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At least 649 records · Page 36Linked to original sources
PubMed2004

Vascular control of the renal pedicle using the hem-o-lok polymer ligating clip in 50 consecutive hand-assisted laparoscopic nephrectomies.

BACKGROUND AND PURPOSE: A crucial step in laparoscopic nephrectomy is control and ligation of the renal pedicle. Commonly, an endovascular gastrointestinal anastomosis (GIA) stapling device, titanium staples, or both is employed for vascular control. Herein, we report on the use of the Hem-o-Lok polymer ligating clip (Weck Closure Systems, Research Triangle Park, NC) for the routine control of the renal pedicle (both venous and arterial) during hand-assisted laparoscopic radical nephrectomies. PATIENTS AND METHODS: From March 2001 to December 2002, 50 hand-assisted simple or radical nephrectomies were performed by a single surgeon. The Hem-o-lok polymer ligating clip was utilized exclusively for ligation of the renal pedicle, with placement of two clips on the patient's side and one distally on the specimen side. RESULTS: Vascular control was achieved safely in all cases. Neither slippage nor complications were found in any of these cases. CONCLUSIONS: Vascular control of the renal pedicle via the Hem-o-Lok polymer ligating clip is safe and dependable for laparoscopic radical/simple nephrectomies.

Adult↗
PubMed2002

Development and characterization of a novel, graded model of clip compressive spinal cord injury in the mouse: Part 2. Quantitative neuroanatomical assessment and analysis of the relationships between axonal tracts, residual tissue, and locomotor recovery.

A detailed examination of the histopathological features of the clip compression injury in mice was performed to understand the relationships between neurological function and existing pathology of the spinal cord. Adult, female CD1 mice underwent three grades of extradural clip compression injury (3-g, 8-g, and 24-g FEJOTA mouse clips), transection, and sham injury at T3-4. Quantitative behavioural assessments were performed for 4 weeks following SCI. After 4 weeks, Fluoro-Gold was introduced caudal to the SCI site, at T9, and was retrogradely transported for 5 days to the origin of spared axons through the injury site. Counts of retrogradely labeled neurons in the brain-stem, midbrain, and sensory-motor cortex indicated that the number of intact descending axons that traversed the lesion decreased with increasing injury severity (F > 28; df = 4; p < 0.0001; one-way ANOVA). Independent linear correlation analyses were performed between indices of neurological recovery (BBB and IP test), counts of retrogradely labeled neurons and morphometric assessments of normal residual tissue at the injury epicenter. The BBB test correlated strongly with the amount of residual tissue at the injury epicenter (R = 0.945, df = 28, p < 0.0001). Counts of neurons retrogradely labeled with Fluoro-Gold were also strongly correlated with the BBB scores. The extrapyramidal (raphespinal, reticulospinal, vestibulospinal, and rubrospinal) tracts had Pearson correlation coefficients (R) of 0.814, 0.812, 0.813, and 0.747, respectively (df = 28, p < 0.0001). The pyramidal (corticospinal) tract had a correlation of R = 0.747, df = 28, p < 0.0001 with the BBB scores. The IP scores also correlated strongly with the persistence of extrapyramidal (raphespinal, reticulospinal, vestibulospinal and rubrospinal) tracts with correlation coefficients of 0.801, 0.782, 0.790, and 0.836, respectively (df = 28, p < 0.0001). These data indicate that the counts of retrogradely labeled neurons at the origin of distinct descending motor pathways are predictors of the variance of the functional recovery measured by the BBB and IP tests following spinal cord injury. In addition, we provide a detailed neuroanatomical study of clip compression injury in mice that can be used to study the molecular mechanisms of SCI in knockout and transgenic mice.

Animals↗
PubMed1993

Ligation of the renal pedicle during laparoscopic nephrectomy: a comparison of staples, clips, and sutures.

Evaluation of the role of staples, clips, and sutures for laparoscopic ligation of the renal artery revealed that occluding the renal artery with three, 9 mm titanium clips is as secure as occluding the renal artery with standard 2-0 and 0-silk ligatures. However, a triple staggered line of 2.5 mm staples placed across the renal artery was not as secure as either clips or silk sutures. The authors also studied eight female farm pigs who underwent laparoscopic nephroureterectomy with en masse stapled occlusion of the renal hilum. In one animal, an arteriovenous fistula was documented 6 months postoperatively. Currently, when laparoscopically occluding the renal hilum, the authors recommend a thorough dissection of the renal artery and renal vein; each should then be separately occluded so that three individually placed titanium clips remain on the stump of the renal artery and on the renal vein.

Animals↗
PubMed1996

Induction of T cell responses to the invariant chain derived peptide CLIP in mice immunized with the group 1 allergen of house dust mite.

In this study we demonstrate that immunization of H-2(b) mice with the allergen Der p 1 induces MHC class II restricted T cells that proliferate to residues 15-29 of Der p 1 (p15-29) and to the murine MHC class II-associated invariant chain derived peptide (CLIP). T cells from naive H-2(b) mice and those immunized with murine CLIP fail to respond to either CLIP or p15-29. T cell lines and clones reactive with p15-29 strongly proliferate in response to splenic antigen-presenting cells (APC) from normal H-2(b) mice but show reduced proliferation to APC from invariant chain deficient mice. Furthermore, T cells isolated from Der p 1 primed mice and expanded on H-2(b) spleen cells in the absence of the p15-29 epitope retained specificity for both p15-29 and CLIP, suggesting that naturally presented self components can act as mimetic peptides and may maintain T cell memory to foreign antigens.

Allergens↗
PubMed1999

Reduction of zygomatic arch fracture using a towel clip.

The authors describe a simple technique for reducing zygomatic arch fractures with a towel clip. The orbital rim and zygomatic arch are outlined with a marking pen. The exact fracture site is then marked by palpation. The depressed fracture site is held with a towel clip and pulled outward gently. A clicking noise may be heard. The clip is then released. The contour of the zygomatic arch is compared with the other side. Using this technique the authors reduced 11 fractured zygomatic arches (arch only, displaced medially) in 11 patients and the results were satisfactory in all patients. The towel clip method is one procedure to reduce zygomatic arch fracture.

Adolescent↗
PubMed1983

Release of prostaglandins during reversal of one-kidney, but not two-kidney, one clip hypertension in the rat.

Changes in systolic blood pressure and urinary excretion of PGE2 and 6-keto PGF1 alpha 24 h after removing the renal artery clip were compared in one-kidney and two-kidney, one clip Goldblatt hypertension in the rat. Unclipping the one-kidney rat returned blood pressure to normotensive levels within 24 h and was associated with a substantial increase in urinary PGE2 and 6-keto PGF1 alpha. Although hypertension was also completely reversed in the two-kidney model there was no significant change in urinary prostaglandin excretion. Prior treatment with indomethacin (6.0 mg/kg) markedly reduced urinary prostaglandins after clip removal in both forms of hypertension but attenuated the fall in blood pressure in the one-kidney model only. There were no significant changes in urinary kallikrein activity following unclipping. It is suggested that in the one-kidney, one clip rat prostaglandins are released as the result of exposing the unclipped kidney to elevated arterial pressure and that these contribute to the subsequent fall in blood pressure.

Animals↗
PubMed1989

Increased prostaglandin synthesis in the unclipped kidney of one-kidney, one clip hypertensive rats.

Reversal of one-kidney, one clip (1-K, 1C) hypertension by removal of the renal artery clip is accompanied by increased renal and vascular prostaglandin (PG) production. It was postulated that PG biosynthesis is stimulated in the unclipped hypertensive kidney. In order to test this hypothesis, we compared urinary excretion of PGE2 and 6-keto-PGF1 alpha (a breakdown product of PGI2) in perfused kidneys isolated from 1-K, 1C hypertensive rats, 1-K, sham-clipped rats and 1-K, 1C rats which had failed to become hypertensive. Urine was collected over 15 min periods at perfusion pressures of 100, 150 and 200 mmHg. At perfusion pressures of 100 and 150 mmHg there was no significant difference in PGE2 excretion between the three groups. In contrast, 6-keto-PGF1 alpha excretion at 150 mmHg was higher in the hypertensive rats compared with the sham-clipped (P less than 0.05) and failed hypertensive (P less than 0.01) rats. At 200 mmHg, both PGE2 and 6-keto-PGF1 alpha were significantly higher in the hypertensive rats than in the control groups. These increases in PG excretion were clearly dissociated from changes in urinary flow rates. The findings support the hypothesis of increased synthesis of renal vasodilatory and natriuretic PGs in 1-K, 1C hypertension which is particularly evident at higher perfusion pressures, such as may be encountered when the hypertensive kidney is unclipped and exposed to high arterial pressure.

6-Ketoprostaglandin F1 alpha↗
PubMed1990

Effects of repeated temporary clipping of the middle cerebral artery on pial arterial diameter, regional cerebral blood flow, and brain structure in cats.

Temporary clipping of the major arterial trunk is an important maneuver to control excessive unexpected bleeding in neurosurgical operations; however, repeated temporary clipping can give rise to severe neurological deficits after surgery. The present study was performed to confirm and explain these clinical findings. Initially, a single 20-minute or 1-hour occlusion of the middle cerebral artery was performed in each of 5 cats. Pial arterial diameter was determined by video imaging, regional cerebral blood flow was measured by autoradiography, and cerebral edema and infarction were observed. In the 20-minute occlusion group, no abnormal changes were found 5 hours after recirculation. In the 1-hour occlusion group, pial arteries were dilated by 45%, and regional cerebral blood flow increased to more than twice the resting cortical values. The extent of cerebral edema was 41.2 +/- 7.5% (SE) and infarction was 34.5 +/- 9.5% (SE) of the hemisphere. In the second experiment, three 20-minute occlusions of the middle cerebral artery in a 1-hour interval were performed in 20 cats. In 10 of them, thiopental (40 mg/kg) was used to protect the brain. In the group without barbiturate treatment, pial arteries were dilated by 40% at the end of experiment, regional cerebral blood flow decreased to about 70% compared with single 20-minute occlusion, cerebral edema was 19.5 +/- 8.1% (SE), and infarction was 8.1 +/- 3.7% (SE) of the hemisphere. In the treated group, these were only trivial changes. The effect of repeated clipping may cumulatively cause brain damage, and barbiturates should be used whenever repeated clipping is necessary.

Animals↗
PubMed1997

Direct clip obliteration of a ruptured giant aneurysm of the posterior communicating artery: case report.

OBJECTIVE AND IMPORTANCE: A review of the literature documents that giant posterior communicating artery (PCoA) aneurysms are rare. To our knowledge, this report is the first to describe a ruptured giant aneurysm arising from a PCoA that was successfully clipped. CLINICAL PRESENTATION: A 27-year-old man had a left oculomotor palsy and then suffered a subarachnoid hemorrhage. Cerebral angiography and three-dimensional computed tomographic angiography revealed a giant fusiform aneurysm of the left PCoA. These imaging techniques documented the rapid growth of the aneurysm from a moderate to a giant size in fewer than 3 days. INTERVENTION: The patient underwent a left subtemporal craniotomy. The neck was constructed and was successfully clipped, and the PCoA was reconstructed with five sequentially placed fenestrated clips in a tandem fashion. The patient experienced a good recovery. CONCLUSION: This report describes the usefulness of three-dimensional computed tomographic angiography in planning the surgical approach to giant aneurysms originating from the PCoA and the use of fenestrated clips to obliterate giant fusiform aneurysms.

Adult↗
PubMedDate not supplied

Using film clips to enhance nursing education.

Film clips in nursing education provide a unique way to promote active learning. Several methods for using film clips and combining them with other teaching strategies are discussed. Suggestions for the use of popular clips, logistical aspects of showing clips in class, and legal issues associated with copyright are addressed. Faculty are encouraged to use this strategy to evoke emotional responses, generate discussion, enhance clinical decision making, and provide vicarious learning.

Audiovisual Aids↗
PubMed1996

Renal transplantation without sutures using the vascular clipping system for renal artery and vein anastomosis--a new technique.

A cadaveric renal transplant was performed on a 63-year-old woman. The donor renal artery and vein were anastomosed to the recipient external iliac vessels using the vascular clipping system. These vascular anastomoses were performed with four stay sutures and several clips for each anastomosis, without a continuous vascular suture. The time taken was 8 min for each anastomosis. There were no postoperative complications and the patient went home after 6 days in the hospital. At 1 month follow-up her serum creatinine was 1.3 mg/dl. We conclude that cadaveric renal transplantation can be performed using clips for the vascular anastomoses. This technique permits an expeditious, interrupted anastomosis. Since the arcuate legged clips are nonpenetrating, there is minimum trauma to the vascular intima. In pediatric transplantation this interrupted technique may be of special importance, since it should allow the anastomoses to grow with time. The ability to quickly perform this type of anastomosis may reduce warm ischemia time as well. The safety and technical ease of this technique should allow its application in the anastomosis of other tubular structures as well. This might further improve the currently excellent outcomes of solid organ transplantation.

Arteriovenous Shunt, Surgical↗
PubMedDate not supplied

Development of a clipped single-bag with bicarbonate replacement fluid to ensure proper mixing.

A clipped single-bag for bicarbonate replacement fluid was developed to ensure proper mixing before administering to the patient. Nonmixture can cause imbalances of electrolytes and pH, which is a key problem for the current double-bag type bicarbonate replacement fluid sets. To resolve this problem, this single bag properly mixes the solutions before use. The new bag consists of a clip that is placed in the middle to keep the two solutions separated and sealed. When the caregiver is ready to administer treatment, the bag is simply unfolded and the clip automatically detaches, releasing the fluids. Thereby, the bicarbonate fluids are effectively mixed. An optimal clip size with an outer diameter of 16 mm and thickness of 2 mm was determined using compression tests and drop tests. This bag may be a safer and more effective way to provide proper replacement fluid supply for both hemofiltration and hemodiafiltration.

Bicarbonates↗
PubMedDate not supplied

Failure of suppression of intrarenal angiotensin II in the contralateral kidney of one-clip two-kidney hypertensive rats.

1. Two-kidney one-clip hypertension was produced in rats by application of a 0.20 mm clip to the left renal artery. 2. After three weeks, the animals had mildly elevated PRA, kidney renin was elevated in the clipped kidney and markedly suppressed in the contralateral kidney when compared to values in sham-operated rats. 3. Intrarenal AII was elevated in the clipped kidney either when compared to the contralateral kidney or to values in the controls. However, in the contralateral kidney, AII was not different from controls. 4. Changes in intrarenal AII do not, therefore, always parallel those of renal renin. Failure of suppression of AII in the contralateral kidney is likely to be of pathogenetic importance in development of hypertension in this experimental model.

Angiotensin II↗
PubMed2005

Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery.

BACKGROUND: After surgery for ruptured anterior communicating artery (ACoA) aneurysm, several patients who have achieved a favorable neurological outcome yet have been observed to suffer from a poor cognitive outcome. The aim of this study was to explore the possible effects of temporary clip applications on frontal lobe functions in the patients with ruptured ACoA aneurysm. METHODS: Forty patients were chosen among a series of cases who underwent an early surgery (within 96 h) after ACoA aneurysm bleeding. All of them were in Hunt-Hess grade 1 or grade 2. Of the 40 patients, temporary clipping was used in 22 patients (group A), whereas it was not used in 18 patients (group B). These two groups were compared with 20 volunteers (group C) without neurologic or psychiatric disorders. RESULTS: The mean duration of temporary vessel occlusion for both A1 was 8.2 +/- 2.9 min (4-15) in group A. Neither clinical nor radiographic strokes were detected. An improvement in frontal lobe function occurred at long term in group B patients. Whereas, cognitive deficits were persisting at long-term follow-up in group A, especially in patients who had temporary clipping duration longer than 9 min. CONCLUSIONS: The results emphasize that the negative effects of temporary vessel occlusion on cognitive changes occur before ischemic damage. Thus, such negative effects of temporary clipping on cognitive functions should not be neglected by surgeons during surgery.

Adolescent↗
PubMed2005

Shape memory alloy clip for compression colonic anastomosis.

This study was setup to investigate the design and performance of a shape memory alloy clip for colonic anastomosis. The thermo-mechanical properties of the shape memory alloy material were studied and the data were used to derive a nonlinear material model. This enabled the development of computer computer aided design models and finite element analysis of the clip and tissue compression. The maximum strain of the anastomosis clip was within the recoverable range, and it exerted parallel compression of the colonic walls with a uniform pressure distribution. The design of the anastomosis clip was optimized for safe, simple, and effective use in colon surgery.

Anastomosis, Surgical↗
PubMedDate not supplied

An algorithm for the reduction of metal clip artifacts in CT reconstructions.

Implanted surgical metal clips often produce objectionable artifacts in CT reconstructions. The artifacts appear as streaks which emanate radially from the site of the clip. It is shown in this paper that these artifacts stem primarily from motion of the clip during the scan. An algorithm is described which reduces the intensity of these artifacts. The procedure attempts to remove the metal object entirely from the scan data by replacing the measured projection values of rays that passed through a neighborhood of the clip with calculated values consistent with an object whose density is an average of the surround. Examples are given for head and body scans as well as for computer simulations which show substantial reduction of the streak intensity.

Humans↗
PubMed2002

Clipping of cerebral aneurysm under hypothermic cardiac arrest and simultaneous coronary artery bypass grafting: case report.

This report describes a case where joint neurological and cardiac surgery teams cooperated to perform simultaneous procedures of clipping a complex internal carotid artery under hypothermic cardiac arrest and coronary artery bypass grafting. A 69 year old man was evaluated for complaints of double vision, pain behind his right eye, and progressively worsening headaches. Examination showed bilateral upgoing toes and difficulty performing a tandem gait. The patient had a history of myocardial infarction. Brain MRI showed a 1.6 cm diameter, partially thrombosed aneurysm of the right internal carotid artery and posterior communicating artery. Cardiac catheterisation showed critical coronary artery disease of the distal segment of the right coronary artery with 90% stenosis of the midcircumflex artery and an ejection fraction of 40%. After initial exposure of the aneurysm, the cardiac team instituted hypothermic cardiac arrest (21 degree C). The aneurysmal sac was collapsed and dissected from the surrounding perforators. An encircling fenestrated clip was applied and a small part of the neck of the aneurysm was further clipped with straight clips. The cardiac surgery team performed the coronary artery bypass grafting procedure. The patient recovered fully, returned to his normal activities, and is functioning independently.

Aged↗
PubMed2002

Endovascular coiling versus neurosurgical clipping in patients with a ruptured basilar tip aneurysm.

OBJECTIVES: To compare endovascular coiling with neurosurgical clipping of ruptured basilar bifurcation aneurysms. METHODS: Patient and aneurysm characteristics, procedural complications, and clinical and anatomical results were compared retrospectively in 44 coiled patients and 44 patients treated by clipping. The odds ratios for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for age, clinical condition, and aneurysm size were assessed by logistic regression analysis. RESULTS: In the endovascular group, five patients (11%) had a poor outcome v 13 (30%) in the surgical group; the adjusted odds ratio for poor outcome after coiling v clipping was 0.28 (95% confidence interval, 0.08 to 0.99). Procedural complications were more common in the surgical group. Optimal or suboptimal occlusion of the aneurysm immediately after coiling was achieved in 41 patients (93%). Clipping was successful in 40 patients (91%). CONCLUSIONS: The results suggest that embolisation with coils is the preferred treatment for patients with ruptured basilar bifurcation aneurysms.

Aneurysm, Ruptured↗