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Clinical Reviews in Allergy 1990The technique of BAL performed through the fiberoptic bronchoscope has, in two decades, provided clinicians and researchers with the ability to safely sample the... (Review)
Review
The technique of BAL performed through the fiberoptic bronchoscope has, in two decades, provided clinicians and researchers with the ability to safely sample the inflammatory-immune cell milieu of the human lung. Standardized BAL and processing of the lavage constituents provides assistance in determining the optimal care of patients with a variety of lung diseases, and renders diagnosis in selected cases. It has become indispensable in the diagnosis of pulmonary infiltrates in immunocompromised patients, and plays an important role in improving clinical management. Finally, it continues to yield an ever increasing amount of data for the researchers studying the mechanisms and pathogenesis of lung disease. It is likely that BAL will become an even more valuable tool with increasing relevance to the practice of chest medicine in the 1990s.
Topics: Bronchoalveolar Lavage Fluid; Humans; Lung Diseases; Therapeutic Irrigation
PubMed: 2292101
DOI: 10.1007/BF02914451 -
AIDS and Behavior Apr 2018To inform the development of HIV-prevention rectal douches, we reviewed the scientific literature and online instructional videos on rectal douching associated with... (Review)
Review
To inform the development of HIV-prevention rectal douches, we reviewed the scientific literature and online instructional videos on rectal douching associated with receptive anal intercourse (RAI). Up to 88% of men who practice RAI ever have douched, while 43-64% have douched recently. Of them, 87-97% douche before RAI and 13-48% afterwards. Water, occasionally mixed with soap or salt, is used most often, although up to 31% of men use commercial products. Douching is more common among individuals reporting substance use, sexually transmitted infections, or being HIV-infected. Scant literature is available on women's rectal douching practices, but it is apparently less frequent than among men (32 vs. 70%). Videos advise using 2-3 doses of liquid and retaining it for 10-30 s before expelling. These findings can inform the development of a safe and acceptable rectal douche for HIV prevention.
Topics: Administration, Rectal; Adult; Anti-Infective Agents; Enema; Female; HIV Infections; Homosexuality, Male; Humans; Male; Sexual Behavior; Sexually Transmitted Diseases; Therapeutic Irrigation
PubMed: 29098455
DOI: 10.1007/s10461-017-1959-3 -
BMC Ophthalmology Feb 2022A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.
BACKGROUND
A simple technique to facilitate removal of subincisional cortex in cataract surgery is presented.
METHODS
A disposable 27-gauge blunt needle attached to a 5.0-ml syringe containing balanced salt solution (BSS) is introduced through the side port incision into the anterior chamber. The tip of the needle is directed toward the capsule fornix beneath the incision site, and BSS is flushed to disperse the remaining cortex. Thereafter, the coaxial irrigation/aspiration device is used to remove the loosened cortex.
RESULTS
This technique was used in 60 eyes of 60 patients with difficulty of removing cortical remnant in the subincisional space. Subincisional cortical material was successfully removed in 93.3% (56/60 eyes). There were no intraoperative and postoperative complications related to this procedure.
CONCLUSIONS
The hydro-dispersion technique is a simple and safe approach to remove the subincisional cortical material that is difficult to manage with the standard coaxial irrigation/aspiration device.
Topics: Anterior Chamber; Cataract Extraction; Humans; Lens, Crystalline; Phacoemulsification; Postoperative Complications; Therapeutic Irrigation
PubMed: 35177028
DOI: 10.1186/s12886-022-02314-0 -
American Family Physician May 2007Cerumen is a naturally occurring, normally extruded product of the external auditory canal. It is usually asymptomatic, but when it becomes impacted it can cause... (Review)
Review
Cerumen is a naturally occurring, normally extruded product of the external auditory canal. It is usually asymptomatic, but when it becomes impacted it can cause complications such as hearing loss, pain, or dizziness. It also can interfere with examination of the tympanic membrane. Depending on available equipment, physician skill, and patient circumstances, treatment options for cerumen impaction include watchful waiting, manual removal, the use of ceruminolytic agents, and irrigation with or without ceruminolytic pretreatment. The overall quality of the evidence on treatment is limited. Referral to an otolaryngologist for further evaluation is indicated if treatment with a ceruminolytic agent followed by irrigation is ineffective, if manual removal is not possible, if the patient develops severe pain or has vertigo during irrigation, or if hearing loss is still present after cerumen has been removed. The use of cotton swabs and ear candles should be avoided.
Topics: Cerumen; Curettage; Ear Canal; Family Practice; Hearing Loss; Humans; Referral and Consultation; Surface-Active Agents; Therapeutic Irrigation
PubMed: 17555144
DOI: No ID Found -
Biomedical Papers of the Medical... Mar 2015Arthrocentesis is a very gentle method for lavage of the joint space. The principle consists in the introduction of a pair of needles into the upper joint space and... (Review)
Review
BACKGROUND
Arthrocentesis is a very gentle method for lavage of the joint space. The principle consists in the introduction of a pair of needles into the upper joint space and subsequent lavage using physiological saline or Ringer's solution. Arthrocentesis of the temporomandibular joint is used in both cases of acute closed lock and treatment of various temporomandibular disorders.
METHODS
A literature search in Pubmed database, using key words: Temporomandibular joint (TMJ), Arthrocentesis, indications, technique, results.
CONCLUSION
Arthrocentesis of the temporomandibular joint is a minimally invasive treatment method at the boundary between conservative and surgical therapy. It is usually performed on an out-patient basis under local anaesthesia. It is used both in cases of acute block caused by displacement of the articular disc and also to treat degenerative inflammatory diseases of the joints. The main objective of arthrocentesis is to wash out inflammatory mediators, release the disc, break adhesions, eliminate pain and improve joint mobility. It is a method with a minimum number of complications, it is simple and not demanding in terms of instruments, and it can be performed repeatedly. For this reason, it has become widespread and very popular in the treatment of internal disorders of the temporomandibular joint.
Topics: Arthrocentesis; Humans; Isotonic Solutions; Ringer's Solution; Temporomandibular Joint Disorders; Therapeutic Irrigation
PubMed: 23579112
DOI: 10.5507/bp.2013.026 -
The Cochrane Database of Systematic... Apr 2016This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Nasal saline irrigation is commonly used to improve patient symptoms.
OBJECTIVES
To evaluate the effects of saline irrigation in patients with chronic rhinosinusitis.
SEARCH METHODS
The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 9); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 30 October 2015.
SELECTION CRITERIA
Randomised controlled trials (RCTs) with a follow-up period of at least three months comparing saline delivered to the nose by any means (douche, irrigation, drops, spray or nebuliser) with (a) placebo, (b) no treatment or (c) other pharmacological interventions.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the commonest adverse event - epistaxis. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of local irritation and discomfort. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
MAIN RESULTS
We included two RCTs (116 adult participants). One compared large-volume (150 ml) hypertonic (2%) saline irrigation with usual treatment over a six-month period; the other compared 5 ml nebulised saline twice a day with intranasal corticosteroids, treating participants for three months and evaluating them on completion of treatment and three months later. Large-volume, hypertonic nasal saline versus usual care One trial included 76 adult participants (52 intervention, 24 control) with or without polyps.Disease-specific HRQL was reported using the Rhinosinusitis Disability Index (RSDI; 0 to 100, 100 = best quality of life). At the end of three months of treatment, patients in the saline group were better than those in the placebo group (mean difference (MD) 6.3 points, 95% confidence interval (CI) 0.89 to 11.71) and at six months there was a greater effect (MD 13.5 points, 95% CI 9.63 to 17.37). We assessed the evidence to be of low quality for the three months follow-up and very low quality for the six months follow-up. Patient-reported disease severity was evaluated using a "single-item sinus symptom severity assessment" but the range of scores is not stated, making it impossible for us to determine the meaning of the data presented.No adverse effects data were collected in the control group but 23% of participants in the saline group experienced side effects including epistaxis. General HRQL was measured using SF-12 (0 to 100, 100 = best quality of life). No difference was found after three months of treatment (low quality evidence) but at six months there was a small difference favouring the saline group, which may not be of clinical significance and has high uncertainty (MD 10.5 points, 95% CI 0.66 to 20.34) (very low quality evidence). Low-volume, nebulised saline versus intranasal corticosteroids One trial included 40 adult participants with polyps. Our primary outcome of disease-specific HRQL was not reported. At the end of treatment (three months) the patients who had intranasal corticosteroids had less severe symptoms (MD -13.50, 95% CI -14.44 to -12.56); this corresponds to a large effect size. We assessed the evidence to be of very low quality.
AUTHORS' CONCLUSIONS
The two studies were very different in terms of included populations, interventions and comparisons and so it is therefore difficult to draw conclusions for practice. The evidence suggests that there is no benefit of a low-volume (5 ml) nebulised saline spray over intranasal steroids. There is some benefit of daily, large-volume (150 ml) saline irrigation with a hypertonic solution when compared with placebo, but the quality of the evidence is low for three months and very low for six months of treatment.
Topics: Administration, Intranasal; Adrenal Cortex Hormones; Adult; Chronic Disease; Humans; Hypertonic Solutions; Nasal Polyps; Nasal Sprays; Quality of Life; Randomized Controlled Trials as Topic; Rhinitis; Sinusitis; Sodium Chloride; Therapeutic Irrigation; Time Factors
PubMed: 27115216
DOI: 10.1002/14651858.CD011995.pub2 -
Explore (New York, N.Y.) 2021This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning... (Review)
Review
This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning their curative or preventive role against SARS-CoV-2 infection, previous work on their utility against influenza and recent post-hoc analysis of the Edinburgh and Lothians Viral Intervention Study (ELVIS) provide compelling support to their applicability in the current crisis. Saline water gargling and nasal irrigation represent simple, economical, practically feasible, and globally implementable strategies with therapeutic and prophylactic value. These methods, rooted in the traditional Indian healthcare system, are suitable and reliable in terms of infection control and are relevant examples of harmless interventions. We attempt to derive novel insights into their usefulness, both from theoretical and practical standpoints.
Topics: COVID-19; Humans; Nasal Lavage; Pharynx; SARS-CoV-2; Saline Solution; Saline Solution, Hypertonic; Therapeutic Irrigation
PubMed: 33046408
DOI: 10.1016/j.explore.2020.09.010 -
Asian Journal of Surgery Feb 2022
Topics: Humans; Therapeutic Irrigation
PubMed: 34969571
DOI: 10.1016/j.asjsur.2021.12.019 -
AIDS and Behavior Sep 2021Despite clinicians consistently advising against vaginal douching, 29-92% of women worldwide report douching. This review documents women's douching practices,...
Understanding Women's Vaginal Douching Behaviors and Practices for Consideration in the Development of a Potential Future Vaginal Microbicide Douche for HIV Prevention: A Systematic Review of the Literature.
Despite clinicians consistently advising against vaginal douching, 29-92% of women worldwide report douching. This review documents women's douching practices, motivations for douching, and specific associations (or absence of associations) between vaginal douche use and vaginal outcomes thought to be associated with douching. Understanding women's existing douching behaviors and vaginal health outcomes is critical for developing a safe vaginal microbicide douche that can be used as HIV pre-exposure prophylaxis (PrEP). A vaginal douche as PrEP could help prevent new HIV infections, since emerging evidence shows some women discontinue oral PrEP. We performed a systematic review of the literature using the guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Articles included in the analysis (N = 48) were published 2009-2019 in English and focused on women's experiences with douching. Two trained independent reviewers assessed these articles for content on vaginal douching, including racial/ethnic focus of studies, study design, sampling, women's reasons for douching, contents of douche solutions, and associations between vaginal douching and vaginal health outcomes. Several studies focused on Black women (N = 12 studies) or had no racial/ethnic focus (N = 12). Just over half of all studies (N = 24) were cross-sectional and involved a self-reported questionnaire and lab samples. Studies sampled women from health clinics where they were (N = 13) or were not (N = 14) presenting for vaginal health complaints. Women's primary motivation for douching was for "general cleanliness" (N = 13), and most douche solutions contained water (N = 12). There was little empirical agreement between vaginal douche use and most vaginal health outcomes. Future studies of PrEP vaginal douches should be well controlled and prioritize safety to ensure positive vaginal health outcomes.
Topics: Anti-Infective Agents; Cross-Sectional Studies; Female; HIV Infections; Humans; Pre-Exposure Prophylaxis; Vaginal Douching
PubMed: 33977356
DOI: 10.1007/s10461-021-03290-0 -
The Cochrane Database of Systematic... Jul 2017Extravasation injury, a complication commonly seen in the neonatal intensive care unit, can result in scarring with cosmetic and functional sequelae. A wide variety of... (Review)
Review
BACKGROUND
Extravasation injury, a complication commonly seen in the neonatal intensive care unit, can result in scarring with cosmetic and functional sequelae. A wide variety of treatments are available, including subcutaneous irrigation with saline (with or without hyaluronidase), liposuction, use of specific antidotes, topical applications, and normal wound care with dry or wet dressings. All such treatments aim to prevent or reduce the severity of complications.
OBJECTIVES
Primary objective To compare the efficacy and safety of saline irrigation or saline irrigation with prior hyaluronidase infiltration versus no intervention or normal wound care for tissue healing in neonates with extravasation injury. Secondary objectives To evaluate by subgroup analysis of controlled trials the influence of type of extravasate, timing of irrigation following extravasation, and postmenstrual age (PMA) of the neonate at the time of injury on outcomes and adverse effects.Specifically, we planned to perform subgroup analysis for the primary outcome, if appropriate, by examining:1. time to irrigation from identified extravasation injury (< 1 hour or ≥ 1 hour);2. type of extravasate (parenteral nutrition fluid or other fluids or medications);3. amount of saline used (< 500 mL or ≥ 500 mL); and4. PMA at injury (< 37 completed weeks or ≥ 37 completed weeks).
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1), MEDLINE via PubMed (1966 to 2 February 2017), Embase (1980 to 2 February 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 2 February 2017). We also searched clinical trial databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We used the Google Scholar search tool for reverse citations of relevant articles.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing saline irrigation with or without hyaluronidase infiltration versus no intervention or normal wound care for the management of extravasation injury in neonates.
DATA COLLECTION AND ANALYSIS
Three review authors independently reviewed and identified articles for possible inclusion in this review. We used the GRADE approach to assess the quality of evidence.
MAIN RESULTS
We found no eligible studies. Our search revealed 10 case reports or case series describing successful outcomes with different interventions for this condition.
AUTHORS' CONCLUSIONS
To date, no RCTs have examined the effects of saline irrigation with or without prior hyaluronidase infiltration for management of extravasation injury in neonates. Saline irrigation is frequently reported in the literature as an intervention for management of extravasation injury in neonates. Research should focus first on evaluating the efficacy and safety of this intervention through RCTs. It will also be important for investigators to determine effect size by examining the timing of the intervention, the nature of the infusate, and severity of injury at the time of intervention.
Topics: Extravasation of Diagnostic and Therapeutic Materials; Humans; Hyaluronoglucosaminidase; Infant, Newborn; Medical Records; Skin; Sodium Chloride; Solutions; Therapeutic Irrigation
PubMed: 28724193
DOI: 10.1002/14651858.CD008404.pub3