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At least 991 records · Page 55Linked to original sources
PubMed1988

Pancreatic abscess: results of prolonged irrigation of the pancreatic bed after surgery.

The mortality from pancreatic abscess may approach 70 per cent and the survivors often require repeated operations to debride the pancreas and to drain recurrent abscesses. We report the results of prolonged irrigation of the pancreatic bed after surgical débridement in 11 patients. Surgery was performed at an average of 17 days (range 8-25 days) after the onset of symptoms. The pancreatic slough was thoroughly debrided and 2-6 large drains were placed in the pancreatic bed. Irrigation with saline or Diaflex solution (2-6 l/day) was started after 2 days and continued for a mean of 25 days (range 5-54 days). There were three deaths (27.3 per cent) after surgery: one of these patients required reoperation and packing for massive postoperative haemorrhage and all three had some evidence of persisting sepsis at autopsy. Prolonged irrigation of the pancreatic bed after surgical débridement may reduce mortality and the need for repeated drainage procedures in patients with pancreatic abscess, but the detection and treatment of persisting sepsis remains the major problem.

Abscess↗
PubMed2001

The effect of irrigation on peak temperatures in nerve root, dura, and intervertebral disc during laser-assisted foraminoplasty.

BACKGROUND AND OBJECTIVE: The Holmium: YAG (Ho: YAG) laser has been used for the ablation of prolapsed discs but alternative techniques are available, and this application remains controversial. It also has potential for the decompression of nerve roots within narrowed foraminae with the technique of endoscopic laser foraminoplasty. Traditional methods of decompression necessitate a major surgical procedure with potential destabilisation of the lumbar spinal segment. Nevertheless, minimally invasive techniques are attractive only if serious complications can be avoided. This study reports the peak temperatures reached in surrounding tissues with and without saline irrigation. STUDY DESIGN/MATERIALS AND METHODS: Investigation of the hypothesis was carried out in excised sheep lumbar spines. T-type thermocouples were used for the measurement of tissue temperatures during laser ablation of nerve root foraminae. The temperature was assessed in the nerve root, dura mater, and disc space. RESULTS: The Ho: YAG laser was effective in widening the foraminae by approximately 1.5 mm with a total energy of 4.60 kJ. This was statistically significant in both vertical and horizontal directions (P < 0.0003 and P < 0.00005, respectively). The mean temperature of the nerve root, dura, and disc space during the procedure was 44 +/- 3.1 degrees C, 42.8 +/- 4.7 degrees C, and 41 +/- 3.4 degrees C respectively. There were transient high peaks seen in the temperature profiles. Using saline irrigation at 27 ml/minutes these temperatures were reduced to 34.1 +/- 1.8 degrees C (P = 0.0002), 34.9 +/- 1.5 degrees C (P = 0.002), and 37.2 +/- 1.2 degrees C (P < 0.014), for nerve roots, dura, and disc space respectively. CONCLUSIONS: Laser ablation of bone and ligament for nerve root decompression using the Ho: YAG laser may offer substantial advantages, but the risk of serious complication may only be avoided if the technique is combined with saline irrigation.

Animals↗
PubMed1992

A special irrigation liquid to increase the reliability of laser-induced shockwave lithotripsy.

For the laser-induced shockwave lithotripsy (LISL) the laser-pulses of a Q-switched Nd:YAG laser produce an optical breakdown in the irrigation liquid surrounding the urinary stone. Subsequently high-pressure shockwaves are emitted causing stone fragmentation. Since the LISL is an endoscopic technique, problems arise from the transmission of the laser pulses through optical fibers. The intensity threshold for an optical breakdown in commonly used saline solution amounts to 21 GW/cm2, in optical silica fibers, to about 3 GW/cm2. Therefore bare fibers cannot be used without being destroyed by a breakdown. So we have developed an irrigation liquid by adding small quantities of metal ions to saline solution to lower the threshold intensity. The most suitable ion was Fe3+ in a concentration of 0.02 mmol/l, which shows a lowering to 5 GW/cm2. In combination with a spherically shaped fiber exit the intensities that have to be transmitted are below the threshold of the fiber material. Using this irrigation liquid the overall reliability of the method could be significantly increased and several stone fragmentations can be performed with a single optical fiber.

Evaluation Studies as Topic↗
PubMed1988

Management of chronic osteomyelitis using an irrigation suction technique.

Fifty cases of chronic osteomyelitis were treated by closed, continuous, suction and irrigation and followed up for between six months and eight years. In group A, 25 cases were treated by irrigation with antibiotics, and in group B, 25 cases were treated by irrigation with Bitadine solution, irrespective of the culture and sensitivity reports. Appropriate antibiotics were given systemically. There was no notable difference in the results in the two groups, with an overall success rate of about 80%.

Adolescent↗
PubMed1982

Exposure of the cat brain surface to neurosurgical irrigation fluids, hydrogen peroxide and air. Quantitative assay of blood-brain barrier dysfunction.

The effect of different irrigation fluids used in neurosurgery and of cortical exposure to air or hydrogen peroxides on the cat brain surface was tested by quantitative assay of extravasated albumen in the cortex and the white matter. Ringer's solution and Elliott's solution B induced no major blood-brain barrier (BBB) dysfunction after closed subdural perfusion for 3 hours. Normal saline induced slight BBB dysfunction extending throughout the cortex into the white matter after the same time of exposure. When these three solutions were applied to the brain surface via pledgets during exposure for 3 hours no further damage was induced. If 15 minutes exposure to air preceded the open perfusion via pledgets with Ringer's solution or Elliott's solution B for 2 hours and 45 minutes, no significant cortical BBB dysfunction was induced. There was a manifold increase in BBB dysfunction after perfusion with Ringer's solution or Elliott's solution B for 2 hours and 45 minutes followed by exposure to three per cent hydrogen peroxide for 5 minutes and a further 10 minutes perfusion with the previous irrigation fluid. Thus, normal saline was found unsuitable for neurosurgical irrigation purposes, due to disturbance of the BBB. Ringer's solution and Elliott's solution B protected the brain adequately even if only applied in pledgets. A short period of exposure to air had no effect on the BBB in the cortex, whilst exposure to hydrogen peroxide was detrimental to the BBB.

Animals↗
PubMed1976

Microbiological studies on some bladder irrigation fluids.

A 1.5% glycine solution has recently been introduced as a bladder irrigation fluid. In this study, glycine solution was compared with two other recognised bladder irrigants (chlorhexidine and noxythiolin) for its inhibitory activity against common urinary tract pathogens. Glycine solution supported the growth of nearly 50% of the bacterial strains tested whereas chlorhexidine and noxythiolin were completely inhibitory. In quantitative studies with selected strains it was found that growth could be initiated from as few as 200 organisms/ml. It was concluded that glycine solution was capable of supporting bacterial growth and thus, from a microbiological viewpoint, was unsuitable as a bladder irrigant.

Bacteria↗
PubMed1989

The use of an alum irrigation in the treatment of massive bladder haemorrhage.

Severe, massive bladder haemorrhage is a difficult and often frustrating clinical problem. The aetiologies are numerous and include irradiation, malignancy, severe infection and drug-induced changes. Among the numerous modalities of treatment that have been reported formalin, phenol and silver nitrate instillations have often been associated with significant side effects, morbidity and mortality and have had varying degrees of success. During the last two years we have used continuous closed irrigation of a sterile 0.5% alum solution in 16 patients. Alum is an astringent and acts by protein precipitation over the bleeding surface. Because of a low cell permeability its action is limited to the cell surface and interstitial spaces. The permeability of the cell membrane is reduced but remains viable. The preparation and the pharmaceutical aspects of the 0.5% alum irrigation will be discussed. The conclusion is that the technique of managing massive bladder haemorrhage is simple, efficient, nontoxic and less expensive than previously reported therapies. Therefore, irrigation with alum before instituting invasive means to control bleeding is recommended.

Aged↗
PubMed1992

Safety of saline irrigation for angioscopy: results of a prospective randomized trial.

This study evaluates the hemodynamic effects and safety of saline irrigation necessary to obtain high-quality completion angioscopic studies, as compared with standard completion arteriography during infrainguinal bypass grafting. One-hundred ten patients undergoing primary infrainguinal bypass grafting, were prospectively randomized to either arteriography (N = 50) or angioscopy (N = 60) for a completion study to monitor the bypass procedure. All patients were hemodynamically monitored with pulmonary artery catheters and arterial lines. The arteriography group received an average of 27 ml (range 8-60 ml) of contrast per completion study, with a total administered intraoperative fluid volume of 2095 ml (range 650-4000 ml). The angioscopy group received an average bolus of 321 ml (range 90-650 ml) of irrigation fluid per completion angioscopy study, with a total administered intraoperative fluid volume of 2140 ml (range 850-5000 ml). Transient increases in pulmonary artery systolic and diastolic pressures and central venous pressures were measured during angioscopy. Although these changes reached statistical significance, the changes were of minimal clinical relevance, 1.9 (= 4.5), 1.6 (= 3.0) and 1.4 (= 2.3) mmHg respectively, and returned to baseline levels within 30 minutes. Intraoperative intervention with vasodilators and diuretics, the perioperative cardiac morbidity, and less than 30 day mortality, was not different between the two groups. Pressures generated within 24 bypass grafts were within physiologic arterial range for most of the study. With careful angioscopic technique applied and high quality care extended to the patient, irrigation with saline solution is simple, effective and safe.

Angiography↗
PubMed1991

Postoperative irrigation-suction drainage after pelvic colonic surgery. A prospective randomized trial.

A 2-year randomized prospective clinical trial was undertaken to determine whether postoperative irrigation of the pelvis would result in a decreased incidence of local septic complications. Two hundred consecutive patients undergoing low pelvic procedures with rectal resection and entry of the presacral space by a single surgeon, were randomized. In the irrigation group, two of four presacral sump drains were placed to low intermittent suction and the remaining sumps infused continuously with saline until the effluent was clear. In the drainage alone group, all four presacral sump drains were placed to suction. Drains were removed when drainage was less than 50 ml/24 hours. Perioperative antibiotics and bowel preparation were identical. Postoperative complications included pelvic abscess (n = 7), anastomotic leak/cuff sinus (n = 11), abdominal wound infection (n = 19), and perineal wound infection (n = 5). Postoperative irrigation of the pelvis did not result in a reduction in the overall rate of local pelvic septic complications. Positive intraoperative presacral cultures, the presence of anaerobes in the presacral space, and duration of pelvic drainage had no effect on the development of pelvic sepsis.

Abscess↗
PubMed1998

Appendicostomy irrigation for facilitating colonic evacuation in colostomy patients. Preliminary report.

A method for bowel irrigation through an appendicostomy (antegrade colonic enema) for patients with a left colostomy is described. The appendicostomy is easily constructed without morbidity. Irrigation through the appendicostomy is performed with minimum equipment, uses a small volume of irrigation water, and takes a relatively short time. This may improve colonic evacuation in patients with left colostomy.

Appendix↗
PubMed1998

A new ancient irrigation therapy for childhood renal candidiasis.

Methylene blue (MB) alone, MB metabolites in the urine and the effect of MB plus alkalization on Candida species were determined. MB was used for the treatment of childhood renal candidiasis (CRC) in 3 patients as an irrigating solution. Besides irrigation, fluconazole 3 mg/kg/day intravenously and MB 0.2 mg/kg/day were administered perorally. Urine cultures were cleared of Candida. DMSA scans obtained after 6 months showed no evidence of scarring. MB can be used for irrigation of the urinary tract, with fewer side effects than amphotericin B (AB). Additionally we advocate the use of ureteral catheters instead of nephrostomy in the treatment of CRC.

Administration, Oral↗
PubMed1995

Ultrastructural changes following overhydration with irrigating fluids.

We studied ultrastructural alterations caused by intravenous infusion of 150 ml/kg of irrigating fluid containing mannitol and/or sorbitol in 15 rabbits. The osmolality of the solutions varied between 165 and 350 mosmol/kg. Specimens for electron microscopic examination were obtained from the kidney, brain and lung. Regardless of the choice of solute, the hypo-osmotic solutions caused damage to kidney and brain tissue by inducing marked interstitial and cellular oedema. No such changes were observed after administration of isosmotic irrigating fluid. We conclude that ultrastructural changes following overhydration with irrigating fluid vary with the osmolality of the solution but not with the choice of solute. Moreover, the consistent absence of tissue damage in the lungs suggests that the lung is not a primary target organ for the "TUR syndrome".

Animals↗
PubMed1995

Blood loss during transurethral prostatic resection with continuous bladder irrigation.

A total of 120 men with benign prostatic hypertrophy were assigned randomly into three groups. Transurethral prostatic resections were performed in all patients. In Group I the operation was performed with continuous flow bladder irrigation, in Group II with suprapubic flow irrigation (without suction pump) and in Group III without continuous flow irrigation. Blood loss was determined by a colorimetric method. There were no statistically significant changes in blood loss between the groups of patients.

Blood Loss, Surgical↗
PubMed1986

Whole-gut irrigation in infants and young children.

In the search for a superior alternative to conventional bowel preparation which often gives unsatisfactory results in children, we have introduced whole-gut irrigation for pediatric use. After a pilot study on 15 children during which adjustments on the technique were made, we settled on an intensive regimen with some notable modifications from conventional adult practice: the use of warm Hartmann's solution, a relatively large fluid load (mean volume 5.3 l/kg body weight, range 3.0 - 12.0 l/kg) and a rapid infusion rate (1.5 ml/kg/min). We then evaluated its safety, effectiveness, and acceptability prospectively on 45 patients undergoing colonoscopy or colorectal surgery, age ranging from 4 months to 11 years, with a mean of 3.9 years. Subjective complaints were mild and included nausea/vomiting, 12 cases (26.7 percent); abdominal colic, two (4.4 percent); and distending discomfort, three (6.7 percent). There was a mean weight gain of 4.0 percent but no gross electrolyte disturbances. Results of bowel preparation were satisfactory in 33 (73.3 percent), adequate in ten (22.2 percent) and poor in two (4.4 percent). Compared with our previous method, in which inadequate preparation occurred in 4/20 patients, (20 percent) by conventional measures, whole-gut irrigation represents a statistically significant improvement (P less than 0.05). In addition, whole-gut irrigation shortened hospital stay and obviated the traditional need of two to three days' dietary restrictions.

Age Factors↗
PubMed2000

Surgical management of ascending aortic graft infection. No-sedation-technique for open mediastinal irrigation.

Two patients with ascending aortic graft infection were successfully treated. The first patient underwent ascending aortic replacement using a Dacron graft for aortic dissection, and developed graft infection. After 25 days' open mediastinal irrigation, allograft replacement and rectus muscle flap transfer were performed. The second patient underwent translocation of the aortic valve with a composite graft for calcific aortic stenosis, and developed graft infection. After 29 days' open irrigation, omental and rectus muscle flap transfer were performed. We were able to perform long-term open mediastinal irrigation using our original no-sedation-technique without any severe complication such as bleeding or secondary infection. We believe this technique is helpful in the management of severe ascending aortic graft infection.

Aortic Dissection↗
PubMed2005

Synovectomy, debridement, and continuous irrigation for infected total knee arthroplasty.

Since 1990, a total of ten joints in nine patients with infected total knee arthroplasty have been treated in our department within 21 days of the onset of infection. Their radiographs showed no evidence of implant loosening or "moth-eaten" appearance. They underwent synovectomy, debridement, and continuous irrigation without implant removal. Continuous irrigation was maintained for 7-29 days. It was possible to retain implants in eight joints of seven patients. Two joints of two patients were removed. Pain disappeared in all eight joints in which the implants were retained. Four patients could walk with one cane; one patient could walk with one crutch. Range of motion in five joints remained over 100 degrees. We recommend synovectomy, debridement, and continuous irrigation to cure an early stage infection of total knee arthroplasty.

Aged↗
PubMed2006

High-pressure irrigation and gentian-violet application for mediastinitis following replacement of ascending aorta and aortic valve.

Mediastinitis following ascending aortic replacement is intractable and potentially fatal, and the feature is characterized as having both high mortality and morbidity when its causation pathology is methicillin-resistant Staphylococcus aureus (MRSA). Possible treatments for the condition, which include debridement, irrigation, and healthy tissue transposition, often result in failure. We report a case of MRSA mediastinitis after replacement of the ascending aorta and the aortic valve successfully treated by continuous saline lavage and drainage, debridement, high-pressure irrigation, and gentian-violet application, and delayed omental-flap transposition. The application of gentian violet and high-pressure irrigation may provide an additional option to the standard therapy for intractable mediastinitis after ascending aortic replacement.

Aged↗
PubMed2004

Endo-bowel clamp (PL540S) for safe rectal irrigation in laparoscopy-assisted rectal resection.

We describe a technique of rectal irrigation using an endo-bowel clamp (PL540S) in laparoscopy-assisted rectal resection. One of the major concerns associated with current techniques of laparoscopy-assisted rectal resection is accidental tumor spillage because it is difficult to perform the necessary procedures without grasping and manipulating the bowel and mesorectum near the tumor. Therefore, sufficient intraoperative rectal irrigation is essential for preventing intraluminal implantation of rectal cancer. However, this can be difficult, especially if the tumor is located in the rectum. By placing a PL540S before transection, it is possible to occlude the rectum completely and irrigate it effectively. We think that the PL540S is a valuable device in laparoscopic surgery for rectal cancer.

Constriction↗