***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Fifty-six patients undergoing abdomino-perineal excision of the rectum for carcinoma were r and omized to receive twice daily irrigation of the perineal wound with either 1 % povidone-iodine ( PVP-I ) or normal saline for 5 days following surgery . The incidence of perineal wound infection , primary and delayed wound healing and persistent sinus formation was recorded . There was a highly significant reduction in perineal wound infection in the PVP-I group ( P less than 0.01 ) and this was true even if perineal wound contamination had occurred during operation ( P less than 0.05 ) . Primary wound healing was significantly improved in the treatment group ( P less than 0.02 ) and this was found also in the presence of contamination ( P less than 0.005 ) . There was no significant difference between the treated and control group in the incidence of delayed wound healing and persistent sinus formation OBJECTIVE This double-blind r and omised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds . METHOD The trial was conducted in two metropolitan community health centres in New South Wales , Australia . Thirty-five patients with 49 acute or chronic wounds were r and omised to receive  wound irrigation  with either normal saline or tap water . RESULTS Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water . CONCLUSION Although the small sample size is a limitation of this study , the research ers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients 1 . Topical irrigation with normal saline is known to produce rapid healing in chronic leg ulcers . This study was design ed to determine if the rate of healing could be improved by the addition of topical nutrition to the irrigating solution . 2 . Forty-eight patients with chronic leg ulcers were admitted to hospital for a minimum of 6 weeks bed-rest . During this time the ulcers were continuously irrigated by one of four test solutions . The solutions were : normal saline ; a dilute amino acid solution isotonic with the normal saline ; a hyperosmolar saline solution ; a hyperosmolar amino acid solution . There were 12 ulcers in each group . 3 . The amino acid solutions produced significantly faster healing than the saline solutions ( P less than 0.01 ) . Concentration had no significant effect on healing ( P greater than 0.15 ) . 4 . The application of amino acids does appear to enhance healing in this model of delayed wound healing . This effect does not depend only on the osmolarity of the solution used OBJECTIVES To compare wound infection rates for irrigation with tap water versus sterile saline before closure of wounds in the emergency department . METHODS The study was a multicenter , prospect i ve , r and omized trial conducted at two Level 1 urban hospitals and a suburban community hospital . Subjects were a convenience sample of adults presenting with acute simple lacerations requiring sutures or staples . Subjects were r and omized to irrigation in a sink with tap water or with normal saline using a sterile syringe . Wounds were closed in the st and ard fashion . Subjects were asked to return to the emergency department for suture removal . Those who did not return were contacted by telephone . Wounds were considered infected if there was early removal of sutures or staples , if there was irrigation and drainage of the wound , or if the subject needed to be placed on antibiotics . Equivalence of the groups was met if there was less than a doubling of the infection rate . RESULTS A total of 715 subjects were enrolled in the study . Follow-up data were obtained on 634 ( 88 % ) of enrolled subjects . Twelve ( 4 % ) of the 300 subjects in the tap water group had wound infections , compared with 11 ( 3.3 % ) of the 334 subjects in the saline group . The relative risk was 1.21 ( 95 % confidence interval = 0.5 to 2.7 ) . CONCLUSIONS Equivalent rates of wound infection were found using either irrigant . The results of this multicenter trial evaluating tap water as an irrigant agree with those from previous single institution trials STUDY OBJECTIVE Studies have documented the efficacy of normal saline irrigation in decreasing wound infection rates . Wounds traditionally are irrigated using a syringe and needle with manual injection of fluid , a time- and labor-intensive method . We compared irrigation times and infection rates for wounds cleansed with syringe irrigation versus a new , single-use canister of pressurized ( 8 psi ) sterile normal saline . DESIGN Prospect i ve , r and omized , controlled . SETTING Two Level I emergency departments in tertiary care hospitals , both with emergency medicine residency programs . PARTICIPANTS Patients with lacerations requiring closure were eligible . Exclusion criteria were wounds above the clavicle more than ten hours old , wounds below the clavicle more than six hours old , insulin-dependent diabetes mellitus , or antibiotic or steroid therapy . Patients ( 550 ) were entered between August 1 , 1990 , and January 31 , 1991 . Characteristics of the two treatment groups were similar for patient age , age of the wound , size and depth of the laceration , and number of sutures . INTERVENTIONS Lacerations were irrigated with 250 mL saline in a syringe or 220 mL saline in a pressurized canister for each 5 cm of laceration . At follow-up or suture removal , patients were evaluated for signs of wound complications ( cellulitis , ascending lymphangitis , purulent discharge , or dehiscence ) . MAIN RESULTS The mean irrigation time for the pressurized canister group ( 281 ) was 3.9 minutes versus 7.3 minutes in the syringe irrigation group ( 254 ) ( P < .0001 ) . The complication rate for the pressurized canister group was 5.0 % compared with 3.6 % for the syringe irrigation group ( not significant , P = .50 ) . Only three of the 20 total complications required antibiotics ( two in the pressurized canister group , one in the syringe irrigation group ) . CONCLUSION Syringe irrigation times were nearly twice as long as the pressurized canister irrigation times . Use of the pressurized canister facilitates ease of irrigation and markedly decreases the time involved in this traditionally labor-intensive activity . In addition , delivery of the saline is no longer operator dependent , ensuring generation of pressures appropriate for wound cleansing . The pressurized canisters may be useful in st and ardizing irrigation in wound management research Venous ulcers are still today one of the main socioeconomic problems of medical interest in terms of prevalence , morbidity , and costs to the health service . In the past , various studies have been carried out to identify a systemic pharmacologic treatment able to accelerate venous ulcer healing times , but frequently the results have not been satisfac tory . The aim of this study was to evaluate the efficacy of sulodexide , a drug with profibrinolytic and antithrombotic activity , in accelerating venous ulcer 's healing time .  Ninety-four patients ( 32 men and 62 women ) , aged 72 years old on average , were r and omly distributed between two groups . In the first group ( " control group " ) a st and ard treatment was applied , which consisted of cleansing by washing with physiological solution and the application of elastic compression with short-extensibility , removable b and ages . The second group ( " sulodexide group " ) received the st and ard treatment plus sulodexide ( 600 lipoprotein lipase releasing units [ LRU ] by i m route per day for 30 consecutive days , followed by 500 LRU by oral route per day for a further 30 days ) . After 2 months the venous ulcers were found healed in 15 patients ( 36 % ) in the control group and in 30 patients ( 58 % ) in the sulodexide group ( p = 0.03 ) . The life table showed that the healing times were shorter in the sulodexide group in the first 2 months of treatment . Total healing times amounted to 110 days in the control group and 72 days in the sulodexide group ( p = 0.08 ) and the results were in proportion to the initial severity of the lesion . A significant correlation was noted between ulcer healing times and severity of the initial ulcerous lesion , the duration of the ulcer , and the group the patient belonged to . No correlation was found between age , gender of the patient and the etiology of the ulcer . In conclusion sulodexide was shown effective in the treatment of venous leg ulcers , yielding healing more quickly than the st and ard treatment Wound healing produced by isotonic saline irrigation via a special dressing was compared with that produced by conventional saline dressings in 12 in patients with 18 leg ulcers . Patients served as their own controls .  Wound cleansing was estimated by fibrin crust disappearance and granulation tissue formation . Both occurred earlier during irrigation . Wound contraction was similar during the two treatments . Wound blood flow , estimated by means of a laser Doppler flowmeter , increased earlier with irrigation Two studies were carried out to assess the relative roles of insulin and zinc in the acceleration of wound healing . In the first study , six diabetic and five non-diabetic human volunteers had two uniform cuts created , one on each forearm . One forearm wound was treated with topical regular insulin ( Iletin-II ) and the other with normal saline four times a day until healed . Treatment was double-blind and forearms were assigned r and omly . The wounds treated with insulin  healed 2.4 + /- 0.8 days faster than the wounds treated with saline ( P < 0.001 by paired t-test ) . Zinc is used to crystallise insulin . When wounds are treated with insulin , they are therefore also being treated with zinc . If insulin accelerates wound healing , it is not clear if the increase in the rate of healing would be due to insulin ( a known growth factor ) , the zinc it contains , or a combination of the two . The second study used a r and omised , double-blind , placebo-controlled design to compare the efficacy of insulin with that of a solution containing the same amount of zinc in accelerating the healing of st and ardised wounds in rats and humans . Although these pilot investigations did not have the power to define the relative roles of insulin and zinc with accuracy , the results suggest that zinc does play a role in the wound healing process . It is concluded that topical insulin accelerates wound healing in humans . More importantly , however , this study describes a method of creating uniform wounds in humans acceptable to an institutional review board , thus solving one of the major impediments to the scientific evaluation of human wound healing STUDY OBJECTIVE Irrigation , a critical component of wound management , is commonly performed with sterile normal saline solution . The purpose of this study was to compare the infection rates of wounds irrigated with normal saline solution versus those of wounds irrigated with running tap water . METHODS A prospect i ve trial was conducted in an urban pediatric emergency department . Tap water pressure and flow rates were measured , and cultures were obtained before the study and at 5 months after study initiation . Patients 1 to 17 years of age presenting to the pediatric ED with a simple laceration were eligible . Exclusion criteria included immunocompromise , complicated lacerations , or current use of or need for antibiotics . Patients were allocated to the running tap water group or the st and ard normal saline solution irrigation group . Wounds were closed in st and ard fashion . Patients returned to the pediatric ED in 48 to 72 hours for evaluation . RESULTS Two hundred seventy-one patients were enrolled in the  normal saline solution group and 259 in the  tap water group  . Tap water and normal saline solution  pressures and flow rates differed . The groups did not differ in terms of patient demographic characteristics or wound characteristics . However , more wounds were located on the h and in the tap water group ( 21.3 % ; 95 % confidence interval [ CI ] 16.3 % to 27.1 % ) compared with those in the normal saline solution group ( 9.2 % ; 95 % CI 5.9 % to 13.4 % ) . The wound infection rates were similar in the 2 groups ( normal saline solution group : 2.8 % [ 95 % CI 1.1 % to 5.7 % ] versus running tap water group : 2.9 % [ 95 % CI 1.2 % to 5.9 % ] ) . CONCLUSION There were no clinical ly important differences in infection rates between wounds irrigated with tap water or normal saline solution . Tap water might be an effective alternative to normal saline solution for wound irrigation in children Summary A prospect i ve r and omised study was carried out on 86 patients with first , second and third degree open fractures in order to compare the effect of isotonic saline ; distilled water and boiled water as irrigating fluids . The st and ard management consisted of emergency surgical toilet , use of broad spectrum antibiotics and fracture immobilization . The results show that the outcome was not affected by the type of irrigating fluid used . RésuméUne étude r and omisée a été effectuée sur 86 patients présentant des fractures ouvertes de degré 1 , 2 et 3 , en vue de comparer l'effet d'une solution saline isotonique , de l'eau distillée et de l'eau simplement bouillie , utilisées comme liquide d'irrigation 
    Output:
    
The use of isotonic saline , distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected .
AUTHORS ' CONCLUSIONS There is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it .
However there is not strong evidence that cleansing wounds per se increases healing or reduces infection .
In the absence of potable tap water , boiled and cooled water as well as distilled water can be used as wound cleansing agents