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PubMed1989

The use of distilled water as an irrigating fluid in patients undergoing transurethral resection of the prostate.

Thirty patients undergoing transurethral resection of the prostate using distilled water as an irrigating fluid were studied. There was no significant change in the serum concentration of the variables studied (preoperatively compared to postoperatively) as possible indicators of haemolysis or absorption of irrigating water such as sodium, potassium, albumin, total protein, creatinine, uric acid, urea, haemoglobin, haematocrit and haptoglobin. The mean value of plasma haemoglobin (P-Hb), observed immediately postoperatively and reflecting the magnitude of haemolysis, was delta 294.8 mg/l. There was a good correlation between P-Hb and the inflowing irrigating distilled water (r = 0.69). The P-Hb variation (delta) correlated with resection time and with the weight of the resected prostate (r = 0.54 and r = 0.52, respectively). A good correlation was also found between resection time and delta body weight which reflects the amount of water absorbed (r = 0.67) and between delta body weight and the inflowing irrigating water (r = 0.61). Our study shows that distilled water can be used as an irrigating fluid quite safely. The advantages of distilled water outweigh the disadvantages which can be avoided easily if proper attention is given.

Absorption↗
PubMed2000

Efficacy and safety of an irrigated-tip catheter for the ablation of accessory pathways resistant to conventional radiofrequency ablation.

BACKGROUND: Radiofrequency catheter ablation of accessory pathways (APs) is very effective in all but a minority of patients. We examined the usefulness and safety of irrigated-tip catheters in treating patients with APs resistant to conventional catheter ablation. METHODS AND RESULTS: Among 314 APs in 301 consecutive patients, conventional ablation failed to eliminate AP conduction in 18 APs in 18 patients (5.7%), 6 of which were located in the left free wall, 5 in the middle/posterior-septal space, and 7 inside the coronary sinus (CS) or its tributaries. Irrigated-tip catheter ablation was subsequently performed with temperature control mode (target temperature, 50 degrees C), a moderate saline flow rate (17 mL/min), and a power limit of 50 W (outside CS) or 20 to 30 W (inside CS) at previously resistant sites. Seventeen of the 18 resistant APs (94%) were successfully ablated with a median of 3 applications using irrigated-tip catheters. A significant increase in power delivery was achieved (20.3+/-11.5 versus 36.5+/-8.2 W; P:<0.01) with irrigated-tip catheters, irrespective of the AP location, particularly inside the CS or its tributaries. No serious complications occurred. CONCLUSIONS: Irrigated-tip catheter ablation is safe and effective in eliminating AP conduction resistant to conventional catheters, irrespective of the location.

Adult↗
PubMed2000

Urokinase cisternal irrigation therapy for prevention of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage: a study of urokinase concentration and the fibrinolytic system.

BACKGROUND AND PURPOSE: Cisternal irrigation therapy with urokinase (UK) was performed in multiple institutions to prevent symptomatic vasospasm. The efficacy and safety of this therapy were evaluated, and the optimal concentration of UK was estimated. METHODS: This therapy was performed in 28 patients who underwent surgery within 72 hours of the onset of severe subarachnoid hemorrhage (Fisher's group 3, CT number [Hounsfield units] >60). After the aneurysm was clipped, irrigation tubes were placed in the Sylvian fissure (inlet) unilaterally and in the prepontine or chiasmatic cistern (outlet). Lactated Ringer's solution with UK (30, 60, or 120 IU/mL) was infused at a rate of 30 mL/h. The presence of symptomatic vasospasm was evaluated by changes in the clinical symptoms and the presence of a new low-density area on CT scan. Drained irrigation fluid and peripheral blood were examined chronologically to evaluate the fibrinolytic system. RESULTS: Symptomatic vasospasm was observed transiently in 3 cases (10.7%) without any low-density area on CT scan. In the 120-IU/mL group, no symptomatic vasospasm occurred. Analysis of drainage fluid suggested that UK 120 IU/mL is effective. The mean values of total drained blood volume for the respective groups were as follows: 58 mL in 30 IU/mL, 106 mL in 60 IU/mL, and 143 mL in 120 IU/mL. No abnormal changes were observed in the coagulative and fibrinolytic systems after UK irrigation. CONCLUSIONS: These results suggest that cisternal irrigation therapy with UK is safe and effective for the prevention of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage.

Biomarkers↗
PubMedDate not supplied

The effects of chlorhexidine irrigation solution on contaminated bone-tendon allografts.

The purpose of this study was to determine an expedient and effective method for disinfecting contaminated human bone-tendon allografts. The first part of this study used beef muscle and cadaveric human tissues to determine the most effective solution and volume to decontaminate tissues inoculated with four different organisms: Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Of the solutions tested (benzalkonium chloride, castile soap, castile soap followed by benzalkonium chloride, triple antibiotic, chlorhexidine gluconate, and chlorhexidine gluconate/triple antibiotic), only the 4% chlorhexidine power irrigation solution and 4% chlorhexidine/triple antibiotic bath completely disinfected all tissues. Work in part 2 revealed that a 2% chlorhexidine irrigation solution was equally effective as the 4% solutions. Part 3 of the study involved human Achilles tendon-calcaneus allografts. We found similar results: 3 liters of 2% chlorhexidine power irrigation solution thoroughly removed all microorganisms from the contaminated tissues. All control allografts irrigated with normal saline solution alone revealed positive bacterial growth for all four organisms after 72 hours' growth on sheep blood agar. Total decontamination time was 10 to 12 minutes. Two percent chlorhexidine irrigation solution may be an effective method for decontaminating human bone-tendon allografts challenged with a polymicrobial inoculum. This method of disinfecting bone-tendon allografts is at least five times more expeditious than methods in previously reported studies.

Animals↗
PubMed1986

Ventilation tube surgery and middle ear irrigation.

Tympanostomy and insertion of ventilation tubes has become one of the most commonly performed operations in the United States. Most authors reporting complications of this procedure describe a postoperative rate of otorrhea in the range of 10%-20% with some reports much higher. This rate of presumed suppuration would generally be considered high by surgeons operating in other areas of the body. It is a commonly accepted surgical practice to follow incision and drainage of a relatively closed space effusion with irrigation of that space. This is true in the surgery for the paranasal sinuses, deep space infections of the neck, joint spaces, and abscesses in general. However, this practice is not routinely performed when incising and draining the middle ear. We have completed a prospective controlled double blind study on post-tympanostomy tube otorrhea utilizing irrigation of the middle ear. In 220 consecutive cases, the use of middle ear irrigation reduced postoperative infections in the first 6 months from 16% to 4%. Irrigation was also found to be useful in removing very thick effusions from the middle ear by displacement, including those effusions localized in the hypo or epitympanum which were not initially identified at the time of incision and suction. A soft plastic, angled irrigation catheter with radial ports was developed for this purpose.

Adolescent↗
PubMed1991

Catastrophic otologic injury from oral jet irrigation of the external auditory canal.

Jet irrigation is an accepted method for removal of cerumen from the external auditory canal. Even at a submaximal power setting, oral jet irrigators can generate enough force to rupture the tympanic membrane. Parameters for safe use of these irrigators have never been established. Three cases are reported in which, in addition to tympanic membrane rupture, oral jet irrigators caused ossicular disruption, round and oval window fistulae, and subluxation of the stapedial footplate. A prospective study performed on 25 fresh cadavers demonstrated a 6% incidence of tympanic membrane perforation when the power setting was one-third full power or greater. Recommendations are made for safe use of oral jet irrigators for removal of external auditory canal cerumen.

Aged↗
PubMed2002

Nonsurgical treatment for odontogenic maxillary sinusitis using irrigation through the root canal: preliminary case report.

As a new nonsurgical treatment for odontogenic maxillary sinusitis (OMS), irrigation of the maxillary sinus through the root canal of the causal tooth was carried out to the patient with OMS that had proved refractory to conservative treatments (i.e., root-canal treatment of the causal tooth and antibiotic therapy). Clinical signs, symptoms, and radiographs before and after the new treatment revealed evidence of good healing. The clinical signs and symptoms, such as oppressive pain in the cheek and retrorhinorrhoea, entirely disappeared immediately after the irrigation (which was done only once) without pain, and the obstructed ostiomeatal unit was aerated on the follow-up CT images. There was no side effect associated with saline irrigation, nor any recurrence of symptoms since the irrigation. We therefore propose the irrigation through the root canal of the causal tooth as a new treatment for periapical disease-induced maxillary sinusitis, a technique that should ensure proper ventilation and drainage by relieving obstruction of the ostiomeatal unit.

Acute Disease↗
PubMed2005

Test-plot studies on runoff of sulfonamides from manured soils after sprinkler irrigation.

Three test-plot series have been performed to gather information on runoff of sulfonamides from manured arable and grassland after sprinkler irrigation. To prepare test slurries with defined aged residues, liquid bovine manure was fortified with sulfadiazine, sulfadimidine, and sulfamethoxazole and stored short-term. After test-slurry application, the arable land was treated by soil cultivation before irrigation, and the manured grassland was irrigated directly with 50 mm h(-1) for 2 h. The runoff suspensions were sampled at 5- to 10-min intervals, separated into aqueous phase and suspended matter and residue analyzed. Higher runoff emissions were found from manured grassland plots. The discharge volumes ranged from 106 to 252 L and the total runoff emissions ranged from 13 to 28% of sulfonamides applied initially. Within the first 20 min of the irrigation period that represented a rainfall of 17 mm, emissions, on average, were 4%. The loads of sulfonamides predominantly occurred in the runoff water. The only emissions via suspended matter, on average, were 0.02%. On arable land, however, the runoff was reduced by soil cultivation. Discharge volumes and sulfonamide emissions were 36 to 128 L and 0.1 to 2.5%, respectively. Despite the high-intensity sprinkler irrigation, major emissions did not occur until a 60-min delay.

Agriculture↗
PubMed1992

Effect of subgingival irrigation with chlorhexidine during ultrasonic scaling.

This study examines the effect of a chlorhexidine irrigant during ultrasonic scaling and root planning and compares clinical results with those obtained using a water irrigant. The irrigant was delivered either through a conventional or a recently-introduced ultrasonic scaler, which allows the irrigant solution to be passed through the inside of the scaler tip. The study utilizes a split-mouth design and contrasts the effectiveness of both instruments in improving periodontal health, as measured by standard clinical indices. A preliminary investigation of patient tolerance to treatment performed throughout the clinical trial was also undertaken. Statistical analysis at the 3 and 6 month post-treatment stage revealed no significant differences between the 4 experimental groups in respect of probing attachment levels (P > 0.5), bleeding index (P > 0.1), or plaque index (P > 0.05). Clinical attachment gain assessed by probing ranged from 0.6 to 0.9 mm. Chlorhexidine increased patient tolerance in 77% of cases and the new model ultrasonic scaler was favored over the traditional model in 70% of cases. The magnitude of the tolerance differences was however not statistically significant. The possible potential of the new scaler and of chlorhexidine as an irrigant to reduce patient discomfort is worthy of further investigation than was possible in this study.

Adult↗
PubMed1992

Subgingival delivery by an oral irrigation device.

Irrigating devices have been incorporated into numerous oral hygiene regimens. Newer types of these devices are designed to deliver irrigating solutions directly into the periodontal pocket. We examined the ability of a powered irrigating device with a soft rubber tip to deliver subgingivally into periodontal pockets. When subgingival irrigation was used, the mean pocket penetration was 90% of the pocket depth (less than or equal to 6 mm) compared to a mean of 21% in the oral rinse group. The irrigation was not uncomfortable to patients.

Dental Equipment↗
PubMed1994

Mechanism of irrigation effects on gingivitis.

Although gingivitis is initiated by plaque and plaque removal controls gingivitis, gingival irrigation with water has been shown to reduce gingivitis without reducing plaque. This study attempted to explore possible mechanisms involved in the treatment of gingivitis by water irrigation. Patients (n = 125) with more than 20 teeth, less than 4 sites with probing depth (PD) deeper than 6 mm, bleeding on probing (BOP) frequency of 30% or higher, and no systemic disease were randomized to one of four treatment groups: toothbrushing alone (brush), toothbrushing plus chlorhexidine 0.12% rinse 2x/day (CHX), toothbrushing plus water irrigation 1x/day (irr+H2O), or toothbrushing plus chlorhexidine 0.04% irrigation 1x/day (irr+CHX). Six sites/tooth were examined at baseline, and at 3 and 6 months for BOP and PD using an automated probe, and for gingival index (GI) and plaque index (PI) by standard means. A prophylaxis and oral hygiene instructions were provided after baseline and 6 month measurements. Subgingival microbial samples and crevicular fluid (GCF) were collected from 2 teeth/subject at each time point. Microbial samples were processed for anaerobic culture and the predominant cultivable flora was determined. CHX and irr+CHX had a 30 to 35% decrease in mean PI, while brush and irr+H2O had only a 12 to 16% decrease. BOP was reduced by 14% in the brush group and 23 to 24% in the other groups. GI was significantly correlated with PI in the brush, CHX, and irr+CHX groups, but not in the irr+H2O group. Prevotella intermedia was significantly reduced in both irrigation groups, but not CHX or brush groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Efficacy of subgingival irrigation using herbal extracts on gingival inflammation.

BACKGROUND: The aim of the present study was to investigate the efficacy of an herbal-based mouthrinse in combination with an oral irrigator in reducing gingival inflammation. METHODS: A total of 89 patients (45 females, 44 males; mean age 49.1 +/- 1.31 years) were included in this prospective, randomized, double-blind clinical study and allocated to 3 treatment groups: group 1 (n = 34), treated with an oral irrigator with subgingival tips and an herbal-based mouthrinse; group 2 (n = 29), the oral irrigator was applied in combination with a conventional mouthwash; and group 3 (n = 26), treated with the conventional mouthwash without subgingival irrigation. Data collected at baseline and after 4, 8, and 12 weeks included gingival index (GI), sulcus bleeding index (SBI), plaque index (PI), and probing depth (PD). RESULTS: Over a period of 3 months, GI decreased from 1.80 +/- 0.04 to 1.56 +/- 0.04 in group 1; from 1.79 +/- 0.05 to 1.68 +/- 0.04 in group 2; and remained nearly constant in group 3 (from 1.79 +/- 0.05 to 1.81 +/- 0.04). Differences between the groups were significant (analysis of variance, P < 0.05). SBI values in group 1 were reduced from 2.51 +/- 0.06 to 2.13 +/- 0.06 after 3 months and were significantly lower than in group 2 (P = 0.001) and 3 (P = 0.002), with SBIs of 2.44 +/- 0.06 and 2.42 +/- 0.07, respectively, after 12 weeks. A reduction in PI was noted for all 3 groups throughout the follow-up period, with no statistically significant differences. Probing depths were not reduced significantly in any group. CONCLUSION: Subgingival irrigation with an herbal-based mouthrinse led to a significant reduction in both SBI and GI. This regimen can, therefore, be recommended as an adjunctive procedure to reduce gingival inflammation.

Analysis of Variance↗
PubMed2001

Cytologic evaluation of surgical irrigation fluid following resection of head and neck squamous cell carcinoma.

INTRODUCTION: Historically, squamous cells exfoliated from head and neck carcinoma resection have been implicated in locoregional recurrence, but there have been few studies demonstrating the presence of these cells. This study was designed to evaluate the presence of exfoliated malignant cells in surgical irrigation fluid collected during head and neck cancer resection. METHODS: Thirty patients undergoing surgery for biopsy-proven squamous cell carcinoma had their surgical sites irrigated with 1,000 cc of normal saline. Surgical gloves and instruments were also washed. These samples were prepared and stained using standard squamous cell cytologic stains. All cases were reviewed by one cytopathologist. RESULTS: Eighteen patients (60%) had positive or suspicious cytology detected in at least one of the surgical samples. In patients with T0 and T1 tumours, all surgical samples were negative. Positive or suspicious cytology was detected in the primary site and glove and instrument irrigation in 40% of patients with T2 tumours, 42% of patients with T3 tumours, and 50% of patients with T4 tumours. This was statistically significant (p < .05). Positive or suspicious cytology was detected in the neck and glove and instrument irrigation in 29% of patients with an N0 neck, 31% of patients with an N1 neck, 39% of patients with an N2 neck, and 100% of patients with an N3 neck. Five of seven patients (71%) with previous radiation therapy had positive or suspicious cytology in at least one of the surgical samples. CONCLUSIONS: Higher tumour and nodal staging and a previous history of radiation therapy are associated with an increased incidence of positive or suspicious cytology in surgical irrigation fluid. These findings have implications for surgical protocols.

Adult↗
PubMed2004

Selective irrigation of the sinuses in the management of chronic rhinosinusitis refractory to medical therapy: a promising start.

BACKGROUND: Although endoscopic sinus surgery has been widely used for the treatment of chronic rhinosinusitis, some patients fail to derive clinical benefit from this procedure. We evaluated the efficacy of a treatment regimen consisting of selective irrigation of diseased sinus mucosa with topical antibiotics and steroids in conjunction with oral antibiotics and steroids. METHODS: Twenty patients suffering from chronic rhinosinusitis and resistant to medical treatment (mean duration 3.4 years) underwent intubations of the affected maxillary and/or ethmoid sinuses for irrigation for a duration of 21 to 30 days. A computed tomographic (CT) scan of the paranasal sinus was taken both pre- and post-treatment and staged according to the Lund-MacKay system. Clinical symptoms were scored for rhinorrhea, facial pain, nasal congestion, and smell at least 2 months prior to treatment and approximately 18 months after the follow-up. RESULTS: The clinical experience with the technique of intubation and irrigation was well tolerated by all patients. We found an improvement in all symptom scores, including rhinorrhea, nasal congestion, smell (n = 20; p < .001), and facial pain (n = 20; p < .01). Similar improvements were seen on the CT scans, with reduced staging from 14.6 +/- 1.1 to 5.6 +/- 1.1 (p < .001). Only three patients did not respond to selective irrigation of the sinuses and needed further surgery. CONCLUSION: These results suggest that sinus irrigation could provide a reasonable and effective alternative to ethmoidectomy with drainage procedures and offer promise for the treatment of patients with chronic rhinosinusitis who are resistant to medical treatment.

Adult↗
PubMed1991

Blood ammonia concentrations resulting from absorption of irrigating fluid containing glycine and ethanol during transurethral resection of the prostate.

In 30 patients the blood ammonia concentration was measured 30 min was after transurethral resection of the prostate during which absorption of irrigating fluid containing 1.5% of glycine and 1% of ethanol had been indicated by serial expired breath tests. The volume of irrigating fluid that had been absorbed was either measured volumetrically (n = 25) or estimated from the ethanol concentration in the expired breath (n = 5); the median volume of irrigating fluid absorbed was 1.3 litres (range 0.2-4.3). There was no consistent rise in the blood ammonia concentration, nor was there any correlation between the blood ammonia concentration and the volume of irrigating fluid absorbed. No patient developed symptoms that could be clearly related to hyperammonaemic glycine toxicity, but 18 of the 30 patients developed other signs of the "TURP syndrome". The present results suggest that irrigating fluid containing both glycine and ethanol does not significantly increase blood ammonia concentration or produce symptoms of glycine toxicity.

Absorption↗
PubMed1986

BSS Plus: a potential irrigating solution for neurosurgery.

BSS Plus is a pH-stable balanced salt solution similar to glutathione bicarbonate Ringer's solution. Extensively used in ophthalmology, it is of potential value in neurosurgery. In comparative tests of its effectiveness, 28 cats underwent bilateral irrigation of the surface of the cerebral cortex with normal saline on one side and BSS Plus on the other. After 2 hours, a marked decrease was seen in the surface pH of the hemisphere irrigated with normal saline but not of the hemisphere treated with BSS Plus. Blood-brain barrier changes (measured with Evans blue dye techniques) were more evident following saline irrigation. Somatosensory evoked potentials and cerebral blood flow were not significantly altered. Conventional light microscopy using three standard stains did not reveal a significant difference. Transmission electron microscopy studies were performed in 14 animals and scanning electron microscopy in six. In five animals both transmission and scanning electron microscopy studies were conducted after irrigation with both agents without a cottonoid cover and with immediate harvest of superficial layers from the living brain and immersion-fixation in glutaraldehyde. Tissue preservation was superior on the BSS Plus side in all studies. This agent may represent an improved irrigation solution for neurosurgery, but further studies are required.

Animals↗
PubMed2006

Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients.

OBJECT: When complicated by infection, craniotomy bone flaps are commonly removed, discarded, and delayed cranioplasty is performed. This treatment paradigm is costly, carries the risks associated with additional surgery, and may cause cosmetic deformities. The authors present their experience with an indwelling antibiotic irrigation system used for the sterilization and salvage of infected bone flaps as an alternative to their removal and replacement. METHODS: The authors retrospectively reviewed the medical records for 12 patients with bone flap infections following craniotomy who received treatment with the wash-in, wash-out indwelling antibiotic irrigation system. Infected flaps were removed and scrubbed with povidone-iodine solution and soaked in 1.5% hydrogen peroxide while the wound was debrided. The bone flaps were returned to the skull and the irrigation system was installed. Antibiotic medication was infused through the system for a mean of 5 days. Intravenous antibiotic therapy was continued for 2 weeks and oral antibiotics for 3 months postoperatively. Wound checks were performed at clinic follow-up visits, and there was a mean follow-up period of 13 months. Eleven of the 12 patients who had undergone placement of the bone flap irrigation system experienced complete resolution of the infection. In five patients there was involvement of the nasal sinus cavities, and in four there was a history of radiation treatment. In the one patient whose infection recurred, there was both involvement of the nasal sinuses and a history of extensive radiation treatment. CONCLUSIONS: Infected bone flaps can be salvaged, thus avoiding the cost, risk, and possible disfigurement associated with flap removal and delayed cranioplasty. Although prior radiation treatment and involvement of the nasal sinuses may interfere with wound healing and clearance of the infection, these factors should not preclude the use of irrigation with antibiotic agents for bone flap salvage.

Adult↗
PubMed2005

Protective effects of cisternal irrigation on leptomeningeal and cortical structures in meningitis: an experimental study.

BACKGROUND: Meningitis, termed as foreign material collection in the subarachnoid space, leads to various meningeal, cerebral and spinal cord pathologies. Meningitis still remains a problematic disease with severe complications in spite of advanced medical technology. AIMS: In this study, we aimed to investigate the role of cisternal irrigation in the prevention of meningitis complications. SETTING AND STUDY DESIGN: Experimental study was done in the Social Security Hospital of Erzurum. Histopathological specimens were evaluated in the Pathology Department in the Ataturk University Research Hospital, Erzurum, Turkey. MATERIALS AND METHODS: This study was conducted on twelve lambs. Experimental meningitis was achieved with streptococcus pneumonia. Two animals were not treated. Ten animals were given Cefotaxime (4 x 1g/day) for 20 days, and additionally half of these animals underwent cisternal irrigation. Then, all animals were sacrificed and brains were observed histopathologically. RESULTS: Massive purulent CSF formation, hemorrhagic cortical lesions, vascular congestion, leptomeningeal and cortical adhesions and brain edema were observed in the non-irrigated group, but these findings were observed slightly or absent in the irrigated group. CONCLUSION: Meningitis can affect all central neural tissues, consequently serious central nervous system lesions may develop. The irrigation procedure may decrease the percentage and severity of meningitis complications by way of the excretion of inflamed purulent collection from the subarachnoid spaces.

Animals↗