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PubMed2000

Electrolyzed strong acid aqueous solution irrigation promotes wound healing in a burn wound model.

The purpose of the study was to understand the effectiveness of electrolyzed strong acid aqueous solution (ESAAS) for acceleration of epithelialization in a rat burn wound model. Eighteen anesthetized Sprague-Dawley rats received 30% total body surface area third-degree burns, and 2 days after injury, the wound eschars were removed. Rats were divided into 3 groups: Group 1, no irrigation; Group 2, irrigation with physiological saline; and Group 3, irrigation with ESAAS. Wounds were observed macroscopically until they were fully epithelialized, and epithelialized wounds were examined microscopically. Epithelialization of the wounds occurred significantly early in the rats treated with ESAAS (p < 0.05). Proliferation of associated lymphocytes and macrophages was more extensive in all rats that underwent irrigation than it was in control rats. ESAAS irrigation may promote tissue growth in burn wounds.

Acids↗
PubMed2001

Effects of linear, irrigated-tip radiofrequency ablation in porcine healed anterior infarction.

INTRODUCTION: Radiofrequency (RF) catheter ablation for ventricular tachycardia (VT) in healed infarction is modestly successful. More extensive, anatomically based procedures and irrigated RF delivery may improve outcome. However, limited data exist regarding the characteristics of irrigated RF lesions in infarcted myocardium. This study addresses this shortcoming. METHODS AND RESULTS: Linear lesions were created at the medial border of a healed anterior infarct in eight pigs using irrigated RF energy guided by sinus rhythm electroanatomic voltage mapping and intracardiac echocardiography (ICE). Lesion morphology and effects on ventricular function were assessed with ICE imaging and pathologic analysis (n = 5). The response to programmed stimulation also was determined before and after linear lesions (n = 6). A mean of 9.4 +/- 1.3 RF applications created linear lesions 37.0 +/- 10.6 mm long, 5 to 12 mm wide, and 4 to 8 mm deep. Thrombus formation was not observed. Lesion delivery resulted acutely in increased local wall thickness at the RF site (26.9% +/- 27.5%; P < 0.0001) and transient systolic dysfunction in adjacent normal myocardium (fractional shortening -38% +/- 34%; P < 0.01). Uniform sustained VT (cycle length 232 +/- 41 msec) was induced in 4 of 6 pigs before ablation, but sustained VT could not be induced afterward. CONCLUSION: Irrigated RF energy produced relatively large lesions in infarcted myocardium without thrombus formation. Changes in tissue thickness and echo density observed with ICE verify irrigated RF lesion delivery. Temporary left ventricular dysfunction is consistently observed in the normal myocardium adjacent to the linear lesion.

Animals↗
PubMed2005

Saline-irrigated radiofrequency ablation electrode with external cooling.

INTRODUCTION: Open flush, irrigated ablation electrodes may improve the safety of radiofrequency catheter ablation by preventing protein aggregation and coagulum formation. This is particularly important in left-sided procedures like catheter ablation of atrial fibrillation. Electrode cooling and the inherent loss of temperature feedback, however, grossly reduce the ability to monitor tissue heating. Intimate contact may not be recognized and the delivery of nominal RF power levels may then lead to excessive tissue heating, steam explosions, and even tamponade. METHODS AND RESULTS: Standard, open flush, irrigated catheters (Sprinklr, Medtronic Inc, Minneapolis, MN) were modified by thermally insulating the irrigation channels inside the ablation electrode. Using the thigh muscle preparation, multiple lesions were created with standard and modified catheters using 60 s, 20-50 Watt applications and a constant saline flush rate of 20 cc/min. A total of 57 lesions were created on five thigh muscles of three dogs. Lesion dimensions were not significantly different between both types of catheter, but the maximum electrode temperature rise during ablation was significantly higher with the modified catheter. Insulation of the irrigation channels improved the correlation coefficient between maximum electrode temperature rise and lesion volume from 0.38 (ns) to 0.62 (P < 0.001). CONCLUSION: Thermal insulation of the irrigation channels facilitates temperature feedback during radiofrequency ablation and controllability of lesion formation.

Animals↗
PubMed2002

Ex vivo testing of a temperature- and pressure-controlled amnio-irrigator for fetoscopic surgery.

BACKGROUND: Currently, amnioinfusion fluids used in operative fetoscopy usually are preheated to body temperature. As the complexity of procedures increases, purposed designed devices should be designed that allow control of pressure and temperature during amnioinfusion or amnioexchange. In the current study, a prototype amnio-irrigator and fluid heater were evaluated. METHODS: The medical fluid heater heats fluid by conduction up to 37 degrees C. The maximum irrigation pressure and flow rates can be preset. Actual irrigation pressure (0 to 30 mm Hg) and flow rate (0 to 300 mL/min) can be read on the front panel. A series of ex vivo experiments were set up to determine the relationship between the flow rate (FR) and lumen of the instruments as well as the maximum flow rate (MFR) with and without the pressure control. Further, the relationship between FR and the irrigation pressure (IP) was determined. In an artificial pseudoamniotic sac the relationship between FR and change in temperature was measured, with and without the use of the medical fluid heater. RESULTS: When the IP was limited to 24 mm Hg, FR and pressure were correlated (r = 0.34; P <.001). The larger the functional lumen of the fetoscopic instrumentation, the higher the flow (r = 0.43; P <.001) and the lower the increase in IP (r = -0.47; P <.001). A quadratic relation between flow and temperature was observed both for preheated fluid as when using the fluid heater (r(2) = 0.71 and r(2) = 0.88; P <.001). However, at low flow rates, a thermal decrease of over 3 degrees C was observed when the fluid heater was not used. CONCLUSIONS: The current study quantifies an expected relationship between the diameter of the irrigation channel and achievable flow rates. It also shows that a medical fluid heater is needed when strict control of temperature would be desired.

Equipment Design↗
PubMed2004

Irrigation pressure and vessel injury during microsurgery: a qualitative study.

Irrigation solution is routinely used in microsurgery. While the anticoagulation solution may aid in anastomotic patency, the direct effect of pressure irrigation can have a detrimental effect on the vessel. An experimental study was performed to determine the effect of irrigation pressure on the vessel wall. Histological evaluation with hematoxylin and eosin (H&E) stain and scanning electron microscopy (SEM) was performed on the arteries of New Zealand white rabbits irrigated with lactated Ringer's solution at pressures of 80 mmHg, 100 mmHg, and 500 mmHg. H&E staining and SEM microscopy demonstrated injury to the endothelial cells and internal elastic lamina at pressures of 100 mmHg or greater. Controlling microsurgical irrigation pressure to less than 100 mmHg may help to avoid vessel injury.

Animals↗
PubMed1996

[Effect of postoperative endonasal mucous membrane care on nasal bacterial flora: prospective study of 2 irrigation methods with NaCl solution after paranasal sinus surgery].

BACKGROUND: Endonasal irrigation with saline solution is a widely used constituent of mucosal care after sinus surgery. This procedure could explain a repeatedly observed phenomenon: contamination of the endonasal mucosa by facultative skin pathogens from the palm during paranasal sinus irrigation. METHOD: For this reason the effect of nasal rinses with saline solution on the endonasal bacterial flora was investigated (use of so-called nasal douche [Siemens & Co., Bad Ems] compared to rinsing by hand). In 36 patients (23 m., 13 f., 36 +/- 19.5 years of age) with chronic sinusitis, a total of 288 swabs was collected before, during, and after surgery. The collected specimens were transferred to a Port-A-Cul transport medium and processed within four hours. RESULTS: Two hundred sixty-six cultures of 325 bacterial strains were aerobic (82%), while 59 were anaerobic (18%). Staphylococcus aureus (33%) and representatives of the Enterobacteriaceae family (31%) were the most common enriched germs. The number of times that enterobacteriaceae could be isolated was significantly (p < 0.05) lower (13%) when a nasal douche was used than when irrigation was done using the palm (38%). An irrigation technique-related effect was found on neither the spectrum of the pathagonic organisms nor the wound healing process. CONCLUSION: The frequent isolation of enterobacteria in nasal swabs of individuals rinsing by hand constitutes the difference between irrigation by nasal douche and by hand in the postoperative care of the endonasal mucosa. These pathogens can sustain the paranasal sinus system.

Adult↗
PubMedDate not supplied

[Treatment of calcific humero-scapular periarthropathy using needle irrigation of the shoulder: retrospective study].

212 patients with calcareous tendinitis of the shoulder were retrospectively analysed with a pain questionnaire after treatment with needle irrigation. Age, sex, number of needle irrigations and the time interval between treatment and interview were recorded from a file-card, also the side of affection. 149 questionnaires could be analysed by relational data bank processing on a personal computer. The median pain duration previous to the irrigation was 24 months; the median time interval between chalk deposition in x-ray studies of the shoulders and irrigation was 6 months. The sex ratio was 2:1 with preference given to females. The mean age at intervention was 47 years among the females and 49 years among the males; this age difference was not significant. There was no relationship between the preferred hand for working and the side of subacromial chalk deposition. We found in 54.5% painful calcareous depositions in the right shoulder and in 33.5% in the left. Both sides were affected in 12%. The median interval between needle irrigation and questionnaire analysis was 5 years. At this time 60% of all patients were free of pain, 34% stated a marked relieve of pain and 6% were unchanged.

Calcinosis↗
PubMed1991

[Differences in the pathogen spectrum of the conjunctival sac before and after irrigation of the lacrimal apparatus].

The microbial flora in the conjunctival sac of 30 patients was investigated. Qualitative and quantitative differences before and after irrigation of the lacrimal system were found. In some cases a quantitative increase was registered. In 12 cases conjunctival samples before and after irrigation changed. Negative results before and bacterial growth of coagulase-negative staphylococci after irrigation were found in 4 cases. In 3 cases unfavourable changes were seen. Pseudomonas, Klebsiella and beta-hemolytic streptococci were isolated after irrigation in these cases. In the other cases differences were insignificant. The sense of preoperative irrigation of the lacrimal system is discussed and questioned.

Aged↗
PubMed2001

Activated charcoal alone and followed by whole-bowel irrigation in preventing the absorption of sustained-release drugs.

OBJECTIVE: Our objective was to study the effect of activated charcoal on the absorption of sustained-release drugs ingested 1 hour earlier and to examine whether whole-bowel irrigation affects the efficacy of charcoal. METHODS: In this randomized, 3-phase crossover study, 9 healthy subjects received, at the same time, 200 mg carbamazepine, 200 mg theophylline, and 120 mg verapamil. All drugs were given as sustained-release tablets. One hour after taking the tablets, the subjects were assigned to one of the following treatments: 25 g activated charcoal as a suspension, 25 g activated charcoal as a suspension followed by whole-bowel irrigation with polyethylene glycol (PEG) electrolyte lavage solution, or 200 mL water (control). The absorption of the drugs was characterized by using the area under the plasma drug concentration-time curve from time zero to 24 hours [AUC(0-24)], peak plasma concentration (C(max)), C(max) minus the plasma concentration at 1 hour (C(Delta)), and time to peak (t(max)). RESULTS: Activated charcoal alone given 1 hour after drug intake significantly (P <.001) reduced the absorption [AUC(0-24)] of all 3 drugs (by 62%-75%). Also the C(max) and C(Delta) values of these drugs were significantly reduced by charcoal alone. Whole-bowel irrigation did not increase significantly the effect of charcoal on any absorption parameters of the 3 drugs studied. On the contrary, whole-bowel irrigation significantly (P <.01) decreased the efficacy of charcoal with respect to carbamazepine. CONCLUSIONS: Activated charcoal alone given 1 hour after intake of sustained-release drugs was effective in preventing the absorption of all 3 drugs studied. Whole-bowel irrigation may even decrease the efficacy of charcoal if the drug is well adsorbable onto charcoal. However, our study was performed with therapeutic drug doses only. In overdoses their possible effects on gastrointestinal motility may modify the efficacy of decontamination methods.

Adult↗
PubMed1999

Distribution and elimination of the solute and water components of urological irrigating fluids.

OBJECTIVE: Irrigating fluids are used to dilate mucosal spaces and to remove blood and cut tissue from the operating field during endoscopic procedures. We have studied their disposition, since irrigating solutions are sometimes absorbed and may therefore be regarded as intravenous drugs. MATERIAL AND METHODS: The distribution and the rate of elimination of four irrigating fluids containing glycine, mannitol and sorbitol were studied after infusing 0.75 ml/kg/min of them over a period of 20 min in 10 male volunteers. Kinetic calculations were based on 12 blood samples collected over 120 min using traditional pharmacokinetics for the solutes and volume kinetics for the water component. RESULTS: The solutes had distribution half-lives of between 3 and 7 min; the elimination half-lives were 39 min (glycine), 97 min (mannitol) and 33 min (sorbitol). The volume of distribution during steady state was between 20 and 36 litres, while the volume of the body fluid space expanded by the water component of the irrigating fluids varied between 6 and 9 litres. Although the solutes became distributed over a much larger space than the infused fluid volume, the intersubject variation was smaller for the solute concentrations than for the dilution of the plasma fraction of the blood. CONCLUSIONS: The kinetics of the solute and water components of urological irrigating fluids can be analysed and compared using computer-based mathematical models.

Adult↗
PubMed1994

Rigid ureteroscopes with fiberoptic imaging bundles: features and irrigating capacity.

A new ureteroscope design incorporates fiberoptic imaging bundles to replace the rod lens system in a rigid ureteroscope body. These ureteroscopes have evolved along two lines: instruments with a movable eyepiece and those with a small outer diameter (< 10F). The fiberoptic imaging bundles take up less space than the rod lens system. These ureteroscopes thus have a larger working channel than instruments of a similar outer diameter with rod lens imaging systems. Measurement of irrigation rates through a representative sample of these ureteroscopes demonstrated that gravity irrigation was adequate through the empty working channel. However, if an accessory instrument was placed in the working channel, gravity irrigation was insufficient in the smaller models. Manual irrigation was more than adequate under all conditions. The larger models now offer relatively little advantage to counter the decrease in image quality associated with the "honeycomb" fiberoptic image. Nevertheless, the more recent small ureteroscopes allow an adequate irrigant flow while accepting working instruments suitable for a variety of procedures. They thus seem to be ideal for diagnostic ureteroscopy, as they are quick and easy to use, not even requiring ureteral dilation. Furthermore, their small size does not limit their therapeutic applications; on the contrary, it expands them.

Equipment Design↗
PubMed1999

Correlation of orbital computed tomographic findings with office probing and irrigation in 17 patients after successful and failed dacryocystorhinostomy.

PURPOSE: To investigate the role of orbital computed tomography (CT) in the evaluation of patients after dacryocystorhinostomy (DCR). METHODS: Computed tomography scans of patients who underwent both successful and failed DCR were examined to determine the relationship of the soft-tissue changes to the surgical ostium, and the findings were correlated with postoperative results of office probing and irrigation. RESULTS: After a successful DCR (n = 7), a patent fistulous tract was confirmed by office probing and irrigation. A characteristic "Y-on-its-side" configuration of the soft tissue was noted on a CT scan. Total occlusion of the osteotomy by soft tissue on probing and irrigation corresponded to a mucocelelike soft-tissue density with a central lucency and soft-tissue obstruction (n = 2). Total occlusion of the osteotomy by inadequate excision of bone and adjacent soft tissue, visualized by CT imaging, was confirmed by palpation of bone by office probing (n = 1). Partial obstruction on probing and irrigation was associated on a CT scan with an increased soft-tissue density (n = 4) and bone in the region of the osteotomy (n = 3). CONCLUSIONS: Computed tomography allows visualization of a patent fistula after successful DCR as well as soft-tissue or bone obstruction of the surgically created fistula after failed DCR. When combined with probing and irrigation, CT helps to formulate a surgical plan after failed DCR.

Anti-Bacterial Agents↗
PubMed2001

An in vitro evaluation of the accuracy of the root ZX in the presence of various irrigants.

The purpose of this study was to evaluate the accuracy of the Root ZX in vitro in the presence of a variety of endodontic irrigants. The in vitro model, described by Donnelly, consisted of refrigerated gelatin made with 0.9% sodium chloride instead of water. The following irrigants were tested: 2% lidocaine with 1:100,000 epinephrine, 5.25% sodium hypochlorite, RC Prep, liquid EDTA, 3% hydrogen peroxide, and Peridex. A total of 30 extracted, single-rooted teeth were used. The experimental measurements in the presence of the various irrigants were compared with the actual canal lengths. The present data indicate that the Root ZX electronic apex locator reliably measured canal lengths to within 0.31 mm and that there was virtually no difference in the length determination as a function of the seven irrigants used. These results strongly support the concept that the Root ZX is a useful, versatile, and accurate device for the determination of canal lengths over a wide range of irrigants commonly used in the practice of endodontics.

Analysis of Variance↗
PubMed2000

Clinical study and literature review of nasal irrigation.

OBJECTIVES/HYPOTHESIS: Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. STUDY DESIGN: A prospective controlled clinical study. METHODS: Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease-specific symptoms and completed a self-administered quality of well-being questionnaire before intervention and at follow-up. RESULTS: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. CONCLUSIONS: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease.

Humans↗
PubMed1996

New jet irrigation bipolar system.

Irrigation bipolar systems are particularly useful for the washout of hematomas in subarachnoid hemorrhage during the acute stage of surgery and for preventing adherence of tissue to the bipolar tips during coagulation. These systems have become essential tools, and numerous improvements have been made to them. First, regarding the flow volume, both the interval of droplets and the size of individual water droplets can be adjusted. Second, this system is equipped with two major functions. The first is a preirrigation function, in which a small amount of irrigation water flows before operation of the bipolar coagulation. This wets the bipolar tips, eliminating any heat remaining from the previous use. Another function is postirrigation; after the coagulation has stopped, continuous irrigation is quickly provided to achieve a standby state by cooling down the tissue and the tips of the bipolar forceps. By using both of these functions, mild coagulation without adherence of burned tissue and clots to the bipolar forceps and minimization of residual heat during frequent use can be achieved. This article describes the new jet irrigation bipolar system and the use of an actual system that combines jet irrigation functions with the new cooling functions.

Electrocoagulation↗
PubMed2004

Evaluation of the effect of endodontic irrigation solutions on the microhardness and the roughness of root canal dentin.

The purpose of this study was to evaluate the effect of 0.2% chlorhexidine gluconate on the microhardness and roughness of root canal dentin compared with widely used irrigation solutions. Ninety, mandibular, anterior teeth extracted for periodontal reasons were used. The crowns of the teeth were removed at the CEJ. The roots were separated longitudinally into two segments, embedded in acrylic resin, and polished. A total of 180 specimens were divided into 6 groups of 30 teeth at random according to the irrigation solution used: group 1: 5.25% NaOCl for 15 min; group 2: 2.5% NaOCl for 15 min; group 3: 3% H2O2 for 15 min; group 4: 17% EDTA for 15 min; group 5: 0.2% chlorhexidine gluconate for 15 min; and group 6: distilled water (control). Each group was then divided into 2 subgroups of 15 specimens: groups 1a, 2a, 3a, 4a, 5a, and 6a were submitted to Vickers microhardness indentation tests; groups 1b, 2b, 3b, 4b, 5b, and 6b were used for determination of the roughness of root dentin. The data were recorded as Vickers numbers and Ra, microm for roughness test. The results were analyzed statistically by using one-way ANOVA and Tukey tests. The results indicated that all the irrigation solutions except chlorhexidine significantly decreased microhardness of root canal dentin (p < 0.05); 3% H2O2 and 0.2% chlorhexidine gluconate had no effect on roughness of the root canal dentin (p > 0.05). Although there are many other factors for irrigation solution preference, according to the results of this study, 0.2% chlorhexidine gluconate seems to be an appropriate endodontic irrigation solutions because of its harmless effect on the microhardness and roughness of root canal dentin.

Analysis of Variance↗
PubMed2005

The influence of preparation size on the mechanical efficacy of root canal irrigation in vitro.

This study tested the hypothesis that the mechanical efficacy of irrigation in reducing intracanal bacteria is dependent on canal preparation size. Root canals of 30 extracted permanent cuspids were prepared consecutively to sizes 36, 60, and 77 at working length (WL) using ProFile 0.04 taper Series-29 files. Smear layer was removed and teeth autoclaved following completion of each instrumentation sequence. Root canals were inoculated with a 15-mul suspension (1x10 cells) of Pseudomonas fluorescens 5RL, a salicylate-inducible bioluminescent reporter strain. Bioluminescence was measured before inoculation (background), after inoculation and after irrigation with 6 ml of irrigant delivered 1 mm from WL using a 28G safety-ended needle. The percentage of bacteria remaining following irrigation was 26.95+/-9.71%, 10.46+/-5.87%, and 10.64+/-6.01% for sizes 36, 60, and 77, respectively (p<0.001; repeated-measures ANOVA), with no difference between sizes 60 and 77 (p>0.05; Tukeys). Irrigation 1 mm from WL was significantly less effective in canals prepared to size 36.

Analysis of Variance↗
PubMed2006

Mitigation of hearing loss from semi-circular canal transection in pseudomonas otitis media with ciprofloxacin-dexamethasone irrigation.

HYPOTHESIS: Irrigation of the mastoid with a quinolone antibiotic-steroid solution may mitigate hearing loss caused by iatrogenic semicircular canal injury in the presence of Pseudomonas aeruginosa (PA) otitis media (OM). BACKGROUND: Studies have shown the cochlea to be more vulnerable to semicircular canal transection (SCT)-related hearing loss in the presence of PA OM. Prophylactic systemic antibiotics and steroids may decrease this hearing loss, but SCT is usually not planned. The aim of this study was to determine if irrigation with ciprofloxacin-dexamethasone (cipro-dex) could improve hearing outcomes following SCT in PA OM. METHODS: PA OM was induced in 28 animals. After three to five days, unilateral SCT was performed in each animal, with sham SCT on the contralateral ear. At surgery, half of the animals (n = 14) underwent irrigation of the both mastoid bullae with cipro-dex; the second group of animals (n = 14) underwent irrigation of the bullae with sterile saline. Auditory thresholds were obtained immediately prior to SCT and 7-10 days after SCT. RESULTS: SCT ears treated with cipro-dex showed a mean click threshold improvement of 4.6 dB from pre-transection to 7-10 days post-transection, whereas thresholds in the SCT ears treated with saline worsened by 7.5 dB (p = 0.15). CONCLUSION: Irrigation of the guinea pig bulla with cipro-dex following SCT in the setting of PA OM appears safe and may yield beneficial effects on hearing.

Animals↗