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Variability in infusion pressure and continuous flow rate delivered from pressurized bag pump flush systems.

Using 10 different infusion bag pressure pumps, indicated manometer pressures were compared with measured infusion pressures proximal to the flow-regulating device in an in vitro experiment. Flow rates delivered through the flow-regulating device were gravimetrically measured at different monitored pressure levels. Significant differences were found between manometer and measured infusion pressures among the tested pressure bagpumps (e.g. 500 ml bag volumepressurized to 300 mmHg manometerpressure: 219.6 +/- 7.8 to 407.2 +/- 2.7 mmHg). The infusion pressures were additionally affected by the vertical level of the infusion bag pump and by the volume of the infusion bag. Flow rates delivered through the flow-regulating device were directly correlated to the measured infusion pressure (r2= 0.9926). Differences inflow rates can have a considerable impact on maintaining catheter patency and avoidance of fluid overload and retrograde flushing into the central arterial circulation in neonates and small children. A simple manoeuvre using the invasive pressure transducer allows monitoring and adjustment of the infusion pressure in the clinical setting.

Humans↗

Perimenopause: more than hot flushes and night sweats for some Australian women.

OBJECTIVE: To identify the most common perimenopausal symptoms experienced by a group of Australian women and explore the extent to which those symptoms were distressing. DESIGN: A quantitative survey. SETTING: All women's health centers listed with the New South Wales Women's Information and Referral Service. PARTICIPANTS: A convenience sample of 200 healthy women, aged 45 to 55 years, drawn from a statewide population of women residing in Australia. MAIN OUTCOME MEASURE: The Women's Health Assessment Scale. RESULTS: Most frequently occurring perimenopausal symptoms included forgetfulness, lack of energy, irritability, and weight gain. The most distressing perimenopausal symptoms included weight gain, heavy bleeding, poor concentration, leaking of urine, and feeling as though life were not worth living. Current use of hormone replacement therapy contributed to the prediction of both symptom occurrence and symptom distress. CONCLUSION: Perimenopause is marked by more than hot flushes and night sweats; cognitive and affective changes are other distressing symptoms. The relationships between hormone replacement therapy use and both symptom occurrence and symptom distress warrant further investigation. In addition, practitioners should address concerns related to urinary incontinence, weight gain, cognitive and affective dysfunction, and general health status.

Estrogen Replacement Therapy↗

Magnesium-flush infusion into the aortic root just before reperfusion reduces the requirement for internal defibrillation and early post-perfusion arrhythmias.

Pre- and post-operative administration of magnesium has beneficial effects on post-operative ischaemia and reperfusion arrhythmias, but few studies have examined whether intra-operatively administered magnesium can prevent the effects of intra-operative arrhythmias. The aim of this randomized, double-blind study was to compare the effects of intra-operative magnesium or placebo on intra-operative arrhythmias in patients undergoing coronary bypass grafting. Patients received a flush infusion of magnesium or placebo into the aortic root before cross-clamp removal. The results showed that rate of spontaneous resumption of a cardiac rhythm was significantly higher, and number of shocks for defibrillation, energy requirement for defibrillation and rate of intra-operative ventricular tachyarrhythmias were significantly lower in the magnesium group, compared with the placebo group. The differences in need for temporary pacing, and in serum magnesium levels, were not significant. Intra-operative administration of magnesium has beneficial effects on the outcome of surgery. Larger, multicentre clinical investigations should now be undertaken.

Aged↗

Suppression of plasma catecholamines and flushing by clonidine in man.

Administration of the anti-hypertensive agent clonidine as a single (0.5 mg) oral dose or as multiple doses (0.2-0.4 mg/day for 4 days) markedly reduced plasma catecholamines (decrement = 81 +/- 3% and 68 +/- 5%, respectively; X +/- SE, % of basal; both P less than 0.001) in normal male volunteers. Five patients with various metabolic disorders showed similar responses. The absolute decrements in plasma catecholamines correlated significantly with basal catecholamine levels (P less than 0.001). Clonidine-induced decrements in mean arterial blood pressure correlated significantly with decrements in plasma catecholamines (P less than 0.001). The clonidine effect upon catecholamine levels was reversed by phentolamine (clonidine = -68 +/- 5%; clonidine with phentolamine = -1 +/- 16%). The decrements in catecholamines induced by clonidine in normal subjects were associated with increased sensitivity to the pressor effect of infusion of exogenous norepinephrine. In an analogous fashion flushing associated with endogenous adrenergic discharge was blocked by clonidine, whereas that due to exogenous catecholamines was intensified. These data are compatible with data in experimental animals suggesting that clonidine acts at least in part by interaction with a central alpha adrenergic receptor.

Adenoma, Islet Cell↗

A double blind study to evaluate the effect of methyldopa on menopausal vasomotor flushes.

Vasomotor flush (VMF) is the most consistent symptom associated with the menopause. Nonsteroidal agents such as clonidine have been demonstrated to decrease VMF. Anecdotal reports suggested that VMF were reduced in hypertensive women receiving methyldopa, which is also an alpha2-adrenergic agonist. This study describes a double-blind cross-over placebo-controlled study to evaluate the effect of methyldopa on VMF. Diary reports were made and serum LH and digital skin temperature were measured in 10 menopausal women with 30 or more VMF/week and serum FSH levels of 40 mIU/ml or greater. The frequency of VMF, LH pulse, and temperature elevation during a 5-h observation period and VMF per week based on diary reports were compared for the baseline and fourth week of therapy with methyldopa (250 mg, three times daily) and placebo therapy. The patients reported some amelioration of VMF (P less than or equal to 0.02) during drug therapy. Objectively, only the frequency of LH peaks was decreased with methyldopa therapy (P less than or equal to 0.05). Because of significant side effects and minimal symptomatic improvement, methyldopa is not likely to be an acceptable therapy for VMF.

Adult↗

Short communication: venous uptake of 99Tcm-MIBI during resting cardiac imaging: incidence and the effect of using a flush.

99Tcm-methoxy-isobutyl-isonitrile (99Tcm-MIBI) is taken up by the vein through which it is injected in some individuals. We prospectively analysed technical and clinical factors that may be associated with this uptake. Imaging was performed over 1 h after injection so excluding a blood pool effect. The frequency of uptake could be reduced from 25.9% to 4.2% by using a 20 ml saline flush (p < 0.05). Other factors appeared irrelevant. The presence of venous uptake did not affect myocardial counting statistics but, if unrecognized, it could cause confusion in studies of the neck or chest that use 99Tcm-MIBI.

Adult↗

Effectiveness of flushing on reducing lead and copper levels in school drinking water.

Samples from drinking water fountains in 50 schools in New Jersey were collected at specific times during a typical school day and analyzed for lead, copper, pH, alkalinity, and hardness. First-draw lead and copper levels (medians 0.010 mg/l and 0.26 mg/l, respectively) decreased significantly after 10 min of flushing in the morning (medians 0.005 mg/l lead and 0.068 mg/l copper), but levels increased significantly by lunchtime (medians 0.007 mg/l lead and 0.12 mg/l copper) after normal use of fountains in the morning by students. Corrosive water, as defined by the aggressive index, contained significantly higher levels of lead and copper (medians 0.012 mg/l and 0.605 mg/l, respectively) than noncorrosive water (medians 0.005 mg/l and 0.03 mg/l, respectively).

Child↗

Transfer of canine embryos at various developmental stages recovered by hysterectomy or surgical uterine flushing.

In dogs, embryo transfer (ET) techniques such as induciton of excessive ovulation and synchronization of estrus have not progressed well. Therefore, using embryos at various developmental stages, ET was investigated in dogs from a beagle colony in which the ovulation days were close, as estimated by the progesterone level. Embryos were, recovered 8-11 days after ovulation (4-9 days after mating) by excising the oviducts and uteri (excision method) in 16 animals and by surgical flushing of the uteri at laparotomy (surgical method) in 3 animals. In 24 dogs with -4 to +2 days of difference in the timing of ovulation between donor and recipient dogs, 1-10 embryos at the 8-cell to blastocyst stages were transferred per animal. The mean embryo recovery rate by the excision method (97.1%) was significantly higher than that by the surgical method (42.5%) (p<0.01). Twelve (57.1%) of 21 animals with -1 to +2 days difference in ovulation day became pregnant after the transfer of 8-cell to blastocyst stage embryos. Although 3 dogs with -4 to -2 days of difference of ovulation day underwent ET of morula or compacted morula, none of these dogs became pregnant. The mean ratio of the number of newborns to the number of transferred embryos was only 51.9%. The mean duration of the period between ovulation and delivery in the pregnant recipients was 65.8 days, which tended to be longer than that in natural mating. These results demonstrate that pregnancy can be induced by ET at the 8-cell to blastocyst stage in dogs with -1 to +2 days difference in ovulation day.

Animals↗

Dansac Invent convex in the management of flush ileostomy.

This article examines the use of the Dansac Invent convex drainable stoma appliance. A review of the literature highlights the indications for use of convexity and discusses the potential contraindications. A short case study describes the use of convex appliances in a patient with a flush, high-output ileostomy.

Aged↗

Acid phosphatase and leucine aminopeptidase activity in the uterine flushings of non-pregnant and pregnant gilts.

The activities of uteroferrin, measured as acid phosphatase (AP), and an aminoacylpeptidase (AA) were measured in uterine flushings collected from gilts on Days 6, 8, 10, 12, 14, 15, 16 and 18 of the oestrous cycle and pregnancy (N = 37). Changes in AP (P less than 0.05) were associated with day for both specific and total AP in non-pregnant and pregnant gilts. For pregnant and non-pregnant gilts, AP activity was greatest between Days 14 and 16 and then decreased to Day 18. The AA specific activity increased (P less than 0.01) between Days 10 and 12 of the oestrous cycle and pregnancy, but neither effects of pregnancy nor day by pregnancy status interaction were detected. The AA total activity was greater for pregnant gilts (P less than 0.01). These data suggest an inhibitory effect of oestrogens of blastocyst origin on synthesis and/or secretion of uteroferrin, but not AA.

Acid Phosphatase↗

Comparison of three enzyme immunoassays for measuring 17beta-estradiol in flushed dairy manure wastewater.

Natural steroidal estrogens are an environmental concern because low nanogram per liter concentrations in water can adversely affect aquatic vertebrate species by disrupting the normal function of their endocrine systems. There is a critical need to accurately measure estrogens in dairy wastes, a potential source of estrogens such as 17beta-estradiol, to assess the risk of estrogen contamination of agricultural drainage waters resulting from land application. Commercially available enzyme immunoassay (EIA) kits have been used for measuring 17beta-estradiol in livestock manure, but it is not known if different EIAs provide similar results. We compared three EIAs by measuring 17beta-estradiol in two samples of flushed dairy manure wastewater (FDMW). The measured concentrations of 17beta-estradiol in FDMW differed according to the immunoassay used. The differences were attributed to a matrix interference associated with coextracted humic substances. Future research should develop methods that enable routine measurement of 17beta-estradiol in livestock wastes by more conclusive analytical techniques such as gas chromatography-mass spectrometry.

Animals↗

Determination of steroidal estrogens in flushed dairy manure wastewater by gas chromatography-mass spectrometry.

There is a critical need to accurately measure the concentrations of natural steroidal estrogens in flushed dairy manure wastewater (FDMW) to assess any potential risk of waterway contamination resulting from land application. Estrogens are a concern because low concentrations (10-100 ng L-1) in water can adversely affect aquatic vertebrate species such as fish, turtles, and frogs by disrupting the normal function of their endocrine systems. The objective of this study was to develop a sample preparation method that permits the quantification of four natural steroidal estrogens (17alpha-estradiol, 17beta-estradiol, estrone, and estriol) in FDMW by gas chromatography-mass spectrometry (GC-MS). Solid-phase extraction with graphitized carbon black was used for the bulk extraction of estrogens from FDMW and additional sample purification was accomplished with C-18. The sample preparation method allowed estrogens to be detected accurately by GC-MS in FDMW. Spiked recovery experiments indicated that the method is satisfactory for measuring the estrogens of interest in FDMW with average recovery of >90%. As expected in FDMW, characterization of the estrogen profile revealed a large abundance of 17alpha-estradiol relative to 17beta-estradiol and estrone. Estriol was not detected in FDMW. The methodology developed in this research helps provide an analytical foundation for the quantification of steroidal estrogens in FDMW by GC-MS.

Animals↗

Effect of tympanic cavity evacuation and flushing on microbial isolates during total ear canal ablation with lateral bulla osteotomy in dogs.

OBJECTIVE: To evaluate differences in bacterial numbers, identity, and susceptibility in samples obtained from the tympanic cavity on entry (preflush) and after evacuation and lavage (postflush) and assess perioperative and empiric antimicrobial selection in dogs that underwent total ear canal ablation (TECA) with lateral bulla osteotomy (LBO) or reoperation LBO. DESIGN: Prospective clinical study. ANIMALS: 34 dogs. PROCEDURE: TECA with LBO or reoperation LBO was performed on 47 ears. Pre- and postflush aerobic and anaerobic samples were obtained from the tympanic cavity. Isolates and antimicrobial susceptibility patterns were compared. RESULTS: Different isolates (31/44 [70%] ears) and susceptibility patterns of isolate pairs (6/44 [14%] ears) were detected in pre- and postflush samples from 84% of ears. Evacuation and lavage of the tympanic cavity decreased the number of bacterial isolates by 33%. In 26% of ears, bacteria were isolated from post-flush samples but not preflush samples. Only 26% of isolates tested were susceptible to cefazolin. At least 1 isolate from 53% of dogs that received empirically chosen antimicrobials postoperatively was resistant to the selected drugs. Anaerobic bacteria were recovered from 6 ears. CONCLUSIONS AND CLINICAL RELEVANCE: Accurate microbiologic assessment of the tympanic cavity should be the basis for selection of antimicrobials in dogs undergoing TECA with LBO. Bacteria remain in the tympanic cavity after evacuation and lavage. Cefazolin was a poor choice for dogs that underwent TECA with LBO, as judged on the basis of culture and susceptibility testing results.

Animals↗

Survival of pig embryos flushed from the reproductive tract immediately or two hours after slaughter of donors.

Four- to eight-cell embryos were collected from genital tracts of slaughtered gilts. Prepuberal donors were synchronized and superovulated by PMSG and hCG, inseminated and eventually slaughtered approximately 78 h after the expected time of ovulation. Genital tracts were flushed either immediately after slaughter (group A) or after 2 h storage at either 37 degrees C (group B) or 20 degrees C). Best results were achieved in group A, followed by group B and, by a wide margin, group C. Differences in viability of embryos became more evident with longer culture times.

Animals↗

Flush perfusion of rabbit kidneys with autogeneic, allogeneic and xenogeneic blood.

A simple perfusion model was developed to study the events that lead to rejection of renal xenografts. Flush perfusion of the kidneys of 24 rabbits was carried out with blood from rabbits, cats, or humans. Light microscopy showed alterations with neutrophilic granulocytes margination of the vessels after only 15 min of perfusion. In the experiments with human blood the immunofluorescence microscopy showed deposits of immunoglobulins and complement factor III. This simple method is therefore a useful way of studying perfusion in renal xenografts.

Animals↗

Mechanical complications of the reservoirs and flushing devices in ventricular shunt systems.

Complications of valve reservoirs or flushing devices are seldom reported as a cause of shunt malfunction. The authors document their experience in six cases of mechanical complications of shunting devices. Two cases presented with collapse and intracranial migration of the valve reservoir, a complication that has not been reported previously. In two cases, the plastic dome became disconnected from the metallic base of the reservoir. A fifth patient, with an integral shunt system, showed a fracture in the soldered join of the distal tube to the reservoir dome. The last patient had the valve reservoir partially collapsed by bone growth at the time of shunt revision.

Cerebrospinal Fluid Shunts↗

Intracellular-type solution flush for preservation of myocardium and coronary and pulmonary artery flow surface.

Modified Euro-Collins solution (ECS), which has been successfully used in kidney, liver and lung transplantation, was tested concerning myocardial and endothelial preservation in nine piglets. In six (group I), 1-hour cardiac arrest was induced with cold modified ECS, and in three (group II) heart-lung transplantation was performed, using modified ECS for graft preservation. In group I myocardial energy preservation was determined with biochemical assays for adenosine triphosphate, creatine phosphate, lactate and creatine 5, 15, 30 and 60 minutes after aortic clamping, and preservation of endothelium in the aorta and coronary arteries was studied with scanning electron microscopy. In group II electron microscopy was performed on endothelial samples from the ascending aorta and coronary and pulmonary arteries of the heart-lung block after excision, after 2 hours of ischemia, and after 1-2 hours of reperfusion. High-energy phosphates decreased progressively during the ECS cardioplegia in group I, and circulatory support was required during the post-transplantation reperfusion period in group II. The endothelial lining in all specimens was remarkably well preserved, however. Modified ECS flush thus was ideal for vascular endothelium but, because of its poor energy-preserving capacity, unsuitable for cardioplegia.

Animals↗

Effect of lactose on calcium absorption from the rat small intestine with a non-flushed ligated loop.

To assess the effect of dietary lactose on the utilization of 40Ca and 45Ca, a one-day balance experiment was carried out. The urinary 45Ca excretion and 45Ca deposition in the femur were significantly higher in the 10% lactose diet group. In the second experiment, non-flushed lower small intestine was ligated in situ and calcium absorption was observed shortly after injecting lactose solution into the loop during the postprandial state. The estimated amounts of 40Ca and 45Ca absorbed and of 45Ca deposited in the femur were increased in the presence of lactose in the test solution. These results suggest that dietary lactose stimulates calcium utilization and also increases calcium absorption from the undisturbed small intestine containing digests.

Animals↗