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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↗
PubMed2005

The effect of clipping and coiling in acute severe subarachnoid hemorrhage after international subarachnoid aneurysmal trial (ISAT) results.

Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age>70 years, subacute stage (4--14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0--3, grade 4 (GCS 9--12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0--3 days after bleed). The patient's outcome was measured using GOS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8 % and 48 % of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16 % of clipping cases and 44.06 % of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.

Acute Disease↗
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↗
PubMed2004

Comparison of the Ti-knot device and Hem-o-lok clips with other devices commonly used for laparoscopic renal-artery ligation.

BACKGROUND AND PURPOSE: New devices such as the Ti-knot and Hem-o-lok clips have been developed for laparoscopic surgical applications. We compared the effectiveness of Ti-knot TK5 (LSI Solutions), Hem-o-lok MLK clips (Weck Closure), Ligaclip 5-mm titanium clips (Ethicon), and Endopath vascular staples (35 mm long, 12.3 mm wide) (Ethicon). MATERIALS AND METHODS: Renal artery segments from 5 to 6 mm in diameter were harvested from fresh porcine kidneys. One end of the vessel was intubated with a 25-gauge ball-tipped needle and fastened with two silk ties. The other end was occluded with one of the test devices. Saline was infused into each arterial segment at 3 mL/min with the maximum pump pressure at 800 mm Hg. The maximum pressure with leakage was recorded. Each of the five test devices was tested eight times on a rotating basis. Saline infusion was stopped when the maximum pump pressure was reached or when leakage was observed. RESULTS: All Ti-knot devices, Hem-o-lok clips, titanium metal clips, and standard hand ties tolerated pressures >800 mm Hg with no leakage, but 4 of the 8 vascular staple lines (50%) leaked before this maximum pump pressure was reached. For those that leaked, the mean leak pressure was 273 mm Hg (range 237-322 mm Hg). CONCLUSIONS: All devices tested are capable of occluding renal arteries under physiologic conditions. Ti-knot devices and Hem-o-lok clips occluded renal arteries to pressures that exceeded 800 mm Hg. They are equivalent to hand ties under supraphysiologic conditions.

Animals↗
PubMed1998

Effect of tragus clips on gastric peristalsis: a pilot study.

In the past 22 years we have used the "hunger point" on the tragus of the ear to induce aversion to cigarette smoking and inhibit appetite for weight reduction with varying degrees of success. This has generally been accomplished by inserting press needles into the tragus of both ears. Because these needles gradually lose effect over a 5- to 7-day period, they have had to be changed every 5 to 7 days. To obviate this need, ear-clips (Aculite; I-Openers, Cranston, RI) were devised to be worn on the tragus. Previous work using press needles on the tragus induced slowing of gastric peristalsis, thought to be mediated by inhibition of a branch of the vagus nerve that innervates the tragus. The present study measured the duration of single gastric peristaltic waves before and after wearing the ear-clips for two cycles. There was a marked prolongation of gastric peristalsis time (GPT) when the ear-clips were applied, a return to baseline times when the clips were off, and a second, but less dramatic prolongation when the clips were on, p = 0.01. We conclude that the ear-clips were effective in delaying gastric peristalsis, and may have value in reducing appetite in association with weight loss programs.

Acupuncture Points↗
PubMed1994

Quantitation of force to dislodge endoscopic ligation clips: EndoClip II vs. Ligaclip ERCA.

The mean forces required to dislodge two types of endoscopic ligation clips from both porcine cystic ducts and silicone tubing were quantitated. The two types of endoscopic clips were EndoClip II and Ligaclip ERCA. Following application of the clips, the force required to dislodge the clips in both a perpendicular direction and a longitudinal direction was determined. The mean levels of force required to dislodge the EndoClip II clips in both directions were significantly (p < or = 0.01) greater than those required to dislodge the Ligaclip ERCA clips.

Animals↗
PubMed2004

Injuries to Scottish farmers while tagging and clipping cattle: a cross-sectional survey.

BACKGROUND: Anecdotal reports suggested that farmers were sustaining significant injuries while ear tagging newborn calves or clipping cattle prior to slaughter. AIMS: This national survey was designed for determining the incidence and nature of self-reported injuries to farmers that were sustained while tagging calves and clipping cattle. METHODS: A cross-sectional, anonymous, postal questionnaire survey was sent to all members of the National Farmers Union of Scotland with beef or dairy cattle (n = 4495). RESULTS: In total, 2439 (54%) usable questionnaires were received and 1341 injuries were reported by 591 (24%) respondents. Tagging-related injuries were reported by 297 (12%) respondents. The most commonly described injury was bruising, but lacerations (3%) and fractures (3%) also occurred. Fifty-eight (20%) individuals lost time from work, with a median of 3 days [interquartile range (IQR) = 2-7 days]. Four hundred and eighteen (17%) respondents reported clipping-related injuries. The most common injury was bruising, but lacerations (6%) and fractures (7%) also occurred. Ninety-five (23%) individuals lost time from work, with a median of 4 days (IQR = 2-14 days). Tagging injuries more commonly affected lower limbs and the trunk, while clipping injuries affected the upper limbs. Tagging injuries were associated with working alone, in an open field and with a vehicle nearby, while clipping injuries were associated with working alone, with beef cattle and with younger age. Both types of injury were associated with injuries from livestock in other circumstances. CONCLUSIONS: Tagging calves and clipping cattle prior to slaughter are associated with a significant risk of injury, which may be severe, necessitating treatment and time lost from work. Policy makers, safety advisers and the farming community should reconsider whether these procedures are necessary and whether current guidelines should be modified in order to improve safety.

Adult↗
PubMedDate not supplied

Clinical application of vascular closure staple clips for blood access surgery.

We investigated the usefulness of nonpenetrating titanium vascular closure staple (VCS) clips developed for anastomosis of peripheral blood vessels. VCS clip applier systems (Autosuture; United States Surgical Corporation, Norwalk, CT) were used for 10 patients on hemodialysis who needed peripheral vascular anastomoses for blood access. Two arteriovenous (AV) fistulas, one closure of a fistula with reconstruction of the radial artery, six vascular graft implantations, and one vascular graft closure were performed. Medium clips were used for AV fistulas and large clips for vascular graft implantation. It took 12 min, on average, for vascular access graft anastomoses and 8.5 min, on average, for the AV fistulas. In two patients, bleeding from the anastomosed site occurred after declamping and additional sutures were required; however, neither hematoma nor wound infection occurred at 9 to 12 months after surgery. In one patient, stenosis of the graft-venous junction was found and was successfully treated by percutaneous transluminal angioplasty. The VCS clip applier is easy to manipulate, is as safe as hand-suture methods, and has time saving potential. We conclude that these VCS clips are useful for vascular anastomoses of blood access.

Anastomosis, Surgical↗
PubMed1994

Effect of peak clipping on speech recognition threshold.

Speech recognition thresholds (SRTs) were measured for a closed set of spondees that had been processed by peak clipping and compression. Both hearing-impaired and normal-hearing subject groups showed progressively higher SRTs with increasing levels of peak clipping, with significant threshold shifts occurring for clipping levels greater than 18 to 24 dB. Neither subject group showed significantly elevated SRTs for the compression processed stimuli. Magnitude-squared coherence analysis of the speech stimuli revealed high levels of distortion generated by peak clipping and relatively low levels generated by the compression processing. Subsequent analysis suggested that the addition of distortion products and not the alteration of the speech waveform envelope was responsible for the observed threshold shifts, and that coherence analysis may be a valuable tool for predicting the effects of distortion on speech intelligibility. Judgments of sound quality showed that the clipping level where SRTs began to be significantly affected coincided with the clipping level at which the quality of the speech was judged to be unacceptable.

Adult↗
PubMed1985

Antihypertensive effect of sialoadenectomy in one-kidney, one clip hypertension in the rat.

We have examined the effect of removal of the submandibular gland on one-kidney, one clip (1K1C) hypertension in the rat. Five weeks after application of a silver clip with a 0.20-mm gap, 15 hypertensive rats were sialoadenectomized. This was followed by a decrease in systolic blood pressure (SBP) within 1 day by 22 +/- 4 mmHg (+/- s.e.m.) and in nine rats pressure stabilized within 1 week at 133 +/- 5 (cf. 166 +/- 2 before sialoadenectomy). In the other six rats the initial hypotensive response was followed by a gradual return to hypertensive levels, reaching 178 +/- 4 mmHg 6 weeks later. Sham-sialoadenectomized rats remained hypertensive throughout. When a 0.15-mm gap clip was used in a similar experiment rats became hypertensive after 2 weeks, and sialoadenectomy lowered SBP to normal in half of them, after which pressure tended to return to hypertensive levels in most. No change in SBP was found in sham-operated hypertensive rats. Sialoadenectomy performed at the time of clipping with a 0.15-mm gap clip and unilateral nephrectomy delayed the development of hypertension. Systolic pressure then fell from 153 +/- 14 at 4 weeks to 105 +/- 8 at 12 weeks after operation in five rats, but continued to increase in eight rats from 148 +/- 10 at 4 weeks to 172 +/- 15 at 12 weeks. These experiments thus demonstrate that the submandibular gland may contribute to the onset and maintenance of one-kidney, one clip hypertension in the rat, particularly in less severe stenosis.

Adrenal Cortex↗
PubMed1988

Atrial natriuretic factor: specific binding to renal glomeruli during the development of two-kidney, one clip hypertension in the rat.

Blood pressure (BP), atrial and plasma concentrations of atrial natriuretic factor (ANF), hematocrit and renal glomerular ANF receptors were studied during the development of hypertension in two-kidney, one clip (2-K, 1C) rats and were compared with normotensive controls. Plasma ANF was elevated in the 2-K, 1C group in all stages of hypertension, even after 3 weeks when BP, although higher than in sham-operated animals, had not yet reached arbitrarily-set hypertensive levels. At this time, hematocrit was higher in the hypertensive rats than in the controls, but the difference later disappeared. Lower atrial ANF concentrations were observed in the 2-K, 1C group at week 3, but only in the right atrium. No difference in ANF levels was noted in either the left or right atrium between hypertensive and normotensive animals 5 and 7 weeks after clipping. The glomerular ANF receptor population was markedly smaller in the clipped left kidney of 2-K, 1C rats during all stages of hypertension, and in the untouched right kidney at 5 and 7 weeks after surgery, but was larger in the non-clipped right kidney in the pre-hypertensive phase (3 weeks). It is concluded that receptor density changes during the evolution of high BP in the 2-K, 1C Goldblatt model of experimental hypertension. Our data suggest that the increases and decreases in density of renal glomerular ANF receptors may play a role in the differential handling of sodium by the clipped and non-clipped kidney during the various stages of development of 2-K, 1C hypertension in the rat.

Animals↗
PubMed1998

Roles of vascular angiotensin converting enzyme and chymase in two-kidney, one clip hypertensive hamsters.

BACKGROUND: A chymase-dependent angiotensin II-forming pathway is present in human vascular tissues; however, the role, if it plays any, of chymase in the pathogenesis of hypertension is not known. When investigating the role of chymase, it is important to recognize marked differences in vascular angiotensin II-forming systems among species. We found recently that hamsters, like humans, possess the dual angiotensin II-forming system. OBJECTIVE: To analyze the potential involvement of angiotensin converting enzyme and chymase in the pathogenesis of hypertension, and to further characterize the efficiency of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for the treatment of hypertension. METHODS AND RESULTS: The mean arterial pressure in the two-kidney, one clip hamster model had increased significantly 2 weeks after clipping (acute stage), reached a peak after 4 weeks, and was sustained at the high level until 32 weeks after clipping (chronic stage). Plasma renin activity increased markedly during the acute stage, but returned to the normal level during the chronic stage. Vascular angiotensin converting enzyme activity during 4-32 weeks after clipping was significantly higher than that in the control hamsters. By contrast, vascular chymase was not activated throughout the experimental period. Administrations of an angiotensin converting enzyme inhibitor, trandolapril, and an angiotensin II receptor antagonist, CV-11974, equally lowered the mean arterial pressure during the acute and chronic stages. CONCLUSIONS: Vascular angiotensin converting enzyme plays a predominant role in the maintenance of two-kidney, one clip hypertension in hamsters, which, like humans, possess a dual system of formation of angiotensin II. Vascular chymase was not involved in the pathogenesis of two-kidney, one clip hypertension in the hamster.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

M2/M2 side-to-side rescue anastomosis for accidental M2 trunk occlusion during middle cerebral artery aneurysm clipping: technical note.

OBJECTIVE: A technically feasible and rapid technique for revascularizing the main branches of the middle cerebral artery (MCA) is described. This technique is applied mainly when clipping of an MCA aneurysm is complicated and occlusion of the origin of an MCA main branch results. METHODS: M2/M2 side-to-side anastomosis was applied in two patients in whom unplanned M2 occlusion occurred during the course of complicated MCA aneurysm clipping. The first patient underwent an emergency procedure after temporoparietal intracerebral hemorrhage. Unilateral mydriasis precluded preoperative angiographic workup, and a complex large MCA aneurysm was found as the source of hemorrhage. Shaping of the aneurysm neck by bipolar coagulation and clipping resulted in accidental occlusion of the superior trunk, and patency could not be regained despite multiple clip corrections. The second patient had an unruptured multilobulated aneurysm 8 mm in maximum diameter. Continuity of the inferior trunk was lost during clipping because of a tear at the origin. In both instances, side-to-side anastomosis was placed approximately 15 mm from the bifurcation, where the MCA main trunks ran side by side for a length of approximately 5 mm. RESULTS: After intracerebral hemorrhage, the first patient recovered to a level of moderate disability within 2 months. Substantial hemiparesis and expressive dysphasia remained as sequelae of the intracerebral hemorrhage. Digital subtraction angiography 2 months after the emergency procedure confirmed patency of the side-to-side anastomosis. The second patient was neurologically intact after recovery from anesthesia. Before discharge from the hospital on postoperative Day 8, digital subtraction angiography confirmed patency of the anastomosis. CONCLUSION: The MCA main branches usually run in close proximity for a short segment at the bottleneck entrance to the insular cistern. M2/M2 side-to-side anastomosis at this site is a rapid and feasible mode of revascularization of an M2 trunk accidentally occluded during complicated MCA aneurysm clipping.

Adult↗
PubMed2003

Surgical clip found in duodenal ulcer after laparoscopic cholecystectomy.

The wide use of surgical clips in laparoscopic surgery has led to a variety of complications. We describe two cases in which a surgical clip was incorporated into a duodenal ulcer after laparoscopic cholecystectomy. The presenting symptom was acute gastrointestinal bleeding. Both patients were treated endoscopically, and the bleeding stopped after the clip was removed from the ulcer base. Although the mechanism by which a surgical clip migrates into the duodenum is unclear, we recommend meticulous Calot's triangle dissection and removal of any wandering or misplaced clips. Endoscopic removal is recommended when a surgical clip is discovered in a bleeding ulcer.

Aged↗
PubMedDate not supplied

A novel use of endoscopic clips in the treatment planning for radiation therapy (XRT) of esophageal cancer.

GOAL: To determine if the placement of metal endoclips improves radiotherapy (XRT) planning for esophageal cancer. BACKGROUND: XRT is an important modality in the treatment and palliation of esophageal cancer. Accurate simulation of the radiation field ensures optimal therapy while limiting toxicity. STUDY: Patients with esophageal carcinoma underwent EGD and endoscopic mucosal clip placement at the proximal and distal margins of the tumor. At XRT simulation the radiation oncologist simulated the field based on barium study, CT scan, and endoscopy report. A second radiation oncologist then assessed the ease of identification of the clips/margins of the tumor, shift in the field isocenter, and change in the radiation field width and length because of the metal clips. RESULTS: Seven patients with cancer of the esophagus had endoscopic clips placed followed by XRT simulation. The clips could be identified in all 7 patients. Simulation with the use of clips caused a shift in the field isocenter with a mean longitudinal shift (y-axis) of 3.5 cm (range, 1-6 cm) and a mean lateral shift (x-axis) of 0.33 cm (range, 0-1 cm). CONCLUSIONS: Endoscopically placed mucosal metal clips can aid field simulation when planning radiation therapy in patients with esophageal cancer.

Aged↗