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At least 937 records · Page 52Linked to original sources
PubMed2003

[A case of common bile duct stone formed around a surgical clip after laparoscopic cholecystectomy].

Laparoscopic cholecystectomy has now rapidly replaced open cholecystectomy. Rarely a calculus may arise from a metallic surgical clip migrated into the common bile duct (CBD) after this surgical procedure was performed. We report a 50-year-old man with CBD stone formed around a surgical clip, who had undergone a laparoscopic cholecystectomy because of acute calculous cholecystitis 14 months before. Abdominal CT revealed a single stone in mildly dilated CBD. A high density core within the CBD stone, was suspected to be a surgical clip. The stone was removed using a retrieval balloon catheter and basket after endoscopic sphincterotomy.

Cholecystectomy, Laparoscopic↗
PubMed1992

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.

Anastomosis, Surgical↗
PubMed2005

Bile leakage presenting as acute abdomen due to a stone created around a migrated surgical clip.

BACKGROUND: Surgical clips may migrate into the common bile duct after surgery for cholecystolithiasis leading to usually early or middle-term complications. CASE REPORT: A 31-year-old woman, 6 years after laparoscopic cholecystectomy, developed acute abdomen and choloperitoneum after rupture of a secondary bile duct and bile leakage. This complication was due to a solitary common bile duct stone. The stone was formed around a surgical clip that had migrated from the cystic duct remnant to the common bile duct. The patient underwent investigative laparotomy and, subsequently, an ERCP with stone extraction and clearance of the common bile duct. She was perfectly well at the follow-up after 14 months. CONCLUSIONS: Rupture of a bile duct and biliary peritonitis may be a delayed complication of laparoscopic cholecystectomy due to surgical clip migration and formation of a stone. Definitive treatment of the condition may be achieved through ERCP. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdomen.

Abdomen, Acute↗
PubMedDate not supplied

Successful closure of spontaneous esophageal perforation (Boerhaave's syndrome) by endoscopic clipping.

Endoscopic clips have been used mainly for control of gastrointestinal (GI) bleeding and occasionally for closure of GI perforations. However, closure of spontaneous esophageal perforation (Boerhaave's syndrome) by clipping has not been reported. We described successful non-surgical closure of spontaneous esophageal perforation by endoscopic clipping in a patient with bilateral pyopneumothorax and septicemia.

Diagnosis, Differential↗
PubMedDate not supplied

Endoscopic thoracic sympathetic block by clipping for recurrent palmar hyperhidrosis.

Postoperative complications of endoscopic thoracic sympathectomy may be troublesome in some patients. Between January 1998 and September 2002, a total of 16 patients with recurrent palmar hyperhidrosis underwent video-assisted thoracoscopic T2 and T3 sympathetic block. There were seven men and nine women, with a mean age of 21.1 years (range, 12-35 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the T2 sympathetic block for patients with still intact T2 ganglion using an 8-mm, 0 degrees thoracoscope. An additional T3 block should be given if patients received either previous T2 sympathectomy or elevated palmar temperature <1 degrees C after T2 sympathetic block. The mean operation time was 30 minutes. The level of sympathetic blocks were the T2 and T3 in five patients, only T2 block in four, patients, and only T3 block in seven patients. Improvement of palmar hyperhidrosis can be obtained in all patients. One patient received a reverse operation 12 days after the T2 and T3 clipping and obtained improvement of troublesome compensatory sweating and dry hands 1 day after removal of all clips. All patients obtained improvement of palmar hyperhidrosis without recurrence after a mean of 37.1 months of follow-up (range, 12-56 months). Endoscopic thoracic T2 with or without T3 sympathetic block by clipping is a safe and effective method in treating patients with recurrent palmar hyperhidrosis.

Adolescent↗
PubMedDate not supplied

Laparoscopic gastric wedge resection for Dieulafoy's disease following preoperative endoscopic localization with India ink and endoscopic clips.

BACKGROUND: Dieulafoy's lesion is a vascular malformation, usually of the stomach but occasionally of the small or large bowel. It is an uncommon, but clinically significant, source of upper gastrointestinal hemorrhage. Three cases have been reported in the literature of laparoscopic gastric wedge resection of these lesions by using intraoperative endoscopic localization. We present the only reported case of preoperative endoscopic localization of a Dieulafoy's lesion with India ink and an endoscopic clip before laparoscopic resection. CASE REPORT: We present an 82-year-old female patient who presented to the emergency department with 3 episodes of hematemesis. Esophagogastroduodenoscopy revealed an actively bleeding Dieulafoy's lesion in the fundus of the stomach along the greater curvature, which was controlled endoscopically. However, the patient had a recurrent episode of bleeding. Repeat endoscopy was performed and the lesion was tagged with 2 endoscopic clips and marked with India ink. A laparoscopic wedge resection was performed after the India ink was identified in the fundus. The patient did well postoperatively. CONCLUSION: Preoperative localization of a Dieulafoy's lesion with India ink and endoscopic clips before laparoscopic wedge resection is a feasible procedure. Therefore, no need exists for intraoperative endoscopy to aid in the localization, as previously reported.

Aged, 80 and over↗
PubMedDate not supplied

[Temporary clipping and cerebral blood flow in patients with cerebral aneurysms].

Regional cerebral blood flow (RCBF) was measured with cerebral aneurysms by the H2-inhalation technique during intraoperative occlusion test in 15 patients. Temporary clipping was followed by a decrease of RCBF below the critical values in most patients. Reperfusion at the removal of a clip from the internal carotid and middle cerebral artery induced a significant hyperemia (298 +/- 55 ml/100 g x min). At the same time, there was no increase in the frequency of postoperative complications due to temporary clipping. This suggests that their development is related to the duration of cerebral ischemia and the state of the blood-brain barrier.

Administration, Inhalation↗
PubMed1991

Sympathetic and renin-angiotensin system in conscious rabbits with two-kidney, one clip hypertension.

We attempted to clarify the contribution of the altered neural mechanism associated with increased angiotensin II to two-kidney, one clip (2K1C) hypertension on the 3rd and 35th days after renal artery stenosis. 2K1C hypertension was produced in 20 rabbits, and a sham operation was performed in 11 rabbits. Sarl, Ile8 angiotensin II (AIIA) infusion tests and baroreflex sensitivity determinations by bolus injection of phenylephrine were performed on the 3rd and 35th days after renal artery stenosis. The blood pressure was 12 mmHg higher in the hypertensive rabbits than in the sham operated rabbits on the 3rd day after clipping. The blood pressure returned to the control level during the infusion of AIIA. On the 35th day after clipping, AIIA-sensitive or AIIA-resistant hypertension developed. The blood pressure was higher in the AIIA-sensitive rabbits than in the AIIA-resistant rabbits (131 +/- 5 vs 116 +/- 4 mmHg, p less than 0.05). The baroreflex sensitivity was lower in the AIIA-sensitive rabbits than in the AIIA-resistant rabbits (1.8 +/- 0.3 vs 2.8 +/- 0.3 msec/mmHg, p less than 0.05). There was no difference in plasma norepinephrine between the two groups on either the 3rd or 35th day. Thus, impaired baroreflex sensitivity was found in the accelerated hypertension seen in the chronic phase of 2K1C hypertension. Neural mechanisms mediated by the peripheral sympathetic nervous system did not appear to contribute to the development of 2K1C hypertension.

Angiotensin II↗
PubMed1991

[Migrating clips; a complication following sterilization].

Almost twenty thousand laparoscopic sterilizations are performed in the Netherlands yearly. The use of clips (Filshie clips) is increasingly common and has replaced coagulation in many institutes. In spite of the fact that the method is known to provide a permanent form of contraception, women and gynaecologists are uneasy about the method, as a result of the publicity around some pregnancies having occurred after tubal sterilisation and the ensuing liability suits. The laparoscopic findings in two patients with migrating clips are presented. It is indicated how accuracy and documentation of the laparoscopic sterilisation may be increased. This is of utmost importance in view of the legal consequences of failure.

Adult↗
PubMed1990

Clips or sutures for herniorrhaphy wounds?

This study compares the pain experienced by fifty patients following bilateral herniorrhaphy using two different methods of wound closure. No significant difference was found between the use of Michel clips and interrupted monofilament nylon sutures. Clips were preferred by a significant majority of patients, probably because they cause less pain on removal. The use of Michel clips should not be limited by the belief that they cause more pain than conventional sutures.

Female↗
PubMed1990

[Morphologic and surgical indications for temporary partial occlusion of the inferior vena cava by soft clipping].

In the experiment performed on 72 dogs peculiarities of morphological changes in the posterior vena cava wall have been studied at a temporal disturbance of blood flow in it by means of a complete or partial ligation of the vessel with catgut, a complete or partial closing of the lumen of the vein by means of a wavy catgut clip, covered with glue MK-6. Predominance of the soft clipping at the temporal disturbance of the blood flow in the vein with the aim of prophylaxis of thromboembolism of the pulmonary artery has been demonstrated. At the soft clipping in the place of the vascular compression, the blood flow partially remains, thrombi in the lumen do not form, rough dystrophic and necrotic changes in the vein are absent, that is the organ preservation of the vein is ensured. In 1.5 months the vascular lumen is completely restored, and structure of its wall at the place of compression does not differ from the normal one.

Animals↗
PubMed1990

[A case of epidural hematoma occurring on the opposite site of craniotomy after clipping surgery performed on internal carotid giant aneurysm].

Postoperative epidural hematomas remote from the operating field are sometimes seen as a complication after ventricle drainage, ventricle-peritoneal shunt or suboccipital craniotomy. Reported here is a very rare case of epidural hematoma which occurred on the opposite site of craniotomy after clipping surgery performed on internal carotid giant aneurysm. A 43-year-old woman was admitted to our hospital because of progressive visual disturbance in her right eye for twelve months. Precise examinations of her right eye revealed deterioration of visual acuity (0.02) right temporal-hemianopsia and an optic disc atrophy. A computed tomography scan (CT) showed a suprasellar round mass which was homogeneously well enhanced. Right carotid angiogram disclosed a large internal carotid artery aneurysm directed supramedially. The aneurysm was explored in June 1988. The neck was clipped with Sugita's ring clips through right frontotemporal craniotomy. The patient recovered fully and extubation was performed soon after the operation. Neurological examinations revealed no abnormal findings. Two days after the operation, she gradually developed impairment of consciousness and nausea. CT scan showed mass effect caused by epidural hematoma over the left temporoparietal region contralateral to the craniotomy site. Evacuation of the hematoma was carried out urgently. She had a good clinical course and postoperative angiogram demonstrated disappearance of the giant aneurysm. She was discharged and returned home without new neurological deficits. We review literature, and discuss presumptive pathogenesis responsible for such unexpected postoperative epidural hematomas.

Adult↗
PubMed1989

Differential renal responses to atrial natriuretic peptide in two-kidney, one clip goldblatt hypertensive rats.

Bilateral renal clearance experiments were performed to examine the effects of synthetic rat atrial natriuretic peptide (ANP, atriopeptin II) on the arterial blood pressure (BP) and individual kidney function in anesthetized 2-kidney, 1 clip Goldblatt hypertensive rats (n = 14) and normotensive rats (n = 15). Bolus administration of graded doses of ANP from 2.5 to 10 micrograms/kg produced dose-related reductions in BP in hypertensive and normotensive rats. Despite profound reductions in BP, there were significant increases in glomerular filtration rate, urine flow, absolute and fractional excretion rates of sodium and potassium, osmolar clearance, and free water clearance in the nonclipped kidney, whereas no significant changes in these renal indices occurred in the clipped kidney. The enhanced renal responses were dose-dependent. The normal kidney responded to ANP with similar magnitude. When ANP was infused intravenously (0.3 microgram/kg.min i.v.) during 2 h, BP maximally reduced by 36 +/- 2 mm Hg (24 +/- 1%) in the hypertensive group and by 27 +/- 2 mm Hg (22 +/- 2%) in the control group. Again, there were distinct renal responses between the two kidneys of hypertensive rats. These results indicate that ANP effectively reduces BP and preferentially increases the excretory function of the nonclipped kidney without compromising the function of the clipped kidney in this hypertensive model.

Animals↗
PubMed1989

Clip appendectomy.

The clip appendectomy is an alternative to the classical suture appendectomy. The use of a new polymer clip facilitates this technique. During pelvic reconstructive surgery an appendectomy may be indicated when suspected appendiceal pathology (such as endometriosis) could adversely affect the surgical outcome. Clip appendectomy can reduce the operative time without increasing morbidity.

Appendectomy↗
PubMed1989

Paper clip stab wounds: four case reports.

Four prisoners recently evaluated at a county hospital sustained self-inflicted paper clip stab wounds of the abdomen on 22 occasions. Guidelines for management based on physical examination, abdominal films and wound exploration with paper clip extraction and short-term admission for observation have been successful in avoiding laparotomy in most instances. Evaluation and surgical treatment of penetrating abdominal injuries are controversial. Some authors propose mandatory laparotomy for all stab wounds violating the peritoneum, while others recommend selective management based on physical findings, local exploration of the wound and subsequent peritoneal lavage. Recently, four prisoners have inserted sharpened paper clips into and through the abdominal wall on 22 occasions, raising questions about the appropriate treatment of these injuries. These wounds differ from other stab wounds in several respects: 1) underlying psychiatric disturbances and the self-inflicted nature of the wound increase the difficulty of patient management; 2) attempts are often multiple, precluding repeated peritoneal lavage for evaluation; 3) the foreign body may be completely intraperitoneal; and 4) peritoneal penetration is similar to that incurred during a peritoneal tap with an 18-gauge needle. The differing presentations of these patients are reported, and a plan for management of these injuries is proposed.

Abdominal Muscles↗
PubMed1988

Comparison of MR imaging and CT in patients with intracranial aneurysm clips.

CT and MR imaging of the brain were performed without complications in 16 patients who had undergone surgery for a ruptured aneurysm with the use of nonferromagnetic Yasargil 316 or Sugita Elgiloy clips. MR was performed on a 0.3-T Fonar beta-3000M imaging system. The artifacts caused by the clips were smaller on MR than on CT, and, therefore, anatomic structures such as the brainstem and temporal lobes were better visualized on MR. Brain-tissue lesions corresponding to the frontotemporal surgical approach were seen with MR in seven patients and with CT in six. In three patients temporal-lobe lesions seen on MR were not seen on CT because of beam-hardening artifacts. Lesions unrelated to the region of surgery were seen with MR in nine patients and with CT in five. In conclusion, MR was safe and superior to CT both in demonstrating anatomic details and in detecting tissue lesions in patients with aneurysm clips.

Alloys↗
PubMed1987

Antihypertensive and bilateral renal responses to diuretics in 2-kidney, 1-clip Goldblatt hypertensive rats.

Experiments were conducted to assess the effect of furosemide or amiloride alone and a combination of both agents on each kidney in anesthetized 2-kidney, 1 clip Goldblatt hypertensive rats (n = 25). Intravenous infusion of furosemide alone (1.02 mg/kg.hr) significantly reduced the blood pressure by 14 +/- 5 mmHg. There were 6- to 10-fold increases in water, absolute sodium and fractional sodium excretions and a 2-fold increase in potassium excretion in the nonclipped kidney. A smaller but significant increase in the excretory function was also observed in the clipped kidney. There was no significant change in GFR of both kidneys. Indomethacin pretreatment (2 mg/kg) failed to significantly alter the vasodepressor and renal responses to furosemide in both hypertensive and normal rats. Removal of the renal artery clip from the hypertensive rats reduced the blood pressure by 12 +/- 3 mmHg and enhanced the function of the ipsilateral, unclipped kidney. Subsequent administration of furosemide further increased the excretory response. Administration of amiloride alone (2.4 mg/kg.hr) or with furosemide into hypertensive rats reduced the arterial pressure and increased excretion rates of urine flow and urinary sodium. Potassium excretion rate decreased bilaterally in amiloride treated rats but did not alter significantly in rats which received a combination of amiloride and furosemide. These results indicate that diuretics ameliorate the excretory function of both the stenotic kidney and the nonstenotic kidney and that the improvement of the kidney function is independent of prostaglandin. Furthermore, removal of the stenosis accentuates the beneficial effect of diuretics on the kidney.

Amiloride↗
PubMed1979

[Preoperative calculation for stereotaxic clipping of cerebral aneurysms].

Preoperative calculations employing geometric methods make it possible to determine the optimum site for forming the trephination opening and the position of the plane for parting the clips in operations of stereotaxic clipping. Some new special terms are suggested which are used in geometric constructions. The suggested method was applied in 23 operations on 20 patients with arterial and arteriovenous aneurysms of the brain treated by the method of stereotaxic clipping.

Arteriovenous Fistula↗