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PubMed1976

Effect of clipping the coat of the Japanese macaque (Macaca fuscata) on the thermoregulatory responses.

Effect of clipping the coat of the Japanese macaque on thermoregulatory responses was studied. Heat production was significantly increased in clipped animals in comparison without clipped coats at ambient temperatures ranging from 5 to 25 degrees C. At ambient temperatures of 5, 15, and 25 degrees C tissue thermal conductance and cooling constant were significantly higher in clipped animals. Clipped animals could maintain thermal equilibrium at an ambient temperature of 5 degrees C, conpensating for the increase of heat loss by elevating heat production markedly.

Animals↗

PubMedDate not supplied

Effects of whitening and peak-clipping on speech intelligibility in the presence of a competing message.

The purpose of this experiment was to determine the effects of peak clipping on speech intelligibility when both a target speech and a competing message were simultaneously peak-clipped. A competing message composed of 5 talkers was electrically mixed with CNC discrimination words. This composite signal was presented to normally hearing subjects in three ways: unmodified, whitened, and whitened and peak-clipped. Discrimination functions were obtained for the CNC material by varying the signal-to-competition ratio. Under these conditions, essentially identical discrimination functions were yielded by the unmodified and whitened speech, whereas substantially reduced discrimination scores were obtained with the whitened/clipped speech. These results would suggest that speech intelligibility is reduced by whitening and peak clipping when more than one talker is present. This is true even though earlier studies have shown that whitening and peak clipping do not reduce speech intelligibility when only a single talker is present. Such a finding has implications for wearable amplification.

Acoustic Stimulation↗

PubMed1997

The role of thromboxane A2 in the altered microvascular reactivity in two-kidney, one-clip hypertension.

To investigate the nature of the arachidonic acid metabolite involved in the altered reactivity of microvessels of two-kidney, one-clip hypertensive rats and the possible contribution of this product to the elevated blood pressure levels found in two-kidney, one-clip hypertension, mesenteric arterioles either perfused in vitro or studied in vivo were used along with blood pressure determinations. The decreased response to acetylcholine observed was normalized by ridogrel, a thromboxane A2 receptor antagonist, and dazoxiben, a thromboxane A2 synthase inhibitor. The smooth muscle response to nitric oxide, tested with sodium nitroprusside, was unaltered in two-kidney, one-clip hypertensive microvessels. Neither ridogrel nor dazoxiben modified the response to this vasodilator. In contrast, the potentiated response to noradrenaline was corrected by ridogrel and dazoxiben in vitro but not in vivo. Noradrenaline and acetylcholine increased the release of thromboxane A2 from the mesenteric microvessels of two-kidney, one-clip hypertensive rats. Ridogrel and dazoxiben decreased but did not normalize the elevated blood pressure of hypertensive rats. Based on these results, we concluded that: 1) the decreased responsiveness of smooth muscle to acetylcholine resulted from an increase in thromboxane A2 formation rather than a decrease in sensitivity to nitric oxide; 2) thromboxane A2 contributes to the increased noradrenaline response in mesenteric microvessels perfused in vitro while in in vivo other blood borne vasoactive agents may also be involved since the potentiated noradrenaline response was not corrected by inhibiting thromboxane A2 synthesis or receptors; 3) in addition to thromboxane A2, another as yet unidentified factor, may contribute to the elevated blood pressure in two-kidney, one-clip hypertension.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗

PubMed1979

A new method for testing the force of clips for aneurysms or experimental spinal cord compression.

A new method is described for the determination of force-distance curves for aneurysm clips. A dissecting microscope with a goniometer eyepiece was used to determine the angle between the clip blades as various forces were applied to open the clip. The cosine law was then used to calculate the force-distance curves. The method allows accurate characterization of different clips and is especially useful for the early detection of clip weakening.

Aneurysm↗

PubMed1994

Titanium dural clip testing. Technical note.

Spinal dural lacerations can be a difficult part of spinal surgery. A dural tear can result in complications that include meningitis and pseudocyst formation. Appropriate treatment for these tears is generally suturing, using 4.0, 5.0, or 6.0 suture. For successful closure of dural lacerations, the authors have collaborated in the design of a titanium clip, which resembles an aneurysm clip in appearance and is applied with standard aneurysm clip appliers. The titanium clip was tested against suture and Weck hemostatic vascular clips and found to have excellent tissue-approximating capacity and a rapid application time. It is believed that this is an appropriate device for the repair of spinal dural lacerations.

Aneurysm↗

PubMed1999

Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series.

OBJECT: The goal of this study was to delineate the angioanatomical features that determine whether a patient with an unruptured middle cerebral artery (MCA) aneurysm is treated using endovascular coil placement or surgical clipping. METHODS: Thirty consecutive patients harboring 34 unruptured MCA aneurysms were evaluated. Patients with unruptured aneurysms are managed prospectively according to the following protocol: the primary treatment recommendation is endovascular packing with Guglielmi detachable coils (GDCs). Surgical clipping is recommended after failed attempts at coil placement or in the presence of angioanatomical features that contraindicate that type of endovascular therapy. Of 34 unruptured MCA aneurysms, two (6%) were successfully embolized and 32 (94%) were clipped. Of these 32 surgically treated aneurysms, in 11 (34%) an attempt at GDC embolization had failed, whereas in 21 (66%) primary clipping was performed because of unfavorable angioanatomy. Of the 13 aneurysms treated endovascularly, two (15%) were successfully excluded, whereas GDC treatment failed in 11 (85%). An unfavorable dome/neck ratio (< 2) and an arterial branch originating at the aneurysm base were the reasons for embolization failure. CONCLUSIONS: Careful evaluation of the angioanatomy of unruptured aneurysms allows selection of the most appropriate treatment. However, for unruptured MCA aneurysms, surgical clipping appears to be the most efficient treatment option. Series of unruptured aneurysms are ideal for comparing treatment results.

Adult↗

PubMed2003

Circumferential wrapping and clipping with temporalis fascia for treatment of unclippable intracranial aneurysms.

We utilized a clip-reinforced wrapping technique using temporalis fascia for treating unclippable aneurysms in 14 patients. Herein, we describe a modification of the clip- reinforced wrapping technique and report on the results. An appropriately sized strip of temporalis fascia is passed around the aneurysms with cuts made to accommodate perforating arteries. After applying fibrin glue, the aneurysm clip is positioned to secure the circumferential wrapping. Of the 14 patients, 4 (29%) were unclippable microbleb, 4 (29%) were wall defect, 3 (21%) were imperfect clipping due to the complexity of the aneurysm, 2 (14%) were bleb at the base of the aneurysm and 1 (7%) was a fusiform aneurysm. Multiple aneurysms were found in 6 (43%) patients and half (50%) of the 14 patients had MCA aneurysms. Postoperative angiography demonstrated no narrowing of parent arteries or enlargement of the aneurysms. No subsequent bleeding was observed during the 1 year follow-up period. These results suggest that circumferential wrapping-clipping with temporalis fascia and biological glue provides an alternative and safe method of treatment for unclippable intracranial aneurysms.

Adult↗

PubMed2002

[Prognostic value of CLIP score system for patients with resection of hepatocellular carcinoma].

OBJECTIVE: To evaluate the prognostic value of CLIP score system for patients with resection of HCC. METHODS: A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. 153 of 174 patients with curative resection were followed up for at least three years. Disease-free survival rate was defined as the time relapsed from the date of image diagnosis and either the date of death or the date of the latest follow-up visit, with final evaluation at June 30, 2001. Recurrences were classified into early (</= 3 year) and late (> 3 year) recurrence. Risk factors for recurrences and prognostic factors for survival in each group were analyzed by the chi-square test, the Kalain-Meier estimation and the COX proportional hazards model respectively. RESULTS: The 1-, 3-, 5-, 7-, and 10-year cumulative disease free survival rates were 57.2%, 28.3%, 23.5%, 18.8% and 17.8%, respectively. The associated factors with early recurrence were as fellows: tumor size > 5 cm, microsatellite, venous invasion, tumor morphology, tumor extension, advanced TNM stages, CLIP scores, radical resection, and resection margin, respectively. But both CLIP scores and Child stage were associated with late recurrence. Univariate survival curves analysis expressed that Child grades, radical resection, resection margin, tumor size, microsatellite, venous invasion, tumor morphology, tumor extension, TNM stages, and CLIP scores were associated with prognosis. The multivariate analysis by COX proportional hazards model, the independent prognostic factors for survival were radical resection, resection margin, and TNM stages. CONCLUSIONS: CLIP score, which takes into account both liver function and tumor extension, has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis. It could be an useful tool in predicting the patient recurrence and prognosis with resection of HCC. Meanwhile, it may help physicians to decide the more appropriate management in advance for patients with HCC.

Adolescent↗

PubMed2002

Six-month angiographic evaluation of beating-heart coronary arterial graft interrupted anastomoses using the coalescent U-CLIP anastomotic device: a prospective clinical study.

BACKGROUND: Interrupted suture technique avoids the "purse string" and puckering effects frequently seen with continuous suture techniques and should represent the standard of care in the creation of high-quality vascular anastomoses. This clinical study evaluated the safety and effectiveness of a self-closing surgical clip (Coalescent Surgical U-CLIP Anastomotic Device [U-CLIP]) designed to facilitate this interrupted technique. Left internal mammary artery (LIMA) to left anterior descending (LAD) coronary bypass grafting was studied. METHODS: Eighteen patients meeting inclusion criteria were enrolled (October 2000 through September 2001) into this prospective study. Anastomoses were performed using a beating-heart median sternotomy procedure (off-pump coronary artery bypass) in 17 cases (94%) and a minimally invasive beating-heart procedure (minimally invasive direct coronary artery bypass [MIDCAB]) in one case (6%). Six-month follow-up was completed on 18 patients (100%), with angiograms performed on 17 patients (94%) at a mean of 179 days (range, 168-191 days). Qualitative and quantitative angiographic assessment was performed by an independent core laboratory. RESULTS: The U-CLIP was used for 18 LIMA-to-LAD interrupted anastomoses without the requirement for knot tying or suture management and with no device-related morbidity or mortality. Mean LIMA-to-LAD anastomosis time was 8.6 minutes (range, 5-14 minutes). All anastomoses were FitzGibbon grade A at 6 months postprocedure. Quantitative analysis showed mean luminal diameters proximal to the anastomosis of 2.32 mm, at the anastomosis of 2.25 mm, and immediately distal to anastomosis of 1.99 mm. The average ratio of anastomosis to LAD diameter was 1.17 (range, 0.93- 1.93). Anastomotic stenosis as a percentage of average LIMA/LAD diameter was a negative 4.2%, comparing favorably with the 23% to 24% reported in the POEM (Patency, Outcomes, Economics of MIDCAB) study. CONCLUSIONS: The interrupted technique, facilitated by a self-closing anastomotic clip, yielded 6-month follow-up and angiographic results that compared favorably with results of other published studies.

Aged↗

PubMed1992

Importance of nasal clipping in screening investigations of flow volume curve.

Comparative analysis of some basic lung indices obtained from a screening investigation of the flow volume curve by using two techniques, with a nose clip and without a nose clip, was made on a cohort of 86 workers in a factory shop for the production of bearings. We found no statistically significant differences between the indices obtained by the two techniques. Our study showed that the FVC and FEV1 obtained in workers without using nose clips were equal to or better than those obtained using nose clips in 60% of the workers. The reproducibility of the two methods was similar. The analysis of the data has shown that the flow volume curve investigation gives better results when performed without a nose clip, especially in industrial conditions.

Adult↗

PubMed2004

[Micro-tourniquet method: a substitute or supporting technique for aneurysm clipping].

The micro-tourniquet method is designed as a substitute and/or supporting technique for obliterating aneurysms that are difficult to operate on using the conventional clipping technique. This method is useful for squeezing the aneurysm neck and making a detour around the neck to spare the branching vessels. These micro-tourniquet instruments are a ligature with both ends attached to a ligature guide, a guide holder, a silastic sheath, and a hemostatic clip or a small aneurysm clip set. The ligature is a 20cm long GORE-TEX suture CV-3, and is attached on both ends to a ligature guide. These ligature guides are made of 7mm wire, and are malleable enough to be bent intentionally during surgery. However, they are also rigid enough to be used as a micro dissector. The silastic sheath is made of a 20G infusion needle, and is cut to a length of 2cm. After branching vessels and perforators are dissected and spared with the aid of the ligature guide, the ligature is passed around the aneurysm neck, both ends of the ligature are passed through the sheath, the aneurysm neck is squeezed, and a clip is applied as a stopper on the ligatures adjacent to the distal end of the sheath. By gently displacing the distal end of the sheath, a conventional aneurysm clip is applied on the aneurysm neck just distal or proximal to the ligature on the neck. Then, the ligature is removed. Two demonstrable cases are presented and the usefulness of the micro-tourniquet method is discussed.

Humans↗

PubMedDate not supplied

Treatment of palmar hyperhidrosis using needlescopic T2 sympathetic block by clipping: analysis of 102 cases.

Endoscopic thoracic sympathicotomy, or sympathectomy by a 2-mm scope, is an effective method for treating palmar hyperhidrosis. However, postoperative compensatory sweating may be troublesome in some patients. We report needlescopic T2 sympathetic block by clipping, which may provide reverse operation for patients encountering compensatory sweating. Between January 1998 and January 2002, a total of 102 patients with palmar hyperhidrosis underwent video-assisted thoracoscopic sympathetic blocking of the T2 ganglion. There were 47 males and 55 females (mean age, 24.1 years; range, 9-50 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed T2 sympathetic block by clipping at the second and third intercostal spaces using a 2-mm, 0 degrees thoracoscope. Among these 102 patients, all bilateral T2 sympathetic blockings were achieved. The operation was usually accomplished within 30 minutes (range, 16-40 minutes). All patients were discharged within 4 hours after the operation. There were no surgical complications or surgical mortality cases. The mean postoperative follow-up period was 37.1 months (range, 16-64 months). Improvement of palmar hyperhidrosis can be obtained in all patients. Eighty-six patients (84%) have developed compensatory sweating of the trunk and lower limbs. Two patients had a reverse operation and had improvement of compensatory sweating at 2 and 13 days after removal of endo clips. Needlescopic T2 sympathetic block by clipping is a safe and effective method for treating palmar hyperhidrosis; compensatory sweating may be improved after reverse operation removal of endo clip.

Adolescent↗

PubMedDate not supplied

Role of endoscopic clipping for determining the resection line for tumors located in the middle or upper corpus of the stomach: experience with 100 gastrectomies for early gastric cancer.

BACKGROUND: The efficacy and limitations of preoperative endoscopic clipping for determining the resection line in patients with early gastric cancer remain unclear. MATERIALS AND METHODS: Subjects comprised 100 patients with early gastric cancer (33 females, 67 males; mean age, 60.5 years; range, 33-84 years) who underwent pre-operative endoscopic clipping for lesions located in the middle or upper corpus of the stomach. The results of endoscopic clipping for a selection of appropriate surgical procedures were investigated. RESULTS: Distal gastrectomy was performed in 94 patients, the mean length between the lesion and proximal surgical margin of the resected stomach being 28.9 +/- 18.0 mm (mean +/- SD). The surgical margin was eventually free of tumor in all patients. In 5 patients, clips were considered to be placed inadequately, and all 5 tumors were macroscopically depressed or flat and > 40 mm in size. CONCLUSION: Pre-operative endoscopic clipping represents a safe and reliable procedure to determine the resection line for tumors located in the middle or upper corpus of the stomach for treatment of early gastric cancer. During surgical resection, frozen section examination of the proximal cut end is recommended for patients with tumors that are macroscopically depressed or flat and > 40 mm in size, or that display a macroscopically unclear proximal margin.

Adult↗

PubMed2005

Endoscopic clipping focused on "triclip" for bleeding Dieulafoy's lesion in the colon.

Endoclips were among the earliest accessories developed for gastrointestinal endotherapy. Now they are currently used for the control of gastrointestinal bleeding and for the closure of perforations, fistulas, and anastomotic leaks. Numerous technical improvements of the original device have led to the development of new devices: rotatable clip, preloaded hemoclip, TriClip and repositioning clip device. The endoclip devices are easy to use. The technique comprises three steps: exposing the clip from the sheath, opening the clip to the maximum, and deploying the clip. Dieulafoy's lesion is an abnormal, submucosal "caliber-persistent artery" that protrudes through a minute mucosal defect. Although it accounts account for up to 5% of acute upper gastrointestinal bleeding, only a few cases involving colo-rectum have been reported. We report a case of Dieulafoy's lesion of the colon which has given us the opportunity to briefly review the indications and technique of endoclipping.

Aged↗

PubMedDate not supplied

Laparascopic cholecystectomy: cystic duct occlusion with titanium clips or ligature? A prospective randomized study.

During laparoscopic cholecystectomy (LC), cystic duct occlusion can be done with titanium clips or laparoscopically tied knots. However, till date, there is no randomized, controlled study reported in the literature that has prospectively compared the outcome using either of these methods. In the present study, 105 patients who were to undergo LC were randomly assigned to two groups. Group I comprised patients undergoing cystic duct occlusion with clips while group II comprised those undergoing cystic duct occlusion with knots. Our aim was to compare the postoperative outcome in both the cases. The incidence of overall bile leak following LC was 4 out of 105 (3.8%) while the leak rate following cystic duct occlusion with clips was 2 out 52 (3.9%), and that following ligature was 2 out of 53 (3.8%). The procedure using ligature took slightly longer time than that using clips. There was no significant difference in the postoperative outcome in either group. The use of ligature is a feasible, safe and cost-effective alternative to the use of titanium clips for cystic duct occlusion during LC.

Adolescent↗

PubMed2005

Monitoring fluoride exposure with fingernail clippings.

The purpose of this review is to discuss new information regarding the relationship between the level of fluoride exposure and the corresponding fluoride concentrations in fingernail clippings. While there are several techniques available to extract fluoride from fingernails prior to analysis with the electrode, the HMDS-facilitated diffusion method is the most popular. Fluoride enters fingernails at the growth end and reaches the distal end approximately three months later. The fluoride concentration in the clipping reflects the average fluoride intake and plasma concentration during the period when the clipping was formed. Therefore, the concentration in the clipping is directly related to the average fluoride exposure that occurred during a 1-2 week period (depending on the length of the clipping) about three months ago and not to recent and possibly variable exposures that occur during the day. Published studies have demonstrated that fingernail fluoride concentrations reflect fluoride exposures from drinking water, toothpaste and the work environment and can be expected to do so for any source of intake including salt.

Cariostatic Agents↗

PubMed2005

Influences of emotion on context memory while viewing film clips.

Participants listened to words while viewing film clips (audio off). Film clips were classified as neutral, positively valenced, negatively valenced, and arousing. Memory was assessed in three ways: recall of film content, recall of words, and context recognition. In the context recognition test, participants were presented a word and determined which film clip was showing when the word was originally presented. In two experiments, context memory performance was disrupted when words were presented during negatively valenced film clips, whereas it was enhanced when words were presented during arousing film clips. Free recall of words presented during the negatively valenced films was also disrupted. These findings suggest multiple influences of emotion on memory performance.

Adult↗

PubMed2005

Expanding use of nonpenetrating clips in various surgical specialities.

The Anastoclip Vessel Closure System (VCS) (LeMaitre Vascular, Burlington, MA, USA), introduced primarily to facilitate microvascular anastomoses performed during neurosurgical extra-intracranial bypasses, has been used for several other applications as well. The relatively new anastomotic technique includes a clip applier, clip remover, and everting forceps. With the applier, tiny nonpenetrating titanium clips were installed on everted walls of tubular structures. The technical ease of application, reduced anastomotic time, superior hemodynamics, and an improved healing pattern at the anastomosis have been recognized as major advantages compared to conventional suturing. This chapter describes the various indications for use of the system and categorizes them by specific surgical specialties, which include neurosurgery, urology, and gynecology, as well as plastic and reconstructive, vascular, thoracic, transplantation, hepatopancreaticobiliary, and orthopedic and trauma surgery. The largest clinical experience with clips is in vascular access surgery for hemodialysis purposes, both in autologous constructs and with prosthetic grafts. Promising clinical results also have been achieved in neurosurgical cases (both for microvascular anastomoses and with closure of dura mater), microvascular free-tissue transfer, and renal and liver transplantations. Future clinical applications include the use of clips for nerve repair and closure of various types of tubular structures using a laparoscopic approach.

Anastomosis, Surgical↗