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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A group of 176 patients undergoing cardiac surgery utilizing a technique of rapid core hypothermic cardioplegia with a hyperosmotic solution is presented. A cold, 2 to 4 degrees C hyperosmotic (396 mOsm) perfusate, injected under pressure, induced cardiac arrest without fibrillation within 2 to 4 seconds in every instance. At the end of each procedure, flushing of the cold solution out of the coronary system re-establishes spontaneous normal sinus cardiac rhythm in 96% (119 of 124) of coronary surgical procedures, 69% (11 of 16) of aortic valve replacements, 62% (10 of 16) of mitral valve replacements, 55% (five of nine) of aortic valve replacements combined with multiple coronary grafting, 57% (four of seven) of mitral valve replacement combined with multiple coronary grafting, and in 50% (two of four) of double valve replacements. Combined core and topical hypothermia with ice slush used in valve replacements and combined valve with coronary operations allowed periods of total ischemia up to 134 minutes without signs of detectable myocardial damage.
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PMID:Cardioplegia without fibrillation or defibrillation in cardiac surgery. 30 Sep 6

Simple flushing and cold storage of human kidneys for transplantation has not been accepted for preservation times exceeding 24 hours. A prospective study of 25 primary cadaver kidney transplants was performed to evaluate Collins C2 solution for human kidney preservation. Cold storage time was 10 to 23 hours in 14 cases and 26 to 44.5 hours in 11 cases. Seventeen (68%) of the kidneys had immediate, sustained function. The one-month function rate was 88%. There were no significant differences between the 10- to 23-hour and the 26- to 44.5-hour groups with respect to the incidence of first-week dialysis, one-month graft function, or mean lowest serum creatinine value. Human kidney preservation time can be safely extended beyond 24 hours with Collins C2 flushing followed by simple cold storage.
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PMID:Human kidney preservation by flushing with intracellular solution and cold storage. 35 90

Canine kidneys, flushed with either Collins solution or autologous cryoprecipitated plasma, were then stored for 24 hr by either simple cold storage (submersion) in the flushing solution, or by continuous hypothermic pulsatile perfusion with cryoprecipitated plasma. After autotransplantation without contralateral nephrectomy, detailed split renal function studies were carried out immediately as well as 2 and 7 days later. Measurements were made of inulin clearance, maximal transport of p-aminohippurate, reabsorption of sodium, chloride, and glucose, and the reabsorption of free water. Contralateral nephrectomy was performed 7 days after transplantation, following measurement of renal functions on that day, and plasma urea nitrogen and creatinine were measured periodically over the ensuing 3 weeks. Renal function after transplantation was affected very little by the choice of flushing solution, and the course of azotemia that developed following contralateral nephrectomy was the same in all groups. However, the detailed functional measurements showed that during the 7-day period after transplantation, renal function was depressed to a much greater extent in kidneys treated by simple cold storage than in those that had been perfused.
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PMID:Function of autotransplanted kidneys after 24-hour preservation by hypothermic pulsatile perfusion or simple cord storage. 36 May 23

In situ flushing of kidneys through an isolated segment of aorta was done on mongrel dogs. The 500 cc cold perfusate at 3 to 4C (delivered in 6 minutes) effectively cooled the kidneys to about 15C. This simplified technique of in situ flushing, its usefulness and rationale are discussed.
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PMID:In situ flushing of donor kidneys: its technique and rationale. 37 63

Flushing of harvested kidneys with hypothermic perfusates is presumed to cause inappropriate circulation due to vasospasm. Effects of initial normothermic flushing prior to hypothermic flushing and cold preservation were tested in canine kidneys. Analysis of the perfusion characteristics revealed that a brief initial flushing with solutions at 37 degrees C. eliminates vasoconstriction and even facilitates subsequent hypothermic flushing. In amounts not exceeding 100 cc. it was not deleterious to transplant function. Larger volumes of normothermic flushing were proved to cause endothelial injury and resulted in poor transplant survival.
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PMID:Effects of preliminary normothermic flushing on hypothermic renal preservation. 38 6

Gaseous oxygen perfusion of the stored kidney provides life-supporting renal function in canine kidneys damaged by 30 min of warm ischaemia followed by cold storage for a total of 24 hr. Other simple methods of renal preservation, including simple flushing and cold storage and oxygenation of the flush solution and the fluid surrounding the kidney during storage, did not result in consistent life-supporting renal function under these experimental conditions. Low pressure venous oxygen perfusion of the kidney produced significantly better renal function than arterial oxygen perfusion as measured by post-transplant creatinine values. This preservation technique uses apparatus readily available in hospitals and once instituted does not require supervision. It may have clinical application in cadaveric renal transplantation, particularly if the donor kidney has been subjected to warm ischaemia.
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PMID:Gaseous oxygen perfusion of the renal vessels as an adjunct in kidney preservation. 39 31

Four solutions for initial flushing of kidneys prior to transplantation were tested under conditions designed to resemble those of clinical cadaveric donor renal transplantation. The experimental model was the dog subjected to bilateral nephrectomy with renal autograft. Kidney grafts were subjected to 15 minutes' anoxia in vivo, 30 minutes' warm ischaemia at 37 degrees C ex vivo, and two hours' cold ischaemia before reimplantation. The four solutions used were Collins (C3), Perfudex (P), hyperosmolar citrate (HC), and a solution of bovine albumin containing dog red blood cells (BBA). Effects of the flushing fluids were compared by parameters relating to dog survival, renal function, and serum enzyme levels. With all parameters studied the best results occurred in HC perfused kidneys. Results with BBA perfusion were marginally worse, while C3 perfused kidneys were again inferior. P perfused kidneys clearly did least well. The results support the use of HC for clinical application.
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PMID:A comparison of flushing fluids for initial perfusion of kidneys for transplantation. 39 35

Hilar drainage fluid of dog kidneys was analyzed as an approximation to renal extracellular fluid after preservation by flushing with chilled high K-low Na solution (Collins C4) followed by ice-cold storage for 24 and 48 hr in a bath of flushing medium. Compared with the medium, Na and Cl were increased to 30 mM/liter and K decreased slightly to 93 mM/liter. Glucose decreased, whereas lactate, lactic dehydrogenase, and creatine phosphokinase increased by significant amounts in both the drainage fluid and bath. The inulin space of the undrained kidney average 37% of wet weight. Calculated intracellular Na and Cl concentrations averaged 50 and 37 mM/kg cell water while K remained within normal limits. A significant fraction of red blood cells retained during initial flushing entered the effluent during storage. Bath and effluent composition of a human cadaver kidney approximated those of a dog.
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PMID:Extracellular fluid of the kidney preserved by the Collins technique. 46 28

The isolated perfused rat kidney has been used to study the effects of cold ischaemia during ice storage. Tissue adenine nucleotide levels in freeze-clamped kidneys were closely correlated with their function after circulation had been reestablished in the perfusion circuit. The ATP content was depleted to a greater extent than total adenine nucleotide after 8 hr of cold ischaemia but both were considerably diminished after 24 hr. The model was also used to compare four solutions which are available clinically for preliminary flushing of organs in the ice storage preservation technique. The results indicated that for periods of 8 and 24 hr of cold ischaemia, renal function and adenine nucleotide content were significantly better maintained with a solution based on hyperosmolar citrate than with Collins, Sacks, or Perfudex solutions. This study confirmed recent observations of the clinical efficacy of citrate solution, while demonstrating how the isolated perfused rat kidney could be used for rapid screening of modifications in preservation techniques.
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PMID:Evaluation of hypertonic citrate flushing solution for kidney preservation using the isolated perfused rat kidney. 65 4

Cold nonperfusional (flushing and ice storage) with Collins or Sacks solution and perfusional preservation with cryoprecipitated plasma or albumin were compared in dog kidneys. All these methods were effective in achieving excellent 48-hour preservation of fresh kidneys. After exposure to 20 minutes of ischemia at 37 C, neither of the flushing solutions yielded kidneys that permitted survival of recipients after 48 hours of preservation, and flushed kidneys functioned poorly after 24 hours of preservation. In contrast, both plasma- and albumin-perfused kidneys exposed to ischemia supported life satisfactorily and with normal function. Therefore, simple and inexpensive flushing and ice storage techniques are entirely satisfactorily for the preservation of ideally harvested cadaver kidneys, while the more complex and expensive perfusional techniques must be employed in preserving ischemia-damaged organs.
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PMID:Forty-eight-hour kidney preservation. A comparison of flushing and ice storage with perfusion. 76 32


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