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At least 253 records · Page 14Linked to original sources
PubMed1978

Interrelationship of aneurysm clips and vascular tissue.

Various straight-jawed aneurysm clips were tested for occluding capabilities on a vascular tissue model. Occluding pressures varied markedly among the clip styles and were altered by changes in the lumen and tissue composition of the model. Mechanical characteristics are highly variable between clip styles, but fall within a narrow range for clips of a similar style. The complex interplay of the unique aspects of clip design and force generated by the spring in conjunction with tissue characteristics and precise clip placement upon the tissue are major variables in the apparent ability of a particular clip to occlude the neck of an aneurysm.

Animals↗
PubMed1994

Wrap-clipping with a Dacron mesh silastic sheet. Technical note.

A technique combining wrapping and clipping using a Silastic sheet coated with Dacron mesh is described for treatment of fusiform or broad-based cerebral aneurysms. This sheet is easily tailored to wrapping the aneurysm base while avoiding involvement of the cranial nerves or branching vessels. The sheet is semitransparent so that the caliber of the newly constructed parent artery is easily adjusted during wrap-clipping. After the aneurysm and the parent artery have been circumferentially wrapped with the sheet, aneurysm clips are applied on the sheet so that the base of the aneurysm is clipped between the two leaves of the sheet. This wrap-clipping technique avoids the risks involved in extracting the aneurysm from the parent artery. The Dacron mesh coating the outer surface and sufficient clip closing pressure are both helpful in preventing the clip blades from sliding. Similar previously reported techniques are reviewed and discussed in detail.

Humans↗
PubMed2001

Altered renal expression of aquaporin-2 water channels in rats with experimental two-kidney, one clip hypertension.

The present study was aimed at examining the regulation of aquaporin (AQP)-2 water channels in the kidney in two-kidney, one clip (2K1C) hypertension. Rats were made 2K1C hypertensive for 6 weeks, and their expression of AQP2 channel proteins was determined in the clipped and contralateral kidneys. To examine the upstream affecting AQP2 channels, adenylyl cyclase activity was also determined. Along with the hypertension, in the clipped kidney, the abundance of AQP2 proteins was significantly decreased in the cortex, outer and inner medulla, while their trafficking remained unaltered. Concomitantly with the reversal of the blood pressure at 24 hours following removal of the clip, the AQP2 abundance also returned to the control level. The arginine vasopressin-evoked generation of cAMP was decreased in the clipped kidney, which again was reversed to the control level following removal of the clip. In contrast, the expression of AQP2 channels as well as the activity of adenylyl cyclase remained unaltered in the contralateral kidney. These results indicate an altered regulation of AQP2 water channels in the clipped kidney in 2K1C hypertension.

Adenylyl Cyclases↗
PubMed1999

Comparison of arcuate-legged clipped versus sutured hepatic artery, portal vein, and bile duct anastomoses.

Attempts at improving anastomoses have included the development of stapling techniques. Our purpose was to evaluate arcuate-legged clipped versus standard sutured anastomoses of the hepatic artery (HA), portal vein (PV), and bile duct in a porcine liver transplantation model. Two groups of pigs were studied intraoperatively and 1 day after liver transplantation. A control group underwent sutured anastomosis of PV and HA with polypropylene and of bile duct with polydioxanone (n = 8). An experimental group underwent anastomoses with arcuate-legged clips (n = 8). We analyzed the time to perform anastomosis and flows before and at various time points after anastomosis. In addition, patency and histology of the anastomoses were evaluated 1 day after operation, including a fibrin-thrombosis score, medial injury, and inflammation score. Times to complete HA and PV anastomoses were not different between clipped and sutured groups. However, the time was shorter to complete bile duct anastomosis with clips than with sutures (6.3 +/- 1.1 minutes and 13.3 +/- 2.0 minutes, respectively). Flows through HA anastomoses were not different between groups, but flow through the PV was higher in clipped compared with sutured anastomosis (P = 0.06). Patency was 100 per cent with no leaks for all three anastomoses in both groups. Histologic data were similar between vascular anastomotic groups. Sutured bile duct anastomoses revealed mild smooth muscle injury in 75 per cent whereas clipped bile duct anastomoses displayed no smooth muscle injury. We conclude that arcuate-legged clipped anastomosis represents a viable option to sutured anastomoses of the PV, HA, and bile duct anastomoses. Bile duct anastomoses were completed in less than half the time and with less tissue damage documented histologically.

Anastomosis, Surgical↗
PubMed1999

[Our experience with the use of Absolok polydioxanone resorbable clips in laparoscopic surgery].

BACKGROUND: The study aims to evaluate the efficacy of resorbable clips in polydioxanone in laparoscopic surgery. METHODS: The authors report their personal experience regarding the use of Absolok (ABL) resorbable clips in laparoscopic surgery. Out of a total of 745 laparoscopic operations performed from September 1992 to February 1997, 438 included the use of resorbable clips in place of metal clips, both for cystic duct section during cholecystectomy and vascular structures, or to lock continuous sutures. ABL clips were also used for major vessels (e.g. mesenteric artery) during laparoscopic colic resections. RESULTS: In all cases when they were used, ABL never gave rise to complications, such as biliary outflow or hemorrhage caused by the dislocation of the clips themselves. CONCLUSIONS: The authors conclude by affirming the value and safety of this type of clip.

Humans↗
PubMed2000

Sutureless vascular reconstruction with titanium clips.

Attempts to find alternatives to sutured vascular reconstruction techniques has continued for decades and include various forms of rings, tubes, endoluminal stents as well as gluing or welding techniques of large vessel anastomoses. One recently introduced technique uses nonpenetrating titanium clips for everted vessel approximation and closure. Experimental work on their use in various types of large vessel repairs and reconstructions has shown that the clips are easily applied with a short learning curve, create good conditions for vessel wall healing without causing excessive inflammation or fibrosis, and are considerably faster to apply when compared to standard suture techniques. Although there are some clinical reports of defective clipped closures causing postoperative bleeding complications, they are rare and most probably related to technical errors in applying the clips. The main disadvantages of the clips include the limited experience of their applicability in atherosclerotic vessels, lack of long term follow-up and cost. Potentially, the clips could be useful in the repair of multiple vascular injuries, in vessel repair or ligation performed in confined spaces, and in vascular procedures requiring the shortest possible cross-clamping time. Future applications could include endoscopic procedures as well as the use of a one-shot device which simultaneously applies up to a dozen clips to symmetrically everted and approximated vessel edges.

Animals↗
PubMed2001

Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis.

Advancements in laparoscopic surgery are often dictated by the limitations of technical instrumentation. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. With their success surgeons have begun using these on structures other than blood vessels with little or no data establishing their efficacy or safety. This study evaluates alternative energy sources in sealing ductal structures for possible use in liver or gallbladder surgery. After elective cholecystectomy cystic ducts (n = 45) were resealed ex vivo with surgical clips (n = 14), ultrasonic coagulating shears (n = 16), or electrothermal bipolar vessel sealer (n = 15), and bursting pressures were measured. Nineteen additional human cystic ducts were randomized to seal by ultrasonic coagulating shears (n = 9) or electrothermal bipolar vessel sealer (n = 10) and fixed in 10 per cent buffered formalin for histologic evaluation of thermal spread (mm). After this nine adult pigs were randomized to laparoscopic ligation and transection of the common bile duct using surgical clips (n = 3), ultrasonic coagulating shears (n = 3), or electrothermal bipolar vessel sealer (n = 3). The animals underwent necropsy for assessment of seal integrity on the sixth postoperative day. In the ex vivo study the mean cystic duct bursting pressure was 621 mm Hg with surgical clips and 482 mm Hg with the electrothermal bipolar vessel sealer (P = 0.39). The mean cystic duct bursting pressure after ultrasonic coagulating shears was 278 mm Hg, which was statistically less than surgical clips (P = 0.007) and electrothermal bipolar vessel sealer (P = 0.02). The mean thermal spread was 3.5 mm for ultrasonic coagulating shears and 13.4 mm for electrothermal bipolar vessel sealer (P = 0.0002). All animals undergoing ligation and transection of the common bile duct with ultrasonic coagulating shears and electrothermal bipolar vessel sealer developed bile peritonitis by postoperative day 6 as a result of seal leak. All animals undergoing surgical clip ligation and transection of the common bile duct maintained seal integrity. The mean common bile duct pressure above the surgical clip was 12 mm Hg (range 10-14). In conclusion the acute ex vivo study demonstrated a significant difference in the cystic duct bursting pressure between surgical clips and ultrasonic coagulating shears and between electrothermal bipolar vessel sealer and ultrasonic coagulating shears. The ultrasonic coagulating shears and electrothermal bipolar vessel sealer failed to maintain seal integrity in the in vivo animal study. Given the failure of the ultrasonic coagulating shears and electrothermal bipolar vessel sealer in the animal model these energy sources should not be used for transection of the cystic duct or major hepatic ducts during hepatobiliary surgery.

Animals↗
PubMed1985

[Recurrence of cerebral aneurysm after neck clipping--report of a case and review of literature].

A case of recurrent cerebral aneurysm after complete neck clipping is reported. A 38-year-old man was admitted to our service 14 days after attack of subarachnoid hemorrhage. On admission, ruptured left middle cerebral artery aneurysm with intercerebral hematoma and non-ruptured right anterior cerebral artery aneurysm were revealed by radiological examinations. Neck clipping was successfully performed to both of aneurysm and aneurysm was completely disappeard in the postoperative angiographical study. Postoperative course was also uneventful and he was discharged with slight right hemiparesis and motor aphasia. Thirteen months after the neck clipping, however, he was readmitted to our hospital with attack of subarachnoid hemorrhage. After admission, a new aneurysm was noted just under the clip at the right anterior cerebral artery. Neck clipping against this aneurysm was performed by reopening the craniotomy. For his postoperative normal pressure hydrocephalus, ventriculoperitoneal shunt was performed at one month after neck clipping. Postoperative course was uneventful and discharged. From review of literature, it was presumed that hemodynamic stress in the site of aneurysm and injury of arterial wall by the clip may be two major factors as a cause of recurrent aneurysm formation. In our case, possibility of the latter cause was suggested.

Adult↗
PubMed1984

Clinical comparison of Michel and Proximate clips used for abdominal wound closure.

For many years Michel clips (Down Surgical, Mississauga, Ont.) have been used to close wounds and results have been good, but several newer clips are now available (e.g., Proximate; Ethicon Sutures Ltd.), which are said to be easier to use and produce a better scar. However, they are much more expensive. The authors carried out a prospective controlled study in which 30 patients with abdominal incisions had half of the skin incision closed with Michel clips and the other half with Proximate clips. They assessed ease of insertion and removal, and appearance of the wound immediately after removal and 2 months later. Ethicon Proximate clips were, in general, slightly easier to insert, less uncomfortable to remove in 8 of the 30 patients and gave a better immediate cosmetic result in 9 patients. However, there was no difference in the appearance of the wound 2 months later. The authors do not consider that Ethicon Proximate clips offer an advantage over the much less expensive Michel clips.

Abdomen↗
PubMed1995

Enhancement of intrarenal angiotensin II levels in 2 kidney 1 clip and angiotensin II induced hypertension.

Previous studies have indicated that the hypertension that develops after unilateral arterial constriction (2 kidney, 1 clip) involves an active participation by the non-clipped contralateral kidney. Even though the non-clipped kidney is not the initial causative factors, and despite the progressive renin depletion during the early weeks following clipping, the non-clipped kidney is highly responsive to angiotensin blockers. Furthermore, the non-clipped kidney has augmented tissue ANG II levels and ACE activity suggesting that some renin-independent mechanism may be stimulating intrarenal ANG II formation. This model has been simulated by infusing ANG II at low subpressor doses (40 ng/min) to uninephrectomized rats for 14 days. With this model, plasma and renal renin levels are markedly suppressed; however, the renal ANG II levels are increased to levels above those that can be explained on the basis of circulating ANG II. In agreement with the responses observed in the non-clipped kidney of 2K1C rats, there is also an increased renal ACE activity. In contrast to the marked suppression of renin gene expression and renin activity, angiotensinogen gene expression is not suppressed. These results support the hypothesis that small elevations in circulating ANG II stimulate intrarenal ANG II production through a renin-independent mechanism.

Angiotensin II↗
PubMed1993

Migration and slipping of metal clips after celioscopic cholecystectomy.

Most surgeons performing in laparoscopic cholecystectomy have opted for the use of metal clips to secure the cystic duct before division. Accordingly, we have been using double proximal clipping of the cystic duct for our patients. Certain disadvantages of clips are well known, among them, their ability to slip. We report one case of clip migration into the common bile duct, which led to obstructive jaundice. The clip was recovered after endoscopic sphincterotomy. Slipping of the second metal clip lead to biliary peritonitis necessitating surgical drainage. The case presented raises the question of whether suture ligation of the proximal end of the cystic duct should be preferred to clipping.

Cholecystectomy, Laparoscopic↗
PubMed1997

[Value of absorbable clips in laparoscopic cholecystectomy. A randomized prospective study].

Most surgeons use metal clips in laparoscopic cholecystectomy. The aim of this prospective randomized controlled study was to evaluate the efficacy of absorbable clips in elective laparoscopic cholecystectomy. One hundred consecutive patients with symptomatic gallstones without complications were randomized into groups; group T had two metal clips (titan clip ETHICONR), group R (laproclipR Davis and Geck) had one absorbable clip applied on the cystic duct and cystic artery. The patients were followed for one year. There was no difference between the two groups concerning operative time, hospital stay and postoperative complications. The absorbable clips seem to be as effective as metal clips in providing hemostasis in cystic artery and in cystic duct ligation.

Adult↗
PubMed1998

[Dislocation of clips of the cystic duct stump].

The security of six different laparoscopic clips was investigated using 60 kryopreserved specimens of human cystic ducts. After fixation of the cystic duct the cross placed clips were distracted in axial direction and the maximum forces to remove the clip were registered. The mean dislocation-force was 4.6 Newton for titanium clips and 9.3 Newton for absorbable clips with a highly significant difference (p < 0.001, Wilcoxon-test). Additional to the advantage of complete biodegradibility these data favour the use of absorbable clips, because of a better hold force compared to titannium clips.

Biodegradation, Environmental↗
PubMed2001

The transmembrane segment of invariant chain mediates binding to MHC class II molecules in a CLIP-independent manner.

Invariant chain (Ii) association with MHC class II molecules is strongly dependent upon interaction of CLIP (Ii exon 3, residues 81 - 104) with the peptide binding groove of the class II dimer. This dominant interaction does not adequately explain, however, the efficient association of Ii with class II molecules of diverse allelic and isotypic origin, which have markedly different affinities for synthetic peptides corresponding to CLIP. In agreement with other recent observations, we demonstrate here that class II molecules with occupied binding sites unable to engage CLIP maintain association with Ii in mild detergent. The association is direct and not mediated through unoccupied class II chains bound to properly assembled and loaded class II dimers, nor is it mediated through chaperones. The site of this CLIP-independent binding has been mapped using truncation mutants and an Ii-human transferrin receptor chimeric protein to the transmembrane segment of Ii. The existence of multiple low-affinity sites of interaction between MHC class II and Ii helps explain how effective occupancy of all newly synthesized class II molecules can occur despite substantial variations in the strength of CLIP-dependent association that arise from class II binding domain polymorphism. These data establishing a site of Ii-MHC class II association N-terminal to CLIP also provide new insight into the possible functional relationship between the sequential endocytic proteolysis of Ii from its C terminus and a series of contact sites with MHC class II molecules spread from the transmembrane region through to the tip of the lumenal segment of Ii.

Animals↗
PubMedDate not supplied

A comparison of the clip and ring techniques for laparoscopic sterilization of postabortion and postpartum patients.

The spring-loaded clip and the tubal ring techniques of laparoscopic female sterilization are compared for ease of performance, safety and effectiveness at the Kandang Kerbau Hospital in Singapore. The two techniques were randomly assigned to 299 postpartum patients and 300 postabortion patients. The assigned procedure could not be performed for two of the ring cases and three of the clip cases. Bleeding and equipment problems made laparotomy necessary in two clip cases and equipment problems caused a change in technique in the other clip case. Hydrosalpinx and adhesions were responsible for a change to laparotomy in the two ring cases. Surgical difficulties, chiefly the result of equipment problems, were significantly higher for both postpartum and postabortion clip procedures. Complications and complaints reported immediately after surgery and at the 7- to 21-day follow-up visit were low for all four groups. For both postabortion and postpartum patients, six- and 12-month data show that pregnancy rates are significantly higher for patients sterilized with the clip than with tubal rings.

Abortion, Induced↗
PubMed1990

Tissue reactivity and degradation patterns of absorbable vascular ligating clips implanted in peritoneum and rectus fascia.

Absorbable vascular ligating clips are finding increasing use in intraabdominal surgery. We report the results of a light and scanning electron microscope investigation of the tissue reactivity and clip degradation patterns of two such materials, Absolok (polydioxanone) and Lactomer (copolymer of glycolic and lactic acid), implanted in the fascia and peritoneum of rabbits for intervals of 2 to 70 days. Cellular response to the clips, defined as the number of inflammatory cells/10(4) microns 2, was maximum at day 4 postimplantation, then gradually declined as the duration of implantation increased. This pattern, seen with both types of clips, was similar to that seen with polydioxanone (PDS) suture, but significantly greater than that associated with polypropylene (Prolene) suture. Although cellular response to the clips was greater in peritoneum than in fascia, especially on two occasions associated with adhesion formation, this was not statistically significant. Based on our morphological observations, the signs of clip degradation which were indicated by the appearance of surface crazing and cracks occurred earlier in peritoneum than in fascia.

Abdomen↗
PubMed1981

Reduced vascular trauma after temporary occlusion with modified Biemer and Yasargil clips.

The Biemer and Yasargil microvascular clips that are currently available commercially can traumatize the vascular endothelium. In an effort to resolve this problem, both clip designs were structurally modified by changing the length, width, and surface of the clip blades in various ways. Also, the occlusion force of the clips was set at either 15 or 30 g. Studies on the carotid arteries of 140 rats showed a correlation between the structural and mechanical alterations of the clips and the degree of endothelial trauma produced by temporary occlusion for 1 hour. The most favorable results were obtained with a Biemer clip that had long, wide, smooth blades and an occluding force of 15 g.

Animals↗
PubMed1996

Absorbable Adams-DeWeese caval clip: an experimental study.

Adams-DeWeese caval clips have been shown to be effective in preventing pulmonary embolism. However, the use of Teflon clips constitutes a permanent solution for this transient risk. We tested an absorbable caval clip made of currently available synthetic biodegradable polymers in five female beagle dogs. The polymer used was PLA 96 containing 96% L lactic acid and 4% D lactic acid. After placement through a laparotomy, clips were routinely inspected and samples of the material were collected at regular intervals between 3 and 19 months postoperatively. The characteristics of absorption of PLA 96 in the retroperitoneal space were the same as those previously described in the literature. The clip retained its shape, rigidity, and effectiveness for 7 months. Complete degradation of the clip took between 18 and 19 months. Absorption did not cause a major inflammatory reaction and had no thrombogenic effect. Given the small number of animals studied, these results must be considered preliminary.

Animals↗