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PubMed1991

Use of whole bowel irrigation in an infant following iron overdose.

An 11-month-old, 11-kg infant presented to the emergency department after ingesting 130 to 150 mg/kg of elemental iron. Emesis was induced twice and the child was lavaged throughout a 4-hour period with some tablet return. An abdominal radiograph after gastrointestinal decontamination showed at least 16 whole iron tablets remaining in the stomach. Serum iron drawn 2 hours postingestion was 46.7 mumol/L. Blood glucose was 7.7 mmol/L and white blood count was 21,800 mm3. Despite a second lavage 8 hours postingestion, a large number of whole tablets were visualized in the stomach per radiograph. Whole bowel irrigation with polyethylene glycol electrolyte lavage solution (Golytely, Braintree Laboratories, Inc, Braintree, MA) was begun via nasogastric tube 14 hours after the ingestion. Serial abdominal radiographs showed tablet movement out of the stomach within 4 hours after initiating whole bowel irrigation. This case demonstrates the safety and efficacy of WBI in an infant when conventional gastrointestinal decontamination has failed.

Deferoxamine↗
PubMed1992

Whole bowel irrigation in an acute oral lead intoxication.

An 89-year-old man acutely ingested approximately three ounces of a ceramic glaze preparation with a 30% lead oxide content. A blood lead level of 18 micrograms/mL was reported from a sample drawn within 1 hour of ingestion and just prior to gastric lavage. Following lavage, an abdominal radiograph demonstrated lead throughout the small intestine. Whole bowel irrigation was then undertaken and subsequent x-rays demonstrated clearing of all lead in the small bowel. At 16 and 24 hours post-ingestion, blood lead levels rose to 39 micrograms/dL and 42 micrograms/dL, respectively, and the patient then underwent a 5-day course of chelation therapy. This is the first reported case of the use of whole bowel irrigation in an acute lead ingestion. The use of decontamination techniques in acute lead ingestions is reviewed.

Administration, Oral↗
PubMed1994

Antibiotic irrigation and conservative surgery for major aortic graft infection.

PURPOSE: Traditional surgical treatment for panprosthetic aortic graft infection entails radical excision of the graft, aortic stump closure, and extraanatomic revascularization of the lower limbs. This carries an early mortality rate of 24% to 45%. Amputation rates range from 11% to 37%. Multiple operations and prolonged hospital stay are usual. We have developed a more conservative management technique with the aim of improving outcome. METHODS: We describe an innovative method of treating the condition with prolonged, high-dose, local antibiotic irrigation therapy, systemic antibiotic treatment, surgical debridement, and graft conservation in a prospectively studied series of 10 patients. RESULTS: The actual 30-day patient survival rate is 90%, the 1-year survival rate is 80%, and the 4-year survival rate is 67%. Two patients died because of graft infection, and the third died, uninfected, of an unrelated cause. No limbs have been amputated. Only two patients required a second operation. Mean postoperative hospital stay was 32 days. The seven survivors have been closely followed up with regular computed tomography or indium scanning and clinical examination and appear to be free from infection at a mean of 61 months after cessation of irrigation therapy. CONCLUSION: The technique appears to represent a significant improvement in the management of this major complication of vascular surgery.

Adult↗
PubMed1989

Elevated position of the irrigation outflow during arthroscopy: an experimental study.

The purpose of this study was to investigate different types of irrigation systems and to record pressures and flows in a joint model. Gravity inflow and three different pumps were compared, and the level of the outflow in relation to the model was tested. Flow rates of 100-200 ml/min and pressures ranging from negative to 100 mm Hg were found. There were minor differences between the irrigation systems, mainly concerning safety aspects. Elevated position of the outflow could be of value in controlling and optimizing pressures and flows during arthroscopy.

Arthroscopy↗
PubMed1991

Effects of irrigation fluid on human menisci: an experimental comparison of water, normal saline, and glycine.

A technique has been developed to demonstrate the macroscopic morphology of collagen fiber arrangement in human menisci. It was observed that 0.9% normal saline solution removed the ground substance of the meniscus, leaving intact collagen bundles. This suggests that meniscal damage may occur as a direct result of using normal saline for irrigation during knee arthroscopy. Experiments were conducted using demineralized water and 1.5% glycine for comparison. The disruption of collagen fiber binding in the meniscus by normal saline is time and temperature dependent. Glycine solution causes fibroblast lysis and a lesser degree of collagen alteration. Demineralized water can cause edema in the fibroblast but no notable change in collagen fibers. None of the irrigation solutions tested has proved to be completely safe. Demineralized water is not the ideal solution but is preferable to normal saline or glycine solution, especially when it can be used in conjunction with electrosurgery.

Adult↗
PubMed2005

The role of subacromial shoulder irrigation in the treatment of calcific rotator cuff tendinosis: a case series.

OBJECTIVE: To study the efficacy of subacromial shoulder irrigation in the treatment of calcific rotator cuff tendinosis. DESIGN: Consecutive case series. SETTING: Musculoskeletal rehabilitation clinic. PARTICIPANTS: Twenty-eight tennis players (16 women, 12 men; mean age, 44.3y) with calcific rotator cuff tendinosis, who failed conservative measures. INTERVENTION: Subjects underwent fluoroscopically guided subacromial shoulder irrigation (50-75 mL of normal saline in 10 mL aliquots) followed by a corticosteroid injection (5 mL solution of 1 mL triamcinolone [40 mg/mL] and 4 mL of 0.5% bupivacaine). After the procedure, all patients completed the same exercise regimen. MAIN OUTCOME MEASURES: LInsalata Shoulder Rating Questionnaire (LSRQ) score, visual numeric pain score, and patient satisfaction. RESULTS: At 1-year follow-up, 85.7% reported a successful outcome with significant improvements in the LSQR and numeric pain scores. CONCLUSIONS: Our minimally invasive approach was safe, well tolerated, and effective, which should make it useful in providing relief for patients with rotator cuff tendinosis.

Acromion↗
PubMed2006

The influence of a one-step reamer-irrigator-aspirator technique on the intramedullary pressure in the pig femur.

BACKGROUND: Increased intramedullary pressure in the femoral cavity causes intravasation of bone marrow content to the circulation which may lead to occlusion of pulmonary vessels and cardiorespiratory dysfunction. A one-step reamer-irrigator-aspirator (RIA) technique has been developed to reduce the intramedullary pressure (IMP) during the reaming procedure. This study was design to compare IMP with a standard reaming technique with IMP during reaming with the RIA system with a hypothesis that the RIA system would involve lower pressures. MATERIAL AND METHOD: In a randomised study in 19 Norwegian landrace pigs reamed intramedullary nailing was performed with two different reamer devices. Nine animals were operated with a traditional reamer and 10 animals with RIA. One animal in the RIA group was excluded due to a perioperative femoral fracture, and three animals in the traditional group were excluded due to a perforation of the distal medial femoral cortex. The intramedullary pressure was registrated with a transducer-tipped pressure monitoring catheter during reaming. RESULTS: There was a significantly higher intramedullary pressure (P<0.05) during reaming in the traditional reamer group (mean 188+/-38 mmHg) than in the RIA group (mean 33+/-8 mmHg). Intramedullary pressures recorded before surgery, at the opening of the femoral cavity with an awl, by insertion of a guide wire, at insertion of the intramedullary nail, and 10 min after nail insertion showed no significant differences between the groups. CONCLUSION: The use of a one-step reamer-irrigator-aspirator technique in the pig femur induced less intramedullary pressure increase than the use of a traditional reamer.

Animals↗
PubMed2005

Success of simple probing and irrigation in patients with nasolacrimal duct obstruction and otitis media.

PURPOSE: To examine whether, as has been reported in the literature, a history of otitis media (OM) affects the success of probing and irrigation (P&I) for nasolacrimal duct obstruction (NLDO). METHODS: All patients who underwent P&I at the Saint Louis University Eye Institute between 2001 and 2002 were prospectively studied. A preoperative questionnaire assessed the laterality of NLDO and history and laterality of OM. Intraoperatively, site of NLDO and recovery of fluorescein were recorded. The success of the probing was determined by follow-up interview 6 months postoperatively. RESULTS: Overall success of initial P&I was 86.2%. Patients with OM did not have a statistically significant decrease in success of P&I ( P = 1.00, RR 0.920, 95% CI 0.298-2.736 by Yates-corrected chi-square). The failure rate of initial P&I was not statistically different regardless of fluorescein recovery. NLDO occurred most frequently at the valve of Hasner (45.8%). CONCLUSIONS: OM was not a risk factor for initial P&I failure. Omission of fluorescein irrigation to assess patency may save time and cost.

Administration, Intranasal↗
PubMed2005

Intralenticular bimanual irrigation: aspiration for subluxated lens in Marfan's syndrome.

We describe a new technique of aspiration of subluxated lens in young patients with Marfan's syndrome. Two small circular anterior capsulorhexis (1.5 mm to 2.0 mm) openings were created, and bimanual irrigation/aspiration was performed by introducing the irrigation cannula through 1 capsular opening and the aspiration cannula through the other. The irrigation cannula served the dual purpose of hydrating the lens matter and holding the lens in central position to ensure complete aspiration of the lens matter. The lens capsule was later removed and anterior vitrectomy performed by a vitrectomy cutter. This new technique of intralenticular irrigation/aspiration is effective and safe in performing lens aspiration in extensively dislocated crystalline lens in Marfan's syndrome.

Adolescent↗
PubMed2005

Irrigation vs. closed drainage in the treatment of chronic subdural hematoma.

A number of different techniques are used to treat chronic subdural hematomas surgically. In this study, 70 chronic subdural hematomas were surgically treated and analyzed prospectively. Patients were classified according to clinical features and computed tomography images. Results of the cases that underwent burr-hole craniostomy-irrigation (group A; n=35) were compared with those undergoing burr-hole craniostomy-closed system drainage (group B; n=35). The most common etiological factor was trauma in both groups. Complete resolution in the early period was higher in group B compared to group A (60% vs. 40%). However, no difference was noted at the first month-follow-up. Recurrence rates were 17% in group A and 14% in group B. No significant difference was noted in terms of hospitalization duration or postoperative complications. In conclusion, we believe that the burr-hole craniostomy-irrigation technique is a reliable and effective method compared to burr-hole craniostomy-closed system drainage in the treatment of chronic subdural hematoma.

Adolescent↗
PubMed2006

Comparative evaluation of endodontic irrigants against Enterococcus faecalis biofilms.

The aim of this study was to compare the efficacy of root canal irrigants against E. faecalis biofilms using a novel in vitro testing system. Biofilms grown in a flow cell system were submerged in test irrigants for either 1 or 5 minutes. Statistical analysis revealed a significant relationship between test agent and percentage kill of the biofilm bacteria (P < 0.05). No statistically significant relationship between time and percentage kill was found. The percentage kill of the biofilm bacteria was: 6% NaOCl (>99.99%), 1% NaOCl (99.78%), Smear Clear (78.06%), 2% chlorhexidine (60.49%), REDTA (26.99%), and BioPure MTAD (16.08%). Post-hoc analysis showed a significant difference between 1% and 6% NaOCl, and all other agents including Smear Clear, 2% chlorhexidine, REDTA, and BioPure MTAD (P < 0.05). Within the parameters of this study, both 1% NaOCl and 6% NaOCl were more efficient in eliminating E. faecalis biofilm than the other solutions tested.

Analysis of Variance↗
PubMed2006

Ultrastructure of smear layer-covered intraradicular dentin after irrigation with BioPure MTAD.

The structure of mechanically instrumented intraradicular dentin after irrigation with NaOCl as the initial rinse and BioPure MTAD as the final rinse were examined from the coronal, middle, and apical parts of root canal walls using transmission electron microscopy. Sterile distilled water and EDTA as final rinses were employed as the respective positive and negative controls under the same experimental conditions. There were 2 to 5 mum thick smear layers produced on mechanically instrumented root canal walls that were completely removed by EDTA and BioPure MTAD under agitation. Both irrigants created a zone of demineralized collagen matrices in eroded dentin and around the dentinal tubules, with the mildly acidic BioPure MTAD being more aggressive than EDTA. These demineralized dentin zones create the opportunity for dentin hybridization by infiltration of hydrophilic adhesives/sealers. However, the potential consequences of compaction of hydrophobic sealers against air-dried, collapsed collagen matrices, and hydrolytic degradation of incompletely infiltrated matrices remain unresolved.

Bicuspid↗
PubMed2006

The effectiveness of different acid irrigating solutions in root canal cleaning after hand and rotary instrumentation.

The goal of this study was to evaluate the cleaning ability of three acid irrigating solutions after hand and rotary instrumentation. Eighty human teeth were randomly divided in eight groups. Four groups were prepared with hand instrumentation and other four with ProTaper. The irrigating solutions were 15% citric acid plus 2.5% NaOCl; 15% EDTA plus 2.5% NaOCl; 5% orthophosphoric acid plus 2.5% NaOCl; and 2.5% NaOCl alone as control. Canal walls were observed with scanning electron microscopy, and photomicrographs were taken in apical, middle, and coronal thirds. A scoring system for debris and smear layer was used. Acid solutions with 2.5% NaOCl were effective in the elimination of smear layer or debris, and no significant differences were showed in smear layer removal between techniques. However, 2.5% NaOCl did not remove smear layer or debris, and no significant differences in debris were observed between manual and rotary techniques.

Acids↗
PubMed2005

The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms.

OBJECTIVE: To assess quality of life (QOL) in patients with sinonasal symptoms in response to hypertonic saline nasal irrigation (HSNI), and to assess HSNI use patterns. STUDY DESIGN AND SETTING: The study was an uncontrolled 12-month follow-up to a randomized controlled trial (RCT) and used HSNI in a community setting. We included 54 participants with recurrent or chronic sinonasal symptoms. Forty participants had been in the intervention group of a previous study; 14 had been control participants. Primary outcome measures were the Rhinosinusitis Disability Index (RSDI), a sinus-symptom severity assessment (SIA), and the Sino-Nasal Outcomes Test (SNOT-20). Secondary outcome measures were frequency and pattern of HSNI use, side effects and satisfaction. RESULTS: Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 +/- 2.6 points to 80.6 +/- 2.4 points (P < 0.001). SIA and SNOT-20 scores remained stable. Former control participants reported QOL improvement similar to that of HSNI users in the prior RCT. RSDI scores improved from 62.0 +/- 3.9 points to 79.7 +/- 3.7 points (P < 0.05), SNOT-20 scores improved from 43.5 +/- 5.7 points to 28.4 +/- 4.8 points, and SIA scores improved from 4.2 +/- 0.3 points to 2.6 +/- 0.3 points (P < 0.01). Mean HSNI use for all participants was 2.4 irrigations per week; 33% of participants used HSNI regularly, 55% when symptomatic. Side effects were minor; satisfaction was high. CONCLUSIONS: Participants with chronic sinonasal symptoms reported improved QOL and frequent, satisfying use of HSNI. SIGNIFICANCE: HSNI is an effective adjunctive treatment of chronic sinonasal symptoms.

Adult↗
PubMed2005

Head position dependency of induced nystagmus to ice-water irrigation in peripheral vestibulopathy.

OBJECTIVE: Evaluation of head-position dependency during the ice-water test is essential when the test is indicated. Because ice-water irrigation (IWI) in the prone position is frequently skipped in many laboratories, we investigated the importance of evaluating position dependency in an ice-water test. DESIGN AND SETTING: Twenty-five unilateral peripheral vestibulopathy patients showing no nystagmus during warm irrigation were included. IWI was performed in supine and prone positions, and maximum slow-phase velocity and direction of nystagmus were assessed by using video nystagmography. RESULTS: Eleven cases showed head-position dependency and were interpreted as hypofunctional. Fourteen cases showed no dependency, suggesting the absence of end organ function. In the latter group, 6 patients showing definite nystagmus in supine position could have been misinterpreted as hypofunctional, had it not been for prone-position results. CONCLUSIONS: Evaluation of head position dependency by using IWI is important in the determination of lateral semicircular canal function.

Adult↗
PubMed2004

Possible harmful effects on central nervous system cells in the use of physiological saline as an irrigant during neurosurgical procedures.

BACKGROUND: Physiologic saline is routinely used as an irrigant in neurosurgery especially in Japan. Cerebrospinal fluid (CSF) differs from physiologic saline in its concentration of inorganic salts, osmolality, and pH and is completely different insofar as it contains glucose, protein, cholesterol, and other lipids. The present study was designed to compare the possible functional and morphologic deleterious influence of these differences on cultured rat neural cells using saline (S), Ringer's solution with glucose (Lactec G, LG; Otsuka Pharmaceutical Co.; Tokyo, Japan) and without glucose (Lactec, L; Otsuka Pharmaceutical Co.), and an artificial CSF (ACSF). METHODS: Primary cultured rat neurons and astrocytes were divided into five groups according to the medium used, the four experimental groups (ACSF, L, LG, and S) and one control group (C). At various time points up to 24 hours, the rhodamine 123 uptake by neuronal or astrocytic cellular mitochondria was evaluated as cell function assessment. Morphologic assessment for both neuron and astrocyte culture was carried out with scanning electron microscopy (SEM) at the 24-hour time point. RESULTS: SEM showed little difference between the C and ACSF groups, whereas morphologic deterioration was particularly severe in the S group for both neurons and astrocytes. In the case of neuronal mitochondrial activity, the L and S groups demonstrated respectively severe and some deterioration, particularly in the mitochondria of the neuronal processes. The deleterious effects in mitochondrial activity of the S group were even more apparent in the astrocytic cells. CONCLUSION: These results suggest that physiologic saline, when used as an irrigant in neurologic surgery, might in some circumstances cause damage to exposed and compromised neural cells.

Animals↗
PubMed2006

The use of a sump antibiotic irrigation system to save infected hardware in a patient with a vagal nerve stimulator: technical note.

The authors describe the use of a sump irrigation system that was used to successfully treat the battery implantation site of a vagal nerve stimulator (VNS). Irrigation was composed of a dilution of vancomycin in lactated Ringer's solution. At long-term follow up, the patient has not returned with signs or symptoms of wound infection. She continues to effectively combat her epilepsy with VNS. The authors believe this to be the first description of this technique for salvaging an implanted VNS.

Anti-Bacterial Agents↗
PubMed2007

The antimicrobial effects of root canal irrigation and medication.

The role of microorganisms in the development and maintenance of pulpal and periapical inflammation have been well documented. The success of root canal treatment largely depends on the elimination of microbial contamination from the root canal system. Although mechanical instrumentation of root canals can reduce bacterial population, effective elimination of bacteria cannot be achieved without the use of antimicrobial root canal irrigation and medication. This review will discuss the antimicrobial effects of the known root canal irrigants and medicaments and explore future developments in the field.

Anti-Bacterial Agents↗