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At least 397 records · Page 22Linked to original sources
PubMed2006

Primary treatment of a blister-like aneurysm with an encircling clip graft: technical case report.

OBJECTIVE: Blister-like aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery are a rare but important cause of subarachnoid hemorrhage. We report a case of subarachnoid hemorrhage caused by a ruptured blister-type aneurysm, review the pertinent literature, and hope to remind readers of the wisdom of the use of an encircling clip as the primary treatment of these challenging lesions. CLINICAL PRESENTATION: A 41-year-old woman presented with sudden onset of headache. An admission computed tomographic (CT) scan revealed thick and diffuse subarachnoid hemorrhage involving primarily the carotid cistern and the proximal left sylvian fissure. A cerebral angiogram was initially interpreted as absent for aneurysm, but a follow-up angiogram performed 1 week later confirmed an enlarging aneurysm. INTERVENTION: A craniotomy with placement of an encircling clip graft around a blister-like aneurysm was performed. CONCLUSION: Although Sundt advocated the encircling clip graft for the blister-type aneurysm almost 40 years ago, use of an encircling clip graft in the treatment of blister-like aneurysms of the supraclinoid portion of the internal carotid artery seems to be reserved as a secondary or "rescue" measure in current practice. Neurosurgeons must familiarize themselves with this distinct entity (the blister-type aneurysm), recognize the possible risks associated with parallel clipping, and consider the use of an encircling clip graft as the primary treatment.

Adult↗
PubMed1989

[Recurrent cerebral aneurysm suggestive of misplaced clipping. Case report].

A case of recurrent cerebral aneurysm after complete neck clipping is described. A 47-year-old male who presented with headache and nausea underwent neck clipping of a berry aneurysm of the left middle cerebral artery. Ten days later, angiographic findings suggested the presence of a second, large aneurysm adjacent to the first, which suggested misplaced clipping. Reoperation confirmed that a new aneurysm had formed next to the original aneurysm. A possible explanation of the recurrence is as follows. The M1 flowed into the M2 at a right angle. The aneurysmal neck was situated on the distal end of the M1 and the dome protruded antero-inferiorly at an angle of nearly 90 degrees to the long axis of the M1 opposite the origin of the M2. The parent artery bulged slightly, and its wall was thin and reddish, just distal to the aneurysmal neck. Proximal to the neck there was another small bulge, but the wall here was normal. These bulges were coated with Oxycel and Biobond at the time of aneurysmal neck clipping. After clipping, blood flow into the dome was interrupted, and the consequent hemodynamic stress caused the bulges to expand dramatically and form a new aneurysm. The authors conclude that there is a likelihood of early recurrence after neck clipping if the parent artery exhibits such morphological features as observed in this case.

Cerebral Arteries↗
PubMed2005

Using movie clips in PowerPoint presentations: part 1, compatibility issues.

OBJECTIVE: The purpose of this article is to discuss common compatibility issues relating to the use of movie clips in PowerPoint presentations. CONCLUSION: Our investigations found that successful display of movie clips in PowerPoint depends on the following three factors: movie file format, codec selection, and cross-platform compatibility. These factors primarily result from the rapid change in today's computer operating systems. Based on a compatibility study of common movie clips used in radiology presentations, a general guideline for preparing movie clips is presented. Also, a simple method is described for converting movie clips into compatible movie formats and reducing large movie clips to manageable file sizes to ensure smooth presentation.

Motion Pictures↗
PubMed1979

Endothelial lesions after temporary clipping. A comparative study.

The effect of temporary clipping on the arterial endothelium of rats was examined with scanning electron microscopy. The opening pressure of four Heifetz clips was modified by changing the springs. Four different clip forces (20, 35, 45, and 65 gm), four periods of clipping (10, 30, 60, and 180 minutes), and three vessel diameters (smaller than 1 mm, 1.1 to 1.3 mm, and 1.4 to 2 mm) were compared. Different grades of endothelial damage were observed. On gross examination the damage involved a detachment of endothelium and the adherence of platelets to the subendothelial tissue. The duration of clipping seemed to be of more importance than the clip force, whereas the vessel diameter had no recognizable influence.

Animals↗
PubMed1997

Aneurysm clips: magnetic quantification and magnetic resonance imaging safety. Technical note.

Knowledge of the magnetic properties of cerebral aneurysm clips in patients undergoing magnetic resonance (MR) imaging is imperative. The authors quantified in electromagnetic units the magnetic properties of 13 different types of aneurysm clips by using a vibrating sample magnetometer. Their results showed that the magnetic moment of these clips ranged from 0.15 EMU/g to as high as 152.7 EMU/g. Based on these results and tests of the movement of the clips during MR imaging, they conclude that aneurysm clips with a magnetic moment less than 1 EMU/g may be safely used during MR imaging. The quantification of magnetic properties into electromagnetic units by using a vibrating sample magnetometer is a reliable method applicable to any testing field gradient. This method can be used as a standard to measure and label the magnetic properties of aneurysm clips.

Aneurysm↗
PubMed2004

Balloon-assisted microvascular clipping of paraclinoid aneurysms. Technical note.

Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.

Aged↗
PubMed2004

Monitoring and preventing blood flow insufficiency due to clip rotation after the treatment of internal carotid artery aneurysms.

The authors report a case in which anterior choroidal artery (AChA) blood flow insufficiency due to aneurysm clip rotation was detected intraoperatively by motor evoked potential (MEP) monitoring and ischemia was successfully avoided. The patient had an incidentally discovered aneurysm for which occlusion of its neck was performed through a standard frontotemporal craniotomy without changing the MEP amplitude. After it was confirmed that the surrounding arteries were not stenotic, the brain retractor on the frontal lobe was released; MEP amplitude subsequently decreased. Rotation of the clip toward the frontal base by repositioning of the frontal lobe caused the AChA stenosis at the origin of its branches. On reorienting the clip toward the frontal lobe, the AChA stenosis was released and MEP amplitude recovered. To prevent repeated clip rotation, a large amount of gelatin (Spongel) was inserted between the frontal base and the clip. The authors confirmed that clip rotation did not occur after repositioning of the frontal lobe. Motor evoked potential amplitude was maintained until dural closure. Postoperatively, the patient demonstrated no neurological deficit and there was no newly developed low-density area on computerized tomography scans.

Adult↗
PubMed2006

Comparison of multislice computerized tomography angiography and digital subtraction angiography in the postoperative evaluation of patients with clipped aneurysms.

OBJECT: In this study the accuracy of multislice computerized tomography (MSCT) angiography in the postoperative examination of clip-occluded intracranial aneurysms was compared with that of intraarterial digital subtraction (DS) angiography METHODS: Forty-nine consecutive patients with 60 clipped aneurysms (41 of which had ruptured) were studied with the aid of postoperative MSCT and DS angiography. Both types of radiological studies were reviewed independently by two observers to assess the quality of the images, the artifacts left by the clips, the completeness of aneurysm occlusion, the patency of the parent vessel, and the duration and cost of the examination. The quality of MSCT angiography was good in 42 patients (86%). Poor-quality MSCT angiograms (14%) were a result of the late acquisition of images in three patients and the presence of clip or motion artifacts in four. Occlusion of the aneurysm on good-quality MSCT angiograms was confirmed in all but two patients in whom a small (2-mm) remnant was confirmed on DS angiograms. In one patient, occlusion of a parent vessel was seen on DS angiograms but missed on MSCT angiograms. The sensitivity and specificity for detecting neck remnants on MSCT angiography were both 100%, and the sensitivity and specificity for evaluating vessel patency were 80 and 100%, respectively (95% confidence interval 29.2-100%). Interobserver agreements were 0.765 and 0.86, respectively. The mean duration of the examination was 13 minutes for MSCT angiography and 75 minutes for DS angiography (p < 0.05). Multislice CT angiography was highly cost effective (p < 0.01). CONCLUSIONS: Current-generation MSCT angiography is an accurate noninvasive tool used for assessment of clipped aneurysms in the anterior circulation. Its high sensitivity and low cost warrant its use for postoperative routine control examinations following clip placement on an aneurysm. Digital subtraction angiography must be performed if the interpretation of MSCT angiograms is doubtful or if the aneurysm is located in the posterior circulation.

Angiography, Digital Subtraction↗
PubMed2000

Plastic bread-bag clips in the gastrointestinal tract: report of 5 cases and review of the literature.

Plastic bread-bag clips have been identified as a cause of local perforation or obstruction at many sites in the gastrointestinal tract. This study is the largest case series yet reported, consisting of 3 cases presenting as small-bowel perforation, 1 case in which the clip was found incidentally in the small bowel at laparotomy during vascular surgery and 1 case in which the clip was found incidentally in the small bowel at autopsy. In all cases there was no radiographic evidence to suggest a foreign body in the gastrointestinal tract. People older than 60 years of age who have either partial or full dentures seem to be particularly at risk for the accidental ingestion of these devices. If accidentally ingested, plastic bread-bag clips represent a significant health hazard. As the population ages, small-bowel perforation secondary to ingestion of such clips may occur with increasing frequency. The authors recommend elimination or redesign of the clips, to prevent their being swallowed and becoming impacted in the small bowel or to allow them to be identified in the gastrointestinal tract by conventional radiography.

Age Factors↗
PubMedDate not supplied

[Own experience with the treatment of intracranial aneurysms using "Perneczky" - Zeppelin clips].

The basic design and the mechanism of clip application have not changed for many years. However in cases of aneurysms located deeply inside brain structure, in narrow spaces, multiple aneurysms or those which require applying of several clips the surgeon may have problems with visual control of the position of the clamping arms on the neck of aneurysm, nearby blood vessels and nerve structures. The above mentioned problems motivated prof. Axel Perneczky to construct a new model of clip with an applying and a removing holder whose mechanism is based on the principle of inverted--spring. Between February and August 1998 in the Neurosurgical Clinic in Katowice, 12 Perneczky's clips were applied in 9 patients. Intraoperative complications were not observed in any of the cases. In two cases of aneurysms located on the bifurcation of the basilar artery, application of two clips enabled precise intraoperative control of clip position.

Basilar Artery↗
PubMed2000

Clips versus suture technique: is there a difference?

INTRODUCTION: Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost. OBJECTIVE: To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients. PATIENTS AND METHODS: One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars. RESULTS: There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year. CONCLUSIONS: Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.

Aged↗
PubMed2001

[Influence of different clipping intensity and R/FR ratio in light radiation on tillering of weeping lovegrass].

Pot experiment with weeping lovegrass was conducted laboratory in the Department of Rangeland, Wildlife and Fisheries Management, Texas Tech University in 1996. The plants grown in green house were used to study the effect of different clipping intensities on tillering, and those grown in laboratory were used to study the interaction between different R/FR(red/farred) ratio of the light reaching to the lower strata of the canopy and different clipping intensities on tillering. The results show that increasing clipping intensity decreased the net gain tillers, bt R/FR ratio had no significant effect on tillering, except no clipping treatment. The compensatory growth effect of tillering did not existed at all clipping intensities, but the elongation speed of young leaves quickened with clipping intensities. It is suggested that suitable utilization, intensified utilization and no utilization were all not beneficial to the growth and development of weeping lovegrass.

Light↗
PubMed2002

[Craniotomy side for neck clipping of the anterior communicating aneurysm via the pterional approach].

The safety and reliability of neck clipping of the anterior communicating artery (Acom) aneurysm via the pterional approach was evaluated in terms of craniotomy side in 39 consecutive cases operated on by the senior surgeon from April 1991 through March 2000. These aneurysms were approached in principle via the side where the proximal A2 portion of the anterior cerebral artery was located posteriorly, for the purpose of easier identification of all five arteries involved, i.e., A1 and A2 portions of the anterior cerebral arteries of both sides and Acom. All aneurysms were clipped safely irrespective of the approach side because it was possible prior to aneurysmal dissection to prepare both A1 portions of the anterior cerebral arteries for temporary clipping, but not as far as the place where the aneurysm projects inferiorly and its fundus adheres firmly to the optic chiasm. The security of perforating arteries, however, could not be confirmed even after the completion of neck clipping in 9 cases. Clipping was impossible in the other 2 cases. In 2 of these 11 aneurysms the difficulty in clipping was not based on what side was used for craniotomy but on their large size. In the remaining 9 aneurysms, the necks of which were all situated on the posterior wall of the Acom, the craniotomy side turned out to be inappropriate when they were approached via the side where the proximal A2 portion of the anterior cerebral artery was located posteriorly. It was concluded that the craniotomy side should be selected so that the surgeon can observe directly the neck of the aneurysm.

Adult↗
PubMed2002

Accuracy of marker clip placement after mammotome breast biopsy.

OBJECTIVE: To assess, after stereotaxic, vacuum-assisted breast biopsy, the accuracy of marker clip deployment for guiding subsequent needle localization procedures and surgery. METHODS: We conducted a retrospective review of 100 vacuum-assisted core breast biopsies that were followed by marker clip deployment. Craniocaudal (CC) and mediolateral oblique (MLO) mammograms were used to locate clips relative to the centre of the target lesion in 5-mm increments. RESULTS: In the 94 of 100 cases adequate for review, maximum marker clip displacement of less than 10 mm on either the CC or MLO views was observed in 68 (72%) cases. In 9 (10%) cases, the localization clip was positioned more that 24 mm from the target lesion. CONCLUSION: Post-biopsy CC and MLO radiographs are recommended to identify those cases in which there is a significant difference between the location of the marker clip and the biopsied lesion.

Biopsy↗
PubMedDate not supplied

[Intraperitoneal migration of Filshie tubal sterilization clips: an uncommon cause of chronic abdominal pain].

Tubal clips for female sterilization account for about 10 to 40% of the contraceptive methods used throughout the world. Clip migration is an unusual complication which may lead to chronic unexplained abdominal pain. We report here the case of a 44-year-old woman who suffered from chronic abdominal pain. The diagnosis of intraperitoneal migration of the Filshie clip fixed five years earlier was made. Cure was achieved with ablation of the clip. Late complications of Filshie clips are uncommon and non-specific. They include tubal necrosis and section, sterilization failure (0.7%), and migration (0.6%). Rare migrations into the bladder, the peritoneum, the appendix, or the vagina have been reported. When investigating chronic abdominal pain in a female patient, the clinician should inquire about sterilization history and carefully examine plain x-rays of the abdomen in women with tubal clips.

Abdominal Pain↗
PubMed2002

[Effect of clipping at seedling stage on growth and yield of spring wheat].

The compensation for spring wheat (Triticum aestivum) under simulated herbivory stress by clipping was examined in a semi-arid region of Gansu province in 1996. The results showed that clipping at seedling stage reduced spring wheat growth under two irrigation conditions. The yield of spring wheat generally under-compensated the clipping effect. Heavy clipping (cutting all leaves above the ground, T0, T1) resulted in a more serious reduction in yield, compared with light clipping cutting half of the leaves, H0, H1). The yields of all treatments were lower than controls(CK0, CK1), i.e., CK0 > H0 > T0 > CK1 > H1 > T1. Irrigation for once right after clipping increased wheat growth and its compensatory ability, although they were still under-compensation.

Agriculture↗
PubMed2002

[Hemodynamic changes of microvascular anastomosis with nitinol clips].

OBJECTIVE: To investigate the hemodynamic changes of the end-to-end anastomosed arteries with nitinol clips. METHODS: Fifteen New Zealand rabbits were divided into anastomosis clip group, suture group and control group randomly. The carotid arteries were resected and end-to-end anastomosis were carried out with nitinol clips in anastomosis clip group and with traditional suture in suture group. The carotid arteries remained undamaged in control group. On the days of 3, 9, 21 and 30 postoperatively, mean blood velocity (Vm), pulsatility index (PI) and resistance index (RI) of anastomosed arteries were determined by Ultrasonography Doppler. RESULTS: On the days of 8 and 9 postoperatively, there were no significant differences of VM, PI and RI between two experimental groups (P > 0.05). On the days of 20 and 30 postoperatively, the differences of Vm and RI were significant (Vm: P < 0.01, P < 0.05: RI: P < 0.01, P < 0.05). The hemodynamic restoration of the anastomosis clip group was better than that of the suture group. CONCLUSION: The hemodynamics of arteries anastomosed with nitinol clips is better than that with traditional suture. This technique has practical value clinically.

Alloys↗
PubMedDate not supplied

[Temporary arterial clipping in surgery for cerebral aneurysms in acute subarachnoidal hemorrhage].

Temporary clipping was used during operations in 69 patients. Of them, 51 patients underwent temporary arterial clipping, forced temporary arterial clipping was used in 18 patients. A total of 104 patients were operated on with preventive temporary clipping. Aneurysmal rupture occurred in 18 (17.3%) patients of them. The bioelectrical activity of the brain was intraoperatively monitored by using EEG and ECG in 12 patients of whom 11 felt rather well on discharge. The temporarily arterial clipping technique using EEG and ECG makes it possible to monitor the allowable time of temporary arterial clipping, which is in turn associated with a less risk for postoperative ischemic complications.

Acute Disease↗