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PubMed2006

Wrap-clipping with polytetrafluoroethylene for ruptured blisterlike aneurysms of the internal carotid artery. Technical note.

A technique combining wrapping and clip occlusion of aneurysms by using polytetrafluoroethylene (PTFE) for treatment of ruptured blisterlike aneurysms of the supraclinoid internal carotid artery (ICA) is described. The diameter of the abnormal arterial lesion along the long axis of the ICA and the distance between the origin of the ophthalmic artery and the origin of the posterior communicating artery (PCoA), or the origin of the PCoA and the origin of the anterior choroidal artery are measured intraoperatively; a strip of PTFE membrane is then trimmed with scissors to match this diameter and distance. After temporarily occluding the cervical ICA, the intracranial ICA that includes the lesion is wrapped with the strip of PTFE, and one or more aneurysm clips are applied parallel to the ICA. This procedure was successfully accomplished in six patients, all of whom had an uneventful postoperative course with no recurrent subarachnoid hemorrhage during the follow-up period. "Wrap-clipping" using PTFE is a useful procedure for management of ruptured blisterlike aneurysms of the ICA.

Adult↗

PubMed1985

Reduction of blood pressure and increased diuresis and natriuresis during chronic infusion of atrial natriuretic factor (ANF Arg 101-Tyr 126) in conscious one-kidney, one-clip hypertensive rats.

Conscious one-kidney, one-clip hypertensive rats and their normotensive controls were infused during 7 days with synthetic ANF (Arg 101-Tyr 126) at 100 ng/hr/rat (35 pmol/hr/rat) by means of osmotic minipumps. The basal blood pressure of 193 +/- 6 mmHg gradually declined to 145 +/- 6 mmHg at day 4 after the infusion was started. No changes in blood pressure were observed in ANF-infused normotensive rats. A significantly higher diuresis and natriuresis was observed in ANF-infused hypertensive rats when compared to the non-treated hypertensive group. No such changes were observed in ANF-treated normotensive animals. No differences in PRA were seen in any group. Atrial immunoreactive ANF was significantly lower in one-kidney, one-clip rats than in the normotensive animals, but whether this is the reflection of an increased release in the circulation remains to be elucidated. It is suggested that the hypotensive response of one-kidney, one-clip animals to ANF may be secondary to a dual mechanism, vasodilatation and volume depletion.

Animals↗

PubMed1987

Failure of naloxone to influence surgical reversal of two-kidney, one-clip hypertension in the rat.

The rapid fall in blood pressure after removal of the constricting clip in two-kidney one-clip (2K-1C) hypertension in the rat is not fully explained by inhibition of the renin-angiotensin system or change in sodium balance. It has been postulated that compounds released in the renal venous effluent following unclipping of 2K-1C rats have a central opiate-like action and endogenous opioids are recognized to have profound hypotensive properties. To investigate this, we removed the clip from, or performed a sham operation in, early phase (less than 6 weeks) 2K-1C hypertensive rats during an infusion of naloxone, an opioid antagonist, or vehicle alone. The infusion of naloxone did not affect the pattern of blood pressure fall in either unclipped or sham-operated rats. Both naloxone-treated and control groups were similarly normotensive at 24 hr postoperation, the MAP being significantly lower than in the sham-operated groups, which regained previously hypertensive levels. Heart rate was unchanged 24 hr postoperatively in all groups. Morphine-induced bradycardia and hypotension were significantly reduced by naloxone infusion. Thus, naloxone infusion had no effect on blood pressure or heart rate in either the sham-operated or the unclipped groups, indicating that endogenous opioids do not have a major role in the reversal of renovascular hypertension under these circumstances.

Animals↗

PubMed1984

Influence of toe-clipping and stocking density on laying hen performance.

Three experiments were conducted to investigate the influence of toe-clipping and bird density on laying hen performance. Toe-clipping was done on day-old chicks by removal of the digital claws from the front toes. Toe-clipped (TC) and intact (IN) pullets were assigned randomly to laying cages (Experiments 1 and 2, 19 weeks of age) or housed in similar body weight groups (Experiment 3, 18 weeks of age) at caging densities of either 4 (465 cm2/hen) or 5 (372 cm2/hen) hens per cage. Experiment 3 body weight groups were: heavy (greater than or equal to 1475 g), medium (greater than or equal to 1375 g, but less than 1475 g), light (greater than or equal to 1275 g, but less than 1375 g), and extra light (less than 1275 g). Body weights were determined at various ages during the grow-out and egg-laying periods. Beginning at 22 weeks of age, average daily egg weight, feed consumption, feed conversion, hen-day egg production, and mortality measures were made for 12 periods of lay of 28 days each. In Experiments 1 and 2, IN pullets were consistently heavier throughout the grow-out period and consumed significantly more feed during the egg laying period than TC birds. Significantly greater average daily egg weights were found in IN than in TC hens in Experiment 1 but not in Experiment 2. Increasing the number of hens from 4 to 5 hens per cage resulted in a significant reduction in feed intake and body weight gain in Experiments 1, 2, and 3. In Experiment 1, mean daily egg weight was significantly increased (.11 g) upon crowding. In Experiment 2, crowding elevated mortality. In Experiments 1 and 2, but not 3, a significant toe treatment by bird density interaction was observed for hen-day egg production. The IN birds had lowered hen-day egg production rates when crowded than when they were afforded more space, whereas hen-day egg production was elevated in crowded TC hens when compared to TC hens housed at the less crowded density. In Experiment 3, an initial (4 weeks of age) significant depression in pullet body weight was found in the TC pullets but disappeared by the 8th week. Feed usage was also significantly greater in IN than in TC hens in Experiment 3. Toe treatment did not affect any other hen performance variable measured. Egg weight, feed intake, and feed conversion measures varied by body weight groups. In general, the heavier hens consumed more feed and laid heavier eggs, but they were less efficient in converting feed into eggs.

Animals↗

PubMed1985

An economic analysis of performance data from toe-clipped laying hens housed at variable stocking densities.

Data from a previously reported study investigating the interaction of toe-clipping and stocking density on laying-hen performance were subjected to economic analyses to determine optimal profit-producing combinations of these two management practices. In three separate trials, toe-clipped (TC) and intact (IN) pullets were examined at caging densities of either 4 (465 cm2/hen) or 5 (372 cm2/hen) birds per cage. In each trial, beginning at 22 wk of age, hen production performance (hen-day egg production, hen-housed egg production, feed consumption, body weight, and mortality) was assessed for 12 28-day periods of lay. Performance criteria were averaged over all trials and used to determine per cage returns ($) above feed and pullet rearing costs (irrespective of fixed costs) and per cage profits (gross returns minus total costs) for the four treatment combinations. Economic analyses were also adjusted for hatchery toe-clipping costs. Profits (or losses) from each toe treatment stocking-density combination were calculated under variable egg and feed prices. At a blended egg price of $.35/doz, all cage systems lost money. Housing hen TC, 5/cage, yielded the greatest profits or least losses in 76% of the toe treatment stocking-density combinations studied. Economic returns were greatest for TC hens, 5/cage, at an egg price of $.55/doz when feed costs ranged from $140 to $230/ton and at egg prices higher than $.55/doz, regardless of feed prices. However, when these price combinations exist, housing hens IN, 4/cage is more profitable than housing hens TC, 4/cage.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Husbandry↗

PubMed1985

The normal post-cholecystectomy sonogram: gas vs. clips.

Although both gas and heavy metals create multiple reverberations, they can be distinguished both in vivo and in vitro by the differences in origin (focus) and the duration (persistence) of the artifact. A phantom experiment showed that surgical clip artifacts emanate from short echogenic foci, and are persistent, whereas gas foci are either long or short, with evanescent artifacts. In 78 consecutive post-cholecystectomy patients, 96 per cent (24/26) of the patients with clips demonstrated multiple reverberation artifacts, whereas 6 per cent (2/31) of the patients without clips demonstrated several reverberation artifacts. Analyzing these characteristics as well as the positional relationships of reverberation artifacts in the porta hepatis and gallbladder fossa should enable one to suspect the post-cholecystectomy state and differentiate from an abnormal gas collection.

Cholecystectomy↗

PubMed1999

Migration of sterilisation clips: case report and review.

A case is reported of a sterilisation clip which was discovered, three years after operation, to have migrated to the subcutaneous tissue. A review of current techniques of female sterilisation is given together with a discussion of other relevant accounts of clip migration. It is shown to be a rare event with no reported serious sequelae. There is no conclusive evidence to suggest that one type of clip is more likely to migrate than another.

Adult↗

PubMed2000

[Two cases with coil embolization following incomplete neck clipping].

We report two cases with embolization (coil embolization) using Guglielumi detachable coils of residual aneurysms following incomplete neck clipping. The first case, a 75-year-old woman suffered from a subarachnoid hemorrhage due to the rupture of a left internal carotid posterior communicating aneurysm in June, 1997. Neck clipping of the aneurysm was performed at day 1. Follow-up angiogram at day 7 showed a residual aneurysm involving the dome of the initial aneurysm. We performed coil embolization of the residual aneurysm following the angiogram. Almost complete obliteration of the aneurysm lasted during the follow-up period of two and a half years. The second case, a 71-year-old woman suffered from a subarachnoid hemorrhage due to the rupture of a right internal carotid posterior communicating aneurysm in May, 1999. Neck clipping of the aneurysm was performed at day 1. Follow-up angiogram at day 7 showed a residual aneurysm involving only a part of the initial aneurysm near the neck. Because no spontaneous thrombosis of the residual aneurysm was obtained after 2 months, we performed coil embolization of the residual aneurysm. Almost complete obliteration of the aneurysm lasted during the follow-up period of 7 months. These patients were discharged with good performance status. We consider the morphologic feature of the residural aneurysm to be most important for determining when to perform coil embolization of such residual aneurysms.

Aged↗

PubMed2000

[The effect of exogenous nitric oxide on endothelial dysfunction in two-kidney, one-clip renovascular hypertensive rats].

Previous studies have shown that hypertension causes endothelial dysfunction. To study the influence of exogenous nitric oxide(NO) on endothelial dysfunction produced by hypertension, we administered a non-depressor dose of nipradilol to two-kidney, one-clip renovascular hypertensive rats(2K1C). Sprague-Dawley rats underwent either sham surgery(G-1) or clipping of the left renal artery. From day seven, 2K1C were randomized into 3 groups, placebo treatment(G-2), nipradilol treatment(G-3,) and propranolol treatment(G-4). Urinary NO2- + NO3-(NOx) excretion (UNOx V) was measured 4 weeks after clipping, and then, acetylcholine(Ach), A23187, or sodium nitroprusside(SNP)-induced relaxation were measured in the aorta. Blood pressure was increased in G-2, G-3, and G-4 compared to G-1. UNOx V was lower in G-2, G-3, and G-4 compared to G-1, but UNOx V was higher in G-3 compared to G-2 and G-4. Although Ach or A23187-induced relaxation was significantly decreased in isolated artery from G-2, G-3, and G-4 compared with those from G-1. Ach- or A23187-induced relaxation was improved in G-3. SNP-induced relaxation did not differ among the 4 groups. These results suggest that exogenous NO from nipradilol reduces the endothelial dysfunction caused by hypertension without changing the blood pressure.

Acetylcholine↗

PubMed2001

[Can minimal arterial aggressions using non-penetrating mechanical clip suture prevent myo-intimal hyperplasia? Preliminary results].

SUBJECT: Vascular anastomosis is still associated with a significant rate of early (stenosis, thrombosis) and delayed (intimal hyperplasia) complications. Even though suture closure remains the most widespread standard procedure, many mechanical systems have been developed mostly using non penetrating clips, aiming to make the suture easier, to reduce the operating time and to reduce the scarring process of the arterial wall. We investigated the usefulness of non penetrating titanium Vascular Closure Staple (VCS) developed for peripheral blood vessels anastomosis, in a study on 20 rabbits with the small VCS system. MATERIAL AND METHODS: On 20 rabbits, 9 of the aortic sutures were done with VCS clips and 11 were done by standard closure. RESULTS: We found a significant improvement in the operating time of the closure (9 +/- 2 minutes versus 14 +/- 4 minutes), early and delayed (10 weeks) patency and the respect of the aorta diameter (0.248 +/- 0.01 centimetres versus 0.246 +/- 0.039 centimetres) and loss of surface (40.3 +/- 5.59% versus 45.6 +/- 6.34%). The main improvement is the reduced intimal hyperplasia (0.128 +/- 0.05 millimetres versus 0.198 +/- 0.032 millimetres. P=0.012). CONCLUSION: Arterial closure can be performed more rapidly with VCS clips than with suture closure, and with a marked reduced reaction of intimal hyperplasia. With those elements it is necessary to continue the experimental studies and to evaluate the VCS sutures at mean and long term.

Animals↗

PubMed2001

[Endovascular treatment of partially clipped aneurysms].

Partial clipping may occur in about 4% of surgical procedures. The risk of hemorrhage persists if the aneurysm is not completely excluded. Reoperations are often difficult, technically demanding and may carry an increased risk of complications. We report our experience with the use of Guglielmi detachable coils in the treatment of 9 aneurysm remnants. Five patients (55.6%) presented with a second subarachnoid hemorrhage. Eight of the aneurysms (88.9%) were located on the anterior circulation. Postoperative angiography showed complete occlusion in 8 cases (88.9%). Certain partial clipping types may assist and favor a stable coiling procedure allowing a more compact cast. On the other hand, the clip may interfere with the correct visualization of the neck. In this series, there was no neurological morbidity associated with the procedure. There were no hemorrhagic events during or after the embolization. Endovascular treatment of aneurysm remnants can be performed safely and may constitute a valuable option to microsurgery.

Adult↗

PubMed2001

Laparoscopic instrumentation: Linear cutters, clip appliers, and staplers.

Some of the most common forms of instrumentation and technology used laparoscopically include linear cutters, clip appliers, and staplers. The clip applier was the instrument that finally allowed the surgeon to be able to perform laparoscopic cholecystectomies. Staplers were developed quickly thereafter for tacking tissue together or for applying mesh for hernia repairs. Linear cutters became much more useful when the laparoscopic procedures became more advanced, and their application continues to expand. This report reviews the technology regarding these instruments and discusses clip appliers, linear cutter-staplers, and hernia staplers, which are currently available on the market. However, it should be noted that there remains a lack of peer-reviewed literature regarding the efficiency, efficacy, and cost of these instruments compared with that of laparoscopic suturing and knot tying.

Equipment Design↗

PubMed2001

[A giant thrombosed aneurysm of the anterior communicating artery which developed 18 years after clipping: a case report].

A 64-year-old man, who had undergone clipping surgery 18 years before for a ruptured anterior communicating artery (ACoA) aneurysm, presented with mild aphasia. A computerized tomography (CT) scan showed a subcortical hemorrhage in the left temporal lobe, and a high density large mass at the ACoA. Neuro-imaging study revealed a giant thrombosed ACoA aneurysm. Thrombectomy and neck clipping were successfully performed, using the interhemispheric approach. The patient was discharged without additional neurological deficits. A long-term follow-up study is thus considered necessary after neck clipping of a ruptured aneurysm.

Humans↗

PubMed1975

The use of tantalum clips in general surgery.

Two and a half years' experience of a new type of tantalum clip for ligation and indication in general surgery is reported. 200 cholecystectomies were followed up without noting any complications due to the use of the clips. Other indications for the use of tantalum clips are discussed.

Cholecystectomy↗

PubMed1996

Chronic angiotensin II antagonism with losartan in one-kidney, one clip hypertensive rats: effect on cardiac hypertrophy, urinary sodium and water excretion and the natriuretic system.

OBJECTIVE: To evaluate the effect of 7-day angiotensin II antagonism with losartan, an AT1-receptor antagonist, on systolic blood pressure, renal sodium and water excretion and on the atrial natriuretic factor system in one-kidney, one clip hypertensive rats. METHODS: The one-kidney, one clip hypertensive rats were separated into four groups: untreated (group 1), low-sodium diet (group 2), losartan (20 mg/kg orally, group 3) and low-sodium diet with losartan (group 4). All of the rats were kept in metabolic cages with urinary volume, urinary sodium level and water intake being evaluated daily. Body weight and blood pressure were assessed before treatment and at the end of the observation period. Renal glomerular and papillary atrial natriuretic factor receptors were assessed by radioligand binding experiments. RESULTS: No differences were observed either in body weight or in blood pressure between groups at the outset After 1 week, blood pressure was 184+/-4, 184+/-7, 170+/-5 and 78+/-8 mmHg, in groups 1, 2, 3 and 4, respectively. Group 3 rats failed to gain weight and had high urinary volume. In contrast, group 4 rats lost 15% of their original body weight. Both of the losartan-treated groups presented an apparently reduced cardiac hypertrophy but it was only clear in the low-sodium diet group. Both of the losartan-treated groups had high plasma renin activity. All of the three treated groups showed upregulation of glomerular and no changes in papillary atrial natriuretic factor receptors. Overall, mortality was 18, 27, 0 and 36% in groups 1, 2, 3 and 4, respectively. CONCLUSION: Losartan administration reduces blood pressure in one-kidney, one clip rats only when combined with a low-sodium diet. Both low-sodium diet and angiotensin II antagonism upregulate renal glomerular but not papillary atrial natriuretic factor receptors, suggesting a divergent regulatory mechanism.

Angiotensin Receptor Antagonists↗

PubMed2002

Coiling of cerebral aneurysm remnants after clipping.

OBJECTIVE: During the past decade, options for the management of aneurysm remnants after clipping have expanded. Advances in aneurysm coiling techniques and technology have allowed for more remnants to be treated safely. We present our experience with this approach and discuss its indications, limitations, and results. METHODS: We retrospectively reviewed the Northwestern Memorial Hospital experience with aneurysm coiling between January 1996 and June 2001. We identified five patients who underwent coiling for aneurysm remnants after clipping. We reviewed the clinical history, all follow-up notes, and all relevant imaging studies. We also reviewed MEDLINE for all articles published in the English language between 1990 and September 2001 that included patients treated with this approach. RESULTS: Complete to near-complete aneurysm occlusion was achieved in all five patients in our study. There was no permanent morbidity or mortality associated with the procedure in any of these patients. In the literature, we found seven articles that discuss 21 patients who were treated with coiling for their remnants. There were no permanent complications reported for these 21 patients. Adequate long-term follow-up in these 21 patients, however, is lacking. CONCLUSION: Complete aneurysm occlusion is the goal of aneurysm clipping. When this goal cannot be achieved safely, coiling of the remnant, if size and morphology are amenable, is a safe option that should be considered. Clinical and angiographic long-term follow-up of patients treated in this manner should be studied and reported.

Aged↗

PubMed1976

Laparoscopic sterilization with electrocautery, spring-loaded clips, and Silastic bands: technical problems and early complications.

Among 2283 patients, rates of technical failure, technical difficulty, and operative and early postoperative complications were evaluated for different methods of tubal occlusion at laparoscopy: electrocoagulation (980 cases), spring-loaded clip application (991 cases), and Silastic band application (312 cases). Rates of technical failure and technical difficulty at surgery were significantly higher (P less than 0.05) for the spring-loaded clip technique than for the electrocoagulation and Silastic band techniques. Mechanical and optical difficulties with the prototype spring clip applicator were the major sources of technical difficulties. Rates of operative (1.2%) and early postoperative (1.9%) complications were not significantly different for the three techniques of tubal occlusion. It is concluded that all three study techniques appear to be practical, and large, long-term, randomized, comparative studies to determine rates of failure and subsequent gynecologic problems are necessary to determine the best method of sterilization.

Electrocoagulation↗

PubMed1977

Laparoscopic sterilization with spring-loaded clips: double-puncture technique.

The application of a spring-loaded clip to each fallopian tube using a second-incision clip applicator is a safe and effective method of laparoscopic sterilization. The operation is quick and easy to perform and is suitable for use with local anesthesia. The method avoids the dangers of hemorrhage, for the clip only alters 3 mm of the fallopian tube and does not transect the tube or mesosalpinx. No pregnancies have followed the sterilization procedure. An intrauterine pregnancy has occurred after a reversal procedure in one patient.

Abdomen↗