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Six different types of continuous flush devices have been assessed for accuracy in vitro and ease of use in vivo. Only two types of device matched the manufacturers' specifications of performance. The other four gave higher flow rates than expected.
The effect of oral administration of indomethacin (100 mg/day), a potent inhibitor of prostaglandin (PG) biosynthesis, on the PG levels and cellular profile in the uterine flushings in response to the use of an IUD (Lippes Loop size C) was studied in sixty women. Indomethacin reduced the cell counts in both follicular and luteal phases of menstrual cycles before and after IUD insertion. The anti-inflammatory drug decreased PGE2 and PGF2 alpha levels in both phases of the cycle before IUD insertion. After insertion, it inhibited only the formation of PGF2 alpha and its 13,14-dihydro-15-keto metabolite in the luteal phase but not in the follicular phase. In long-term users, however, the drugs reduced the levels of all PGs studied in the luteal phase and only PGF2 alpha and its metabolite in the follicular phase. The implications of these findings in the mechanisms of contraceptive action of IUDs and their side effects are discussed.
The aim of the present paper was to evaluate the prevalence of the chlorpropamide-alcohol-flush (CPAF) in patients with type 2 and with type 1 diabetes. Ninety-seven patients with type 2 diabetes and 33 with type 1 diabetes drank 40 ml vermouth 12 h after placebo and again 12 h after 1 tablet of chlorpropamide (250 mg) or 12 h after the last of repeated administrations of chlorpropamide (250 mg b.i.d. for 2 days). Skin temperature was recorded in all patients by a thermocouple probe connected to the left cheek. In 47 patients serum concentrations of chlorpropamide and of its metabolite CBSU were also determined. The prevalence of CPAF was similar in type 1 and type 2 diabetes, was greater in women than in men, and was significantly greater after repeated administrations than after one single administration of chlorpropamide. The increase of skin temperature during a 30-min period was significantly higher in patients with CPAF than in patients without CPAF. Serum concentrations of chlorpropamide and of its metabolite CBSU were more elevated after 4 than after 1 tablet of chlorpropamide, but were not significantly different in patients with and without CPAF. These data indicate that both genetic factors and the amount of chlorpropamide used affect the appearance of CPAF. To assess the possible role of serotonin and of dopamine in the CPAF, some patients with CPAF were tested again after treatment with metergoline, an antiserotonin agent, or with bromocriptine, a dopamine-agonist. Neither drug influenced the CPAF, indicating that the two neurotransmitters are not involved in the CPAF.
The activity of matrix metalloproteinases (MMPs) in the uterine flushing and endometrial tissue of normal adult women wearing FCu-IUD (fixed Cu-IUD) or FICu-IUD (indomethacin-releasing FCu-IUD) was observed by using zymography on SDS-PAGE containing gelatin. The results showed that the activity and kinds of MMPs in FCu-IUD group were increased significantly as compared with themselves before being inserted FCu-IUD. However, compared with the FCu-IUD group, the activity of some kinds of MMPs in the FICu-IUD group was decreased significantly. These data suggest that IUD can enhance the activity of MMPs in human endometrium, intermediated by prostaglandins, and MMPs may have relation to IUD-induced menorrhagia and indomethacin reduces IUD-induced menorrhagia by partly inhibiting MMPs synthesis.
PURPOSE: Thromboses occur in connection with the use of venous port systems. Valid data on the instillation of heparin-based solutions in the lumen of the port system are lacking. METHODS: One hundred and seventy-three patients with malignancy from 19 centres who had participated in an observation study of subcutaneous thromboprophylaxis with dalteparin-Na (Fragmin P/-Forte) were analysed with a view to flushing the port systems and investigating any related influence on the occurrence of catheter-associated thromboses. RESULTS: All catheter-associated thromboses were seen in centres which used either no UFH, or UFH concentrations of up to 250 IU/ml (8/108; 7.4%). The rate of thrombosis rose to 10% (6/60) if no high-risk dose of dalteparin was applied subcutaneously. On the other hand, the rate of catheter-associated thromboses under the high-risk dose of dalteparin and/or a more highly concentrated instillation fluid, at 0.9% (1/113), was much lower. One haemorrhage from gastric ulcer occurred under the highest UFH concentration in the instillation fluid (2,500 IU UFH/ml). CONCLUSION: The results indicate that a concentration between 500 IU UFH/ml and 1,000 IU UFH/ml in the instillation solution, at the same time as high-risk prophylaxis with subcutaneous dalteparin for prevention of catheter-associated thromboses, is effective in patients with manifest tumour disease. The instillation of LMWH-based solutions at a concentration of approx 500 anti-Xa units/ml should be discussed as a pending issue.
Because central venous catheters often become blocked by clot at their tip despite heparin flushes, a more effective anticoagulant is needed. We hypothesize that lepirudin, a recently introduced protein anticoagulant, might be more effective than heparin because of its tendency to adsorb to silicone, a commonly used catheter material. We preliminarily tested this hypothesis in vitro by measuring residual lepirudin and heparin activity at the tip of a catheter that had been submerged in a flowing stream of water for various periods of time. We observed that lepirudin is less readily removed than heparin from the catheter by fluid washing over it. This "slow-release" property of lepirudin might provide prolonged protection against clot formation at the catheter tip. A clinical trial will be necessary, however, to determine whether this property translates into significant improvement in catheter function.
PURPOSE: The clinical efficacy of two methods of preanesthetic leak test,namely the oxygen flush leak test (OFLT) and the low-flow leak test (LFLT), was compared regarding their ability to detect leakage in the anesthesia circuit and their accuracy. METHODS: Examinees comprised 16 staff anesthesiologists and 7 physicians undergoing anesthesia training at our institution. They performed the two leak tests on anesthesia machines with some intentional leaks (0.1-1.0 l.min(-1)). The leakage detection rates (LDR) were analyzed by the chi(2)-test. The ability to detect leaks was measured by recording how many leaks were detected by 50% (LDR(50)) and 95% (LDR(95)) of the examinees. RESULTS: The LDRs in the two tests were significantly different (chi(2)- analysis, P < 0.0001). Both LDR(50) and LDR(95) for the LFLT (0.23 and 0.41 l.min(-1), respectively) were smaller than the values for the OFLT (0.37 and 0.82 l.min(-1), respectively). The sensitivity and specificity of the LFLT (0.97 and 0.84, respectively) were higher than those of the OFLT (0.78 and 0.80, respectively). CONCLUSION: The LFLT was found to be superior to the OFLT regarding leak detection and reliability. We therefore recommend the LFLT for preanesthetic leak testing.
The vasomotor flush (VMF) is the most common reason for menopausal women to seek hormonal therapy, but the evaluation of therapeutic regimens has been hampered by the observation that placebo therapy can decrease VMF and, until recently, by a lack of objective criteria of measurement of the VMF. Using the objective criteria of temperature elevations (TEs) and luteinizing hormone (LH) pulses, we evaluated the effect of placebo and medroxyprogesterone acetate (MPA) on VMF. MPA and possibly also placebo were found to reduce not only the subjectively noted VMF but also the frequency of TEs recorded. In addition, MPA, but not placebo, significantly reduced the frequency and amplitude of LH pulses. Possible mechanisms of action of MPA and placebo therapy are discussed.
Tailoring treatment to the individual limb, by using flush ligation for the incompetent long saphenous vein and compression sclerotherapy for perforating veins and major control points, gives good control of venous disease. The long saphenous vein can be preserved in these circumstances. Compression sclerotherapy is easily repeated if necessary. Varicography and local ligation should be considered for large recurrences in the thigh where compression sclerotherapy is difficult. Compression sclerotherapy has replaced fasciotomy in my practice, and I strongly recommend this combined approach to surgeons interested in the treatment of venous disease.
A glue embolization of a cerebral arteriovenous malformation in a 3-year-old boy was complicated by a massive pulmonary embolus due to glue entering the venous circulation. Attempted pulmonary embolectomy via pulmonary arteriotomy after emergency cardiopulmonary bypass was unsuccessful. However, retrograde flushing of the pulmonary veins with cold saline solution produced large quantities of embolus through the pulmonary arteriotomy. Bypass was discontinued uneventfully with no residual cardiopulmonary problems.
We used a bilateral lung transplant model to confirm, in primates, the results of lung preservation studies previously obtained in a canine single-lung transplant model. The donor lungs were flushed with low-potassium dextran solution and maintained semiinflated with 100% oxygen at 10 degrees C for a planned ischemic time of 12 hours for the lung implanted first. Of eight experiments performed, results in the 6 operative survivors form the basis of this report. After bilateral lung transplantation, animals were maintained on a ventilator for 6 hours; arterial oxygen tension, pulmonary artery pressure, and pulmonary vascular resistance were determined in the recipients at 2, 4, and 6 hours after transplantation and compared with donor values, which served as controls. Arterial oxygen tension in the recipients did not differ from the controls (p = not significant), whereas the pulmonary artery pressure and pulmonary vascular resistance showed significant elevation (p < 0.05 versus control values). After the 6 hours of assessment, the animals were extubated and 3 survived for 48 to 72 hours with a mean arterial oxygen tension of 69 mm Hg on room air. These results demonstrate excellent lung function after a minimum of 12 hours of preservation in a primate model in which the animal is totally dependent on the function of transplanted lung tissue, and confirm the potential for prolonged clinical lung preservation.
To assess the effectiveness of pulmonary perfusion we evaluated the lung mechanics of 36 canine lungs in an isolated perfused working lung (IPWL) model. Four groups of lungs (n = 9 each) were preserved by pulmonary artery flushing with either high-potassium colloid (UW), high-potassium crystalloid (EuroCollins', EC), low-potassium crystalloid control (lactate), or low-potassium substrate-enhanced crystalloid (RPMI) followed by 130 +/- 10 min of cold storage. Ventilation remained constant (TV 10 ml/kg at 14 breaths/min with 5 cm H2O PEEP). Assessed data included lung resistance (R), timed expiratory volume (EV0.3 sec as %TV), lung compliance (C), elastic work (Wel), and flow-resistive work (Wres). Immediately following storage, R and Wel were similar for all groups (16 +/- 3 cm H2O/liter/sec and 149 +/- 18 gm/min). UW preserved lungs were less compliant (1.5 +/- 0.1 X 10(-2) liter/cm H2O) and required more inspiratory work (Wres 5.8 +/- 0.8 gm/min) compared to the low-potassium crystalloid (Lactate) group (2.0 +/- 0.1 X 10(-2) liter/cm H2O and 3.4 +/- 0.6 gm/min, respectively, P less than 0.05). For 3 hr of reperfusion, crystalloid lungs showed no significant change in R, C, Wel, or Wres. In contrast, R of the UW group increased significantly to 32 +/- 5 and 40 +/- 8 cmH2O/liter/sec at 1 and 3 hr, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
A 15-mm diameter degenerating embryonic vesicle and a normal, 200-u early blastocyst were recovered in a uterine flush of a mare 7 d after ovulation. From its size, the degenerating vesicle appeared to be 13 to 14 d of age. The mare had been bred during a previous cycle and then treated with prostaglandin 9 days after ovulation. The advanced vesicle that was recovered suggests that a conceptus from the previous cycle continued to grow for about 5 d after prostaglandin administration, and remained in the uterus during estrus, when plasma progesterone concentrations were below 1 ng/ml. From the estimated age of the conceptus, its development stopped at about the time the mare was inseminated. Had this conceptus survived through estrus and insemination, superfetation would have occurred.
BACKGROUND: During a 2-week period, seven cases of nosocomial polymicrobial gram-negative rod bacteremia occurred on a 39-bed medical and cardiac step-down unit. Combinations of Enterobacter cloacae (seven isolates), Klebsiella pneumoniae (five isolates), and Citrobacter freundii (two isolates) were isolated from blood cultures. METHODS: Concurrent and retrospective chart reviews were used to look for further cases and common exposures. Epidemiologic methods were used to refine determination of common exposure. Restriction enzyme DNA analysis was performed on the isolates. RESULTS: Concurrent and retrospective chart reviews revealed four additional possible cases during the same period. All case patients were exposed, through peripheral saline solution locks or central venous catheters, to saline solution "flush" from a central 0.9% saline solution bag and a needleless dispensing pin. Epidemiologic methods implicated probable extrinsic contamination of a single bag and pin used during a 24-48-hour period (Fisher's Exact Test, p < 0.002). There were no other common exposures. Restriction enzyme DNA analysis of the isolates further supported a common source for the outbreak. CONCLUSIONS: The introduction of needleless intravascular systems has been embraced for employee protection. Our report is the first to raise the question of patient safety with such systems. This outbreak highlights the inherent risks in rapid introduction of new technologies and points out the delicate balance among patient health, employee safety, and cost containment.
Clinical assessment of the severity and frequency of post-menopausal hot flushes can be made objectively by measuring the associated changes in skin conductance and skin and core temperature. Such measurements provide a more reliable index of the response to therapy than does subjective reporting which has been employed in the past. The design and use of a working analyzer is presented that is sufficiently simple, rugged, safe and portable to be used under normal clinical conditions to provide a permanent record of the attacks.
The reduction of gonadotrophin levels, urinary calcium and hot flushes in post-menopausal patients by ethinyl oestradiol is shown to be dose dependent, near maximum response being achieved by a dose of 15 micrograms daily. Equivalent ethinyl oestradiol doses to a number of other gonadal hormone preparations have been assessed using the derived dose-response curve of the reduction in urinary calcium.
Hot flushes (HF) were demonstrated definitively in a hypogonadal man by continuous recordings of finger temperature, skin resistance and subjective symptoms. The magnitudes and temporal interrelationships of these physiological changes were similar to those previously observed in oophorectomized women. HF were abolished by injections of methyl testosterone (MT) and during oral administration of fluoxymesterone (FM), a non-aromatizable androgen. Increases of the non-SHBG bound fractions of T and E2 were noted during MT therapy, either of which may have been responsible for suppression of HF. No significant changes of the non-SHBG bound levels of E2 were observed during FM ingestion. These data confirm that typical HF occur in the male and support the concept that androgen acts directly on the central nervous system without requiring aromatization to estrogen in the brain or other tissues.
Analysis of Psilocybe cubensis (Earle) Singer grown in controlled culture showed that the level of psilocin was generally zero in the first (or sometimes even the second) fruiting of the mushroom from a given culture and that the level reached a maximum by the fourth flush. The level of psilocybin, which was nearly always at least twice the level of psilocin, showed no upward or downward trend as fruiting progressed, but was variable over a factor of four. Samples obtained from outside sources had psilocybin levels varying by over a factor of ten from one collection to the next.