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PubMed1996

Titanium aneurysm clips: Part II--Seizure and electroencephalographic studies in implanted rabbits.

Because titanium is widely used in neurosurgical procedures, we compared spontaneous and induced epileptiform activity in 12 rabbits with titanium clips implanted in the subarachnoid space with 12 rabbits with cobalt alloy clips and 6 rabbits that were not operated on that served as controls. Beginning 1 week after surgery, 30-minute electroencephalographic recordings were made at monthly intervals for 6 months. Recordings were scored by an electroencephalographer unaware of which treatment group was being recorded. In 48 recordings made during 6 months, no epileptiform activity was observed in any animal. Seizure threshold was evaluated by continuous intravenous injection of the convulsant drug, pentylenetetrazole (2 mg/kg/min), with continuous electroencephalographic recording. Time to spiking for the nonsurgical control group was 327 mean seconds +/- 181 standard deviation (SD), 216 mean seconds +/- 135 SD for the titanium group, and 389 mean seconds +/- 290 SD for the cobalt group. There were no significant differences among the groups (P = 0.17). Latency to behavioral tonicoclonic seizure was 1031 seconds +/- 537 SD for the group not operated on, 875 seconds +/- 334 SD for the titanium group, and 1267 seconds +/- 764 SD for the cobalt group. This study suggests that titanium clips are well tolerated within the brain and will not induce seizures.

Animals↗
PubMed2000

What percentage of surgically clipped intracranial aneurysms have residual necks?

OBJECTIVE: To determine the angiographically proven rate and persistence of occlusion of intracranial aneurysms after surgical clipping as reported in the literature. This should establish a basis for comparing surgery with new endovascular methods of treatment. METHODS: We reviewed the literature published during the period from 1979 through 1999, dividing the articles into two groups. The first group of articles reported patients undergoing surgical treatment with immediate postoperative angiography. The second group of articles documented symptomatic recurrence or regrowth of aneurysms that were surgically treated previously. The data from these articles are presented for analysis. RESULTS: During the period 1979 to 1999, six series of patients undergoing surgical treatment of aneurysms with immediate postoperative angiography were reported. These reported series comprised a total of 1,397 patients, of whom 1,370 underwent postoperative angiography demonstrating 1,569 clipped aneurysms. Residual filling was found in 82 aneurysms (5.2%) on postoperative angiography. Of the 1,370 patients, only 124 patients with 169 aneurysms were reported to have had any long-term angiographic follow-up. The second group consisted of 226 patients representing six reported groups of patients, who either presented up to 24 years after aneurysm clipping with recurrent symptoms of hemorrhage or mass effect, or had important findings on intraoperative and postoperative angiograms. CONCLUSION: The lack of information regarding both the frequency of residual filling or regrowth and long-term angiographic follow-up of patients with surgically treated aneurysms makes meaningful comparison between surgical treatments and new treatment methods for intracranial aneurysms difficult or impossible. Detailed analysis with high-quality angiography should be performed to determine the success of surgical treatment.

Cerebral Angiography↗
PubMed2001

New method for obliterative treatment of an anterior wall aneurysm in the internal carotid artery: encircling silicone sheet clip procedure--technical case report.

OBJECTIVE AND IMPORTANCE: Aneurysms on the anterior surface of the internal carotid artery (ICA) have been shown to be somewhat different from ordinary berry aneurysms because they are rather small, grow rapidly in a short time, and easily lead to rupture, especially during surgery. The most difficult problem is that this type of aneurysm cannot be eliminated easily by an ordinary clipping procedure without causing apparent arterial stenosis or occlusion. CLINICAL PRESENTATION: A 52-year-old man experienced a subarachnoid hemorrhage because of a ruptured aneurysm located on the anterior surface of the ICA. The tiny aneurysmal body, which was covered with a layer of brain tissue, was successfully exposed. The ICA seemed to be atherosclerotic, and the aneurysmal portion was solitary and had a reddish color. TECHNIQUE: A large silicone sheet encircling clip (Vascwrap; Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) was selected for this patient. The proximal margin of the silicone sheet was incised with a V-shaped cut, and the middle part of the sheet, which covered the diagonal part of the ICA, was trimmed to make it shorter. The blade of the fenestrated clip was applied to obliterate the aneurysm and was attached to the normal arterial wall together with this modified Vascwrap sheet to create a small space between the normal arterial wall and the surrounding Vascwrap sheet. Then tiny pieces of Teflon fiber (E.I. duPont de Nemours and Co., Wilmington, DE) was inserted from both margins, and the whole Vascwrap sheet was sealed with fibrin glue to ensure good adhesion. CONCLUSION: This method seemed adequate in treating this difficult aneurysm without causing postoperative regrowth or occlusion of the patient's ICA.

Carotid Artery, Internal↗
PubMed1984

Report of a high pregnancy rate after sterilization with the Bleier clip.

We investigated a report of a pregnancy rate of 7.3% after tubal sterilization procedures with the Bleier clip in one physician's practice. A review of ongoing clinical investigations of this method of tubal sterilization revealed a failure rate of 0.3%. Our investigation determined that misapplication of the clips was the most probable explanation for the high failure rate, though how the misapplications occurred is not known. The Bleier clip is probably an effective method of tubal occlusion, but close monitoring is needed to determine whether the high failure rate reported here is an isolated instance or a recurrent problem.

Evaluation Studies as Topic↗
PubMed2006

IMA clipping for a type ii endoleak: combined laparoscopic and endovascular approach.

We describe herein a combined laparoscopic and endovascular approach to treat a type II endoleak due to retrograde flow in the patent inferior mesenteric artery (IMA). A 61-year-old gentleman presented with enlarging aneurysm sac confirmed on computed tomography scan evaluation after elective endovascular repair of an infrarenal abdominal aortic aneurysm. A combined laparoscopic and endovascular approach was used. After distal IMA was identified and marked with a clip laparoscopically, on-table angiography showed a proximal left colic branch and persistent flow in the IMA. Therefore, further laparoscopic exploration was performed by dissection along the distal branch. The origin of IMA was then located and subsequently sealed with 2 surgical clips. The completion angiography confirmed the proper position of the surgical clips and absence of endoleak. Our case demonstrated useful role of endovascular techniques in identifying the origin of IMA during laparoscopic approach for treating type II endoleak.

Aortic Aneurysm, Abdominal↗
PubMed2003

Genetic inactivation of the B2 receptor in mice worsens two-kidney, one-clip hypertension: role of NO and the AT2 receptor.

OBJECTIVE: Previous studies have suggested that activation of angiotensin II (ANG II) type 2 (AT2) receptors results in nitric oxide (NO) release via activation of endothelial bradykinin B2 (B2R) receptors. The present study was performed to examine the interplay of AT2 and B2R in the development and maintenance of two-kidney, one-clip (2K1C) Goldblatt hypertension. METHODS: B2R knockout (B2R-/-) mice and their wild-type controls (B2R+/+) underwent clipping of the right renal artery and were infused with either saline (SAL) or PD 123319, an AT2 receptor antagonist (PD), via an osmotic pump implanted intraperitoneally. Systolic blood pressure (SBP) was measured in conscious mice. On day 27, mean arterial pressure (MAP) responses were measured in response to consecutive blockade of AT(2) receptors and NO synthase (NOS). RESULTS: A significant and sustained rise in SBP was observed in both 2K1C B2R+/+ and B2R-/- versus sham-operated groups from day 10 to day 24 after clipping. After this time, SBP rose to significantly higher levels in 2K1C/B2R-/- than in 2K1C/B2R+/+ mice. MAP on day 27 was also higher in 2K1C/B2R-/- than 2K1C/B2R+/+ mice. Chronic PD infusion did not alter the course of hypertension in 2K1C/B2R+/+ or 2K1C/B2R-/- mice as compared with saline-infused mice. Likewise, acute PD infusion did not affect MAP in any of the groups. However, acute NOS inhibition caused significantly greater increases in MAP in 2K1C/B2R+/+ and PD/2K1C/B2R+/+ than 2K1C/B2R-/- and PD/2K1C/B2R-/- mice. CONCLUSIONS: These results indicate that B2R inactivation selectively worsens the maintenance phase of 2K1C Goldblatt hypertension and support the notion that B2R-deficient mice exhibit an impaired ability to release NO in response to elevations of ANG II levels. Chronic administration of an AT2 receptor blocker did not modify the course of 2K1C Goldblatt hypertension in either B2R-/- or B2R+/+ mice. Therefore, the role of AT2 receptors in B2R-mediated protection against ANG II-dependent hypertension remains uncertain.

Angiotensin II Type 2 Receptor Blockers↗
PubMedDate not supplied

Computed tomography appearance of the Lapra-Ty and Weck hem-o-lok clips in patients who recently underwent laparoscopic urologic surgery.

The nonmetal suture securing Lapra-Ty clip (LTC) and vessel ligating Weck hem-o-lock clip (WKHL) are useful tools for the laparoscopic surgeon. We report the postoperative computed tomography (CT) scan appearance of these clips. The CT imaging of patients who underwent urologic surgery demonstrate the WKHL and LTC to be radiopaque. Urologists and radiologists should be aware of the radiographic appearance of the LTC and WKHL given the ease with which they could be confused with urinary lithiasis when applied near the urinary system.

Adult↗
PubMedDate not supplied

Ultrasound demonstration of clip migration to Skin within 6 weeks of 11-gauge vacuum-assisted stereotactic breast biopsy.

A 39-year-old woman underwent 11-gauge vacuum-assisted stereotactic biopsy of a cluster of calcifications at the 5 o'clock location in the left breast. Initial clip placement was confirmed by mammograms to be at the biopsy site. The patient experienced episodic minimal bleeding at the skin entry site when she went home. The patient presented 6 weeks later with a history of progressive discomfort and lump at the stereotactic breast biopsy scar site. Ultrasound confirmed clip migration to the skin incision site. The clip was removed percutaneously by the radiologist, relieving the patient of her symptoms.

Adult↗
PubMed2006

The impact of body site, topical melatonin and brushing on hair regrowth after clipping normal Siberian Husky dogs.

The aims of this study were to determine the impact of body site, vigorous brushing and topical melatonin treatment on hair regrowth after clipping normal dogs. Siberian Husky dogs were randomly assigned to three groups of eight dogs each. All dogs had the lumbosacral region and both lateral thighs clipped. The left thigh and lumbosacral area received no treatment and were compared in all 24 dogs. Eight dogs had the right thigh treated with 0.1% melatonin twice daily for 2 months, and hair regrowth was compared with the left thigh. Eight dogs had the right thigh brushed twice daily for 2 months, and hair regrowth was compared with the left thigh. Eight dogs had neither thigh treated. Hairs were plucked before and 2 months postclipping, and the proportion of hair growth from the original length was calculated and compared as described above. Biopsy samples were collected before and after treatment to determine if brushing induced dermal inflammation and melatonin increased the proportion of anagen follicles. Proportionally, left thigh hairs were significantly longer compared to lumbosacral hairs 2 months postclipping. No significant differences in hair regrowth were noted between the nontreated thigh and the thigh treated with melatonin or brushed. No significant difference in dermal inflammation was noted before and after brushing. No significant differences were observed in the proportion of anagen follicles before and after topical melatonin treatment. Our results showed that the hairs in the lumbosacral region were proportionally shorter than lateral thigh hairs 2 months postclipping. Moreover, topical melatonin and brushing had no impact on hair regrowth after clipping normal dogs.

Adjuvants, Immunologic↗
PubMedDate not supplied

Isolation of fungi from onychomycosis-suspected nails by two methods: clipping and drilling.

We examined 101 nails clinically suspected of onychomycosis by taking specimens with two different techniques: clipping and drilling. We then compared the mycological results of these two techniques. The microscopic results were similar, but culture was more successful with the clipping technique. Twenty-seven per cent of specimens obtained by clipping were culture positive for dermatophytes compared with 20% obtained by drilling and a combined positivity rate of 31%.

Candida↗
PubMedDate not supplied

Role of prostaglandins during reversal of one-kidney, one-clip hypertension in the rat.

Unclipping the one-kidney, one-clip 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 excretion. Prior treatment with indomethacin (6.0 mg/kg) markedly reduced urinary prostaglandins after clip removal and attenuated the fall in blood pressure. Aspirin (100 mg/kg) treatment, which reduced 6-keto PGF1 alpha to a lesser degree without altering PGE2 excretion, had no significant effect on the blood pressure fall. 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↗
PubMed1998

Dieulafoy's disease treated by endoscopic haemostatic clipping.

Dieulafoy's disease is an uncommon cause of upper gastrointestinal haemorrhage. We report three patients with Dieulafoy's disease treated with the endoscopic haemostatic clip application. There was no recurrent bleeding from the upper gastrointestinal tract after application of the clips in all three patients. Two patients survived while the third succumbed to renal failure after hypovolaemic shock. We conclude that endoscopic haemostatic clip may have a role in the treatment of Dieulafoy's disease.

Adult↗
PubMed1997

Role of platelet-activating factor in two-kidney, one-clip hypertension.

BACKGROUND: Platelet-activating factor (PAF) is a bioactive phospholipid which is a potent hypotensive agent. To investigate the role of PAF in renovascular hypertension, we determined the PAF concentration and its production level assessed by the activity of cholinephosphotransferase (CPT) in renal tissue and examined the effect of a PAF antagonist on the mean arterial pressure (MAP) in control and two-kidney with one clipped (2K1C) hypertensive rats. MATERIALS AND METHODS: The concentration of PAF and CPT in the renal medulla and cortex were determined by radioassay. Also, the effect of a PAF antagonist, CV-6209, on MAP was also examined in both 2K1C hypertensive and normal control rats. RESULTS: The PAF concentration and CPT activity were significantly higher in the medulla than in the cortex in both 2K1C hypertensive and normal control rats, and both values in the medulla were also significantly higher in the clipped kidney than in the contralateral unclipped kidney or in control rat kidneys. We also observed a significant negative correlation between the PAF concentration in the medulla, and the medulla weight in the clipped kidney of 2K1C hypertensive rats. Infusion of the PAF antagonist, CV-6209, did not affect MAP in 2K1C hypertensive rats, but was significantly increased (P < 0.05) in control rats. CONCLUSIONS: These findings suggest that PAF, whose production is induced by renal ischemia due to renal artery stenosis, plays an important role in the renomedullary vasodepressor system, but the effect of PAF as a vasodilator in the peripheral vessels is limited in 2K1C hypertension.

Animals↗
PubMed2005

Comparison of the usefulness of three staging systems for hepatocellular carcinoma (CLIP, BCLC, and JIS) in Japan.

OBJECTIVES: We retrospectively compared the usefulness of three different staging systems for hepatocellular carcinoma (HCC), the Cancer of the Liver Italian Program (CLIP) scoring system, the Barcelona Clinic Liver Cancer (BCLC) classification system, and the Japan Integrated Staging (JIS) system, in terms of patient distribution and survival rates. METHODS: Subjects were 1,508 patients diagnosed as having initial HCC during the period of 1976-2003. The disease was staged in all patients by means of the three staging systems, and the distribution of patients across stages and associated survival rates were compared between systems. In addition, comparisons were made on the basis of the time of diagnosis: 1976-1990 (n = 497) and 1991-2003 (n = 1,011). RESULTS: Patients were evenly distributed across stages within each staging system, and survival rates differed between stages except for BCLC C and D. During the period 1991-2003, when HCCs were smaller at diagnosis, JIS system is in particular yielded even distribution of patient across stages and marked differences in survival rates. CONCLUSIONS: Overall, the CLIP and the JIS scoring systems proved to be suitable for patients in Japan with HCC. The CLIP staging systems proved to be more suitable before 1991. In contrast, the JIS system was the most suitable after 1990, when early detection and early treatment of HCC became common. The JIS system is, therefore, the appropriate system in this era of early detection and treatment of HCC.

Adult↗
PubMedDate not supplied

Ultrasonographic assessment of metallic clip carotid anastomosis in sheep.

The aim of this study was to use ultrasonography to assess an experimental carotid arteriotomy followed by end-to-end anastomosis in the lamb. Animals were subjected to an experimental surgical procedure consisting of a right carotid artery arteriotomy and subsequent end-to-end anastomosis with nonpenetrating metallic clips. Left side arteries were used as control. Duplex ultrasonography was performed postoperatively to assess the evolution of the experimental anastomosis. Measurements were made on the right carotid to assess blood flow, peak systolic velocity, and end diastolic velocity, as well as arterial diameter. Animals were periodically checked during the six-month postoperative period. Operated vessels appeared normal during follow up, with pulsatile movements and size similar to non operated carotid arteries. A hyperechoic band, perpendicular to the vessel main axis, was seen on the longitudinal image in operated arteries, but not in the control group. This band corresponded to the anastomosis area, where the clips were positioned. No image suggestive of thrombosis was observed in any operated artery, and blood flow was maintained through the experiment. Finally, a decrease of vessel lumen diameter was evidenced at the level of the anastomosis during the first 30 postoperative days, but it was not present after the 90th postsurgical day. Duplex ultrasonography is a useful imaging technique for the assessment of anatomical details, acoustical properties of the vascular lumen, and study of the intimal surface and vessel wall in growing arteries subjected to surgery. Metallic clips as suturing technique in arterial anastomosis allow for normal vascular growth, as shown by the evolution of flow velocity and vessel diameter.

Analysis of Variance↗
PubMed2005

Depolarization pattern of ventricular epicardium in two-kidney one-clip hypertensive rats.

The present study is the first attempt to examine the effect of left ventricular hypertrophy (LVH) on the excitation pattern of the ventricular epicardium in experimental hypertensive rats. The left renal artery was clipped in Wistar rats (n = 8; 6-8 months old; weight, 174-295 g) to produce two-kidney one-clip (2K1C) hypertension. After 4 weeks, blood pressure was measured, and epicardial potential mapping was performed under sinus rhythm from 64 unipolar electrodes regularly distributed over the ventricular epicardium. Systolic blood pressure was approximately 40% higher in the rats with a clipped renal artery (162 +/- 14 mmHg, mean +/- s.d.) than in the normotensive rats (115 +/- 3 mmHg). LVH (approximately 23% increase in the ratio of the left ventricular weight to the body weight, P < 0.05) was observed in the 2K1C hypertensive rats. The depolarization pattern of the ventricular epicardium in the normotensive rats was similar to that in the rats with 2K1C hypertensive LVH. The duration of ventricular epicardial activation was shown to increase (approximately 35%, P < 0.05) in the hypertensive rats as compared to the normotensive animals. This study provides an explanation for alterations of the body surface potential distribution in hypertensive patients with LVH.

Animals↗
PubMed2000

A technique for the evaluation of failed fallopian tube ligation with metal clips.

The evaluation of fallopian tubes after failed tubal ligation can be difficult because conventional histopathological techniques are unable to section the metal clips when in situ. Once the clips have been removed, any evidence of tube patency is lost. This report describes a technique of embedding and sectioning that enables sections to be made while the metal clips are still in situ. This is a modification of a method first described to embed mineralised bone and involves the use of plastic embedding and a diamond saw. Using this technique, a permanent record is made of the tube location and patency.

Adult↗