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Embolic protection during saphenous vein graft intervention using a second-generation balloon protection device: results from the combined US and European pilot study of the TriActiv Balloon Protected Flush Extraction System.

BACKGROUND: Stent placement in saphenous vein bypass grafts is associated with a high incidence of myonecrosis usually resulting from embolization of thrombus and friable atheroma. Embolic protection devices reduce the incidence of adverse events after vein graft stenting. However, first-generation balloon occlusion systems are still associated with a 10% incidence of periprocedural adverse events. We report the first experience with a new second-generation balloon occlusion embolic protection device, the TriActiv Balloon Protected Flush Extraction System. METHODS: Ninety-six lesions in 78 saphenous vein grafts were treated in 74 patients. The primary end point was major adverse cardiovascular events at 30 days. RESULTS: Device success was achieved in 92% of patients, and atheromatous debris was recovered in 69% of analyzed aspirates. By 30 days, major adverse cardiovascular events, which were limited to non-Q-wave myocardial infarctions, occurred in 16.2%. Per protocol analysis in patients with device success revealed a rate of adverse events of only 5.7%. CONCLUSIONS: The initial experience with the TriActiv Balloon Protected Flush Extraction System demonstrated a high success rate and recovery of embolic debris with an acceptable rate of adverse events. A large randomized trial will compare this device to other embolic protection systems.

Adult↗

Influence of season and parity on the recovery of in vivo canine oocytes by flushing fallopian tubes.

Assisted reproductive technology (ART) in dogs largely depends on the in vivo matured oocytes due to lack of a suitable in vitro maturation system. The present study evaluated the technique of flushing fallopian tubes to collect in vivo matured canine oocytes by laparotomy, and determined the effects of seasons, and parity of donor bitches on the success of oocyte retrieval. Oocytes were retrieved from anesthetized bitches by laparotomy. About 7 ml of TCM-199 supplemented with HEPES was used to flush each individual fallopian tube. Oocytes were categorized as good, fair, poor, immature or aged based on the nuclear stage, cumulus cell layers, color and homogeneity of ooplasm. Oocytes categorized as being good or fair were considered usable, while poor, aged or immature oocytes were considered unusable for ART. A significantly higher number of oocytes per bitch were retrieved during the spring (11.2) compared to the winter (7.9). The oocyte recovery rates were 89.4, 92.2, 89.7 and 89.3% for spring, summer, autumn, and winter, respectively. The highest percentage of usable oocytes (74.7%) was retrieved during autumn (P>0.05). The number of oocytes was influenced by the parity of the donor bitch. Significantly more oocytes were collected from the multiparous bitches (10.3) compared to nulliparous bitches (7.7). The percentage of usable oocytes was more in multipara (71.5%) compared to nullipara (64.7%) (P>0.05). Collection of in vivo produced oocytes by laparotomy represents a potential source of matured oocytes for ART in dogs.

Animals↗

Photo-Fenton treatment of TNT contaminated soil extract solutions obtained by soil flushing with cyclodextrin.

The technical feasibility and performances of coupling flushing abilities of cyclodextrin solutions for 2,4,6-trinitrotoluene (TNT) removal from contaminated soil and the ability of Photo-Fenton treatment for final disposal of soil extract solutions containing high TNT loads have been investigated at laboratory scale. Methylated-beta-cyclodextrin (MCD) has shown better ability than hydroxypropyl-beta-cyclodextrin (HPCD) to complex TNT. The MCD solution increased the aqueous concentration of TNT in soil extract effluents as much as 2.1 times the concentrations obtained during the water flush of the soil. TNT in soil extract solution has been treated by Photo-Fenton. Our results indicate that MCD has a beneficial effect on the degradation rates of TNT. This relative improvement of TNT degradation rate (1.3 time) in presence of high amounts of hydroxyl radical scavengers can be ascribed to the formation of a ternary complex (TNT-cyclodextrin-iron) which can direct hydroxyl radical reaction toward TNT. Complete mineralization of soil extraction solutions was not achieved and TNT degradation pathway has been elucidated in order to ensure that no potential toxic intermediate is left at the end of the treatment time. After successive TNT hydroxylations, oxidative opening of the TNT aromatic ring quickly occurred, leading to the accumulation of short chain carboxylic acids such as oxalic acid and formic acid.

Cyclodextrins↗

Otic flushing.

Otic flushing has the potential to help a number of patients with ear disease. Because the diagnostic and therapeutic benefits of this procedure exceed its risks, veterinarians should offer otic flushing for patients with poorly responsive or chronic otitis externa.

Animals↗

Heavy metals extraction from contaminated soil: recovery of the flushing solution.

The optimum conditions for the recovery of copper from a contaminated soil by using the soil flushing technique are evaluated. Tests on a soil artificially contaminated with copper chloride were carried out in order to evaluate the influence of the speed of percolation and of the chelating agent concentration (aqueous solution of an ethylendiaminotetraacetic acid di-sodium salt Na2-EDTA). At pH=7.3 an efficiency up to 93.9% for copper extraction was achieved by flushing 500 ml of Na2-EDTA 0.05 M solution and 100 ml of pure water at 0.792 cm/h. At these operating conditions the formation of EDTA complexes with other competitive cations (calcium and iron) was negligible. The experimental results were in agreement with the ones obtained using a model describing the chemistry of metal extraction. This model assessed that above pH=6 the formation of calcium and iron EDTA complexes was excluded and only the chelation of copper was allowed. The recovery of 91.6% of EDTA was also achieved by evaporating and acidifying the extracted solution: after filtration, solid EDTA was obtained, through the addition of sodium hydroxide Na2-EDTA. About 99.5% of the extracted copper was finally precipitated under alkaline conditions from the liquid phase.

Chelating Agents↗

Vasomotor flushes in menopausal women.

Vasomotor symptoms after menopause are multifactorial in origin but result primarily from the loss of estrogen as ovarian function ceases. Although hot flushes typically last for 0.5 to 5.0 years after natural menopause, they may persist for as long as 15 years in a small percentage of postmenopausal women. In contrast, hot flushes tend to last longer and be more severe in surgically menopausal women. One of the major complaints associated with vasomotor symptoms is insomnia, which can have a domino effect on the patient's overall quality of life. Conventional hormone replacement therapy is effective in controlling vasomotor symptoms, including insomnia, for most postmenopausal women. However, data suggest that estrogen-androgen replacement therapy provides additional relief for women with persistent or severe vasomotor symptoms, especially women scheduled to undergo surgical menopause.

Androgens↗

Safety and efficacy of continuous flush systems for arterial and pulmonary artery catheters.

Air embolism and static pressure errors have been attributed to continuous infusion systems. Experiments show that the primary source of air bubbles in such a system is the drip chamber. A drip chamber that minimizes this problem was tested and is recommended. Pressure errors due to the flush system are shown to be clinically insignificant. Fast flushing through a central arterial catheter is shown to be a minimal hazard.

Arteries↗

A randomized controlled trial of tubal flushing with lipiodol for unexplained infertility.

OBJECTIVE: To test the hypothesis that, in couples with unexplained infertility, tubal flushing with an oil-soluble media (lipiodol) would increase the pregnancy rate within 6 months compared with expectant management. DESIGN: A prospective, randomized, controlled study in which couples were allocated to either a single treatment with lipiodol or no further action. SETTING: Two tertiary referral centers for assisted reproduction. PATIENT(S): Couples with a diagnosis of primary or secondary unexplained infertility based on a normal semen analysis according to World Health Organization criteria, patent fallopian tubes at hysterosalpingography or laparoscopy, and ovulatory menstrual cycles based on midluteal phase progesterone levels or ultrasonic follicle tracking. INTERVENTION(S): In those patients randomized to lipiodol, a single treatment was performed. MAIN OUTCOME MEASURE(S): Biochemical (i.e., positive pregnancy test) and clinical (i.e., fetal heart on ultrasound scan) pregnancy rates. RESULT(S): Seventeen couples were randomized to lipiodol and 17 to expectant treatment. The higher pregnancy rate after lipiodol was statistically significant. There were no complications after lipiodol treatment. CONCLUSION(S): There was a statistically significantly higher pregnancy rate in couples with unexplained infertility randomized to a single tubal flush with lipiodol compared with no treatment.

Adult↗

A simple method for the collection of human uterine flushing.

A method for the collection of human uterine lavages using a double-barreled cannula that allows for simultaneous injection and aspiration of the flushing is described. The method is simple and quick, is precise, and gives lavage volume recoveries of 77% to 100%. Protein determination of the human uterine flushing gave measurable levels, which are lower than in the plasma. Access to human uterine luminal secretions by this method, which can be repeatedly performed, can facilitate investigations into the sequential biochemical and hormonal uterine secretions in vivo in the same individual.

Catheterization↗

Percutaneous management of ureteral calculi facilitated by retrograde flushing with carbon dioxide or diluted radiopaque dye.

Of 356 patients in whom percutaneous nephrostomy was performed at this institution 59 had ureteral stones. In our experience with the first 36 patients antegrade techniques for ureteral stone extraction had many assets but sometimes they were difficult. Recently, we incorporated a retrograde flushing technique, using carbon dioxide and diluted radiopaque dye, into our percutaneous approach to ureteral stones. Based on our experience with this technique in the next 23 consecutive patients, we believe that percutaneous nephrostolithotomy and retrograde flushing should be added to the armamentarium of urologists committed to the percutaneous endourological approach to ureteral stones.

Carbon Dioxide↗

The value of magnesium in flush solutions for human cadaveric kidney preservation.

A cooperative clinical trial was conducted among 5 transplant centers in the western United States to determine the value of magnesium sulfate in intracellular electrolyte flush solutions for hypothermic, human kidney storage. Kidneys from alternate donors were flushed with either magnesium-free Euro-Collins' solution or magnesium-containing Collins' 2 solution. Donor and recipient ages, and mean preservation times were not significantly different between the 2 groups. There was a significantly lower dialysis requirement during the first week in the magnesium-containing Collins 2 group (33 per cent) versus the Euro-Collins group (54 per cent). Function rates and serum creatinine nadirs at 1 month were not significantly different. The beneficial effect of magnesium sulfate was more evident when preservation times exceeded 24 hours.

Adult↗

Human kidney preservation using machine perfusion followed by intracellular electrolyte flushing.

Transplant centers that do not have pulsatile machine perfusion capabilities are reluctant to accept kidneys from programs that do. Four human kidneys were retrieved by other centers, initially placed on pulsatile machine perfusion pumps for 13 to 28 hours, removed from the pumps, flushed with intracellular electrolyte solutions and cold-stored for 13 to 36 hours before transplantation at our institution. All recipients required dialysis during the first week after transplantation. The 1-month serum creatinine nadir was 2.2 plus or minus 1.1 mg. per dl., and all kidney grafts were functioning 3 months after transplantation. Pulsatile machine perfusion followed by ice-cold intracellular electrolyte flushing and simple cold storage can provide satisfactory renal function when the warm ischemia time is short.

Cold Temperature↗

Comparison of imported with locally retrieved kidneys preserved by intracellular electrolyte flushing followed by cold storage.

Ice-cold intracellular electrolyte flushing followed by cold storage and economy air shipment is the cheapest method to share kidneys for transplantation. This study from 1 center compares 62 primary cadaver kidney grafts imported from other centers to 128 that were retrieved locally. Cold ischemia time was 36.4 plus or minus 8.6 hours (mean plus or minus standard deviation) in the imported group and 24.2 plus or minus 8.8 hours in the locally retrieved group. The significant increase in first week dialysis (71 versus 42 per cent) and 1-month serum creatinine nadirs (2.63 plus or minus 2.73 versus 1.78 plus or minus 1.04 mg./dl.) was explained by longer cold ischemia times in the imported kidney grafts. There were no significant differences between the 2 groups with respect to actuarial kidney graft survivals and serum creatinine levels at 1, 2 and 3 years. Intracellular electrolyte flushing followed by simple cold storage and air transportation provides kidney graft survivals and long-term kidney graft function at minimal expense when the kidneys are retrieved from beating-heart cadavers and have undergone minimal warm ischemia.

Cold Temperature↗

In situ flushing of donor kidneys: its technique and rationale.

In situ flushing of kidneys through an isolated segment of aorta was done on mongrel dogs. The 500 cc cold perfusate at 3 to 4C (delivered in 6 minutes) effectively cooled the kidneys to about 15C. This simplified technique of in situ flushing, its usefulness and rationale are discussed.

Animals↗

The effects of freshwater flushing on marine heterotrophic protists--implications for ballast water management.

Survivorship of ballast-entrained marine heterotrophic protists was examined following freshwater flushing. The recovered taxa, including typical marine rhizopods such as Platyamoeba murchelanoi, Labyrinthula spp, Pontifex maximus, Thecamoeba orbis, and the ciliate Condylostoma arenarium, were reared in waters of various salinities. After 2 months, the original salinity subsample retained five protist taxa, the freshwater six, including the amoeba Cochliopodium bilimbosum, the brackish water 22 taxa, and the seawater 19 taxa. Since protists form a major component of marine microbial food webs, their survival may be instrumental in supporting complex ballast-entrained food webs. Our study raises questions as to the reliability of open-ocean exchange (OOE) or freshwater flushing as effective control measures.

Animals↗

Development of mouse embryos in media supplemented with fractionated bovine uterine flushings.

The effects of fractionated bovine uterine flushings (BUF) on in vitro mouse embryo development were evaluated. Uterine flushings were nonsurgically collected from six cows and fractionated by ultrafiltration using 1,000 D and 30,000 D molecular weight exclusion limit membranes. Retentates were designated as 1,000 D (1 KR) and 30,000 D retentates (30 KR) and were evaluated for total protein, plasmin, plasmin inhibitor and support of mouse embryo development. Medium with bovine serum albumin (BSA) as a control was fractionated in a similar manner and frozen and thawed to assess any developmental limitations induced by the procedure. Consistent significant relationships, as determined by correlation-regression analysis, between the extent of embryo development and levels of protein, plasmin and plasmin inhibitor were not observed in either 1 KR BUF or 30 KR BUF. The numbers of embryos developing into blastocysts in 1 KR BUF on Days 9, 12, 15, 18 and 21 of the collection period were reduced when compared with the 30 KR BUF (P<0.05). Fewer blastocysts hatched in 1 KR BUF than in 30 KR BUF on Days 12, 15, 18 and 21 of the collection period (P<0.05). Embryo development in medium with 1 KR BSA tended to be superior to development in unfractionated media and in 30 KR BSA at comparable protein levels. No detrimental effects of freezing and thawing culture media on embryo development were observed (P>0.10). These data suggest that luteal phase BUF contain an inhibitor of embryo development, and commercial BSA preparations may possess a small molecular weight contaminant which reduces in vitro embryo survivability.

Journal Article↗

Chlorpropamide alcohol flushing and diabetic retinopathy.

"Mason-type" diabetics (mild diabetes which is dominantly inherited) are relatively free of retinopathy. Alcohol almost invariably causes facial flushing in these patients when they are given chlorpropamide (chlorpropamide alcohol flush, C.P.A.F.). 291 non-insulin-dependent diabetics were examined to see whether there was a difference in frequency of retinopathy between C.P.A.F. positive and negative cases who were of comparable age and duration of diabetes. Retinopathy was commoner and often severe in CPAF negative patients. Blindness from retinopathy was almost confined to C.P.A.F.-negative cases. Lens opacities, on the other hand, were equally common in both groups. Since C.P.A.F. is an inherited trait, retinopathy in non-insulin-dependent diabetics is to a considerable extent, although not entirely, determined by genetic factors.

Cataract↗

Is cutaneous flushing prostaglandin mediated?

Intravenous administration of nicotinic acid (25 mg), resulted in a readily reproducible facial flush. The development of this flush was inhibited by two prostaglandin synthetase inhibitors, indomethacin and benorylate, but was not affected by the administration of the opiate receptor antagonist naloxone. Indomethacin, the agent with the greater anti-prostaglandin activity, was markedly more effective than benorylate in inhibiting the nicotinic-acid-induced rise in facial temperature. These findings will be useful in the in vivo assessment of the activity of prostaglandin inhibitors.

Adolescent↗