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PubMed1982

Rat bladder irrigation with PVP-I2.

Despite technical advances, Foley catheter associated urinary tract infections continue to be the leading cause of nosocomial infections. PVP-I2 has been shown to be nonirritating to abraded tissue and we have shown that dilute solutions are bactericidal for organisms causing Foley catheter associated urinary tract infections. The purpose of this study was to ascertain the toxicity of PVP-I2 on the catheterized rat bladder and to measure the systemic absorption of I2. Bladder catheters were surgically placed into each of 3 groups of rats: group 1, catheters only; group 2, irrigation with PBS q.8h; and group 3, irrigation with a 1:3 dilution of a 10 per cent PVP-1 per cent I2 solution q-8h. One-half of each group was sacrificed at 1 and 2 weeks respectively. Photographs of mounted bladders and histologic sections were then graded by 3 independent observers. Blood for protein bound iodine (PBI), T3 and T4 levels was obtained before the study and at sacrifice. No difference in ulcerations, erythema or inflammation was noted. PBI was higher in group 3 rats at conclusion than group 1 and 2 (6.88 mg./dl. versus 3.42 mg./dl.) (p less than 0.05). There was no difference in T3 or T4 levels. In this study, PVP-I2 was no more toxic to the bladder than catheterization alone or irrigation with PBS.

Absorption↗
PubMed1980

Dissolution of cystine stones by irrigated tiopronin solution.

A new method involving the introduction of tiopronin solution directly into the renal pelvis or bladder has been developed for the treatment of cystine stones. Therapeutic irrigation by tiopronin solution was done in 4 cases of residual cystine kidney stones using a nephrostomy tube, and in an infant with bladder cystine stones using a Foley 3-way catheter. In every case all of the cystine stones were dissolved completely. During the course of the treatment no abnormality was noted on blood, liver function or immunological tests. Neither have there been any negative side effects, such as eruption, anorexia, nausea, diarrhea or general fatigue. The significance of this irrigation process is that whereas nephrectomy, heminephrectomy or nephrolithotomy was necessary previously to remove kidney cystine stones, now only pyelolithotomy and nephrostomy tube insertion are necessary. Furthermore, an operation is unnecessary in cases of bladder cystine stone dissolution by tiopronin irrigation.

Adolescent↗
PubMed1976

Radioisotope investigation of continuous bladder irrigation after transurethral resection.

Radioisotope studies using 131I serum albumin were performed on 20 patients to investigate the possibility of intravascular absorption of the irrigating solution during continuous bladder irrigation after transurethral resection of the prostate. In only 5 of 20 patients was a minimal absorption of 1 to 34 cc observed. On the basis of these studies the routine use of continuous bladder irrigation after transurethral resection can be recommended, provided techniques are sterile.

Absorption↗
PubMed2001

An intraoperative irrigation device using disposable syringes and an extension tube: technical note.

BACKGROUND: The authors present a simple irrigation device used in a microsurgical setting. METHODS: The system consists of a disposable i.v. catheter, an extension tube, a three-way stopcock and two disposable syringes, capable of assembly during a surgical procedure. RESULTS: The length of the handpiece of this device is comparable to other microsurgical tools, which allow both the assistant and the surgeon to grab and irrigate in a coordinated fashion. Clots, tumor contents, and tissue debris are effectively washed away. This tool is particularly useful for lavage of subarachnoid clots during surgery for ruptured intracranial aneurysms, allowing precise anatomic orientation. This device is also practical for cooling tissues adjacent to drilling sites. CONCLUSION: This system is as efficacious as other available self-irrigating microneurosurgical instruments.

Disposable Equipment↗
PubMed1996

Survival after high-dose intravenous infusion of irrigating fluids in the mouse.

OBJECTIVES: Fluid absorption is still a potentially fatal complication in patients undergoing transurethral resection of the prostate. We induced experimental overhydration in animals to find out which of three widely used irrigating fluids is most strongly associated with survival. METHODS: The survival and incidence of voiding was studied in 120 mice after an intravenous infusion of either 225, 250, 275, or 300 mL/kg of glycine 1.5%, mannitol 5%, or sorbitol 2% plus mannitol 1% over 60 minutes. RESULTS: Only 20% of the animals survived the glycine solution, whereas the overall survival rate after mannitol was 60%. The corresponding figure for sorbitol plus mannitol was 32%. Logistic regression analysis showed that survival was significantly more likely after infusion of mannitol 5% compared with the other irrigating fluids. The likelihood of survival was also higher in the animals in which the infusion induced diuresis and when the smaller volumes of irrigating fluid were given. CONCLUSIONS: Mannitol 5% offered the best chance of survival.

Animals↗
PubMed1998

DNA cytometry and chromosome 9 aberrations by fluorescence in situ hybridization of irrigation specimens from bladder cancer patients.

OBJECTIVES: To determine the sensitivity and specificity of combining fluorescence in situ hybridization (FISH) measurement of chromosome 9 and DNA cytometry of bladder irrigation specimens in the detection of bladder cancer. METHODS: Bladder irrigation specimens were obtained from 37 normal control patients and 317 bladder cancer patients during cystoscopic examinations. Bladder cancer patients were sampled in the absence of observable tumor (256 specimens) and concurrently with tumor (204 specimens). Chromosome 9 copy number was determined on a cellular basis by FISH, and cellular DNA content was determined by Feulgen DNA staining and image cytometry. RESULTS: Sensitivity of chromosome 9 FISH was 42% for all tumors and was not correlated to transitional cell carcinoma tumor grade, while the sensitivity of DNA cytometry was 55% and improved with increasing grade from 38% for grade 1 to 90% for grade 3 tumors. The results of FISH and DNA cytometry were combined, resulting in specificity of 92% and sensitivity of 69% for grade 1, 76% for grade 2, and 97% for grade 3 tumors. CONCLUSIONS: The lack of increase with grade in the percentage of positive specimens by FISH supports the hypothesis that chromosome 9 aberrations are critical events in bladder tumorigenesis for many patients. These data demonstrate the presence of cells in irrigation specimens with specific genomic lesions of chromosome 9 and DNA content. Combining FISH on chromosome 9 and DNA cytometry provides an increase in sensitivity to transitional cell carcinoma over either test alone.

Carcinoma, Transitional Cell↗
PubMed1993

Ferric sulfate hemostasis: effect on osseous wound healing. II. With curettage and irrigation.

Hemorrhage control is often a problem for the clinician during osseous surgery. Ferric sulfate is an effective hemostatic agent, but with prolonged application to an osseous defect can cause persistent inflammation and delayed healing. The purpose of this investigation was to evaluate the effectiveness of ferric sulfate as a hemostatic agent and to determine its effect on healing after thorough curettage and irrigation from osseous surgical wounds. Standard size osseous defects were created bilaterally in the mandibles of rabbits. Ferric sulfate was placed in one defect until hemostasis was obtained; the contralateral defect was allowed to fill with blood and clot. After 5 min both defects were curetted and irrigated. The repair of the defects was evaluated histologically at 18 and 46 days. There were no significant differences between the ferric sulfate-treated defects and the untreated controls. When adequately curetted and irrigated from the surgical site prior to closure, ferric sulfate did not cause persistent inflammation or delay osseous repair in comparison to controls.

Alveolar Process↗
PubMed1992

Efficacy of several concentrations of sodium hypochlorite for root canal irrigation.

Sodium hypochlorite (NaOCl) has been recommended for irrigation during root canal preparation. This investigation used scanning electron microscopy to examine instrumented and uninstrumented surfaces in the middle third of root canals following the use of several concentrations of NaOCl (5.25%, 2.5%, 1.0%, and 0.5%). NaOCl was delivered with either an endodontic irrigation needle or an ultrasonic device. All of the concentrations of NaOCl with either delivery system were very effective in flushing out loose debris from the root canals. A smear layer with some exposed dentinal tubules was seen on all instrumented surfaces regardless of concentration of NaOCl or irrigation device. NaOCl in concentrations of 5.25%, 2.5%, and 1% completely removed pulpal remnants and predentin from the uninstrumented surfaces. Although 0.5% NaOCl removed the majority of pulpal remnants and predentin from the uninstrumented surfaces, it left some fibrils on the surface.

Bicuspid↗
PubMed1983

Irrigation treatment of leg ulcers.

Wound healing produced by isotonic saline irrigation via a special dressing was compared with that produced by conventional saline dressings in 12 inpatients with 18 leg ulcers. Patients served as their own controls. Wound cleansing was estimated by fibrin crust disappearance and granulation tissue formation. Both occurred earlier during irrigation. Wound contraction was similar during the two treatments. Wound blood flow, estimated by means of a laser Doppler flowmeter, increased earlier with irrigation.

Adult↗
PubMed1994

Postoperative cerebral oedema after transcervical endometrial resection and uterine irrigation with 1.5% glycine.

Absorption of irrigating solution during transcervical resection of endometrium can cause dilutional hyponatraemia, nausea, and cerebral oedema. We studied 6 patients who absorbed more than 1500 mL of 1.5% glycine, and 14 patients who absorbed less. Cerebral oedema was diagnosed by blinded, paired comparison of computed tomography (CT) scans 3-6 hours and 3-6 days after operation. The absorbed volume of irrigating glycine solution was correlated with peroperative decrease in serum sodium. 10 patients who absorbed 500 mL of glycine or more had postoperative nausea, with cerebral oedema suspected in 9. None of the 10 patients who absorbed less than 500 mL had nausea; changes on CT scan suggestive of cerebral odema were found in 1. 8 patients who absorbed 1000 mL or more had a decrease in serum sodium of 10 mmol/L or more, nausea, and cerebral oedema on CT scan. Cerebral oedema may contribute to the development of postoperative nausea in patients undergoing transcervical surgery who absorb more than 500 mL of 1.5% glycine irrigating solution.

Absorption↗
PubMed1991

Retrobulbar bupivacaine irrigation for postoperative pain after scleral buckling surgery. A prospective study.

The authors conducted a prospective, randomized, double-masked clinical trial to determine if retrobulbar irrigation with bupivacaine hydrochloride 0.75% (Marcaine) has an effect on postoperative pain after scleral buckling surgery. Fifty consecutive patients undergoing scleral buckling under general anesthesia were randomized to receive either bupivacaine or balanced salt solution as a retrobulbar irrigation at the end of their retinal detachment procedure. Of the 25 patients who received bupivacaine, only three (12%) required parenteral pain relief in the first 24 hours after surgery. This was statistically significant when compared with the 18 (72%) of 25 patients requiring parenteral pain relief in the placebo group (P less than 0.0001). In addition, when questioned about their perception of the degree of postoperative pain, patients in the control group rated their level of pain as significantly more severe than did patients in the bupivacaine group. The authors conclude that retrobulbar irrigation with bupivacaine is a safe and effective way to achieve postoperative pain relief after surgery for scleral buckling.

Adolescent↗
PubMed1997

Diffuse nasal polyposis: postoperative long-term results after endoscopic sinus surgery and frontal irrigation.

Diffuse nasal polyposis remains a challenge despite recent improvements in endonasal surgery. The purpose of this study is to evaluate the results after a radical complete sphenoethmoidectomy with peroperative and postoperative frontal irrigation in cases of diffuse nasal polyposis. In this prospective study, we include 50 consecutive patients with diffuse nasal polyposis suffering from nasal obstruction, anosmia, and other symptoms of chronic sinusitis. All patients were refractory to medical therapy. In each patient an endoscopic complete sphenoethmoidectomy including total excision of all diseased ethmoid mucosa was performed. Preoperative and postoperative frontal irrigation was performed systematically. The patients were followed closely with serial endoscopic examination, and CT scanning was performed between 2 and 3 years after surgery. There were no complications. Thirty-nine of the 50 patients regained satisfactory olfaction. Partial nasal obstruction persisted in four of the 50 patients. Endoscopically, polyp recurrence was noted in 3% of posterior ethmoids, 23% of anterior ethmoids, and 50% of frontal recesses. We conclude that in cases of refractory and extensive nasal polyposis, a total sphenoethmoidectomy with perioperative frontal irrigation followed by long-term postoperative topical steroid therapy provides excellent improvement or cure with safety and reliability.

Adult↗
PubMed2002

Flexible ureterorenoscopy for the treatment of lower pole calyx stones: influence of different lithotripsy probes and stone extraction tools on scope deflection and irrigation flow.

The 7.5 and 9.0 F flexible ureterorenoscopes are used widely in endourology. These scopes, along with new available tools and probes, enable intrarenal ureteroscopic access to renal stones in the lower pole. Following individual clinical experiences the infundibulopelvic angle has to be respected for the selection of different scopes, tools and probes. The aim of this study was to determine the influence of different scopes, tools and probes on the angle of the active and passive flexion of the flexible ureterorenoscope. The angles of the active and passive flexion and maximum irrigation flow of different flexible ureterorenoscope (9.0 F Wolf, 7.5 F Olympus, 7.5 F Storz) were measured repeatedly in vitro using nine different inserted tools and/or probes. In addition, the maximum allowing for easy passage of the nine different tools/probes through the channel of the scope were measured. The Olympus scope without working instrument present, allows for the greatest deflection. The flexible Lithoclast, the non-nitinol baskets, and the 365 microns laser probes significantly inhibit the deflection of all scopes. The greatest deflection with inserted working tool was possible using the Wolf and Storz scopes. Both nitinol tools as well as the 200 microns laser probe had only minimal influence on the deflection. The 200 microns laser probe reduces the irrigation flow from 50 to 28 ml/min. In contrast, the baskets reduce the irrigation flow from 50 to 2 ml/min. There are significant differences of the active and passive flexion depending on the ureterorenoscopes itself and the different tools. In order to perform a successful flexible ureterorenoscopic stone treatment in the lower pole, the inhibition of the flexion of the different scopes together with the individual infundibulopelvic angle must be respected when selecting different tools and probes.

Alloys↗
PubMed2003

Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter.

OBJECTIVES: We evaluated the safety and acute procedural efficacy of a combined electrophysiologic and anatomic approach to ablation of all inducible ventricular tachycardias (VT) during sinus rhythm using an irrigated radiofrequency (RF) ablation catheter. BACKGROUND: Ventricular tachycardia associated with chronic myocardial infarction (MI) is frequently hemodynamically intolerable and associated with multiple electrocardiographic morphologies. Because traditional mapping techniques are contingent on hemodynamic stability for adequate VT mapping, VT ablation therapy for many patients has been disappointing. METHODS: High-density electroanatomic mapping was performed during either sinus rhythm in 11 consecutive patients with a history of MI and ventricular arrhythmias. The RF ablation was performed using an irrigated-tip ablation catheter. All inducible VTs were targeted for catheter ablation during sinus rhythm. RESULTS: The RF ablation lesions were placed in a linear fashion traversing the border zones of infarcted and normal tissue (mean of 3.4 linear lesions/patient). With this strategy, the target VT was eliminated in 9 of 11 patients (82%). Furthermore, when targeting all inducible monomorphic VTs, complete procedural success was achieved in 7 of 11 patients (64%). During the follow-up period (mean 13.1 +/- 1.9 weeks), spontaneous VT was only noted in the two patients with no acute procedural benefit. CONCLUSIONS: By identifying potentially arrhythmogenic tissue during sinus rhythm, substrate mapping can guide the ablation of a majority of inducible VTs using an irrigated RF ablation catheter. This emerging therapeutic paradigm may be considered in the management of patients with multiple hemodynamically unstable monomorphic VTs.

Aged↗
PubMed1993

Effect of irrigation fluids on the articular cartilage: a scanning electron microscope study.

Four irrigation solutions, two for general arthroscopic examination and two for electrosurgery, were evaluated for their effects on the ultrastructure of the articular cartilage surface using an animal model with a scanning electron microscope (SEM). The murine knee joints were irrigated continuously for 1 or 2 h with normal saline, Ringer's lactate, 3% sorbitol, or distilled water, respectively. The articular cartilage of the patella was evaluated in situ; that is, the cartilage was kept intact as it related to the underlying bone tissue, so that artifacts during the biopsy procedure could be prevented. Results of the study showed no significant differences among the four solutions and the unirrigated control group. We conclude that Ringer's lactate, normal saline, distilled water, and 3% sorbitol can all be safely used as irrigation solutions in arthroscopic surgery.

Animals↗
PubMed1997

Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty.

The results of 24 infected total knee arthroplasties (22 patients) that were treated by irrigation, debridement, and retention of the prosthetic components were prospectively studied. Strict criteria were used for the selection of this method of treatment. Patients had to be less than 30 days after index arthroplasty (postsurgical group) or had to have less than 30 days of knee symptoms (hematogenous group). In addition, there had to be no radiographic signs of osteitis or evidence of a loose prosthetic component. Patients had one to three irrigation and debridement procedures depending on systemic signs, knee symptoms, or the results of knee aspirations. All of the immediate postsurgical infections (10 knees) and 10 of the 14 (71%) late hematogenously infected knees retained the prosthesis without further evidence of infection at the final follow-up visit at 48 months (range, 24-140 months). This study shows that in selected circumstances, irrigation, debridement, and retention of the components can result in low morbidity with high success rates.

Aged↗
PubMed2001

Anterior chamber stability during bimanual irrigation and aspiration. Theoretical and experimental analysis.

PURPOSE: To determine the requirements for maintaining a stable anterior chamber during bimanual irrigation and aspiration (I/A) using side-port cannulas. SETTING: Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. METHODS: A theoretical fluid dynamic model of the closed I/A system was developed. Model predictions were compared with experimental flow measurements made on the Alcon Legacy 20000 system using a number of commercial and custom I/A cannulas. RESULTS: Bore diameter, length, and orifice size determine the pressure-flow relationship of cannulas. Four of 18 tested irrigation cannulas were able to maintain anterior chamber stability when used with a 23-gauge/0.3 mm orifice aspiration cannula and maximum aspiration settings. All 4 had a 21-gauge lumen diameter. A shorter cannula length also contributed to higher flow. CONCLUSIONS: Anterior chamber stability during bimanual I/A required the irrigation system to have lower flow resistance than the aspiration system, which can be provided by using cannulas with larger lumen diameters and shorter lengths. Special cannula designs can provide these characteristics without requiring larger side-port incisions.

Anterior Chamber↗
PubMed1986

Particulate and microbial contamination of intraocular irrigation solutions.

The risk of anterior chamber microbial or particulate contamination or both during extracapsular cataract extraction has increased because of the need for large volumes of irrigating solution during the procedure. I performed a clinical trial using an in-line microfiltration apparatus fitted with a 0.8 micron filter. After passing 500 ml volume bottles of each of six manufacturers' irrigating solutions through individual filters, a variety of particulate matter was observed to be trapped by the filter. In addition, I had samples of 500 ml bottles from each of seven manufacturers' irrigating solutions analyzed independently. This independent analysis involved the determination of particulate counts by Coulter counter analysis and photographic documentation of the particulate matter found in the samples. All the solutions were found to contain some particulate matter. The quantity found ranged from as few as 20 particles per ml to as many as 2,400 particles per ml. The results of this study support the use of an in-line microfiltration apparatus during planned extracapsular and phacoemulsification cataract surgery.

Bacteria↗