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At least 307 records · Page 17Linked to original sources
PubMed1998

Are allergic reactions to skin clips associated with delayed wound healing?

BACKGROUND: Metal skin clips are used in surgery. They may contain metals that might cause allergic reactions and delayed wound healing. METHODS: The metal composition of 18 different surgical clamps was examined. The allergy status of 184 patients was determined by patch tests and was correlated with the clinical outcome of wound healing after application of skin clips. RESULTS: Skin clips contained chromium, nickel, molybdenum, cobalt, and titanium in concentrations high enough to cause allergic reactions. Eighteen percent of the men and 23% of the women were sensitive to nickel and 16% of the men to chromium. We found a positive correlation between the grade of nickel allergy and the reaction to the skin clips. CONCLUSIONS: Our study suggests that allergic reactions and delayed wound healing can be caused by the use of surgical skin clips. Therefore skin clips are not recommended for patients with a history of contact dermatitis to metals and/or atopy.

Adolescent↗
PubMed1999

Preliminary prospective randomized experience with vascular clips in the creation of arteriovenous fistulae for hemodialysis.

BACKGROUND: A new vascular clipping system (VCS) has been introduced for clinical use. This study was developed to determine whether patency rates and treatment outcomes for anastomoses in hemodialysis access surgery can be improved by the application of this new technology. METHODS: During a 10-month period, 96 consecutive patients requiring autologous fistula, synthetic fistula, or graft revisions for hemodialysis were prospectively randomized into two treatment groups. Anastomoses were constructed with the VCS in 46 patients and with polytetrafluoroethylene (PTFE) suturing in 49 patients. The procedures were performed in an outpatient setting, at a large medical center, by one surgeon. Time to construct the anastomosis, amount of bleeding from the anastomotic site, and primary and secondary graft patencies were analyzed. RESULTS: The mean time to construct anastomoses in autologous and synthetic grafts using VCS clips was significantly shorter than with sutures (autologous 14 versus 22 minutes, P = 0.0001; and new grafts 26 versus 30 minutes, P = 0.04). Blood loss was less in anastomoses done with the VCS clip; however, statistical significance was reached only for autologous fistulas (P = 0.0001). At 2-year follow-up, primary and secondary patencies were similar for both the VCS and suture groups with the exception that a statistically significant improvement was found in secondary patency for autologous fistulas when performed with the VCS. CONCLUSIONS: The VCS clip is easy to use and produces a more rapid anastomosis with less bleeding. Primary and secondary patencies using the VCS clip were equivalent or improved when compared with standard suture. In our experience, no complications have been attributed to the use of the clip technique.

Anastomosis, Surgical↗
PubMed2003

Effect of suture size and carotid clip application upon blood flow and infarct volume after permanent and temporary middle cerebral artery occlusion in mice.

Problems with the intraluminal suture method for induction of focal cerebral ischemia in genetically altered mice include occurrence of subarachnoid hemorrhage (SAH) and variability of infarct volume. We hypothesized that use of 5-0 curved or 6-0 straight suture for carotid cannulation might decrease SAH and that the application of a microvascular clip to the common carotid artery (CCA) might decrease variability of infarct volume. The purpose of this study is to evaluate and explain the results of these technical modifications. Strain related differences in vascular anatomy were evaluated. Male C57BL/6 mice were divided into two groups for permanent and temporary middle cerebral artery occlusion (MCAO). Results of 5-0 curved suture and 6-0 straight suture insertion with and without CCA clip application were examined. Cerebral perfusion was monitored by laser-Doppler flowmetry and infarct volume was measured. After permanent MCAO, larger and more consistent infarct volumes resulted using CCA clip application with a 6-0 but not with a 5-0 suture. After temporary MCAO, the SAH rate was 12.5% with a 5-0 curved suture and 11.1% with a 6-0 straight suture. A 40% rate was observed in a pilot study with 5-0 straight suture. Infarct volume after temporary MCAO with a CCA clip was significantly larger and variability of infarct volume was smaller than without the CCA clip using 5-0 curved and 6-0 straight suture. In summary, SAH is less frequent using a 5-0 curved or 6-0 straight suture. Infarct volume is enlarged by application of a CCA clip (249).

Animals↗
PubMed2000

Influence of a 1-h immobilization stress on sleep and CLIP (ACTH(18-39)) brain contents in adrenalectomized rats.

Basal sleep amounts in adrenalectomized rats (AdX), as compared to intact animals, exhibit a significant increase in slow-wave sleep (SWS), a tendency towards an increase in paradoxical sleep (PS), and circadian rhythms (SWS and PS) flattened in amplitude. An immobilization stress (IS) of 1 h, imposed on AdX rats at the beginning of the dark period, is accompanied by an intense polygraphic waking. Just after the IS, SWS amount become significantly higher than in control rats (+44%/11 h of darkness) whereas significant increases of PS occur only 5-10 h after the IS (+24%/11 h of darkness). A specific radioimmunoassay for CLIP (corticotropin-like intermediate lobe peptide or ACTH(18-39)) was performed in biopsies taken either from the nucleus raphe dorsalis (nRD) or the arcuate nucleus (AN). In the nRD, just after the IS, phosphorylated CLIP (Ph-CLIP) concentration exhibits a decreasing tendency, but 4 h later, it increases significantly (+22%, p<0.05). In the AN, Ph-CLIP concentration remains unchanged after the IS as well as 4 h later. These results differ from those previously reported in intact animals also submitted to a 1-h IS, that is, a SWS rebound less marked (+27%/11 h of darkness), a PS rebound more important starting immediately after the IS (+46%/11 h of darkness) and a significant increase in Ph-CLIP occurring just after the end of the restraint. In conclusion, data obtained after a restraint stress either in AdX or in control rats point out the dependence of the PS rebound on the nRD Ph-CLIP concentration.

Adrenalectomy↗
PubMed2000

Two randomized controlled trials comparing the tubal ring and filshie clip for tubal sterilization.

OBJECTIVE: To compare the effectiveness and safety of the Filshie Clip and Tubal Ring systems when applied via minilaparotomy and laparoscopy. DESIGN: Prospective, multicenter randomized controlled clinical trial, with postoperative evaluation by a physician who was masked to the operative technique. SETTING: Healthy volunteers in a variety of hospital settings. PATIENT(S): 2746 women (915 in the minilaparotomy study and 1831 in the laparoscopy study) who had requested permanent surgical sterilization. INTERVENTION(S): Surgical tubal ligation, using either Filshie Clips or Tubal Rings. A physician other than the surgeon evaluated the patients after the operation and again at 1, 6, and 12 months after surgery. MAIN OUTCOME MEASURE(S): Pregnancy rates and safety-related events. RESULT(S): During the 12 months after surgery, two women who received the Filshie Clip and two women who received the Tubal Ring became pregnant, giving a 12-month life-table pregnancy probability of 1.7 per 1000 women in both groups. The Tubal Ring was more difficult to apply and had higher rates of tubal or mesosalpingeal injuries at surgery. The Filshie Clip group had three cases of spontaneous clip expulsion during the follow-up period. CONCLUSION(S): Both the Filshie Clip and Tubal Ring are effective and safe for use in tubal occlusion.

Adult↗
PubMed2005

Image documentation of endoscopic findings in ulcerative colitis: photographs or video clips?

BACKGROUND: Previous studies have shown deficiencies in the endoscopy reports and substantial interobserver variation in the assessments of endoscopic findings. The aim of this study was to determine how to perform systematic digital image documentation in ulcerative colitis and to evaluate if mucosal inflammation is assessed equally on a still image and on a video clip. METHODS: Eighteen video clips and their corresponding photographs that visualize different severities of ulcerative colitis were shown in randomized order to 20 experienced endoscopists. They assessed the mucosal inflammation of each image twice on a visual analog scale. Three comparisons were performed between the video clips, the photographs, and the video clips to the photographs, respectively. RESULTS: The mean score of the inflammation of the video clips at tape 1 and 2 was 4.74: 95% confidence interval (CI)[4.41, 5.08] and 4.90: 95% CI[4.56, 5.24), respectively, and of the photographs 4.53: 95% CI[4.19, 4.88] and 4.43: 95% CI[4.09, 4.77], respectively. The first answer explains 83% of the variation in the second answer for all comparisons, and the agreement index ranged from 0.38 to 0.42. CONCLUSIONS: The mucosal inflammation might be documented nearly as well with a still image as on a video clip. Systematic use of still images probably improves the endoscopy reports by adding more objective information about the mucosal inflammation.

Colitis, Ulcerative↗
PubMed1999

A novel clinical application for endoscopic mucosal clipping.

BACKGROUND: Endoscopic hemoclipping has been shown to be effective in the treatment of gastrointestinal bleeding. Here we describe a novel clinical application for endoscopic application of metal clips. METHODS: A middle-aged man with inoperable squamous cell cancer of the esophagus underwent per protocol a barium esophagogram to document tumor margins prior to radiation therapy. This study failed to localize the full extent of the tumor. At endoscopy, the tumor margins were clearly visible. To delineate the proximal and distal margins, detachable metallic clips were passed through the accessory channel of a standard endoscope and using a clip fixing device the clips were placed at each level. Subsequently, a chest x-ray was obtained. RESULTS: Placement of mucosal clips facilitated radiotherapy. CONCLUSIONS: Endoscopic mucosal clipping may serve as a useful technique for localizing or marking gastrointestinal lesions, especially for demarcating a precise radiation field when conventional techniques fail.

Carcinoma, Squamous Cell↗
PubMed1999

New semicircular clip for internal carotid artery aneurysms. Technical note.

BACKGROUND: Complete clipping of internal carotid artery (ICA) aneurysms without residual aneurysmal neck may conflict with preservation of the anterior choroidal artery, posterior communicating artery, or their branches. In addition, the neck of the aneurysm is often situated behind the ICA, as seen through the operative microscope. The blades of fenestrated clips can be inserted over the ICA, followed by reconstruction of the ICA wall to minimize the residual aneurysmal neck. However, the blades are out of the field of vision behind the ICA when they are closed, so that ICA branches or perforators may be clipped together with the aneurysmal neck. We have developed a semicircular clip to avoid this type of misclipping. METHODS AND RESULTS: We have treated four patients with ruptured ICA aneurysms and two patients with unruptured ICA aneurysms with this semicircular clip. In all cases, the aneurysms were clipped without residual neck, and the ICA branches were preserved. CONCLUSION: This instrumentation is especially useful in cases of ICA aneurysms protruding posteriorly or medially.

Carotid Artery, Internal↗
PubMed2002

Rac1 and Cdc42 capture microtubules through IQGAP1 and CLIP-170.

Linkage of microtubules to special cortical regions is essential for cell polarization. CLIP-170 binds to the growing ends of microtubules and plays pivotal roles in orientation. We have found that IQGAP1, an effector of Rac1 and Cdc42, interacts with CLIP-170. In Vero fibroblasts, IQGAP1 localizes at the polarized leading edge. Expression of carboxy-terminal fragment of IQGAP1, which includes the CLIP-170 binding region, delocalizes GFP-CLIP-170 from the tips of microtubules and alters the microtubule array. Activated Rac1/Cdc42, IQGAP1, and CLIP-170 form a tripartite complex. Furthermore, expression of an IQGAP1 mutant defective in Rac1/Cdc42 binding induces multiple leading edges. These results indicate that Rac1/Cdc42 marks special cortical spots where the IQGAP1 and CLIP-170 complex is targeted, leading to a polarized microtubule array and cell polarization.

Actins↗
PubMed1998

The CLIP-substituted invariant chain efficiently targets an antigenic peptide to HLA class II pathway in L cells.

The presentation of antigenic peptides by major histocompatibility complex (MHC) class II to CD4+ T cells is crucial to initiate immune responses. We developed a new system for delivery of an antigenic peptide to the MHC class II pathway, using the invariant chain (Ii). We designed a mutated human p33-form Ii, CLIP-substituted Ii, in which streptococcal M12p55-68 (RDLEQAYNELSGEA) was substituted for CLIP (class II associated invariant chain peptide). We examined the peptide presenting function of this construct, in comparison with the previously reported C-terminal fused Ii, in which a cathepsin cleavage site and M12p54-68 was ligated to the C-terminus of Ii. Mouse L cell transfectants expressing either of these two mutated Ii along with HLA-DR4 could process and present M12p55-68 to the peptide specific and DR4-restricted CD4+ T cell clone. CLIP-substituted Ii was much more efficient in antigen presentation than was the C-terminal fused Ii. Similar to the wild-type Ii, the CLIP-substituted Ii was associated intracellularly with DR4 molecules. These results indicate that the peptide substituted for CLIP of Ii p33 bound to the groove of DR molecules in the same manner as CLIP and it was preferentially presented to the CD4+ T cell clone in the absence of HLA-DM molecules. This system may prove useful for immunotherapy with DNA vaccines or for construction of an antigen presenting cell library with diverse peptides.

Amino Acid Sequence↗
PubMed1997

Arterial and venous repair with vascular clips: comparison with suture closure.

PURPOSE: Nonpenetrating, arcuate-legged titanium vascular closure staple (VCS) clips were initially developed for microvascular anastomoses with little experience of their use in larger vessels. The purpose of this study was to compare the VCS clips with standard suture closure of arteriotomies and venotomies in common iliac vessels of pigs. METHODS: In nine pigs, longitudinal 1 cm iliac arterial and venous incisions were repaired with VCS clips on one side and continuous 6-0 polypropylene suture on the other, and the macroscopic and microscopic results were assessed after 3 months. RESULTS: The time required for vessel repair was significantly shorter with clips than with sutures both in arteries (51 +/- 9 vs 414 +/- 36 seconds) and in veins (100 +/- 32 vs 439 +/- 45 seconds). There was no significant difference in the inner diameter, intimal thickness, or intima-to-media height ratios of the arteries or veins after either method of closure. CONCLUSIONS: Repair of 1 cm incisions in small-diameter arteries and veins with VCS clips results in wound healing as good as that achieved with standard suture closure, when assessed for patency, leakage, degree of narrowing, and intimal reaction. The time required for clip closure is considerably shorter than for suture closure.

Animals↗
PubMedDate not supplied

Preparation of a spermine conjugate of the bis-phenanthroline ligand Clip-Phen and evaluation of the corresponding copper complex.

We described the synthesis of conjugates of N, N-diethylethylenediamine and spermine with Clip-Phen, a new ligand with two 1,10-phenanthrolines linked by serinol. The ability of the copper complexes of these Clip-Phen conjugates to cleave PhiX174 DNA when activated by a reductant in the presence of air was compared to that of 1,10-phenanthroline copper complexes. The results indicated that Clip-Phen-spermine with copper was the most active DNA cleaver. Comparison with a conjugate having only one phenanthroline unit linked to spermine showed that the high activity of Clip-Phen-spermine-Cu was not only due to the presence of spermine, which increases the affinity of the Clip-Phen entity for the DNA, but was effectively due to the presence of the two bridged phenanthroline entities. The DNA cleavage activity of (Clip-Phen-spermine)CuCl2 was analyzed on a 167 bp restriction fragment and a 45-mer double-stranded oligonucleotide.

Bacteriophage phi X 174↗
PubMed2004

Upregulation of the CLIP self peptide on mature dendritic cells antagonizes T helper type 1 polarization.

Dendritic cells (DCs) initiate and regulate immunity against foreign and self antigens. Here we identified more than 200 individual major histocompatibility complex class II-associated peptides on human DCs and found that mature DCs selectively upregulated the self peptide CLIP. CLIP cosegregated together with foreign antigenic peptides in tetraspan microdomains on the surface and localized to DC-T cell synapses. The increased representation of CLIP-major histocompatibility complex class II complexes favored polarization of autologous naive T cells toward the nonpolarized and T helper type 2 (T(H)2) phenotype. There was also a considerably higher T(H)2/T(H)1 ratio in H2-DM-deficient mice, which have a CLIP(hi) phenotype, in contrast to wild-type, CLIP(lo) mice. Thus, the self peptide CLIP on DCs qualifies as an endogenous regulator in priming of T helper cells by antagonizing the polarization toward the T(H)1 phenotype.

Antigen Presentation↗
PubMed1996

Quality ratings for frequency-shaped peak-clipped speech: results for listeners with hearing loss.

Peak clipping is a common form of distortion in hearing aids and can reduce the subjective quality of the amplified speech. In a previous study involving listeners with normal hearing (Kates & Kozma-Spytek, 1994), the effect of peak clipping on speech quality ratings was studied using sentence test materials that were filtered using three different frequency response contours and then clipped at four different clipping levels. The present study extends the quality ratings to include those from a group of listeners having moderate to profound hearing impairments. The experimental results indicate that the clipping level, and the interaction of the frequency-response shaping with the clipping level, significantly affects speech quality. It is also shown that the distortion effects on speech quality for the listeners with impaired hearing can be modeled by a distortion index computed from the magnitude-squared coherence of the speech-processing system in response to a shaped-noise input signal. The distortion-index weights derived for the group of listeners with impaired hearing, however, differ substantially from those derived for listeners with normal hearing, and substantial inter-listener variation was also observed.

Audiometry, Speech↗
PubMed2001

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program.

To reliably estimate the prognoses of patients with hepatocellular carcinoma (HCC), both liver function and tumor-related factors should be accounted for. However, there are few worldwide staging systems that assess prognostic value in the context of selecting individual patients for randomized stratification in therapeutic and clinical trials. We investigated the value of known prognostic systems and verified the usefulness of the new scoring system proposed by the Cancer of the Liver Italian Program (CLIP), as determined from 662 Japanese patients. A retrospective analysis of the HCC diagnoses at 4 Japanese institutions from 1990 and 1998 was performed. Overall survival was the only end point used in the analysis. Discriminatory ability and predictive power of the CLIP score were compared with those of Okuda stage and AJCC TNM stage. Compared with the Okuda and AJCC staging systems, the CLIP score's enhanced discriminatory capacity, which was tested by the linear trend test and Harrels' c-index, revealed a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. Moreover, the likelihood ratio test showed that the CLIP score had additional homogeneity of survival within each score above that of the Okuda stage or the AJCC stage. This was true for 3 subgroups of patients who received surgery, transcatheter arterial chemoembolizations, and percutaneous ethanol injections. Collectively, these findings indicate that the CLIP score has the highest stratification ability with regard to prognosis in patients with HCC. The CLIP score could be used internationally to stratify randomization groups in therapeutic and clinical trials.

Adult↗
PubMed2004

Immediate postoperative angiography after aneurysm clipping--implications for quality control and guidance of further management.

BACKGROUND: To determine the impact of postoperative angiography after aneurysm clipping on quality control and further management. METHODS: A recent consecutive series of n = 296 patients (186 females, 110 males, mean age 51 yrs) who underwent 324 craniotomies to clip 384 aneurysms was reviewed. New irregularities on postoperative angiographies were categorized as unrelated (e. g. vasospasm) or related (= vessel occlusion/residuum) to clipping and expected or unexpected by the surgeon. Therapies prompted by these findings as well as subsequent negative sequelae were analyzed. Factors related to negative events were identified by logistic regression (p < 0.05). RESULTS: Twenty-six (8%) unrelated findings prompted medical or intravascular therapy. Of 36 (9.4%) clip-related findings (n = 17 occlusions, n = 19 residua), 14 (3.6%) were unexpected (n = 9 occlusions, n = 5 residua). This was followed by 9 (2.3%, n = 4 occlusions, n = 5 residua) clip readjustments and 6 aggressive medical therapies. Nine patients were scheduled for angiographic follow-up, of which in five performed so far no change of aneurysm remnants was noted. Permanent sequelae from vessel occlusion occurred in 9 cases. Major premature rupture (p < 0.005), giant size/fusiform configuration (p < 0.001), posterior circulation aneurysms (p < 0.05) and ophthalmic segment location (p < 0.008) were significantly related to adverse postoperative findings. The use of microvascular Doppler significantly reduced the rate of unexpected vessel occlusion (3.3 vs. 0.9%). CONCLUSIONS: Apart from the need for quality control in aneurysm clipping--especially with respect to coiling--our results stress the importance of postoperative angiography, because a small, but significant subset of patients will benefit from immediate intervention and/or deserves long-term follow-up.

Angiography↗
PubMed1999

An endoscopic aneurysm clip applicator: preliminary development.

Visualization of an aneurysm and its associated vessels is necessary for the proper application of aneurysm clips. Microscopes provide binocular magnification and excellent illumination but often visualization is obscured by overriding vessels and the limitation of the operative approach. If this occurs the aneurysm may be incompletely clipped or small perforators may be included in the clip. In an attempt to improve visualization during aneurysm clipping we have incorporated a small endoscope into the aneurysm clip applicator so that the tips of the clip can be observed at all times. Here we report our initial experimental results with this instrument.

Cadaver↗
PubMed2003

Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy.

BACKGROUND: The most common major complication of colonoscopic polypectomy is postpolypectomy hemorrhage. Although several factors have been implicated in the occurrence of hemorrhage, accurate prediction of delayed bleeding remains difficult. This randomized controlled trial evaluated the efficacy of prophylactic clip application for prevention of delayed postpolypectomy bleeding. METHODS: Postpolypectomy ulcers created by colonoscopic removal of polyps (mean size 7.8 [4.0] mm) with the endoscopic mucosal resection technique were randomly assigned to prophylactic clip placement (n = 205) or no clip (n = 208). Baseline characteristics of the patients and polyps excised were comparable between the groups. Delayed bleeding was defined as the postprocedure passage of bloody stool or massive hematochezia. The site of delayed bleeding was identified at emergent colonoscopy. RESULTS: Delayed bleeding was identified from 2 ulcers in each group from 1 to 4 days after resection (mean 2.3 days). Delayed bleeding occurred from 0.98% of ulcers in the clip group and 0.96% in the non-clip group (p > 0.9999). No patient with delayed bleeding required transfusion or surgery. CONCLUSIONS: Prophylactic clip placement did not decrease the occurrence of delayed bleeding after colonoscopic polypectomy.

Adenocarcinoma↗