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PubMed2002

Effective management of posthemorrhoidectomy secondary hemorrhage using rectal irrigation.

PURPOSE: How to manage posthemorrhoidectomy secondary hemorrhage, a rare but serious complication, effectively remains controversial. This study evaluated the effectiveness of using rectal irrigation as an initial treatment for posthemorrhoidectomy secondary hemorrhage. METHODS: Among 4,880 patients on whom elective closed hemorrhoidectomy for symptomatic hemorrhoidal disease was performed, 45 (0.9 percent) developed posthemorrhoidectomy secondary hemorrhage. The 45 patients were divided into two groups based on the initial treatment in the stoma therapy room (n = 25) or in the operating room (n = 20). Patients in the stoma therapy room group were treated with rectal irrigation, whereas those in the operating room group were examined under anesthesia and the bleeding point (if any) was under-run using a suture. The two groups were then compared with respect to the cost-effectiveness of treatment, rehospitalization stay, and satisfaction with treatment. RESULTS: The two groups (stoma therapy room vs. operating room groups) were comparable with respect to the mean age of patients (44 vs. 38 years), interval of hemorrhage (9.4 vs. 7.8 days), and estimated amount of blood loss (560 vs. 520 ml). Bleeding effectively stopped in 22 (88 percent) patients in the stoma therapy room group but only in 12 (60 percent) patients in the operating room group (P = 0.010). The rehospitalization stay was three days in the stoma therapy room and 4.9 days in the operating room group (P = 0.016). In addition, the stoma therapy room group had a greater satisfaction rate than the operating room group did (80 vs. 10 percent, P < 0.001). Moreover, the average cost of treatment in the operating room group was six-fold higher than that in the stoma therapy room group. CONCLUSIONS: Our data suggest that rectal irrigation is an effective initial treatment for posthemorrhoidectomy secondary hemorrhage and offers a high rate of patient satisfaction with a reduced hospital cost.

Adult↗

PubMed1986

Comparison of low- and high-volume irrigation-aspiration systems for extracapsular cataract extraction.

A low-volume irrigation-aspiration system with a 1-mm tip (0.3-mm aspiration port) has been developed for extracapsular cataract extraction. This autoclavable system uses approximately 36% less irrigating fluid during the irrigation and aspiration of cortical material when compared to currently available models. The time required for cortical aspiration is also shortened by 33%. After three years of clinical experience with the low-volume system at the Miami Veterans Administration Medical Center, where almost all extracapsular cataract surgery is now performed with the new system, there have been no adverse effects and subsequent capsulotomy has rarely been necessary.

Aged↗

PubMed1991

Thoracoscopic debridement and pleural irrigation in the management of empyema thoracis.

As a sequel to a paper reporting good results obtained in 12 patients with empyema thoracis treated by thoracoscopic debridement and irrigation in our department, subsequent experience with a further 18 patients is reported. Drainage of pus and irrigation resulted in resolution of pyrexia with improvement in general condition in all patients. Overall, complete resolution was obtained by this technique alone in 60% (18/30). Of the 12 patients in whom complete resolution was not obtained, secondary surgical measures resulted in resolution of empyema in 8. Four patients died; all were elderly and severely debilitated, 3 with advanced malignancy. Their deaths were not related to the technique, which was well tolerated in all cases. Thoracoscopic debridement and irrigation used routinely as a first-line measure in empyema thoracis is a safe and relatively atraumatic procedure, does not exclude the use of any subsequent surgical measure, and provides valuable time to improve the condition of debilitated patients so that they may tolerate more aggressive surgical procedures.

Adolescent↗

PubMed1992

A comparison of heparinised saline irrigation solutions in a model of microvascular thrombosis.

The use of heparinised irrigation solutions has become common in microvascular surgery, but the concentration of heparin has been determined empirically. A laboratory model of microvascular thrombosis, employing a crush injury, intimal abrasion, and stasis to the rat superficial femoral artery was used to compare heparinised saline irrigation solutions of various concentrations. The solutions included normal saline (Group I, controls) and heparinised normal saline in concentrations of 10 U/ml (Group III), 250 U/ml (Group IV), and 500 U/ml (Group V). Group I animals had a patency rate of 25% at 20 min and 0% at 24 h. Group II showed a patency rate of 75% at 20 min but fell to 37.5% at 24 h. Patency in Group III was 87.5% at 20 min and at 24 h. Group IV had a 100% patency rate at 20 min and at 24 h. Group V animals were 100% patent at 20 min and 87.5% patent at 24 h. The activated partial thromboplastin time was prolonged in animals exposed to 250 U/ml and 500 U/ml of heparinised saline. Patency was significantly improved in animals exposed to 100 U/ml, 250 U/ml and 500 U/ml when compared to the control group (p less than 0.001). These results suggest that topical heparinised saline administration is of benefit in the prevention of microvascular thrombosis. Higher concentrations tested in this study resulted in a significant increase in patency, but also prolonged the activated partial thromboplastin time. 100 U/ml is the ideal concentration of heparinised saline irrigation because it significantly improved patency but did not produce detectable systemic effects in this model.

Animals↗

PubMed1990

Iodine toxicity secondary to continuous povidone-iodine mediastinal irrigation in dogs.

Mediastinitis is a devastating complication following median sternotomy. Continuous povidone-iodine (PVP-I) irrigation has been advocated as therapy because of its broad antimicrobial spectrum and its apparent safety. However, several recent clinical reports have warned of suspected local and systemic iodine toxicity. The purpose of this study is to determine if significant amounts of iodine can be absorbed systemically via the mediastinum, and if so, what toxicity (local and/or systemic) may result. PVP-I (0.5%) was continuously irrigated into the pericardial sacs of three dogs via catheters for 48 hr. Serial serum and urine iodine levels were determined. The serum steady-state concentration (Css), the rate elimination constant (k), the urinary clearance (Cl), and the serum half-life (t 1/2) for iodine were assessed. Serum electrolytes, Bun, Cr, and arterial pH were measured to assess systemic iodine toxicity. Tissue samples of the heart, pericardium, liver, and kidney were examined histologically for evidence of local or end-organ iodine toxicity. This study demonstrated that the absorption of iodine during continuous mediastinal irrigation with PVP-I follows zero-order pharmacokinetics, just as if it were being given by continuous intravenous infusion. The baseline serum iodine concentration was 145.9 +/- 64.3 micrograms/dl, Css was 29,290 +/- 101.4 micrograms/dl, k was 0.0996 +/- 0.009/hr, Cl was 872.4 +/- 119.3 ml/hr, and t1/2 was 6.22 hr. Urinary excretion of iodine increased in proportion to the serum iodine. Measured serum chloride increased in a linear manner (r = 0.949), while serum Na, K, Bun, Cr, and pH were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

PubMed1982

The effect of chlorhexidine gluconate irrigation on the root canal flora of freshly extracted necrotic teeth.

Forty freshly extracted teeth with necrotic pulps were endodontically treated under simulated clinical conditions. Bacteriologic samples were obtained before during, immediately after, and 24 hours after instrumentation, irrigation, and medication either with 0.2 percent chlorhexidine gluconate or with sterile saline. There was a highly significant (p less than 0.0049) reduction in microorganisms in the chlorhexidine-treated specimens after the instrumentation and irrigation procedures. Further significant reductions were noted after intracanal dressing of the teeth for 24 hours with the chlorhexidine gluconate solution. The teeth treated with saline also demonstrated a generalized decrease in flora after the biomechanical procedures. However, there was an absolute increase in numbers of microorganisms for 80 percent of the uniradicular and 50 percent of the multiradicular specimens when no intracanal, antimicrobial dressing was applied. It was concluded that chlorhexidine gluconate in a 0.2 percent solution can be an effective antimicrobial agent when used as an endodontic irrigating solution and that as an intracanal, interappointment dressing, chlorhexidine helps to further reduce bacteria remaining within the root canal system.

Bacteria↗

PubMed1994

Smear layer removal by root canal irrigants. A comparative scanning electron microscopic study.

The effect of six endodontic irrigants on smear layers created by hand instrumentation was evaluated in vitro in the middle and apical sections of 53 root canals. The irrigants evaluated were: 1% and 5% sodium hypochlorite, a combination of 24% phosphoric acid and 10% citric acid, 0.2%, 17%, and 3% ethylenediaminetetraacetic acid. After instrumentation and treatment with the respective irrigants, the root canal specimens were examined by scanning electron microscopy to determine the presence or absence of smear layer. The two sodium hypochlorite solutions did not remove the smear layer, even when 5% sodium hypochlorite was scrubbed on the dentinal walls. The 0.2% ethylenediaminetetraacetic acid solution was more effective than sodium hypochlorite, but it did not completely remove the smear layer, especially at the orifices of the dentinal tubules. The other three solutions effectively removed the smear layer, but no significant difference was found between them (p > 0.05). The solution of 3% ethylenediaminetetraacetic acid was as effective as phosphoric-citric acid and 17% ethylenediaminetetraacetic acid. Ethylenediaminetetraacetic acid, however, did not show the marked demineralizing effect on the dentinal walls and tubules as the acidic solution.

Adult↗

PubMed1994

Effects of intranasal ZnSO4 irrigation on olfactory and trigeminal cues.

Intranasal irrigation with ZnSO4 solutions is used for experimental induction of anosmia. It is, however, unknown whether the trigeminal nerve is affected by the treatment. One day after irrigation (concentrations investigated were between 0.05-1%) the ability of food finding, an olfactory cue, was decreased in a concentration-dependent manner. The trigeminal effect was investigated from a reflexively induced decrease in respiratory rate due to n-propanol exposure. No impairment occurred at 1% ZnSO4. Anosmia was also seen 2-3 h after an irrigation with solutions of 0.05-1% ZnSO4. At the same time, 0.2 and 1% solutions in themselves decreased the respiratory rate due to reflexes from the upper and lower respiratory tract. A conspicuous systemic effect can be ruled out as the Zn++ antidote, CaNa2EDTA, had no effect on the decrease. A direct activation of the trigeminal nerve due to a reaction with a thiol group may explain the effect from the upper airways.

1-Propanol↗

PubMed1981

Hemiacidrin irrigations to dissolve stone remnants after nephrolithotomy. Problems with solution flow.

Following surgery for branched renal calculi, hemiacidrin irrigation may be useful to dissolve any residual stones. Struvite, the mineral in these stones, is itself an alkaline buffer and can raise the pH of the irrigating solution rendering it ineffective. Large volumes of hemiacidrin must reach the stone remnants or they are unlikely to dissolve. Two cases are described in which creative positioning of the patient or the irrigation catheters was necessary to permit adequate amounts of hemiacidrin to reach and dissolve stone remnants.

Adult↗

PubMed1983

Irrigation of indwelling urinary catheters.

Patients with chronic indwelling urinary catheters were studied to determine whether or not catheter irrigation with a sterile nonbacteriostatic solution should be part of routine care. One thousand catheter days were studied with catheters irrigated half of the time. Irrigation was found to be a costly and time-consuming procedure which had no effect on the patients' clinical course except to decrease the incidence of catheter plugging.

Bacteriuria↗

PubMed1992

A randomized study on the effect of bladder irrigation with povidone-iodine before removal of an indwelling catheter.

We have evaluated the effect of povidone-iodine (PVP-I) bladder irrigation prior to catheter removal on subsequent bacteriuria. Of 264 patients, 138 received PVP-I irrigation and 126 were controls. Both groups were similar with respect to duration of catheterization and bacteriuria before removal of the catheter. Of 497 cultures taken after catheter removal 99 (20%) were positive. This included 52 of 233 in the control group (22%) and 47 of 264 in the study group (18%). Patients with positive cultures had a significantly longer period of catheterization. Our trial did not demonstrate that PVP-I bladder irrigation before catheter removal reduces subsequent bacteriuria.

Adult↗

PubMed1993

Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients.

Five patients with extensive deep burns developed septicaemia due to Pseudomonas aeruginosa serogroup O-7.8 and phage type 21 or 21/188 shortly after they had been admitted to hospital. Four other burned patients became colonized with the same strain. The source of infection was contaminated tap water used for irrigation of the burns, as part of the first-aid treatment which the patients received when entering the hospital. Contamination was restricted to showers and tubing that were permanently connected to the taps, and the outbreak stopped after they had been disinfected. Tubing and showers used for irrigation of burns should be dismantled and heat-disinfected after each patient and not reconnected to the taps until immediately before the next treatment. Taps used for irrigation of burns should be monitored regularly for the presence of P. aeruginosa and other potentially pathogenic bacteria. Routine typing of P. aeruginosa isolates from burned patients is indicated in order to detect and eliminate hidden sources of infection.

Adult↗

PubMed1988

A comparison of irrigation solutions for microanastomoses.

A comparative study of irrigating solutions that contained various clot-active substances and/or vasodilating substances was done using a crush injury model of the rat's femoral artery. A routine microanastomosis was done with one of seven irrigation solutions employed in the study. The patency rate of lactated Ringer's solution (10%) (the control solution) was compared with solutions of heparin (35%) urokinase (50%), phentolamine (35%) tissue plasminogen activator (tPA) (15%), a combination of urokinase, heparin, and phentolamine (55%), and a combination of tPA, heparin, and phentolamine (42.5%). Statistically significant improvement in patency rates were obtained with heparin (p less than 0.0005), phentolamine (p less than 0.03), urokinase (p less than 0.001), the tPA, heparin and phentolamine combination (p less than 0.001), and the urokinase, heparin, and phentolamine combination (p less than 0.0001). There seems to be a benefit with the addition of either vasoactive agents or clot-active agents to the microvascular irrigating solution during construction of a compromised microanastomosis.

Anastomosis, Surgical↗

PubMed1992

Clinical effect of subgingival chlorhexidine irrigation on gingivitis in adolescent orthodontic patients.

Twenty-three adolescent orthodontic patients with gingivitis affecting all banded first molars volunteered for the study. Three measures associated with gingivitis (papilla bleeding index, plaque index, and probing depth) were recorded at four sites for all four molars. A single application of subgingival irrigation with 0.12% chlorhexidine digluconate or isotonic saline was performed for 5 seconds at each site. As determined by coin toss, the first molars on the right or left side of the mouth received either chlorhexidine or saline irrigation. The papilla bleeding index, plaque index, and probing depth were recorded before the treatment and subsequently at 2 weeks and then 4 weeks. The gingival bleeding as determined by papilla bleeding index, was virtually eliminated in 4 weeks by a single application of subgingival irrigation with either chlorhexidine or saline. However, there was no significant reduction in pocket depth or plaque index. In addition, no significant difference between the effect of chlorhexidine or saline was found for any of the outcome measures.

Adolescent↗

PubMed2005

Early open thoracotomy and mediastinopleural irrigation for severe descending necrotizing mediastinitis.

OBJECTIVE: Descending necrotizing mediastinitis (DNM) is a severe infection spreading from the cervical region to the mediastinal connective tissue. The mortality rate was reported as 40% until the 1980s. Since DNM is uncommon, few reports of large series of patients with DNM (i.e. more than 10 cases) have been published. The present aim was to evaluate our treatment strategy for DNM by retrospective chart review. METHODS: Retrospective chart review was performed in 10 patients with DNM between 1991 and 2003. The mean age was 53.8+/-23.3 years (median 58, range 16-82). The causes of DNM were primary peritonsillar or parapharyngeal abscess in 5 patients, post-extraction odontogenic abscess in 3, cervical abscess of post-tracheostomy in 1, and unknown in 1 patient. In nine cases, the abscess extended from the cervical region to the lower mediastinum. Immediately after the diagnosis of DNM, broad-spectrum antibiotics were administered empirically, and surgical treatments consisting of cervical drainage, thoracotomy with radical surgical debridement of the mediastinum and excision of necrotic tissue, decortication, and irrigation were performed in all cases. Post-operatively, mediastinopleural irrigation with saline was performed once or twice a day until a culture of pleural effusion became negative. RESULTS: The mean duration of chest tube retention was 26.7+/-17.0 days, and the mean hospital stay was 62.3+/-33.9 days. Five patients suffered from severe complications including septic shock, acute respiratory distress syndrome, disseminated intravascular coagulation, and pan-peritonitis due to duodenal perforation. The outcome was favorable in 8 patients. Of those with severe complications, two patients, who were older than 75 and had diabetes, died of multiple organ failure due to septic shock. Therefore, the mortality rate was 20%. CONCLUSION: Our treatment strategy for severe DNM was efficacious for early treatment and reduced the mortality rate. Early detection of DNM, and immediate thoracotomy and irrigation of the mediastinum and thoracic cavity, are recommended.

Abscess↗

PubMed2004

Heparin in the intraocular irrigating solution in pediatric cataract surgery.

PURPOSE: To investigate the antiinflammatory effects of adding heparin sodium to the irrigating solution to prevent fibrinoid reaction and related long-term complications after pediatric cataract surgery. SETTING: Department of Ophthalmology, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey. METHODS: Thirty eyes of 18 children who had cataract or other ocular surgery were included in the study. Bilateral cataract surgery was performed in 20 eyes of 10 children and bilateral secondary intraocular lens (IOL) implantation in 4 eyes of 2 children (Group 1). Four eyes of 4 children had unilateral cataract surgery and 2 eyes of 2 children with previous perforating eye injury had synechiotomy and pupilloplasty (Group 2). Heparin sodium was added to the irrigating solution during surgery in 12 left eyes of children with bilateral surgery (Group 1a) and in all eyes in Group 2. Heparin sodium was not added during surgery in 12 right eyes of children having bilateral surgery (Group 1b, control). Early and late postoperative intraocular reactions were recorded and compared. RESULTS: In Group 1a (heparin added), 6 eyes had less fibrinoid reaction and fewer related complications such as posterior synechias, pupil irregularity, and intraocular lens (IOL) decentration than the fellow right eyes. No eye in Group 1a having primary cataract surgery had hyphema or intraocular bleeding. Hyphema occurred on the first postoperative day in 1 eye in Group 1a that had secondary IOL implantation. CONCLUSIONS: Adding heparin sodium to the irrigating solution decreased postoperative inflammatory and fibrinoid reactions and related complications such as synechias, pupil irregularity, and IOL decentration in pediatric cataract surgery. However, the use of heparin during surgery can be risky in eyes with a defective blood-aqueous barrier such as after previous ocular surgery.

Adolescent↗

PubMed2006

Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems.

The purpose of this study was to determine the minimum instrumentation size required for the effective penetration of irrigants and elimination of debris and smear layer from the apical third of the root canals. The mesiobuccal canals of 40 freshly extracted human mandibular first molar teeth were instrumented using the crown-down technique. The teeth were divided into four test groups according to the size of their Master Apical File (#20, #25, #30, #35), and two control groups. After final irrigation, the removal of debris and smear layer from the apical third of root canals was determined under a scanning electron microscope. The data was analyzed using Kruskal-Wallis and Mann-Whitney tests. Based on the results, it appears that the minimum instrumentation size needed for penetration of irrigants to the apical third of the root canal is a #30 file.

Dental Instruments↗

PubMed2006

Cleaning efficacy and dentin micro-hardness after root canal irrigation with a strong acid electrolytic water.

The purpose of this study was to evaluate the cleaning effect of root canal walls using strong acid electrolytic water (SAEW) as a root canal irrigant, and to investigate the influence of SAEW on the root canal dentin by micro-hardness test. Forty-three single-rooted, single-canaled teeth were instrumented using standard step-back technique with K-files. Irrigation was performed using distilled water, 5.25% NaOCl and 3% H(2)O(2), SAEW, or 15% EDTA solution in five groups. Samples were prepared to be examined under a scanning electron microscope (SEM) and micro Vickers hardness (H(V)) test machine. Our results showed that the root cleaning effects of the combined use of SAEW and NaOCl solution as root canal irrigants were equivalent to those in the group with NaOCl and 15% EDTA. When SAEW was used for 1 min under ultrasonic vibration, no decreases in the hardness of dentin inside the root canal were detected.

Acid Etching, Dental↗