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Mixing of two solutions combined by gravity drainage.

A variety of medical therapies require the mixing of solutions from two separate bags before use. One scenario for the mixing is to drain the solution from one bag into the other by gravity through a short connecting tube. The degree of mixing in the lower bag depends on the relative densities of the two solutions, the geometry of the two bags and the connecting tube, and the placement of the connecting tube. Solutions with densities differing by as much as 12% were mixed by draining the solution from an upper bag into a lower bag for a particular geometric configuration. The two solutions had different electrical conductivities, and the conductivity of the combined solution as it exited from the lower bag was used as a measure of the effectiveness of mixing. When the more dense solution was drained from the upper bag into the less dense solution in a lower bag, mixing was very effective. The incoming jet of high density solution entrained the low density solution. Flow visualization indicated that the incoming jet penetrated to the bottom of the lower bag, and resulting large vortical structures enhanced mixing. When the less dense solution was drained from the upper bag into the more dense solution in the lower bag mixing was less effective. The buoyancy force reduced the momentum of the incoming jet such that it did not penetrate to the bottom of the lower bag, resulting in stratification of the solutions.

Drug Compounding↗

Incomplete recovery of working heart function after twenty-four-hour preservation with a modified University of Wisconsin solution.

BACKGROUND AND METHODS: This study was designed to determine the function of isolated rabbit hearts after static preservation with modified University of Wisconsin solution for 24 hours. Commercially available University of Wisconsin solution, modified with CaCl2 1 mmol/L and 2,3-butanedione monoxime 30 mmol/L, was used as the preservative. After flushing the coronary vasculature with medium, hearts were submersion stored at 1 degree C to 4 degrees C. After preservation, isolated heart function at 37 degrees C was quantified for 30 minutes in a non-ejecting mode and for 4 hours ejecting at a physiologic workload. Fresh control hearts (n = 5) and University of Wisconsin solution-preserved hearts (n = 6) were studied. RESULTS: Nonworking (non-ejecting) left ventricular function of the two groups did not differ, except for peak rate of left ventricular pressure development which was higher for the University of Wisconsin solution hearts than for controls. When the hearts were subjected to a physiologic workload, however, left ventricular function of the two groups differed significantly. Three of the six University of Wisconsin solution hearts failed before the 4-hour perfusion end point, whereas all five control hearts maintained stable working function for the full 4 hours. The University of Wisconsin solution hearts, while in the ejecting mode, exhibited significantly impaired function. Mean values were as follows (p < 0.05): left ventricular systolic pressure (in millimeters of mercury), control 105 +/- 1, University of Wisconsin solution 86 +/- 4; peak rate of left ventricular pressure development (in millimeters of mercury per millisecond), control 3.33 +/- 0.11, University of Wisconsin solution 2.39 +/- 0.24; cardiac output (in milliliters per minute per gram), control 400 +/- 25, University of Wisconsin solution 288 +/- 26; stroke work (in milliJoules per gram), control 20.1 +/- 1.3, University of Wisconsin solution 11.9 +/- 1.1; left ventricular end-diastolic pressure (in millimeters of mercury), control 5.4 +/- 0.3, University of Wisconsin solution 10.2 +/- 1.3; peak aortic flow rate (in milliliters per minute), control 946 +/- 9, University of Wisconsin solution 659 +/- 44; millimoles of lactate produced in 30 min/Joule stroke work, control 0.50 +/- 0.06, University of Wisconsin solution 6.99 +/- 0.37. CONCLUSIONS: These results indicate that (1) hypothermic storage in this modified University of Wisconsin solution does not preserve hearts sufficiently to support a physiologic workload for an extended period and (2) assessment of post-preservation function with a non-ejecting heart model does not accurately predict the ability of the preserved heart to support a physiologic workload.

Adenosine↗

Efficacy of ophthalmic solutions to detach adhering Pseudomonas aeruginosa from contact lenses.

PURPOSE: To compare the efficacies of two all-in-one contact lens (CL) cleaning solutions and a detergent mixture on the detachment of a pathogenic bacterium adhering to two types of contact lenses in the absence and presence of a tear film. METHODS: Bacterial-detachment studies were carried out in a parallel-plate flow chamber. Rigid gas permeable (RGP) CLs with and without a tear film were fixed on the bottom plate of the flow chamber. After adhesion of Pseudomonas aeruginosa no. 3, bacterial detachment was stimulated by perfusing the system either with an all-in-one CL-cleaning solution, for soft contact lenses (SCL solution) and for rigid lenses (RCL solution), or with a detergent mixture of 0.25% (wt/vol) sodium lauryl sulfate (SLS) and 0.2% sodium methyl cocoyl taurate (Tauranol). In addition, the all-in-one RCL-cleaning solution supplemented with 0.025% (wt/vol) SLS and 0.02% (wt/vol) Tauranol was evaluated. A surface physical-chemical analysis of the lenses before and after application of the solutions was done to determine whether remnants of the ophthalmic solutions or detergents could be found adsorbed to the CL surfaces. RESULTS: Both all-in-one CL-cleaning solutions stimulated minor bacterial detachment from CL surfaces with or without a tear film. The SLS/Tauranol detergent mixture, however, removed < or = 95% of the adhering P. aeruginosa cells, whereas the RCL-cleaning solution supplemented with detergents also stimulated significant detachment. Surface physical-chemical analysis clearly demonstrated the presence of a tear film on the CL surfaces, but remnants neither of the ophthalmic solutions nor of the detergents could be found. CONCLUSION: Ophthalmic solutions are not effective in stimulating detachment of adhering bacteria from CL surfaces. Supplementing of an all-in-one CL-cleaning solution with only small amounts of detergents yielded a solution much more effective in stimulating bacterial detachment while leaving no detectable remnants of the ophthalmic solution or of the detergents on the CL surfaces.

Bacterial Adhesion↗

Effects of cardioplegic solutions on the vasoreactivity of the internal mammary artery.

BACKGROUND: During free internal mammary artery grafting, cardioplegia administration can be performed through the internal mammary artery. The present study examined whether cardioplegic solutions produce arterial graft constriction and functional endothelial damage. METHODS: Forty internal mammary artery segments from 10 patients were incubated in Krebs solution (n=10), University of Wisconsin solution (n=10), Broussais Hospital solution (n=10), or blood cardioplegia (n=10). RESULTS: There was a significant difference in sensitivity to norepinephrine between segments in Krebs solution and those in University of Wisconsin solution or Broussais Hospital solution but not segments in blood cardioplegia. There was a significant difference in relaxation to acetylcholine between segments in Krebs solution and those in the three other cardioplegic solutions and between those in blood cardioplegia and segments in University of Wisconsin solution or Broussais Hospital solution. There was no significant difference in relaxation to sodium nitroprusside between segments in any of the solutions. CONCLUSIONS: These experiments suggest that storage in the different cardioplegic solutions studied does not preserve the initial vasoreactivity of the internal mammary artery. However, blood cardioplegia appears to be less deleterious in regard to endothelial and myogenic vascular function.

Acetylcholine↗

Effects of storage solutions on in vitro vasoreactivity of radial artery conduits.

OBJECTIVES: Surgical preparation of coronary conduits for coronary artery bypass grafting may affect their early and long-term patency; one mechanism may involve endothelial damage. We investigated the effect of 3 commonly used solutions-Ringer's solution, normal saline solution, and heparinized whole blood-on in vitro endothelial and contractile functions of the human radial artery. METHODS: Radial artery segments were harvested, cut into 3-mm rings, and stored in unoxygenated Ringer's solution, normal saline solution, or heparinized whole blood for 45 minutes. Rings stored in Krebs solution were used as controls. The rings were then mounted and stretched to an optimal resting tension in oxygenated Krebs solution at 37 degrees C. Contraction responses to potassium, norepinephrine, and serotonin and relaxation responses to acetylcholine, verapamil, and nitroprusside were evaluated. RESULTS: Fifty-six radial artery ring segments from 14 patients (n = 7 rings for each contraction-relaxation curve) were studied. Equilibrated resting tension was 9.6 +/- 0.3 mN (5.9 +/- 0.2 g), and resting internal circumference was 6.4 +/- 0.2 mm. Absolute maximum contraction to potassium was significantly less in rings stored in normal saline solution than in rings stored in control solution (10.7 +/- 0.6 g vs 14.5 +/- 0.6 g, P <.01; 95% confidence intervals, 0.9-6.9). There was no difference in the contraction to norepinephrine (P =.11) and serotonin (P =.25) among the 3 solutions compared with the control solution. Rings stored in heparinized whole blood had significantly greater endothelium-dependent relaxation to acetylcholine (P <.007), whereas those stored in normal saline solution had reduced responses. Endothelium-independent relaxation to verapamil and nitroprusside were similar among the 3 solutions. CONCLUSION: Heparinized whole blood is a better physiologic medium for preservation of radial artery endothelial and contractile functions during storage before grafting.

Acetylcholine↗

Kidney preservation with the UW and Euro-Collins solutions. A preliminary report of a clinical comparison.

This is a preliminary report of a European Multicenter Trial of the efficacy and safety of the UW solution in kidney preservation. The results obtained with the UW solution are compared with those obtained with Euro-Collins solution in a prospectively randomized study. To date 257 patients have been evaluated, with 128 receiving kidneys preserved in UW solutions and 129 receiving kidneys preserved in Euro-Collins solutions. Demographic characteristics of donors and recipients were identical in both groups. Median (and range) preservation times were similar (24 hr in EC and 24 hr in UW). Maximum preservation time in each group was about 48 hr. The results show that the UW solution is a safe preservation solution for kidneys, with postoperative renal functions, at least, equivalent to those seen in patients transplanted with kidneys preserved in EC solution. In this preliminary analysis of 257 kidneys, use of the UW solution resulted in a more rapid reduction in postoperative serum creatinine, higher creatinine clearance rate, and less postoperative dialysis (21% vs. 31%) when compared with kidneys preserved in EC solution. This study indicates that the UW solution is an effective preservation medium for clinical kidney transplantation. It supports the use of UW solution as a general flushout and cold storage solution for all intraabdominal organs used for transplantation.

Adenosine↗

Rise in the pH of an unfrozen solution in ice due to the presence of NaCl and promotion of decomposition of gallic acids owing to a change in the pH.

Oxidative decomposition of gallic acid occurs in alkaline solutions but hardly arises in acidic solutions. We have found that the addition of sodium chloride promotes the decomposition of gallic acid caused by freezing even under neutral and acidic conditions. Even at pH 4.5, gallic acid was decomposed by freezing in the presence of NaCl; however, in the absence of NaCl, it was hardly decomposed by freezing at pH lower than 7. Chloride ions are more easily incorporated in ice than sodium ions when the NaCl solution is frozen. The unfrozen solution in ice becomes positively charged, and as a result, protons transfer from the unfrozen solution to the ice. We measured the pH in the unfrozen solution which coexists with single-crystal ice formed from a 5 mmol dm(-3) NaCl solution and determined the pH to be 8.6 at equilibrium with CO(2) of 380 ppm or 11.3 in the absence of CO(2) compared to pH 5.6 in the original solution. From the model calculation performed for gallic acid solution in the presence of 5 mmol dm(-3) NaCl, it can be estimated that the amount of OH(-) transferred from the ice to the solution corresponds to 1.26 x 10(-5) mol dm(-3). The amount of OH(-) transferred is concentrated into the unfrozen solution and affects the pH of the unfrozen solution. Therefore, the pH in an unfrozen gallic acid solution in ice becomes alkaline, and the decomposition of gallic acid proceeds. It is expected that other base-catalyzed reactions in weakly acidic solutions also proceed by freezing in the presence of NaCl without the need for any alkaline reagents.

Journal Article↗

Chemical parameters, antimicrobial activities, and tissue toxicity of 0.1 and 0.5% sodium hypochlorite solutions.

ffe chemical parameters, antimicrobial activity, and tissue toxicity of two sodium hypochlorite (NaOCl) solutions buffered to a physiologic pH were studied. Initially, a 0.5% NaOCl solution buffered with 3 g of NaH2PO4 per liter was examined. The solution had a pH of 7.49 and an osmolality of 352 mOsmol/liter. When compared with unbuffered and NaHCO3-buffered 0.5% NaOCl solutions, the NaH2PO4-buffered solution was significantly more effective in killing Staphylococcus aureus in vitro. However, the pH of the NaH2PO4-buffered solution decreased over time with a concomitant decrease in antibacterial activity. A freshly prepared solution decontaminated human cadaveric skin colonized by S. aureus, Pseudomonas aeruginosa, or Candida albicans in vitro within 10 min of exposure, whereas a 24-h-old solution cleared the skin of organisms within 15 min. When gauze soaked with 0.5% NaOCl was applied to guinea pig skin for 2 weeks, a 15% decrease in basal cell viabilities was noted. Because of the pH instability and basal cell toxicity, a 0.1% NaOCl solution buffered with NaH2PO4-Na2HPO4 was evaluated. This solution had an osmolality of 386 mOsmol/liter and a pH of 7.4 that was stable over 1 week. A freshly prepared 0.1% NaOCl solution decontaminated skin colonized with S. aureus, C. albicans, and P. aeruginosa within 10, 20, and 30 min, respectively. A 24-h-old solution did not completely decontaminate the colonized skin but significantly reduced the number of microorganisms on the skin surface (P less than 0.001). Application of this solution of guinea pig skin for 2 weeks produced no significant effect on basal cell viabilities. These solutions may serve as alternative topical agents for use in burn therapy.

Animals↗

A systematic review of the effectiveness of ofloxaxin otic solution for the treatment of suppurative otitis media.

The objectives of the study were to determine the effectiveness and incidence of adverse events of ofloxacin otic solution for suppurative otitis media compared with other treatments. All randomized controlled trials and nonrandomized comparative clinical trials published from 1966 to 2000 using ofloxacin otic solution as one of the interventions were reviewed and data were extracted and analyzed. Eleven clinical trials (9 randomized and 2 nonrandomized) enrolling 1,484 adults and children were finally included in the analysis. Five studies employed clear concealment procedure in the allocation of treatment whereas evaluation of outcome was at least single-blinded in 6 trials. The probability of overall cure rate was higher with 0.3% ofloxacin otic solution than with other topical or systemic antibiotics in 9 of the studies analyzed (OR = 2.67; 95% CI = 2.04, 3.50). Resolution of secondary outcome parameters evaluated at least 1 week after treatment was higher with 0.3% ofloxacin otic solution: resolution of otalgia (4 trials; OR = 2.41; 95% CI = 1.2, 4.82); resolution of otorrhea (11 trials; OR = 2.78; 95% CI = 2.12, 3.65), and bacterial eradication rate (6 trials; OR = 3.86; 95% CI = 2.54, 5.87). A subgroup analysis of 4 studies comparing ofloxacin otic solution with antibiotic- and steroid-containing otic solution showed a higher cure rate for ofloxacin otic solution (OR = 2.73; 95% CI = 1.52, 4.90). Another subgroup analysis on 3 studies comparing ofloxacin otic solution with oral systemic antibiotics showed higher resolution of otorrhea with ofloxacin otic solution (OR = 2.78; 95% CI = 2.12, 3.65). Of 4 studies with data on adverse events, the probability of adverse events was lower with ofloxacin otic solution than with other topical antibiotics (OR = 0.28; 95% CI = 0.19, 0.42). Subgroup analysis showed that 0.3% ofloxacin otic solution showed better results in terms of overall cure rate, resolution of otorrhea, otalgia, bacterial eradication rate and incidence of adverse events. Whether due to chronic suppurative otitis media (CSOM) or draining tympanostomy tube, the overall cure rate (CSOM OR = 4.86; with tympanostomy tube OR = 2.13) and resolution of otorrhea (CSOM OR = 4.42; with tympanostomy tube OR = 1.66) were likewise in favor of 0.3% ofloxacin otic solution. The studies included in this meta-analysis showed generally homogenous results in all clinical and laboratory outcomes analyzed, except for the evaluation of adverse events. The authors conclude that 0.3% ofloxacin otic solution is better than other otic antibiotic drops and other oral antibiotics in terms of overall cure rate and resolution of secondary outcome parameters. Estimates on the beneficial effects of ofloxacin otic solution are limited to the period of study included in this review.

Anti-Infective Agents↗

Contribution of multivitamins, air, and light in the generation of peroxides in adult and neonatal parenteral nutrition solutions.

OBJECTIVE: To compare the concentrations of peroxides between adult and neonatal total parenteral nutrition (TPN) solutions in response to protection against inducers of peroxidation such as multivitamins and exposure to light or air. METHODS: Peroxide concentrations were measured in freshly prepared adult and neonatal solutions of fat-free TPN in four settings: with or without an air inlet, and protected or unprotected from ambient light. An oxygen washout was performed by exposing a fat-free neonatal TPN solution to a continuous flow of nitrogen. RESULTS: Globally, light was the main inducer of peroxides in adult and neonatal solutions. However, in adult solutions the concentration of peroxides remained <15 micromol/L, while in neonatal solutions the peroxide concentration was as high as 300 micromol/L in ambient light. Although the oxygen washout did prevent the generation of peroxides, avoiding air inlet was not as effective as was photoprotection in decreasing the important peroxide load in the neonatal TPN solution. CONCLUSIONS: The higher concentration of peroxides found in neonatal solutions compared with adult solutions is explained by the differences in nutrient composition between the two solutions. Contamination of parenteral solutions by air during compounding accounts for the photoinduced generation of peroxides in TPN solutions. It is more convenient to protect TPN solutions from light exposure after the admixture of the multivitamin solution than to avoid contact with oxygen.

Adult↗

Effect of a topical diclofenac solution for relieving symptoms of primary osteoarthritis of the knee: a randomized controlled trial.

BACKGROUND: Treatment of osteoarthritis with oral NSAID therapy provides pain relief but carries a substantial risk of adverse effects. Topical NSAID therapy offers an alternative to oral treatment, with the potential for a reduced risk of side effects. The objective of this trial was to assess the safety and efficacy of a topical diclofenac solution in relieving the symptoms of primary osteoarthritis of the knee. METHODS: We identified 248 men and women from southern Ontario with primary osteoarthritis of the knee and at least moderate pain. The patients were randomly assigned to apply 1 of 3 solutions to their painful knee for 4 weeks: a topical diclofenac solution (1.5% wt/wt diclofenac sodium in a carrier containing dimethyl sulfoxide [DMSO]); a vehicle-control solution (the carrier containing DMSO but no diclofenac); and a placebo solution (a modified carrier with a token amount of DMSO for blinding purposes but no diclofenac). The primary efficacy end point was pain relief, measured by the Western Ontario and McMaster Universities (WOMAC) LK3.0 Osteoarthritis Index pain subscale. Secondary end points were improved physical function and reduced stiffness (measured by the WOMAC subscales), reduced pain on walking and patient global assessment (PGA). Safety was evaluated with clinical and laboratory assessments. RESULTS: In the intent-to-treat group the mean change (and 95% confidence interval [CI]) in pain score from baseline to final assessment was significantly greater for the patients who applied the topical diclofenac solution (-3.9 [- 4.8 to -2.9]) than for those who applied the vehicle-control solution (-2.5 [- 3.3 to -1.7]; p = 0.023) or the placebo solution (-2.5 [-3.3 to -1.7]; p = 0.016). For the secondary variables the topical diclofenac solution also revealed superiority to the vehicle-control and placebo solutions, leading to mean changes (and 95% CIs) of -11.6 (-14.7 to -8.4; p = 0.002 and 0.014, respectively) in physical function, -1.5 (-1.9 to -1.1; p = 0.015 and 0.002, respectively) in stiffness and -0.8 (-1.1 to -0.6; p = 0.003 and 0.015, respectively) in pain on walking. The PGA scores were significantly better for the patients who applied the topical diclofenac solution than for those who applied the other 2 solutions (p = 0.039 and 0.025, respectively). The topical diclofenac solution caused some skin irritation, mostly minor local skin dryness, in 30 (36%) of the 84 patients, but this led to discontinuation of treatment in only 5 (6%) of the cases. The incidence of gastrointestinal events did not differ between the treatment groups. No serious gastrointestinal or renal adverse events were reported or detected by means of laboratory testing. INTERPRETATION: This topical diclofenac solution can provide safe, site-specific treatment for osteoarthritic pain, with only minor local skin irritation and minimal systemic side effects.

Administration, Topical↗

Tissue damage of different submucosal injection solutions for EMR.

BACKGROUND: When choosing submucosal injection solutions for EMR, tissue damage should be considered, as well as the lesion-lifting ability. The objective of the study was to find out the potential tissue damage of submucosal injection solutions. METHODS: The submucosal injection solutions examined were the following: normal saline solution (NS), 3.75% NaCl, 20% and 50% dextrose water (DW), a glycerin solution (Glyceol; 10% glycerin with 0.9% NaCl plus 5% fructose), and two hyaluronic acid (HA) solutions (0.25% 1900 kDa/NS solution and 0.125% 1900 kDa/ Glyceol solution). Furthermore, DW with different concentrations (5%, 10%, 15%, 30%, 40%) also was examined to find out the tolerable concentration without tissue damage. A total of 2 mL of each solution per stomach were injected by endoscopy into the submucosal layer at the separate sites of 4 living minipigs. Two minipigs were euthanized after 30 minutes of endoscopic observations, and the others were euthanized after additional endoscopic observations a week after injection. RESULTS: There was no apparent tissue damage in NS, 5% and 10% DW, Glyceol, or two solutions of HA, whereas, hypertonic solutions, except Glyceol and 10% DW, have more or less potency of tissue damage. In 3.75% NaCl and DW with concentrations of >or=20%, considerable tissue damage was observed, which might affect resected EMR specimens and ulcer healing. CONCLUSIONS: Use of hypertonic solutions except Glyceol is not recommended with respect to tissue damage. A combination of HA and Glyceol is the most favorable submucosal injection solution, considering tissue damage and lesion-lifting ability.

Animals↗

Comparison of the protective properties of four clinical crystalloid cardioplegic solutions in the rat heart.

Although few surgeons dispute the benefits of high-potassium crystalloid cardioplegia, objective comparison of the efficacy of various formulations is difficult in clinical practice. We compared four commonly used cardioplegic solutions in the isolated rat heart (N = 6 for each solution) subjected to 180 minutes of hypothermic (20 degrees C) ischemic arrest with multidose cardioplegia (3 minutes every half-hour). The clinical solutions studied were St. Thomas' Hospital solution, Tyers' solution, lactated Ringer's solution with added potassium, and a balanced saline solution with glucose and potassium. Postischemic recovery of function was expressed as a percentage of preischemic control values. Release of creatine kinase during reperfusion was measured as an additional index of protection. St. Thomas' Hospital solution provided almost complete recovery of all indexes of cardiac function following ischemia including 88.1 +/- 1.6% recovery of aortic flow, compared with poor recovery for the Tyers', lactated Ringer's, and balanced saline solutions (20.6 +/- 6.5%, 12.5 +/- 6.4%, and 9.6 +/- 4.2%, respectively) (p less than 0.001). Spontaneous defibrillation was rapid (less than 1 minute) and complete (100%) in all hearts in the St. Thomas' Hospital solution group, but much less satisfactory with the other formulations. Finally, St. Thomas' Hospital solution had a low postischemic level of creatine kinase leakage, contrasting with significantly higher enzyme release in the other solutions tested (p less than 0.001). Although differences in composition are subtle, all potassium crystalloid cardioplegic solutions are not alike in the myocardial protection they provide. Comparative studies under controlled conditions are important to define which formulation is superior for clinical application.

Animals↗

Preservation of bladder tissue in different solutions for varying times.

OBJECTIVES: To evaluate three popular storage media and the effect of 24-hour cold storage on bladder tissue. METHODS: Guinea pig bladders were stored in three solutions: UW solution (a media used for transplant organs), Reznikoff solution [cell culture medium], and Krebs' solution with and without aeration. RESULTS: Cell potassium and sodium concentrations and total tissue water (a measurement of cell swelling) are important parameters for evaluating tissue damage. Reznikoff solution and Krebs' solution without gases maintained tissues for 24 hours with the least tissue damage; these solutions require no special equipment or attention. Twenty-four hour uniterrupted aeration of Krebs' solution caused the greatest degree of cell swelling with possible redistribution of receptors and required adjustment and regulation of the preservation apparatus. UW solution induced dehydration of cells, required the longest recovery period after cold storage, and is far more expensive than the other solutions. CONCLUSIONS: Reznikoff solution caused consistent relative changes in smooth muscle receptors and was superior to aerated Krebs' and UW solutions for 24-hour bladder tissue storage. It is unnecessary to aerate Krebs' solution during 24-hour cold storage.

Adenosine↗

Pharmacological study of BRS, a new bicarbonated Ringer's solution, in partially hepatectomized rabbits.

BACKGROUND AND OBJECTIVE: The effects of bicarbonated Ringer's solution were evaluated and compared with those of acetated Ringer's, lactated Ringer's and Ringer's solutions in partially hepatectomized rabbits. METHOD: Animals were randomly divided into six groups (n = 6 in each group): a sham-operated group, an operated group without infusion, and four operated groups with infusions of each of the four Ringer's solutions. Each Ringer's solution was intravenously administered at 40 mL kg(-1) h(-1) for 1.5 h. Arterial blood gases, plasma magnesium concentrations and cardiovascular parameters were analysed. RESULTS: The partial hepatectomy-induced decrement of base excess was inhibited by bicarbonated Ringer's solution more remarkably than by either lactated or plain solutions (P < 0.01). The alkalinizing effect of bicarbonated Ringer's solution tended to be more marked than that of the acetated solution but not significantly so. Plasma magnesium concentrations were well maintained by bicarbonated solution as compared to the other solutions (P < 0.01). CONCLUSIONS: These results suggest that bicarbonated Ringer's solution is the most suitable perioperative solution for metabolic acidosis and plasma electrolyte balance among the Ringer's solutions tested.

Acidosis↗

Preservation of dog liver, kidney, and pancreas using the Belzer-UW solution with a high-sodium and low-potassium content.

The UW solution developed for cold storage of the liver, pancreas, and kidney was used in a modified form in this study and tested in the orthotopic transplantation of dog livers, kidneys, and pancreases preserved for 48 hr. The modification was the alteration of the concentrations of potassium and sodium. The original UW solution contained 120 mM K+ and 30 mM Na+. In this study the Na+ was 140 mM and the K+ only 9 mM, all other agents were identical to the original UW solution. Six of 11 dogs survived with livers preserved for 48 hr. The five deaths were due to technical complications and unrelated to preservation failure. Postoperative AST and partial thromboplastin time (PTT) values were lower (statistically significant on days 1, 3, and 4) in livers preserved in the high Na+ UW solution than as previously shown in the high-k+ UW solution. Other measures of liver function (bilirubin and fibrinogen) were similar between the high-Na+ and high-K+ groups. Six dogs survived with kidneys preserved for 48 hr in the high-Na+ UW solution. The results were comparable to those obtained with the high K+ solution. Four of six dogs survived for up to 28 days with pancreases preserved for 48 hr. The two deaths were due to technical complications unrelated to preservation failure. Three of the four dogs had normal blood glucose values for one month, and intravenous glucose tolerances test on day 7 and 28 were identical to those obtained in pancreases preserved with the high-K+ UW solution. The high-Na+ version of the UW solution appears equally or slightly more effective for 48-hr organ preservation than the original high-K+ UW solution. The use of a high-Na+ UW solution reduces the problems of hyperkalemic cardiac arrest in in situ flushing of the donor for multiple organ harvesting and in transplantation of the liver. Thus, with this solution livers do not need to be flushed with a low K+-containing solution prior to transplantation.

Animals↗

24-hour rat liver preservation using UW solution and some simplified variants.

The results of a series of 32 rat liver transplants are described to analyze the efficacy of components of UW solution. Rat livers were stored at 4 degrees C in standard UW solution or one of three simplified variants for 24 hr prior to orthotopic liver transplantation. In standard UW solution (solution A) the one-week survival rate was 3 of 8. Using solution B, which differs from solution A in the omission of hydroxyethyl starch and adenosine, the one-week survival rate was 2 of 8. Solution C, a further-simplified version of solution B with omission of allopurinol, Bactrim, and insulin, gave a one-week survival rate of 3 of 8. Solution D is identical to solution B except that the sodium and potassium concentrations are reversed. Using this solution, 5 of 8 rats survived more than one week. We conclude that the effectiveness of UW solution is maintained in a substantially simplified form, and that solution D, with the Na/K ratio reversed to give a high Na variant, may improve survival.

Adenosine↗

Functional and morphological assessment of rat aorta stored in University of Wisconsin and Eurocollins solutions.

University of Wisconsin (UW) and Eurocollins (EC) solutions are widely used for preservation of organs before transplantation. However, effect of storage solutions on vascular interface for transplant success is not known. In this study, we have used rat aorta as a model and assessed the effects of cold storage in UW and EC solutions on smooth muscle and endothelial function and the morphology. Smooth muscle and endothelial functions of the rat aorta were assessed using in vitro isometric tension measurement. Morphologic studies were done with scanning and transmission electron microscopy. No significant difference in contractile response to either norepinephrine (NE) or potassium chloride was observed between control aorta and aorta stored in UW solution for 1 hr or 24 hr. In contrast, sensitivity, but not the reactivity to NE and KCl, was increased in aorta stored in EC solution for 1 hr. If the tissues were stored in EC solution for 24 hr, both sensitivity and reactivity to NE and KCl were significantly reduced. Relaxatory response to acetylcholine, in endothelium-intact vessels were reduced in aortas stored in EC solution, but not in UW solution. The magnitude of relaxations observed in tissues stored in the EC solution for 24 hr was less than in tissues stored for 1 hr. Sodium nitroprusside elicited similar relaxatory response in endothelium-denuded control tissue and in tissues stored in UW and EC solution. Electron microscopy data revealed marked swelling of the cell, loss of mitochondria and other intracellular organelles, and striking calcium deposits after preservation of the vessels in EC for 1 or 24 hr. In aorta stored in UW solution for 24 hr, endothelial and smooth muscle cells were intact, with moderate-size vacuoles in the cytoplasm. These results suggest that the UW solution is more suitable than EC solution for short-term preoperative storage of blood vessels.

Acetylcholine↗