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PubMed2006

Wash-out of the non-heart-beating donor liver: a matter of flush solution and temperature?

BACKGROUND AND AIMS: Ischemically damaged donor livers are prone to graft non-function. This can in part be explained by a suboptimal wash-out during procurement. An enriched machine perfusion (MP) preservation solution for livers, named Polysol, was developed. The aim of this study was to investigate the type of flush solution, temperature and anticoagulant content on the wash-out of the non-heart-beating donor (NHBD) rat liver. METHODS: Rat livers were flushed after 30 min warm ischemia. After excision, livers were reperfused at 37 degrees C, with analysis of damage and function, concerning (1) solutions (University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK) and Polysol); (2) temperature (4 degrees C, 18 degrees C and 37 degrees C); (3) addition of heparin and (4) wash-out followed by 24 h MP. RESULTS: (1) Reperfusion results were inferior in the UW group; (2) less damage and improved function were seen after wash-out using Polysol at 37 degrees C; (3) No effects were seen of the addition of heparin to Polysol; (4) MP after wash-out using HTK resulted in more liver damage and decreased liver function as compared with wash-out using Polysol. CONCLUSIONS: Polysol is applicable as a flush solution for the NHBD liver, resulting in equal to better wash-out as compared with UW and HTK. The best temperature for this NHBD wash-out is 37 degrees C.

Adenosine↗
PubMed2005

Monocyte enrichment of mononuclear apheresis preparations with a multistep back-flush procedure on a cord blood filter.

INTRODUCTION: Monocytes or mononuclear cells have been investigated for the treatment of chronic wounds and spinal cord injuries, as well as serve as a source for dendritic or endothelial cell culture. Because these cells may have clinical benefit yet no rapid and inexpensive closed system for monocyte purification is commercially available, a method was investigated to enrich monocytes from mononuclear apheresis units using a cord blood filter. METHODS: A 4-step method for monocyte enrichment was developed which involved 1) filtering a mononuclear apheresis unit through a cord blood filter, 2) chasing with medium to remove non-adherent residual cells and plasma, 3) back-flushing under low shear conditions to remove loosely adherent lymphocytes, and 4) back-flushing under high shear conditions to collect a fraction enriched in monocytes. Apheresis units and enriched monocyte preparations were characterized by cell count and differential, filter-isolated preparations were cryopreserved, and thawed preparations were assayed for viability, and phagocytosis. Enriched monocyte preparations were also assayed for inflammatory cytokines secretion and secretion of prostaglandin E2 during short-term culture. RESULTS: Monocytes were viable, capable of phagocytosis, and enriched using the multistep filter elution technique to represent 42 +/- 13-percent of white cells in the final preparation. Fifty-three-percent of monocytes were recovered in the final preparation, while total cell counts of red cells, platelets, neutrophils and lymphocytes were reduced to 3.0, 3.0, 4.5 and 16-percent, respectively, from levels present in mononuclear apheresis units. Filter enriched monocyte preparations secreted IL-8, IL-6, MCP-1, and MIP-1alpha, during short term culture. CONCLUSION: The use of a multi-step back flush procedure with a cord blood filter resulted in rapid enrichment of viable and functional monocytes from mononuclear apheresis units with significant reduction of contaminating platelets and red cells.

Blood Component Removal↗
PubMed1995

Mock drug delivery to the proximal aorta during cardiopulmonary resuscitation: central vs peripheral intravenous infusion with varying flush volumes.

OBJECTIVE: To compare mock drug deliveries to the proximal aorta during CPR after peripheral vs central i.v. administration when the mock drug is followed by different postinfusion flush volumes. METHODS: Delivery of indocyanine green (ICG) dye to the proximal aorta of an instrumented 20-kg canine cardiac arrest model was examined. The ICG administration (2.5 mg) preceded either a 2-mL or a 10-mL saline flush, for either a central or a peripheral i.v. route of dye administration. Five dogs each underwent three sets of the four possible route/flush-volume combinations in a stratified randomized order. Real-time dye-absorbance-vs-time curves, as sampled from the proximal aorta, modeled central-circulation drug delivery. Systolic and diastolic blood pressures (BPs) were monitored, and the absorbance-vs-time curve upstroke phases were used to estimate cardiac output during arrest. RESULTS: Times (mean +/- SD) to onset of dye appearance did not differ significantly between peripheral/10 mL (126 +/- 35 sec) and central/10 mL (108 +/- 35 sec), or between central/2 mL (123 +/- 31 sec) and central/10 mL. Times to onset of dye appearance did differ between peripheral/2 mL (161 +/- 70 sec) and central/10 mL [analysis of variance (ANOVA) p = 0.032]. Times to peak dye concentration did not differ significantly between peripheral/10 mL (230 +/- 88 sec) and either central/10 mL (202 +/- 88 sec) or central/2 mL (215 +/- 83 sec), but differed between peripheral/2 mL (326 +/- 134 sec) and every other route/flush-volume combination (ANOVA p = 0.009). Peak dye concentrations and systolic/diastolic BPs (averaging 23/10 for all route/flush-volume combinations) did not differ significantly between any route/flush-volume combinations. CONCLUSION: An adequately sized postinfusion crystalloid flush (0.5 mL/kg) permits peripherally administered model drug to reach the central circulation as quickly and in equivalent concentration as centrally administered drug during CPR in a canine cardiac arrest model.

Analysis of Variance↗
PubMed1983

Facial flushing after thermocoagulation of the Gasserian ganglion.

The development of a facial flush during thermocoagulation of the Gasserian ganglion was monitored in 16 patients with pulse recording techniques and in a further 17 patients with thermography. There was a close association between the development of the facial flush in the distribution of one or more divisions of the trigeminal nerve and the subsequent demonstration of postoperative analgesia. In regions where significant changes took place, vascular pulsations increased 25-233% (mean 96%) and facial temperature rose 0.5-2.0 degrees C. The response persisted for up to an hour postoperatively, and was not diminished in patients with pre-operative analgesia from a previous procedure. Possible mechanisms for the facial flush, including stimulation of an active vasodilator system, the antidromic release of vasoactive substances from trigeminal nerve terminals and the release of tonic vasoconstriction are discussed. A practical application of the pulse recording technique used in the present investigation would be to monitor the distribution of vasodilatation at operation to avoid unwanted first division sensory loss.

Adult↗
PubMed2004

Natural saline-flush is sufficient to maintain patency of immobilized-urokinase double-lumen catheter used to provide temporary blood access for hemodialysis.

BACKGROUND: Thrombotic occlusion is a frequent complication of central venous catheters used to provide temporary blood access on hemodialysis therapy. Heparin-lock is conventionally used to maintain patency of the catheter, but the necessity of heparin-lock has not been determined yet. METHODS: After the immobilized-urokinase double-lumen central venous catheter was inserted into 48 Japanese hemodialysis patients, 22 patients randomized to the heparin group received a 20-ml saline-flush, followed by 2 ml of 1,000 U/ml heparin-lock, and 26 patients randomized to the saline group received only the 20-ml saline-flush once a day for each lumen. RESULTS: Thrombotic occlusion was observed in only 1 out of 22 patients in the heparin group and 1 out of 26 patients in the saline group. No significant difference of the catheter survival was observed between the two groups (p = 0.8599). CONCLUSIONS: Natural saline-flush is sufficient for maintaining the patency of an immobilized-urokinase double-lumen central venous catheter.

Aged↗
PubMed2006

Impact of organ preservation using HTK for graft flush and subsequent storage in UW in rat kidney transplantation.

BACKGROUND: In kidney transplantation, preservation has a significant influence on organ function. Since previous reports have indicated a benefit of combining histidine-tryptophan-ketoglutarate (HTK) and University of Wisconsin (UW) solution, we evaluated the effects of initial flush with low viscosity HTK, followed by storage in UW. MATERIAL AND METHODS: Kidneys from inbred Lewis rats were procured using HTK or UW for initially perfusion and re-flushed after 30 min with either solution. In a third group, after perfusion with HTK, organs were re-flushed with UW. Organs were stored for 16-24 h (4 degrees C). Study parameters were high-energy phosphates, histology, apoptosis, recipient survival and urine excretion of 15-F2t -isoprostanes (oxidative stress marker). RESULTS: Prior to transplantation, tissue ATP/ADP concentrations were: HTK/UW > UW-only > HTK-only. In transplanted kidneys, histological damage was highest after preservation in HTK-only. Twenty-four hours after transplantation (24 h cold ischemia time - CIT), cleaved-PARP was most abundant using UW-only. 16 h of CIT resulted in higher urine concentrations of isoprostanes in the order HTK-only (368 +/- 308) > UW-only (157 +/- 105) > HTK/UW (67 +/- 26), and was lower in HTK/UW after 24 h of CIT (146 +/- 38) vs. UW-only (507 +/- 33 pg/mg creatinine). Survival (24 h CIT) was significantly reduced, and percentage of initial non-functioning (INF) kidneys highest in HTK-only (2.6 +/- 0.3 days, 100%), compared to UW-only (13 +/- 4.4 days, 75%) and HTK/UW (18.5 +/- 4.6 days, 33%). CONCLUSIONS: In long-term preservation, UW is superior over HTK. However, our results indicate that perfusion with HTK prior to storage in UW may improve the results of UW alone which is reflected by better survival, lower rate of INF, higher cellular energy conservation and a decrease of free radicals.

Adenosine↗
PubMed1992

Hazardous information from bedside fast-flush device test for fluid-filled pressure monitoring systems.

The fast-flush device test--based on the square-wave principle--has been used in clinical practice to test the accuracy of fluid-filled pressure-monitoring systems. One assumption with the square-wave test is that the system is a second-order approximation. To elucidate the problem, the authors compared, in vitro, a reference test method (frequency response test), valid for second-order systems, with a pure square-wave test and a fast-flush device test. They showed that the two tested systems did not have any relation to the reference system, which suggests that the second-order approximation is not valid. Therefore, the fast-flush device test cannot be used reliably in testing the total chain of catheter, tubing, transducer, and monitor for invasive pressure measurement.

Blood Pressure Determination↗
PubMed1982

Saline flush: a simple method of reducing diazepam-induced thrombophlebitis.

Five hundred outpatients undergoing endoscopy were admitted into a controlled trial comparing the incidence of thrombophlebitis following intravenous diazepam administered in the way, with the effects of either a saline flush following the diazepam or diluting the drug with the patient's own blood before injection ('barbotage'). The results were assessed using a questionnaire completed by patients two weeks after endoscopy; 80% replied. A saline flush reduced the incidence of side effects, particularly pain (P less than 0.05). 'Barbotage' gave the highest incidence of side effects. Saline flush is therefore recommended as a means of reducing the thrombophlebitis which may follow intravenous diazepam.

Clinical Trials as Topic↗
PubMed1976

Continuous flush system for radial artery cannulation.

A prospective study of 50 radial artery cannulations was carried out using the Intraflo continuous flushing device. Functional patency was maintained in all cannulations. No serious complications were seen. It is concluded that this method of continuous flushing is preferable to intermittent manual flushing.

Adult↗
PubMed1985

A comparison of continuous flush devices.

Six different makes of continuous flush device were compared for reliability of flow rate and ease of use. All of the devices tested were considered suitable for flushing of vascular pressure monitoring catheters. However, flow rates were considered too variable for control of drug infusions or flushing of intracranial pressure monitoring systems.

Blood Pressure Determination↗
PubMed1984

Veralipride versus conjugated oestrogens: a double-blind study in the management of menopausal hot flushes.

A double-blind, randomized study was carried out in 43 women, who had undergone spontaneous menopause at least 6 months earlier, to compare the effectiveness and tolerance of veralipride with that of a conjugated oestrogens preparation in the control of hot flushes. Twenty-one women received 100 mg veralipride per day and 22 were due to receive 1.25 mg per day of the hormone preparation over a period of 20 days but 3 women in the oestrogen group discontinued the trial without giving any reason. The number, duration and severity of hot flushes were assessed and scored at the start of the trial and during treatment. Statistical analysis of the results showed marked relief with both preparations but no significant difference between them in terms of effectiveness or tolerance. Veralipride, however, appeared to provide better control in patients who had complained of severe hot flushes initially.

Adult↗
PubMed1987

Effect of estrogen on the growth hormone response to the alpha-adrenergic agonist clonidine in women with menopausal flushing.

The serum GH response to the alpha 2-adrenergic receptor agonist clonidine (0.15 mg, iv) was measured in 8 postmenopausal women with hot flushes before and during treatment with the conjugated estrogen premarin (1.25 mg, orally daily for 4 weeks), 9 normal premenopausal women, and 12 normal men. The men had a significantly greater GH response than did the age-matched premenopausal women (P less than 0.05). The mean individual peak GH response was significantly higher in the premenopausal compared with the postmenopausal women (P less than 0.05). Premarin decreased the number of hot flushes (P less than 0.01), but had no effect on the GH response to clonidine. These results suggest that estrogens do not enhance alpha 2-adrenergic mechanisms that regulate GH secretion and that improvement in menopausal flushing after estrogen therapy is not mediated by an effect on central alpha 2-adrenergic function.

Adrenergic alpha-Agonists↗
PubMed1993

Can an anesthesia machine flush valve provide for effective jet ventilation?

Transtracheal jet ventilation (TTJV) using a percutaneously inserted intravenous (IV) catheter for the patient who cannot be ventilated or tracheally intubated or, using a jet stylet for changing endotracheal tubes (ETT) in patients for whom subsequent ventilation and/or tracheal reintubation may be difficult, are extremely valuable therapeutic options. The jet ventilation system must have a sufficiently high pressure-oxygen source to drive oxygen through noncompliant tubing and through relatively small IV catheters and/or jet stylets in order to achieve adequate ventilation and oxygenation. There is no evidence that using the common gas outlet of an anesthesia machine by activating the flush valve can provide enough flow (V) and tidal volume (VT) for effective jet ventilation. This in vitro study utilized a mechanical lung model that had a varying lung compliance [Cset (10-100 mL/cm H2O)] to determine the VT (measured by integrating a pneumotachograph flow signal) and corresponding minute ventilation (VE) through 14-, 16-, and 18-gauge IV catheters and small, medium, and large jet stylets. The flow of O2 was generated by activating the flush valve of Dräger Narkomed 2 and 2A and Ohmeda Modulus II and II Plus anesthesia machines at an inspiratory:expiratory (I:E) ratio = 1:1 (unit of time = 1 s). We found that the largest VT and resultant VE were consistently obtained by activating the flush valve of the Ohmeda Modulus II and Dräger Narkomed 2 anesthesia machines. The smallest VT and VE were produced using the Ohmeda Modulus II Plus anesthesia machine.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1977

The progesterone content of rabbit uterine flushings.

A detailed study has been made of the progesterone content of uterine flushings taken from rabbits of different endocrine states. A high content of progesterone was recovered from the uterine lumen of pregnant and pseudopregnant rabbits. The amount of progesterone recovered in the flushings was not simply dependent on the concentration in the plasma, because plasma progesterone concentrations rose before detection of progesterone in the flushings and remained high after uterine progesterone content had fallen. Progesterone did not appear in the uterine fluid unless uterine protein was present. This was particularly evident in rabbits treated with progesterone in which, despite abnormally high plasma concentrations, little progesterone was found in uterine fluid until the protein content increased. After treatment of rabbits with oestrogen at the time of ovulation, uterine progesterone was present in higher amounts concomitant with an elevation of protein content although the peak values of progesterone and protein were delayed by 2--3 days. Plasma progesterone concentrations of about 5 ng/ml were necessary before progesterone appeared in the uterine lumen.

Animals↗
PubMed1978

Cyclic variation in concentrations of protein and hexose in human uterine flushings collected by an improved technique.

Uterine flushings were obtained from fertile women at various stages of the menstrual cycle. A technique was used which excluded contamination with cervical mucus and significantly lowered contamination with blood in comparison with an established technique. Contamination of the uterine flushings with seminal plasma and tubal fluid was also prevented. The concentrations of protein and hexose in the uterine flushings, corrected for contamination with plasma, were significantly lower in the secretory stages than in the proliferative stages of the cycle. It is concluded that proteins and carbohydrates are present within the uterine lumen not only after ovulation but also during the preovulatory period.

Adult↗
PubMed1978

Effect of human uterine flushings collected at various stages of the menstrual cycle on mouse blastocysts in vitro.

Mouse blastocysts were cultured in vitro in a defined medium supplemented with uterine flushings (containing 500 microgram protein/ml) obtained from normal women at various stages of the menstrual cycle. With one exception (uterine flushing collected on the last day of a menstrual period) blastocyst hatching and attachment were not impaired by flushings collected before or after ovulation.

Animals↗
PubMed1978

Protein patterns of human uterine flushings collected at various stages of the menstrual cycle.

Uterine flushings and plasma collected from normal, parous women at various stages of the menstrual cycle were subjected to gel electrophoresis. The protein profiles of the flushings differed in many instances from the plasma pattern by the presence of between one and eleven non-plasma proteins. The distribution of the major non-plasma proteins during the menstrual cycle was not statistically significant but that of a pretransferrin, observed in uterine flushings and in peritoneal fluid, was significant. However, the appearance of this protein band could not be related to a particular phase of the cycle, and hence to a specific hormonal condition.

Ascitic Fluid↗