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At least 1,189 records · Page 66Linked to original sources
PubMed1994

Basilar artery dissection: an early postoperative complication of aneurysm clipping. Case report.

Recurrent subarachnoid hemorrhage (SAH) in the early period following successful clipping of a cerebral aneurysm is unusual. The authors report a unique case of distal basilar artery dissection and fatal SAH on the 6th day postoperatively. It is concluded that this complication was related to vascular trauma inflicted by repositioning the aneurysm clips during a seemingly uneventful procedure for a basilar artery tip aneurysm.

Adult↗
PubMed2002

Effectiveness of neurosurgical clip application in patients with aneurysmal subarachnoid hemorrhage.

OBJECT: Neurosurgical clip application is the standard method used to prevent rebleeding in patients with aneurysmal subarachnoid hemorrhage (SAH). The authors assessed the magnitude of the reduction in poor outcomes that accompanies a strategy aimed at surgery. METHODS: Three hundred forty-six consecutive patients with aneurysmal SAH were studied. The authors estimated the number of surgically treated patients with good outcomes who would have had poor outcomes as a consequence of rebleeding if clip application had not been performed (A). They also assessed the number of patients whose poor outcomes were exclusively caused by operative complications (B). Without an operation some of these patients would have had poor outcomes because of rebleeding (C). The authors represented the number of patients in whom poor outcome was prevented by surgery with the following formula: A - B + C. They assessed the relationships between baseline characteristics of patients and aneurysms and the likelihood that a patient underwent surgery, the risk of operative complications, and the risk of rebleeding. The absolute reduction in the risk of poor outcome found in patients who undergo surgery was 9.7%. This implies that to prevent a poor outcome in one patient, surgery had to be performed in 10. The relative risk of poor outcome following surgery compared with that after conservative treatment was estimated to be 0.81. Logistic regression analysis showed a statistically significant relationship between patient age older than 65 years and the occurrence of operative complications (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.03-6.03), between age older than 65 years and the likelihood of undergoing surgery (OR 0.12; 95% CI 0.07-0.2), and between a poor clinical condition at admission and the likelihood of undergoing surgery (OR 0.26; 95% CI 0.14-0.47). The authors did not identify any predictive factors for rebleeding when the Cox proportional hazard model was used. CONCLUSIONS: The beneficial effect of a treatment strategy in which the goal is surgery is substantial. If new treatment modalities such as embolization with coils are explored, these should carefully be compared with surgery before they are generally introduced.

Aged↗
PubMed1986

Vascular smooth muscle membrane potential in rats with early and chronic one-kidney, one-clip hypertension.

It has been suggested that the cell membrane of vascular smooth muscle in one-kidney, one-clip hypertension, and other forms of volume-dependent, low-renin hypertension, is partially depolarized due to the effects of a circulating ouabain-like factor, and that this depolarization is an important mechanism of the hypertension. Levels of circulating ouabain-like factors in early stages of volume-dependent hypertension are reported equal to, or greater than, those in chronic hypertension. Therefore, we measured intracellular membrane potential (Em) in vitro (37 degrees C, physiological salt solution) in vascular smooth muscle of the caudal artery from normotensive control rats (1K) and rats in the early and chronic stages of one-kidney, one-clip hypertension (1K1C). In 20 chronic 1K1C (4-6 weeks of systolic pressure greater than 140 mm Hg) the resting Em's (M +/- SEM) were -46.7 +/- 0.7 mV, compared to -50.9 +/- 0.6 for 20 1K (P less than 0.01). The delta Em due to 1 mM ouabain was attenuated in 10 1K1C compared to 11 1K (+5.4 +/- 0.9 and +10.0 +/- 0.7 mV, respectively; P less than 0.01). The Em's of the two groups after ouabain were the same. In contrast, in 16 early 1K1C rats (less than 7 days hypertension, average 3 days) compared to 15 appropriate 1K, there were no significant alterations in resting Em (-50.1 +/- 0.4 mV, compared to -50.5 +/- 0.5, respectively) and there were no differences in ouabain response. These results suggest a temporal dissociation between levels of humoral inhibitors and depolarization, and between depolarization and hypertension, and thus fail to support the hypotheses that there are casual relationships between these variables in volume-dependent, low-renin hypertension.

Animals↗
PubMed2005

Clinical application of clip-assisted endoscopic method for nasoenteric feeding in patients with gastroparesis and gastroesophageal wounds.

AIM: To report the clinical experiences in the application of clip-assisted endoscopic method for nasoenteric feeding in patients with gastroparesis and patients with gastroesophageal wounds, and to compare the efficacy of nasoenteric feeding in these two indications. METHODS: From April 2002 to January 2004, 21 consecutive patients with gastroparesis or gastroesophageal wounds were enrolled and received nasoenteric feeding for nutritional support. A clip-assisted method was used to place the nasoenteric tubes. Outcomes in the two groups were compared with respect to the successful rate of enteral feeding, percentage of recommended energy intake (REI), and complication rates. RESULTS: The gastroparesis group included 13 patients with major burns (n = 7), trauma (n = 2), congestive heart failure (n = 2) and post-surgery gastric stasis syndrome (n = 2). The esophageogastric wound group included eight patients with tracheoesophageal fistula (n = 2) and wound leakage following gastric surgery (n = 6). Two study groups were similar in feeding successful rates (84.6% vs 75.0%). There were also no differences in the percentage of REI between groups (79.4% vs 78.6%). Additionally, no complications occurred in any of the study groups. CONCLUSION: Nasoenteric feeding is a useful method to provide nutritional support to most of the patients with gastroparesis who cannot tolerate nasogastric tube feeding and to the cases who need bypass feeding for esophageogastric wounds.

Adult↗
PubMed1991

Use of paper clips in organizing unit dose fills.

A system is described that improves the quality of medication cart filling, increases the speed and quality of medication cart checking, and decreases omissions or incorrect dosage errors in medication administration. In a system where scheduled medications and PRN medications are kept in separate drawers, all of the patients' oral medications are attached by a paper clip to a long (2" x 10") card. The medications are organized so that each dose is separated, even when two tablets equal one dose. A medication given three times a day will have three consecutive but separate paper-clipped doses to the card. Nursing and pharmacy staff have an improved ability to check for compliance of medication administration at the end of each shift.

Drug Administration Schedule↗
PubMed1999

A retrospective study using nail clippings of rheumatoid susceptible alleles of HLA-DRB1 as a prognostic factor in early rheumatoid arthritis.

OBJECTIVE: To evaluate whether the number of susceptible factors influences disease progression in Japanese patients diagnosed with early rheumatoid arthritis (RA). METHODS: Fifty-eight Japanese outpatients (46 female, 12 male; mean age 48.9 yrs) with early RA of less than one year after onset were enrolled in the study. The criteria for early RA (Japanese Ministry of Welfare) were used. DNA was extracted from fingernail clippings and the gene frequencies of HLA-DRB1 alleles were investigated. The degrees of progression of (1) clinical symptoms, (2) laboratory findings, (3) radiographic changes, and (4) magnetic resonance imaging score were analyzed by a comparison of the above at time of diagnosis and at final examination (an average of 14 months after the time of diagnosis). RESULTS: The frequencies of the susceptible factors (S: 0101, 0401, 0404, 0405, 1001, and 1402) were 17, 3.4, 0.9, 29, 0, and 0%, respectively. The progression of inflammatory autoimmune activity, erosion incidence, and synovial proliferation severity in the S/S group was significantly more rapid than that in the other groups. In the disease activity at each time, the difference between the S/S group and the S/N group was significant, as was that between the S/S group and the N/N group, but the difference between the S/N group and the N/N group was not significant. CONCLUSION: Haplotyping of HLA-DRB1 using the patient's nail clippings may be useful as a prognostic marker for disease progression in early RA.

Adult↗
PubMed1999

[Vein of Galen aneurysmal malformation: multi-staged feeder clipping in two neonatal cases with intractable heart failure].

The authors reported the surgical experience of two cases of vein of Galen aneurysmal malformation in the newborn, whose congestive high-output cardiac failure was intractable. Along with the intensive care to clinical manifestations of the heart failure, multi-staged feeder clipping was carried out to decrease the high-flow shunt of the malformation. As stages going on, heart failure was relieved gradually and cathecolamines were weaned. Although certain retardation became apparent in both cases, they are showing satisfactory development in the long-term follow up. By the recent advancement of the embolization technique, the embolization appears to have already taken place the treatment of choice for this malformation. According to the neonatal evaluation score of Lasjaunias, the embolization would no longer be recommendation in neonates, whose general condition scored less than eight points. The authors believe, based on our two cases, that multi-staged feeder clipping is one of the effective modality of treatment in neonates of the vein of Galen aneurysmal malformation with severe multiorgan failure.

Cardiac Output, High↗
PubMed2000

[Intraaneurysmal embolization and parent artery trapping to treat a giant partial thrombosed vertebral artery aneurysm after surgical proximal clipping].

We encountered a case with a giant partially-thrombosed vertebral artery aneurysm successfully treated by endovascular trapping following a surgical parent artery clipping two years previously. The patient complained only of headache on her admission. Initial CT showed no subarachnoid hemorrhage, and MRI of the left anterior aspect of the pons showed flow void and hematoma. The angiogram showed fusiform dilatation of the left vertebral artery just proximal to the vertebral union. At first, the patient was treated by surgical proximal clipping of the left vertebral artery, under a diagnosis of arterial dissection. Her symptom improved and the angiogram showed a slight retrograde aneurysmal filling after the operation. Two years later, she complained of dysphasia, right hemiparesis, and hemidysesthesia caused by the compression of the brain stem. On MRI study, a partially-thrombosed giant aneurysm was detected in the left anterior aspect of the brain stem. The retrograde filling did not change remarkably on the angiogram. We performed the GDC embolization of the left distal vertebral artery and non-thrombosed residual neck with an assisting balloon positioned through the right vertebral artery to the basilar artery. After the embolization, the patient's neurological deficits caused by the compression of the brain stem disappeared. MRI study showed the mass volume reducing gradually over a two-years follow-up period. Treatment for a partially-thrombosed giant vertebral artery aneurysm is difficult and controversial. It is necessary to shut off the blood flow into the aneurysm completely, so we consider that endovascular trapping with intraaneurysmal embolization is the most effective procedure.

Embolization, Therapeutic↗
PubMed1998

[Direct surgical clipping the carotid-ophthalmic aneurysms through a extradural-intradural approach].

OBJECTIVES: To exlore the approach for treating carotid-ophthalmic aneurysms and introduce experience in reducing postoperative complications. METHODS: We treated 31 patients with carotid-ophthalmic aneurysms, which accounted for 8.3% of all intracranial aneurysms we encountered in 1994 and 1997, by direct surgical clipping. RESULTS: No operative death occurred and the rate of postoperative complications was 19%. All aneurysms were occluded and later confirmed by angiography. CONCLUSION: The direct clipping of aneurysms involving the carotid-ophthalmic artery is best treated by the extradural-intradural approach.

Adolescent↗
PubMed2000

[A case of ruptured aneurysm in a patient over 90 years of age, successfully treated by clipping with the use of a one-way ball valve for cisternal drainage].

The authors report a case of ruptured aneurysm in a patient in her 90's who was treated by clipping and returned to her independent life after discharge. A 91-year-old woman with a diagnosis of SAH of Hunt & Kosnik Grade III was treated using a conventional clipping operation with cisternal drainage. The cisternal drainage was assembled as a closed system using a newly developed one-way ball valve to regulate the CSF outflow. With this system the patient was able to take any posture and do any movement she wished, not being obligned to stay in bed. Early postoperative rehabilitation was able to be started to prevent pneumonia and muscular atrophy. The drainage was stopped on the 27th postoperative day when the CSF became clear. During the period of drainage, neither valve obstruction nor meningitis was noted. This valve system allows patients under cisternal drainage to move freely. It would be useful, especially when dealing with the elderly, to prevent unwanted complications often caused by postoperative restraint imposed by confinement to bed.

Aged↗
PubMed2000

[Thoracoscopic clipping of thoracic duct in a woman with persisting chylothorax].

A 78-year-old female had chest pain, radiating to the back, caused by a thoracic aneurysm of the aorta. A vascular prosthesis was sutured into place through a left-sided thoracotomy. Six days after the operation she developed chylothorax on the right side. Following 14 days of conservative management, chyle leakage persisted at a rate of 1500 ml per 24 hours. By thoracoscopy the thoracic duct was dissected and clipped, which stopped the chyle leakage. The patient recovered moderately well. Conservative measures, such as adjusted nutrition, are successful in 50% of patients. Clipping of the thoracic duct by thoracoscopy is a definitive and minimally invasive procedure to treat persistent chyle leakage.

Aged↗
PubMedDate not supplied

The Filshie clip for laparoscopic adnexal surgery.

BACKGROUND: Gynecologic endoscopic procedures are increasingly common and require the ability to control large vascular structures. METHOD: The Filshie clip is a silicone-lined, titanium occlusive device, originally designed and Food and Drug Administration (FDA) approved for surgical contraception. This device also has the potential for occluding vascular structures during laparoscopic surgery. EXPERIENCE AND RESULTS: We describe a salpingectomy, an excision of bilateral hydrosalpinges, and a salpingo-oopherectomy. We performed all procedures laparoscopically using this device as the primary modality for assuring hemostasis. CONCLUSION: The Filshie clip is a useful and economical device for assuring hemostasis during gynecologic endoscopic surgery.

Adnexa Uteri↗
PubMed2001

Electromyography in cycling: difference between clipless pedal and toe clip pedal.

The purpose of this study was to verify if there is electromyographic difference in biceps femoris (long portion), semitendinous, semimembranous and gastrocnemius (lateralis and medialis) muscles, using clipless pedal and toe clip pedal. Thirty seven triathletes answered a questionnaire about their preferred type of pedal, which showed that 5.4% used toe clip pedal and 94.6% used clipless pedal. Four male triathletes (age: 21.75 +/- 2.50 years old; cycling experience: 5.00 +/- 2.45 years; preferred cadence: 83.75 +/- 7.5 rpm) rode their own bicycles on a stationary roller at 100 rpm. The subjects performed one trial with each type of pedal. Bipolar surface electrodes placed on right lower limb picked up the EMG signal during 6 s. A band-pass filter (10-600 Hz) was used. Two muscles (semitendinous and semimembranous) presented lower activity with clipless pedal for all subjects. Biceps femoris and gastrocnemius lateralis presented lower activity with clipless pedal for three subjects. This led us to conclude that there is less electromyographic activity with the use of clipless pedal.

Adult↗
PubMed2001

Pollen on grass clippings: putting the suspect at the scene of the crime.

In a case of alleged sexual assault, the pollen content of samples of grass clippings and soil from the suspect's clothing and shoes was compared to that of a sample of grass clippings from the alleged crime scene (a grassy area) to determine whether or not the suspect had been at the scene. The clothing and shoe samples showed a very strong correlation with each other and with the sample from the alleged crime scene in the combination of the different types of pollen present, very strongly supporting the contention that the suspect had been at the scene.

Adult↗
PubMed2000

Combined treatment of cerebral aneurysms with utilization of clipping and coiling techniques.

Cerebral aneurysm clipping is a widely used and accepted treatment option. However, in some patients in severe condition (IV and V WFNS grade), with aneurysms of basilar and vertebral part of the arterial circulation and with high general surgical risk, direct aneurysm surgery can be a real technical and clinical problem. Therefore, low risk of coiling procedures gain more and more support. Out of 218 patients with diagnosed aneurysms, 60 were selected for coiling treatment, and 15 patients with multiple aneurysms were treated with both procedures. Special attention has to be addressed to the selection of patients for coiling procedures, especially in the cases when aneurysmal neck is directed accordingly to the main blood stream. The follow-up of the treatment effects is necessary. In the cases with growing aneurysms clipping is recommended. In the cases with stable size of the aneurysmal sack and visible coils compression, the coiling procedure is repeated. The coiling procedures can offer a valuable treatment option for selected patients. However, the maintenance of permanent occlusion of the aneurysm sack after coiling gives rise to some controversy.

Embolization, Therapeutic↗
PubMed2001

[Coronary artery bypass-grafting using interrupted anastomosis with the U-clip].

For coronary artery anastomosis, the continuous suture technique is generally used because it is easy to perform, there is less anastomotic leakage, and a shorter anastomotic time compared with the interrupted suture technique. However, with this technique there is a potential risk of anastomotic stenosis caused by the purse-string effect, which does not occur with the interrupted suture technique. The U-Clip device was designed to facilitate the interrupted suture technique in coronary anastomosis by eliminating the need for suture management, knot tying, and surgical assistance. The device employs the superelastic properties of nitinol and two components: 1. a needle/suture delivery system, and 2. a detachable nitinol self-closing wire. We used this device successfully for LITA-LAD anastomosis in MIDCAB. When this device is applied to small caliber conduits, such as the internal thoracic arteries and the gastroepiploic artery, the side-to-side anastomosis can reduce the anastomotic leakage more efficiently, since the coronary incision and graft incision can be perfectly matched. The U-Clip facilitates coronary anastomosis by simplifying and decreasing the amount of manipulation and complexity required in minimally invasive CABG procedures. Nitinol technology also has potential in robotic and endoscopic surgical applications.

Aged↗
PubMed2001

[The role of renal vasodepressor and natriuretic systems and ouabain-like factor on the early phase of hypertension in two-kidney, one-clip hypertensive rats].

Recent studies have shown that not only an enhanced renin-angiotensin system, but also relative volume retention might contribute to hypertension even in the early phase of a two-kidney, one-clip hypertensive model. To evaluate the role of renal depressor and natriuretic systems in the development of high blood pressure in the early phase of this model, we measured urinary excretion of kallikrein(uKAL), prostaglandin E2(uPGE2), and dopamine(uDA) in male Sprague-Dawley rats instrumented with a 0.2 mm diameter clip on the left renal artery(2K1C) and compared the results with those of sham-operated rats(sham). We also measured ouabain-like factor(OLF) in the plasma(pOLF) and urine(uOLF) in both groups. In 2K1C, systolic blood pressure(SBP) progressively increased and plasma renin activity was higher than the sham in the 3rd week. UDA and uPGE2 were not different between these groups, but uKAL attenuated in 2K1C in the 1st and 3rd week compared to the sham. There was a negative correlation between %delta SBP and %delta uKAL. On the other hand, uOLF increased in 2K1C in the 1st, 2nd and 3rd week compared to the sham. There was a positive correlation between SBP and uOLF. And pOLF was higher in 2K1C than in the sham. Furthermore there was a negative correlation between %delta uKAL and %delta uOLF. These results indicated that even in the early phase, suppression of the renal kallikrein-kinin system would contribute to high blood pressure in part, and OLF might play a compensatory role against the impaired natriuretic system in the kidney. However, OLF might contribute to blood pressure elevation through vasoconstriction in 2K1C.

Animals↗