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At least 811 records · Page 45Linked to original sources
PubMed1981

Effect of the converting-enzyme inhibitor SQ 14 225 (captopril) in early one-kidney, one-clip hypertension in the rat.

1. Arterial plasma renin activity was significantly elevated in rats with one-kidney, one-clip hypertension of less than 3 weeks duration. 2. Intraperitoneal injection of the angiotensin-converting enzyme inhibitor SQ 14 225 (captopril) caused a dose-related decrease in systolic blood pressure in hypertensive rats. The lowest dose of captopril used (3.5 mg/kg) inhibited conversion of exogenous angiotensin I and maximally potentiated the depressor response to bradykinin, but failed to restore blood pressure to that of the normotensive controls. 3. Removal of the solitary clipped kidney also did not restore blood pressure to normal. Injection of captopril (3.5 mg/kg) 24 h after nephrectomy, when no circulating renin activity was detectable, lowered blood pressure further in hypertensive but not in similarly nephrectomized controls. 4. These results indicate that raised blood pressure in early one-kidney, one-clip hypertension in the rat cannot be entirely attributed to the renin-angiotensin system, even when plasma renin activity is significantly increased. 5. This study has also confirmed a hypotensive action of captopril in anephric rats when plasma renin activity is undetectable.

Angiotensin II↗
PubMed1982

Indomethacin or aprotinin infusion: effect on reversal of chronic two-kidney, one-clip hypertension in the conscious rat.

1. Blood pressure was monitored continuously in conscious rats with chronic Goldblatt two-kidney, one-clip hypertension. 2. Hypertension was rapidly reversed by removal of the constricting clip and the reversal was complete by 12 h, although structural vascular changes persisted for much longer. 3. Blood pressure in this model of hypertension was not affected by a 15 h infusion of either indomethacin or aprotinin. 4. The pattern of fall in blood pressure after removal of the clip was similar when animals were infused with either indomethacin or aprotinin. Blood pressure at 24 h was normal and did not differ significantly from that of unclipped rats given a glucose infusion. 5. The fall in blood pressure produced by unclipping therefore did not appear to be mediated via the prostaglandin or kallikrein systems.

Animals↗
PubMed1996

Effect of angiotensin-converting enzyme inhibitors on resistance artery structure and endothelium-dependent relaxation in two-kidney, one-clip Goldblatt hypertensive and sham-operated rats.

1. This study was designed to examine the effect of angiotensin-converting enzyme inhibitors on resistance artery structure and endothelium-dependent relaxation in Goldblatt two-kidney, one-clip hypertensive rats. Four weeks after clipping, hypertensive and sham rats were treated with either perindopril (1 mg day-1 kg-1) or quinapril (3 or 30 mg day-1 kg-1). After 6 weeks mesenteric resistance arteries were mounted in a myograph for measurements of vascular structure. The endothelium-dependent relaxation response to acetylcholine and bradykinin and the response to the nitric oxide donor sodium nitroprusside were recorded. 2. All treatment regimes lowered the blood pressure and reversed both cardiac and resistance artery hypertrophy. Two-kidney, one-clip rats treated with quinapril showed a dose-dependent reduction in media cross-sectional area and media to lumen ratio. 3. Hypertension of 10 weeks' duration was associated with an impaired endothelium-dependent relaxation response to acetylcholine and bradykinin. Treatment with perindopril and either dose of quinapril prevented the development of impaired endothelium-dependent relaxation but had no effect on the response to sodium nitroprusside. Treatment had no effect on endothelium-dependent relaxation in sham rats. 4. Angiotensin-converting enzyme inhibitor treatment is effective in normalizing blood pressure and cardiovascular structural changes. Angiotensin-converting enzyme inhibitor treatment prevented the development of impaired endothelium-dependent relaxation to both acetylcholine and bradykinin. The ability of angiotensin-converting enzyme inhibitors to reverse cardiovascular structural changes and prevent the development of abnormal endothelium-dependent relaxation may contribute to the overall effect of this type of antihypertensive drug.

Acetylcholine↗
PubMed2000

Management of posterior epistaxis by endoscopic clipping of the sphenopalatine artery.

Posterior epistaxis poses a challenge to the otolaryngologist as the bleeding point itself cannot easily be identified. Haemostasis by conventional means is usually nasal packing and this results in repeated/persistent haemorrhage, morbidity and prolonged bed occupancy. In recent years the increased availability of rigid endoscopes and a better understanding of the anatomy of the nasal cavity have facilitated a direct approach to the sphenopalatine artery. Using a 0 degrees or 30 degrees rigid nasendoscope the sphenopalatine artery-the main blood supply to the nose-can be clearly identified and treated. Over the last 12 months we have employed endoscopic intranasal clipping of the said artery under a general anaesthetic to control persistent posterior nasal bleeding. Twelve patients have undergone 14 procedures within 48 h of failure of their conservative management. In all the epistaxis was controlled no complications were noted. The average follow-up period in our series was nine months. We believe that intranasal endoscopic clipping of the sphenopalatine artery is effective and less traumatic than either any other site of arterial ligation technique or repeated packing. In this series we employed only clipping of the artery and not diathermy/electrocautery to reduce the theoretical risk to adjacent structures

Adult↗
PubMed2002

Cerebral vasospasm and ischaemic infarction in clipped and coiled intracranial aneurysm patients.

The influence of the treatment modalities (clipping/coiling) on the incidence of vasospasm and ischaemic infarction in aneurysm patients is still judged controversially. The purpose of this study was to analyse and compare retrospectively cerebral vasospasm and ischaemic infarction, as well as neurological deficits and outcome within a large population of clipped and coiled patients with ruptured and unruptured aneurysms. Within a 2-year period, a total of 144 interventions (53 clipping/91 coiling) entered the study. Daily bilateral transcranial Doppler sonographic monitoring was performed to observe vasospasm development. All cerebral computed tomography (cCT) and magnetic resonance imaging (MRI) scans were reviewed with respect to occurrence and localization of ischaemic infarctions. Focal neurological deficits were recorded and clinical outcome was evaluated using the Glasgow Outcome Scale. Statistical analysis included the use of multivariate logistic regression models to find determinants of vasospasm, ischaemic infarction and neurological deficits. Altogether, vasospasm was detected after 77 (53.5%) interventions, 61.8% in females (P < 0.01). Clipped patients significantly more often exhibited vasospasms (69.8 vs. 44.0%, P < 0.005) and were treated 1 week longer at the intensive care unit (P < 0.005). Seventy-seven patients (53.5%) developed ischaemic infarctions, 62.3% after clipping and 48.4% after coiling (P > 0.05). In the multivariate analysis, aneurysm-rupture was the strongest predictor for vasospasm and vasospasm was the strongest predictor for infarction. Neurological deficits at discharge (46.5%) were independent of treatment modality, the same applied for the mean Glasgow Outcome Scores. There was no significant difference in mortality between surgical and endovascular treatment (9.4 vs. 12.1%). Whilst the vasospasm incidence was significantly higher after surgical treatment, ischaemic infarctions were only slightly more frequent. The incidence of neurological deficits and clinical outcome was similar in both treatment groups.

Adult↗
PubMed1999

Clips and scar as the guidelines for breast radiation boost after lumpectomy.

BACKGROUND AND AIMS: Breast-conserving therapy in early breast cancer is equally effective as mastectomy, with advantages of cosmesis and quality of life over mastectomy. Local control is improved when entire breast irradiation is combined with a radiation boost to the tumour bed. METHODS: Localization of the tumour bed was compared in 45 consecutive patients using surgical scar and radiopaque clips placed intra-operatively in the lumpectomy cavity. RESULTS: The area (A) of the radiation boost field and volume (V) of the tumour bed, designed on the basis of scar (AS and VS), were 1.4 times larger than those designed on the basis of the clips (AC and VC). AS and VS missed about one-quarter of the tumour bed which had been delineated by clips intra-operatively, while about one-half of it encompassed tissues beyond the AC and VC. CONCLUSIONS: A boost planned by scar dimensions can miss a substantial portion of the tumour bed, compromising local control. On the other hand, a substantial amount of breast tissue beyond the tumour bed can be unnecessarily irradiated, compromising cosmetic treatment results. Thus, the scar provides an inadequate landmark for radiation boost planning in breast-conserving therapy.

Adult↗
PubMed1978

[Early and late results in the prevention of pulmonary embolism and caval patency after implantation of caval clips according to Adams--De Weese as compared to Mobin-Uddin umbrella filters (author's transl)].

A collective of 56 female and 54 male patients between 15 and 78 years were operated to prevent pulmonary embolism. 27 umbrella filters and 83 vena cava clips were implanted. Postoperative mortality was 15 per cent after umbrella filter implantation as compared to 0 per cent after clip application. 35 clip and 9 filter implantations were followed up by cavographic examination. Venograms were classified in three types according to caval patency. A significantly higher number of complications were observed after filter implantation. On the basis of a flow physics hypothesis an explanation is suggested for the liability to caval thrombosis after filter implantation. An evaluation of both operative methods and their indications is given.

Filtration↗
PubMed2000

[Biliary endo-to-end anastomosis with extramucosal titanium clips. Initial results of a new technique].

BACKGROUND: Bile duct anastomoses are still associated with a high failure rate. Although following iatrogenic bile duct transection only a positive selected group of patients get a primary end-to-end reconstruction, long-term results demonstrate an incidence of postoperative strictures up to 78%. Also in orthotopic liver transplantation biliary tract complications remain a significant cause of morbidity with an incidence of up to 49%. Since these complications can also be seen under optimal circumstances, the methodically based disadvantages of the conventional hand suturing like perforating needle injury of the choledochal wall with intraluminal suture material, the suboptimal approximation of the mucosal edges and an inhibited blood flow in the choledochal stumps caused by a suture related tissue strangulation may also responsible. Thus there is a search for alternative anastomosis techniques. METHOD: To test extramucous placed titanium clips for biliary reconstruction after complete division of the bile duct we performed an end-to-end-anastomosis in 9 pigs. Therefore we used the VCS (Vascular Closure Staples)-instruments (Auto Suture). RESULTS: The application of the VCS-clips (medium size) permitted the technical realization of a tension free, everted anastomosis with an exact approximation of the mucosal edges. One of the animals died from aero embolism intraoperatively. All the others showed a complication-free postoperative period without any signs of anastomotic leakage or stenosis (follow-up: 6 months). At histological examination there were smooth and intact mucosal surfaces in all pigs and--especially important for the development of strictures--only a very mild fibrosis and inflammation. CONCLUSIONS: The potential advantage of the VCS-clip-technique is the non-penetrating tissue approximation with optimal contact of the mucosal layers that does not compromise the blood flow in the choledochal stumps. Before clinical use can be recommended further studies are required.

Anastomosis, Surgical↗
PubMed2000

Endoscopic clipping of perforation following pneumatic dilation of esophagojejunal anastomotic strictures.

Two patients with small perforations occurring after endoscopic balloon dilation of esophagojejunal anastomotic strictures were treated conservatively using metal clips. Closure of the perforation was achieved in both cases, using one and two clips in a single session. There was no procedure-related morbidity and no patient developed complications. Patients were discharged from hospital on days 4 and 5, respectively. In patients with esophagojejunal anastomotic strictures, endoscopic treatment of postdilation perforation by metal clips is safe and effective.

Aged↗
PubMed2000

Experimental lung transplantation using non-penetrating vascular clips for anastomosis of the pulmonary artery.

BACKGROUND: Reliable and rapid anastomosis is critical in lung transplantation. The purpose of this study is to show the appropriateness of sutureless anastomosis of the pulmonary artery using a nonpenetrating vascular clipping device. METHODS: The left lung was excised and the cranial lobe was transplanted autologously in 9 dogs. The anastomosis of the left main pulmonary artery (PA) (1 cm) was performed using a vascular clipping system. RESULTS: PA anastomosis was performed in 7 dogs in 8 to 13 minutes. The endovascular surface of the anastomotic site was smooth, and passage of silicone rubber through the anastomosis was good 14 or 28 days after surgery. Microscopic examination of the anastomotic sites showed excellent healing without evidence of intimal hyperplasia. CONCLUSIONS: The vascular clipping system facilitates anastomosis of the PA in lung transplant surgery.

Anastomosis, Surgical↗
PubMed2002

Surgical clipping of basilar aneurysms: relationship between the different approaches and the surgical corridors.

BACKGROUND: Surgical clipping for basilar artery aneurysm (BAA) is a technically demanding procedure due to the depth of the surgical field and the presence of vital perforating arteries in the vicinity. The incorporation of various modifications in the conventional approaches has expanded the surgical armamentarium in dealing with these difficult lesions. METHODS AND FINDINGS: 87 patients of BAA were operated at our center, out of which in 48 patients, a pterional transsylvian approach was used. In 12 patients, this approach had to be extended to incorporate the anterior temporal approach in 6 cases, transzygomatic subtemporal approach in 2 cases and transcavernous approach in 4 cases. The surgical indications for the additional approaches and the relationships between the surgical corridors gained by their inclusion were studied. The use of neuroendoscopy facilitated adequate clipping in one case of high BAA without the incorporation of bone drilling, thus opening new surgical corridors. INTERPRETATION: The variable situation of the BAA makes it mandatory for the surgeon to be prepared to simultaneously work through multiple surgical corridors. Neuroendoscopic-assisted microneurosurgery occasionally utilizes a narrow surgical corridor to facilitate BAA clipping using the conventional approaches and eliminates the need to gain access using additional surgical corridors.

Basilar Artery↗
PubMed2007

Comparison of experimental microvascular end-to-end anastomosis via VCS-Clips versus conventional suture technique in an animal model.

In this experimental study on 96 CD rats, microvascular end-to-end anastomoses created via suture or alternatively by means of a VCS-Clip-Application-System, were compared. The aorta abdominalis of the animals, with a diameter of 1.5 +/- 0.2 mm, was experimentally dissected, and the free ends of the vessel then anastomosed. The results were evaluated using sonography, microangiography, histologic examination, and vascular imprints. Postoperative examination was carried out after 1, 3, 7, 14, or 30 days. Major advantages of the VCS-Clip technique over suturing were that it was easy to learn, significantly faster to perform (execution of anastomosis 10.9 +/- 2.6 min versus 19.4 +/- 5.0 min), and produced significantly more favorable histologic results in terms of less inflammatory response, foreign body reaction, necrosis of the tunica media, hyperplasia of the intima, and thrombosis of the vessel lumen. The main disadvantage of the clip technique was a significantly higher rate of stenoses (15.8 +/- 6.0 versus 4.1 +/- 6.6 percent).

Anastomosis, Surgical↗
PubMed1990

Urinary excretion of digoxin-like factor (DLF) and ADH during DOCA-salt and Goldblatt 2 kidney-1 clip hypertension development.

Urinary digoxin-like factor, ADH, sodium and potassium excretion and urine osmolality were studied during the development of two pathogenically different models of hypertension, DOCA-salt (low-renin) and Gold-blatt 2 kidney-1 clip (renin-dependent). Urinary digoxin-like factor was increased in rats that were given saline (NaCl 1%) to drink, uninephrectomized-salt and DOCA-salt rats, with no significant differences between the two groups urinary ADH was elevated in DOCA-salt rats during the study, compared with uninephrectomized-salt rats. Urinary digoxin-like factor and urinary ADH were not significantly modified in Goldblatt 2 kidney-1 clip and sham-operated rats. In addition, positive correlations between digoxin-like factor urinary excretion and urinary ADH and also with sodium urinary excretion were found. These data suggest that: a) digoxin-like factor and ADH could play a role in the pathogenesis of DOCA-salt but not in Goldblatt 2 kidney-1 clip hypertension. b) A common mechanism may stimulate ADH and digoxin-like factor simultaneously. c) Digoxin-like factor plays a role in the control of urinary sodium excretion.

Animals↗
PubMed1988

[Vaginal closure with resorbable clip in total abdominal hysterectomy].

The latest type of clip stapler with resorbable clips for closure of the vaginal stump in abdominal hysterectomies was used by nineteen different surgeons on 80 patients at two university clinics, employing the same surgical procedure. Perioperative handling and the complication-free postoperative course were considered satisfactory. There was no dyspareunia, previously described in association with metal clips. Granular tissue requiring therapy and serosanguinous discharge were clearly reduced. On the basis of measurements of vaginal cuffs removed at the same time it can be said that there is no shortening of the vagina. The question of costs is discussed.

Female↗
PubMed1984

[A physical model on the problem of the slipped clip].

The authors present their physical concept of determining the blade pressure of various aneurysm clips. On the basis of this concept, the consequences for the practical use of such clips are discussed. A new clip for aneurysm surgery is presented.

Biomechanical Phenomena↗
PubMed1997

Efficient loading of HLA-DR with a T helper epitope by genetic exchange of CLIP.

The HLA class II-associated invariant chain (Ii)-derived peptide (CLIP) occupies the peptide binding groove during assembly in the endoplasmic reticulum, travels with HLA class II to endosomal compartments, and is subsequently released to allow binding of antigenic peptides. We investigated whether the exchange of CLIP with a known T helper epitope at the DNA level would lead to efficient loading of this helper epitope onto HLA class II. For this purpose, a versatile Ii-encoding expression vector was created in which CLIP can be replaced with a helper epitope of choice. Upon supertransfection of HLA-DR1-transfected 293 cells with an Ii vector encoding a known T helper epitope (HA307-319), predominantly length variants of this epitope were detected in association with the HLA-DR1 molecules of these cells. Moreover, this transfectant was efficiently recognized by a peptide-specific T helper clone (HA1.7). The results suggest that this type of Ii vector can be used to create potent class II+ cellular vaccines in which defined T cell epitopes are continuously synthesized.

Amino Acid Sequence↗
PubMed1987

Stereotactic clipping of arteriovenous malformations of the brain.

The authors have developed a new technique for the stereotactic clipping of the feeding vessels of deep-seated arteriovenous malformations (AVM), for use when direct attack may be very dangerous or impossible. A special clipping device and the technique for its application are described. The instrument is introduced through a burr hole using the stereotactic apparatus designed by the authors. The clipping is monitored by intraoperative angiography. The method was used in 32 patients with supratentorial AVMs. It is concluded that in selected cases the method is effective, is less traumatic and gives successful results.

Adolescent↗
PubMed1998

Mutual link among the approaches to clipping of basilar aneurysms.

The pterional approach for basilar aneurysm clipping, has become the most common approach among surgeons, since it was advocated by Yasargil in 1982. However, other approaches aiming at an adequate but less invasive surgery to meet conditions of peripheral blood vessels (including aneurysmal size, direction and perforating arteries and arteriosclerosis) and the direction of clip insertion have also been developed. The approaches will be recommended to be expanded according to situations of the actual intra-operative findings in the future. The mutual link among the approaches to clipping of basilar aneurysms was investigated.

Adult↗