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At least 199 records · Page 11Linked to original sources
PubMed1997

[Postoperative three-dimensional CT angiography (3D-CTA) in evaluation of proximal clipping for ruptured vertebral aneurysms].

At present, intra-arterial angiography remains the gold standard for most cerebrovascular problems. Recently, three-dimensional computed tomographic angiography (3D-CTA) has been reported as a screening method for the diagnosis of cerebrovascular disease. This imaging modality uses the information obtained on a contrast-enhanced CT scan to generate three-dimensional images of the cerebrovascular system. We performed 3D-CTA in the preoperative and postoperative evaluation of patients undergoing proximal clipping of ruptured vertebral artery aneurysms in addition to conventional cerebral angiography. In this study, the value of 3D-CTA after proximal clipping of ruptured vertebral artery aneurysm was evaluated retrospectively. Six patients were examined with a spinal CT (HITACHI CT-W 3000) after intravenous bolus injection of 100 ml contrast material (Iohexhol 300 mgI/ml) at the rate of 2 ml/s with a 25 second pre-scanning delay. The images of 3D-CTA were reconstructed using a new 3D-volume-render (Voxel Transmission) technique. The ages of the six patients ranged from 33 to 61 years and five cases were males and one case was female. Only one patient had a saccular aneurysm and the other five had fusiform aneurysms. Two patients underwent emergency operations within 4 days, and the other four had delayed operations. The outcome was good recovery in five cases and severe disability in one case. Postoperative conventional cerebral angiography demonstrated no delineation of the aneurysms in five cases. These results correspond well to postoperative 3D-CTA. Postoperative conventional cerebral angiography could not be performed in only one patient, but the aneurysm was visualized on the third postoperative 3D-CTA. Proximal clipping is still one of the therapeutic options for ruptured vertebral aneurysms, but some reports emphasized the possibility of rebleeding after proximal clipping of vertebral artery aneurysms. The rebleeding occurred within 1 week after proximal clipping in 6 of 9 cases (66.7%), and the prognoses were extremely poor. Therefore, in patients selected for proximal clipping, it is necessary to undertake postoperative evaluation of the aneurysm within one week after proximal clipping. 3D-CTA is minimally invasive and can be easily performed repeatedly, even if the patients are in a poor condition. In conclusion, 3D-CTA is very useful especially for evaluation of ruptured vertebral artery aneurysms following proximal clipping.

Adult↗
PubMed1980

Morphology of Fallopian tubes removed from a patient after failure of clip sterilization.

A bilateral salpingectomy was performed at the time of vaginal hysterectomy in a pregnant patient sterilized 20 months earlier by application of Bleier clips to the fallopian tubes. Clip application to the left tube had been incomplete. Undisturbed tissue (left tube) and clipped tissue (right tube) were examined and compared by light and scanning electron microscopy. The segment of tube fully grasped by the clip had a completely detached lining epithelium with coarse and flattened mucosa, a loose stroma, and disorganized muscular bundles. The left tubal mucosa was normal, whereas the right tube was stenosed at the site of clip placement, with rigid walls and a 0.175 mm luminal diameter. With progressively greater stenosis toward the clip site, mucosal destruction increased. Polypoidal mucosal folds were seen, as well as fibrous adhesions between mucosal folds. These observations indicate that tissue damage is extensive enough after clip application to require excision of the damaged segment of tube and microsurgical re-anastomosis for reversal of sterilization.

Adult↗
PubMed1994

Use of multiple clips for tubal occlusion in interval laparoscopic sterilization: circumstances and consequences.

The use of multiple clips for the occlusion of the Fallopian tubes has been reported in interval laparoscopic sterilization, but the circumstances leading to the performance of the multiple-clip procedure and its effects on safety and efficacy have not been carefully studied. A data set from international multi-center clinical trials of Filshie clips and Wolf (Hulka) clips was used to examine the possible reasons for performing this procedure for 102 women. Their complications, complaints, and surgical and post-surgical events before discharge and during one month of follow-up were compared with those of the 408 women whose tubes were occluded by single clip. Results indicate that multiple clips were most often used when surgical difficulties (and to a much lesser degree, tubal and/or mesosalpingeal injury) were encountered during the sterilization procedure. No increased risk of short-term complications or complaints (including pelvic pain) was found at one-month follow-up for those patients who received multiple clips.

Adult↗
PubMed2000

Aneurysm clips: evaluation of magnetic field interactions with an 8.0 T MR system.

This study was conducted to evaluate magnetic field interactions for aneurysm clips exposed to an 8.0 T magnetic resonance (MR) system. Twenty-six different aneurysm clips were tested for magnetic field translational attraction (deflection angle test) and torque (qualitative assessment method) using previously described techniques. Six of the specific aneurysm clips (i.e. type, model, blade length) made from stainless steel alloy (Perneczky) and Phynox (Yasargil, models FE 748 and FE 750) displayed deflection angles above 45 degrees and torque measurements of +4, indicating that these aneurysm clips maybe unsafe for patients or individuals in an 8.0 T MR environment. The specific aneurysm clips (i.e. type, model, blade length) made from commercially pure titanium (Spetzler), Elgiloy (Sugita), titanium alloy (Yasargil, model FE 750T), and MP35N (Sundt) displayed deflection angles less than 45 degrees and torque that ranged from + 1 to +4. Accordingly, these aneurysm clips are likely to be safe for patients or individuals exposed to an 8.0 T MR system. Depending on the actual dimensions and mass, an aneurysm clip made from Elgiloy may or may not be acceptable for a patient or individual in the 8.0 T MR environment.

Electromagnetic Fields↗
PubMed1997

Initial experience with an absorbable laparoscopic ligation clip.

BACKGROUND: Laparoscopic surgery requires secure and safe methods of ligation and haemostasis. This study evaluated the efficacy of an absorbable ligation clip with a novel compression closure mechanism. METHODS: A new compression-closure absorbable clip was compared with currently available absorbable and non-absorbable clips used in a variety of laparoscopic procedures in 12 centres worldwide. RESULTS: At follow-up to 3 months after the procedure, no complications specific to the use of the compression-closure clip were detected. Operator satisfaction with the clip was high, with criticism directed at its relatively large size. CONCLUSION: This new clip is as safe and effective as presently available metal and absorbable clips in providing haemostasis and securing tubular structures.

Adolescent↗
PubMed1981

A new microvascular surgical clip system.

A new microvascular clip system has been designed that consists of 3 sets of different sized clips, an applicator, and an approximator. The basic clip is a one-piece design consisting of two blades extending from an annular base. Its construction is simple and durable. The blade closing force is predetermined for each size clip and is set at pressures that are non-traumatic to blood vessels. The tips of the applicator allow the clip to rotate through a wide arc. Two basic clips can be used with the approximator to form a double clip.

Humans↗
PubMed2001

CLIP-50 immunolocalization during mouse spermiogenesis suggests a role in shaping the sperm nucleus.

The spermatid nucleus and cytoplasm undergo dramatic morphological modifications during spermatid differentiation into mature sperm. Some of the external force causing this nuclear shaping is generated by a microtubular structure termed the manchette, which attaches to the perinuclear ring of the spermatid. Here, we report the isolation and characterization of a protein component of this perinuclear ring in an immunological screening of a mouse testis cDNA library. We termed this protein CLIP-50 because of its high similarity at the amino acid level to the C-terminal region of the microtubule-binding protein CLIP-170/restin. CLIP-50 lacks the characteristic microtubule-binding motif, but retains a portion of the predicted coiled-coiled domain and the metal-binding motif. The CLIP-50 transcript and protein are abundant in testis. The protein is also expressed in heart, lung, kidney, and skin. A distinct size variant exists in brain. In the spermatids, CLIP-50 protein localizes specifically to the centriolar region where the sperm tail originates and to the perinuclear ring from which the manchette emerges. CLIP-50 staining is retained in the ring throughout its migration over the surface of the nucleus which accompanies the nuclear shaping into its characteristic sperm configuration. This localization pattern indicates a very specific function for this novel CLIP derivative during mouse spermiogenesis.

Animals↗
PubMed1995

Prostaglandins are involved in the stimulation of renin gene expression in 2 kidney-1 clip rats.

This study was done to obtain information about a possible involvement of prostaglandins in the renal baroreceptor mechanism regulating renin secretion and renin gene expression. To this end the effect of the cyclooxygenase inhibition was examined on renin secretion and on renal renin gene expression in 2 kidney-1 clip rats. The influences of the cyclooxygenase inhibitors indomethacin (2mg/kg twice a day) and meclofenamate (8 mg/kg twice a day) on renal renin m-RNA levels, on plasma renin activity (PRA) and on blood pressure were measured 2 days after clipping the left renal arteries of male Sprague-Dawley rats with 0.2 mm clips. In sham-clipped animals, indomethacin and meclofenamate had no significant effect on basal PRA and renin m-RNA levels. In vehicle-treated animals unilateral renal artery clipping increased blood pressure from 120 +/- 4.1 to 150 +/- 6.1 mmHg, increased PR6A from 7.4 +/- 1.6 to 27.6 +/- 3.8 as expressed in nanograms of angiotensin I per hour per millilitre, increased renin m-RNA levels of clipped kidneys from 105 +/- 5.9% of standard to 482.6 +/- 56% of standard and decreased renin m-RNA levels of contralateral kidneys from 116 +/- 9.7% of standard to 34 +/- 9.0% of standard. While blood pressure, PRA and renin m-RNA levels of the contralateral kidneys were virtually unchanged by the cyclooxygenase inhibitors indomethacin and meclofenamate, renin gene expression in the clipped kidney was markedly influenced by inhibition of prostaglandin synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1980

Increase in plasma renin activity, water intake and blood pressure following application and reapplication of a renal artery clip.

Application of a renal artery clip in rats with an undisturbed contralateral kidney caused a sustained increase in blood pressure and a transient rise of plasma renin activity and water intake. The response of blood pressure, plasma renin activity and water intake was augmented after reapplication of the clip to normotensive declipped rats (renal hypertensive rats, from which the clip had been removed 24h before the reapplication). The time-course of the changes of blood pressure, plasma renin activity and water intake were similar after the initial application as after reapplication of the clip. Administration of an inhibitor (SQ 14.225) of the converting enzyme abolished the increase in blood pressure and water intake after reapplication of the clip. These data indicate a critical role of renin in the rise of blood pressure and water intake after initial application of a renal artery clip as well as after reapplication of the clip to declipped rats.

Animals↗
PubMed1994

Endoscopic resection of large colorectal polyps using a clipping method.

PURPOSE: In conventional endoscopic snare polypectomy, bleeding and perforation are the principal concerns. To prevent these complications, we employ an endoscopic clipping technique using the HX-3L clipping apparatus. METHODS: With this method, clips are used to clamp the base of a polyp. A snare is hung peripheral to the clips. The polyp is then resected by coagulating and cutting with an electric current. RESULTS: Neither bleeding nor perforation during or after polypectomy has occurred, nor have complications related to the use of clips developed. Gigantic polyps were not resected piecemeal, but rather were resected en bloc facilitating a clear determination of cancer on the surface of the resected site. Endoscopic clipping permitted site marking for colonoscopic surveillance. CONCLUSION: We conclude that the clipping method has many advantages and is a useful technique in colonoscopic polypectomy.

Adult↗
PubMed1996

Absorbable clips for cystic duct ligation in laparoscopic cholecystectomy.

BACKGROUND: The efficacy and applicability of an absorbable polydioxanone (PDS) clip for cystic duct ligation were evaluated in 297 patients undergoing laparoscopic cholecystectomy. METHODS: The indications for cholecystectomy were symptomatic gallstones (179 patients), acute cholecystitis (67), biliary pancreatitis (23), acute cholangitis (24), and gallbladder polyp (4). RESULTS: Twenty-five patients required conversion to open surgery (8.4%). The conversion rate was 2.7% for uncomplicated and 17.5% for complicated gallbladder diseases. Of the 272 patients with laparoscopic cholecystectomy, the cystic ducts were successfully ligated with PDS clips in 227 patients (83.5%). The success rate was higher in uncomplicated (163/178) than in complicated (64/94) gallbladder diseases (chi square = 24.6, P < 0.001). There was no clip-related complication on follow-up (range 0.4-39.2, median 17.5 months). In 45 patients, PDS clip failed. They were treated with endoloop (14 patients), Roeder slip knot (13), metallic clips and endoloop (8), metallic clips alone (6), and intracorporeal tie (4). CONCLUSIONS: The PDS clip is effective and applicable to the majority of patients. It should be attempted first because of the ease of application.

Absorption↗
PubMed1979

Laparoscopic sterilization with the spring clip: instrumentation development and current clinical experience.

Since the original spring clip sterilization studies were reported, a number of clinically important modifications to the spring clip and applicator have been developed. The spring-loaded clip, manufactured by Richard Wolf Medical Instruments Corporation of Chicago, Illinois, and Rocket of London, Inc., London, England, and New York, New York can be applied with either a one- or two-incision applicator and the clips and applicators currently available incorporate improvements to the original prototypes in design, manufacture, and quality control. The two-incision applicator is associated with significantly fewer misapplications and the high pregnancy rates reported with the original clip and applicator have not occurred with the current designs. Comparative studies between the clip and band have revealed less operative bleeding and pain associated with the clip. The method is appropriate to all women requesting sterilization but especially to those in the younger age group who may subsequently request reversal because of divorce and remarriage.

Female↗
PubMed1996

The invariant chain derived fragment CLIP is an efficient in vitro inhibitor of peptide binding to MHC class II molecules.

The invariant chain derived peptide CLIP inhibits association of peptides to the class II peptide binding site. Two DR3 specific peptides, the microbacterial heat shock protein 65 derived peptide hsp3-13 and the naturally occurring invariant chain derived peptide Ii131-149 were employed to study binding inhibition by CLIP (Ii82-102) in a series of combinations. Incubation of detergent solubilized DR polypeptides from Ii-free cells with 500 microM of synthetic CLIP almost completely prevents binding of 50 microM subsequently added DR3-specific peptides. When CLIP and the peptides were added simultaneously to DR3 molecules, binding of hsp3-13 was abolished, whereas binding of Ii131-149 was only partially blocked. This indicates apparent affinity differences of the peptides. The addition of CLIP to preformed DR-peptide complexes substantially reduced binding of hsp3-13,while there was little effect on the DR associated Ii131-149. The profound inhibitory ability of CLIP, which in vivo would diminish binding of antigenic peptides, suggests an intracellular mechanism that abrogates the persistence of the CLIP-DR complex. The HLA-DM molecules have been suggested as candidates for this function. The strong in vitro binding of the naturally occurring peptide Ii131-149 to DR3 may suggest that only limited amounts of this peptide are available in vivo for competition of exogenous peptide binding to class II molecules.

Amino Acid Sequence↗
PubMed1997

Influence of a 1 h immobilization stress on sleep states and corticotropin-like intermediate lobe peptide (CLIP or ACTH18-39, Ph-ACTH18-39) brain contents in the rat.

A 1 h immobilization stress (IS) was imposed to rats at the beginning of the dark period, i.e., when the animals start to be active. The IS was accompanied by an intense polygraphic waking and followed, over 12 h of the dark period, by a significant rebound of slow-wave sleep (SWS, +17%) and paradoxical sleep (PS, +57%). In order to estimate the IS-related changes in the endogenous concentrations of corticotropin-like intermediate lobe peptide (CLIP, ACTH18-39) and related compounds, a specific radioimmunoassay (RIA) was used. Assays performed in cerebral biopsies taken from arcuate (AN) and raphe dorsalis (nRD) nuclei led to the obtention of 2 main immunoreactive peaks, corresponding to CLIP and its phosphorylated form Ph-CLIP. Just after end of the IS and within the nRD. Ph-CLIP immunoreactivity increased by about 95%. Four hours later, i.e., when PS rebound was maximal, a 37% increase in Ph-CLIP immunoreactivity was measured in the AN. These observations have never been described before. In the blood, at the end of the restraint, CLIP/ACTH1-39 total immunoreactivity was increased by 330%. It returned to baseline level 4 h later. Blood concentration of corticosterone was also increased by 56% at the end of the IS and was close to baseline level 4 h later. Data reported here indicate that the IS first triggers an increase in Ph-CLIP within the nRD. Since the nRD contains sleep permissive components, this increase might be determinant for the SWS and PS rebound induction. The changes observed in the blood as regards CLIP/ACTH1-39 total immunoreactivity and corticosterone concentration testify to the efficacy of the IS and are part of the conventional picture accompanying such a situation. Finally, the increase in Ph-CLIP, occurring in the AN 4 h after the end of the restraint, might be part of the restorative processes necessary to compensate the stress overshoot.

Adrenocorticotropic Hormone↗
PubMed1977

Vas occlusion by tantalum clips and its comparison with conventional vasectomy in man: reliability, reversibility, and complications.

Occlusion of the vas deferens has been carried out by applying tantalum clips in 60 men. Another 50 men were vasectomized conventionally and served as controls. Vasography showed that two clips were required on each vas to bring about perfect and firm occlusion. The incidence of postoperative infection and other complications was much lower in the clip-occluded cases. Under a long-term follow-up, 10% of the conventionally vasectomized men were dissatisfied with the operation as compared with 2% of the clip-occluded group. Both groups became azoospermic within 3 months and the failure rate was zero. Removal of the clips not only was difficult but left the vas compressed and leaking. The method cannot, therefore, be considered reversible by itself. However, recanalization could easily be achieved by end-to-end anastomosis after excision of the small clipped segment or by side-to-side anastomosis without any excision. This, damage to the neuromuscular apparatus of the vas may be minimized. Male sterilization by clip occlusion has the advantages of minimal surgical intervention, shorter operative time, safety from postoperative infection, and easier recanalization if desired.

Evaluation Studies as Topic↗
PubMed1978

Structural changes in the human vas deferens after tantalum clip occlusion and conventional vasectomy.

In 15 human subjects, the vasa deferentia were occluded by applying two tantalum clips on one side and by conventional vasectomy with silk ligatures on the other. After 2 weeks, the occluded segments were recovered for histopathologic examination of serial sections. Obstructing the seminal tract did not, as such, produce any significant change in the vas: the distal and proximal segments appeared to be essentially similar and normal. At the actual site of occlusion, however, tantalum clips produced marked flattening of the tube, complete loss of lining epithelium, distortion of the muscular lamellae, and areas of hemorrhage. The lumen was converted into a narrow slit. Under the ligatures, the damage was largely confined to denudation of the mucosal epithelium. The mucosa of the intersegment left unexcised between two clips showed hyalinization, invasion by macrophages, and degeneration of the epithelium. The changes under the clips suggest that, although clip occlusion may offer several advantages, sterility cannot be reversed merely by removing the clips. The mechanisms of these changes, different in the case of clips and ligatures, are discussed and some possible long-term consequences are considered.

Epididymis↗
PubMed2000

Radiographic evaluation of surgical clips is better than ultrasound for defining the lumpectomy cavity in breast boost treatment planning: a prospective clinical study.

PURPOSE: Breast radiotherapy (BrRT) often includes a "boost" to the lumpectomy bed. Selection of an appropriate electron energy and field size is based upon the dimensions and location of the surgical cavity. This study was performed to confirm our impression that ultrasound (US) inadequately defines the volume at risk compared to radiographic evaluation of surgical clips placed within the operative bed at the time of lumpectomy. METHODS AND MATERIALS Twenty-nine women treated with BrRT at our institution between 1996-1998 were prospectively identified as having surgical clips within the lumpectomy cavity. These patients underwent both US evaluation and radiographic evaluation of the clips to independently define two sets of transverse (T), longitudinal (L), and depth (D) measurements for each cavity. Volumes (V) were calculated for each method, assuming the cavity to be a box (V = T x L x D). Twenty-one women began BrRT following a median postoperative interval of 6 weeks (Group A), and 8 after 24 weeks (Group B) due to delivery of systemic therapy. RESULTS: Dimensions derived by US were smaller than the clip method in 22/29 of T, 25/29 of L, and 23/29 of D, or 80% of all linear measurements. A paired t-test demonstrated the difference between the methods to be statistically significant: T: p = 0.0004; L: p = 0.0001; D: p = 0.0004; and V: p = 0.0001. This underestimation by US did not fit any predictable pattern. Although the mean difference between methods (clips - US) was only 1.3, 1.9, and 1.1 cm for T, L, and D, respectively, differences ranged up to 5. 7, 9.2, and 5.5 cm for T, L, and D. The bias toward underestimation of V by US was significantly greater for Group B than Group A (p = 0. 03). CONCLUSIONS: US significantly underestimates all three dimensions of the lumpectomy cavity and hence the volume at risk compared to radiographic evaluation of surgical clips. Breast-conserving surgery should include placement of clips at the margins of the lumpectomy cavity (superior, inferior, medial, lateral, and posterior) to aid in radiotherapy treatment planning. US should not be utilized to guide the design of the boost field as it will result in inappropriate selection of lower electron energies and smaller field sizes (geographical miss), particularly among patients who receive chemotherapy prior to breast radiotherapy.

Breast Neoplasms↗
PubMed1986

Effects of antihypertensive treatment in one-clip, two kidney hypertension in rats.

In order to investigate the consequences of antihypertensive therapy on hormonal and renal parameters in one-clip, two kidney renovascular hypertension, we compared the effects of converting enzyme inhibition (CEI) with those of tripletherapy (clonidine, dihydralazine and furosemide) in this experimental model in rats. The treatment period was initiated four weeks after application of the clip and was continued for five weeks. In plasma, renin was increased and renin substrate was negatively correlated to plasma renin. Hypertension was associated with activation of the renin angiotensin system in both plasma and kidney. The degree of activation of the renin-angiotensin system in the clipped kidney and its suppression in the unclipped kidney was evaluated by two methods, renal renin content and semi-quantification of juxtaglomerular hyperplasia by immunofluorescent renin. These two methods were correlated. During the treatment period, average systolic blood pressure was 144 +/- 13 mmHg in the CEI treated group (HT1) which was not significantly different from the value found in the sham-operated group (139 +/- 4 mmHg; C2). Blood pressure, however, was lowered only to 173 +/- 18 mmHg in the group treated with tripletherapy (HT2). In control hypertensive animals, the wt of the clipped kidney did not decrease whereas significant hypertrophy was present in the unclipped kidney. Tripletherapy did not alter this relationship, whereas converting enzyme inhibition decreased kidney wt in the clipped kidney and increased further the hypertrophy of the contralateral unclipped kidney. A histological examination revealed that hypertensive microangiopathy was a predominant feature in the unclipped kidney of the untreated hypertensive group and of the group treated with tripletherapy, these lesions were completely absent in the CEI treated group. In the CEI treated group, however, ischemic lesions during this treatment were found to be decreased in the contralateral unclipped kidney and increased in the clipped kidney by comparison with untreated hypertensive rats. These renal lesions observed in the clipped kidney were most likely related to the normalization of blood pressure or to a disturbance of intrarenal mechanisms normally mediated by the renin-angiotensin system during stenosis of a renal artery.

Angiotensin-Converting Enzyme Inhibitors↗