Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thrombotic occlusion of Hickman and Broviac central venous catheters is a serious obstacle to their long-term use. Because resistance to flow (R) through a catheter of lumen radius, r, is proportional to 1/r4, we hypothesized that measurement of R would provide an objective and sensitive monitor for partial occlusions. Our measurements showed that median R at a flow of 17 mL/min was 0.7 cmH2O/mL/min in normally functioning Hickman catheters, and 4.1 cmH2O/mL/min in Broviac catheters. In obstructed catheters, which by subjective standards resisted flushing or blood withdrawal, median R was 3.0 cmH2O/mL/min for Hickman and 5.6 cmH2O/mL/min for Broviac catheters, representing significant increases. In a series of obstructed lines in which urokinase was administered, R decreased from 7.7 to 4.5 in Hickman catheters and from 5.6 to 4.2 in obstructed Broviac catheters. The elevated resistance in Hickman catheters after urokinase suggested that residual catheter obstruction was present even though catheter function returned to normal. Elevated R was seen with abnormal venograms in seven of 13 patients. Four patients had normal R values and abnormal venograms, and two patients had elevated R values with normal venograms. Measurement of resistance in Hickman and Broviac catheters provides a simple technique that can supplement or replace venography in the serial assessment and treatment of partial obstruction.
 ...
PMID:Early detection and simplified management of obstructed Hickman and Broviac catheters. 270 89

Urokinase was used to clear occluded silastic central venous catheters in 14 pediatric patients. The catheters, which had been placed into a neck vein and tunnelled out through the skin of the anterior chest wall, were being used for either long-term parenteral nutrition or chemotherapy. Occluded catheters that could not be cleared by simple flushing with heparinized saline were filled with a solution of urokinase, which was left in place for 2 hours before the catheter was flushed a second time. Twenty-one occluded catheters were managed in this way over a period of 14 months. There were no allergic reactions or bleeding complications. Twelve of the 21 occluded catheters were immediately cleared. Three catheters ruptured during attempted flushing maneuvers but were patent after repair. Two catheters remained partially occluded. Only four catheters were removed because of persistent occlusion. When simpler techniques fail, urokinase instillation appears a safe and effective alternative to the more common practice of removing occluded central venous catheters in children.
 ...
PMID:Urokinase in the treatment of occluded central venous catheters in children. 650 22

In a 7-month period we studied 38 Hickman central venous catheters (CVCs) positioned in children with hematologic malignancies with the aim of evaluating the incidence and clinical impact of CVC clots. Clots were found in 74% of the CVCs. Three methods of catheter care were developed for flushing the clotted CVCs: (a) use of a heparinized solution (400 IU/mL) on alternate days, (b) use of a heparinized solution (400 IU/mL) and saline solution containing urokinase (10,000 IU/mL) on alternate days, and (c) use of a saline solution containing urokinase (10,000 IU/mL) daily. Only method b decreased clot formation (33% success rate). There were no major mechanical complications in any of the CVCs with clots. Eighteen percent of patients with clots in their CVCs presented with CVC-related infections while no infective complications were observed in the patients without clots in their CVCs. In conclusion, CVC clots may predispose the patient to infections, which must be correctly treated.
 ...
PMID:Central venous catheter clots: incidence, clinical significance and catheter care in patients with hematologic malignancies. 764 Jan 77

We evaluated the effect of urokinase on pulmonary microthrombi formation of the donor lung using a canine cadaver left lung allotransplantation model. Donor animals were sacrificed with an intravenous injection of potassium chloride without heparinization and were divided into three groups. In group 1 (n = 6), cadavers were left at room temperature for 1 hour, and lung retrieval was then performed after flushing the lung block with low potassium-dextran-glucose solution. Donor lungs were stored for 3 hours at 8 degrees C. In group 2 (n = 6), donor lungs were treated as in group 1 except that the cadavers were left at room temperature for 2 hours instead of 1 hour before lung retrieval. In group 3 (n = 6), donor lungs were treated as in group 2 except that high-dose urokinase (120,000 IU) was injected into the main pulmonary artery after flushing with low-potassium-dextrose-glucose solution. In all groups after left lung transplantation, the right pulmonary artery was ligated, and recipient animals were followed up for 6 hours after reperfusion. The fibrin degradation product level in the donor lung tissue was also measured. All recipient animals in group 1 survived the 6-hour observation period with excellent gas exchange and stable hemodynamics. Group 3 had significantly better gas exchange than group 2 and similar cardiopulmonary function as group 1. The fibrin degradation product level in the donor lungs before transplantation was significantly higher in group 3 than in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Improved lung function by urokinase infusion in canine lung transplantation using non-heart-beating donors. 777 33

It is now recognized that occlusion of the mesenteric veins not only may complicate a number of disease processes but may occur as a life-threatening complication after abdominal surgery. A 32-year-old woman had mesenteric venous thrombosis after resection of a duodenal inflammatory pseudotumour by pancreatoduodenectomy. She recovered fully after treatment, which consisted of thrombectomy, flushing with urokinase and intravenous administration of heparin. Papaverine infused for 4 days substantially improved bowel viability. Current concepts in mesenteric vein occlusion and the principles of clinical management are reviewed.
 ...
PMID:Superior mesenteric vein thrombosis after the Whipple procedure: an aggressive, combined treatment approach. 941 59

Thrombotic occlusion is frequently a complication of central venous catheters (CVCs). The original designers and producers of CVCs recommended heparin flush regimens to prevent thrombosis and maintain patency. This has become standard practice although no studies have demonstrated a relationship between heparin flushing and reduction of catheter thrombosis. Many consider the routine use of heparin flushing innocuous. However, serious complications including drug interactions and heparin induced thrombocytopenia and thrombosis syndrome (HITS) have been reported in association with heparin flushing. Numerous studies comparing heparin to saline flushing in peripheral devices suggest equal rates of thrombotic occlusions. The purpose of this study was to examine the incidence of thrombotic occlusions in CVCs using heparin compared to saline flushing. The study involved 78 cancer patients undergoing apheresis collection for peripheral blood stem cells; 29 received saline flushes and 49 received heparin (100 U/ml of saline) flushes. Study endpoints included slow apheresis flow rate (< 50 ml/min), urokinase use for thrombolysis, and radiographic evidence of catheter thrombosis. No significant differences were found for any endpoint between the two groups. These findings suggest saline may be as effective as heparin for maintaining patency of CVCs.
 ...
PMID:Normal saline versus heparin flush for maintaining central venous catheter patency during apheresis collection of peripheral blood stem cells (PBSC). 1017 83

Hickman catheters (HC) are associated with complications, in particular infection, occlusion and thrombosis. We tested the hypothesis that regular flushing of catheters with urokinase would reduce the frequency of these complications. Patients who required a double-lumen HC for (1) bone marrow or peripheral blood progenitor cell transplantation or (2) intensive combination chemotherapy for haematological malignancies were randomised to receive twice-weekly flushes of either urokinase (5000 units) or heparin (50 units). HC-survival analysis was determined by Cox regression. 100 patients were enrolled (urokinase=52; heparin=48) and treated for a mean of 8.5 weeks. No significant difference was observed in the incidence of HC-associated septicaemic events, which occurred in 8/52 in the urokinase group and 9/48 in the heparin group (actuarial incidence 20% versus 25%, P=0.50). Similarly, there was no differences in the incidence of exit site infections (urokinase=27/52 and heparin=28/48, P=0.122); HC-septic thromboses (urokinase=2/52 and heparin=4/48, P=0.34); lumen occlusion (urokinase=30/52 and heparin=30/48, P=0.681); or venous thrombosis (urokinase=8/52 and heparin=6/48, P=0.726). Overall, a high incidence of HC-related complications was seen in both groups; 40/52 in the urokinase group and 40/48 in the heparin group (actuarial incidence 80% versus 90%, P=0.367). Despite this only 18% of HC required early removal due to complications (urokinase=8, heparin=10). There was no difference in the incidence of complications in patients undergoing transplantation (n=68) compared with chemotherapy alone (n=32). Patients with haematological malignancies were more likely to have HC-related infective complications (P=0.006), and patients with solid tumours more likely to have venous thrombosis (P=0.027). The cumulative incidence of HC-related complications in this prospective study was higher than in previously reported series. Urokinase did not appear effective in reducing the frequency of these complications.
 ...
PMID:Lack of efficacy of twice-weekly urokinase in the prevention of complications associated with Hickman catheters: a multicentre randomised comparison of urokinase versus heparin. 1172 Aug 31

Plasminogen activators (PAs) are highly specific serine proteases that convert the extracellular zymogen plasminogen into the active proteinase plasmin. Plasminogen-dependent proteolytic activity was detected by zymography both in the tissue membrane fraction of oviducts and in the oviductal flushing obtained at the preovulatory (Pre-Ov), postovulatory (Post-Ov) and mid-luteal (Mid-L) stages of the estrous cycle. A main proteolytic band, with a relative mobility similar to a human melanoma cell tissue-type plasminogen activator (t-PA), was found in all samples. Two additional components were observed in Pre-Ov and Post-Ov oviductal flushing but not in the tissue membrane fraction. In the oviductal flushing the PA activity was significantly higher in the Post-Ov stage than in the Pre-Ov one. Both urokinase-type plasminogen activator (u-PA, 50 kDa) and t-PA (72 kDa) were detected by Western blot; they showed differences in their relative concentration between Post-Ov and Pre-Ov oviductal flushing. The main PA substrate, plasminogen, was detected by indirect immunofluorescence in the cumulus cell extracellular matrix (ECM) and oocyte zona pellucida (ZP). In denuded oocytes, plasminogen was also detected on the surface of the plasma membrane. It is possible that oviductal PAs may act on the plasminogen present in the cumulus cell ECM and ZP; consequently, the generated plasmin could be involved in the rebuilding or degradation of these oocyte structures during fertilization or early development.
 ...
PMID:Plasminogen detection in oocytes and plasminogen activator activities in the porcine oviduct during the estrous cycle. 1612 7

Totally implantable central venous access ports (IVAPs) are frequently used in oncology to assure chemotherapy delivery and other tasks. Obstruction of IVAPs is rare, but when it does occur it may result in treatment delays and/or invasive surgery for the patient. An IVAP unblocking protocol was implemented by the nursing staff of our department. The protocol is based on a precise decision tree comprising several progressive steps: (1) needle exchange; (2) if no result is observed, placement of a second needle and reservoir flushing with normal saline; and (3) if no result is observed, use of urokinase in the two-needle system. During 1 year, all consecutive patients presenting an obstructed IVAP in our unit benefited from this protocol. Medical files were then retrospectively reviewed to look for complication and for factors associated with blocked IVAPs. A total of 12 patients were included. The rate of successful IVAP unblocking was 92% (n = 11/12). The only unblocking failure was due to a mechanical obstruction, i.e., a bent catheter. No local or general complications were reported immediately after the unblocking protocol or in the following month. In 83% of the cases, obstruction occurred during use of IVAPs. Mains treatments administered when obstruction occurred were mannitol 20% (25%) and perfusion completed but non-flushed (50%). In the remaining 17%, obstruction was present before any action (at needle insertion). With all due caution because of the retrospective nature of this study, the IVAP unblocking protocol presented here appears to be efficacious and safe, and thus can be recommend for clinical practice.
 ...
PMID:Clearing obstructed totally implantable central venous access ports: an efficient protocol using a second needle. 2238 90

In this study, cancer patients with venous thrombosis associated with the use of peripherally inserted central catheters (PICCs) underwent complete recanalization by the administration of Panax notoginseng saponins (PNS), which vary from heparin or urokinase in that they do not have the same risks associated with thrombolysis, including bleeding. To the best of our knowledge, this is the first study concerning the treatment of cancers with PNS to be reported in the literature. Three cancer patients aged 30-50 years old, two females and one male, were subjected to chemotherapy. On the first day of chemotherapy, a PICC was inserted into the right basilic vein with its tip in the superior vena cava. On the third day of chemotherapy, pain, swelling and skin flushing started. In the following days, particularly days 10-13, a Doppler ultrasound examination confirmed a long thrombus along the PICC line in the axillary vein and brachial veins in each patient. The patients rejected the insertion of an inferior vena cava filter, and neither heparin nor urokinase were administered due to contra-indications. An injection of PNS (200 mg) was administered every day. On days 20-28 of chemotherapy, the thrombus in the axillary and brachial veins disappeared in the three patients. It was concluded that PNS promote blood circulation, which prevents blood stasis and reduces the toxicity of cisplatin. The results suggest that PNS are a feasible and effective treatment option for many types of cancer, but have a broader clinical impact on cancer patients with PICC-related venous thrombosis. Therefore, this study is an original case report of particular interest to cancer patients with PICC-related venous thrombosis.
 ...
PMID:The complete recanalization of PICC-related venous thrombosis in cancer patients: A series of case reports. 2413 99


1 2 Next >>