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PubMedDate not supplied

[Forced permanent clipping of the internal carotid artery in operations for cerebral arterial aneurysms].

Incidence, causes and results of permanent ICA clipping during arterial cerebral aneurysm surgery were analyzed in randomized group of 470 patients. Permanent ICA clipping was performed in 6 cases (1.3% of all surgeries). The causes of permanent ICA clipping were ICA wall rupture in 4 (0.9%) cases, bleeding from aneurysms of the ophthalmic segment of the internal carotid artery (ICA) in 2 (0.4%). Atherosclerotic changes of ICA were found and verified by biopsy in all cases of ICA rupture. Two variants of rupture were identified. ICA aneurysm avulsion from the artery in the area of aneurysmal neck with vascular wall defect development in 2 (0.6%) cases; in the second variant, ICA rupture was caused by frontal lobe traction. In the study group aneurysms of ophthalmic segment of ICA were found in 19 cases: intraoperative bleeding rate was 31% (6 cases). ICA was clipped in 33% of all cases of intraoperative bleeding. Among 6 patients with permanent ICA clipping, 5 died. Deaths were caused by cerebral infarction in 4 cases and acute blood loss in 1 case.

Adult↗
PubMed1998

[Giant fusiform aneurysm of the middle cerebral artery. Surgical treatment with multiple clipping: a case report].

INTRODUCTION: Giant cerebral aneurysms (GCA) are defined by sizes above 2.5 cm. GCA clinically appear by the mass effect exerted on adjacent structures, and in other cases, by embolismal action of the mural thrombo or as a post rupture subarachnoid hemorrhage. THERAPEUTICAL OPTIONS INCLUDE: inducting mural thrombosis, inserting an intraneurysmatic balloon, setting a bypass and surgical clipping. The major characteristics of giant fusiform aneurysm (GFA), the lack of neck and the inclusion of main vessels, give surgical treatment a great complexity. CLINICAL CASE: 25 year old woman diagnosed of GFA of the middle cerebral artery, treated with direct surgical access with clipping and reconstruction of the vascular wall with fenestrated clips arranged in tandem. CONCLUSIONS: The lack of an accessible neck for clipping and exclusion of giant and fusiform intracranial aneurysms, forced practising bypass as a compulsory surgical alternative. Multiple clipping was a viable choice because of its simplicity and less surgical risk. This technique is not applicable to giant serpentine aneurysms as it is only feasible in cases of fusiform aneurysms with no intraluminal thrombosis. A satisfactory evolution of this case, keeping asintomatic after 18 months of the intervention guarantees its application in young patients with giant thrombosed aneurysms of low clinical repercussion.

Adult↗
PubMed1985

A comparative clinical trial of the tubal ring versus the Rocket clip for female sterilization.

Studies of application of the Rocket clip compared with the tubal ring were conducted at three sites. Procedures were randomly assigned to the patients; 332 women were sterilized with the tubal ring and 331 were sterilized with the Rocket clip. The occlusion devices were applied via a minilaparotomy incision. Surgical difficulties and injuries and technical failures occurred with comparable frequency in the two groups. There were two method failures in each tubal occlusion group; the 24-month life-table pregnancy rate was 1.0 per 100 women in the tubal ring group and 0.9 per 100 in the Rocket clip group. The Rocket spring-loaded clip appears to be as safe, effective, and easy to apply as the tubal ring for tubal occlusion.

Adult↗
PubMed1982

[Operative complications of laparoscopic tubal sterilization with Bleier clips (author's transl)].

The operative complications of 1613 laparoscopic tubal sterilization with Bleier clips were evaluated in a prospective study at the Stadtkrankenhaus Offenbach/M from March 1978 to July 1981 (1239 interval and 374 postabortal procedures; two-puncture technique under general endotracheal anaesthesia). No major complications requiring laparotomy occurred. Minor intraoperative complications were observed in 8.4% of cases. Clip-related problems were encountered in 1.9% (slight tubal or mesosalpingeal bleeding). Other complications included haemorrhage at the puncture site (2.4%), preperitoneal emphysema (1.8%) and uterine perforation during curettage (1,6%). Technical difficulties were recorded in 8,4% of sterilizations; in 6.6% more than one clip per tube was placed to effect complete tubal occlusion. Adnexal pathology prohibited bilateral clip application in 4 women (0.3%). Postoperative complications were negligible. No pregnancies have yet been reported during a mean follow-up period of 17 months. A successful refertilization procedure was performed on one patient. It is concluded that this technique represents a commendable alternative to convention methods of tubal sterilization due to its low operative morbidity, acceptable contraceptive safety and potential reversibility.

Abortion, Legal↗
PubMed1991

Method failures of laparoscopic tubal sterilization in a residency training program. A comparison of the tubal ring and spring-loaded clip.

A prospective, randomized study of 365 women undergoing interval laparoscopic tubal sterilization in a residency training program was undertaken to compare method failures. Two occlusive techniques were compared, the spring-loaded clip (Hulka-Clemens) and the tubal ring (Falope Ring). Patients were randomized to either Falope Rings or Hulka-Clemens clips as the primary method. Demographic characteristics, educational level and operator experience were similar in the two groups. Follow-up at an average of 16 months (range, 6-24) revealed eight pregnancies (4.5%) in 176 women in the clip group and five pregnancies (2.6%) in the ring group. The Hulka-Clemens clip and the Falope Ring have similar incidences of method failure when employed by inexperienced operators. We question the usefulness of chromopertubation utilizing methylene blue dye to ensure proper placement of the occlusive device.

Adult↗
PubMed1991

Postpartum tubal sterilization. A comparative study of the Hulka clip and modified Pomeroy technique.

To assess the feasibility of Hulka clip application for postpartum sterilization, 50 women were enrolled in a randomized, prospective study comparing modified Pomeroy tubal ligation and Hulka clip application. Hulka clip tubal occlusion in the postpartum period compared favorably with the commonly performed postpartum sterilization technique. Because of the simplicity of the technique and its greater potential reversibility, Hulka clip application may have advantages over standard postpartum sterilization techniques and should be considered for use in the postpartum period.

Adult↗
PubMedDate not supplied

Metallic clips as a time/cost saving adjunct to head and neck surgery.

Metal surgical clips are commonly used in head and neck surgery today. In this study of 10 patients, 69 vessels in the neck were ligated with tantalum clips and 68 vessels were ligated with silk ties. The times for cutting and ligating each vessel were recorded and the results show a 31-second timesavings by clipping the vessel as opposed to tying. The use of metal clips on vessels is found to be both safe and effective, while reducing operative time.

Alloys↗
PubMed1998

A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators.

The clinical outcome of cirrhotic patients with hepatocellular carcinoma (HCC) depends both on the residual liver function and tumor characteristics. However, the relative prognostic weight of these variables is not well defined. The aims of this study were to verify the value of known prognostic factors and to devise a prognostic index more sensitive than the commonly used Okuda stage. A retrospective analysis of the cases of HCC diagnosed at 16 Italian institutions from 1990 to 1992 was performed. Overall survival was the only end point used in the analysis. The Cox model, stratified by locoregional treatment, was used for multivariate analyses. The final model was derived from 10 randomly chosen training samples, and the prognostic validity of the Cancer of the Liver Italian Program (CLIP) score was assessed on the corresponding testing samples. Four hundred thirty-five cases of HCC were collected. As of January 1997, 313 patients (72%) were deceased. Overall median survival was 20 months. At multivariate analysis, independent predictive factors of survival were Child-Pugh stage, tumor morphology, alpha-fetoprotein (AFP), and portal vein thrombosis. A simple scoring system (CLIP score) was thus produced, assigning linear scores (0/1/2) to the covariates. Compared with Okuda stage, the CLIP score, structured as a six-category tool, has a greater discriminant ability, revealing a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. The CLIP score is a new prognostic system that accounts for both liver function and tumor characteristics. It is easy to calculate and appears to give more precise information than the Okuda stage.

Adult↗
PubMed1997

Clip compression injury in the spinal cord: a correlative study of neurological and morphological alterations.

Rats subjected to experimental spinal cord compression of different degrees induced by aneurysm clips were neurologically tested 3 and 5 weeks postinjury. The development of spinal cord tissue destruction over time was similar to what has been described for other experimental spinal cord injuries with characteristics such as early edema, axonal swelling, and later necrosis. Three weeks after injury a reactive gliosis was found at the injury epicenter and regenerating axons could be identified in the otherwise necrotic cavity. The extent of degeneration was highly correlated with the closing force of the aneurysm clip. The results of a number of neurological tests were correlated to the degree of clip-induced compression, to lesion volume, and to the remaining area of white matter at the epicenter. The neurological tests with the highest correlation to morphological descriptors were beam walk (r(s) = 0.89-0.95) and motor performance score (r(s) = 0.88-0.92). We conclude that the motor performance score, previously validated for photochemically induced ischemic spinal cord injuries, is equally suitable for clip compression injuries as a fast and reliable neurological test paradigm.

Animals↗
PubMed1980

Stereotaxic clipping of arterial and arteriovenous aneurysms of the brain.

A new method of stereotaxic clipping of arterial and AV aneurysms has been developed. The surgical technique and the special clipping device are briefly described. Successful results have been obtained in 30 clipping operations performed on 27 patients with arterial or AV aneurysms at different locations with follow-up ranging from 6 months to 6 years. There was one fatal outcome not directly related to the clipping operation.

Adolescent↗
PubMed1988

Evaluation of endoscopic hemostasis using an improved clipping apparatus.

Endoscopic clipping hemostasis (ECH) is an effective method to control bleeding. However, ordinary clipping apparatuses have not been widely adopted because of several disadvantages. Accordingly, we developed an improved ECH apparatus that can be used during a general endoscopic examination without requiring an assistant. It is not only easy to operate but also ensures safe and effective hemostasis. The ECH apparatus was employed in 80 patients between February 1983 and August 1987 at the Sakura National Hospital. Fifty-one of the patients had upper gastrointestinal bleeding; in 29, preventive clipping was performed after polypectomy. Permanent hemostasis was maintained in 43 (84.3%) of the patients with upper gastrointestinal bleeding, and no bleeding was recognized in any of the 29 patients treated with prophylactic clipping following polypectomy.

Endoscopes↗
PubMed1984

Corrosion of aneurysm clips: evaluation and clinical implications. Part 1: Metallurgical foundations of stress corrosion failure.

Several intracranial failures of aneurysm clips have been documented recently. Consistently, the mechanism of failure has been stress corrosion. These failures could have been anticipated if certain metallurgical properties of the clips had been known. In this paper, we review the metallurgical basis of stress corrosion failure and offer serial metallurgical tests as screening procedures to determine a clip's propensity towards failure. The importance of determining a clip's fracture toughness, a key indicator of stress corrosion resistance, is emphasized.

Corrosion↗
PubMed1999

Intraoperative localization of colorectal tumors in the early stages using a marking clip detector system.

In laparoscopic colectomy the identification of the site of a tumor is often difficult. The topical injection of india ink or blue dye by preoperative colonoscopy is the most prevalent method to mark the tumor site; however, such a procedure also includes the intrinsic danger of possibly injecting dye into the peritoneal cavity. In addition, the injected marker may also spread so widely that the intended site may become obscure. A marking clip detector system was used to detect metallic marking clips in the luminal side that had been applied to the mucosa adjacent to the lesion during the course of preoperative colonoscopy. This method was able to identify the marked site in 40 percent of cases in which only one clip was applied to the mucosa. However, when the lesion sites were marked with two or three clips, then the detection rate increased to 100 percent. Based on our findings, this procedure was found to be a safe and reliable method for identifying lesions during laparoscopic-assisted colectomy.

Colectomy↗
PubMed2001

A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy.

We report a case of a 28-year-old woman with right-sided breast cancer. The patient had been treated for atopic dermatitis since her infancy. She underwent breast-conserving surgery (BCS) in July 1998, and three titanium clips were placed at the margin of the excision cavity at the time of surgery. Two months after surgery, the patient exhibited a rapid exacerbation of atopic dermatitis. Various drugs were suspected to be the cause of the allergic reaction, but the results of a bi-digital O-ring test (BDORT) suggested an allergic reaction to titanium clips. In August 1999, the patient underwent a second operation to remove the titanium clips under local anesthesia. Allergy to surgical titanium clips is a rare complication, but in patients with a history of severe allergic diseases, a preoperative immunologic examination should be performed and the patient's history of metal allergy should be investigated.

Adult↗
PubMed2001

Age-associated changes in integral cholesterol and cholesterol sulfate concentrations in human scalp hair and finger nail clippings.

In contrast to surface lipids originating from the sebaceous glands, membrane-forming integral lipids occur in keratinized tissues of skin, and skin appendages like fingernail plates or scalp hair. After removal of lipids of sebaceous origin by exhaustive solvent extraction, lyophilizing and hydrolyzing fingernail plate and scalp hair samples, fractions of integral cholesterol (CH) and cholesterol sulfate (CS) were quantified using gas chromatography. We studied these bound lipids and the serum lipids of 70 healthy subjects, aged 20.1 to 92.0 years. We observed higher amounts of CS in hair clippings of men than of women (775+/-241 vs 662+/-239 nmol/g hair, respectively). The highest amounts of CS were found in men with serum LDL-CH > 4.14 mmol/L; this subgroup also showed the highest CH values in fingernail clippings (2293+/-621 nmol/g nail). However, analysis of integral lipids of hair and fingernail plate clippings had little significance in detecting hypercholesterolemia in normal persons. An increase in integral CH levels in fingernail clippings with donor age was noted, independently of variations in serum CH or LDL-CH. This correlation proved to be significant in men (R=0.43), but not in women (R=0.38). In contrast, in women but not in men we found donor age correlated with internal CH of hair samples (R=0.43) and with CS of nail plates (R=-0.59), independently of serum CH or LDL-CH variations. This age-dependent decrease in CS levels might explain the previously observed higher incidence of brittle nails in women. Obviously, the metabolism of internal lipids CH and CS in fingernail and scalp hair differs between genders, and shows age-associated changes.

Adult↗
PubMed2000

Hepatic vein reconstruction by external iliac vein graft using vascular clips.

The utility of hepatic vein reconstruction following resection of segments VII and VIII plus the right hepatic vein (RHV) is still controversial. The purpose of this study was to investigate the surgical benefits of hepatic vein reconstruction using stapled vascular clips and the draining area of hepatic vein using angiographic computed tomography (CT) to determine strict indications for hepatic vein reconstruction. Five patients underwent RHV reconstruction by external iliac vein graft using stapled vascular clips (VCS clips) following resection of segments VII and VIII, regardless of whether an inferior right hepatic vein (IRHV) was present. In eight other patients CT during arterial portography (CTAP) under temporary RHV occlusion using a balloon catheter was performed to determine the drainage area of the RHV. Operating times were 240 to 400 minutes (mean 336 +/- 59 minutes), and the mean hepatic vein reconstruction time was 26 +/- 5 minutes. There were no complications related to the surgery. Follow-up examinations showed patency of the graft in all cases; three patients are still alive with long-term graft patency of 10 to 24 months. CTAP under RHV occlusion demonstrated that segment VI and part of segment V were almost hypoattenuated in cases of absent or small IRHV, although those segments were hyperattenuated in thick IRHV and RHV-IRHV communicating patients. In conclusion, this anastomotic technique using vascular clips resulted in sound patency of the graft, which was accomplished by a simple technique. Preoperative CT AP with the RHV occlusion method can be useful for determining whether hepatic vein reconstruction is necessary.

Aged↗
PubMed2001

Different regulation of left ventricular ANP, BNP and adrenomedullin mRNA in the two-kidney, one-clip model of renovascular hypertension.

The aim of our study was to clarify whether atrial (ANP) and brain (BNP) natriuretic peptides and the hypotensive peptide adrenomedullin (ADM) are regulated differently in the rat heart in the two-kidney, one-clip model of renovascular hypertension. We assessed messenger ribonucleic acid (mRNA) abundance and distribution of ANP, BNP and ADM in the ventricles and atria of rats after unilateral renal artery stenosis (clipping). Rats were clipped for 6 h or 1, 2 or 4 days and mRNA levels were assessed semiquantitatively in left and right atria and ventricles by RNase protection assay. Left ventricular BNP mRNA up-regulation (4.3-fold after 6 hours) preceded ANP up-regulation (4.5-fold after 1 day) and seemed to be transient, whereas ANP mRNA levels were still elevated at day 4 (2.4-fold vs. sham). The right ventricle and the atria did not participate in these responses. Despite the massive changes of natriuretic peptide mRNAs, ADM mRNA did not change in either the ventricles or the atria. In contrast to ANP and BNP mRNA, which predominate in atrial tissue, mRNA for adrenomedullin is equally distributed in ventricles and atria. Plasma levels of immunoreactive (ir)-ANP and ir-BNP changed in parallel with left ventricular mRNA levels. Our findings suggest that renovascular hypertension induced by clipping the renal artery leads to immediate, but independent, up-regulation of ANP and BNP mRNA in the left ventricle whereas adrenomedullin mRNA is not changed.

Adrenomedullin↗
PubMed2001

Study comparing sutures and nonpenetrating titanium clips for arteriotomy closure after embolectomy.

BACKGROUND: The vascular closure staple (VCS) clip applier system is an alternative to suture for closing arteriotomies and performing vascular anastomoses. This study was designed to evaluate the possible advantages of its use in closing arteriotomies after embolectomy. METHODS: In this study, 26 patients with upper or lower extremity embolism underwent embolectomy, and the arteriotomy was closed using either VCS clips (group A) or sutures (group B). RESULTS: The time required for arteriotomy closure with clips (11.2 +/- 2.7s) was considerably shorter than the time required with sutures (241.2 +/- 48.7s; p < 0.0001), resulting also in shorter clamp times (380.8 +/- 127.3s vs 612.7 +/- 112.6 s; p < 0.0001). No hemodynamically significant stenoses or pseudoaneurysms were detected at the arteriotomy sites in any of the patients up to 1 year after embolectomy. CONCLUSIONS: The VCS clip applier system, a quick and easy method for closing arteriotomies, is as safe as sutures in terms of narrowing of the artery and formation of pseudoaneurysm.

Aged↗