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

Malignant ascites is often refractory to therapy and rapidly deteriorating the nutritional and physical state of the cancer patient. Nevertheless, ascites does not always implicate preterminal state of the cancer process (e.g. ovarian carcinoma). A short review is made of the pathophysiology of ascites in cirrhosis and in malignancy, and different modes of treatment are discussed. The results of medical therapy of malignant ascites (salt and water restriction, diuretics, intraperitoneal cytostatics or radiocolloids) are not convincing. The immunotherapy with OK-432, as worked out by Katano (16-46) has to prove its value. The best and most hopeful results in cases of massive previously resistant ascites, are obtained with a peritoneojugular shunt, improving immediately the nutritional status and life condition, providing excellent palliation. The superiority of the Denver shunt versus the Le Veen shunt has been assessed recently, especially for malignant ascites. Some technical and perioperative details merit more attention, to limit the high risk ratio. Control of the intrathoracic position of the catheter tip, the maintenance of the bloodflow in the jugular vein, the intramuscular tunnelisation of the peritoneal catheter, the discard of 3 or 5 liters ascitic fluid and the substitution of part of it by physiological fluid, perioperative prophylactic antibiotics and heparinisation, flow-rate control in the postoperative period by changing patients position, respiratory exercises, daily flushing, all those measures limit the risk of fibrinolysis (DIC), shunt occlusion, fluid overload and infection. The fear of metastasis by shunt is unfounded, since the survival of the primary tumor is mostly too short (41). The postoperative follow up in an intensive care unit is necessary during 24-72 hours.
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PMID:[The Denver shunt in malignant ascites]. 258 Apr 8

The macula densa in rabbits and rats was studied by transmission electron microscopy (TEM). After different experimental procedures, the kidneys were fixed by direct perfusion with the fixative without prior flushing of the blood. With this technique, the renal cortex is consistently well preserved. The lateral intercellular spaces of all proximal and distal nephron segments were constantly found to be closed, whereas those of the macula densa varied: depending on the functional situation of the kidney, they were found to be either dilated or closed. Dilated intercellular spaces in the macula densa were encountered in control, sodium-rich, and sodium-deficient rabbits and rats and, in addition, in rats with hypotonic and isotonic hypervolemia. In contrast, in rats with hypertonic hypovolemia and in rats undergoing furosemide or mannitol diuresis, the lateral intercellular spaces of the macula densa were closed. Whether these findings reflect the in vivo state of the macula densa interspaces remains uncertain. The association with specific functional stages demonstrates, at least, a specific behavior of the macula densa cells that is different from that of all other proximal and distal nephron segments and appears to be similar to that of the collecting duct epithelium. The findings suggest that the macula densa is a water-permeable cell plaque within the otherwise water-impermeable thick ascending limb.
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PMID:Variability of intercellular spaces between macula densa cells: a transmission electron microscopic study in rabbits and rats. 695 82

Using 10 different infusion bag pressure pumps, indicated manometer pressures were compared with measured infusion pressures proximal to the flow-regulating device in an in vitro experiment. Flow rates delivered through the flow-regulating device were gravimetrically measured at different monitored pressure levels. Significant differences were found between manometer and measured infusion pressures among the tested pressure bagpumps (e.g. 500 ml bag volumepressurized to 300 mmHg manometerpressure: 219.6 +/- 7.8 to 407.2 +/- 2.7 mmHg). The infusion pressures were additionally affected by the vertical level of the infusion bag pump and by the volume of the infusion bag. Flow rates delivered through the flow-regulating device were directly correlated to the measured infusion pressure (r2= 0.9926). Differences inflow rates can have a considerable impact on maintaining catheter patency and avoidance of fluid overload and retrograde flushing into the central arterial circulation in neonates and small children. A simple manoeuvre using the invasive pressure transducer allows monitoring and adjustment of the infusion pressure in the clinical setting.
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PMID:Variability in infusion pressure and continuous flow rate delivered from pressurized bag pump flush systems. 1207 43