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

A cluster of five cases of Legionnaires' disease in renal transplant patients is described. They were treated with erythromycin and rifampicin, and all five survived. Two of them had rejected their grafts prior to their Legionella pneumonia; two rejected their transplants after reduction of immunosuppressive therapy to combat the infection. L pneumophila was present in the water distribution system of the hospital. Eradication measures included flushing the water pipes to the transplantation ward with hot and hyperchlorinated water, raising the warm water temperature to 60 degrees C, and installing ultraviolet (UV) irradiation units on the warm and cold water pipes to the ward. These measures were successful in that no new cases of legionellosis occurred after wards. L pneumophila could subsequently not be demonstrated by culture in plastic shower hoses supplied with UV-irradiated water. L pneumophila could be demonstrated by direct fluorescent antibody technique, but nonspecific reactions cannot be excluded. A higher prevalence of elevated L pneumophila antibody titers was observed in patients nursed for more than four weeks in the hospital than in patients with a shorter hospital stay, in hospital staff members, or in the general population. It seems that, with appropriate control measures, transplantation activities need not be discontinued in the presence of a minor cluster of Legionnaires' disease in renal transplant patients.
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PMID:Nosocomial Legionnaires' disease following renal transplantation. 329 50

Calcium channel blockade has been shown to prevent warm renal ischemic damage. The ability of verapamil to decrease the severity of acute tubular necrosis (ATN) after 24-hr cold storage and autotransplantation was studied in a randomized paired study of 12 dogs. Experimental animals pretreated with intraarterial verapamil and flushing of the harvested kidney with cold intracellular solution containing verapamil demonstrated significantly (P less than .05) greater renal function preservation over their matched controls. A subsequent nonpaired study of 6 dogs treated only with flushing of the harvested kidney with perfusate containing verapamil demonstrated no significant preservation advantage over controls. We conclude that verapamil, administered prior to the ischemic event, can enhance the protective effect of hypothermia and decrease the severity of ATN in ischemically injured kidneys.
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PMID:The effect of verapamil in reducing the severity of acute tubular necrosis in canine renal autotransplants. 330 60

The combination of nifedipine and atenolol must be evaluated in terms of risks and benefits to the hypertensive patient. Disadvantages with single-agent therapy justify trials of combination regimens. beta-Blockers may be unacceptable to some patients because of gastrointestinal upset, musculoskeletal symptoms, tiredness, malaise, insomnia, depression or confusion, sweating, breathlessness or cold extremities. The side effect profile varies from patient to patient and between different beta-blockers. Calcium antagonists also have characteristic side effects, including severe headaches, flushing and oedema, tachycardia and possibly worrying palpitations, and polyuria. Combining a calcium antagonist and a beta-blocker can reduce some side effects; for example, tachycardia is offset by addition of beta-blocker to calcium antagonist therapy, and beta-blocker-induced cold extremities may be reversed with a drug such as nifedipine. Moreover, the antihypertensive efficacy is increased, which is useful in previously resistant patients. However, an excessive fall in blood pressure is a possible adverse effect of the combination. There is also the possibility of precipitating heart failure in patients with cardiomegaly and severely compromised left ventricular function. The combination of nifedipine and atenolol was evaluated in 25 patients in a randomised, crossover trial following a month's treatment with atenolol 50mg twice daily. Patients received either atenolol 50mg twice daily alone, or atenolol 50mg twice daily with sustained release nifedipine 20mg or 40mg twice daily, or placebo twice daily during three 4-week treatment periods. Additional antihypertensive benefit was obtained by addition of the low dose of nifedipine compared with atenolol alone, but no further advantage was obtained with the higher nifedipine dose.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Aims of combination therapy--improved quality of life or better blood pressure control? 337 14

Liver preservation and transplantation was performed in pigs. For flush perfusion cold (2 degrees C) and warm (15 degrees C) lactated Ringer's solution were compared. Administration of cold Ringer's resulted in a severe endothelial damage of sinusoids that was aggravated after recirculation, as shown by electron microscopic examination. Using warm Ringer's solution this alteration was limited. Liver parenchymal cells are impaired mainly during reflow as a consequence of microcirculatory disturbance. After cold flushing animals died within a few hours, whereas after flushing with warm Ringer's solution pigs survived definitively.
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PMID:Preservation damage in liver transplantation. Influence of rapid cooling. 352 51

The feasibility of using proton nuclear magnetic resonance (NMR) relaxation measurement to monitor organ perfusion and preservation was studied using a rat model. Intact kidneys were assessed with NMR following various periods of cold storage. Bilateral en bloc donor nephrectomy was performed on Sprague-Dawley rats with prior in situ flushing with Euro-collins', dextrose and other test solutions via a plastic cannula in the aorta. A paramagnetic agent, gadolinium-DPTA, dissolved in perfusion fluid was then injected into the renal vasculature. NMR analysis was repeated and the kidneys were reflushed with perfusion fluid to remove the gadolinium, followed by another NMR analysis. By sequential flushing and NMR measurement after 24, 48 and 72 hours of cold storage, the thoroughness of flushing, the patency of intrarenal vasculature and capillary integrity could be assessed. With the D5W, the T1 relaxation of kidneys dropped 56% with prolonged cold storage, indicating gadolinium accumulation in the interstitium, in effect loss of capillary integrity. With the Euro-collins', the T1 showed a small drop (23%) and almost complete flush-out, indicating superior tissue preservation and patency of vasculature. The addition of trifluoperazine, (TFP, a calmodulin inhibitor) to the Euro-collins' resulted in only a 9% drop in T1 after 72 hours. This possibly indicates TFP has additional protective action on cold ischemic damage. Using the small animal model presented here, proton NMR spectroscopy appears to be a sensitive technique in assessing renal vascular patency after cold storage and provides a useful tool for the investigation of other agents for organ preservation for transplantation.
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PMID:Nuclear magnetic resonance assessment of renal perfusion and preservation for transplantation. 353 21

Transplant centers are reluctant to use kidneys stored cold for more than 48 hours. During a 6-year interval we transplanted 32 kidneys preserved by intracellular electrolyte flushing that were stored cold for 48.2 to 61.4 hours. Of the recipients 91 per cent required dialysis within 1 week after transplantation. The mean serum creatinine nadir within 1 month was 3.0 mg. per dl. and graft survival at 1 month was 81 per cent. Short-term kidney graft function was not influenced significantly by the addition of magnesium sulfate to the flush solutions or by cyclosporin immunosuppression. The 1 and 2-year actuarial kidney graft survival rates were 72 and 58 per cent, respectively. The 1 and 2-year mean serum creatinine levels were 1.9 and 1.6 mg. per dl., respectively. Kidneys can be transplanted successfully after 48 hours of simple cold storage following flushing with an ice-cold intracellular electrolyte solution.
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PMID:Preservation of 32 human kidneys by simple cold storage for more than 48 hours. 354 5

To evaluate the thermal performance of anti-exposure garments in rough seas, eight garment-ensembles were studied: 7 foam-insulated garments (2 tight-fitting "wet" suits, 3 loose-fitting "wet" garments, 2 "dry" suits) and 1 uninsulated, loose-fitting control. Mean calm and rough water temperatures were 10.7 and 11.1 degrees C, respectively. Rectal temperature, back skin temperature, heart rate, and subjective evaluations of garment protection were measured. Loose-fitting, "wet" garments allowed significantly greater (approximately 50-100%) mean rectal temperature cooling rates and significantly larger declines in skin temperature in rough water than in calm water. Such differences were not found for either the tight-fitting "wet" suits or the "dry" suits. Heart rates were significantly higher in rough seas than in calm seas for all garments. Rectal and skin temperature changes were positively correlated with each other and with subjective evaluation of cold water flushing; they were negatively correlated with warmth and tightness-of-fit. "Dry" garments provided better protection than did "wet" garments in both sea conditions, and tight-fitting "wet" garments provided better protection than did loose-fitting "wet" garments in rough but not in calm seas. Accidental immersion in rough seas may be associated with significantly lower survival times than previously estimated from calm-water studies.
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PMID:Immersion hypothermia: comparative protection of anti-exposure garments in calm versus rough seas. 360 16

The function of 18 human kidney grafts was studied before and 3 months after autotransplantation without prior bench surgery on the parenchyma or the vessels. Kidney protection was accomplished by pre-treating the patient with mannitol and low molecular weight dextran solution and flushing the kidney with a Xylocaine-heparin mixture and cold Sacks' II solution. The mean cold ischaemia time was 239 min (range 140-345 min). The glomerular filtration rate (GFR) remained unchanged post-operatively in terms of both total and split kidney GFR. Proximal and distal tubular integrity, as studied by determination of beta2-microglobulin excretion and concentration ability respectively, was also preserved.
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PMID:Function of human autologous kidney grafts after extracorporeal preservation with Sacks' II solution. 389 66

Graft sensitization was measured in dogs receiving autotransplants of perfused, flushed or hypothermically preserved kidneys. Five kidney treatments were studied: (1) continuous pulsatile perfusion with Ross solution for 24 h; (2) flush with Ross solution followed by 24h cold storage; (3) removal and immediate reimplantation; (4) flush with Ross solution and immediate reimplantation; (5) cool and immediate reimplantation. Continuous perfusion resulted in a lower mean creatinine (measured over the first five days after transplant) than did flushing followed by cold storage (P less than 0.001). Creatinines were lower in the groups in which kidneys were not stored (regardless of treatment) than in the stored groups (P less than 0.001). Dogs were said to be immune if their leucocytes were inhibited by nephrectomy kidney antigen in the leucocyte migration inhibition assay [LMI]. Immune dogs had a higher mean creatinine than non-immune animals (P less than 0.05). All autografts were examined for deposition of IgG, IgM and C3 at post-mortem by tissue immunofluorescence [IF]. Positive immune responses (LMI or IF) were seen more often in dogs receiving long preserved grafts than in those receiving immediate graft implantation (P less than 0.05).
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PMID:Immune response to storage-induced injury in non-ischaemic renal autografts. 391 75

In this investigation, we describe a modification of Euro-Collins flushing solution which enables this solution to be effective in preventing normothermic postischemic acute renal failure. The left kidneys of Sprague-Dawley rats were briefly flushed in situ by vascular perfusion with Euro-Collins solution and the renal pedicle clamped to render the kidney ischemic and hold the flushing solution in the kidney. Following 1 h of in situ normothermic ischemia, the pedicle clamp was removed and a contralateral nephrectomy of the right kidney performed. In two other groups of rats the same experimental protocol was followed using Euro-Collins solution in which the dextrose in this solution was replaced with a similar osmolal contribution of either sucrose (64 g/l) or mannitol (35 g/l). Rats with kidneys flushed with the standard Euro-Collins solution containing dextrose (n = 24) exhibited significantly higher postischemic daily serum creatinine levels, a greater degree of tubular necrosis, and a higher mortality (75, versus 31%) than unflushed ischemic controls (n = 22). Rats with kidneys flushed with Euro-Collins, containing either sucrose (n = 25) or mannitol (n = 22) in place of dextrose, all survived, exhibited only focal tubular damage as observed by electron microscopy, and most returned to normal serum creatinine levels within 72 h following ischemia. These findings, together with other reports that mannitol- and sucrose-based flushing solutions provide excellent protection during prolonged cold ischemia, strongly argue for the substitution of sucrose, mannitol or other similar protective impermeant agents for dextrose in flushing solutions such as Euro-Collins.
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PMID:Improving Euro-Collins flushing solution's ability to protect kidneys from normothermic ischemia. 393 Sep 35


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