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Reversal of one-kidney, one-clip hypertension in rats. Effects on myocardial Na+, K(+)-ATPase, arterial Na(+)-K+ pump, arterial membrane potential, and plasma Na(+)-K+ pump inhibitory activity.

We have previously reported that myocardial microsomal Na+,K(+)-ATPase activity, arterial wall ouabain-sensitive 86Rb uptake, and arterial smooth muscle cell membrane potentials are decreased and plasma Na(+)-K+ pump inhibitory activity is increased in rats during the fifth week of one-kidney, one-clip hypertension. We here report measurements of these four parameters and blood pressure following unclipping. A new series of rats with one-kidney, one-clip hypertension was prepared. Each animal was paired with a one-kidney, sham-clipped (nonconstricting clip) control rat. After 5 weeks, the clips were removed. In the hypertensive animals arterial pressure promptly (within 3 h) returned to normal and remained at the level for 7 observation days. On the third day following unclipping, all four parameters were not significantly different from those in the paired control animals. On the seventh day following unclipping, three of the four parameters were not significantly different from those in the paired control animals and arterial ouabain sensitive 86Rb uptake was slightly increased relative to the value in the control animals. These studies invite further inquiry into the possible role of plasma Na(+)-K+ pump inhibitory activity in the genesis and maintenance of the hypertension in this model.

Animals↗

A comparative study between Michel and Proximate clips for the closure of neck incisions.

A prospective study comparing two types of surgical clip, the Proximate II (Ethicon) staple and the Michel clip, was performed on 30 thyroidectomy (horizontal) and 50 carotid endarterectomy (vertical) incisions with reference to their ease of handling, patient comfort, complication rate, cosmetic result and cost. In each patient half of the wound was approximated with one type of clip and half with the other. The Proximate II staple was more comfortable for the patient in the vertical wounds (P less than 0.02), easier to remove as judged by the nurse in both horizontal (P less than 0.001) and vertical (P less than 0.02) wounds, and by the patient in the horizontal wounds (P less than 0.02) only. The incidence of inflammation was significantly higher with the Michel clip (P less than 0.001). In both the horizontal (P less than 0.05) and the vertical (P less than 0.001) wounds, when the scar was assessed at the time of discharge from hospital, the Proximate II staple achieved a significantly better result. However, assessment of the wounds by patient and researcher 6 weeks postoperatively, revealed no significant difference between the wounds with regard to cosmetic outcome. The Proximate II design, however, costs between seven and ten times more than the Michel clip depending on the size of the dispenser used, and since the late cosmetic result offers no advantage over the latter design, we feel these financial variables deserve consideration.

Adult↗

Pulmonary embolization of a vascular ligature clip as a complication of para-aortic lymph node sampling.

A case is reported of a 57-year-old woman who underwent cytoreductive surgery for stage III, grade 2 endometrioid cystadenocarcinoma of the ovary. During para-aortic lymph node sampling, hemostasis was achieved with medium and small metallic ligature clips. The immediate postoperative period was uneventful and the chest radiograph was unchanged from preoperative film. On the sixth postoperative day a chest radiograph showed a radio-opaque object consistent with a metallic ligature clip in the peripheral left middle lung field. The remaining postoperative course was uncomplicated and the patient is well 14 months postoperatively; the ligature clip is unchanged in position. This is an interesting and previously unreported complication of para-aortic lymph node sampling. The means by which the clip entered the vascular system is unknown. Nonsurgical removal of the clip was not feasible due to its peripheral location. No studies exist as to the long-term outcome of foreign bodies embolized to the peripheral lung.

Cystadenocarcinoma↗

Kidney renin mRNA levels in the early and chronic phases of two-kidney, one clip hypertension in the rat.

The effect of clipping the left renal artery on left and right kidney renin mRNA levels during the early and chronic phases of two-kidney, one clip Goldblatt hypertension in the rat was studied. Renin mRNA levels were determined using northern and dot blotting. Four weeks after clipping, renin mRNA levels were sixfold higher in the left kidney and eightfold lower in the right kidney of the Goldblatt rats compared with the left kidney of the sham-operated rats. Similar analysis at 20 weeks after clipping showed a fourfold increase in the left kidney and a 16-fold suppression in the right kidney compared with age-matched sham-operated control rats. The study demonstrates the profound changes that occur in renin gene expression in the clipped and contralateral kidneys in this model of hypertension and shows that these changes persist into the chronic phase of the hypertension.

Animals↗

[Analysis of internal carotid-posterior communicating artery aneurysms with difficulty in clipping: with special reference to radiometry].

Although internal carotid-posterior communicating artery (ICPC) aneurysms seem to be one of the easiest to be operated on, some are known difficult to handle and could not be successfully clipped even with all sorts of preparations. It is, therefore, essential to analyze ICPC aneurysms with difficulty in clipping. Out of 106 cases with ICPC aneurysms admitted to Kyoto University Hospital since May 1977, 83 cases have been registered in this study to the exclusion of either non-operated cases or giant aneurysm cases. Cases with difficulty in clipping procedure are selected and classified depending on its causes, which were judged from operation records as well as operative photographs. Angiograms have been checked to discuss whether possible causes of difficulty in clipping could have been suspected preoperatively. Radiometry were also performed in the following items; distance between the anterior clinoid process (ACP) and proximal side of the aneurysmal neck (W) in AP view, distance of proximal side of the neck from ACP (D) and its height (H) from the baseline between the ACP and posterior clinoid process in lateral view. Causes of difficulty in clipping procedure can be grouped as follows: a) ventrally directed dome of the aneurysm (9 cases), b) incision of the plica petroclinoidea anterior (PPA) or removal of the anterior clinoid process (ACP) to identify proximal side of the neck (7 cases: b group), c) saucer-shaped dome with no apparent neck, d) branches of the internal carotid artery from dome.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗

[A rare case of cerebral aspergillus aneurysm at the site of temporary clip application].

Anterior communicating artery aneurysm was shown in a 48-year-old man who had suffered from subarachnoid hemorrhage (SAH) by cerebral angiography. Right pterional approach was performed on the 40th day after SAH. Premature ruptured occurred during aneurysmal manipulation and temporary clip (Scoville clip) was placed at the middle of the right A1 segment for fifteen minutes. the anterior communicating artery aneurysm was successfully clipped and postoperative course was uneventful. But, four days after the operation, the patient fell into coma following generalized tonic convulsion. Lumbar puncture showed fresh SAH. Consciousness recovered gradually to a lethargic state. A newly formed berry aneurysm was revealed on the righ A1 segment at the site of the temporary clip application by cerebral angiography performed on the seventh day after aneurysmal surgery. Second attack occurred on the 12th postoperative day and the patient died on the 16th day after the operation. Postmortem findings disclosed massive subarachnoid and intraventricular hemorrhage from the ruptured aneurysm at the right A1 segment. Microscopic examination of the aneurysm and the right A1 segment. microscopic examination of the aneurysm and the right A1 segment showed the extensive destruction of the artery and massive proliferation of aspergillus in the arterial wall which was prominent of its outer layer. The mechanism of the formation of the new aneurysm in this case was considered as follows: the arterial wall was primarily damaged by the temporary clip and was weakened rapidly by the invasion of aspergillus, probably producing thrombosis of the vast vasorum, hemorrhage, and necrosis in it.

Aneurysm, Infected↗

A simple rapid technique for vena cava clip replacement.

A method to facilitate clipping of the inferior vena cava is presented. The inferior surface of the clip is protected by a red rubber catheter while being passed behind the vena cava. This avoids any trauma to the posterior wall that may be caused by the serrations or sharp edges of the clip and facilitates passage. Once in place, this catheter is then advanced off the clip and a previously placed silk tie is secured. The operation is then finished expeditiously. Although inferior vena caval clipping has become a less frequently used method of vena cava interruption, definite indications remain for its use and it must be kept in the armanentarium of the surgeon. This method should facilitate the execution of this procedure.

Catheterization↗

Caval ligation versus clipping to counteract pulmonary embolism.

In 1967-1983 31 patients underwent surgical interruption of the inferior vena cava (IIVC) with ligation, and in 1984-1985 five patients were treated by IIVC with clipping (Adams-de Weese clip). The early adverse effects in the legs and complications were studied, and all five IIVC patients with clipping underwent isotope phlebography. The most serious early complication was sudden death on the 9th postoperative day after ligation. In one half of the affected legs moderate or severe oedema was found after the ligation. After clipping early adverse effects in the legs were minimal, and isotope phlebography showed an open inferior vena cava in all cases; only in one patient were collateral veins found past the inferior cava. It is concluded that when IIVC is indicated clipping is the optimal surgical method. IIVC with ligation is indicated only in septic embolism.

Adult↗

Adhesion formation to the uterine horn of the rat in response to nylon and a new absorbable clip.

We have evaluated the tissue reactivity as manifested by adhesion formation to the uterine horn of the rat in response to a new absorbable surgical clip. A standard lesion on the uterine horn was created and repaired with either nylon sutures or an absorbable clip. Adhesion formation to the operative site was evaluated using a point based grading system, seven, 21 and 120 days postoperatively. A statistically significant increase in adhesion formation and their severity was seen on the uterine horns repaired with the surgical clips. The adhesions did not improve with time. In two instances, abscesses were formed around the clips. The use of the surgical clips in the peritoneal cavity needs to be investigated further. Their use in women in the reproductive age group who wish to preserve their reproductive potential is discouraged.

Animals↗

Effect of DOCA-salt on angiotensin dependency and surgical reversal of hypertension in two-kidney, one clip renal hypertensive rats.

The development of hypertension in two-kidney, one clip renal hypertensive rats (2K, 1C RHR) was not altered by treatment with DOCA and saline solution as drinking fluid for two months of observation. However, the administration of DOCA and salt suppressed plasma renin activity (PRA), the renal renin content (RRC) of the clipped kidney and the response to a single oral dose of captopril (10 mg/kg). The weight of the contralateral kidney was increased by the administration of DOCA-salt, while that of the ischaemic kidney was not changed. The withdrawal of DOCA-salt treatment restored the PRA and the effects of captopril to a similar degree to the non-treated group. The acute hypotensive effects of captopril were reduced on the 10th week compared with the 7th week after renal arterial constriction in 2K, 1C RHR. The fall in blood pressure induced by captopril significantly correlated with the initial PRA both in the 7th and 10th week after clipping. There was a significant correlation between PRA and RRC of the clipped kidney. Rats previously treated with DOC-salt had either removal of the contralateral kidney with removal of the clip from the ischaemic kidney, or removal of the ischaemic kidney. Blood pressure fell to normal levels in the unclipped group and in the nephrectomy group, but the fall in the latter group was transient and within two weeks had risen to significantly higher levels than in the unclipped group. It is concluded that structural vascular change following DOC-salt hypertension is insufficient to cause persisting hypertension except when it occurs in the renal circulation.

Animals↗

Tubal sterilization with Filshie Clip. A multicentre study of the ICMR task force on female sterilization.

Female sterilization by the application of Filshe Clip Mark IV has been studied, on a prospective multicentric basis in 869 women for a period of two years. Sixty involuntary pregnancy following ligation were reported giving a failure rate of 8.6 per 100 women at the end of 24 months. Method failures were observed to be evenly distributed throughout the period of observation except in puerperal ligation in whom majority of the pregnancies occurred after six months following ligation. Failure rate was significantly higher in post-abortal ligations as compared to interval ligations. Due to unexpectedly higher failures rate further recruitment of study subjects was discontinued. Information on the status of the clip was available in only 30 of the sixty failures and the clips were in situ in only 4 cases, indicating improper application of clips. In view of high failure rates attributable to improper clip application, the method does not appear to be suitable for programmatic conditions in our country.

Adult↗

[The problem of metal clip artefacts in computerized tomography].

Ligature clips have proved to exhibit increasing radiodensity from titanium up to silver, steel and tantalum, according to the atomic number. clips of titanium, steel and tantalum attached to the patient's abdominal wall confirmed these findings in a plain film (n = 5), a digital scout view (n = 10) and a transverse CT scan (n = 10). The extent of the radial artefacts caused by the clips is directly related to their imaged intensity, being high for tantalum and low for steel and titanium. Because of the poor visualization of the titanium clips on the plain film, the authors recommend steel clips for the clinical test which appears to be necessary in view of the possible concomitant artefacts that could appear due to vascular pulsation.

Silver↗

Surgical clips as a nidus for biliary stone formation: diagnosis and therapy.

Two cases in which a cystic duct stump clip migrated into the common bile duct and formed the nidus for a stone are reported. In one case, the diagnosis was made before ERCP, on the basis of CT findings. In the second case, a retrospective review of plain abdominal films showed evidence of clip migration. Both patients were treated successfully with endoscopic sphincterotomy, as have most such patients reported in the literature. Although clip migration can occur after both open and laparoscopic cholecystectomy, there is some evidence that this complication may be more common after the laparoscopic procedure. Clip migration can be diagnosed before cholangiography by carefully reviewing plain abdominal films and CT scans. ERCP confirms the diagnosis, and sphincterotomy with clip and stone removal is the therapeutic procedure of choice. Additional surgical procedures only rarely are required.

Aged↗

Regeneration of the rat carotid artery after clipping injury. Part I. A morphological study.

We investigated the natural course of the morphological regeneration of the endothelium and smooth muscle of the rat carotid artery after clipping injury. Vascular damage was produced by clipping the right carotid arteries of Wistar rats. Endothelial regeneration was confirmed by the injection of Evans blue dye and the detection of factor VIII-related antigen. The volume of the smooth muscle cell layer and the luminal size were measured by computer-assisted morphometric analysis. Immediately after arterial injury, Evans blue dye freely permeated the smooth muscle layer, suggesting that complete endothelial denudation had occurred. Endothelial regrowth started within 24 hours and was fastest on the third and fourth days after injury. The endothelial injury was repaired within 5 days. The area of the smooth muscle layer did not change immediately after clipping injury, but it gradually increased within a month. The luminal area of the injured artery increased during the 3-month recovery period. These findings suggest that endothelial regrowth is completed within a week after clipping injury, whereas smooth muscle cell regrowth is slower. In addition, arteriosclerotic luminal narrowing did not occur during recovery of the rat carotid artery from clipping injury.

Animals↗

Regeneration of the rat carotid artery after clipping injury. Part II. A pharmacological study.

This study investigated the natural course of functional recovery of the vascular endothelium and smooth muscle after clipping injury of the rat carotid artery. Vascular injury was induced by clipping the right carotid arteries of Wistar rats. The contractile response to KCl, serotonin (5-hydroxytryptamine), and norepinephrine was decreased immediately after arterial injury. The response to KCl and serotonin recovered within 8 weeks, whereas the response to norepinephrine recovered after 12 weeks. Endothelium-dependent relaxation also disappeared immediately after clipping injury, but the recovery of relaxation in response to acetylcholine and adenosine triphosphate was observed within 1 week. Four weeks after clipping injury, higher doses of acetylcholine induced slight arterial contraction. These findings suggest that the recovery of smooth muscle contractility was slower than the process of endothelial regeneration in the rat carotid artery after clipping injury. Endothelium-dependent relaxation recovered within only a week, although the characteristics of the arterial cholinergic receptors may have changed in the chronic recovery stage.

Acetylcholine↗

[Endoscopic sphincteroplasty (not sphincterotomy) using the clips--a preliminary report].

Reports exist that incomplete division of the papilla by endoscopic sphincterotomy may lead to restenosis, cholangitis, and stone recurrence. In view of evolution of surgical sphincterotomy to sphincteroplasty, we studied feasibility of endoscopic sphincteroplasty. In 36 dogs, at laparatomy, the papilla was divided using a diathermy sphincterotome to create retroperitoneal perforation. Twelve dogs underwent approximation of the bile duct and duodenal walls with silk sutures. Another 12 dogs had the walls approximated with clips using an endoscopic clip appliance. The other 12 dogs had no approximation. Blood chemistry was obtained before and serially after surgery. Duodenobiliary barium regurgitation was determined in 2-3 weeks. Four dogs each in each group were sacrificed at 1, 2, and 4 weeks to examine the papilla macro- and microscopically. In regard to hemostasis and prevention of leakage, the effect of the clips was similar to the sutures, resulting in a wide opening with free regurgitation. The no treatment group had persistent abnormal liver function tests and amylase levels. Three dogs died on leakage with abscess and the other nine had stenosis of the papilla. These data suggest that endoscopic sphincteroplasty may be feasible using the clips. A first clinical case where the clips were used to obtain a wide opening which passed a 15-mm balloon is briefly described.

Ampulla of Vater↗

[Chronic venous insufficiency 7 to 10 years after partial vena cava interruption with a clip].

In order to test the responsibility of inferior vena cava clips in post thrombotic venous disease, we performed a comparative retrospective study 7 to 10 years after vena cava interruption by clip. Patients were compared with patients matched for sex, age, and prior deep vein thrombosis (same period and same localisation) but without inferior vena cava partial interruption. The results show that 1) functional complaints were significantly higher in the vena cava clip group; 2) valvular incompetency, in the initially thrombosed leg, (tested by scanning duplex) was not different in the two groups: 3) inversely, on the other leg, valvular incompetency was greater in the vena cava clip group. Furthermore this valvular incompetency was principally located at a femoral level, suggesting that the vena cava clip may induce backward thrombosis; 4) complications were independent of vena cava thrombosis.

Adult↗

A muscle-clamping system with an absorbable jaw clip to reduce suturing in strabismus surgery.

Most of the ocular complications of strabismus surgery are related to needle trauma during the suturing of muscles. The authors have developed a muscle-clamping system with an absorbable jaw clip to facilitate exact techniques of eye muscle surgery and to reduce the risk of complications. The absorbable jaw clip is composed of a lower fixing body with three jaws and an upper supporting body. The clip is used to tie an extraocular muscle (which is moved and reattached with the membrane) with a single scleral bite. Using the absorbable jaw clip, the authors performed superior rectus recession on 16 eyes of eight rabbits. The authors examined the conjunctival injection, muscle adhesion power, and light microscopic findings at 1, 2, 4, and 8 weeks postoperatively. The conjunctival injection diminished with time. Bond strengths ranged from 380 to 620 gram gravity, which is sufficient to withstand the normal pull of human extraocular muscles. Some inflammatory cells were found microscopically, and fibrosis increased with time. The muscle-clamping method with the newly invented clip was technically easy, fast, and exact, and it may reduce suturing and complications during strabismus surgery.

Animals↗