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We describe the case of a fenestrated basilar artery aneurysm successfully clipped by means of a right presigmoid petrosal approach. Three-dimensional CT angiography enabled the surgeon to plan an approach to an aneurysm in this unique location, and the presigmoid petrosal approach was suitable for clipping of the aneurysm.
PURPOSE: To assess the diagnostic accuracy of multi-slice computed tomography (MSCT) angiography compared to digital subtraction angiography (DSA) in detecting residual or recurrent aneurysms in patients undergoing aneurysm clipping surgery. MATERIAL AND METHODS: Eight patients with nine aneurysms who had both MSCTA and DSA were included in the study. Two independent experienced neuroradiologists evaluated the examinations. RESULTS: Accuracy, sensitivity, and specificity of detecting residual or recurrent aneurysms on MSCTA were 0.80, 0.60, and 1.00, respectively. Positive and negative predictive values were 1.00 and 0.71, respectively. CONCLUSION: MSCTA is a promising technique for evaluating residual or recurrent aneurysms in patients undergoing surgical treatment of aneurysm with titanium clips.
The changes of Na,K-ATPase activity and its regulation have been investigated in the renal cortex of 1-clip-1-kidney hypertensive rat. Ouabain-sensitive Na,K-ATPase activity (Emax) and [3H]ouabain-binding site (Bmax) in the hypertensive rat were slightly increased than those in the control. The levels of Na,K-ATPase alpha 1- and beta 1-subunit mRNA of the renal cortex in hypertensive rat were more increased than those in the control. Their increases were repressed by actinomycin-D, but not altered or more increased by cycloheximide. These results suggest that the increase of Na,K-ATPase activities and ouabain binding sites in 1-clip-1-kidney hypertensive rat may be correlated with the increases of gene expression in transcription level and/or of mRNA stability of Na,K-ATPase.
We report the successful use of extracorporeal shockwave lithotripsy for the destruction of a renal stone that had formed around a surgical clip. The SWL led to passage of both the stone and the clip.
Proteins in the cytoplasmic dynein pathway accumulate at the microtubule plus end, giving the appearance of comets when observed in live cells. The targeting mechanism for NUDF (LIS1/Pac1) of Aspergillus nidulans, a key component of the dynein pathway, has not been clear. Previous studies have demonstrated physical interactions of NUDF/LIS1/Pac1 with both NUDE/NUDEL/Ndl1 and CLIP-170/Bik1. Here, we have identified the A. nidulans CLIP-170 homologue, CLIPA. The clipA deletion did not cause an obvious nuclear distribution phenotype but affected cytoplasmic microtubules in an unexpected manner. Although more microtubules failed to undergo long-range growth toward the hyphal tip at 32 degrees C, those that reached the hyphal tip were less likely to undergo catastrophe. Thus, in addition to acting as a growth-promoting factor, CLIPA also promotes microtubule dynamics. In the absence of CLIPA, green fluorescent protein-labeled cytoplasmic dynein heavy chain, p150(Glued) dynactin, and NUDF were all seen as plus-end comets at 32 degrees C. However, under the same conditions, deletion of both clipA and nudE almost completely abolished NUDF comets, although nudE deletion itself did not cause a dramatic change in NUDF localization. Based on these results, we suggest that CLIPA and NUDE both recruit NUDF to the microtubule plus end. The plus-end localization of CLIPA itself seems to be regulated by different mechanisms under different physiological conditions. Although the KipA kinesin (Kip2/Tea2 homologue) did not affect plus-end localization of CLIPA at 32 degrees C, it was required for enhancing plus-end accumulation of CLIPA at an elevated temperature (42 degrees C).
The efferent sympathetic activity of the heart was investigated during reversal of one-kidney, one-clip (1K,1C) hypertension in conscious, freely moving rats using changes in heart rate as an index. One-kidney, one-clip hypertensive rats presented marked tachycardia during the first 8 h after unclipping. Mean arterial pressure fell 28% 3 h after unclipping and 37% 8 h after unclipping. In a separate experiment, short term infusion (15 min) of sodium nitroprusside in conscious freely moving rats produced similar tachycardia in hypertensive and sham-operated rats. The present results indicate that the baroreceptor reflex of the heart was operating normally during the prompt reversal of hypertension after unclipping.
Dr. Skeggs demonstrated the lack of renin dependence in 1-kidney, 1-clip hypertension and elucidated some of the differences between that and Dr. Goldblatt's classic 2-kidney, 1-clip model of hypertension. Studies of these two different types of hypertension have led research in many new directions and helped to reveal the role of the renin-angiotensin system in hypertension and that system's interaction with sodium-induced vasodilation in both animals and humans. More recent research has investigated the processes behind essential hypertension and I present here the proposal that, due to nephron heterogeneity, essential hypertension in humans is parallel in its pathophysiologic processes to Goldblatt hypertension.
Angiotensin II (AII) is a vasoconstrictive peptide with hypertrophic and mitogenic effects on many cell types. Previous studies have shown that in vivo administration of AII in rats results in proliferation of, and phenotypic changes in, many renal cell populations, but in doses also causing hypertension. Thus, it was not possible to differentiate nonhemodynamic from hypertensive effects of AII. Therefore, we studied rats with renin-dependent, AII-mediated hypertension (the two-kidney, one-clip Goldblatt model; mean systolic blood pressure 238 +/- 48 v 140 +/- 6 mm Hg in sham-operated controls). The unclipped kidneys, which were exposed to high blood pressure, developed significant glomerular and tubulointerstitial injury, tubulointerstitial cell proliferation, dense focal interstitial monocyte-macrophage influx, increased deposition of types I and IV collagen, as well as increased cellular expression of desmin and actin, in tubulointerstitial areas when examined at 11 weeks. In contrast, clipped kidneys, protected from hypertension but with high local renin expression, had minimal abnormalities. These studies suggest that in this model increased renin, and presumably AII, does not mediate significant proliferative or phenotypic changes in the kidney in the absence of hypertension at 11 weeks.
BACKGROUND: This study assessed the concentration of rocuronium in the cerebrospinal fluid (CSF) of patients undergoing cerebral aneurysm clipping, and investigated whether the mode of administration (single bolus vs continuous infusion) influenced the CSF concentration. METHODS: Twenty patients with subarachnoid haemorrhage were randomly allocated to receive a bolus dose (bolus group), or a bolus followed by a continuous infusion of rocuronium (infusion group) (n=10 for each group). Arterial blood and ventricular CSF were sampled 2 h after the rocuronium bolus. Samples were analysed by liquid chromatography electrospray ionization-tandem mass spectrometry. RESULTS: Rocuronium could be detected in all the CSF samples. The mean (range) CSF concentration was 2.2 (0.9-4.6) ng x ml(-1) in the bolus group and 12.4 (2.4-34.6) ng x ml(-1) in the infusion group; P<0.01. CONCLUSIONS: This study demonstrated that rocuronium, normally not considered to cross the blood-brain barrier, is regularly found in the CSF of patients undergoing cerebral clipping; continuous infusion of the drug led to higher plasma and CSF concentrations than after a single bolus dose.
The effect on blood pressure (BP) of acute and chronic suppression of angiotensin (ANG) II was studied in the two-kidney, one clip hypertensive rat. Conscious, chronically catheterized rats were given a bolus injection of captopril (2.5 mg/kg) followed by a chronic infusion of either dextrose or captopril (1 mg/kg per h) lasting 5 days. Blood pressure was measured continuously by a computer technique. Following the acute injection of captopril, arterial BP fell from 165.1 +/- 19.4 mmHg (mean +/- s.d.) to a minimum of 137.6 +/- 23.3 mmHg after 15 min. Twelve hours after starting the chronic infusion of captopril, BP fell to a minimum of 112.5 +/- 19.4 mmHg. This was significantly lower than that after the acute injection of captopril. Blood pressure remained lower throughout the 5-day infusion ranging, on the 5th day, from 122.1 +/- 23.4 to 136.0 +/- 30.2 mmHg. In contrast, BP continued to rise in rats given dextrose chronically ranging, on the 5th day, from 163.6 +/- 23.8 to 180.4 +/- 22.5 mmHg. Both the fall in pressure after acute captopril and that after chronic captopril were related to pre-treatment levels of plasma renin concentration. These results suggest that in the two-kidney, one clip hypertensive rat ANG II, in addition to its acute vasoconstrictor property, contribute to the hypertension through a secondary effect, the mechanism of which is as yet uncertain.
In rats with severe two-kidney, one clip (2-K,1C) hypertension the time-course of changes in left and right ventricular (LV and RV) weight and LV dimensions was assessed following initiation of chronic treatment with minoxidil, enalapril or removal of the clipped kidney in relation to changes in blood pressure (BP) and sympathetic activity, as well as plasma and blood volumes. Minoxidil decreased BP markedly, but tolerance to the antihypertensive effect developed after 2-3 weeks. In contrast, enalapril or uninephrectomy caused a rapid and persistent normalization of BP. Significant increases in LV and RV weight occurred after 3-5 weeks of treatment with minoxidil. Left ventricular wall thickness decreased over the initial 1-2 weeks and then returned to untreated levels. Left ventricular internal dimensions showed an increase after 1-2 weeks of minoxidil, which persisted with more prolonged treatment. With enalapril, regression to normal occurred for both LV and RV weight within 1 week of treatment. Following uninephrectomy a more gradual regression took place and normal cardiac weight was not obtained until 3 weeks. Indices of sympathetic activity (plasma catecholamines, BP response to hexamethonium or heart rate) did not differ significantly in minoxidil treatment versus untreated hypertensive rats from 2 to 35 days of treatment. A significant increase in heart rate was found after 1 day of minoxidil and a decrease after enalapril. Plasma and blood volumes were elevated in minoxidil-treated rats from 7 to 35 days, as well as initially after uninephrectomy. Therefore, in 2-K, 1C hypertensive rats long-term treatment with minoxidil induces both RV hypertrophy and LV eccentric hypertrophy. Changes in cardiac volume load may play a major role in the differing effects of different antihypertensive therapies on cardiac hypertrophy.
We performed experiments in the two-kidney, one clip Goldblatt hypertensive dog to see whether angiotensin converting enzyme (ACE) inhibition could improve the sensitivity of hippurate renography in detecting renal artery stenosis. Ten dogs on a sodium-restricted diet were studied before and after induction of a renal artery stenosis. In the absence of renal artery stenosis nine dogs showed normal renograms before ACE inhibition, and one was false positive. During ACE inhibition all 10 renograms were normal. With a renal artery stenosis 50% of the renograms were false negative, whereas a 100% sensitivity was reached during ACE inhibition. The alterations induced by the ACE inhibition on the renograms were not related to changes in renal blood flow. In conclusion, ACE inhibition markedly improved the sensitivity of hippurate renography in the two-kidney, one clip dog.
OBJECTIVE: To examine the role of changes in renal hemodynamics and P-450 metabolites of arachidonic acid in the reversal of one-kidney, one clip (1-K,1C) hypertension in rats. DESIGN: The stimulus for the release of an antihypertensive lipid from the kidney is not known. This study examined whether cortical or papillary blood flow is altered after removal of the clip from the renal artery of 1-K,1C hypertensive rats, and the effects of blockade of the renal metabolism of arachidonic acid by P-450 with 17-octadecynoic acid (17-ODYA) on the fall in blood pressure. METHODS: Cortical and medullary blood flows were measured using laser-Doppler flowmetry. 17-ODYA (33 nmol/min) was infused directly into the renal artery to examine the effect of inhibition of renal P-450 activity on reversal of 1-K,1C hypertension. The renal metabolism of arachidonic acid in control and in 1-K,1C hypertensive rats was assessed by incubating microsomes with [14C]-arachidonic acid, the metabolites formed being measured using reverse-phase high-performance liquid chromatography. The antihypertensive effects of these P-450 metabolites of arachidonic acid were compared with those of medullipin I after intravenous administration in conscious spontaneously hypertensive rats (SHR). RESULTS: Cortical and papillary blood flow increased significantly and arterial pressure fell after unclipping the renal artery in the 1-K,1C hypertensive rats. 17-ODYA prevented the fall in blood pressure after unclipping. The production of epoxy- and dihydroxy-eicosatrienoic acids was elevated in microsomes prepared from the renal cortex of the 1-K,1C hypertensive rats. However, intravenous administration of these metabolites did not mimic the effect of medullipin I to lower arterial pressure in SHR. CONCLUSION: Elevations in renal cortical or papillary blood flow, or both, may stimulate the release of a P-450-derived antihypertensive lipid from the kidney after unclipping of the renal artery in 1-K,1C hypertensive rats. However, it is unlikely that this substance is a P-450 metabolite of arachidonic acid.
OBJECTIVE: To determine whether chronic treatment with benidipine, a calcium antagonist, leads not only to regression of left ventricular hypertrophy, but also to an improvement in coronary flow reserve and microvascular remodeling. DESIGN AND METHODS: Two-kidney, one clip Goldblatt hypertensive rats were assigned either to a benidipine-treatment group or to a group without treatment after their kidneys had been clipped for 4 weeks. Benidipine was administered to rats in the treatment group for 6 weeks. At the end of the treatment, the systemic hemodynamics and coronary blood flow were determined in conscious unrestrained rats by using nonradioactive colored microspheres injected through the left atrium. The coronary blood flow was determined in rats of both groups with the rats at rest and after near-maximal vasodilatation induced by carbochrome. For evaluation of the microvascular remodeling capillary density, the wall : lumen ratio of arterioles and perivascular fibrosis were quantified by using an image analyzer after fixation of heart tissue. RESULTS: Benidipine treatment lowered the blood pressure significantly with a decrease in total peripheral resistance, and the left ventricular mass decreased markedly compared with that of untreated hypertensive rats. The coronary flow reserve of the untreated hypertensive rats was lower than that of the controls, but benidipine treatment improved the coronary flow reserve. We found a significant decrease in capillary density, and significant increases in wall : lumen ratio and perivascular fibrosis in untreated hypertensive rats. These changes in microvasculature were improved by benidipine treatment. CONCLUSION: Taken together, these results suggest that benidipine exerts favorable effects as an antihypertensive drug by reversing cardiac hypertrophy and improving the coronary flow reserve and microvascular remodeling.
OBJECTIVE: To examine the effect of ZD7155, an angiotensin II receptor antagonist, on blood pressure, heart rate and occupancy of tissue angiotensin II receptor in two-kidney, one-clip Goldblatt hypertensive rats. METHODS: Goldblatt hypertension was produced in Sprague-Dawley rats. ZD7155 was administered orally at 3 mg/kg and blood pressure and heart rate were monitored for up to 48 h. In a second series of experiments, the rats were administered increasing doses of ZD7155 and monitored for 1 h. For each time and dose, rats were killed and their blood and tissues were collected. Tissue angiotensin II receptor binding was assessed by quantitative autoradiography in vitro. For a separate group of rats, the pressor response to 0.1 microg/kg angiotensin II was monitored before and after the administration of 3 mg/kg ZD7155. RESULTS: After oral administration of ZD7155, blood pressure was rapidly lowered and this lowering was sustained for up to 48 h. This effect was accompanied by sustained inhibition of angiotensin II receptor binding in the aorta, kidney and adrenal gland, together with an increase in plasma renin activity. Increasing doses of ZD7155 dose-dependently reduced blood pressure and inhibited angiotensin II receptor binding in the tissues. Degrees of inhibition varied among the different tissues and had different time courses. ZD7155 inhibited the pressor response to angiotensin II remarkably for 24 h. CONCLUSIONS: ZD7155 is a potent antihypertensive agent in two-kidney, one-clip Goldblatt hypertensive rats and this effect is accompanied by sustained inhibition of tissue angiotensin II binding.
OBJECTIVE: To compare the effects of chronic administrations of the angiotensin II antagonist losartan and of the angiotensin I converting enzyme inhibitor enalapril on renal function in sodium-depleted rats with one-kidney, one clip hypertension, and to examine the contribution of endogenous kinins to the effect of enalapril. METHODS: We administered enalapril and losartan (10 and 30 mg/kg per day, respectively) for 6 days to hypertensive rats that had been subjected to dietary sodium-intake restriction for 6 days prior to treatment and continued to be subjected to this restriction during treatment. In an additional group, administration of enalapril was combined with infusion of the bradykinin B2-receptor antagonist Hoe 140 (300 microg/kg per day subcutaneously via an osmotic pump). Renal function of anesthetized rats was assessed by using a clearance technique. RESULTS: Despite there being similar falls in arterial pressure, glomerular filtration rate (867 +/- 40 microl/min per g kidney weight in untreated rats) was decreased to a larger extent in enalapril-treated than it was in losartan-treated rats (284 +/- 29 versus 438 +/- 36 microl/min per g kidney weight, P < 0.01). Although infusion of Hoe 140 had no influence on the effect of enalapril on arterial pressure, the level of glomerular filtration achieved in rats of this group (545 +/- 55 microl/min per g kidney weight) was similar to that found in losartan-treated rats. No effect of either treatment on renal plasma flow was detected; as a consequence, the excessive decrease in filtration fraction observed for rats in the enalapril-treated group was corrected by concomitant administration of Hoe 140. Interestingly, administration of enalapril resulted in a greater loss of sodium than did administration of losartan (723 +/- 147 versus 308 +/- 57 micromol during 6 days), and this effect was abolished by infusion of Hoe 140 (353 +/- 42 micromol during 6 days). CONCLUSION: Administration of enalapril to sodium-depleted rats with one-kidney, one clip hypertension reduces their glomerular filtration rate to a greater extent than does administration of losartan despite these agents having similar effects on systemic blood pressure. Combined administration of enalapril and Hoe 140 has a less marked effect on glomerular filtration rate than does that of enalapril alone. This suggests that kinins play a role in the regulation of efferent arteriolar tone in this rat model.
BACKGROUND: Restoring renal perfusion pressure (unclipping) of one-kidney-one-clip renal hypertensive (1 K1C) rats normalizes mean arterial pressure (MAP) rapidly. This has been attributed to salt/volume losses or release of the putative renal medullary depressor hormone (RMDH). OBJECTIVE: To investigate the effects of endothelin receptor A and B (ET(A)/ET(B)) antagonism on unclipping. DESIGN AND METHODS: Telemetric devices were implanted in male Wistar 1K1C rats for measurement of conscious MAP. Hypertension was reversed by unclipping with the animal under brief anaesthesia. Seven rats were treated with the ET(A)/ET(B) antagonist, TAK-044 (two doses of 10 mg/kg intraperitoneally in 24 h), and eight rats received its vehicle. In order to investigate whether endothelin receptor antagonism could release RMDH under resting conditions, TAK-044 was administered to telemetered non-clipped intact and chemically renal medullectomized rats (BEA treatment). RESULTS: TAK-044 did not affect resting MAP, urine flow or sodium excretion in 1K1C rats. However, after unclipping, the TAK-044-treated group showed a more marked reduction in MAP during the first 24 h after unclipping (P< 0.01). TAK-044 also reduced urine flow and sodium excretion during the first 8 h after unclipping (P< 0.05). TAK-044 reduced resting MAP (P< 0.05) to a similar extent in intact and BEA rats. CONCLUSIONS: TAK-044 potentiated the reduction in MAP after unclipping, independently of changes in urine flow and sodium excretion. It also reduced MAP in normotensive rats--an effect that was not dependent on an intact renal medulla. Potentiation of the depressor response to unclipping by TAK-044 could be the result of an interaction of endogenous endothelin receptors with renal depressor mechanisms--possibly, the release, actions, or both, of the putative RMDH.
OBJECTIVE: The systemic and renal effect of omapatrilat was evaluated and compared with that of enalapril (30 and 10 mg/kg per day) in sodium-depleted, one-kidney, one-clip hypertensive rats. Participation of kinins was assessed by concomitant infusion of Hoe140 (300 microg/kg per day). DESIGN: Four weeks after clipping and uninephrectomy, dietary sodium was withdrawn for 2 weeks and rats were treated during the last 6 days of the study. METHODS: Tail-cuff pressure and sodium excretion were determined in conscious rats. Glomerular filtration rate (GFR) and renal plasma flow (RPF) were determined in anesthetized rats using clearance methods. The heart weight index was calculated. RESULTS: Omapatrilat was as effective as enalapril in reducing arterial pressure, and Hoe140 had no influence. Natriuresis increased to a similar extent with omapatrilat and enalapril. Hoe140 prevented the sodium loss only in enalapril-treated rats. Compared with untreated rats, GFR was reduced to a lesser extent by omapatrilat than enalapril (694 +/- 93 and 364 +/- 40 versus 848 +/- 43 microl/min per g kidney weight). Hoe140 had no influence on GFR in omapatrilat-treated animals but attenuated the reduction of GFR in enalapril-treated rats (662 +/- 22 and 543 +/- 62 microl/min per g kidney weight). Since RPF was not significantly affected, reduction of the filtration fraction was more marked in enalapril- than omapatrilat-treated rats (60 and 28%, respectively). Heart weight index was lower in omapatrilat-treated rats than in untreated or enalapril-treated rats. Hoe140 failed to significantly obliterate the antihypertrophic effect of omapatrilat. CONCLUSION: These results suggest that accumulation of natriuretic peptides due to neutral endopeptidase inhibition participated in the antihypertrophic effect of omapatrilat and tended to counteract the deleterious effect of ACE inhibition on renal function.