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PubMedDate not supplied

Mechanism of enhanced blood pressure rise after reclipping following removal of a renal artery clip in rats.

The effect of removing a renal artery clip 14 to 18 days after its application was studied in two-kidney, one clip hypertensive rats. Blood pressure decreased to a normotensive level within 24 hours after the removal of the clip. The cardiovascular effects of reapplication of the clip and infusion of renin, angiotensin II, and norepinephrine were assessed at that time. Reapplication of the clip to the unclipped renal artery was followed in 1 hour by an increase in blood pressure to the level of sham-operated renal hypertensive rats. After reapplication of the clip, plasma renin activity increased to the same level as after the initial application. Application of the clip to the contralateral renal artery did not affect blood pressure and failed to increase plasma renin activity. It appears that renin release is a prerequisite for the rapid rise of blood pressure after reapplication of the clip. The infusion of renin, angiotensin II, and norepinephrine for 90 minutes caused an enhanced blood pressure response similar to that observed following reapplication of the clip. The increase in blood pressure in control rats was associated with bradycardia, which was absent in unclipped rats. The enhanced response of unclipped rats to an infusion of renin was abolished by pithing. It is concluded that removal of a renal artery clip unmasks a hyperreactivity of the cardiovascular system to reapplication of the clip.

Angiotensin II↗
PubMed1992

How secure are laparoscopically placed clips? An in vitro and in vivo study.

We tested the security of laparoscopic, hemostatic clips in vitro and in vivo. In vitro, the force needed to transversely dislodge clips that were applied to silicone (Silastic) tubing ranged from a mean +/- SEM of 1.81 +/- 0.07 N (Endo Clip) to 2.68 +/- 0.04 N (Ligaclip). The force needed to axially dislodge clips that were applied to silicone tubing ranged from 4.08 +/- 0.20 N (Endo Clip) to 4.78 +/- 0.18 N (Ligaclip). In vivo, on mesenteric vessels in anesthetized pigs, 34 of 100 clips that were applied laparoscopically with the Endo Clip were moved or dislodged compared with 11 of 100 of those applied with the Ligaclip. We conclude that laparoscopically placed vascular clips applied with the Ligaclip are more secure than those applied with the Endo Clip. The laparoscopic surgeon should be aware of the relative ease with which clips may be dislodged.

Animals↗
PubMed1983

Spring clip for aneurysm surgery.

This report concerns a clip for aneurysm surgery which has (a) a stabilizing wire that prevents the scissoring of the blades, (b) a stronger coil spring that allows longer blades and a reduced possibility of slippage, and (c) grasping sites that allow the clip to be positioned in both an applier that holds the clip rigidly in one position, and in one that allows the clip to be rotated for optimal placement. The clip is made from stainless-steel wire 2 mm in diameter, which is larger than that used for other clips. The 2-mm diameter permits the clip to have wider clamping surfaces than other clips made from wire, it permits the grasping sites to be notched so that it may be held in a rotating clip applier, and permits the clip to be tooled for a stronger coil spring. The coil springs are of either a standard or a strong tension, and have opening pressures of approximately 175 g and 320 g, respectively.

Aneurysm↗
PubMed1991

Neurosurgical vascular complications associated with aneurysm clips evaluated by postmortem angiography.

Neurosurgical vascular complications were evaluated by postmortem angiography in a consecutive prospective series of 63 patients in Helsinki who suffered a fatal outcome following neurosurgery for ruptured intracranial aneurysm. Operative vascular complications were revealed in 28 (44%) of the cases. Massive intraoperative bleeding resulting from rupture of the aneurysm or adjacent major artery during dissection or clip application complicated the operation in 16 (25%) patients. Clip-induced obstruction of cerebral arteries was detected by angiography in seven cases (11%). In six of the patients an adjacent cerebral vessel was accidentally clipped. In one case a kinking of the clip had caused obstruction of the right anterior cerebellar artery with resulting frontal infarct. A combination of rupture of the internal carotid artery and accidental ligation of the left posterior cerebellar artery occurring simultaneously during the clipping of a ruptured basilar aneurysm was detected in one patient (2%). Other types of complication were revealed in four cases (6%): detachment of clip with re-bleeding; clipping of an uninvolved aneurysm instead of the ruptured one; displacement of the clip beneath the ruptured aneurysm. Operations on ruptured basilar artery aneurysm were significantly (P less than 0.01) more prone to complications. The results indicate that operative vascular complications play a significant role in the mortality of aneurysm patients. Post-mortem angiographic technique with contrast medium that vulcanizes at room temperature is particularly suitable for demonstration of the haemodynamic significance of clip-induced cerebrovascular accidental occlusions, and is the only method at autopsy to reveal an occlusion caused by a kinking of a properly placed aneurysm clip.

Adult↗
PubMed1987

Divided renal and caval vein plasma renin activity in two-kidney two-clip hypertension in rabbits and variations of blood pressure, plasma volume and renal function following unilateral nephrectomy.

Determinations were made of peripheral plasma renin activity, blood pressure, plasma volume and blood urea nitrogen in rabbit models of two-kidney one-clip, two-kidney two-clip or one-kidney one-clip hypertension that were created by staged operation to produce functionally significant renal artery stenosis. The plasma renin activity in the divided renal veins and inferior caval vein was also measured in animals with two-kidney two-clip hypertension. In rabbits with two-kidney two-clip hypertension the plasma renin activity was significantly higher in the renal vein on the more involved side and comparable in the renal vein on the less involved side and the inferior caval vein. This response pattern of renin secretion, unilateral hypersecretion with contralateral suppression, was identical with that observed in animals with two-kidney one-clip hypertension. In animals with one-kidney one-clip hypertension there was a marked increase in plasma volume and blood urea nitrogen. The renovascular hypertension was in decreasing order of severity in animals with one-kidney one-clip hypertension, those with two-kidney two-clip hypertension and those with two-kidney one-clip hypertension.

Animals↗
PubMed1995

Structural features of the invariant chain fragment CLIP controlling rapid release from HLA-DR molecules and inhibition of peptide binding.

The invariant chain (Ii) prevents binding of ligands to major histocompatibility complex (MHC) class II molecules in the endoplasmic reticulum and during intracellular transport. Stepwise removal of the Ii in a trans-Golgi compartment renders MHC class II molecules accessible for peptide loading, with CLIP (class II-associated Ii peptides) as the final fragment to be released. Here we show that CLIP can be subdivided into distinct functional regions. The C-terminal segment (residues 92-105) of the CLIP-(81-105) fragment mediates inhibition of self- and antigenic peptide binding to HLA-DR2 molecules. In contrast, the N-terminal segment CLIP-(81-98) binds to the Staphylococcus aureus enterotoxin B contact site outside the peptide-binding groove on the alpha 1 domain and does not interfere with peptide binding. Its functional significance appears to lie in the contribution to CLIP removal: the dissociation of CLIP-(81-105) is characterized by a fast off-rate, which is accelerated at endosomal pH, whereas in the absence of the N-terminal CLIP-(81-91), the off-rate of C-terminal CLIP-(92-105) is slow and remains unaltered at low pH. Mechanistically, the N-terminal segment of CLIP seems to prevent tight interactions of CLIP side chains with specificity pockets in the peptide-binding groove that normally occurs during maturation of long-lived class II-peptide complexes.

Amino Acid Sequence↗
PubMed1995

The ability of laparoscopic clips to withstand high intraluminal pressure.

OBJECTIVE: To determine if commercially available clips for laparoscopic surgery become displaced with high intraluminal pressures. DESIGN: In vivo model in which the splenic, renal, and mesenteric vessels together with the gallbladder of anesthetized living pigs were individually occluded using titanium and absorbable clips and then subjected to pressures of 300 mm Hg; and in vitro model in which the procedure was repeated on freshly removed human gallbladders with the attached segment of cystic duct. INTERVENTION: The intraluminal pressure of the occluded segment was increased until (1) the clip was released, (2) the vessel burst, or (3) the predetermined pressure (300 mm Hg) was obtained. RESULTS: A total of 90 clips were examined. No clip could be displaced from any porcine vessel at intraluminal pressures of up to 300 mm Hg. One vessel burst before the predetermined pressure was obtained, the clips remaining intact. Clips placed on the porcine and human models also could not be displaced by a pressure of 300 mg Hg. CONCLUSION: Commercially available titanium and absorbable clips do not disrupt when subjected to high intraluminal pressures. Postoperative bile leaks are more likely to result from necrosis of the cystic duct than displacement of the clip by the pressure within the biliary system.

Animals↗
PubMed1984

Avoidance of artifacts on computerized tomograms by selection of appropriate surgical clips.

Surgical clips (metallic or plastic) are frequently used for hemostasis and tumor marking. This study evaluated the radiographic and computerized tomographic appearance of different clips and their relative interference with computerized tomographic scans. Metallic clips (stainless steel, tantalum, and titanium) can all be seen on plain radiographs. Tantalum clips caused extensive distortion on computerized tomographic scans which would interfere with scan interpretation. Both stainless steel and titanium clips resulted in much less artifact and interference on computerized tomographic scans. Recent studies have suggested that there may be some risk of torsion of stainless steel clips in nuclear magnetic resonance scanners resulting in tissue damage. Absorbable plastic clips cannot be seen on plain film but are visualized on computerized tomographic scans and do not appear to cause scan artifact. Overall, we recommend the use of either titanium hemostatic clips when tumor marking on plain film is required or plastic clips when tumor marking is less important.

Evaluation Studies as Topic↗
PubMed1986

Autoregulation of renal blood flow in two-kidney, one-clip hypertensive rats.

Renal blood flow (RBF) autoregulation was examined in the clipped and nonclipped kidneys in two groups of two-kidney, one-clip (2K-1C) hypertensive rats 10 wk after clipping. The arterial pressure distal to the clip and the renin secretion rate (RSR) were also examined. The blood pressure (BP) was 149 +/- 4 and 162 +/- 6 mmHg in the two hypertensive groups vs. 114 +/- 3 mmHg in the controls (P less than 0.02). The RBF (in ml X min-1 X kidney-1) was 4.27 +/- 0.41 in the nonclipped and 2.18 +/- 0.23 in the clipped kidneys (P less than 0.001). The pressure distal to the clip was 104 +/- 7 mmHg. The renal vascular resistance (RVR) (in mmHg X ml-1 X min-1 X g-1) was 25.0 +/- 1.4 in the control kidneys vs. 58.4 +/- 4.5 in the nonclipped (P less than 0.001) and 39.9 +/- 6.6 in the clipped kidneys (P less than 0.01). The RBF autoregulation was well preserved in the nonclipped kidneys but reset to a higher lower pressure limit of autoregulation of 106 +/- 4 mmHg, which was significantly higher than in the normotensive controls (84 +/- 6 mmHg) (P less than 0.01). In the clipped kidneys there was complete loss of RBF autoregulation. RSR decreased with reduction of the perfusion pressure in the clipped kidneys. The increased RVR might have been due to a combination of structural and functional changes in both kidneys.

Animals↗
PubMed1986

Effect of ketanserin on pressor response to vasoactive substances in early phase of one-kidney, one clip renal artery stenosis in rats and rabbits.

The effect of ketanserin (KET), a specific 5-hydroxytryptamine2 (5-HT2) receptor blockade, on pressor response to vasoactive substances was examined in rats with one-kidney, one clip renal artery stenosis of 2 days' duration (2-day clipped rat) and in rabbits with renal artery stenosis of 3 days' duration (3-day clipped rabbits). The 2-day clipped rats showed hyperresponsiveness to norepinephrine (NE), arginine vasopressin (AVP) and 5-HT. All hyperresponsiveness were attenuated by a subdepressor dose of KET. The infusion of KET, 10 micrograms/kg/min for 30 minutes, decreased mean arterial pressure of the 3-day clipped rabbits; the dose did not alter blood pressure of the normal controls. Exaggerated pressor response to NE was observed in the 3-day clipped rabbits and was abolished by a subdepressor dose of KET, 2.5 micrograms/kg/min. These results suggest that 5-HT may be involved in the enhanced pressor response to vasoconstrictor substances in the 2-day clipped rats and 3-day clipped rabbits, and that it may also play an important role in maintaining blood pressure in the 3-day clipped rabbits.

Animals↗
PubMed1985

Clip with enclosed spring for aneurysm surgery. Technical note.

A clip for aneurysm surgery has been designed with several unique features. The coil spring is fully hidden and protected within two hub sections so that it cannot be handled or become entrapped in tissue. The clip is milled from a piece of solid stock of nonmagnetic stainless steel to the desired size and shape by a computer milling process, thus avoiding the stresses and structural weaknesses caused by the bending, curling, and milling needed to prepare clips made from wire or sheet metal. The only means of opening the clip is by applying pressure to the solid milled surfaces, thus the spring cannot be weakened or bent by squeezing it or by trauma applied to the clip. The clip may be grasped in either a clip applier that holds the clip in one fixed position or in an applier that allows the clip to be rotated through an arc of 180 degrees.

Aneurysm↗
PubMed1991

Laparoscopic clips. Evaluation of absorbable and titanium with regard to hemostasis and tissue reactivity.

Advanced laparoscopic techniques require laparoscopic means of providing hemostasis. We tested the hemostatic ability of laparoscopic surgical clips and their tissue reactivity as assessed by adhesion formation in an animal model. Twenty-six New Zealand white rabbits were randomized at laparotomy to one of three treatment groups: titanium surgical clips, absorbable surgical clips (both applied with a laparoscopic clip applicator) and chromic sutures of equal mass. Either the right fallopian tube was transected, with clips or sutures applied proximally and distally to control bleeding, or the clips or sutures were applied 5 mm apart and the tube transected. A clip or suture of the same material was placed on the midportion of the left fallopian tube. Necropsy was performed at 42 days, and each clip/suture site was scored for adhesions. All the materials were easily applied and effective in achieving hemostasis. The adhesion scores tended to be lower with the absorbable clips; however, there were no statistically significant differences between the groups. Laparoscopic clips are effective in providing hemostasis, are easily applied and cause no more adhesion formation than do conventional suture materials.

Animals↗
PubMed1983

[Is tubal sterilization with the Tupla-clip a reversible method?].

Between 1976 and 1981 402 tubal sterilizations were performed with Tupla-clip most of them by laparoscopic application. 11 tubes were removed between 15 and 47 months following the sterilization with the Tupla-clip. The local changes both macroscopically and microscopically to the tupla-clip were evaluated. The possibility of tubal patency following removal of the clips was tested by carbon dioxide pertubation. The tubal-occlusion with the tupla-clip is definitive since all tubes had a fibrous tissue strand where the clip had been applied which still carried blood vessels. No tube was patent with the carbon dioxide pertubation. The intra-operative testing of correct application of the clip and the documentation of this correct application is again mentioned. This is especially important in view of the recent judgements of the federal supreme court regarding liability in failed tubal sterilizations. The excellent chance of reversal by tubal anastomosis and the 100% success rate of this method of sterilization within the 6 years under observation will increase the acceptance of the tupla-clip as a method for tubal sterilizations.

Female↗
PubMed1982

Aggravation of experimental glomerulonephritis by superimposed clip hypertension.

To evaluate the possible enhancing effect of hypertension on the clinical and morphologic features of glomerulonephritis, two-kidney clip hypertension (CH) was superimposed on a mild form of nephrotoxic serum nephritis (NSN) in female Sprague-Dawley rats. The following parameters were assessed regularly over a 6-month period: blood pressure (BP), heart weight, proteinuria (UpV), and renal morphology. Blood pressure and heart weights were increased equally in clip hypertension and in nephrotoxic serum nephritis combined with clip hypertension. While only moderate proteinuria occurred in nephrotoxic serum nephritis (49 +/- 28 mg/24 hr) or clip hypertension (40 +/- 22 mg/24 hr) alone, the superimposition of clip hypertension on nephrotoxic serum nephritis resulted in heavy proteinuria (161 +/- 36 mg/24 hr) (P less than 0.001) after 5 months of hypertension. Glomerular histology in nephrotoxic serum nephritis showed infrequent focal and segmental proliferation and minimal sclerosis; vessels were normal. Clip hypertension was characterized by infrequent and mild vascular sclerosis and glomerular proliferation and sclerosis. Severe glomerular endo- and extracapillary proliferation and widespread glomerular and vascular sclerosis occurred in the majority of rats when nephrotoxic serum nephritis was combined with clip hypertension. The data demonstrate that clip hypertension enhances glomerular proliferation and sclerosis and results in the development of vascular sclerosis in experimental nephritis.

Animals↗
PubMed1982

Effects of saralasin infusion on bilateral renal function in two-kidney, one-clip Goldblatt hypertensive rats.

1. Previous studies have shown that administration of converting enzyme inhibitor (CEI, SQ 20 881) to two-kidney, one-clip Goldblatt hypertensive (GH) rats clipped for 3-4 weeks resulted in marked increases in glomerular filtration rate (GFR), water and sodium excretion by the non-clipped kidneys. The clipped kidneys exhibited reduced function that was due, in part, to the reductions in arterial pressure. To evaluate further the hypothesis that the renal responses to CEI were due primarily to the inhibition of angiotensin II rather than other factors, we infused the angiotensin II competitive blocker, saralasin, into GH rats under sodium pentobarbital anaesthesia and examined renal haemodynamics and excretory function of each kidney before and during saralasin infusion and after cessation of saralasin infusion. 2. Saralasin reduced mean arterial blood pressure from 164 +/- 4 to 124 +/- 4 mmHg. Despite the profound fall of arterial pressure, significant increases in renal blood flow from 5.82 +/- 0.22 to 9.15 +/- 0.76 ml/min and glomerular filtration rate from 1.46 +/- 0.10 to 2.18 +/- 0.14 ml/min were observed in the non-clipped kidneys. Renal vascular resistance decreased from 2.34 (+/- 0.14) x 10(5) to 1.17 (+/- 0.19) x 10(5) kPa 1(-1) s [2.34 (+/- 0.14) x 10(6) to 1.17 (+/- 0.19) x 10(6) dyn s cm-5]. Also, concomitant diuresis and kaliuresis and a delayed natriuresis occurred. 3. The clipped kidneys exhibited reductions in renal blood flow, GFR and excretory function during saralasin infusion. 4. Normal rats receiving the identical dose of saralasin responded with a slight but significant decrease in arterial pressure. The increase in renal blood flow and GFR were less than those observed in the non-clipped kidneys of hypertensive rats. 5. These data provide further support to the hypothesis that an angiotensin II-mediated elevation in renal vascular resistance and impairment of renal function exist in the non-clipped kidneys of GH rats.

Angiotensin II↗
PubMed1983

The importance of the renin-angiotensin system in the development and maintenance of hypertension in the two-kidney one-clip hypertensive rat.

1. Blood pressure, renin concentration and angiotensin II were measured in unanaesthetized two-kidney one-clip hypertensive rats at 1 and 2 days, at weekly intervals up to 10 weeks and at 15 and 20 weeks after clipping. 2. Compared with values in sham-operated rats, renin and angiotensin II were initially increased at 1-2 days but were then suppressed between 2 and 4 weeks to levels similar to that found in sham-operated rats. Between 5 and 20 weeks renin and angiotensin II increased again to high levels. 3. There was a significant correlation between angiotensin II and blood pressure in acute rats 1-2 days after clipping (P less than 0.05) and in chronic rats 8-20 weeks after clipping (P less than 0.001). There was no difference in the slope of the regression lines but the regression line for the chronic rats was shifted upwards in a parallel manner. 4. The acute hypotensive response (-20.3 +/- SD 24.9 mmHg) in 26 chronic rats given converting enzyme inhibitor was related to the basal renin and angiotensin II levels and followed the slope of the angiotensin II/blood pressure regression line for all chronic rats. Only one out of 26 rats reduced its blood pressure to normal levels. 5. In 12 rats at 4 weeks after clipping, when blood pressure was elevated but angiotensin II was suppressed, there was only a small fall in blood pressure (-7.1 +/- SD 7.2 mmHg). This also followed the angiotensin II/blood pressure regression line for chronic rats but at the lower end. Blood pressure again was not reduced to normal. 6. These results suggest that renin and angiotensin II are increased up to 20 weeks after clipping, that there is no change in the net vascular responsiveness to endogenous angiotensin II at any stage in this experimental model and that the acute effect of angiotensin II is determined solely by its position in the same dose-response curve. Also with the exception of 1-2 days immediately after clipping the acute effect of angiotensin II plays only a minor, though variable, role in the hypertension and that some other mechanism, as yet undetermined, is of greater importance and begins to have an effect as early as 2 weeks after clipping.

Angiotensin II↗
PubMed1987

Effects of verapamil and converting enzyme inhibition on bilateral renal function of two-kidney, one-clip hypertensive rats.

Experiments were conducted in two-kidney, one-clip renal vascular hypertensive rats (GHR) to assess the responses of each kidney to acute treatment with the antihypertensive calcium channel blocking agent verapamil in the presence and in the absence of converting enzyme inhibitor (CEI). One group of GHR (0.2 mm inner diam. clip 3 weeks before study) were examined during a control period, and during a second period of infusion of verapamil (600 micrograms h-1 kg-1). A second group of GHR were examined during a control period, during CEI (teprotide, 3 mg h-1 kg-1) infusion and during a third period of verapamil (600 micrograms h-1 kg-1) infusion superimposed on CEI infusion. Although systemic blood pressure (BP) decreased from 175 +/- 4 to 149 +/- 5 mmHg (mean +/- SEM) in response to verapamil alone, renal blood flow for non-clipped kidneys increased from 5.9 +/- 0.4 to 6.5 +/- 0.3 ml/min, indicating a 30% reduction of renal vascular resistance (P values less than or equal to 0.01; n = 9). Glomerular filtration rate (GFR) for non-clipped kidneys (n = 24) increased from 0.91 +/- 0.09 to 1.47 +/- 0.14 ml/min and filtration fraction increased from 0.32 +/- 0.04 to 0.47 +/- 0.03 (P values less than or equal to 0.05). Urine flow rate and absolute and fractional sodium excretion for non-clipped kidneys increased. GFR for clipped kidneys decreased during verapamil. Treatment with CEI alone resulted in nearly identical responses of BP and function of the non-clipped kidney, except filtration fraction was unchanged. The addition of verapamil to ongoing converting enzyme blockade tended to augment the increased GFR of the non-clipped kidney. Plasma renin activity (PRA) increased from 30 +/- 3 to 59 +/- 7 ng of angiotensin (ANG) I h-1 ml-1 with verapamil alone, a significantly larger increment than the increase of PRA from 27 +/- 5 to 39 +/- 9 ng of ANG I h-1 ml-1 in GHR subjected to comparable blood pressure reduction by mechanical aortic constriction. Verapamil resulted in many similar effects on renal function to those observed during blockade of converting enzyme. The increased filtration fraction observed in response to verapamil may be the result of vasodilatation of the afferent arteriole or of an increase in the glomerular ultrafiltration coefficient.

Angiotensin II↗
PubMed1988

Chronic angiotensin converting enzyme inhibition in the two-kidney, one clip hypertensive rat.

Treatment with an angiotensin converting enzyme (ACE) inhibitor in renovascular hypertension produces acute effects on renal function; however, the long-term consequences of this are not known. We have studied the effect of chronic enalapril treatment on renal structure and function in the two-kidney, one clip model of renovascular hypertension in the rat. Four weeks after the left renal artery was clipped, the hypertensive rats were randomly allocated to treatment with enalapril, minoxidil or to no treatment. The drug dose was titrated for maximal hypotensive effect. After 4 months of treatment blood pressures were 129 +/- 3 mmHg (enalapril), 193 +/- 5 mmHg (minoxidil) and 220 +/- 4.8 mmHg (no treatment). Twelve months later survival was 84% (enalapril group), 48% (minoxidil group) and 15% (untreated group). Split kidney function (51Cr-EDTA clearance, ml/min) of the clipped kidneys was 0.0 (enalapril group), 0.26 +/- 0.23 (minoxidil group) and 0.74 +/- 0.13 (untreated group). The clipped kidney from enalapril-treated rats weighed 0.46 +/- 0.1 g, much less than in the minoxidil-treated group (1.2 +/- 0.07) or the untreated group (1.14 +/- 0.10). Enalapril treatment was withdrawn for 2 weeks in five rats, but the clipped kidney remained small and non-functional. Histological examination revealed marked interstitial fibrosis and tubular atrophy in clipped kidneys from both enalapril groups, in contrast to minor changes in the minoxidil-treated and the untreated groups. We conclude that chronic enalapril treatment of two-kidney, one clip hypertension in the rat improved survival and preserved total renal function, but was associated with irreversible fibrotic atrophy of the clipped kidney.

Angiotensin-Converting Enzyme Inhibitors↗