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At least 613 records · Page 34Linked to original sources
PubMed2004

Comparative analysis of T2 selective division of rami-communicantes (ramicotomy) with T2 sympathetic clipping in the treatment of craniofacial hyperhidrosis.

OBJECTIVE: The main cause of dissatisfaction after sympathetic trunk blocking surgery (T2 sympathectomy, sympathetic clipping) for craniofacial hyperhidrosis is compensatory sweating. Preserving sympathetic trunk may decrease the incidence of compensatory sweating, and we introduce T2 ramicotomy, which may better preserve the sympathetic nerve trunk in order to reduce compensatory sweating. METHODS: From January 2000 to November 2002, video-assisted thoracoscopic (VAT) T2 sympathetic clipping and VAT ramicotomy were performed in 44 patients suffering from craniofacial hyperhidrosis. Twenty-two patients underwent T2 sympathetic clipping (group 1), and 22 underwent division of T2 rami-communicantes (group 2). We retrospectively analyzed the rate of satisfaction, dryness of face, and grade of compensatory sweating. RESULTS: Both groups were similar with respect to facial dryness (P = 0.099). Group 1: excessive dry 5 patients (22.7%), dry 17 patients (77.3%); group 2: excessive dry 3 patients (13.6%), dry 15 patients (68.1%), and persistent sweating 4 patients (18.3%). The rate of satisfaction was 77.3% in group 1, and 63.6% in group 2 with no significant difference (P > 0.05). The rate of compensatory sweating in group 2 (72.7%) was significantly lower than in group 1 (95.4%) (P < 0.039). The chance of embarrassing and disabling compensatory sweating was lower in group 2 than in group 1; 76.5% (embarrassing in 8 patients, disabling in 9) in group 1, and 36.4% (embarrassing in 7 patients, disabling in 1) in group 2 which was statistically significant (P < 0.006). CONCLUSIONS: T2 ramicotomy for craniofacial hyperhidrosis lowers the rate of compensatory sweating and excessive dryness of face compared to T2 clipping.

Adult↗
PubMed2004

Feasibility of thoracoscopic U-clip esophageal anastomosis: an alternative for esophageal atresia reconstruction.

BACKGROUND: The authors propose that U-Clips can significantly decrease the technical difficulty of performing thoracoscopic esophageal reconstruction, thus, reducing operating time, the incidence of postoperative leak, and stricture rate. METHODS: After obtaining Institutional Animal Care and Use Committee approval, 3 4-kg female piglets underwent complete thoracoscopic esophageal transections. The esophagus was reconstructed thoracoscopically using S50 and S60 U-Clips over an 8F transanastomotic tube. Esophagrams were performed on postoperative day (POD) 7, 21, 44, and 77. RESULTS: Mean operating time was 57 minutes (45 to 75 min). Two of 3 piglets had no evidence of leak on POD 7 esophagrams. One animal had a small leak that resolved spontaneously on antibiotics. All 3 piglets tolerated a formula diet orally by POD 8. Over a 77-day survival period all 3 piglets had steady weight gain on an oral diet. CONCLUSIONS: U-Clips are a feasible alternative to sutures for esophageal reconstruction in thoracoscopic surgery. Further study is warranted to investigate the full potential of U-Clips in minimally invasive pediatric surgery.

Anastomosis, Surgical↗
PubMed2006

Pedicular vascular control in laparoscopic living donor nephrectomy: The use of clips instead of stapler in 341 donors.

PURPOSE: To demonstrate a less expensive approach for laparoscopic donor nephrectomy. MATERIALS AND METHODS: Left donor nephrectomy was done transperitoneally in flank position. Renal vein and artery were exposed and prepared for nephrectomy. Nondisposable trocars and instruments were used. The adrenal vein was clipped and its arteries were bipolar coagulated. Both renal artery and vein were clip-ligated using three medium large nonautomatic metallic clips and divided, instead of using rather expensive vascular endostapler. Kidney was hand-extracted from suprapubic incision (no Endobag was used). RESULTS: Donor nephrectomy was performed in 341 donors. Mean warm ischemia time was 8.17 minutes. Mean operative time was 260.3 minutes. Conversion and reoperation was required in 2.1% and 3.8% of donors, respectively. Ureteral complications were observed in 2.1% of recipients. No vascular accident occurred from pedicular vessels. One-year graft survival in recipients was 92.6%. By this approach, at least $600 was saved in each nephrectomy. CONCLUSION: Laparoscopic donor nephrectomy can be performed with a less expensive setup without adverse effects on graft outcome. Vascular control using nonautomatic clips instead of more costly vascular endostapler and also hand extraction of the kidney is safe, practical, and economical.

Follow-Up Studies↗
PubMed1993

Development of independent vessel security after ligation with absorbable sutures or clips.

The external jugular vein and the contralateral carotid artery in each of 59 rabbits were ligated with either sutures or absorbable clips and then divided. After 0, 1, 2, 4, 7, or 14 days following ligation, the suture or clip was removed, and the vessel's resistance to leakage was quantitated. When the absorbable clips were removed from arteries after 1 day, their mean resistance pressure prior to leakage was 171 +/- 46 mm Hg; in contrast, arteries ligated with a suture did not achieve independent security until after 4 days. At 4 days, the mean pressure prior to leakage of arteries with the suture removed was only 88 +/- 49 mm Hg. Similar results were obtained with veins. The difference in vessel security was attributed to the significant increase in the width of the vessel wall compressed when an absorbable clip was utilized compared with a strand of suture.

Animals↗
PubMed1994

A new concept for anastomosis of the fallopian tube: tissue reconstruction with nonpenetrating, arcuate, legged clips in the rat model.

OBJECTIVE: To evaluate the titanium Kirsch-Zhu microclip microsurgical reanastomoses of the fallopian tubes. DESIGN: Compare the reanastomoses of the rat uterine horn between Kirsch-Zhu clips (Cushman Engineering, Albuquerque, NM) (group A) and conventional suture microsurgical techniques (group B). SETTING: Microsurgery Research Laboratory, Loma Linda University Medical Center, Loma Linda, California. PATIENTS, PARTICIPANTS: Fifteen SD rats Harlan (Harlan Sprague-Dawley Corp., Indianapolis, IN) were done in groups A and B and six in control group (C). MAIN OUTCOME MEASURE: Pregnancy rate, litter size, tissue of procedure, and histologic results. RESULTS: The clip technique was shorter in procedure time and resulted in equal fertility rate and litter size. Histologically, there were less granulomatous formation and histiocytic inflammation, but muscularis thinning and fibrosis were noted with the clip. CONCLUSIONS: The Kirsch-Zhu clip has potential for application to human fallopian tube reanastomoses.

Anastomosis, Surgical↗
PubMed2003

Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips.

BACKGROUND: The number of complications associated with use of EMR for early-stage gastric cancer, including perforation, has increased with the increasing use of this procedure. Endoscopic clip application was performed in patients who sustained a perforation as a result of EMR for gastric neoplasm. PATIENTS AND METHODS: Seven patients who underwent endoscopic application of metallic clips to close perforations were studied. The omental patch method was applied in one case with a large perforation. OBSERVATIONS: In all patients, endoscopic clip application successfully closed the perforation of the stomach, which occurred after EMR. No patient required laparotomy. CONCLUSIONS: The technique of endoscopic clip application might be useful for treatment of patients who sustain a perforation caused by EMR.

Aged↗
PubMed2006

The CLIP-170 orthologue Bik1p and positioning the mitotic spindle in yeast.

Bik1p is the yeast Saccharomyces cerevisiae representative of the CLIP-170 family of microtubule plus-end tracking proteins. Bik1p shares a number of similarities with its mammalian counterpart CLIP-170, including an important role in dynein function. However, Bik1p and CLIP-170 differ in several significant ways, including the mechanisms utilized to track microtubule plus ends. In addition to presenting functional comparisons between Bik1p and CLIP-170, we provide sequence analyses that reveal previously unrecognized similarities between Bik1p and its animal counterparts. We examine in detail what is known about the functions of Bik1p and consider the various roles that Bik1p plays in positioning the yeast mitotic spindle. This chapter also highlights several recent findings, including the contribution of Bik1p to the yeast mating pathway.

Amino Acid Sequence↗
PubMed1999

Optimal clip application and intraoperative angiography for intracranial aneurysms.

BACKGROUND: The actual incidence of residual aneurysm after clipping is unknown. The natural history of residual aneurysm can be regrowth and hemorrhage. Intraoperative angiography offers a cost-effective, safe interdiction to the problem of residual aneurysm and parent vessel stenosis. METHODS/RESULTS: Forty consecutive patients harboring 54 aneurysms underwent 42 operative procedures to clip 52 aneurysms, during which 220 intraoperative angiographic runs were performed. Ninety-three percent of the procedures were performed on patients with acute subarachnoid hemorrhage. There were 4 giant (>2.5 cm, 4/52 = 8%, all anterior circulation), 21 large (1.0-2.5 cm, 21/52 = 40%, 16/ 21 = 76% anterior circulation, 6/21 = 28% posterior circulation), and 27 small (<1.0 cm, 27/52-52%, 22/27 = 81% anterior circulation, 5/27 = 18% posterior circulation) aneurysms. Intraoperative angiography led to clip adjustment in 18/52 = 34% of aneurysms (4/18 = 22% for parent artery stenosis, 8/18 = 44% for residual aneurysm and 6/18 = 33% for both). Of the 18 adjustments made, 16 = 88% were made on giant or large aneurysms and two were small (one was a complex anterior communicating and one was a vertebral junction aneurysm). Follow-up angiography was performed on 26/42 = 62% of operative cases. Postoperative angiography confirmed intraoperative angiography in all cases. Two complications occurred during 220 angiographic runs: one embolic stroke and one incident of equipment failure. CONCLUSION: A grading scale was applied to test the relationship between anatomical site and size as they relate to the necessity for clip adjustment for complete aneurysm obliteration and/or parent artery compromise. Significance was related to site (basilar bifurcation, anterior communicating, middle cerebral bifurcation, and ophthalmic) and size (>1.0 cm), both as independent and codependent variables. An analysis of the cost-effectiveness of intraoperative angiography was demonstrated.

Adult↗
PubMed2000

The rubber dam interposition technique during intracranial aneurysm clipping under deep hypothermic circulatory arrest.

OBJECTIVE: We describe a technique for isolating perforating arteries by use of a rubber sheet during the clipping of intracranial aneurysms under deep hypothermic circulatory arrest. METHODS: After meticulous dissection of the perforating arteries from the aneurysm, a rubber sheet, cut from a surgical glove to the proper shape, is inserted between the aneurysm and the arteries to prevent arterial reattachment to the aneurysmal neck. RESULTS: Even when perforators are invisible at the time of neck clipping because of a large aneurysmal body, the blade of the clip slides along the rubber sheet without injuring the vessels. CONCLUSION: With this method, an aneurysm, especially a large or giant one, can be clipped easily and safely even when the patient is in deep hypothermic circulatory arrest.

Female↗
PubMed2002

International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial.

BACKGROUND: Endovascular detachable coil treatment is being increasingly used as an alternative to craniotomy and clipping for some ruptured intracranial aneurysms, although the relative benefits of these two approaches have yet to be established. We undertook a randomised, multicentre trial to compare the safety and efficacy of endovascular coiling with standard neurosurgical clipping for such aneurysms judged to be suitable for both treatments. METHODS: We enrolled 2143 patients with ruptured intracranial aneurysms and randomly assigned them to neurosurgical clipping (n=1070) or endovascular treatment by detachable platinum coils (n=1073). Clinical outcomes were assessed at 2 months and at 1 year with interim ascertainment of rebleeds and death. The primary outcome was the proportion of patients with a modified Rankin scale score of 3-6 (dependency or death) at 1 year. Trial recruitment was stopped by the steering committee after a planned interim analysis. Analysis was per protocol. FINDINGS: 190 of 801 (23.7%) patients allocated endovascular treatment were dependent or dead at 1 year compared with 243 of 793 (30.6%) allocated neurosurgical treatment (p=0.0019). The relative and absolute risk reductions in dependency or death after allocation to an endovascular versus neurosurgical treatment were 22.6% (95% CI 8.9-34.2) and 6.9% (2.5-11.3), respectively. The risk of rebleeding from the ruptured aneurysm after 1 year was two per 1276 and zero per 1081 patient-years for patients allocated endovascular and neurosurgical treatment, respectively. INTERPRETATION: In patients with a ruptured intracranial aneurysm, for which endovascular coiling and neurosurgical clipping are therapeutic options, the outcome in terms of survival free of disability at 1 year is significantly better with endovascular coiling. The data available to date suggest that the long-term risks of further bleeding from the treated aneurysm are low with either therapy, although somewhat more frequent with endovascular coiling.

Adolescent↗
PubMedDate not supplied

International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion.

BACKGROUND: Two types of treatment are being used for patients with ruptured intracranial aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative safety and efficacy of these approaches had not been established. Here we present clinical outcomes 1 year after treatment. METHODS: 2143 patients with ruptured intracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in the UK and Europe, took part in the trial. They were randomly assigned to neurosurgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome was death or dependence at 1 year (defined by a modified Rankin scale of 3-6). Secondary outcomes included rebleeding from the treated aneurysm and risk of seizures. Long-term follow up continues. Analysis was in accordance with the randomised treatment. FINDINGS: We report the 1-year outcomes for 1063 of 1073 patients allocated to endovascular treatment, and 1055 of 1070 patients allocated to neurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 patients allocated to neurosurgery, an absolute risk reduction of 7.4% (95% CI 3.6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 years and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebleeding was higher. INTERPRETATION: In patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival benefit continues for at least 7 years. The risk of late rebleeding is low, but is more common after endovascular coiling than after neurosurgical clipping.

Activities of Daily Living↗
PubMed1985

Influence of vessel clips on vascular patency in microarterial grafts less than 0.5 mm in external diameter.

Autogenous interpositional microarterial grafting of 140 saphenous branches of albino rat femoral arteries with an external diameter of 0.3 to 0.5 mm (mean 0.45 +/- 0.06 mm) resulted in an immediate patency rate of 100%. The patency rate observed at 72 hours was 64.3%. The late patency rate was related to blade tip pressure of the double approximator clip used in the microanastomosis. The patency rate with a clip with a blade tip pressure of 22 gm was 52.7% and that with a clip with a blade tip pressure of 2 gm was 77.3%. When arterial occlusion lasted less than 30 minutes, the late patency rate was 76.9% to 78.3%. If arterial occlusion lasted for as long as 1 hour, the late patency rate of vessels occluded by a clip with a blade tip pressure of 22 gm dropped to 27.8%. These results demonstrate that an interpositional microarterial graft as small as 0.5 mm in external diameter is clinically feasible.

Animals↗
PubMed1988

Unfastening of an Adams-de Weese clip: an uncommon cause of recurrent pulmonary embolism after interruption of the inferior vena cava.

Recurrent pulmonary embolism after placement of a caval clip is uncommon. We report the case of a patient admitted for recurrent venous thrombosis of the lower limbs, 11 years after placement of an Adams-de Weese clip. Severe pulmonary embolism occurred in spite of anticoagulant treatment. After an unsuccessful attempt to insert a Greenfield filter, surgery was performed. The clip was found to have come unfastened; simple repeat closure was performed. We were unable to find any similar reports in the literature. In spite of its rarity, this cause should be considered when faced with recurrent pulmonary embolism in patients having undergone inferior vena caval clipping.

Constriction↗
PubMed2001

An alternative system for cerebrovascular reconstructions: non-penetrating arcuate-legged clips.

Non-penetrating, arcuate-legged titanium clips (VCS) have been utilized successfully over the past five years for a variety of cerebrovascular reconstructions. These applications, including both micro and macrovascular reconstructions, their clinical outcomes and technical considerations are described. Applications include patch angioplasty of cervical carotid endarterectomies, superficial temporal to middle cerebral artery 'bypass' procedures, Takayasu's arteritis and cavernous carotid reconstructions. The non-penetrating clip has proven to be a safe and reliable alternative to suture for these demanding reconstructions. Clips provide the advantages of improved anastomotic compliance, reduced operative time, and reduced incidence of post-operative anastomotic intimal hyperplasia and stenosis. Clip related pitfalls are discussed with recommendations regarding usage.

Anastomosis, Surgical↗
PubMed2002

Prospective evaluation of a new sternal closure method with thermoreactive clips.

OBJECTIVES: The role of the sternal closure techniques on the incidence of sternal dehiscence and wound infection are well defined among a high number of other variables involved. In the various series, the incidence of wound complication in cardiac surgery varies from 2 to 8%. The aim of our study is to evaluate the role of thermal-dependent shape-memory Nitillium clips in reducing the incidence of sternal dehiscence following sternotomy. METHODS: We perspectively randomized 1000 consecutive patients requiring cardiac surgery to evaluate the incidence of sternal wound complications (SWC), sternal dehiscence and/or other related complications. We compared Group I (500 patients), in which sternal closure was achieved with standard sternal wires, with Group II (500 patients), in which sternal approximation was carried out by means of thermoreactive Nitillium clips. The two randomized groups were comparable in terms of age, gender, Euroscore and risk factors for sternal/wound complications. RESULTS: In our study the overall incidence of SWC was 4.7%. The incidence of SWC was considerably higher in Group I (6.8%) when compared to Group II (2.6%) (P=0.003). Mechanical sternal dehiscence without infection occurred in 14 patients in Group I and in one patient in Group II (P=0.002). Despite sternotomy wound infection occurred similarly in both groups (15 patients in Group I vs. 12 patients in Group II), sternal revision was performed only in patients of Group I (Group I: 9/15 vs. Group II: 0/12; P=0.001). CONCLUSION: Thermal shape-memory Nitillium clips provided superior results in sternal osteosynthesis following midline sternotomy, due to a considerable reduction of sternal dehiscence and related complications. The clinical benefit of Nitillium clips was demonstrated even in patients with several risk factors for SWC.

Aged↗
PubMed2002

Extravasal occlusion of large vessels with titanic clips: efficiency, indications, and contraindications.

The mechanism of extravasal occlusion of blood vessels with titanic clips "Atrauclip" and "Ligaclip extra" was studied in order to reveal indications and contraindications to their use. Occlusion with the clips of both types was ineffective in vessels with a diameter of >7.0 mm. Arteritis or the presence of an intravascular occlusion facility in the vessel were also the contraindications for clip occlusion. In overcases the procedure of occlusion with titanic clips was efficient and atraumatic.

Animals↗
PubMed2003

Preoperative transcervical analgesia for laparoscopic sterilization with Filshie clips. A double blind randomized trial.

OBJECTIVE: To evaluate the use of preoperative transcervical analgesia for reducing postoperative pain from laparoscopic sterilization with Filshie clips. DESIGN: A double blind, randomized, placebo-controlled trial. SETTING: Gynecologic day-care clinic of Vejle Hospital, Vejle, Denmark. SAMPLE: Seventy-eight healthy women were attending the public hospital requesting sterilization. METHODS: Participants received bupivacaine 0.25% 20 mL or placebo normal saline 20 mL injected into the uterus, though the fallopian tubes and into the pelvis before tubal occlusion with Filshie clips. MAIN OUTCOME MEASURES: Post-operative visual analog pain score and request for analgesia were recorded. RESULTS: At 30 min after clip application there was a non-significant reduction in pain-score on VAS. However, at 1, 2, 3 and 4 h median pain score on VAS was similar in both groups. Patients request for postoperative analgesia was similar in the two groups. CONCLUSIONS: Preoperative transcervical perfusion of the uterus, fallopian tubes and into the pelvis did not reduce postoperative pain or request for analgesics after laparoscopic sterilization with Filshie clips.

Adjuvants, Anesthesia↗
PubMed1985

Pressure dependence of exaggerated natriuresis in two-kidney, one clip Goldblatt hypertensive rats.

This study evaluated the responses of each kidney of two-kidney, one clip Goldblatt hypertensive rats to acute volume loading to delineate the contribution of elevated perfusion pressure to the mechanisms of the exaggerated natriuresis in this model of hypertension. Eleven Goldblatt animals (0.2 mm clip 3 weeks prior to study) were studied at spontaneous blood pressure for each kidney's response to volume loading. In 11 other Goldblatt animals an aortic clamp between the renal arteries allowed reduction of perfusion pressure for the left, nonclipped kidney to normal levels. Ten normal rats served as controls. Renal function was examined during control periods and following the infusion of 3.5% body wt of 154 mM X liter-1 NaCl at 22.5 ml X hr-1. An exaggerated natriuresis was observed for the left, nonclipped kidney of the hypertensive Goldblatt rats, while the clipped kidney exhibited an attenuated natriuresis compared to either kidney of normal control rats. Reduction of perfusion pressure to the nonclipped kidney of Goldblatt animals to normal levels resulted in reduced clearance and excretory function before volume loading and attenuated its natriuretic response to levels less than those for the Goldblatt group at spontaneous, hypertensive blood pressure. The exaggerated natriuresis observed at hypertensive blood pressure was attributable to increases of filtered load of Na+ and reduced fractional absorption. These observations indicate that an exaggerated natriuresis occurs in the two-kidney, one clip Goldblatt hypertensive rat and that this phenomenon depends on the elevated renal perfusion pressure to the nonclipped kidney.

Animals↗