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At least 1,027 records · Page 57Linked to original sources
PubMed2006

Efficacy and safety of right and left atrial ablations on the beating heart with irrigated bipolar radiofrequency energy: a long-term animal study.

OBJECTIVE: The Cox maze procedure is the most effective surgical treatment for atrial fibrillation; however, its complexity has limited its clinical utility. The purpose of this study was to simplify the procedure by using an irrigated bipolar radiofrequency ablation device on the beating heart without cardiopulmonary bypass. METHODS: Six domestic pigs underwent median sternotomy. The pulmonary veins were circumferentially ablated. Electrical isolation was confirmed by pacing. Eight lesions were performed epicardially, and three lesions were performed through purse-string sutures with one of the jaws of the device introduced into the right atrium. After 30 days, magnetic resonance imaging was performed to assess atrial function, pulmonary vein anatomy, and coronary artery patency. Cholinergic stimulation and burst pacing were administered to induce atrial fibrillation. Histologic assessment of the heart was performed after the animal was killed. RESULTS: A modified Cox maze procedure was successfully performed with the irrigated bipolar radiofrequency device with no deaths. In every instance, the pulmonary veins were electrically isolated. Cholinergic stimulation with burst pacing failed to produce atrial fibrillation. Imaging studies revealed tricuspid regurgitation without evidence of pulmonary vein stenosis, coronary artery stenosis, or intra-atrial thrombus. Total atrial ejection fraction was 16.9% +/- 7.5%, a significant reduction. Histologically, 99% of the lesions were transmural, and there was no evidence of coronary sinus injury. CONCLUSION: Lesions on both the right and left atria can be created successfully on the beating heart with irrigated bipolar radiofrequency. The great majority of lesions with this device were transmural. This device should not be used on valvular tissue.

Animals↗
PubMed2004

Intraluminal irrigation with fibers improves mucosal inflammation and atrophy in diversion colitis.

OBJECTIVE: We investigated the effect of irrigating the colorectal mucosa of patients with a colostomy using a solution of fibers. METHODS: Eleven patients (10 male and 1 female; mean age, 34 y; age range, 16-49 y) with loop colostomy due to trauma underwent endoscopic evaluation of the rectum and the proximal and distal mucosa from the colostomy. An endoscopic score (range, 0-10) was used to quantify the intensity of the inflammation at the mucosa. Biopsies were taken from the colostomy border and from the rectum. The mean crypt depth of the five best-oriented glands was registered. Then the diverted colorectal segment was irrigated with a solution containing 5% fibers (10 g/d) for 7 d. The patients underwent repeated endoscopic and biopsy procedures, and then the colostomy was closed. RESULTS: The endoscopic score was higher (P < 0.01) at the distal border (2, 0-5) and the rectum (4, 1-10) when compared with the proximal border (0, 0-1). After treatment, the score at the diverted colon (1, 0-2) diminished (P = 0.03). The macroscopic score of the rectum also decreased after the infusion (4, 1-10, versus 3, 0-4; P = 0.03). Crypt depth at the proximal mucosa was higher than at the diverted mucosa (301 +/- 36 microm versus 205 +/- 76 microm; P < 0.01). After treatment, crypt depth at the diverted mucosa (280 +/- 64 microm) increased (P = 0.03). The rectum mucosa did not change before and after the treatment. CONCLUSION: Irrigation with fibers improves inflammation at the defunctionalized colon.

Adolescent↗
PubMed2005

In vitro assessment of the immediate and prolonged antimicrobial action of chlorhexidine gel as an endodontic irrigant against Enterococcus faecalis.

OBJECTIVE: The aim of this study was to assess in vitro the antimicrobial activity of 2% chlorhexidine gel against Enterococcus faecalis , comparing it to other endodontic irrigants (2% chlorhexidine liquid and 5.25% sodium hypochlorite). STUDY DESIGN: Eighty roots of human mandibular premolars were prepared by serial instrumentation technique, autoclaved, and contaminated for 7 days with E faecalis monocultures. The roots were then divided into 5 groups according to the irrigant substance used during the standardized biomechanical preparation. In order to evaluate the antimicrobial action of the irrigant substances, 3 microbial samples were taken: initial (before the biomechanical preparation); post-treatment (immediately after the biomechanical preparation), and final (7 days after the biomechanical preparation). The microbiological samples were plated to count the colony-forming units (CFU). RESULTS: The 2% chlorhexidine gel and 2% chlorhexidine liquid significantly reduced the E faecalis CFU in the post-treatment and final microbiological samples. The 5.25% sodium hypochlorite also reduced the E faecalis CFU immediately after the root canal instrumentation, but it was not able to keep the root canal free of detectable E faecalis in the final sample. CONCLUSIONS: The 2% chlorhexidine gluconate (gel and liquid) antimicrobial ability was more effective than 5.25% sodium hypochlorite in keeping low CFU of E faecalis for 7 days after the biomechanical preparation.

Anti-Infective Agents, Local↗
PubMed2006

Inflammatory cytokines correlated with clinical outcome of temporomandibular joint irrigation in patients with chronic closed lock.

OBJECTIVE: This study investigated the correlation of clinical outcomes of temporomandibular joint (TMJ) irrigation with the occurrence and concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, IL-8, IL-12, and IL-10 in the washed-out synovial fluid (SF) in patients with chronic closed lock (CCL) of the TMJ. STUDY DESIGN: Thirty-six patients underwent a visually guided TMJ irrigation (VGIR). SF samples were collected immediately before VGIR. The patients were divided into either successful (s-group; n = 25) or unsuccessful groups (u-group; n = 11). The detection rates and concentrations of each cytokine per milligram of total protein in the SF were measured, and then compared between the s- and u-groups. RESULTS: All of the investigated cytokines were detectable with various rates, concentrations, and combination patterns. The detection rate and concentrations of IL-6 were significantly higher in the u-group, and those of IL-10 were significantly higher in the s-group. CONCLUSIONS: The investigated cytokines were suggested to be involved in the pathophysiology of TMJ CCL. The results also suggest that IL-6 in the SF is an indicator of an unsuccessful outcome, and that IL-10 is a significant predictor of a successful outcome of TMJ irrigation for CCL.

Adult↗
PubMed1997

Chlorhexidine vaginal irrigation for the prevention of peripartal infection: a placebo-controlled randomized clinical trial.

OBJECTIVE: Our purpose was to determine whether chlorhexidine vaginal irrigation prevents maternal peripartal infection. STUDY DESIGN: A double-blinded, placebo-controlled, randomized trial was performed. Single 200 ml irrigations of either 0.2% chlorhexidine solution or sterile water placebo were given in active labor or before planned cesarean delivery. The primary outcome measure was the combined rate of chorioamnionitis and endometritis (which were mutually exclusive diagnoses). RESULTS: A total of 1024 patients were enrolled: 508 in the chlorhexidine group and 516 in the placebo group. The two groups were generally well balanced on important clinical factors but differed (p < 0.05) in rates of nulliparity (chlorhexidine 42%, placebo 52%), intrauterine pressure catheter usage (chlorhexidine 65%, placebo 72%), and presence of meconium (chlorhexidine 17%, placebo 22%). There were no recognized adverse maternal or neonatal reactions to irrigation. Rates of infection (chorioamnionitis + endometritis) did not differ significantly between the groups, chlorhexidine 10% versus placebo 13% (relative risk 0.8, 95% confidence interval 0.5 to 1.1). Stratified and logistic regression analyses supported the primary univariate analysis. Neonatal outcomes, including sepsis rates of 0.4%, were equivalent for the groups. CONCLUSION: As used in this trial, chlorhexidine lacked efficacy in the prevention of maternal peripartal infection.

Adult↗
PubMed1985

Iodine toxicity in a patient treated by continuous povidone-iodine mediastinal irrigation.

Continuous povidone-iodine irrigation is frequently used to treat mediastinitis after median sternotomy and has been considered safe and effective. We describe a 34-month-old patient with mediastinitis after median sternotomy who was treated with continuous povidone-iodine irrigation and who absorbed toxic quantities of iodine (total serum iodine, 9,375 micrograms/dl; normal range, 4.5 to 9.0 micrograms/dl). An unexplained metabolic acidosis developed, along with changes in mental status, and the patient died. This experience and a thorough review of the literature lead us to believe that continuous povidone-iodine irrigation of the mediastinum is contraindicated.

Acidosis↗
PubMedDate not supplied

The optimal molecular weight of dispersive type sodium hyaluronate for the reduction of corneal endothelial damage induced by sonication, irrigation, and aspiration.

PURPOSE: The purpose of this study was to investigate the optimal molecular weight of dispersive sodium hyaluronate (Na-HA) for the reduction of corneal endothelial damage induced by sonication, irrigation, and aspiration, using enucleated pig eyes. METHOD: The phaco-needle of phacoemulsification and aspiration (PEA) equipment was inserted into the anterior chamber after aqueous humor replacement with a 1% Na-HA solution of various molecular weights (2420 x 10(3), 1460 x 10(3), 1100 x 10(3), 520 x 10(3) or 290 x 10(3)). Then sonication, irrigation, and aspiration were conducted for 60 seconds. The residual rate of Na-HA in the anterior chamber and the damaged area of corneal endothelium were determined using an image analyzer. RESULTS: Na-HA with a molecular weight of 1100 x 10(3) gradually disappeared from the anterior chamber after mixing with the irrigating solution, and the damaged area in only the 1100 x 10(3) group was significantly smaller compared with that in the control group. CONCLUSION: These results suggest that an optimal molecular weight exists for dispersive hyaluronate applied for the protection of intraocular tissues during PEA. Under the conditions of this study, Na-HA with a molecular weight of 1100 x 10(3) displayed the highest protective efficacy.

Animals↗
PubMed2006

Safety of gentamicin bladder irrigations in complex urological cases.

PURPOSE: Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy. MATERIALS AND METHODS: A retrospective study was performed of all children treated with gentamicin bladder irrigations from 1999 to 2004. The dose was 14 mg gentamicin in 30 ml saline instilled via catheter once or twice daily. Serum creatinine and random gentamicin levels were obtained according to a protocol based on risk of gentamicin toxicity. Patient demographics, laboratory results and outcomes were abstracted from the medical records. RESULTS: A total of 80 patients (38 males and 42 females) were identified. Median patient age was 10 years and median duration of treatment was 90 days. No patient had detectable serum gentamicin levels greater than 0.4 mg/dl. Small increases in serum creatinine were seen in 3 patients, all of whom had chronic renal insufficiency. A total of 21 patients (26%) had breakthrough UTIs, of which 5 (24%) were gentamicin resistant. No adverse events were documented. CONCLUSIONS: Gentamicin bladder irrigations are a helpful adjunct in the management of complex pediatric urological cases involving recurrent symptomatic bacteriuria. We no longer require intensive laboratory monitoring of low risk patients at our institution.

Adolescent↗
PubMed1999

Chromosome 9 monosomy by fluorescence in situ hybridization of bladder irrigation specimens is predictive of tumor recurrence.

PURPOSE: Bladder irrigation specimens are effective for sampling the urothelium for detection of recurrent bladder cancer. These specimens can be evaluated by cytology or quantitative techniques. Proliferation and ploidy changes are readily detected using deoxyribonucleic acid (DNA) cytometry. Tumor associated chromosomal aberrations can be assayed using fluorescence in situ hybridization (FISH). The prognostic values of DNA cytometry, and chromosome 9 and 9p21 FISH on exfoliated cells from bladder irrigation specimens from 61 bladder cancer patients were evaluated. MATERIALS AND METHODS: A total of 61 consecutive bladder irrigation specimens were obtained during cystoscopy. DNA cytometry was performed by image analysis. FISH was performed using a centromeric chromosome 9 probe and a cosmid contig (COSp16) probe to the CDKN2A/p16 tumor suppressor region of 9p21. Proportional hazards regression analysis was performed with statistical software to test the predictor variables of initial patient status (presence of tumor), COSp16 fraction (the proportion of COSp16 signals relative to centromeric probe signals), monosomic and hyperdisomic fractions of the chromosome 9 probe, and hyperdiploid fraction from DNA cytometry. Median time to recurrence was calculated using statistical software survival analysis. RESULTS: Initial patient status and monosomy of chromosome 9 were predictive of bladder cancer recurrence (p <0.0001 and p = 0.0073, respectively). The 11 patients with chromosome 9 monosomy fractions greater than 15% and a visible tumor had a median time to recurrence of 105 days. In contrast, only 8 of the 25 patients with chromosome 9 monosomy fractions less than 15% and no visible tumor had recurrence within 560 days. Median time to recurrence was 185 days for 6 patients with chromosome 9 monosomy fractions greater than 15% and no visible tumor, and 225 for 19 with chromosome 9 monosomy fractions less than 15% and a visible tumor. Hyperdiploid fraction was suggestive but not predictive of bladder cancer recurrence (p = 0.078). COSp16 and hyperdisomic fractions were not predictive of bladder tumor recurrence (p = 0.11 and p = 0.30, respectively). CONCLUSIONS: Chromosome 9 monosomy by FISH was predictive of bladder tumor recurrence. Furthermore, our findings support the hypothesis that losses of tumor suppressor genes on chromosome 9 are critical, perhaps initiating genetic events in bladder cancer.

Adult↗
PubMed1993

Patterns of irrigating fluid absorption during transurethral resection of the prostate as indicated by ethanol.

The absorption of irrigating fluid was measured by the ethanol method every 10 minutes during the course of 700 transurethral prostatic resections. The total blood loss was also measured using a photometer method. We found that ethanol determination is a convenient method of monitoring irrigating fluid absorption in daily practice. Absorption in excess of 150 ml. was detected in 46% of the operations. The volume of irrigant absorbed increased with the weight of the removed prostatic tissue, operating time and blood loss. The uptake of fluid usually started midway through the operation. Once absorption had started, there was an 87% probability that it would continue through the next 10 minutes with the exception of the last 10 minutes of surgery, when there was a 67% probability. A sudden decrease in arterial pressure coincided with the onset of fluid absorption 3.7 times more often than expected by chance. The absorption was no different in the 114 patients with a cancerous histology, compared to those with benign prostatic hyperplasia.

Absorption↗
PubMed1992

Aluminum toxicity and death following intravesical alum irrigation in a patient with renal impairment.

Intravesical alum irrigation is the safest and most effective method of treatment for intractable hematuria. Systemic absorption is reported to be minimal and there have been no reported deaths following its use. We describe an elderly man with compromised renal function (serum creatinine 420 mumol./l.) who was treated with 1% alum irrigation for 48 hours for hematuria due to inoperable bladder cancer. He received a total of 9.6 l. during 48 hours, which controlled the bleeding. After cessation of the alum he became lethargic, suffered respiratory depression and died the next day. Laboratory data showed mild metabolic acidosis and increasing daily aluminum levels that peaked at 7,014 nmol./l. (toxic greater than 2,000) beginning on the day after treatment was commenced. The efficacy and safety profile of alum irrigation is discussed.

Aged↗
PubMed1989

Intravenous infusion of irrigating fluids containing glycine or mannitol with and without ethanol.

Irrigating fluids consisting of 5% mannitol, 3% mannitol + 1% ethanol, 2.2% glycine and 1.5% glycine + 1% ethanol in water were given by intravenous infusion to seven healthy volunteers at a constant rate of 50 ml./min. over 20 min. The irrigants containing glycine produced hyperkalemia and usually prickling and burning skin sensations and slight nausea. The severity of the symptoms apparently correlated to the blood ammonia level, which increased significantly after the glycine but not after the mannitol infusions. With 5% mannitol, there was a pronounced transient increase of the blood volume and a prolonged hyponatremia. There were no differences between the irrigants in respect to their effects on blood pressure and urine excretion. Ethanol caused no adverse effects and allowed the fluid supplementation to be followed by expired breath tests.

Adult↗
PubMed1989

Urothelial injury from ethylenediaminetetraacetic acid used as an irrigant in the urinary tract.

Although solutions containing disodium ethylenediaminetetraacetic acid (EDTA) will dissolve calcium oxalate stones in vitro, the safety of such solutions as urinary tract irrigants is questionable. These studies were designed to assess the degree of urothelial damage produced by the mildest EDTA formulation which has been reported to be effective. Rabbit bladders were irrigated antegrade via a ureterotomy for 20 hours and then removed for histological examination. A 0.03 M solution of disodium EDTA at pH 7.5 produced considerably more urothelial injury than did an otherwise identical solution of calcium EDTA (p = 0.006). The bladders from the latter group were undistinguishable from those irrigated with saline. As prior saturation of EDTA with calcium completely eliminated the tissue injury, these studies indicate that the same calcium chelating property which makes this chemical effective also makes it toxic. There was enough tissue damage from the relatively mild formulation used to suggest no EDTA solution yet formulated is safe for clinical use.

Animals↗
PubMed1986

Encephalopathy and an elevated serum aluminum level in a patient receiving intravesical alum irrigation for severe urinary hemorrhage.

Intravesical alum irrigation is reported to be an effective and relatively safe means of controlling severe urinary hemorrhage. We describe a patient who experienced severe encephalopathy, metabolic acidosis and unexplained coagulopathy while receiving continuous intravesical alum irrigation. The serum aluminum level was elevated. The probable role of alum absorption from the bladder as the etiology of the encephalopathy and metabolic abnormalities, as well as the pathophysiology of aluminum metabolism are discussed. Guidelines for the use of intravesical alum irrigation in patients at high risk for the development of these abnormalities are proposed.

Aged↗
PubMed1983

Hemiacidrin irrigation in the management of struvite calculi: long-term results.

Renacidin (10 per cent hemiacidrin) irrigation has been used in the management of renal struvite calculi in 25 patients. Of these patients 22 were free of stone after irrigation: 16 after dissolution of residual stone fragments postoperatively, 4 after prophylactic postoperative irrigation and 2 after primary, nonsurgical percutaneous dissolution. Recurrent urinary tract infections owing to the original urease-producing bacteria occurred in 14 per cent of these patients and recurrent nephrolithiasis occurred in 9 per cent during an average followup period of 66 months.

Adult↗
PubMed1982

Amphotericin B as a urologic irrigant in the management of noninvasive candiduria.

High urinary colony counts of Candida may develop in patients with prolonged indwelling bladder catheters, multiple antibiotic usage and compromised host resistance. Serum candidal antibody titers may differentiate candidal colonization or early infection from invasive or disseminated infection. The persistence of marked candiduria in the absence of elevated antibody titers or other manifestations of disseminated infection presents a therapeutic dilemma to the urologist. Should the patient be treated with systemic therapy, that is flucytosine or intravenous amphotericin B, or should he be observed until the signs of systemic or renal infection develop? Amphotericin B may be used as a urological irrigant in the management of noninvasive urinary fungal infection. Of 40 patients with persistent candiduria treated with daily irrigations of amphotericin B via a 3-way indwelling urethral catheter or urethral catheter and suprapubic tube for an average of 6 days 37 (92.5 per cent) demonstrated marked reduction or elimination of the candiduria. None of the patients had an adverse reaction. Amphotericin B also has been used as a urological adjuvant to surgical treatment of candidal infection of the kidney and upper tract. It also has a role in the treatment in candidal urethritis. We believe that the timely use of amphotericin B irrigations may prevent the development of disseminated candidal infection.

Adult↗
PubMed1982

Dissolution of cystine calculi by pelviocaliceal irrigation with tromethamine-E.

We report 3 cases of cystine calculi. The stones were dissolved by pelviocaliceal irrigation with tromethamine-E, performed either through a percutaneous nephrostomy tube or ureteral catheters. The 25, 27 and 37-day courses of irrigation were well tolerated by all patients. Complications included a single asymptomatic urinary tract infection that required antibiotic therapy and transient hematuria due to catheter irritation. Our experience demonstrates that cystine calculi, including staghorn, can be dissolved by tromethamine-E irrigation, thereby obviating the need for surgical intervention.

Adolescent↗
PubMed1982

Irrigation during vasectomy: a comparison between sterile water and the spermicide euflavine.

In a randomized, double-blind investigation 36 men undergoing sterilization had irrigation of the vas deferens with either sterile water or the spermicide, euflavine, to reduce the lag to sterility. Semen samples were vital stained by the patients shortly after ejaculation and the smears were mailed to the laboratory. Irrigation with the spermicide was significantly more effective than sterile water. However, even in the group irrigated with euflavine 6 to 35 days elapsed before the semen samples were without potentially fertile spermatozoa.

Acriflavine↗