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Pulmonary angioplasty was successfully performed in two patients using the vascular clip system (VCS). The portion of the pulmonary artery which was directly invaded by primary lung cancer was partially resected. The VCS was used to quickly and easily repair the vascular defect. No bleeding was noted from the clipped vascular walls. Both patients had uneventful recoveries.
BACKGROUND: After open surgery for ruptured ACoA aneurysms, several patients who have achieved a favourable neurological outcome still exhibit significant cognitive deficits. The aim of this study was to investigate the cognitive performances in patients with ACoA aneurysms submitted to different therapeutic options such as endovascular treatment and surgical clipping. METHODS: We evaluated 37 consecutive patients in WFNS grade I or II, who underwent an early treatment (within 48 hours) of a bleeding ACoA aneurysm: 20 out of 37 were surgically clipped (group A) and 17 were treated with endovascular coiling (group B). These two groups were compared with 16 patients (group C) with subarachnoid haemorrhage and negative cerebral panangiography and with 18 volunteers (group D) without neurological or psychiatric disorders. All patients were neurologically intact at discharge and were in Glasgow Outcome Scale 1 at 6 months follow-up after SAH. All subjects were tested to assess selective attention, verbal, spatial and logical memory, frontal lobe executive functions, language and intelligence. Depressive symptoms and anxiety were also examined. FINDINGS: Selective attention, verbal and spatial memory, and intelligence tests didn't show any significant difference between the patients and the controls. Surgically treated patients showed a significant worse performance on the logical memory and on the frontal lobe executive functions compared to controls, while the endovascular group and the group C (not treated) showed a significant decrease only in the literal fluency score.Moreover, the surgical group showed a significant impairment in using grammatical and syntactical rules to produce sentences. No significant difference was found between the group B, C and controls. Treated patients were not significantly more depressive or anxious than controls. INTERPRETATION: Investigation of neuropsychological deficits can show an impairment, even in patients classified as good outcome by Glasgow Outcome Scale (GOS). The frontal lobe functions and language are impaired especially in surgically treated in comparison with controls, but no significant difference was found respect to the endovascular and no treated patients (group C).
The residual aneurysm rate is reported between 3,8% and 21% in the cases followed after intracranial aneurysm surgery. In the formation of the residual aneurysm, the risk factors include such structural characteristics as the size and lobulation of the aneurysm, posterior circulation, para-ophthalmic localisation and intra-operative rupture. The rates and causes of postoperative residual aneurysms were analyzed in 186 intracranial aneurysm of 160 patients, including the possible effects of temporary clipping on the residual rates. The entire series demonstrated a residual rate of 7%. It was found higher in the large lobulating aneurysms and intra-operative rupture. The residual rate considerably decreased to 4,2% in the aneurysms with temporary clipping. The determination of residual aneurysms, identification of any risk factors and elimination of recoverable factors would allow improvement of surgical results in the treatment of the intracranial aneurysms in the future. Moreover we believe that these will be useful in development of the indications for alternative treatment methods.
Compensatory sweating is a major complaint following endoscopic thoracic sympathetic surgery in treatment of palmar hyperhidrosis. T3 ramicotomy was applied in order to decrease compensatory sweating. From Oct 1999 to June 2002, forty patients underwent T3 sympathetic clipping (group I), and 68 patients underwent T3 ramicotomy (group II) to treat palmar hyperhidrosis. We retrospectively analyzed the rate of satisfaction, result of operation, and grade of compensatory sweating. In group I, 36 patients (90%) showed decreased sweating on both hands, 4 patients (10 %) persistent sweating on both hands. In group II, 46 patients (67.6%) had decreased sweating on both hands, 14 patients (23.5 %) had persistent sweating on both hands, and 8 patients (8.9 %) had persistent sweating in one hand. The rate of satisfaction was 82.5 % (33/40) in group I and 67.6 % (46/68) in group II with no significant statistic difference (p = 0.067). Excluding patients with persistent sweating postoperatively, the rate of compensatory sweating in group II was 67.4%, which was significantly lower than in group I 94.1%, with a p value of 0.003. Although the rate of persisting sweating after operation was high, T3 ramicotomy resulted in lower rate of compensatory sweating compared to T3 sympathetic clipping.
This is a report of 1,079 patients who underwent laparoscopic clip sterlization as of March, 1974. A one-year follow-up was obtained on 977 patients, or 90.5 per cent. Complications due to the clip technique appear limited to postoperative cramps for 24 to 48 hours in 26 per cent of patients. No ectopic pregnancies were detected. Pregnancies, when corrected for unsuspected existing pregnancies and surgical and manufacturing errors, occurred in 2 to 6 cases, for a method failure rate of 2 to 6/1,000. This report documents that experienced laparoscopists can perform this practice with local anesthesia, in combination with first-trimester abortion, and in hospital facilities other than an operating room.
Data analyzed from five comparative studies show a relationship between the technique of tubal occlusion and pain experienced by patients both at the time of the procedure and during the recovery period. During the procedure, the spring-loaded clip is the technique least likely and the tubal ring the technique most likely to be associated with pain. During the recovery period, both the spring-loaded clip and the tubal ring are associated with higher rates of abdominal or pelvic pain than is electrocoagulation. Differences in pain that occurred during the recovery period did not persist to the early follow-up visit.
A simple method of atraumatic removal of hemostatic clips is described employing the use of a diagonal cutting pliers. This method is equally effective for the removal of small, medium, or large hemostatic clips.
A series of 55 patients with partial caval occlusion by a smooth clip is presented with a follow-up period of 5 to 12 years. The clip provided continuing protection from fatal emboli, Persistent new postoperative leg swelling was present in 18 percent of patients but was generally well controlled with elastic stockings. In two patients with previous thromboembolism a postphlebitic syndrome proved troublesome. The quality of life led by patients was high and was enhanced by their knowledge of permanent protection against lethal embolism.
The effect of chronic angiotensin AT1 receptor blockade by a specific antibody on the development of two-kidney, one-clip renal hypertension was studied in Wistar rats. Renal artery constriction resulted in a fast and large increase in blood pressure in comparison with that of control rats. On the other hand, the pre-immunization of rats with a small part of the angiotensin AT1 receptor completely prevented the development of renal hypertension. We conclude that the development of two-kidney, one-clip renal hypertension can be blocked by a specific antibody raised against a part of the angiotensin AT1 receptor.
Acid extracts of individual lungfish pituitaries were fractionated by gel filtration on a Sephadex G-75 column and aliquots of column fractions were screened with a heterologous ACTH(1-39) radioimmunoassay (RIA). Two major, incompletely separated, peaks of ACTH-related immunoreactivity were detected. These peaks of ACTH-related material were resolved by reverse-phase high-performance liquid chromatography and were designated Peak A and Peak B. Peak A had a retention time more hydrophilic than synthetic human CLIP [ACTH(18-39)], whereas Peak B had a retention time similar to, but not identical with, human ACTH(1-39). Further analysis indicated that Peak A had an apparent molecular weight of 2.5K and an isoelectric point of 4.3. Based on these characteristics, Peak A would appear to be lungfish CLIP. Peak B had an apparent molecular weight of 4.5K. Based on chromatographic and immunological properties, Peak B would appear to be lungfish ACTH. The detection of these lungfish peptides by heterologous RIA indicates a high degree of primary sequence homology between lungfish and tetrapod ACTH-related polypeptides.
Ten groups of New Zealand white rabbits were used to study the effects of mild, chronic two-kidney, one-clip hypertension (HT) and long-term antihypertensive therapy on atherogenesis. Five groups were fed a normal diet (ND) over the 8-month study period; 2 groups, one of which was given enalapril, remained normotensive (NT) throughout the study. Of the 3 HT groups, one was hypertensive for 7 months; the blood pressures of the other groups were normalized after 2 months with enalapril, or by removal of the clipped kidney. The other 5 groups were similar except that they were fed at 0.1% cholesterol diet (CD). The results showed that: neither mild chronic HT nor abrupt, short-term HT exacerbated atherogenesis in the CD-animals; although fibromuscular vascular lesions were present in the aorta of normal-diet, HT animals no atheroma was observed; enalapril therapy had no effect on atherogenesis; enalapril therapy reduced the total weight and the cholesterol and triglyceride content of the aorta of the ND groups regardless of blood pressure history; the aortic triglyceride content, but not the cholesterol content, of the CD group, was reduced by enalapril; and although heart size was unaffected by either diet or blood pressure levels, the mitochondria volume per unit volume of the left ventricle was reduced in both NT-ND and HT-CD groups treated with enalapril.
Pinch of the nape of the neck, of mice, with a serrated clip, produces immobility and lack of responsiveness to noxious stimulation. In this study we attempted to determine whether clip application produces true blockade of nociception, independent of its immobilizing effect, and examined the level of the neuroaxis at which such an effect takes place. To this end nociception was measured using indices not requiring a motor response. Neck pinch eliminated the elevation of heart rate induced by noxious pinch of the tail without affecting heart rate by itself providing evidence for its analgesic effect. Direct evidence that neck pinch suppresses the transmission of noxious information is also provided. Neck pinch inhibits neural activity evoked by noxious peripheral stimulation while exerting minimal effects on the effects of nonnoxious stimuli. Thus, sensory evoked activity in the periaqueductal gray area, elicited by noxious electrical stimulation, but not innocuous stimuli, is inhibited by neck pinch. Similarly, neck pinch inhibits the response of spinal cord neurons to noxious but not nonnoxious stimulation. It, therefore, appears that neck pinch produces true analgesia by activating supraspinal systems which in turn acts to inhibit the transmission of nociception both at spinal and supraspinal levels.
Several methods are currently available for the treatment of giant intracranial aneurysms. In this report, we emphasize the technique of temporary trapping of the aneurysm followed by aspiration and collapse, and subsequent clipping. This method permits the preservation of the parent vessel and avoids the need for creating a microvascular bypass. Two cases are presented to illustrate this technique; in one case the patient had a giant middle cerebral artery aneurysm, and in the other a giant carotid-ophthalmic artery aneurysm. Both aneurysms were successfully clipped with preservation of the major vessels and a good result. On the basis of the configurations of their necks, giant aneurysms can be classified into three groups. The different methods of treating these aneurysms are reviewed with respect to this classification.
The operative technique used for a thrombosed vertebral artery-posterior inferior cerebellar artery aneurysm that was treated by combined transcerebellar (petrosal surface) thrombectomy and neck clipping is presented. Transcerebellar thrombectomy permitted the successful clipping of this thrombosed vertebral artery-posterior inferior cerebellar artery aneurysm via the cerebello-medullary cistern.
The natural history of incompletely clipped intracranial aneurysms is largely unknown. The authors present two cases of residual aneurysm filling after surgical clipping which were successfully managed by intravascular placement of platinum coils. Management of residual aneurysms and possible future role of transcatheter therapy are discussed.
Hemostatic clips were found in a patient's bladder four months after radical retropubic prostatectomy. A calculus, which had formed on one clip, caused acute urinary retention. Inadvertent enclosure of the hemoclips within the bladder intraoperatively and early intraurethral migration of the hemoclips are possible causes of this complication. Although this problem is rarely reported, hemoclips should be used sparingly, if at all, around the vesicourethral anastomosis.
This study examined the effect of diet-induced changes in prostaglandin synthesis on systolic blood pressure in one-kidney, one clip (1k, 1C) hypertensive rats and on the fall in blood pressure after unclipping. It tested the hypothesis that inhibition of prostaglandin synthesis exacerbates hypertension in this model and prevents complete reversal after unclipping. Rats with sustained hypertension within 8 weeks of renal artery clipping were fed synthetic diets supplemented to 20% of total energy with either safflower oil (linoleic acid) or a mixture of cod liver oil (90%) (containing eicosapentaenoic acid) and linseed oil (10%) (containing linolenic acid) for 4 weeks. The latter oil mixture resulted in a predictable reduction in kidney PGE2 and 6-keto PGF1 alpha (hydrolysis product of PGI2), aortic 6-keto PGF1 alpha and serum TXB2. However, at the end of 4 weeks dietary treatment there were no differences in systolic blood pressure between the two diet groups, and the blood pressure fall 24 hours after unclipping was similar. These findings therefore do not support a role for prostanoids in the maintenance or reversal of 1K, 1C hypertension.
An alternative method for electrically joining two rigid terminals within the flexible encapsulant of a prosthesis was sought after welded platinum wires suffered fatigue failure when implanted. The advantage of using spring clips is discussed and fatigue tests to compare spring-clips, made for one of two gold alloys, with welded Platinum or Pt/Ir wires are described. Some physical properties of the superior gold alloy are tabulated.