Successful treatment of mediastinitis after cardiovascular surgery using electrolyzed strong acid aqueous solution

Effectiveness of Nitazoxanide and Electrolyzed Oxiding Water in Treating Chagas Disease in a Canine Model

Chagas disease (CD) is caused by the protozoan Trypanosoma cruzi, and affects seven million people in Latin America. Side effects and the limited efficacy of current treatment have led to new drug research. The objective of this work was to evaluate the effectiveness of nitazoxanide (NTZ) and electrolyzed oxidizing water (EOW) in a canine model of experimental CD. Náhuatl dogs were infected with the T. cruzi H8 strain and NTZ- or EOW-treated orally for 10 days. Seronegativity was shown at 12 months post-infection (mpi) in the NTZ-, EOW-, and benznidazole (BNZ)-treated groups. The NTZ and BNZ groups had high levels of IFN-γ, TNF-α, IL-6, IL-12B, and IL-1β at 1.5 mpi and low levels of IL-10. Electrocardiographic studies showed alterations from 3 mpi and worsening at 12 mpi; NTZ treatment produced fewer cardiac pathomorphological changes compared to EOW, similar to BNZ treatment. There was no cardiomegaly in any group. In conclusion, although NTZ and EOW did not prevent changes in cardiac conductivity, they were able to avoid the severity of heart damage in the chronic phase of CD. NTZ induced a favorable proinflammatory immune response after infection, being a better option than EOW as a possible treatment for CD after BNZ.

Electrolyzed Saline Irrigation for Elimination of Bacterial Colonization in the Empyema Space

Background: The empyema space is refractory to elimination of bacterial colonization. Electrolyzed saline (ES) was used as intra-pleural irrigation for rapid disinfection of the empyema space.

Patients and Methods: Twenty consecutive patients with para-pneumonic empyema were reviewed in this study from 2007 to 2015. The empyema space was irrigated by miniaturized thoracoscopic surgery (mini VATS), and the efficacy and safety of the use of ES were evaluated.

Results: Sixteen patients were male and four were female, with a mean age of 66.5 ± 9.5 y (27–90 y). Bacterial cultures of the purulent effusions from all 20 patients had positive results. Seventeen patients subsequently underwent continuous catheter irrigation and drainage. No patient had chest pain during ES irrigation. Fever duration after mini VATS was 2.8 ± 1.8 d (0–5 d). Catheter indwelling time was 10.3 ± 7.2 d (3–33 d). Inflammatory markers significantly improved (p < 0.05) within a week after mini VATS. Eighteen patients achieved pleural disinfection, and two patients had residual pathogens, one of whom later died of lung abscess. Space closure was successful in 14 patients. No patient underwent subsequent open drainage. Nineteen (95%) patients were discharged from the hospital. This treatment was successful in 18 (90%) patients, and one (5.6%) patient experienced recurrence.

Conclusions: The ES irrigation facilitates the rapid disinfection and closure of the empyema space.

Electrolyzed acid water nasal irrigation after functional endoscopic sinus surgery

BACKGROUND

Electrolyzed acid water (EAW) has been recognized to have strong bactericidal activity, and the feasibility and safety of EAW irrigation in body cavities has been reported in the literature. This study was conducted to evaluate the effect of EAW nasal irrigation on the postoperative care of functional endoscopic sinus surgery (FESS).

METHODS

Patients with chronic rhinosinusitis who received FESS for treatment were recruited and randomly assigned to three groups at 1 month postoperatively. Patients in group 1 received EAW for nasal irrigation daily for 2 months, those in group 2 received neutral normal saline (NS) daily for 2 months, and those in group 3 did not receive nasal irrigation after surgery. Before and 3 months after FESS, sinonasal symptoms were assessed by questionnaire and patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial culture from middle meatus.

RESULTS

There were 185 patients enrolled between May 2009 and March 2012. Among the patients who completed the study, 36 received EWA irrigation, 35 received NS irrigation, and 39 (group 3) received no irrigation. Patients with nasal irrigation had a better outcome based on questionnaire score and saccharine transit time. However, there was no difference in outcome between patients who received irrigation with EAW and NS.

CONCLUSION

Our study showed that EWA irrigation did not confer a greater benefit than that of NS irrigation in post-FESS care.

Efficacy and safety of strong acid electrolyzed water for peritoneal lavage to prevent surgical site infection in patients with perforated appendicitis

PURPOSE

Our previous experimental study of perforated peritonitis in rats proved that peritoneal lavage with strong acid electrolyzed water (SAEW) has no adverse effects, reduces the bacteria count in the ascitic fluid more effectively than saline, and increases the survival rate significantly. Thus, we conducted a randomized controlled study, applying SAEW in the treatment of perforated appendicitis in children.

METHODS

Forty-four patients, aged 3-14 years, were randomly divided into two groups: Group S (n = 20), in which the peritoneal cavity was lavaged with 100 ml/kg saline and the wound was washed out with 200 ml saline; and Group E (n = 24), in which the peritoneal cavity was lavaged with 100 ml/kg SAEW and the wound was washed out with 200 ml SAEW.

RESULTS

No adverse effect of SAEW was observed in Group E. There was no difference in the bacterial evanescence ratio of ascitic fluid after lavage between Groups S and E (11.1 and 15.8%, respectively). A residual abscess developed in one patient from each group (5.0 and 4.2%, respectively). The incidence of surgical site infection (SSI) was significantly lower in Group E than in Group S (0 and 20%, respectively; P < 0.05). There was no difference in the duration of pyrexia, positive C-reactive protein, leukocytosis, or hospital stay between the groups.

CONCLUSION

Peritoneal lavage and wound washing with SAEW have no adverse effects and are effective for preventing SSI.

Application of an electrolyzed strongly acidic aqueous solution before wound closure in colorectal surgery

BACKGROUND

Electrolyzed strongly acidic aqueous solution which is produced by electrolysis of a sodium chloride solution has been used in Japan for the irrigation of wounds or body cavities even in the absence of particular evidence.

OBJECTIVE

The purpose of this study is to investigate the efficacy or harmful effects of the disinfectant when applied before wound closure in colorectal surgery.

DESIGN

We performed a prospective, randomized study.

SETTING

The study was conducted at Surgical Department of Hyogo College of Medicine

PATIENTS

Patients who underwent elective colorectal surgery were randomly assigned to 2 groups. The surgical wound was irrigated with >500 mL of the disinfectant or saline solution after the completion of fascia closure. Patients with dirty/infected wounds were excluded from the study.

MAIN OUTCOME MEASURES

The primary end point of this study was comparison of the frequency of incisional surgical site infection. The secondary end point was the occurrence of wound dehiscence or wound hernia.

RESULTS

One hundred eighty patients in the disinfectant group and 183 patients in the saline solution group were analyzed. In multivariate analysis, IBD and contaminated wounds were independent risk factors for incisional surgical site infection. Application of the disinfectant tended to lower the risk of the infection (OR 0.457, 95% CI 0.206-1.013). In the analysis of poor wound healing, preoperative hospital stay of >2 weeks, stoma creation, and use of the disinfectant (OR 2.28, 95% CI 1.03-5.04) were independent risk factors.

LIMITATION

This study was not a double-blind trial.

CONCLUSIONS

Application of electrolyzed strongly acidic aqueous solution to the wound impaired wound healing. Routine use of electrolyzed strongly acidic aqueous solution is not recommended in patients undergoing elective colorectal surgery. As for the contribution of the disinfectant to preventing wound infections, further study is needed to make a definitive conclusion.

Antibacterial effect of electrolysed acid water on the nasal discharge from patients with chronic rhinosinusitis

This study was conducted to determine whether electrolysed acid water (EAW) increased the antibacterial effect of irrigating solution used in the management of chronic rhinosinusitis (CRS). One hundred CRS patients were recruited from April 2008 to February 2009. Four swab specimens were taken from the ipsilateral middle meatus of each patient and one was placed in a Thanswab tube, while the other three were each placed randomly in one of three glass tubes containing either 5 ml of EAW, distilled water or 70% alcohol. They were immediately sent to the laboratory for aerobic and anaerobic cultures. Bacteria grew from 36 specimens when they were placed in a Thanswab tube, from four when placed in a tube with EAW, 30 when placed in distilled water and two when placed in alcohol. The culture rate was significantly lower when the specimens were placed in a tube with EAW as compared with distilled water or in a Thanswab tube, but was not different compared with alcohol. The bacteria that grew from four specimens after first being processed by EAW were all anaerobes. This study showed that EAW exhibited an increased antibacterial effect on bacteria grown from the nasal discharge of CRS patients.

Effect of electrolyzed strong acid water on peritoneal irrigation of experimental perforated peritonitis

PURPOSE

Electrolyzed strong acid water (ESAW) is generated by the electrolysis of a weak sodium chloride solution. Although ESAW is known to have a strong bactericidal activity and to be harmless to the living body, its effectiveness and safety in the treatment of perforated peritonitis has not been well established.

METHODS

Male Wistar rats were used for the study. Three hours after cecal ligation and puncture, the cecum was resected and the peritoneal cavity was irrigated with 50 ml of saline (Group S, n=12) or ESAW (Group E, n=14). The 5-day survival rate was compared between the two groups. In another pair of animals (n=10 each), bacteria in the ascitic fluid were counted at 6 and 18 h after irrigation.

RESULTS

No adverse effects of ESAW were observed in the experimental group. The 5-day survival rate was 25% (3/12) and 85.7% (12/14) in Groups S and E, respectively (P < 0.01). The bacterial count at 18 h after the irrigation in Groups S and E was (5.0 +/- 2.5) x 10(5)/ml and (2.2 +/- 2.0) x 10(4)/ml, respectively (P < 0.0001).

CONCLUSION

Peritoneal lavage with ESAW had no adverse effect, and achieved more effective decontamination than saline for perforated peritonitis. Therefore, the results of this study are considered to warrant and support the clinical application of ESAW.

Management with closed irrigation for post-sternotomy mediastinitis

OBJECTIVE

The aim of this study was to assess the adequacy of our treatment strategy for patients with post-sternotomy mediastinitis.

METHODS

Between May 1997 and December 2000, 1,045 consecutive adult cardiac operations were performed at our center. Mediastinitis occurred in 8 patients (0.77%) and as treatment, they underwent (1) aggressive debridement, (2) closed irrigation and drainage, and (3) transvenous administration of antibiotics. We irrigated the mediastinum with 0.1-1.0% povidone-iodine solution, alternating with electrolyzed strong acid aqueous solution. We subsequently reviewed the outcome after the closed irrigation treatment for patients with post-sternotomy mediastinitis.

RESULTS

In four of the 8 patients, the culture specimen grew Methicillin-resistant Staphylococcus aureus. In the others, Serratia marcescens, Staphylococcus epidermidis, Pseudomonas aeruginosa and Gram-negative rods were cultured. The mean period between primary surgery and the diagnosis of mediastinitis was 16.3 (8 -57) days. The mean period between diagnosis of mediastinitis and the start of the irrigation treatment was 0.8 (0-3) days. The mean irrigation period was 30.0 (14-47) days. The irrigation complications were mild hepatic dysfunction in 2 patients, hyponatremia in 2 and protracted wound infection in 1. The hospital mortality was 1/8 (12.5%). Seven survivors are free from recurrent mediastinitis.

CONCLUSIONS

Our experience of closed irrigation and drainage suggests that it can yield satisfactory results after post-sternotomy mediastinitis, comparable to other reported results with or without muscle flaps.

Improved Detection of Tilletia indica Teliospores in Seed or Soil by Elimination of Contaminating Microorganisms with Acidic Electrolyzed Water

Acidic electrolyzed water (AEW) is a germicidal product of electrolysis of a dilute solution (e.g., 0.4% vol/vol) of sodium chloride. This solution can be used to disinfest wheat seed or soil samples being tested for teliospores of Tilletia indica, causal agent of Karnal bunt, without risk of damaging the teliospores. The AEW used in this study had a pH of 2.5 to 2.8 and oxidation-reduction potential of approximately 1,130 mV. In simulations of routine extractions of wheat seed to detect teliospores of T. indica, the effectiveness of a 30-min AEW treatment was compared with a 2-min 0.4% sodium hypochlorite (NaOCl) treatment to eradicate bacteria and nonsmut fungi. Each treatment reduced bacterial and fungal populations in wheat seed extracts by 6 to 7 log₁₀ units when determined on 2% water agar with antibiotics. Reductions of 5 log₁₀ units or more were observed on other media. NaOCl and AEW also were very effective at eliminating bacteria and fungi from soil extracts. In studies to detect and quantitate T. indica teliospores in soil, AEW was nearly 100% effective at eliminating all nonsmut organisms. Free chlorine levels in AEW were very low, suggesting that compounds other than those with chlorine play a significant role in sanitation by AEW. The low pH of AEW was shown to contribute substantially to the effectiveness of AEW to reduce microorganisms. A standardized protocol is described for a 30-min AEW treatment of wheat seed washes or soil extracts to eliminate contaminating microorganisms. A significant advantage of the use of AEW over NaOCl is that, with AEW, teliospore germination is not reduced and usually is stimulated, whereas teliospore germination declines after contact with NaOCl. The protocol facilitates detection and enumeration of viable teliospores of T. indica in wheat seed or soil and the isolation of pure cultures for identification by polymerase chain reaction. The germicidal effects of AEW, as demonstrated in this study, illustrate the potential of AEW as an alternative to presently used seed disinfestants.

Effect of electrolyzed water on wound healing

Electrolyzed water accelerated the healing of full-thickness cutaneous wounds in rats, but only anode chamber water (acid pH or neutralized) was effective. Hypochlorous acid (HOCl), also produced by electrolysis, was ineffective, suggesting that these types of electrolyzed water enhance wound healing by a mechanism unrelated to the well-known antibacterial action of HOCl. One possibility is that reactive oxygen species, shown to be electron spin resonance spectra present in anode chamber water, might trigger early wound healing through fibroblast migration and proliferation.

Electrolyzed strong acid aqueous solution irrigation promotes wound healing in a burn wound model

The purpose of the study was to understand the effectiveness of electrolyzed strong acid aqueous solution (ESAAS) for acceleration of epithelialization in a rat burn wound model. Eighteen anesthetized Sprague-Dawley rats received 30% total body surface area third-degree burns, and 2 days after injury, the wound eschars were removed. Rats were divided into 3 groups: Group 1, no irrigation; Group 2, irrigation with physiological saline; and Group 3, irrigation with ESAAS. Wounds were observed macroscopically until they were fully epithelialized, and epithelialized wounds were examined microscopically. Epithelialization of the wounds occurred significantly early in the rats treated with ESAAS (p < 0.05). Proliferation of associated lymphocytes and macrophages was more extensive in all rats that underwent irrigation than it was in control rats. ESAAS irrigation may promote tissue growth in burn wounds.

Comparison of Effects of Acidic Electrolyzed Water and NaOCl on Tilletia indica Teliospore Germination

Definitive identification of free teliospores of Tilletia indica, causal agent of Karnal bunt of wheat, requires polymerase chain reaction (PCR)-based diagnostic tests. Since direct PCR amplification from teliospores has not been reliable, teliospores first must be germinated in order to obtain adequate DNA. We have routinely surface-sterilized teliospores for 2 min with 0.4% (vol/vol) sodium hypochlorite (NaOCl) to stimulate germination and produce axenic cultures. However, we observed that some spores were killed even with a 2-min NaOCl treatment, the shortest feasible duration. Decreasing the NaOCl concentration in our study from 0.4% to 0.3 and 0.2%, respectively, increased teliospore germination, but treatment times longer than 2 min still progressively reduced the germination percentages. In testing alternative methods, we found "acidic electrolyzed water" (AEW), generated by electrolysis of a weak solution of sodium chloride, also surface-sterilized and increased the rate of T. indica teliospore germination. In a representative experiment comparing the two methods, NaOCl (0.4%) for 2 min and AEW for 30 min increased germination from 19% (control) to 41 and 54%, respectively, by 7 days after treatment. Because teliospores can be treated with AEW for up to 2 h with little, if any, loss of viability, compared with 1 to 2 min for NaOCl, treatment with AEW has certain advantages over NaOCl for surface sterilizing and increasing germination of teliospores of suspect T. indica.