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PubMed2005

Sialoendoscopic and irrigation findings in chronic obstructive parotitis.

OBJECTIVES/HYPOTHESIS: To study the sialographic changes related to sialoendoscopic and irrigation fluid findings in chronic obstructive parotitis. STUDY DESIGN: The sialographic changes were classified according to previous studies and related to sialoendoscopic and irrigation fluid findings. METHODS: This study included 26 patients with a long history of parotid swelling. All patients were examined by radiography and sialography and were diagnosed as having chronic obstructive parotitis without sialolithiasis. Sialoendoscopy was used to observe the ductal system and perform an irrigation treatment. The irrigated liquid was centrifuged, and the fluid deposits were stained and observed using light microscopy. RESULTS: In all cases, sialoendoscopic examination showed the ductal system was filled with fiber-like substances and hyperemia of the ductal wall. Although a few of the thin and short fiber-like substances were found in the chronic obstructive parotitis patients with sialographic type I and type II changes, many thick and long wadding or lumpy fiber-like substances were revealed in chronic obstructive parotitis patients with sialographic type III and IV changes. Microstones were found in two chronic obstructive parotitis patients with sialographic type III changes, which were stained and identified using light microscopy. Irrigation fluid examination showed that the fiber-like substance was composed of desquamative duct epithelial cells, neutrophils, lymphocytes, and acidophils. Also, some epithelial cells were found in two microliths. CONCLUSIONS: Sialoendoscopy can provide direct and more detailed observation of the ductal system compared with sialography. Fiber-like substances in the lumen of the ductal system are considered one of the obstructive factors associated with chronic obstructive parotitis.

Chronic Disease↗
PubMed2005

Ocular irrigant alternatives in pediatric emergency medicine.

Minimizing pain and discomfort is an important consideration in pediatric ocular decontamination. The pH of an irrigant solution plays a significant role in its tolerability, because a solution with a pH that is too low or too high may cause edema and discomfort to the conjunctiva. We reviewed several available ocular irrigation solutions with respect to their chemical composition, pH, and cost efficiency. Currently, the irrigation solution of first choice for most ocular decontaminations in the pediatric emergency department (ED) is 0.9 % saline solution or normal saline (NS), which has a pH range between 4.5 and 6.0. Alternative ocular irrigant solutions available include Lactated Ringers solution (LR), which has a pH range between 6.2 and 7.5, buffered NS with pH adjusted to 7.4 with sodium bicarbonate, and Balanced Salt Solution Plus (BSS Plus), which has a pH of 7.4. Of these alternative solutions, all except BSS Plus are comparable in cost efficiency to NS. The use of more pH neutral solutions such as LR, NS with bicarbonate buffer, or BSS Plus may decrease ocular pain and irritation associated with copious irrigation, and may improve tolerance of ocular decontamination by a child.

Burns, Chemical↗
PubMed1989

The effectiveness of different endodontic irrigation procedures on the removal of the smear layer: a scanning electron microscopic study.

To compare the effectiveness of different irrigation procedures on the removal of the smear layer, 40 curved canals were manually prepared in vitro under copious irrigation with 3 per cent NaOCl. Ten canals served as controls. The remaining 30 were equally distributed in three experimental groups and subsequently irrigated with the following: ultrasound with NaOCl; EDTA; ultrasound with EDTA. In the scanning electron microscope, the appearance of the smear layer was rated over the distribution of dentinal tubule openings for the coronal, middle and apical segments of the canals. Irrigation with NaOCl produced consistently smeared surfaces. Ultrasonic stirring of NaOCl removed the smear layer moderately, while EDTA produced almost smear-free surfaces. Ultrasound in association with EDTA did not enhance the dissolving capability of this chelating agent. A definite decline in the efficiency of the irrigation procedures was also observed along the apical part of the canals.

Dentin↗
PubMed1988

Serum amino acid patterns and toxicity symptoms following the absorption of irrigant containing glycine in transurethral prostatic surgery.

The relationships between the serum concentrations of amino acids, the volume of irrigating fluid absorbed and symptoms of glycine toxicity were analysed in 18 patients who had undergone transurethral resection of the prostate and in whom intravascular absorption of irrigating fluid containing 2.2% glycine had been recorded. A mean of 7% of the transferred glycine could be detected in the serum within 10 min of irrigant absorption. The half-life of glycine in serum was twice as long when the volume of irrigant absorbed exceeded 1500 ml (100 min; n = 6), and the serum levels of alanine, aminobutyrate, proline and serine were significantly more elevated, than when the volume of irrigant absorbed was between 900 and 1300 ml (n = 6). Where the amount of glycine transferred exceeded 0.5 g.kg-1, symptoms of glycine toxicity developed, their onset coinciding with a rapid increase in the serum levels of non-essential amino acids other than glycine.

Absorption↗
PubMed1995

Ethanol monitoring of irrigating fluid absorption in transcervical resection of the endometrium.

BACKGROUND: We evaluated the precision in using ethanol to indicate and quantify absorption of irrigating fluid during transcervical resection of the endometrium. METHODS: The ethanol concentration in the expired breath, the serum sodium level, the blood loss and the volumetric fluid balance were measured over 10-min periods during 62 operations. A solution containing glycine 1.5% and ethanol 1% was used to irrigate the uterus. RESULTS: Most principles previously outlined for ethanol monitoring in transurethral prostatic surgery could also be applied in endometrial resection. In the 21 patients who showed the intravascular pattern of ethanol changes, the breath alcohol measurement corrected for absorption time predicted the volume of irrigant absorbed (up to 2,531 ml) with a standard error of 230 ml at the end of any 10-min period of absorption. Repeated measurement of serum sodium indicated intravascular fluid absorption with practically the same precision as the breath test. Extravascular absorption was found in 14 patients. In these operations, the volume of irrigant absorbed (up to 1,767 ml) could be predicted with a standard error of 92 ml from the ethanol concentration at the plateau level attained after absorption had occurred. CONCLUSION: Ethanol monitoring is precise enough to allow monitoring of irrigating fluid absorption in endometrial resection.

Abdomen↗
PubMed2004

Effects of sodium benzoate on the complications of 1.5% glycine solution using two different intravesical pressures during bladder irrigation.

BACKGROUND: In this experimental study we researched the effects of sodium benzoate on the complications of 1.5% glycine solution using with two different intravesical pressures during bladder irrigation. METHODS: Thirty-six male adult New Zealand rabbits with body weight ranging from 1500 to 2800 g were used in the experiments. The rabbits were randomly allocated to four groups. In groups 1 and 2, 500 ml of 1.5% gylcine was used as irrigating fluid during 30 min, but only group 2 received 500 mg kg(-1) of sodium benzoate treatment by oral route immediately after irrigation. In groups 3 and 4, 500 ml of 1.5% glycine was used as irrigating fluid during 60 min, but only group 4 received the same treatment as group 2. Ammonia, urea, sodium, potassium, hemoglobin, hemotocrit and platelet levels were studied at preirrigation and postirrigation on the 4 h and 24 h. Also electrocardiographic (ECG) changes were monitored at the same time with blood parameters. RESULTS: At 4 h postirrigation, Na+ levels were decreased significantly in group 1 and non-significantly in group 3 when compared with preirrigation levels. But these levels were not changed in groups 2 and 4. Both at 4 h and 24 h, ammonia and urea levels were significantly increased in groups 1 and 3. Ammonia level was decreased but the urea level was not changed in groups 2 and 4 at the same time points. K+ level was significantly changed only in group 1 at 4 h and 24 h. Hemoglobin and hemotocrit concentrations were decreased both at 4 h and 24 h compared with preirrigation levels in all groups. Also there were ECG changes between the treated and untreated groups. CONCLUSION: Sodium benzoate was very effective against the complications of 1.5% glycine during bladder irrigation experimentally. But this needs further investigation, especially for the applicability of this new treatment model in human TURP syndrome.

Administration, Intravesical↗
PubMed1992

The use of a bladder pressure warning device during transurethral prostatic resection decreases absorption of irrigation fluid.

During a period of 4 weeks 102 patients underwent transurethral prostatic resection (TURP). Of these, 50 were randomly allocated to the use of an intravesical pressure device which warned the surgeon at a pressure elevation of 1.5 kPa. Ethanol (1%) was used as a marker in the irrigation fluid (glycine 2.2%), and absorption of ethanol-tagged irrigation fluid was detected by measurements in the expired air. In 28 patients absorption took place (in 8 of the 50 patients equipped with the warning device and in 20 of the 52 without the device). The greatest absorption was seen in the group without the device. No differences were found between the groups with regard to age, resected mass, resection time, resection speed, or haemorrhage. Patients who absorbed irrigation fluid were slightly older and bled more, and the resected mass was larger. The use of a pressure warning device reduces the amount of irrigation fluid absorbed and the number of patients who absorb irrigation fluid, and minimises the risk of the TUR syndrome.

Absorption↗
PubMed1994

Air insufflation versus water irrigation during flexible cystoscopy: a prospective randomized study.

OBJECTIVE: To compare air insufflation with water irrigation during routine diagnostic flexible cystoscopy. PATIENTS AND METHODS: A total of 200 consecutive patients scheduled for routine diagnostic flexible cystoscopy under topical anaesthesia were randomized prospectively to either air insufflation or water irrigation. Their tolerance to the procedure and post-operative symptoms were assessed from a questionnaire completed immediately after the procedure and then 1 week later. RESULTS: Air insufflation offered a better cystoscopic view than water irrigation. With regard to tolerance, in the air insufflation group, 72% reported the procedure to be comfortable, 22% uncomfortable and 6% painful compared to 44%, 45% and 11% respectively in the water irrigation group. This difference in favour of air insufflation was highly significant (Chi-square, P < 0.001). There was no statistical difference in either post-operative symptoms a week later or in the diagnostic yield between the two study groups. There were no complications in either group. CONCLUSION: Air insufflation cystoscopy is as safe and effective as water irrigation but better tolerated by patients. This, together with its more obvious advantages of the ease of administration and low cost, should prompt more routine use of air insufflation cystoscopy for day case procedures.

Carcinoma, Transitional Cell↗
PubMed2005

A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection.

OBJECTIVE: To examine changes in the pathophysiology and frequency of the transurethral resection (TUR) syndrome with two irrigation fluids, as variable amounts of irrigation fluid are absorbed during TUR of the prostate (TURP), and although polar solutes are required to prevent an effect on diathermy, the solutes may have effects when absorbed. PATIENTS AND METHODS: Between December 2001 and March 2003, 250 patients were included in a prospective randomized trial comparing glycine 1.5% with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, temperature change, biochemistry including a glycine assay, and peri-operative symptoms. Blood samples were taken immediately before and immediately, 5 and 24 h after TURP. Irrigating fluid absorption during TURP was measured with 1% ethanol as a marker and breath ethanol measurements. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of < or = 125 mmol/L with two or more associated symptoms or signs of TUR syndrome. RESULTS: Five (2%) patients had TUR syndrome; all five were irrigated with glycine, although this difference was not statistically significant (P = 0.06). Of the five men, three had hypotension, four were tired, one was nauseous, two had parasthesia, two had 'uneasiness', one had blurred vision and two were confused; none had chest pain. There was a large variation between the groups in the level of glycine assayed immediately after TURP; a high glycine level was associated with the TUR syndrome (P = 0.01). There was no difference between the groups in levels of sodium, potassium, urea, creatinine, osmolality, calcium, haematocrit, albumin serum levels or peri-operative blood loss (defined as a change from before to after TURP in haemoglobin level, accounting for transfusions). CONCLUSIONS: An increase in serum glycine was associated with TUR syndrome; there were large variations in the amounts of glycine absorbed, reaching levels many times the upper limit of normal. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long-term effects.

Absorption↗
PubMed2006

Protection of the coronary arteries during epicardial radiofrequency ablation with intracoronary chilled saline irrigation: assessment in an in vitro model.

INTRODUCTION: The coronary arteries can be damaged during epicardial radiofrequency ablation (RFA) procedures. We hypothesized that intracoronary irrigation with chilled saline may be a useful technique for minimizing heat-induced damage to the coronary artery endothelium during this procedure. METHODS AND RESULTS: Twenty-nine ablation procedures were performed on 17 freshly excised ovine hearts. Radiofrequency current was delivered through an internally cooled, 4-mm-tip ablation catheter placed directly over the coronary artery (24 applications) and over noncoronary epicardium (5 applications). An Amplatz coronary catheter was used to internally irrigate the coronary artery with either 37 degrees C or 5 degrees C 0.9% saline (12 ablations each group). Fluroptic temperature probes were placed within the artery lumen under the ablation site and 15 mm distal from the ablation site. The peak intracoronary temperature directly under the ablation catheter was significantly lower (P = 0.001) in the chilled than in the nonchilled saline irrigation group (23.6 degrees C, interquartile range [IQR] 15.7-39.8 vs 54.6 degrees C, IQR 48.9-58.6). Blue tetrazolium stained lesion sections showed that the median distance between the ablation lesion and the artery wall was significantly higher (P = 0.004) for the chilled versus the nonchilled saline irrigation group (0.42 mm, IQR 0.25-0.70 vs 0.00 mm, IQR 0.00-0.28). CONCLUSIONS: Intracoronary irrigation with chilled saline may protect the coronary artery endothelium from heat-induced damage during epicardial RFA.

Animals↗
PubMed1986

The effects of a simplified mechanical oral hygiene regime plus supragingival irrigation with chlorhexidine or metronidazole on subgingival plaque.

23 patients with pockets greater than or equal to 4 mm and evidence of bone loss on radiographs received thorough scaling and root planing followed by instruction in Bass brushing. They refrained from routine interdental cleaning for the first 28 days. A pulsating jet irrigator was used once daily supragingivally with 0.02% chlorhexidine (CH) 0.05% metronidazole (MD) or 0.01% quinine sulphate inactive control (PL), on a randomized double blind basis. Molar sites were not irrigated and served as control sites; they were only mechanically cleaned. For each patient, subgingival plaque samples were obtained from 2 test and 1 control sites at baseline (day 0), and on days 7, 28, 56 and 84. Plaque samples were monitored by darkfield microscopy on the basis of morphological characteristics of 4 types of bacteria: cocci, motile cells, spirochaetes and "others" (nonmotile rods, filaments and fusiforms). The simplified oral hygiene regime of scaling, root planing and Bass toothbrushing combined with interdental supragingival pulsating jet irrigation with CH, MD or PL appeared superior to a system of simplified oral hygiene alone, particularly during the first 4 weeks. However, at most time-points, the benefits were not statistically significant except for metronidazole. By day 84, the end of the experimental period, all groups approximated baseline levels. The results indicate that supragingival pulsated jet irrigation has limited effects on the composition of subgingival plaque. More marked changes occur when the irrigation fluid contains a chemical agent such as metronidazole known to be effective against important subgingival organisms, but probably not to such an extent as to change the composition of the flora from one associated with diseased sites to one associated with healthy sites.

Adult↗
PubMed1987

Effect of sanguinaria extract on development of plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator.

The effects on developing plaque and gingivitis following rinsing with a placebo oral rinse or an oral rinse containing 300 micrograms/ml sanguinaria extract (sanguinaria) were compared to effects produced by supragingival irrigation with dilute solutions of the rinse corresponding to 22.5 micrograms/ml sanguinaria and 90 micrograms/ml sanguinaria. The study design was a repeated measures, single-blind crossover with no oral hygiene over 2 weeks duration. After 7 and 14 [corrected] days, significantly lower plaque and gingivitis scores were obtained with use of the sanguinaria-containing rinse and irrigating solutions compared with the placebo rinse. There were no significant differences in plaque and gingivitis scores between the groups using the sanguinaria rinse and the sanguinaria irrigating solutions. A comparison [corrected] of % distribution of 0, 1 and 2+ scores also indicated that rinsing and supragingival irrigation with sanguinaria was more effective in plaque and gingivitis control than rinsing with the placebo. The results suggest that sanguinaria oral rinse may be effective in controlling plaque and gingivitis when delivered by manual rinsing or supragingival irrigation.

Adult↗
PubMed1995

The effect of irrigation with chlorhexidine or saline on plaque vitality.

24 adult patients suffering from Adult periodontitis were assigned to 4 groups: the 1st rinsed for 1 min with 0.2% chlorhexidine gluconate (CHX); the 2nd group were irrigated for 15 s with 0.2% CHX in a pulsed oral irrigator; the 3rd group rinsed for 1 min with saline and the 4th group were irrigated for 15 s with saline. Plaque vitality was measured after the 4 experimental procedures, using the method described by Netuschil et al. and scored using the method described by Rundegren et al. The results showed that a single rinse or irrigation with 0.2% CHX solution decreased the % of viable micro-organisms, but the vitality of the bacteria remained unchanged in saline groups. Statistical analysis indicated that irrigation with CHX was more effective at reducing plaque vitality than rinsing with CHX.

Adult↗
PubMed1998

The effectiveness of a magnetized water oral irrigator (Hydro Floss) on plaque, calculus and gingival health.

The purpose of this study was to evaluate the effects of a magnetized water oral irrigator on plaque, calculus and gingival health. 29 patients completed this double-blind crossover study. Each patient was brought to baseline via an oral prophylaxis with a plaque index < or = 1 and a gingival index < or = 1. Subjects used the irrigator for a period of 3 months with the magnet and 3 months without the magnet. After each 3 month interval, data were collected using the plaque index, gingival index, and accretions index. The repeated measures analysis on plaque, gingival and calculus indices yielded a statistically-significant period effect for PlI (p=0.0343), GI (p=0.0091), and approached significance for calculus (p=0.0593). This meant that the effect of irrigation resulted in a decrease of all indices over time. Therefore, the treatment effect on each index was evaluated using only the measurements obtained at the end of the first period (i.e., assuming a parallel design). Irrigation with magnetized water resulted in 64% less calculus compared to the control group. The reduction was statistically significant (p< or =0.02). The reduction by 27% in gingival index was not statistically significant. The reduction in plaque was minimal (2.2%). A strong positive correlation between the plaque index and the Watt accretion index was observed. The magnetized water oral irrigator could be a useful adjunct in the prevention of calculus accumulation in periodontal patients, but appears to have minimal effect on plaque reduction. The results indicated a clinical improvement in the gingival index, but this was not a statistically significant finding.

Analysis of Variance↗
PubMed2005

Effect of endodontic irrigation on bonding of resin cement to radicular dentin.

The influence of endodontic irrigation on shear bond strengths of resin cement to radicular dentin was investigated. Human radicular dentin blocks were divided into four groups and subjected to one of four endodontic irrigations: ethylenediaminetetraacetic acid (EDTA) group, 17% EDTA for 60 s; EDTA/sodium hypochlorite (NaOCl) group, 17% EDTA for 60 s followed by 10 ml of 5% NaOCl for 15 s; NaOCl group, 10 ml of 5% NaOCl for 15 s; and control group, no treatment. Morphological changes of dentin surface after endodontic irrigation were observed by scanning electron microscopy (SEM). A resin block was bonded to the radicular dentin after irrigation using resin cement with either wet-bonding (Uni-Etch/One-Step; Bisco) or self-etching (Tyrian SPE/One-Step Plus; Bisco) adhesives. Shear bond strengths were measured and the penetration of resin tags into dentinal tubules at resin-dentin interface was observed by SEM. With the wet-bonding system, the shear bond strengths for the EDTA/NaOCl group, in which dentinal tubules openings and uniform resin tag penetration into dentinal tubules were observed, were significantly higher than the EDTA and control groups. With the self-etching system, the shear bond strengths were significantly lower in the EDTA group compared with the NaOCl and control groups. The effects of endodontic irrigation on the bonding of resin cement to radicular dentin depended on the dentin bonding system used.

Acid Etching, Dental↗
PubMed2005

A critical review of irrigation techniques in acute wounds.

Irrigation is a fundamental concept to the care of acute wounds and therefore of prime importance in all surgical specialties. A significant amount of research has been done in search of the most effective irrigation technique over the last three decades. There is evidence to show that irrigation is beneficial in the management of acute traumatic and elective wounds, but exactly which techniques and irrigation pressures needed for optimal outcome are still undetermined. A significant number of the studies to date lack the rigid scientific design needed in a climate of evidence-based medicine. There are substantial methodological flaws and a lack of standardisation between many studies hindering the ability to draw scientific conclusion and compare different studies. There are few randomised, controlled studies on human wounds, and extrapolation from animal studies must be done with caution. Investigation into different irrigation pressures for different levels of contamination is lacking. This would possibly produce a more logical approach for clinically managing acute wounds rather than a blanket treatment for all acute wounds irrespective of the level of contamination. Further research in this direction with greater attention to scientific methodology and design is needed.

Acute Disease↗
PubMed2006

In vitro evaluation of endodontic debris removal as obtained by rotary instrumentation coupled with ultrasonic irrigation.

The cleaning capacity of rotary Ni-Ti instrumentation using Profile GT files, coupled with irrigation energised by ultrasound, was evaluated. Thirty-six human mandibular incisors were instrumented in vitro using the crown-down technique with the Profile GT system to 1 mm from the anatomical apex to a size 30.04 taper file. The instrumented teeth were then divided randomly into four groups where various final irrigations were used: Group I: 100 ml of 1% NaOCl with a Luer-Lok syringe (control group); Group II, Group III and Group IV: final irrigation with 100 ml of 1% NaOCl energised by ultrasound for 1, 3 and 5 min, respectively. After biomechanical preparation, the apical thirds of the roots were submitted to histological processing and examination. The specimens were analysed at 40x magnification and the images submitted to morphometric analysis with an integration grid. anova showed a statistically significant difference (P < 0.01) between the irrigation techniques. Group I (Luer-Lok syringe) showed the highest percentage of debris (35.81 +/- 4.49) and was statistically different from the other groups energised by ultrasound: Group II (27.28 +/- 4.49), Group III (24.39 +/- 5.72) and Group IV (18.46 +/- 5.25). It was concluded that rotary instrumentation using Ni-Ti files associated with final irrigation of 1% NaOCl energised by ultrasound leads to better debris removal from the apical third of mesio-distally flattened root canal.

Analysis of Variance↗
PubMed1989

New method of postprostatectomy bladder irrigation.

Bacterial filters have been used to sterilise the hospital water supply in order to provide irrigant for postprostatectomy irrigation. This method was compared retrospectively to bladder irrigation derived from a still on the ward. Postoperative bacteriuria was similar in both groups of 75 patients, occurring in 23.7% of patients irrigated from the still and in 20% of patients irrigated via the filters. The bacterial filter proved reliable and as safe as using water from the still.

Aged↗