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At least 271 records · Page 15Linked to original sources
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↗
PubMed1999

The efficiency of absorbable clips in minimally invasive surgery.

This study was conducted to evaluate the efficiency of polymeric clips in minimally invasive surgery. Absorbable polymeric clips were applied to the cystic duct, appendicular stump, and blood vessels in 35 patients undergoing laparoscopic or thoracoscopic procedures. All patients were reviewed 3 months after their operations, and no complications related to the clips were observed. These findings indicate that absorbable clips have more advantages than metallic clips. We believe that as this clip is easy to operate with safety, it should be used in the majority of minimally invasive surgical procedures.

Hemostasis, Surgical↗
PubMed2002

Magnetic resonance angiography with ultrashort echo times reduces the artefact of aneurysm clips.

We evaluated the ability of an ultrashort echo time (TE) three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) sequence to reduce the metal artefact of intracranial aneurysm clips and to display adjacent cerebral arteries. In five patients (aged 8-72 years) treated with Elgiloy or Phynox aneurysm clips we prospectively performed a conventional (TE 6.0 ms) and a new ultrashort TE (TE 2.4 ms) 3D TOF MRA. We compared the diameter of the clip-induced susceptibility artefact and the detectability of flow in adjacent vessels. The mean artefact diameter was 22.3+/-6.4 mm (range 14-38 mm) with the ultrashort TE and 27.7+/-6.4 mm (range 19-45 mm) with the conventional MRA ( P<0.0001). This corresponded to a diameter reduction of 19.5+/-9.2%. More parts of adjacent vessels were detected, but with less intense flow signal. The aneurysm dome and neck remained within the area of signal loss and were therefore not displayed. Ultrashort TE MRA is a noninvasive and fast method for improving detection of vessels adjacent to clipped intracranial aneurysms, by reducing clip-induced susceptibility artefact. The method cannot, however, be used to show remnants of the aneurysm neck or sac as a result of imperfect clipping.

Adult↗
PubMed2002

Needlescopic thoracic sympathetic block by clipping for craniofacial hyperhidrosis: an analysis of 28 cases.

BACKGROUND: Endoscopic thoracic sympathectomy or sympathicotomy of the lower part of the stellate ganglion is an efficient method for the treatment of craniofacial hyperhidrosis, but postoperative compensatory sweating may be troublesome in some patients. Needlescopic thoracic sympathetic block by clipping may achieve a similar effect as well as providing a possible reverse operation for patients who suffer from intolerable postoperative compensatory sweating. METHODS: Between January 1998 and June 2000, we collected a total of 28 patients with craniofacial hyperhidrosis. There were 15 men and 13 women with a mean age of 39.2 years (ranges, 19-50). All patients were placed under single-lumen intubated anesthesia in a semisitting position. Two ports were needed. We used a 2-mm 0 degrees thoracoscope and endo clips to perform a sympathetic block by clipping the lower third of the stellate ganglion at the second intercostal space. RESULTS: The operation was usually accomplished within 20 min (ranges, 15-30). All patients were discharged within 4 h after the operation. There were no surgical complications or surgical mortality cases. All patients achieved improvement of craniofacial hyperhidrosis without recurrent symptoms after a mean of 25.3 months (range, 12-41) of follow-up. Twenty-five patients (85.7%) developed compensatory sweating of the trunk and lower limbs. One of these patients could not tolerate this postoperative sweating; he therefore underwent a reverse operation and obtained improvement of the compensatory sweating 18 days after removal of the endo clips. CONCLUSION: Needlescopic thoracic sympathetic block by clipping is a safe and effective method for the treatment of craniofacial hyperhidrosis; compensatory sweating may be improved after a reverse operation and removal of the endo clips.

Adult↗
PubMed2003

Vascular clips as a landmark for sites of anastomosis.

Vascular clips can be used in bypasses at risk of future occlusion, to assist with catheter placement for radiological intervention. We explain how vascular clips can be placed as a landmark for the sites of anastomosis. After completion of the vascular anastomosis, two or three bullets of medium-sized vascular clips are clipped to the tips of the vascular suture. The sites of the vascular anastomosis are checked by plain X-rays. Finding the inlet of the anastomosis in an occluded graft can be difficult, and the marker proved helpful for introducing the guide-wire through the inlet of the site of anastomosis. The vascular clips around the popliteal anastomosis enabled us to clearly differentiate above-knee from below-knee femoropopliteal bypasses using plain X-ray postoperatively. This is a simple yet effective method of identifying the site of vascular anastomosis. Thus, we recommend using vascular clips as a landmark to aid in postoperative intervention by allowing clear identification of the level of anastomosis.

Anastomosis, Surgical↗
PubMed1998

Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms).

The aim of this prospective study, carried out in a consecutive series of 305 microsurgically clipped aneurysms, was to check the absence of an aneurysmal remnant on post-operative angiography, and if a remnant was found to quantify its size in order to consider additional clipping to avoid the risk of rebleeding. Out of the 305 aneurysms, 292 (96%) were located in the anterior and 13 (4%) in the posterior circulation. Post-operative angiography was performed on average two weeks after surgery. Determination of the presence or not of an aneurysmal remnant and its quantification was done by an independent observer (JCA). Aneurysmal remnants were classified into 5 grades: grade I: less than 50% of neck size, grade II: more than 50% of neck size, grade III: residual lobe of a multilobulated sac, grade IV: residual sac of less than 75% of aneurysmal size and grade V: residual sac of more than 75% of aneurysmal size. Correlations between presence (and size) of the remnant and anatomical-surgical data obtained from the operative report were studied. Clipping was considered incomplete in 18 of the 305 aneurysms (5.9%). The group with residual neck only (grade I = 8 cases, Grade II = 4 cases) amounted to 4% of the whole series, whereas the group with residual neck + sac (grade III = 4, grade IV = 1, Grade V = 1) to 1.9%. Only this latter group was amenable to re-operation for complementary clipping without creating a stenosis of the parent artery. Our results are in the range of those of other published series. Anatomical-surgical factors for predisposition to incomplete clipping are discussed. The rates of sac obliteration using microsurgical clipping are to be compared with those recently achieved by electrically detachable coiling. The classification which we have developed is proposed for future comparison with endovascular results.

Adolescent↗
PubMed1989

Safety of metallic surgical clips in patients undergoing high-field-strength magnetic resonance imaging.

Use of metallic clips with ferromagnetic properties in patients undergoing a large variety of surgical procedures, and in particular, in coronary artery and other vascular reconstructions, has become increasingly popular. The safety of these commonly used surgical clips when subjected to high-intensity diagnostic magnetic resonance imaging fields is still debated. Commonly used hemostatic metallic clips manufactured by the Weck and US Surgical Corporations were tested in an in vitro system to assess their safety with regard to migration and displacement. The two tested hemostatic metallic clips proved safe and did not migrate or become dislodged when they underwent magnetic resonance imaging scans. This is in direct contrast to multiple cerebral aneurysm clips, also tested, which have highly ferromagnetic properties and were previously shown to migrate with disastrous results in patients undergoing diagnostic magnetic resonance imaging scans. This study supports the continued widespread use of small metallic hemostatic clips in the myriad of procedures in which they are presently used and illustrates the need for methods of evaluating such devices before they are clinically implanted.

Electromagnetic Fields↗
PubMed1988

Clip-induced analgesia and immobility in the mouse: pharmacological characterization.

A pinch to the nape of the neck of mice, by application of a noxious clip, produces analgesia and immobility. Because both opiate and dopaminergic systems are usually implicated in analgesia and immobility, the pharmacological profile of clip-induced effects was compared to those elicited by the dopamine antagonist haloperidol, and by morphine. In addition, the effects of a series of pharmacological agents on clip-induced effects was examined. Haloperidol, but not morphine, produced immobility similar to that seen after application of the clip to the neck. Application of clip completely inhibited righting in all tests utilized. Haloperidol inhibited righting in all tests, except for inversion from a supine position. Righting from this position could also be inhibited in mice treated with haloperidol when a mild pinch, ineffective in a naive animal, was applied. Clip-induced immobility, but not analgesia, was reversed by amphetamine. Administration of the cholinergic antagonist scopolamine, but not methylscopolamine, reversed both the analgesia and immobility. Pinch-induced analgesia was as marked as that elicited by morphine but could not be reversed by the opiate antagonist naloxone. It is proposed that pinch-induced immobility is mediated by both dopaminergic and cholinergic systems. Additional unidentified systems are also involved. Analgesia, induced by a noxious pinch, can be dissociated pharmacologically from the immobilizing effect, is non-opiate in nature, and involves activation of central cholinergic synapses.

Analgesia↗