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At least 1,081 records · Page 60Linked to original sources
PubMed2002

Irrigated-tip catheter ablation of pulmonary veins for treatment of atrial fibrillation.

INTRODUCTION: Catheter ablation of pulmonary veins (PV) for treatment of atrial fibrillation (AF) is limited by the disparate requirements of sufficient energy delivery to achieve PV isolation while avoiding PV stenosis. The aim of the present study was to evaluate the safety and efficacy of using an irrigated-tip catheter for systematic isolation of PV. METHODS AND RESULTS: The study population consisted of 136 consecutive patients (109 men, mean age 52 +/- 10 years) with symptomatic, drug-refractory paroxysmal (122) or persistent (14) AF. Cavotricuspid isthmus ablation and systematic radiofrequency isolation of all four PVs (guided by a circumferential mapping catheter) was performed in all patients with a protocol using an irrigated-tip catheter. PV diameter was assessed by selective angiography. The electrophysiologic endpoint of PV isolation was achieved in 100% of patients. Bidirectional cavotricuspid isthmus block was achieved in 99% of patients. Moderate PV stenosis (50% narrowing) was observed in one patient (0.7%) without clinical consequence. No other complications were observed. Reablation procedures were required in 67 patients (49%). After a mean follow-up of 8.8 +/- 5.3 months, 81% of patients were free of AF clinical recurrence, including 66% not taking any antiarrhythmic drugs. CONCLUSION: Systematic radiofrequency ablation of PV using an irrigated-tip catheter in patients with atrial fibrillation allows complete isolation of all four PVs with a very low incidence of stenosis.

Adult↗
PubMed2002

Sigmoid irrigation tube for the management of chronic evacuation disorders.

BACKGROUND/PURPOSE: Antegrade colonic irrigation, in which the right colon is accessed via appendicostomy or cecostomy, now is an important adjunct in the management of children with chronic evacuation disorders. However, in most children, the major area of dysfunction is the left rather than the right colon. The authors developed a simple, percutaneous endoscopic, laparoscopically controlled sigmoid irrigation tube placement and evaluated the results in 4 children. METHODS: A rigid sigmoidoscope is advanced into the upper sigmoid and the loop brought in contact with the abdominal wall under laparoscopic control. A small skin incision is made and a needle pushed across the abdominal and sigmoid walls into the lumen of the sigmoidoscope. A guide wire is advanced through the needle into the scope and retrieved. After the scope is removed, a PEG-type catheter is attached to the guide wire and pulled back, securing the sigmoid loop to the abdominal wall. The tube is subsequently converted to a skin-level device by simply adding an external port valve. RESULTS: All 4 patients achieved prompt evacuation in the sitting position. CONCLUSIONS: Sigmoid tube for antegrade irrigation is an appealing alternative to conventional cecal access. The procedure is simple and may offer physiologic advantages.

Adolescent↗
PubMed2000

Infected total knee arthroplasty treated by arthroscopic irrigation and débridement.

Sixteen patients with infected total knee arthroplasties (4 postoperative and 12 late hematogenous) were treated by arthroscopic irrigation and débridement. All patients had < or = 7 days of knee symptoms, and there were no radiographic signs of osteitis or prosthetic loosening. Six of the 16 original total knee arthroplasties (38%) did not need prosthesis removal at a mean follow-up of 64 months (range, 36-151 months). Ten other knees were treated with irrigation, débridement, and hardware removal within 7 weeks of the latest procedure used to try to retain components. Two (13%) of these cases ultimately required an arthrodesis for persistent infection. Although we still believe that this method is preferable to resorting immediately to implant removal for acute infections, arthroscopic débridement was less efficacious for most situations when compared with open treatment. We would use arthroscopic irrigation and débridement only under selected circumstances (medically unstable or anticoagulated patients).

Aged↗
PubMed1999

Closed continuous irrigation in the treatment of hand infections.

We report our experience with a closed continuous irrigation system in 12 patients with hand infections: six cases of flexor tenosynovitis, three cases of septic arthritis and three palmar abscesses. Four of these patients had undergone previous surgical debridement and peroperative washout without elimination of the infection. The continuous irrigation system consists of two fenestrated tubes placed within the infected space, with the tip of the smaller calibre inlet tube positioned just inside the larger outlet tube. Resolution of infection was achieved in all 12 cases and all regained complete functional recovery. The closed continuous irrigation system is easy to manage, with no leakage of fluid; hand therapy may be started early and the patient is mobile throughout.

Abscess↗
PubMed2000

Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis.

The records of 75 patients admitted with pyogenic flexor tenosynovitis at two academic centers were reviewed. The functional outcomes of patients who received intraoperative irrigation only (n = 20) and those that had both intraoperative irrigation and continuous postoperative irrigation (n = 55) were compared. There were no statistically significant differences between the outcomes in the two groups.

Adolescent↗
PubMed1999

[Irrigation drainage and fibrinolysis for treatment of parapneumonial pleural empyema].

UNLABELLED: We report on our experiences on 336 patients suffering from manifest pleural empyema within a period of 10 years (1985-1995). Considering the pathogenesis, particularly the results of 218 patients with "parapneumonic pleural empyema" were analysed retrospectively. Definite healing could be achieved by chest tube placement and pleural irrigation in 201 patients (= 92.2%). Other 11 patients finally needed surgical interventions (= 5%). Only 6 patients could not be cured: An indwelling tube was palliatively inserted once and 5 patients died in the course of the medical treatment (mortality = 2.3%). Within the first years the irrigation therapy was performed using a single chest tube (n = 38%) but since 1989 a double-lumen drainage was used (n = 158). Since 1987 in most cases (n = 182) intrapleural medicinal fibrinolysis was performed by instillation of streptokinase (Varidase N). If outward invasively pretreated patients (n = 30) are analysed separately, a statistical dependency can be found between the duration and the way of treatment. Without significant difference between the groups (Gr) the average duration of treatment using a single tube without fibrinolysis (Gr1) was 31.8 days, but 26.5 days using a single tube combined with fibrinolysis (Gr2). A clear shortening of the duration is detectable if patients were treated with a combination of double lumen drainage and fibrinolysis: If 2 tubes were used (Gr4) the treatment lasted 20.6 days, using one double-lumen tube (Gr5) it took 19.8 days. There is a proof of significance at comparison of Gr4 with Gr1 (p = 0.005). Gr5 with Gr1 (p < 0.001) and Gr5 with Gr2 (p = 0.014) respectively. A significant longer duration of treatment (40.6 days, p < 0.001) is found for the group of the pretreated patients, if compared with the corresponding groups Gr4 or Gr5. CONCLUSION: Parapneumonic empyemas most often can be cured by irrigation drainage. The mortality is comparatively low. The shortest duration of treatment is needed using the combination of a double-lumen tube with intrapleural instillation of a fibrinolytic agent (Varidase N). Invasively pretreated patients need significantly longer durations at same form of treatment.

Adolescent↗
PubMed2003

A treatment for biliary hypoplasia: tube cholecystostomy and irrigation.

PURPOSE: Biliary Hypoplasia (BH), characterised by a small ductal system and reduction in the number of interlobular bile ducts, has a bad prognosis. It has been claimed that other treatment methods apart from liver transplantation are not effective. Seven patients with BH underwent tube cholecystostomy, decompression and saline irrigation of the biliary tree via tube cholecystostomy. We present our treatment method, together with the early and late biochemical and histopathological results of these patients. PATIENTS AND METHODS: The records of seven patients with BH were reviewed retrospectively. BH was proved by operative cholangiography. Irrigation was performed intermittently with warm saline to the biliary tract via tube cholecystostomy over two to three months. SGOT, SGPT, alkaline phosphatase (AP) and bilirubin levels were evaluated preoperatively and postoperatively. Histopathological findings were also evaluated. RESULTS: Median age at operation was 46 days (range 20 - 90 days). There were six males and one female. Five patients recovered completely. There was a statistical difference between preoperative and postoperative SGOT, SGPT, AP, and bilirubin levels of patients who recovered (p < 0.05). CONCLUSION: Similar to biliary atresia, many factors such as the patient's age, postoperative bilirubin level, histopathology of liver, treatment method, and cholangitis as a complication of the surgical procedure affect the prognosis of BH. Operation before the age of 70 days, normal bilirubin levels after operation, no cholangitis attack, intracellular and intracanalicular cholestasis, and mild mixed cellular infiltration are favourable factors. We believe that decompression and irrigation of the biliary tract is an effective treatment method for suitable cases of BH.

Adult↗
PubMed2006

[Nasal irrigation in case of rhinosinusitis].

Nasal irrigation has proven in several recently published articles its clinical effectiveness and its neglectable rate of side effects even in children and during pregnancy. In most guidelines for the treatment of various nasal pathological conditions nasal irrigation is recommended as stand alone or as additional therapy. Although no common treatment protocol exists, a isotonic (0.9 %) or slightly hypertonic solution (3 - 5 %) is suggested because of its positive influence upon mucociliary clearance. Buffered solutions bring a more pleasant feeling during rinsing, which explains also the beneficial effect of natural brine solutions. In children, nasal irrigation can save antibiotics and reduce decongestant to nil. Important is the hygienic application in order not to introduce additional pathogenic germs into the nasal system.

Administration, Intranasal↗
PubMed2003

Visually guided irrigation for patients with symptomatic internal derangement of the temporomandibular joint: a preliminary report.

OBJECTIVE: Visually guided irrigation (VGIR) is simple joint irrigation with minimally invasive intracapsular inspection through the use of a thin arthroscope. The aims of the present study were to develop VGIR for the superior joint compartment of the temporomandibular joint (TMJ) by using a 1.2-mm-diameter rod-lens arthroscope and to examine the short-term clinical outcomes. The correlation between the clinical outcome of VGIR of the TMJ and intracapsular findings was also evaluated. STUDY DESIGN: Twenty patients who underwent VGIR for symptomatic internal derangement of the TMJ (n = 20) were enrolled in this study. The clinical outcome of VGIR was evaluated in terms of the improvement in the painless range of mandibular motion (ROM: interincisal distance in millimeters), and functional jaw pain was evaluated by using a visual analog scale (VAS) ranging from 0 to 100. Painless ROM and VAS scores 6 months postoperatively were compared with the preoperative data. A good clinical outcome was defined as an increased ROM (ROM > 38 mm) and a decreased VAS score (VAS score < 20%, and <60% of the preoperative level). With respect to these criteria, all joints were classified into either good clinical outcome (GO) or poor clinical outcome (PO) groups. The difference in the distribution of the arthroscopic findings obtained during VGIR, with respect to severity, was analyzed between the GO and PO groups. RESULTS: None of the 20 patients experienced any serious local or systemic complications, including the breakage of instruments. We were able to perform a reliable intracapsular diagnosis during VGIR. Sixteen of 20 patients (80%) had significant improvements in postoperative painless ROM and the VAS score of functional pain, thereby being classified into the GO group. The distribution of the severity of intracapsular findings did not differ significantly between the GO group and the PO group. CONCLUSIONS: VGIR is useful for the treatment and diagnosis of internally deranged TMJs. These data suggest that the clinical outcome of TMJ irrigation is not related to the intracapsular condition of the superior joint compartment.

Adult↗
PubMed2000

Intravesical pressure during irrigating fluid absorption in transurethral resection of the prostate.

OBJECTIVE: In order to control fluid absorption, various approaches are used to reduce intravesical pressure during transurethral resection of the prostate (TURP). With a view to finding a target pressure for such efforts, pressure and fluid absorption were compared in a meta-analysis of four previous studies comprising three different irrigation techniques. MATERIALS AND METHODS: Intravesical pressure was recorded during TURP in which the irrigating fluid was evacuated intermittently (n = 48) by a suprapubic tube (n = 23) or a trocar (n = 30). Fluid absorption was compared with the mean and maximum pressures and the duration of excessive pressure (>2 kPa) over 10-min periods. RESULTS: Mean bladder pressure during fluid absorption was between 1.0 and 2.5 kPa. The maximum pressure during absorption varied greatly during the first 30 min of TURP, but thereafter it ranged between 2 and 3 kPa. Only the duration of pressures >2 kPa increased with fluid absorption (p < 0.02). The maximum pressures were highest with the intermittent technique, while the other indices of intravesical pressure showed the highest values when the suprapubic tube was used. The lowest pressures usually occurred when the trocar was used, but fluid absorption still occurred, as the pressure was much higher during some of these operations. CONCLUSIONS: Fluid absorption occurred at moderate intravesical pressures with all three irrigation techniques. The best strategy for reducing fluid absorption is to keep the pressure below 2 kPa for as long as possible during TURP.

Absorption↗
PubMedDate not supplied

Transmural atrial insulating lesions using epicardially applied radiofrequency energy coupled with saline irrigation.

The Maze procedure has been demonstrated to eliminate atrial fibrillation (AF) refractory to medical management. The procedure, however, is technically difficult and requires prolonged cardiopulmonary bypass (CPB). We investigated the use of epicardially applied radiofrequency (RF) energy delivered using a saline-irrigated probe to functionally reproduce the linear lesions of the surgical Maze procedure. The goals of this study were to safely produce transmural atrial insulation lines without CPB and to investigate whether they could retain their electrical insulation properties and structural integrity over an acute time period. Baseline pacing thresholds were measured on the atria of six swine. Then, circular insulating lesions (n = 11) were created around each pacing site using a saline-irrigated RF probe and specifically designed radiofrequency generator. Pacing thresholds were repeated at the same atrial sites, and in adjacent areas, immediately following lesion creation and at 7 days. At sacrifice the areas of interest were removed for histopathology. Pacing thresholds increased from 0.9 +/- 0.09 V to 9.59 +/- 0.87 V immediately following lesion formation (p <.05) and remained supraphysiologic at 4.05 +/- 0.36 V after 7 days (p <.05). Thresholds from outside the lesions were unchanged from baseline. There was no evidence of perforation and histologic analysis demonstrated transmural necrosis with advancing granulation tissue. Our data suggest that epicardially applied RF energy coupled with saline irrigation can produce transmural electrical insulation lines for up to 7 days. However, the decreasing trend in thresholds toward baseline suggests further investigation is needed to verify insulation line continuity over a chronic time period. These lines were created safely and efficiently without CPB, and may be applicable to a minimally invasive Maze procedure.

Animals↗
PubMed2001

Optimization of debris removal during bladder irrigation.

Debris build-up within the bladder is one of the main problems encountered by patients undergoing long term catheterization. One of the methods of ameliorating this is to wash out the bladder at regular intervals. In this paper, an alternative method of bladder irrigation is investigated experimentally. The effectiveness of several possible catheter designs has been examined, together with other relevant variables such as the proximity and alignment of the tube tip to the debris and the irrigation flow rate. Results show that debris removal is very sensitive to tube design, with best designs achieving almost complete removal and the worst practically none. The proprietary continuous irrigation catheter used was particularly poor for the type of debris used. Removal is insensitive to the distance of the tube tip from the bladder base up to a limiting value, above which it reduces rapidly. Where misalignment causes the inlet jet to miss the debris, removal rates are very low. Increasing flow rate increases removal up to a limiting value, above which it remains constant. Although the results show the general trends, to optimize the system requires further understanding of the detailed flow patterns within the bladder. A theoretical study using computational fluid dynamics is thus being undertaken.

Administration, Intravesical↗
PubMed1995

Effect of temperature and flow rate of irrigant on coagulation necrosis in canine prostate treated with neodymium:YAG laser.

We studied the effect of the irrigant temperature (5 degrees-38 degrees C) and flow rate (100-500 mL/min) on the extent of coagulation necrosis induced during Nd:YAG laser irradiation in the canine prostate model. The tissue response was quantified based on histopathologic evaluation of the lesions. Changing the irrigant temperature or the flow rate within the ranges studied did not significantly affect the size of the thermal lesions. The intraprostatic temperature distribution during laser irradiation is mainly governed by blood perfusion rather than by irrigant variables.

Animals↗
PubMed2006

Appendicostomy stomas and antegrade colonic irrigation after laparoscopic antegrade continence enema.

BACKGROUND: Children with spina bifida, high anorectal anomalies, or neuronal intestinal dysplasia who are treated with a laparoscopic antegrade continence enema to achieve a socially acceptable level of fecal continence sometimes have problems with the stoma and its catheterization. The goal of this study was to determine the nature and incidence of these problems, and their relationship to the underlying condition. MATERIALS AND METHODS: A retrospective review of the hospital case notes of 74 consecutive patients who had a laparoscopic antegrade continence enema was undertaken. RESULTS: The laparoscopic antegrade continence enema procedure is well tolerated but is associated with a variety of usually minor complications including stomal stenosis, leakage, peristomal infection, granulation tissue overgrowth, mucosal prolapse, abdominal discomfort during irrigation, appendiceal false passage, and ineffective irrigation. Surgical revision of the stoma was required in 19% of the cases in this study, usually because of stenosis and skin overgrowth. Ongoing problems achieving colonic emptying were most likely to occur in patients with an anorectal malformation. CONCLUSION: Overall, the laparoscopic antegrade continence enema provides an effective method of facilitating emptying of the bowel. However, it has a high incidence of minor troublesome problems, with stenosis and skin overgrowth of the stoma being the most common. Younger children tend to have more complications and difficulty performing effective irrigation. Children with anorectal malformations were more likely to require surgical revision of the stoma, and often needed ongoing manual evacuation and bowel washouts despite the laparoscopic antegrade continence enema.

Adolescent↗
PubMed1993

Laparoscopic irrigation using a prewarmed pressurized system.

An automatic pressure infusion system equipped with a fluid warmer has been developed for rapid intravenous infusion of homeothermic fluids. The use of this system for irrigation during operative laparoscopy provides the surgeon with the ability to irrigate at a relatively high flow while avoiding the hypothermic effects of irrigation with cool fluids.

Fluid Therapy↗
PubMed1987

Influence of variations in blood haemoglobin concentration on the calculation of blood loss and volumetric irrigating fluid balance during transurethral resection of the prostate.

Blood loss in 38 patients undergoing transurethral resection of the prostate (TURP) was calculated in four different ways by using various reference blood haemoglobin determinations (B-Hb) during the course of preparation and surgery. Blood loss became greater the later the B-Hb was drawn. This increase was because variations in B-Hb acted to underestimate the loss of plasma. The variations also distorted the irrigating fluid balance to give too low values for the absorption of irrigating fluid. It is possible to correct for the errors in blood loss and volumetric fluid balance by the use of haemodilution factors. Haemodilution was greater in patients with complications such as absorption of irrigating fluid or excessive blood loss than in patients without such features if Ringer's acetate was used for i.v. fluid supplementation. With dextran 40, all patients had a similar degree of haemodilution.

Aged↗
PubMed1999

Encephalopathy after bladder irrigation with alum: case report and literature review.

A 70-year-old man with advanced obstructive nephropathy began to hemorrhage from the bladder after decompression with a Foley catheter. Manifestations of encephalopathy appeared after continuous irrigation with 1% alum for 2 days and were associated with elevated serum aluminum concentrations. Repeated treatments with deferoxamine and hemodialysis accomplished some aluminum removal, but the patient succumbed to bronchopneumonia. Brain aluminum content was not excessive at autopsy. A literature review suggests that intact renal function is essential to rapid disposal of a parenteral aluminum load and indicates that most reported instances of encephalopathy after alum irrigation have occurred in patients with compromised renal function. We conclude that alum should not be employed as a bladder irrigant in patients with acute or chronic renal failure.

Aged↗
PubMed2002

Closed-catheter irrigation is as effective as open drainage for treatment of pyogenic flexor tenosynovitis.

Surgical treatment of pyogenic flexor tenosynovitis traditionally consists of open drainage (OD) and irrigation of the flexor tendon sheath. An alternative, less traumatic method of closed-catheter irrigation (CCI) has been advocated, but no comparative studies have been reported. The authors reviewed 47 cases of pyogenic flexor tenosynovitis to determine whether a difference in outcomes exists between these two methods. OD was used in 32 patients and CCI was used in 15 patients. Complications appeared to be more common in the OD group (N = 9) compared with the CCI group (N = 3), but this difference was not significant. This study supports the use of CCI as the preferred treatment for pyogenic flexor tenosynovitis because it provides thorough mechanical tendon sheath irrigation and causes smaller wounds with less scarring, which may offer a more rapid return to function.

Adolescent↗