Effect of Frequent Vaginal Saline Lavage On Maternal Infection Prevention During Mechanical Labor Induction

Background: Induction of labor is performed in up to 25% of pregnancies. The major concern in mechanical labor induction is that it increases the chance of infection when a foreign device is introduced into the cervix. The aim of the study is to test the effectiveness of a vagina saline lavage procedure on infection prevention during labor induction by transcervical double balloon catheter.Methods: Enrolled pregnant women were randomly divided into two groups. The control group received standard aseptic vaginal cleansing with 5% betadine solution. In addition to the standard aseptic preparation, the study group received vaginal lavage with 0.9% saline solution before the device placement and once every 4 hours after the insertion. Results: There was no statistical difference in the demographic characteristics or the indications for induction between the two groups (P > 0.1). The final delivery modes and complication rates were not significantly different (P > 0.05) between the two groups, except for the maternal infection rate (P < 0.05). The rate of infection dropped from 10.6% to 2.9% when the frequent vaginal lavage procedure was performed. Conclusions: Excessive vaginal aseptic preparation by saline solution is easy to apply, safe and effective in reducing maternal infection during mechanical labor induction.

Does Pressurized Carbon Dioxide Lavage Improve Bone Cleaning in Cemented Arthroplasty?

Cemented implant fixation in total joint arthroplasty has been proven to be safe and reliable with good long-term results. However, aseptic loosening is one of the main reasons for revision, potentially caused by poor cementation with low penetration depth in the cancellous bone. Aim of this prospective laboratory study was, to compare impact pressure and cleaning effects of pulsatile saline lavage to novel carbon dioxide lavage in a standardized carbon foam setup, to determine whether or not additional use of carbon dioxide lavage has any impact on cleaning volume or cleaning depth in cancellous bone. Carbon specimens simulating human cancellous bone were filled with industrial grease and then underwent a standardized cleaning procedure. Specimens underwent computed tomography pre- and post-cleaning. Regarding the impact pressure, isolated carbon dioxide lavage showed significant lower pressure compared to pulsatile saline lavage. Even though the combination of carbon dioxide lavage and pulsatile saline lavage had a positive cleaning effect compared to the isolated use of pulsatile saline lavage or carbon dioxide lavage, this was not significant in terms of cleaning volume or cleaning depth.

IMPROVEMENTS IN HIP OSTEOARTHRITIS WITH LAVAGE, TRIAMCINOLONE AND HYLAN G-F20

ABSTRACT Objective: To verify whether the use of Hylan G-F20 improves saline lavage and triamcinolone injection results in the treatment of hip osteoarthritis (HOA). Methods: 82 patients with HOA categorized as grades II and III severity, according to Kellgren and Lawrence criteria, were randomized into the groups: lavage and triamcinolone (G0); lavage, triamcinolone, and 2 mL of hylan G-F20 (G1); lavage, triamcinolone, and 4mL of hylan G-F20 (G2); lavage, triamcinolone, and 6mL of hylan G-F20 (G3). The VAS, range of motion (ROM), WOMAC, and Lequesne questionnaires were administered at baseline, one, three, six, and twelve months post-injection. Results: All groups showed clinically relevant improvements (> 20%) between baseline and first month post-injection, maintaining subjective results throughout the study period (p < 0.001). We found no differences between groups in any subjective evaluations (p > 0.05, for all). G2 and G3 obtained improved flexion results up to a year (p = 0.028). Hylan groups presented an improved external rotation since the first postoperative month and maintained the results up to a year (G1, p = 0.041; G2, p = 0.007), whereas G0 showed no improvement (p = 0.336). Conclusion: Hip lavage and triamcinolone injection, with or without the use of hylan, improves pain, function, and quality of life up to a year in HOA. Hylan may improve ROM up to one year. Level of Evidence IB, Randomized clinical trial.

Veno-venous ECMO as a platform to evaluate lung lavage and surfactant replacement therapy in an animal model of severe ARDS

Background There are limited therapeutic options directed at the underlying pathological processes in acute respiratory distress syndrome (ARDS). Experimental therapeutic strategies have targeted the protective systems that become deranged in ARDS such as surfactant. Although results of surfactant replacement therapy (SRT) in ARDS have been mixed, questions remain incompletely answered regarding timing and dosing strategies of surfactant. Furthermore, there are only few truly clinically relevant ARDS models in the literature. The primary aim of our study was to create a clinically relevant, reproducible model of severe ARDS requiring extracorporeal membrane oxygenation (ECMO). Secondly, we sought to use this model as a platform to evaluate a bronchoscopic intervention that involved saline lavage and SRT. Methods Yorkshire pigs were tracheostomized and cannulated for veno-venous ECMO support, then subsequently given lung injury using gastric juice via bronchoscopy. Animals were randomized post-injury to either receive bronchoscopic saline lavage combined with SRT and recruitment maneuvers (treatment, n = 5) or recruitment maneuvers alone (control, n = 5) during ECMO. Results PaO2/FiO2 after aspiration injury was 62.6 ± 8 mmHg and 60.9 ± 9.6 mmHg in the control and treatment group, respectively (p = 0.95) satisfying criteria for severe ARDS. ECMO reversed the severe hypoxemia. After treatment with saline lavage and SRT during ECMO, lung physiologic and hemodynamic parameters were not significantly different between treatment and controls. Conclusions A clinically relevant severe ARDS pig model requiring ECMO was established. Bronchoscopic saline lavage and SRT during ECMO did not provide a significant physiologic benefit compared to controls.

Veno-venous-ECMO as a platform to evaluate lung lavage and surfactant replacement therapy in an animal model of severe ARDS

Background: There are limited therapeutic options directed at the underlying pathological processes in acute respiratory distress syndrome (ARDS). Experimental therapeutic strategies have targeted the protective systems that become deranged in ARDS such as surfactant. Although results of surfactant replacement therapy (SRT) in ARDS have been mixed, questions remain incompletely answered regarding timing and dosing strategies of surfactant. Furthermore, there are only few truly clinically relevant ARDS models in the literature. The primary aim of our study was to create a clinically relevant, reproducible model of severe ARDS requiring extracorporeal membrane oxygenation (ECMO). Secondly, we sought to use this model as a platform to evaluate a bronchoscopic intervention that involved saline lavage and SRT. Methods: Yorkshire pigs were tracheostomized and cannulated for veno-venous ECMO support, then subsequently given lung injury using gastric juice via bronchoscopy. Animals were randomized postinjury to either receive bronchoscopic saline lavage combined with SRT and recruitment maneuvers (treatment, n=5) or recruitment maneuvers alone (control, n=5) during ECMO.Results: PaO2/FiO2 after aspiration injury was 62.6 ±8 mmHg and 60.9 ±9.6 mmHg in the control and treatment group, respectively (p=0.95) satisfying criteria for severe ARDS. ECMO reversed the severe hypoxemia. After treatment with saline lavage and SRT during ECMO, lung physiologic and hemodynamic parameters were not significantly different between treatment and controls. Conclusions: A clinically relevant severe ARDS pig model requiring ECMO was established. Bronchoscopic saline lavage and SRT during ECMO did not provide a significant physiologic benefit compared to controls.

Veno-venous-ECMO as a Platform to Evaluate Lung Lavage and Surfactant Replacement Therapy in an Animal Model of Severe ARDS

Background: There are limited therapeutic options directed at the underlying pathological processes in acute respiratory distress syndrome (ARDS). Experimental therapeutic strategies have targeted the protective systems that become deranged in ARDS such as surfactant. Although results of surfactant replacement therapy (SRT) in ARDS have been mixed, questions remain incompletely answered regarding timing and dosing strategies of surfactant. Furthermore, there are only few truly clinically relevant ARDS models in the literature. The primary aim of our study was to create a clinically relevant, reproducible model of severe ARDS requiring extracorporeal membrane oxygenation (ECMO). Secondly, we sought to use this model as a platform to evaluate a bronchoscopic intervention that involved saline lavage and SRT. Methods: Yorkshire pigs were tracheostomized and cannulated for veno-venous ECMO support, then subsequently given lung injury using gastric juice via bronchoscopy. Animals were randomized postinjury to either receive bronchoscopic saline lavage combined with SRT and recruitment maneuvers (treatment, n=5) or recruitment maneuvers alone (control, n=5) during ECMO.Results: PaO2/FiO2 after aspiration injury was 62.6 ±8 mmHg and 60.9 ±9.6 mmHg in the control and treatment group, respectively (p=0.95) satisfying criteria for severe ARDS. ECMO reversed the severe hypoxemia. After treatment with saline lavage and SRT during ECMO, lung physiologic and hemodynamic parameters were not significantly different between treatment and controls. Conclusions: A clinically relevant severe ARDS pig model requiring ECMO was established. Bronchoscopic saline lavage and SRT during ECMO did not provide a significant physiologic benefit compared to controls.

Single Procedure Saline Lavage for Treatment of Inspissated Bile

Inspissated bile syndrome is a rare cause of cholestatic jaundice in infancy, occurring due to obstruction of the biliary ducts and gallbladder by biliary sludge. Traditional methods of treatment include surgical drainage or cholecystostomy drain placement. Both can be associated with complications and prolonged admission. We present 2 cases treated with a single percutaneous needle puncture of the gallbladder followed by saline lavage. Two neonates presented with cholestatic jaundice and sonographic evidence of biliary sludge and dilation of the common bile duct. Single sonographic-guided needle puncture of the gallbladder was followed by irrigation with saline. Clearing of the biliary sludge was confirmed by sonography and cholecystocholangiography. There was resolution of the cholestatic jaundice, with no complications or repeat procedures.

Right lumbar abscess containing a gallstone—an unexpected late complication of laparoscopic cholecystectomy

During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.