drinkers with current or former flushing (odds ratio = 6.69, 42.66, and 72.86, respectively) significantly exceeded the risks for those who had never flushed (odds ratio = 1.27, 10.12, and 15.61, respectively), even after adjustment for age, smoking, and diet. The flushing questionnaire may be used in large-scale epidemiological studies as a surrogate marker of ALDH2 genotype to predict individual cancer risk.

Adult↗
PubMed1998

Self-reported flushing and genotypes of ALDH2, ADH2, and ADH3 among Taiwanese Han.

The aims of this study are to investigate whether self-reported facial flushing postalcohol consumption (PAC) among subjects with ALDH2*1/*1 can be attributed to ADH2 or ADH3 and whether the prediction of ALDH2 genotype can be improved by examining the combination of flushing and other accompanying reactions of PAC sensitivity. Fifty-eight subjects of Han ancestry in Taiwan were interviewed for alcohol-sensitivity reactions and their blood samples were genotyped for ALDH2, ADH2, and ADH3. For subjects with ALDH2*1/*1 (n = 46), 70% reported to have no flushing PAC and 30% reported flushing PAC. When subjects with ALDH2*1/*1 had ADH2*1/*1 (n = 11), all reported to have no flushing; otherwise, 35% (for ADH2*1/*2, n = 17) and 44% (for ADH2*2/*2, n = 18) reported flushing. For subjects with ALDH2*1/*1 and at least one ADH2*2 allele, the genotype of ADH3 was not associated with self-reported flushing. PAC flushers with ALDH2*1/*1 (50%) were more likely to report nausea than those with ALDH2*1/*2 (8%). The probability of ALDH2*1/*1 given flushing reported was 0.29, while the probability of ALDH2*1/*1 given both flushing and nausea reported was 0.71. The results indicate that self-reported flushing is determined by both ALDH2 and ADH2 and that prediction of ALDH2 genotype on the basis of self-reported flushing and nausea can help identify subjects at increased risk for alcoholism.

Adult↗