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PubMed2002

Radiofrequency ablation of the long saphenous vein without high ligation versus high ligation and stripping for primary varicose veins: pros and cons.

Primary varicose vein disease is prevalent in our society, and although it is infrequently the cause of serious venous insufficiency, it often is associated with symptoms of local discomfort. These symptoms eventually may outweigh any cosmetic concerns of patients with this disease. Greater saphenous vein (GSV) reflux is the most important pathophysiologic component of primary venous insufficiency. To date, the surgical treatment of GSV reflux has evolved into 1 of 3 procedures: high ligation of the saphenofemoral junction, with or without perforator ligation; high ligation and stripping of the GSV; and high ligation with retrograde sclerotherapy of the GSV. High ligation and stripping of the GSV to below the knee enjoys the most durable success yet is associated with significant perioperative morbidity. A new treatment, radiofrequency ablation of the GSV without high ligation, recently has been described and promises a less invasive alternative to stripping with decreased morbidity and increased patient acceptance. The results of high ligation and stripping of the GSV will be compared with those with radiofrequency ablation of the GSV without high ligation.

Catheter Ablation↗
PubMed2000

Variceal band ligation and variceal band ligation plus sclerotherapy in the prevention of recurrent variceal bleeding in cirrhotic patients: a randomized, prospective and controlled trial.

BACKGROUND: The combination treatment of band ligation plus sclerotherapy has been proposed to hasten variceal eradication. The aim of this study was to assess the efficacy of band ligation alone versus band ligation plus sclerotherapy in the prevention of recurrent variceal bleeding. METHODS: Eighty cirrhotic patients were randomized to group I (band ligation) with 41 patients or to group II (band ligation plus sclerotherapy) with 39 patients in whom polidocanol (2%) was injected 1 to 2 cm proximal to each band. RESULTS: At baseline, both groups were similar with regard to clinical, demographic and laboratory data. Mean follow-up time (standard error) for group I was 336.5 +/- 43.4 days and for group II 386.1 +/- 40.1 days (p = 0.4). No statistical differences were observed between group I and group II in relation to recurrence of bleeding (31.7% vs. 23%, p = 0.38), treatment failure (24.4% vs. 12. 8%, p = 0.18), death (39% vs. 30.8%, p = 0.44) and variceal eradication (65.8% vs. 74.4%, p = 0.40). Group II had a significantly higher number of complications than group I, 30.8% versus 7.3%, respectively (p = 0.05). The number of bleeding related deaths was higher in group I than in group II (22% vs. 10.3%, respectively; p = 0.15). CONCLUSIONS: No significant difference was observed between band ligation and band ligation plus sclerotherapy in prevention of recurrent variceal bleeding. Furthermore, there was a higher incidence of complications in the latter group.

Combined Modality Therapy↗
PubMed1999

Sclerotherapy plus ligation versus ligation for the treatment of esophageal varices: a prospective randomized study.

BACKGROUND: We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival. METHODS: Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions. RESULTS: Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) (p < 0.01). The survival rates and incidences of treatment-related complications have been similar among patients treated by both methods. CONCLUSIONS: Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence.

Aged↗
PubMed1984

Comparison of suture ligation, bipolar cauterization, and hemoclip ligation in the management of small branching vessels in a rat model.

In elective microsurgical procedures, it is necessary to occlude small branches when mobilizing vessels in obtaining vein grafts. The purpose of this study was to evaluate the relative merits of suture ligation, bipolar cauterization, and hemoclip ligation, and to determine the minimum safe distance of occlusion. The left inferior epigastric vein and the right profunda femoris artery were ligated under operating microscope magnification with 10-0 nylon suture, small hemoclip, or bipolar cauterization at distances of 0, 1, or 2 mm from the parent vessel in 75 rats. Suture ligation was significantly better than bipolar cauterization (p less than .01) and hemoclip ligation (p less than .001). All cauterization failures occurred at 0 and 1 mm. Hemoclip failures occurred at all three distances. In the management of small branching vessels: suture ligation is safe at 0, 1, and 2 mm; bipolar cauterization is safe at 2 mm; and hemoclip ligation is unsafe.

Animals↗
PubMed1985

Surgical control of pelvic hemorrhage: bilateral hypogastric artery ligation and method of ovarian artery ligation.

Hypogastric artery ligation and internal iliac artery ligation are the same procedure. It has been several years since extensive work on this procedure has been reported in the literature. Since this has proved to be a potentially life-saving technique in serious obstetric and pelvic hemorrhage, it is somewhat surprising to find that the procedure is poorly understood. We have reviewed this procedure in depth, emphasizing important aspects and restating indications for its use. We have also included a case presentation in which we recently performed bilateral ligation of the hypogastric arteries and the ovarian arteries to control intractable hemorrhage. Although ovarian artery ligation is often mentioned as an adjunct in controlling pelvic hemorrhage, we believe the technique has never been described in the English language. We present a surgical technique for ligating the ovarian arteries, believing that teaching both bilateral hypogastric artery ligation and ovarian artery ligation should be an integral part of obstetric and gynecologic training.

Adult↗
PubMedDate not supplied

Endoscopic management for bleeding esophageal varices: sclerotherapy versus sclerotherapy plus band ligation versus band ligation alone. One year experience at a main hospital in Saudi Arabia.

BACKGROUND/AIMS: This study was done retrospectively to compare the outcome of sclerotherapy alone, band ligation alone and band ligation alternating with sclerotherapy in treatment of esophageal varices. METHODOLOGY: During 1 year 30 patients were admitted with variceal bleeding. They received either injection sclerotherapy (8 patients) or band ligation (11 patients), and 11 patients had a combination of both either during first bleed or during follow-up therapy, which is more than 2 sessions in each group. RESULTS: The success rate for stopping first bleeding was 100% in the band ligation and sclerotherapy alone group. The rebleeding rate was 27% in the combination group, 9% in the band ligation group, and none had rebleeding in the sclerotherapy group during follow-up. Eradication of varices was observed in 33% of patients after a second set of sclerotherapy and band ligation. CONCLUSIONS: Our study showed no significant difference between sclerotherapy versus band ligation in stopping initial bleeding or eradication of varices during the follow-up period, but there was a difference in re-bleeding rates among the three groups.

Adolescent↗
PubMed1979

Effect of renal vein ligation with or without suprarenal inferior vena cava ligation on sodium and phosphate excretions during acute extracellular volume expansion in the rat.

Right nephrectomy with or without inferior vena cava (IVC) ligation was performed in rats 1 week after left renal vein ligation. Left kidney function and sodium and phosphate excretions by volume expansion were investigated. Inulin (CIN) and para-aminohippuric acid (CPAH) clearances and fractional excretions of sodium (FENa) and phosphate (FEP) were examined before and after volume expansion was induced by normal saline. Kidney functions were well preserved with development of collateral venous channels; biochemical parameters returned to the normal ranges. However, CIN and CPAH were reduced to 33 to 25 per cent of control values and the filtration fraction was elevated. After volume expansion, a marked increment of FENa was observed in cases of IVC ligation but the increment in animals without IVC ligation was less than in the control group. FEP was also increased in experimental groups but the magnitude of phosphaturia was not so prominent compared to the control group. The increment of FEP was not comparable to that of FENa. Thus, from the aspect of kidney function, this experiment showed the rationality of left renal vein ligation with contralateral nephrectomy. From the pathophysiologic aspect, the magnitude of natriuresis and phosphaturia by volume expansion was not prominent and a reduced reabsorptive capacity for sodium and phosphate may exist in a solitary kidney with a ligated renal vein. When suprarenal IVC ligation was also done, prominent natriuresis was observed with saline infusion.

Animals↗
PubMed1998

Cytochrome c folding traps are not due solely to histidine-heme ligation: direct demonstration of a role for N-terminal amino group-heme ligation.

In previous work, heme ligation effects on the folding of cytochrome c have been attributed to histidine side-chains. A variant of yeast iso-1-cytochrome c designated TM, which lacks all histidine residues except His18, still shows evidence of denatured state heme ligation in the pH range between 5 and 6 where normally only histidine ligation is expected. Conversion of the N-terminal amino group of TM to a carbonyl group through a transamination reaction with glyoxylate produced a protein (ModTM) with no terminal amino group. The midpoint pH (pH1/2) for loss of heme ligation in 3 M guanidine-HCl shifts from 5.9 to 7.4 as a result of this modification, providing direct evidence for N-terminal amino group-heme ligation under these conditions. The N-terminal amino group thus competes with histidine for misligation of iso-1-cytochrome c under denaturing conditions. To assess the effect of denatured state N-terminal amino group-heme ligation on the folding of iso-1-cytochrome c, stopped-flow kinetics experiments were conducted. At pH 6.2, the major refolding lifetimes (3 M-->0.27 M guanidine-HCl) for ModTM, TM and the wild-type protein are 11.6 ms, 30 ms and 1.3 seconds, respectively. Denatured state ligation of the N-terminal amino group thus slows folding 2.6-fold.

Cytochrome c Group↗
PubMed2005

Prospective randomized clinical trial on suction elastic band ligator versus forceps ligator in the treatment of haemorrhoids.

OBJECTIVE: This prospective randomized clinical trial was undertaken to compare the use of a single-operator vacuum suction ligator and the traditional forceps ligator in terms of pain perception following the procedure, intra-procedure bleeding and other complications. METHODS: One hundred consecutive patients with second- and third-degree haemorrhoids presenting between July 2002 and September 2003 were randomized into suction and forceps groups for rubber band ligations. They were equally distributed in both groups, with a mean age of 48.7 years (range, 15-83 years). The immediate, 24-hour, 7-day and 14-day pain scores after the procedure were evaluated using a visual analogue scale. Intra-procedure bleeding and other complications at follow-up were evaluated. RESULTS: Pain perception was worse in the forceps group immediately after ligation, with a mean score of 6.08 compared with 3.08 in the suction group (p < 0.001). Pain score remained high among the forceps patients at 24 hours post-banding, with a mean score of 4.00 compared with 1.92 in the suction group (p < 0.001). There was no significant difference in terms of immediate and 24-hour pain perceptions whether two or three haemorrhoids were banded per session (p = 0.904 and p = 0.058). The amount of analgesia consumed after banding correlated well with the severity of pain reported, being higher among the forceps group with a mean of 4.48 tablets (p = 0.003). Intra-procedure bleeding occurred in 25 patients in the forceps group compared with five in the suction group (p < 0.001). There were no severe complications such as perianal sepsis, urinary retention, sphincter dysfunction or bleeding during the trial. CONCLUSION: Suction band ligation is superior to forceps ligation for the treatment of second- and third-degree haemorrhoids in terms of pain tolerance, amount of analgesia consumed and intra-procedure bleeding.

Adolescent↗
PubMed2003

A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial.

OBJECTIVE: To compare simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately for the treatment of 2nd degree haemorrhoids. PATIENTS AND METHODS: Between 1993 and 1996, 255 patients that suffered from 2nd degree haemorrhoids were divided into 3 groups of 85 patients, each to receive either simultaneous sclerotherapy for smaller and rubber band ligation for larger piles (SCL/RBL) in one session, or sclerotherapy (SCL), or rubber band ligation (RBL), respectively. After a period of 4 years all patients were examined and their symptoms were recorded. RESULTS: The patients of the SCL group developed significantly fewer complications after treatment compared to the other two methods (P < 0.001), which did not differ from each other. After the SCL/RBL treatment, significantly more patients were symptom free (46%) than after SCL (8%), P < 0.001. There was no significant difference between the SCL/RBL (46%) and the RBL (31%) groups (P = 0.217), although the combined treatment seemed to be more effective than rubber band ligation. Only 10% of the patients of the SCL/RBL group needed additional sessions 6-24 months after the initial treatment compared to 30% of the patients of the SCL group (P = 0.001). However, there was no significant difference between SCL/RBL and RBL (17%) groups (P = 0.151). CONCLUSION: The combination of sclerotherapy and rubber band ligation for treatment of 2nd degree haemorrhoids is significantly more efficient than sclerotherapy on its own.

Combined Modality Therapy↗
PubMed1976

[Studies on the reaction of the rabbit testis after ligation of the arteria and vena testicularis compared with ligation of the vein alone].

In surgical treatment of Varicocele compete the ligation of the V. testicularis (Ivanissevich/Bernardi) with the ligation of the A. and V. testicularis (Palomo). Because there are doubts against throttling the arterial blood supply of a previous damaged testis, the effect of ligation of A. and V. testicularis on the testis was studied and compared with the ligation of the vein alone. On 18 adult rabbits either the Palomo operation was performed on one side, leaving the contralateral side as control, or on one side only the vein was ligated and on the other side artery and vein were ligated, permitting, so a direct comparison on the same animal. All the testes were examined histometrically. In the control group the diameter of the tubuli increased from 218 mu after 3 months to 253 mu after 10 months. In the Palomo-group the diameter decreased from 153 mu after 3 months to 82 mu after 6 months, and increased again to 153 mu after 10 months. In the Bernardi-group no differences to the normal testes were found.

Animals↗
PubMed1975

Endocrine function of the canine pancreas. The effect of duct ligation and transplantation of the total duct ligated pancreas.

Pancreas transplantation was studied in the dog using a total duct ligated pancreas as allograft. In a group of 10 mongrel dogs the effects of long-term (6-36 months) total duct ligation on the endocrine pancreas function were studied by means of repeated intravenous glucose tolerance tests (iv-GTT). One year after total duct ligation the mean glucose assimilation coefficient (k-value) was 75%, the median insulin peak value (IPV) 63% and "total" insulin secretion in the first thirty minutes (TIS) 58% of the pre-operative values. These levels were maintained up to three years after duct ligation. The total duct ligated pancreas was then used as an allograft in 28 beagles in order to study the influence of DL-A (dog leucocyte-antigens) matching on the survival time of the graft. DL-A identity compared to one or two haplotype difference gave a fourfold increase in median survival time from 9 to 40 days. In a second group of 14 beagles with one haplotype difference the effect of immunosuppressive therapy was studied. The methods used (antilymphocyte serum and a combination of prednisone and azathioprine) increased the median survival time to the level seen in DL-A identity. In conclusion the total duct ligated pancreas can be used as an insulin secreting allograft, providing rejection can be suppressed adequately.

Animals↗
PubMed1994

Characterization of intra- and intermolecular DNA ligation mediated by eukaryotic topoisomerase I. Role of bipartite DNA interaction in the ligation process.

The capacity of eukaryotic topoisomerase I to catalyze intra- and intermolecular DNA strand transfer via a two-step cleavage/ligation reaction was investigated by use of purified enzyme and defined DNA substrates. Topoisomerase I-mediated cleavage requires separate interaction with a duplex region encompassing the cleavage site (region A) and a duplex region located on the side holding the 5'-OH end generated by cleavage (region B). Cleaved topoisomerase I-DNA complexes containing enzyme covalently attached at internal and terminal positions were employed to characterize the intra- and intermolecular ligation reactions. Enzyme attached covalently at an internal position of a partially single-stranded DNA molecule is able to catalyze ligation of a complementary dinucleotide within region A in the absence of interaction with region B. Moreover, the dinucleotide confines the minimal DNA acceptor for intramolecular ligation. Topoisomerase I attached covalently to DNA at a terminal position can ligate the cleaved strand to heterologous duplex DNA regardless of sequence, whereas ligation does not proceed with single-stranded DNA. When these features are considered together with the observation that intermolecular ligation is inhibited by 1 M NaCl, it suggests that the reaction requires bipartite DNA interaction. A model is proposed that relates the bipartite DNA binding of eukaryotic topoisomerase I to the catalytic functions.

Base Sequence↗
PubMed2000

Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial.

Both beta-blockers and endoscopic variceal ligation (EVL) have proven to be valuable alternatives to sclerotherapy in the prevention of variceal rebleeding. Sucralfate is a mucosal protector. The effects of combinations of beta-blocker, band ligation, and sucralfate (triple therapy) remain unknown. A total of 122 patients with a history of esophageal variceal bleeding were randomized to receive EVL only (group A, 62 patients) or triple therapy (group B, 60 patients). The procedure for the triple therapy included ligation with the addition of sucralfate granules until variceal obliteration. In addition, nadolol was administered during the course of the study or until death. After a median follow-up of 21 months, recurrent upper gastrointestinal bleeding developed in 29 patients (47%) in group A and 14 patients (23%) in group B (P =.005). Recurrent bleeding from esophagogastric varices occurred in 18 patients in group A and 7 patients in group B (P =.001). Twenty-one patients in group A (50%) and 12 patients (26%) in group B experienced variceal recurrence after variceal obliteration (P <.05). Treatment failure occurred in 11 patients (18%) in group A and in 4 patients (7%) in group B (P =.05). Twenty patients from group A and 10 patients from group B died (P =.08); 9 and 4 of these deaths, respectively, were attributed to variceal hemorrhage (P =.26). The combination of ligation, nadolol, and sucralfate (triple therapy) proved more effective than banding ligation alone in terms of prevention of variceal recurrence and upper gastrointestinal rebleeding as well as variceal rebleeding.

Adrenergic beta-Antagonists↗
PubMed2003

Perioperative outcomes after three different single extrahepatic portosystemic shunt attenuation techniques in dogs: partial ligation, complete ligation and ameroid constrictor placement.

OBJECTIVE: To compare the perioperative outcomes of single extrahepatic portosystemic shunt occlusion by complete and partial silk ligation and ameroid constrictor placement in dogs. DESIGN: A retrospective analysis of 30 dogs with single congenital extrahepatic shunts. PROCEDURE: Records between 1990 and 2000 were reviewed. Patient age, breed, weight, presenting clinical signs, clinical pathology results, diagnostic imaging results, the surgery procedure performed, implant used, time taken, intra operative complications and perioperative complications were recorded. Mortality rates were calculated. RESULTS: Twenty dogs had a silk ligation procedure, 10 partially occluded and 10 completely. Ten dogs had an ameroid constrictor placement procedure. Ameroid constrictor surgery was significantly shorter in duration than silk ligation. Time for silk ligation was 91.8 +/- 35.2 minutes (median 90.0); time for ameroid constrictor placement was 71.5 +/- 12.0 (median 72.5, P = 0.049). A reduction in intraoperative complications was also noted in the ameroid constrictor surgery group. CONCLUSION: The ameroid constrictor offered a surgical occlusion procedure of single extrahepatic portosystemic shunts in dogs that was clinically as effective as silk ligation in the perioperative period, with a significantly shorter surgery time.

Animals↗
PubMedDate not supplied

Outcome of rubber band ligation of haemorrhoids using suction ligator.

BACKGROUND: Haemorrhoids are a common surgical problem seen in the outpatient department. Rubber band ligation using suction is an effective treatment for symptomatic haemorrhoids but associated with significant morbidity. This prospective observational study was carried out to assess the efficacy, effectiveness and complications of rubber band ligation performed in outpatient for symptomatic haemorhoids using suction ligator. The results and outcome of procedure performed by the consultants and senior residents were also compared. METHODS: 56 consecutive patients with symptomatic haemorrhoids underwent rubber band ligation in the outpatient clinic of the department of general surgery, Pakistan Institute of Medical Sciences. Outcome measures were symptomatic cure i.e. stoppage of bleeding and reduced mucosal prolapse. Complications were categorized as immediate, early (within one week) and late (within 3 months). RESULTS: Symptomatic cure was achieved in 50(89.20%) patients (stoppage of bleeding and reduced mucosal prolapse). Six (10.72%) patients required further banding. Pain (mild to severe) was most common immediate and intermediate complication (14 and 20 patient's respectively). CONCLUSION: Rubber band ligation is an effective, outdoor procedure for symptomatic haemorrhoids, but associated with certain degree of morbidity.

Adult↗
PubMed1993

A comparison of the forces required to produce tooth movement in vitro using two self-ligating brackets and a pre-adjusted bracket employing two types of ligation.

Friction in fixed appliance systems has received considerable attention in the recent literature, although that attributable to the type of ligation used has not been fully investigated. This in vitro study of 0.022 x 0.028 inch slot Minitwin, Activa ('A' Company, San Diego, California, USA), and SPEED brackets (Strite Industries Ltd., Cambridge, Ontario, Canada), investigates friction in two forms of self-ligating brackets and in two methods of ligating Minitwin straight wire brackets with polyurethane elastomeric ligatures. The resistance to sliding of rectangular archwires through the ligated brackets was measured on a vertically mounted Instron testing machine. The stainless steel archwires used were straight lengths of 0.016" x 0.022", 0.017" x 0.025", 0.018" x 0.025", and 0.019" x 0.025" Nubryte Gold (GAC International Inc., Central Islip, New York, USA). The results showed a significant reduction (P < 0.01) in frictional resistance in the Activa brackets compared with SPEED brackets by a factor of approximately 15. When the SPEED brackets were compared to Minitwin brackets, the reduction in friction was by 50-70 per cent (P < 0.01). The placing of 'figure-of-eight' elastomeric ties increased friction by a factor of 70-220 per cent compared to conventional elastomeric ties (P < 0.01) except for 0.016" x 0.022" archwires. The results indicate that self-ligating brackets require less force to produce tooth movement because they apply less frictional contact to the archwire than conventionally tied siamese brackets.

Analysis of Variance↗