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PubMed1989

[Relationship between flushing response and drinking behavior].

Shipyard employees and their spouses in Kawasaki were surveyed twice as subjects on the relationship between flushing response and drinking behavior. Data obtained from 1,463 respondents of the two surveys, are used for the analysis. Flushing responses were classified into five types according to the amount of absolute alcohol which induced flushing; fast flushing (FF), medium flushing (MF), slow flushing (SF), no flushing (NF) and unknown. A distribution of the flushing types in males did not show statistical differences among native places and age groups, but among jobs. The distribution in females was not statistically different among native places and jobs, but among age groups. A large number of drinkers who frequently drank belonged to NF and SF. Those who belonged to NF and SF drank every day during the surveyed period (for 1 week). Most of drinkers who drank two kinds and more alcoholic beverages at a chance of drinking belonged to SF and NF. The alcohol consumption during the surveyed period ranged in due to order among males as: FF less than MF less than unknown less than SF less than NF, and among females as: unknown less than FF less than MF less than SF and NF. The results analyzed by "Hayashi's quantification scaling type I" showed that the drinking frequency and the most favorite alcoholic beverage much contributed to the alcohol consumption, but the flushing type didn't so much. However, it made the fact clear that NF contributed to increase alcohol consumption, and unknown and FF did to decrease alcohol consumption.

Adult↗
PubMed2005

Joint chemical flushing of soils contaminated with petroleum hydrocarbons.

How to increase the efficiency of chemical flushing and decrease the remediation expenses of contaminated soils are two key scientific and technological issues to be solved. Joint chemical flushing was tested and compared with the water-flushing. The joint acid-flushing could effectively remove petroleum hydrocarbons in contaminated aquorizem and the dosage of washing powder as a flushing agent was greatly reduced, thereby, saving approximately 1200 US dollars of expenses relative to the water-flushing. The joint salt-flushing could be an optimal method for the cleanup of meadow burozem contaminated with petroleum hydrocarbons under the experimental conditions. Moreover, the amount of surfactant remained in the two washed soils after the joint acid-flushing and the joint-salt-flushing was minimal.

Acetates↗
PubMed1995

Impact of initial flush potassium concentration on the adequacy of lung preservation.

The effects of initial lung flushing with intracellular and extracellular fluid type solutions were studied in lungs stored with the University of Wisconsin solution. Excised Sprague-Dawley rat lungs (n = 39) were flushed first with one of the following solutions: (1) the University of Wisconsin solution (K+ = 140 mmol/L), (2) modified (low potassium) University of Wisconsin solution (K+ = 20 mmol/L), (3) phosphate buffered saline solution (K+ = 3.9 mmol/L), (4) modified low-potassium phosphate-buffered saline solution (K+ = 20 mmol/L), (5) modified high-potassium phosphate-buffered saline solution (K+ = 40 mmol/L), and (6) Euro-Collins solution (K+ = 115 mmol/L) followed by secondary flush with storage solution and cold (4 degrees C) storage in University of Wisconsin solution for 24 hours. The lungs were then reperfused in the isolated, pulsatile, blood-perfused working lung system for 2 hours or until lung failure. Blood gas analysis and shunt fraction, aerodynamic parameters (airway resistance, lung compliance, elastic work, and flow resistive work), and total pulmonary vascular resistance were measured throughout the perfusion period. The mean oxygen tensions (in millimeters of mercury) at 30 minutes after the onset of reperfusion for University of Wisconsin solution, modified University of Wisconsin solution, phosphate-buffered saline solution, modified phosphate-buffered saline solutions (20 and 40 mmol/L), and Euro-Collins solution were 56.1 +/- 4.2, 72.7 +/- 9.1, 87.7 +/- 6.9 (p < 0.01 versus University of Wisconsin solution; p < 0.01 versus Euro-Collins solution), 86.0 +/- 9.6 (p < 0.01 versus University of Wisconsin solution; p < 0.01 versus Euro-Collins solution), 87.9 +/- 7.7 (p < 0.01 versus University of Wisconsin solution; p < 0.01 versus Euro-Collins solution), and 53.5 +/- 6.0, respectively. All aerodynamic parameters in the lungs flushed with extracellular fluid type solutions were superior to those flushed with intracellular fluid type solutions. We conclude that the efficacy of initial flushing was essential for successful lung preservation and that extracellular fluid type solutions were superior to intracellular fluid type solutions, at least for flushing the lung before storage with University of Wisconsin solution. Potassium concentration in flushing solution should be 20 mmol/L or less to obtain appropriate flushing and subsequent adequate distribution of the storage solution.

Adenosine↗
PubMed2000

Hormone replacement therapy for oxidative stress in postmenopausal women with hot flushes.

OBJECTIVE: To assess the association of hot flushes during postmenopause with oxidative stress and to determine whether hormone replacement therapy (HRT) affects the plasma redox status of postmenopausal women. METHODS: We conducted a prospective clinical study of 49 postmenopausal women who have (n = 29) or do not have (n = 20) hot flushes. Twelve of the postmenopausal women with hot flushes and six without were treated with HRT (estradiol patches and medroxyprogesterone acetate) for 4 months. Plasma level of estradiol, total antioxidant status, reduced sulfhydryl groups, lipoperoxides, total cholesterol, and triglycerides were measured at 4-month intervals in both groups, before and after treatment. RESULTS: Postmenopausal women who have hot flushes, had lower total basal antioxidant status in plasma (.9 +/-.01 compared with 1.14 +/-.01 mmol/L), lower concentration of reduced sulfhydryl groups (145 +/- 4 compared with 200 +/- 3 micromol/L), and higher concentration of lipoperoxides (2.88 +/-.04 compared with 2.61 +/-.04 micromol/L) than women without hot flushes. After HRT, total antioxidant status and reduced sulfhydryl groups increased, and lipoperoxides decreased similarly in both groups. Hormone replacement therapy decreased the frequency of hot flushes per day from 11.2 +/- 0.8 to 1.4 +/- 0.3. CONCLUSION: Hot flushes in postmenopausal women were associated with the oxidative process. Hormone replacement therapy decreases oxidative stress and the number of episodes of hot flushes. Because oxidative stress is associated with a high risk for cardiovascular diseases, HRT might protect women with hot flushes.

Antioxidants↗
PubMed1980

A method for measuring the cleaning effect of flushing disinfectors.

A method is presented with which the mechanical cleaning effect of flushing disinfectors can be estimated independently of the thermal disinfecting effect of the hot flushing water. This makes it possible to specify the demands to be placed on the disinfecting effect of flushing with water of 85 degrees C or more. Bacillus stearothermophilus spores suspended in faeces were used as indicators because of their non-sensitivity to the hot-water temperature. Their elimination by flushing could thus be attributed to the mechanical effect of the water and not to the disinfecting effect of the temperature. A simple bacteriological technique was used, and the elimination factor (EF) was calculated as the ratio of the number of micro-organisms in the contamination before and after flushing. By using flushing water below 50 degrees C for 130 s the EF on a bedpan was about 10(4)-10(6). The effect of flushing with water of the same temperature for only half that time was somewhat weaker and when the temperature was raised to 85 degrees C after half the flushing time the effect was somewhat stronger. It can be presumed that the conventional disinfecting phase with hot (85 degrees C) water for about 45 s in the commonly used flushing units could be substantially shortened and the costs of their use thereby reduced.

Disinfection↗
PubMed2003

Efficacy of soyfoods and soybean isoflavone supplements for alleviating menopausal symptoms is positively related to initial hot flush frequency.

Soy has received attention as an alternative to conventional hormone replacement therapy (HRT) largely because it is a unique dietary source of isoflavones. Isoflavones are diphenolic compounds that have both hormonal and nonhormonal properties and are considered to be selective estrogen receptor modulators. The estrogen-like effects of isoflavones in combination with the low reported frequency of hot flushes in Japan has prompted investigation of the effect of soy on menopausal symptoms. The purpose of this review is to evaluate the efficacy of soyfoods and isoflavone supplements for the alleviation of hot flushes. Nineteen trials (13 using a parallel design) involving more than 1,700 women were identified. Six trials were excluded from analysis: two that involved breast cancer patients, two that reported data on severity but not hot flush frequency, one that was not blinded, and one that did not include a control group. Based on a simple regression analysis of the remaining data set (13 trials), there was a statistically significant relationship (P =.01) between initial hot flush frequency and treatment efficacy. Initial hot flush frequency explained about 46% of the treatment effects, and hot flush frequency decreased by about 5% (above placebo or control effects) for every additional initial hot flush per day in women whose initial hot flush frequency was five or more per day. Although conclusions based on this analysis should be considered tentative, the available data justify the recommendation that patients with frequent hot flushes consider trying soyfoods or isoflavone supplements for the alleviation of their symptoms.

Adult↗
PubMed1995

Accentuation of gas exchange gradients in flushes of ponderosa pine exposed to ozone.

Two-year-old ponderosa pine seedlings (Pinus ponderosa Laws.) were exposed to episodic O(3) concentrations in open-top chambers for two consecutive growing seasons (June through September of 1990 and 1991). Near the end of the second season of O(3) exposure, gas exchange was measured on needles of surviving flushes at saturating CO(2) and photosynthetic photon flux density (PPFD). Both photosynthetic capacity (A(sat)) and stomatal conductance to water vapor (g(wv)) declined linearly with needle age but differences within a flush were also found. Gas exchange rates of needles from the base of the current-year flush were significantly lower than those of needles from the top of the flush, even though age differences between needles were negligible. Although most measurements were conducted at saturating CO(2), similar patterns of gas exchange were also found at 350 micro mol mol(-1) CO(2), indicating that photosynthesis of needles at the bottom of the flush was more strongly affected by O(3) than that of needles at the top of the flush, even though the potential for O(3) uptake was probably less in needles at the bottom of the flush because of reduced stomatal conductance. Carboxylation efficiency (deltaA/deltaC(i)), the linear slope of the A/C(i) response, was highly correlated with A(sat), varying with needle age, needle position in the flush and O(3) exposure, but the magnitude of the reductions was greater than for A(sat). We conclude that susceptibility to O(3) damage among needles of an individual seedling varies not only with needle age but also with needle position, and that reductions in photosynthetic capacity may not be directly attributable to increased uptake of the pollutant. The data also indicate the need to consider within-flush variation when estimating whole-plant carbon gain and O(3) uptake.

Journal Article↗
PubMed1990

Lipid peroxidation and ultrastructural changes in rat lung isografts after single-passage organ flush and 48-hour cold storage with and without one-hour reperfusion in vivo.

Rat lung isografts were preserved for 48 hr at 0 degrees C using a simple organ flush technique. After storage alone, isotonic saline flush resulted in significantly raised indices of lipid peroxidation in vitro (Schiff bases and thiobarbituric-acid-reactive material [TBAR]). Lungs flushed with hypertonic citrate (HCA) had significantly less oxidative damage than saline-flushed lungs. The addition to the HCA flush of verapamil, a calcium channel blocker, or desferrioxamine, an iron chelator, significantly reduced TBA reactivity in stored lungs compared with HCA alone. After 1-hr reperfusion in vivo, lipid peroxidation was reduced in HCA-flushed lungs compared with saline flush (TBAR alone), but no additional protection from the use of desferrioxamine or verapamil was demonstrated. Electron microscopy after saline flush and storage alone showed gross endothelial swelling and fragmentation. Reperfusion with blood for 1 hr resolved cell swelling, but alveolar/capillary wall rupture occurred. HCA protected against cell swelling, but endothelial vesiculation and widening of the basement membrane were observed. After reperfusion, HCA-flushed lungs developed much endothelial loss that was considerably reduced by the use of desferrioxamine and verapamil. The lipid peroxidation results suggest that iron- and calcium-mediated free radical production may be important mechanisms in oxidative damage to stored rat lungs. Electron microscopy findings correlated with biochemical evidence of free-radical-mediated injury. Reduction of endothelial loss on reperfusion by the use of verapamil and desferrioxamine provides circumstantial evidence that ischemia and reperfusion damage of organs stored for transplantation is partly due to Fe++(+)- and Ca+(+)-dependent mechanisms that probably involve increased free radical production.

Animals↗
PubMedDate not supplied

Effects of a standardized soy extract on hot flushes: a multicenter, double-blind, randomized, placebo-controlled study.

OBJECTIVE: To investigate the effect of an oral soy isoflavone extract (Phytosoya) on hot flushes in menopausal women. DESIGN: The study was conducted on outpatients according to a multicenter, randomized, double-blind, placebo-controlled, parallel-group design. A total of 75 patients in natural or surgical menopause suffering from at least seven hot flushes per day were randomized to receive during 4 months either soy isoflavone extract (total of 70 mg genistin and daidzin per day) or placebo. RESULTS: There is evidence to suggest that 16 weeks of treatment with soy extract can help reduce the mean number of hot flushes per 24 hours in menopausal women. Withdrawals during this trial made it difficult to obtain an unbiased estimate of the true treatment effect, but numerous sensitivity analyses lend support to the suggestion that taking soy extract can be beneficial in the treatment of hot flushes. In particular, women taking soy extract had a 38% reduction in the mean number of hot flushes by week 4 and a 51% reduction by week 8. By the end of week 16, patients taking soy extract had a 61% reduction in their daily hot flushes versus a 21% reduction obtained with the placebo. "Responders" (defined as patients whose hot flushes were reduced by at least 50% at the end of treatment period) were 65.8% in the soy extract group and 34.2% in the placebo group ( < 0.005). CONCLUSION: Soy isoflavone extract may help to reduce the frequency of hot flushes in climacteric women and provides an attractive addition to the choices available for relief of hot flushes.

Double-Blind Method↗
PubMed2006

Gabapentin, estrogen, and placebo for treating hot flushes: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of gabapentin, estrogen, and placebo in the treatment of hot flushes. METHODS: We performed a randomized, double-blind, placebo-controlled trial of 60 postmenopausal women to assess the efficacy of estrogen and gabapentin in the treatment of moderate-to-severe hot flushes. Participants were randomly assigned to receive either 0.625 mg/d of conjugated estrogens (n = 20), placebo (n = 20), or gabapentin titrated to 2,400 mg/d (n = 20) for 12 weeks. Participants recorded frequency and severity of baseline hot flushes on a hot flush diary for 2 weeks before randomization and for 12 weeks after randomization. The primary outcome measure was the weekly hot flush composite score, which takes into account both severity and frequency of hot flushes. Secondary outcome measures were differences in pre- and posttreatment scores pertaining to depression (Zung Depression Scale) and other climacteric symptoms (Greene Climacteric Scale). RESULTS: Intention-to-treat analysis showed that the reduction in the hot flush composite score for both estrogen (72%, P = .016) and gabapentin (71%, P = .004) was greater than the reduction associated with placebo (54%) at the conclusion of the 12th week. The extent of reduction in hot flush composite score, however, was not significantly different between estrogen and gabapentin (P = .63). No differences were seen between groups in the Zung Depression Scale, or in any of the Greene Climacteric subscales except for the Somatic Symptom cluster, which was significantly greater in the gabapentin arm than in the placebo arm. Despite a lack of group differences in adverse events, the Headache, Dizziness, and Disorientation cluster appeared with greater frequency in the gabapentin group. Estimation of the number needed to harm in this cluster suggests that these symptoms may occur with every fourth patient treated with gabapentin. CONCLUSION: Despite the small scale of this study, gabapentin appears to be as effective as estrogen in the treatment of postmenopausal hot flushes. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT 00276081. LEVEL OF EVIDENCE: I.

Amines↗
PubMed1988

Comparison of rapid in situ, regular in situ, and ex vivo flushing on hepatic function.

The efficacy of three flushing techniques on subsequent liver function was assessed using the in vivo isolated liver perfusion model (ILPM). Livers from brain-dead mongrel dogs were flushed with cold Euro-Collins as follows: Group I, rapid in situ flushing (10 min); Group II, regular in situ flushing (45 min); Group III, ex vivo flushing (10 min). All livers were then heterotopically transplanted into recipients, using the ILPM, by anastomosis of the portal vein, vena cava, and hepatic artery to the recipient's portal vein, iliac vein, and iliac artery. Reperfusion followed for 30 min. Laboratory samples collected at 0, 5, 15, and 30 min showed that hepatic function was not altered by ex vivo flushing and was only slightly altered by rapid in situ flushing. Regular in situ flushing proved to be damaging to livers. Histological analysis confirmed these findings. Therefore, either rapid in situ or ex vivo flushing can be safely used by the transplant specialist.

Adenosine Triphosphate↗
PubMed2005

Lung preservation: pulmonary flush route affects bronchial mucosal temperature and expression of IFN-gamma and Gro in regional lymph nodes.

Optimal lung preservation via flush of the pulmonary vasculature minimizes early graft failure post-lung transplantation. We hypothesized that the route of pulmonary flush has differential effects on thermal gradients in the lung and expression of inflammatory mediators. Swine underwent antegrade flush (AG) via pulmonary artery; AG/RG: antegrade + retrograde flush via pulmonary veins or AG/BA: antegrade + bronchial artery flush via bronchial artery. Temperatures were recorded in bronchial mucosa and peribronchial lymph nodes. RT-PCR was utilized to detect cytokine gene expression in the nodes. AG/BA flush resulted in greatest cooling of bronchial mucosa and lymph nodes (p < 0.001). The route of flush did not affect expression of RANTES, MCP-1, IL-8, IL-1beta, TNF-alpha or IL-6. However, expression of Gro was reduced 4-h post-preservation in all groups. Only AG/BA resulted in decreased IFN-gamma transcripts. These data show that, compared to AG or AG/RG, AG/BA flush results in the greatest cooling of lung compartments and down regulates lymph node expression of a cytokine and chemokine that have key roles in inflammation and immunity. These data suggest that pulmonary flush via AG/BA during donor harvest may be optimal to decrease the risk of early graft failure.

Animals↗
PubMed1999

Metalloproteinases and tissue inhibitor of metalloproteinase 1 (TIMP-1) in endometrial flushings from pre- and post-menopausal women and from women with endometrial adenocarcinoma.

The presence of metalloproteinase activity in endometrial flushings obtained from premenopausal women, during the proliferative and secretory phases of the menstrual cycle, control post-menopausal women and women with post-menopausal bleeding (PMB) with or without adenocarcinoma was analysed by zymography. In addition, quantitative measurements of matrix metalloproteinase 2 (MMP-2), MMP-3, MMP-9 and tissue inhibitor of metalloproteinase 1 (TIMP-1) in the flushings were obtained by ELISA. The zymography results showed eight bands of activity, with molecular weights ranging from 51 to 208 kDa in the flushings from pre-menopausal women and post-menopausal women, particularly those with adenocarcinoma. Both zymography and ELISA showed that MMP-2 and MMP-9 were the major metalloproteinases found in the flushings and only low concentrations of MMP-3 were found. Concentrations of MMP-2 in pre-menopausal women were higher in flushings obtained during the secretory phase of the menstrual cycle than those obtained in the proliferative phase (P < 0.05), suggesting that it may play a role in embryo implantation. Concentrations of MMP-2 (P < 0.001), MMP-9 (P < 0.05) and TIMP-1 (P < 0.001) in the flushings from post-menopausal control women were lower than those from pre-menopausal women. Concentrations of MMP-2 (P < 0.05) and TIMP-1 (P < 0.05) were higher in flushings from women with PMB without carcinoma compared with post-menopausal controls and concentrations of MMP-9 (P < 0.01) and TIMP-1 (P < 0.05) in flushings from women with adenocarcinoma were higher than in post-menopausal controls. Among subjects with PMB, concentrations of MMP-9 in women with adenocarcinoma were higher than those without carcinoma (P < 0.05). Our results show that concentrations of MMP-2, MMP-9 and TIMP-1, but not MMP-3, are associated with endometrial activity and, therefore, may have a role in the breakdown of endometrial tissue. In addition, the increased concentrations of MMP-9 in flushings of women with adenocarcinoma indicate that this particular proteinase is associated with the presence of endometrial neoplastic cells.

Adenocarcinoma↗
PubMed2002

[Changes of plasma serotonin precursor metabolite concentrations in postmenopausal women with hot flushes].

OBJECTIVE: To investigate the relationship between changes of serotonin metabolism and hot flushes in climacteric women. METHODS: Ninety seven climacteric women, aged 40 - 60 were enrolled and divided into 4 groups, group A: early menopausal transition 20 cases, group B: late menopausal transition, 26 cases with skip of periods 3 - 12 months, group C: early postmenopause (1 - 3 years) 28 cases, group D: late postmenopause (> 3 - 6 years) 24 cases. Twelve normal women of reproductive age were served as young controls. Fifty two postmenopausal women were subdivided into 3 groups according to presence or absence of hot flushes. (1) postmenopausal controls without hot flush, 17 cases, (2) mild hot flushes group fewer < or = 5 times/day. (3) severe hot flushes group more than 5 times/day. Plasma concentrations of tryptophan (TP), 5-hydroxytryptophane (5-HTP), 5-hydroxytryptamine (5-HT or serotonin) and 5-hydroxyindoleacetic acid (5-HIAA) were measured in all participants by high pressure liquid chromatography-fluorescence spectrophotometer. Plasma level luteinizing hormone (LH) was measured in postmenopausal women by radioimmuno assay. The relationship between serotonin metabolic parameters and menopause, hot flushes and LH level were analysed. RESULTS: (1) Mean 5-HT and 5-HIAA concentrations in plasma were significantly higher in climacteric women than those in young controls, especially in the group B. Mean 5-HTP and 5-HT levels were higher and 5-HIAA lower in group D as compared with those of young controls. (2) Plasma 5-HT levels was positively correlated to luteinizing hormone concentration in postmenopausal women (P < 0.001). (3) In the mild hot flushes group, only plasma 5-HTP levels was significantly higher than that in the postmenopausal control group. In severe hot flushes group, plasma 5-HT and 5-HTP contents were significantly higher and 5-HIAA/5-HT ratio lower than those in the postmenopausal control groups. CONCLUSION: Our results suggest that the catabolic disorder of serotonin may involve in the underlying mechanism of hot flushes in postmenopausal women.

Adult↗
PubMedDate not supplied

"Flush before fill" in children receiving automated peritoneal dialysis.

OBJECTIVE: To evaluate the impact of the "flush before fill" technique on the frequency of peritonitis in children receiving automated peritoneal dialysis (APD). DESIGN: Randomized prospective multicenter study. SETTING: Participating pediatric dialysis programs of the Pediatric Peritoneal Dialysis Study Consortium. PATIENTS: 121 pediatric (< 21 years of age) patients that had received peritoneal dialysis for > or = 2 months and that were currently receiving APD were randomized to use (flush group) or non-use (no flush group) of the "flush before fill" option. 66 patients were followed for > or = 12 months. MAIN OUTCOME MEASURE: Peritonitis rates. RESULTS: Overall, patients enrolled in the flush group experienced a peritonitis rate of 1 infection every 16.8 patient months; patients in the no flush group experienced a rate of 1 infection every 12.6 patient months (p = 0.193). However, analysis by gender revealed the peritonitis rate of females in the flush group (1 infection every 44.7 patient months) to be significantly better than females in the no flush group (1 infection every 12.4 patient months) (p < or = 0.01). There was no difference noted in the male patients. CONCLUSION: The use of the "flush before fill" option in pediatric patients receiving APD is associated with a marked improvement in the peritonitis rate of female but not male patients. Further study is indicated to explain the gender differences.

Adolescent↗
PubMed2004

Flushing as a side effect following lumbar transforaminal epidural steroid injection.

BACKGROUND: Epidural steroid injections (ESI) are commonly used in managing radicular pain. The risk of complications with epidural steroids is small, with the majority of complications being non-specific. Flushing is a known side effect of corticosteroid administration. The occurrence of flushing after epidural steroids has not been studied prospectively. OBJECTIVE: To compare flushing as a side effect of Betamethasone acetate/Betamethasone sodium phosphate (Celestone) vs. Methylprednisolone (DepoMedrol) in fluoroscopically guided epidural steroid injections. STUDY DESIGN: Non-concurrent Prospective Database Study METHODS: Two-hundred forty patients, who underwent epidural steroid injections in the University of Rochester Spine Center in the year 2001 were included. Eighty-one patients underwent epidural steroid injections with Celestone. One hundred fifty nine patients received treatment with Depo-Medrol. Patients were contacted two days after the procedure by a staff member and specifically asked about the presence of flushing following steroid injection. The answers were recorded as "yes" or "no". RESULTS: Out of 81 patients who underwent ESI with Betamethasone acetate/Betamethasone sodium phosphate, 13 reported a flushing reaction (16%). Out of 159 patients, who underwent ESI with Methylprednisolone, 14 reported a flushing reaction (9%). This side effect difference was not statistically significant (p < 0.143 and odds ratio of 0.505). The overall incidence of flushing was approximately 11%. CONCLUSION: Flushing reaction appears to be more widespread than previously assumed, with an overall incidence of 11%. There was no significant difference in self-reported flushing reactions following lumbar epidural steroid injections using either betamethasone or methylprednisolone.

Journal Article↗
PubMed2006

Update: Delayed onset Pseudomonas fluorescens bloodstream infections after exposure to contaminated heparin flush--Michigan and South Dakota, 2005-2006.

In March 2005, CDC reported a multistate outbreak of Pseudomonas fluorescens bloodstream infections associated with use of syringes preloaded with heparin intravenous catheter flush. The heparin flush became contaminated during preparation by IV Flush, LLC (Rowlett, Texas). Thirty-six patients in four states were identified who had been exposed to the contaminated flush and subsequently experienced P. fluorescens bloodstream infection during December 2004-February 2005. Based on a recommendation by the Food and Drug Administration (FDA), IV Flush voluntarily recalled the preloaded syringes in late January; on January 31 and February 4, 2005, FDA issued nationwide alerts recommending that consumers and institutions stop using and return the preloaded syringes to IV Flush or the distributor (Pinnacle Medical Supply, Rowlett, Texas). Approximately 3 months after the product was recalled, patients in Michigan and South Dakota were identified with P. fluorescens bloodstream infections. As of April 2006, a total of 15 patients in Michigan and 13 in South Dakota had been identified with delayed onset P. fluorescens bloodstream infections, with occurrences ranging from 84 to 421 days after their last potential exposure to the contaminated flush. The patients all had indwelling central venous catheters and received treatment during October 2005-February 2006 at clinics known to have used the contaminated flush. This report describes the investigation of these cases, which determined that these were delayed onset cases of P. fluorescens bloodstream infection from a past exposure to contaminated flush, and provides recommendations for ongoing surveillance for delayed P. fluorescens bloodstream infections among similarly exposed patients.

Anticoagulants↗
PubMed1989

In vitro study of the flush effect in two reusable continuous ambulatory peritoneal dialysis (CAPD) disconnect systems.

Previously published in vitro results, confirmed by clinical studies, indicate that the use of a flush significantly reduces peritonitis in single-use and reusable continuous ambulatory peritoneal dialysis (CAPD) systems. Since reusable systems may use the flush plus inline disinfectant between exchanges, the question remains as to whether or not the flush could be used alone in all disconnect systems. Using an in vitro model, we evaluated the flush in two reusable disconnect systems that use both flush and disinfectant in vivo. In a series of twenty sets per organism per incubation (0 h and 10 h), Y sets were inoculated in the lumen with three pure cultures (10(3) CFU range). Ability of flush without disinfectant to clear sets of contamination was analyzed by collecting multiple samples at each step of the procedure, enriching with tryptone broth and verifying bacterial growth. When contaminated sets were not incubated, flush efficacy of the systems was consistent with previous data showing 100% removal of Staphylococcus epidermidis, but only partial elimination of Staphylococcus aureus and Pseudomonas aeruginosa. After incubation, simulating reusable systems, the flush was able to eliminate S. epidermidis less than 50% of the time. There was no significant difference in results between the two systems tested. Reusable systems allow more contact time between bacteria and plastic resulting in reduced flush efficacy suggesting that, for safest conditions, they should be used with inline disinfectants.

Bacterial Infections↗