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PubMed1997

An alternative technique in the management of bullous emphysema. Thoracoscopic endoloop ligation of bullae.

STUDY OBJECTIVES: With the improvements in video-assisted thoracoscopic surgery, more older patients and patients with respiratory impairments are undergoing bulla ablation using new and costly technology. We evaluated the cost-effective technique of thoracoscopic endoloop ligation of bullae in patients with bullous emphysema. PATIENTS: From March 1992 through January 1996, 79 advanced age (mean age, 64 years) and oxygen dependency patients underwent thoracoscopic procedure using endoloop ligation for treatment of bullous emphysema. Clinical data were collected from chart review. Only patients with radiographically confirmed diagnosis of bullous emphysema were included in this evaluation. Thoracoscopic endoloop ligation of bulla was carried out under general anesthesia with double-lumen endotracheal tube and single-lung ventilation. RESULTS: Sixty-five patients (82%) exhibited subjective improvement in their symptom status at 3-month follow-up (from grade 2 or 3 to grade 1 or 2) according to the Modified Medical Research Council dyspnea scale. The mean duration of chest drainage was 6 days (range, 4 to 16 days). Average hospital stay was 9.5 days (range, 5 to 26 days). There was no postoperative death. A comparison of preoperative and postoperative functional evaluation was available in only 16 patients who showed an increase in FEV1 (from 0.85 to 1.02 L) and a decline in residual volume after operation. Complications include persistent airleak over 10 days in seven patients (8.9%), wound infection in three patients, and localized empyema in two patients. There was no recurrence after a mean follow-up of 21 months. CONCLUSION: These encouraging results have shown that thoracoscopic endoloop ligation of bulla has proved to be a safe, reliable, and cost-effective technique for bullous emphysema. With careful preoperative evaluation and meticulous postoperative care, many patients could be rehabilitated by endoloop litigation of the bullae.

Cost-Benefit Analysis↗
PubMed1979

A rational approach to ligation of patent ductus arteriosus in the neonate.

During a 23-month period, 25 premature infants underwent ligation of a patent ductus arteriosus performed in the neonatal intensive care unit utilizing a limited posterolateral muscle-retracting incision. This approach afforded adequate exposure with minimal surgical time and trauma. All infants manifested severe respiratory distress and congestive heart failure. Both standard and contrast echocardiographic studies were used for noninvasive preoperative evaluation. Echocardiographic study proved to be a highly reliable and sensitive indicator of ductal patency. Eight infants (32 percent) died at 8 to 225 days of age. The primary cause of death was progressive pulmonary disease with subsequent failure of multiple organ systems. Seventeen (68 percent) of the 25 infants survived to leave the hospital. Advantages of ligation of a patent ductus arteriosus in the neonatal intensive care unit include the elimination of problems of transportation (thermoregulation, ventilation, and loss of lines) and continuity of ongoing care and monitoring. The standard facilities of the neonatal intensive care unit proved completely satisfactory for ligation of a patent ductus arteriosus. Ligation in the neonatal intensive care unit is suggested to minimize potential complications of care in the operating room and transport of these critically ill infants.

Ductus Arteriosus, Patent↗
PubMed1985

Effect of surgery and efferent duct ligation on testicular blood flow and testicular steroidogenesis in the rat.

A moderate reduction in testicular blood flow was observed in both testes 24 h after unilateral efferent duct ligation without any corresponding change in testosterone secretion as indicated in the peripheral blood, in testicular venous blood, or in testicular tissue fluid. At 21 days a pronounced unilateral decrease in blood flow was associated with the extensive degeneration of tubules in the testis on the ligated side. These changes were also associated with decreased testosterone secretion by the testis on the ligated side, although Leydig cell function was not abolished since testosterone in the tissue increased rather than decreased. It is therefore concluded that testicular blood flow may play an important role in the changes of testosterone secretion that follow unilateral efferent duct ligation.

Animals↗
PubMed2005

Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices.

BACKGROUND: Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. PATIENTS AND METHOD: Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of São Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence. RESULTS: Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group), recurrence (26.7% vs 42.9%, respectively) and death related to any cause (21.7% vs 13.9%). In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8%) and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality. CONCLUSIONS: Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.

Adult↗
PubMed2006

[Common bile duct ligation as a model of hepatopulmonary syndrome and oxidative stress].

BACKGROUND: The hepatopulmonary syndrome is characterized by hepatic dysfunction and presence of dilated pulmonary vessels, with alterations in air diffusion that can be demonstrated in the experimental model of common bile duct ligation. AIM: To evaluate the oxidative stress in pulmonary tissue of cirrhotic rats with common bile duct ligation. MATERIAL/METHODS: We used 12 male Wistar rats weighing between 200-300 g divided in two groups: control (Co = 6) and cirrhotic (Ci = 6). We evaluated aminotransferases, arterial gasometry, lipoperoxidation and chemoluminescence), and antioxidant enzymatic activity with superoxide dismutase. The tissues analyzed for hepatopulmonary syndrome were cirrhotic liver and lung. RESULTS: The animals with common bile duct ligation showed alterations in the following aminotransferases: aspartate aminotransferase, Co = 105.3 +/- 43/Ci = 500.5 +/- 90.3, alanine aminotransferase, Co = 78.75 +/- 37.7/Ci = 162.75 +/- 35.4, and alkaline phosphatase, Co = 160 +/- 20.45/Ci = 373 +/- 45.44. The lipoperoxidation and the antioxidant response had significant differences between the groups when evaluated in lung (lipoperoxidation) Co = 0.87 +/- 0.3/Ci = 2.01 +/- 0.9, chemoluminescence Co = 16008.41 +/- 1171.45/Ci = 20250.36 +/- 827.82 superoxide dismutase Co = 6.66 +/- 1.34/Ci = 16.06 +/- 2.67. CONCLUSIONS: Our results suggest that in this experimental model of cirrhosis using common bile duct ligation, there is an increase in lipoperoxidation in pulmonary tissue as well as an increase in superoxide dismutase's antioxidant activity, suggesting a pulmonary injury caused by secondary biliary cirrhosis.

Animals↗
PubMedDate not supplied

The importance of the ligation of the inferior thyroid artery in parathyroid function after subtotal thyroidectomy.

UNLABELLED: We prospectively studied the effects of the ligation of the inferior thyroid artery (ITA) on postoperative hypoparathyroidism in 48 patients who underwent functional subtotal thyroidectomy. Patients were randomized into two groups: A, with bilateral ligation of the ITA and B, without ligation of the ITA. Parathyroid function was checked preoperatively and after surgery by clinical examination and measurement of total calcium, intact PTH, urinary calcium, and AMPc. RESULTS: A significant incidence of postoperative hypocalcemia occurred: 17% in group A and 13% in B on the 4th postoperative day. Six months later, the incidence was 5% in Group A and 0% in Group B. These differences were not statistically significant between the two groups, and neither were any of the other clinical and laboratory observations. CONCLUSION: The ligation of the ITA was not an important causal factor for the occurrence of postoperative hypocalcemia after subtotal thyroidectomy.

Adult↗
PubMed1987

Coronary artery ligation and reperfusion in rabbits made diabetic with alloxan.

The biochemical and functional changes associated with ligation (40 min) of the left circumflex coronary artery and subsequent reperfusion (60 min) in the rabbit made diabetic with alloxan were studied and compared with those of control animals. Measurement of haemodynamic parameters revealed that both left ventricular pressure and mean arterial pressure were significantly (P less than 0.05) decreased after ligation and reperfusion in the diabetic animals compared with controls. Analysis of subcellular organelle enzyme markers from the ischaemic tissue revealed that sarcolemmal Na+,K+-ATPase, mitochondrial ATPase and sarcoplasmic reticulum ATPase activities were decreased after ligation to the same extent in the diabetic and control animals. However, upon reperfusion, the recovery of mitochondrial ATPase activity was significantly (P less than 0.05) less in the diabetic animals than in the controls. Ion measurements revealed a significant (P less than 0.05) depletion of Mg in diabetic hearts before ligation, and this was augmented during reperfusion. In contrast, a significantly (P less than 0.05) higher calcium accumulation was observed upon reperfusion in the hearts of diabetic animals. Similarly, both tissue ATP levels and the ability of the mitochondria to generate ATP were depressed to a greater degree in the diabetic animals. Our results indicate, therefore, a greater susceptibility of the diabetic myocardium to ischaemic/reperfusion injury which in the clinical situation would exacerbate the problems associated with atherosclerosis and possibly contribute to the high mortality from cardiovascular complications in diabetic patients.

Adenosine Triphosphate↗
PubMed1996

Proximal ligation of large distal posterior inferior cerebellar artery aneurysm.

A 41-year-old male presented with vertigo, nausea, and vomiting suggesting a space-occupying lesion of the posterior fossa. Computed tomography (CT) and left vertebral angiography revealed a large distal posterior inferior cerebellar artery (PICA) aneurysm. Operation revealed the fusiform aneurysm was partially embedded in the medulla, preventing neck clipping or trapping of the aneurysm. Therefore, proximal ligation of the PICA was performed. The symptoms caused by the mass effect improved, and the aneurysm was not visualized by CT or angiography. Ligation of the PICA proximal to the choroidal point is not necessarily safe. In our case, ligation was distal to the tonsillomedullary segment from which the perforating arteries mainly arose, so the postoperative course was good without new neurological deficits. Proximal ligation is an effective treatment for distal PICA aneurysms manifesting as mass effect if other interventions are not possible.

Adult↗
PubMed1975

Renal blood flow and function in the rabbit after surgical trauma. IV. Effects of ureteral ligation.

After 1, 2, 4, 7, 14 and 21 days of ureteral occlusion, renal blood flow was measured on both sides by means of a dye-dilution method and the glomerular and tubular functions were evaluated by measuring the extraction of 51-Cr-EDTA and 125-I-Hippuran. The results showed an increase in the weight of the obstructed kidney parenchyma and indicated an incipient compensatory hypertrophy of the contralateral kidney after 14 days of occlusion. The blood flow to the occluded kidney was reduced on the first day after ligation and ranged in all experiments between 24% and 44% of the total renal blood flow, without correlation to the duration of stasis. The blood flow to the contralateral kidney was mostly above the average in the control group. A small glomerular and tubular extraction was noted in more than 50% of the ligated kidneys. The glomerular filtration rate and the clearance of Hippuran by the contralateral kidney were increased after one day of occlusion, but no relationship between the changes in renal function and the duration of ligation was revealed. It is concluded that ureteral ligation causes a decrease in the blood flow to the occluded kidney and an increase in that to the contralateral kidney. The function of the contralateral kidney increases initially, but thereafter only as a consequence of the compensatory hypertrophy which is evident around the 14th day post occlusion.

Angiography↗
PubMed1993

Rat renal functions during the first days post-bile duct ligation.

Renal functions during the early stage of hepatic damage before ascites formation were studied in adult female rats. Tubular and hemodynamic parameters were analyzed for 12 days after common bile duct ligation. The fractional excretion of water, sodium, and potassium increased from control values at every day studied. Glomerular filtration rate and renal plasma flow were found to be diminished on the fourth day. Renal plasma flow remained decreased while glomerular filtration rate was recovered on the sixth day after common bile duct ligation. Filtration fraction in both experimental groups (4 and 6 days) was higher than in control animals. These observations suggested a preferential efferent arteriole vasoconstriction that could be responsible for a blood flow redistribution to the medulla. This fact might cause the sodium diuresis with diminished urine-to-plasma osmolalities ratio. The onset of cortical vasoconstriction was confirmed by dopamine infusion to bile duct-ligated rats 4 days postsurgery. Hemodynamic and tubular parameters recovered to control values during dopamine administration. All the data point out diuresis and natriuresis as the earliest renal abnormalities in bile duct-ligated rats. This phenomenon could be associated not only to the cortical vasoconstriction proposed but also to another systemic modification associated to liver damage.

Animals↗
PubMed1988

Effect of partial portal vein ligation on hepatic regeneration.

To evaluate the effect of portal hypertension and diminished portal venous blood flow to the liver on hepatic regeneration, male rats were subjected to partial portal vein ligation and subsequently to a two-thirds partial hepatectomy. The levels of ornithine decarboxylase activity at 6 h after partial hepatectomy were greater (p less than 0.001) in the rats with prior partial portal vein ligation than in those without portal hypertension. The rats with prior partial portal vein ligation also had greater (p less than 0.005) levels of thymidine kinase activity at 48 h after partial hepatectomy than did those without portal hypertension. Hepatic sex hormone receptor activity was not affected by prior partial portal vein ligation either before or after partial hepatectomy. The reductions in both estrogen and androgen receptor activity observed in the hepatic cytosol after partial hepatectomy were similar to those observed in control animals. These data indicate that animals with portal hypertension having a diminished hepatic portal blood flow have a normal capacity to regenerate hepatic mass following a hepatic resection.

Animals↗
PubMed1997

Femoral artery ligation stimulates capillary growth and limits training-induced increases in oxidative capacity in rats.

OBJECTIVE: The purpose of this study was to assess the interaction of arterial insufficiency and exercise training on soleus and plantaris muscle capillarity and oxidative capacity in adult rats. METHODS: Arterial insufficiency was created by ligation (LIG) of the right femoral artery, and exercise training (TR) was performed on a rodent treadmill. The left hindlimb served as a normally (NORM) perfused control. Capillary:fiber ratio number of capillary contacts per fiber, and citrate synthase activity (CS) were evaluated in the plantaris (Plant) and soleus (Sol) muscles. RESULTS: In sedentary rats, CS was similar between LIG and NORM (Plant: 24.4 vs. 24.3 mumol.min-1.g-1; Sol: 16.6 vs. 16.9 mumol.min-1.g-1), but capillaries per fiber and capillary contacts per fiber were significantly elevated in the plantaris muscle of LIG (2.46 vs. 2.10 caps/fiber, 5.78 vs. 5.03 capillary contacts). CS was elevated in both limbs of TR but was lower in LIG than in NORM (Plant: 28.5 vs. 32.4 mumol.min-1.g-1; Sol: 21.1 vs. 24.9 mumol.min-1.g-1). Treadmill training did not significantly affect capillarity in NORM. However, muscles in the ligated limb of TR tended to have greater capillarity than comparable muscles in either NORM of TR of LIG in SED. CONCLUSIONS: These results demonstrate capillary proliferation in the plantaris but not soleus muscle of rat hindlimbs with femoral artery ligation. Capillarity and CS adaptations were not obligatorily related in LIG, and femoral artery ligation and exercise training appeared to have interactive effects on skeletal muscle capillarity.

Animals↗
PubMed1977

Measurement of CBF and carotid artery pressure compared with cerebral angiography in assessing collateral blood supply after carotid ligation.

Angiographic assessment of collateral circulation to the brain at the circle of Willis was compared with measurements of cerebral blood flow (CBF) and internal carotid artery pressure during temporary carotid clamping in the prediction of tolerance of unilateral carotid ligation as treatment for intracranial carotid aneurysms in 92 patients. From CBF studies it was predicted that a substantial number of patients (27%) would suffer severe cerebral ischemia if carotid ligation were carried out. No single angiographic feature provided this predictive information. Bilateral fetal type of posterior communication arteries were associated with significantly lower carotid artery back pressure on temporary carotid occlusion, and unilateral absence of posterior communicating arteries was related to llower CBF, but neither feature was associated with a signifiant reduction in the rate of successful carotid ligation. We believe that preliminary percutaneous digital corotid compression with electroencephalographic monitoring, followed by intraoperative measurement of the change in regional CBF and internal carotid artery pressure during temporary carotid clamping provides a safe method of selecting patients for carotid ligation. Carotid angiography with or without contralateral carotid compression is of little value in this respect.

Adolescent↗
PubMed1980

Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass.

Ten patients with intracranial internal carotid artery (ICA) aneurysms were managed by combining ICA ligation with an extracranial to intracranial bypass procedure. Nine of these grafts were proven patient by angiogram. One patient was unable to return for postoperative angiograms; his graft ahd appeared patent on physical examination. Seven aneurysms were intracavernous, two were giant carotid-ophthalmic aneurysms, and one aneurysm was at the intracranial bifurcation of the ICA. Despite occlusion cerebral blood flow (CBF) measurements of 20 ml/100 gm/min or less in six patients, only one patient was unable to tolerate ICA ligation. Three patients developed transient aphasia, but there were no permanent neurological deficits associated with the carotid occlusion. Seven patients had improvement in pre-existing extraocular palsies or visual field defects. Others remained stable. The combination of an extracranial to intracranial microvascular bypass procedure with ICA ligation seems to be an effective method of treatment for aneurysms near the base of the skull that cannot be obliterated by a direct intracranial approach. The addition of the bypass procedure permits ICA ligation in patients who would not otherwise have tolerated occlusion of that vessel. Intraoperative xenon CBF measurements are an important adjunct to the operation.

Carotid Artery Diseases↗
PubMed1976

Plasma zinc levels in nephrectomized and ureteral ligated rats.

The effect of nephrectomy and ureteral ligation on the plasma zinc levels of zinc-supplemented and unsupplemented rats was studied. Bilateral nephrectomy, and to a greater extent bilateral ureteral ligation, resulted in a significant lowering of plasma zinc in the unsupplemented rats. Sham operation caused a lesser but significant lowering of plasma zinc which was not different from the effect of unilateral nephrectomy or unilateral ureteral ligation. Adding zinc to the drinking fluid of the bilateral nephrectomized rats raised their plasma zinc levels to that of sham-operated controls, but had no effect on the plasma zinc levels of the bilateral ureteral-ligated rats.

Animals↗
PubMed2002

The experience of ligation of transverse or sigmoid sinus in surgery of large petroclival meningiomas.

The authors present the experience of ligation of transverse or sigmoid sinus in the surgical removal of petroclival meningiomas. We reviewed the medical records and venograms of 14 patients with petroclival meningiomas, in whom the intraoperative ligation of transverse or sigmoid sinus had been done at our hospital between 1986 and 1999. All patients passed the intraoperative test clamping of the sinus. The drainage pattern of confluence of Herophili was classified into four types: type A, confluence and equal drainage on both transverse sinuses; type B, confluence and non-dominant transverse sinus on the tumor side; type C, confluence and dominant transverse sinus on the tumor side; and type D, unilateral transverse sinus only. Among the 14 cases, four cases were in type A, five cases in type B, and two were type C. There was no evidence of brain swelling after intraoperative test clamping of the sinus for more than 30 min. None of the patients experienced postoperative complications related with sinus ligation. Our observation suggests that the transverse or sigmoid sinus ligation is tolerable to patients who show the drainage patterns of type A, type B, and type C, if the test clamping proves to be safe.

Adolescent↗
PubMed1992

The effectiveness of ligating or detaching ceca as an alternative to cecectomy.

Cecectomy (the surgical removal of ceca) is a technique that has been used to explore the nutritional and osmoregulatory role of the ceca in domestic fowl and other birds. The operation imposes a high level of physiological stress on a bird. The current study describes the effectiveness of ligating or detaching the ceca in young turkeys as an alternative to complete removal of the organ. Birds with ligated ceca showed less postsurgical depression and initiated feeding and other normal activities sooner than birds with detached ceca. Birds with detached ceca also had a significantly slower rate of weight gain 1 wk after surgery. Both surgically treated groups were more depressed than were sham-operated turkeys. Post-mortem examinations revealed that cecal detachment was more successful in actually separating the ceca from the rectum and in preventing flow of digesta in and out of the ceca. Evidence of growth of cecal stumps that remained attached to the rectum was found following both ligation and detachment. Post-mortem examinations revealed that in four birds both ligated or detached ceca left in the abdominal cavity became enlarged and filled with a dark, pasty, odorous substance. This increase in cecal size and volume of contents with time apparently indicates that some microbial metabolic activity continued in the cecal lumen. If so, this might have negative implications for studies that assume that such ceca are no longer functional.

Animals↗
PubMed2003

Changes in serum cytokine concentration: a morphological study of liver cirrhosis induced by common bile duct ligation in rats.

BACKGROUND: Liver cirrhosis is a diffuse hepatic fibrosis, and nodule formation. The transforming growth factor-beta 1 (TGF-beta 1) and interleukin-10 (IL-10) are very important cytokines in hepatic fibrogenesis. The aim of this study was to examine the relationship between the changes of the serum cytokines and morphological changes following common bile duct ligation in experimental rats. METHODS: Common bile ducts of fifty male Sprague-Dawley rats were ligated and seven male rats were set aside as controls. Five rats each were sacrificed in 1, 2, 4, 6, 8, and 10 experimental weeks. Light microscopic studies and liver function tests were performed during the above experimental weeks. The levels of serum TGF-beta 1 and IL-10 were analyzed by ELISA. Also, alpha smooth muscle actin (alpha-SMA) immunohistochemical stains were performed. RESULTS: On the eighth week after common bile duct ligation, most hepatic lobular areas had been replaced by proliferated bile ducts and fibrous tissue (typical biliary cirrhosis). Serum TGF-beta 1 levels between the control group and the common bile duct ligation group showed statistically significant changes. The alpha-SMA was stained at proliferated bile ducts. These findings were correlated with each other. CONCLUSION: Thus, this experiment may clarify our understanding of the mechanism in liver fibrogenesis. Also, indicated is a need to explore the therapeutic potential of these cytokines as anti-fibrotic agents.

Actins↗