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PubMed1985

Role of sodium balance on maintenance of blood pressure in the chronic phase of two-kidney, one-clip hypertension.

Blood pressure and sodium balance have been studied after unclipping, nephrectomy and sham operation of ischemic kidney in the chronic phase (16 weeks) of two-kidney, one clip hypertension. In hypertensive rats the fractional excretion of sodium was 85.5 +/- 2.3% and blood pressure (BP) was significantly increased (187.1 +/- 4.5 mmHg, p less than 0.001). Removal of either the constricting clip or ischemic kidney induced a decrease of BP to normal level whereas sham operation did not produce any change. However, rats submitted to these three experimental manipulations showed, at 1, 2, 3 and 4 days, and at 3 weeks, similar changes in sodium excretion. In the groups with unclipping or nephrectomy of ischemic kidney, water intake was less and urine volume smaller than in the sham operated group. These results suggest that a positive sodium balance is not important to maintain hypertension at this stage and that changes in sodium balance, after both unclipping and nephrectomy of ischemic kidney, have no influence in BP normalization.

Animals↗
PubMed1982

[Aneurysm of anterior communicating artery associated with aortitis syndrome--a treated case by aneurysmal neck clipping (author's transl)].

A rare case of the cerebral aneurysm associated with aortitis syndrome was reported. It seems to be the first case in which neck clipping was successfully performed for aneurysm of the anterior communicating artery. The patient was a 48-year-old female afflicted with pulseless disease. She was admitted to Iwate Central Hospital with severe headache, vomiting and unconsciousness on November 16, 1980. Her radial pulse was faint on the right side. The left carotid angiography revealed an aneurysm in the anterior communicating artery, and neck clipping of the aneurysm was performed 17 days after the onset. The right serial brachiocephalic arteriography revealed occlusion of the right brachiocephalic artery and the right common carotid artery. The serial aortography revealed stenosis of the left common carotid artery and the left vertebral artery. In the literature, 4 cases of those 7 cases associated with aortitis syndrome had aneurysms at the basilar bifurcation or basilar top. It seems to be the reason that the vertebral artery outlasts longer in aortitis syndrome. In our case, we can relate the aneurysmal formation of the anterior communicating artery to the hemodynamic overload of the left A1. General anesthesia in such cases was discussed.

Aortic Arch Syndromes↗
PubMedDate not supplied

[Laparoscopic sterilization using tubal rings and clips].

From 1978 to April 1980, 36 laparoscopic sterilization procedures were completed at the Gynecological Department in Maribor. For tubal occlusion in 16 cases Tupla clips and in 20 cases the Tubal Falope ring were used. It appears that the incidence of complications and other technical difficulties is somewhat more frequent with clips. There have been no pregnancies in all these cases.

Adult↗
PubMed1982

Evidence for a sodium-induced activation of central neurogenic mechanisms in one-kidney, one-clip renal hypertensive rats.

The mechanisms sustaining high blood pressure in conscious one-kidney, one-clip Goldblatt rats were evaluated with the use of SK&F 64139, a phenylethanolamine N-methyltransferase inhibitor capable of crossing the blood-brain barrier and of captopril, an angiotensin converting enzyme inhibitor. The rats were studied 3 weeks after left renal artery clipping and contralateral nephrectomy. During the developmental phase of hypertension, two groups of rats were maintained on a regular salt (RNa) intake, whereas two other groups were given a low salt (LNa) diet. On the day of the experiment, the base-line mean blood pressure measured in the LNa rats (177.4 +/- 5.2 mm Hg, mean +/- S.E., n = 15) was similar to that measured in the RNa rats (178.7 +/- 5.4 mm Hg, n = 16). SK&F 64139 (12.5 mg p.o.) induced a significantly more pronounced (P less than .001) blood pressure decrease in the RNa rats (-25.6 +/- 3.6 mm Hg, n = 8) than in the LNa rats (-4.3 +/- 3.3 mm Hg, n = 7) during a 90-min observation period. On the other hand, captopril (10 mg p.o.) normalized blood pressure in LNa rats (n = 8), but produced only a 13.4 mm Hg blood pressure drop in RNa rats (n = 8). RNa rats treated with SK&F 64139 were found to have decreased phenylethanolamine N-methyltransferase activity by an average 80% in selected brain stem nuclei when compared with nontreated rats. No significant difference in plasma catecholamine levels was found between the RNa and LNa rats. These results suggest that, in this experimental model of hypertension, the sodium ion might increase the model of hypertension, the sodium ion might increase the vasoconstrictor contribution of the sympathetic system via a centrally mediated neurogenic mechanism while at the same time it decreases the renin-dependency of the high blood pressure.

Animals↗
PubMedDate not supplied

[Stereotaxic clipping of cerebral arteriovenous aneurysms].

The method of stereotaxic clipping was used in the surgical treatment of 14 patients on whom 16 operations were conducted for clipping of the afferent vessels of arteriovenous aneurysms. A stereotaxic atlas was used for the first time to determine the localization of the aneurysms and the structures they occupied. In 12 patients the aneurysms were found to be unsuitable for radical operation. Besides angiography, examination of the volumetric cerebral blood flow was conducted by the modified Kety and Schmidt method to appraise the eficacy of the operation. The examination of 5 patients showed marked (approximately by half) decrease in the bloodflow after operation in 3 patients and its normalization in 2 patients.

Adolescent↗
PubMed1978

Late thrombosis of middle cerebral artery following clipping and coating of aneurysms.

Twenty days after clipping and coating with Aron Alpha (ethylcyanoacrylate) of two adjacent middle cerebral artery aneurysms, the patient developed a complete thrombosis of the parent vessel at the site of the aneurysms. The routine postoperative angiograms on the seventh day after surgery had revealed a patent middle cerebral artery. The possible roles of Aron Alpha and multiple Heifetz clips are discussed.

Cyanoacrylates↗
PubMed1982

[Cancer of the kidney with inferior caval thrombus. Value of a temporary caval clip].

In renal cancers with malignant thrombus in the inferior vena cava, extension and migration of the thrombus towards the right cardiac cavities may be prevented for a long time by the efferent flow of the hepatic veins acting as a haemodynamic barrier. The authors describe a new technique in which a temporary caval clip is placed in a downstream position without opening the right atrium. After thrombectomy and enlarged nephrectomy the clip is removed and a classical barrier upstreams of the renal veins/vena cava junction is installed.

Abdomen↗
PubMed1980

Effect of magnesium sulfate on platelet deposition in rabbits following temporary arterial occlusion with surgical clips.

The effect of magnesium sulfate on thrombus formation in vivo was studied by scanning electron microscopy utilizing the model of endothelial damage by temporary arterial occlusion with a Heifetz clip. Examination of arterial segments compressed by the surgical clip for 30 minutes, followed by 2 hours of reflow, revealed marked attachment of platelets and deposition of erythrocytes, with very few leukocytes, to exposed subendothelial tissues. This thrombotic deposition protruded as much as 150 mu into the vascular lumen (15% of luminal diameter). By contrast, in animals pretreated with magnesium sulfate, this deposition was limited to isolated areas of single or very few platelets with few erythrocytes or leukocytes. The difference in overall quantity of thrombus formation between nontreated and magnesium sulfate-treated groups was much less obvious after 24 hours; however, fewer leukocytes and erythrocytes were seen to be attached to the platelet carpet in the treated group as compared with the nontreated group. The effect of magnesium sulfate on the overall quantity of thrombus formation corresponded inversely to the measured levels of serum magnesium in these groups.

Animals↗
PubMed1980

[Indications of the different routes of inferior vena cava for inserting the clip of Adams De Weese (author's transl)].

Partial occlusion of inferior vena cava with clip of Adams De Weese is now currently performed in cavo-iliac thrombosis. The authors recall technical modalities for inserting clip and they try to bring to light the indications of each modality according to following parameters: upper level thrombosis, state of abdominal cavity, general condition of the patient and researched result: temporary or definitive artial oclusion, with or without associated thrombectomy. In localizations under renal veins, a definitive partial occlusion is indicated by sub-mesocolic way, eventually retro-peritoneal way in case of poor risk; it is a fact that associated thrombectomy will be realized easily, only by transmesenteric and submesocolic way. In localizations above renal veins, the authors think that transpericardiac way which allow temporary occlusion and thrombectomy of retro-hepatic part of vena cava is indicated.

Humans↗
PubMed1994

Cardiovascular hypertrophy in one-kidney, one clip renal hypertensive rats: a role for angiotensin II?

OBJECTIVE: To investigate the role of angiotensin II (Ang II) in cardiovascular hypertrophy in the Goldblatt one-kidney, one clip (1-K, 1C) renal hypertensive rat. METHODS: Six-week-old Wistar-Kyoto (WKY) rats underwent uninephrectomy and left renal artery clipping. After surgery, rats were treated with perindopril, an angiotensin converting enzyme (ACE) inhibitor, or losartan, an Ang II type 1 (AT1) receptor antagonist, for 4 weeks. Untreated 1-K, 1C rats and uninephrectomized (sham) rats served as controls. RESULTS: The rise in systolic blood pressure in the perindopril-treated and losartan-treated rats was not significantly different from that in the untreated 1-K, 1C group throughout the treatment period. At 4 weeks after surgery the heart weight:body weight ratios of the untreated 1-K, 1C and losartan-treated 1-K, 1C groups were significantly greater than for sham-operated normotensive rats and hypertensive perindopril-treated rats. The total number of smooth muscle cells in the thoracic aortae of the 1-K, 1C untreated, losartan-treated 1-K, 1C and sham groups were similar. However, after treatment the aortae of the perindopril-treated group contained significantly fewer smooth muscle cells. The medial cross-sectional wall area and wall: lumen ratio were similar in the 1-K, 1C untreated and perindopril-treated 1-K, 1C groups. CONCLUSION: These results suggest that Ang II, via its effects on cardiac and vascular AT1 receptors, does not contribute to the development of cardiovascular hypertrophy in the 1-K, 1C rat. Attenuation of cardiac and vascular growth after ACE inhibition appears to be mediated by mechanisms independent of the actions of the renin-angiotensin system.

Angiotensin II↗
PubMed1994

Sodium but not chloride ion modulates left ventricular hypertrophy in two-kidney, one clip hypertension.

OBJECTIVE: To assess the role of dietary sodium with or without chloride on the development of hypertension and left ventricular hypertrophy. METHODS AND RESULTS: Forty-nine male Sprague-Dawley rats with two-kidney, one clip hypertension were fed three different diets for 4 weeks after clipping: free access to sodium chloride, sodium citrate or sodium-free diet. Sham-operated rats were used as controls. The final conscious systolic arterial pressure was similar in all hypertensive groups, regardless of diet. A similar increase in left ventricular mass was observed in the rats on the sodium chloride and sodium citrate diets, whereas left ventricular hypertrophy was strikingly attenuated in the rats on the sodium-free diet. CONCLUSION: Dietary sodium restriction prevented the development of left ventricular hypertrophy without affecting consistently the final level of hypertension. Also, the anion associated with sodium had no influence on the level of arterial pressure and left ventricular mass when compared with rats maintained on sodium chloride. It is suggested that dietary sodium itself might be an important modulator of the left ventricular response to hypertension.

Animals↗
PubMed1994

Heterogeneity of vascular DNA synthesis in response to the development of Goldblatt two-kidney, one clip hypertension.

OBJECTIVE: To examine the changes in the rate of DNA synthesis in the aorta and mesenteric and subcutaneous resistance arteries during the development of renovascular hypertension. METHODS: Goldblatt two-kidney, one clip hypertensive and sham-operated control rats were studied 3, 7, 14 and 28 days after surgery. DNA synthesis was measured as the hourly rate of [3H]-thymidine incorporation into the DNA. RESULTS: Three days after renal artery constriction there was a significant increase in the DNA synthesis in both the aorta and the mesenteric vessels, although the blood pressure was not changed. DNA synthesis was elevated during the development of hypertension, but returned to control levels after 28 days when the blood pressure had reached a plateau. By contrast, there was no increase of DNA synthesis in the subcutaneous vessels at any time after renal artery constriction. The plasma renin concentration also was increased after 3 days in the clipped rats and remained elevated throughout the study. There were no significant changes in the blood pressure, the plasma renin concentration or the rate of vascular DNA synthesis in the sham-operated control rats. CONCLUSIONS: These data indicate that there are regional differences in the vascular response to the induction of renovascular hypertension and that in some vascular beds an increase in DNA synthesis precedes the rise in blood pressure.

Animals↗
PubMed1993

Laparoscopic hernia repair: use of a fenestrated PTFE graft with endo-clips.

A prospective study of 15 patients undergoing elective laparoscopic herniorrhaphy was performed using the introduction of a polytetrafluorethylene (PTFE, GORE-TEX) patch fenestrated around the edges to facilitate the use of an Endo-Clip applier. Patient tolerance was increased, and time lost from work was reduced. Two patients treated for prostatitis resumed sexual activity within the first 10 days with no recurrences or intra-abdominal infections. Fenestration of the PTFE patch was possible without fraying the material and without compromising the strength of the patch. The Endo-Clip applier secures the patch to the ligamentous structures. Initial cases were followed for 6 months.

Adult↗
PubMed1993

Anesthetic management of cerebral aneurysm clipping during pregnancy: a case report.

A 35-week pregnant female presented emergently for clipping of a cerebral aneurysm under general anesthesia. The patient was neurologically stable with an active fetus. Anesthetic goals for this patient included maintenance of uteroplacental perfusion, fetal well-being, and maternal well-being. Maternal monitoring consisted of invasive arterial blood pressure, central venous pressure, and urine output, in addition to the standard monitors for anesthesia. Fetal monitoring consisted of fetal heart rate by external Doppler and uterine activity by external tocometer. Anesthesia care was directed at ensuring optimal maternal and fetal well-being. The aneurysm was clipped, and the patient emerged from anesthesia without neurological deficits. No uterine activity was noted intraoperatively. Fetal heart rate was maintained between 125 and 160 beats per minute. A healthy baby was delivered 11 days postoperatively by cesarean section under regional anesthesia. The Apgar score was 8/9 at 1 and 5 minutes.

Adult↗
PubMed1993

[Inferior branch palsy of the oculomotor nerve following clipping of basilar apex aneurysm].

A 67-year-old woman experienced a severe headache and vomiting. A computed tomographic (CT) scan showed a mild subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm at the apex of the basilar artery. Several days later, she noticed mild hemiparesis of the left extremities. She underwent a clipping operation on the aneurysm by approaching from the right temporal love. Postoperatively, she developed diplopia and dilatation of the left pupil. Cerebral angiography revealed an occlusion of the left posterior cerebral artery. She was admitted to another hospital in order to continue rehabilitation. General physical examination was normal. Neurological examination revealed paralysis of the left medial and left inferior rectus muscles and palsy of the left inferior oblique muscle. The pupil of the left eye was dilated, measuring 5 mm in diameter, and it did not constrict to any stimuli. The left superior rectus and levator palpebrae superioris functioned normally. Visual acuity and visual fields were normal except for the influence of a senile cataract. She had a mild left hemiparesis, slight left ataxia and slurred speech. She had numbness of the left half of the body. A CT scan showed small low density areas in the right thalamus and left cerebellar hemisphere. Her ophthalmologic findings were compatible with the inferior branch palsy of the oculomotor nerve. The ophthalmoplegia of this case seems to be due to partial damage of the oculomotor nerve induced by ischemia of vascular supply. It is supposed to be caused by a vasospasm of the left posterior cerebral artery following a clipping operation of the basilar apex aneurysm.

Aged↗
PubMed1993

Comparison of sound quality and clarity with asymmetrical peak clipping and output limiting compression.

This study compared the preferences of 12 subjects with mild-to-moderate hearing losses for a linear circuit when the type of output limitation could be changed between asymmetrical peak clipping and output limiting compression. Through a paired-comparison paradigm, subjects rated the sound quality and clarity of speech in quiet, speech in noise, and music when the output levels were well below saturation and when slight saturation and high saturation occurred. A significant preference was found for the output limiting compression for each of the three stimuli for both sound quality and clarity. The preference became stronger with increases in saturation. The results suggest that if linear hearing aids are being used, the output should be limited with compression rather than peak clipping.

Acoustic Stimulation↗
PubMed1977

Mechanisms of hypertension during the chronic phase of the one-clip, two-kidney model in the dog.

The mechanism of the chronic phase of one-clip, two-kidney hypertension was investigated in 23 dogs. Mean arterial pressure (MAP), renal hemodynamics, and arterial and renal venous plasma renin activity (PRA) were studied before and at 1 and 3 months after graded, unilateral renal artery constriction. In the dogs that demonstrated sustained hypertension, the magnitude of changes in MAP, renal hemodynamics, PRA, and renal renin secretion correlated with the severity of renal artery constriction. In dogs with severe constriction (group 3, 78-86% renal blood flow reduction), MAP and arterial PRA were significantly elevated throughout. In groups 1 and 2 (0% and 50-56% renal blood flow reduction, respectively), although MAP remained significantly elevated, arterial PRA decreased to baseline values by 3 months. In group 3, there was an initial, apparent redistribution of ipsilateral renal blood flow, and prolonged reductions in ipsilateral renal plasma flow (RPF) and glomerular filtration rate accompanied by significantly increased creatinine clearance (CCreat) in the untouched kidney. Similar but less marked renal hemodynamic changes occurred in the other hypertensive dogs. All hypertensive dogs, regardless of degree of renal artery constriction, demonstrated significantly increased ipsilateral renal renin secretion and contralateral renin suppression. In three dogs that were studied 6, 12, and 16 months postconstriction, the high rate of ipsilateral renin secretion persisted throughout. Ipsilateral nephrectomy consistently resulted in rapid amelioration of the hypertension. These findings are in accord with a renal-dependent and probably renin-mediated mechanism for the maintenance of high blood pressure in the chronic phase of the one-clip, two-kidney dog model.

Animals↗
PubMed1996

Increased vascular collagen and noncollagenous protein synthesis contributes to sustain chronic phase of two-kidney, one-clip renovascular hypertension.

PURPOSE: Although the enhanced renin-angiotensin (R-A) system responsible for two-kidney, one-clip (2K-1C) hypertension is well known, there may be a shift with time so that this, hemodynamic factor plays a less important role and increased vascular resistance is predominant in sustaining hypertension. While increased vascular protein synthesis has been demonstrated in genetically hypertensive rats, we evaluated the possible relationship between vascular protein synthesis and 2K-1C hypertension with special reference to the R-A system. MATERIALS AND METHODS: Two-kidney one-clip rats were treated with splanchnicotomy, beta-aminopropionitrile (collagen inhibitor), or captopril (angiotensin converting enzyme inhibitor) in the acute or chronic hypertensive phase. 3H-proline was injected into rats, and incorporation rates of 3H-proline into vascular collagen, noncollagenous protein and elastin were counted. The plasma level of the R-A system was assayed. RESULTS: In the acute phase of 2K-1C hypertensive rats whose R-A system was enhanced, captopril treatment further enhanced plasma renin activity and plasma angiotensin I and suppressed plasma angiotensin II while reducing blood pressure. Synthesis of the vascular proteins was almost identical. In the chronic phase of 2K-1C hypertensive rats whose R-A system was within normal limits, increased incorporation rates of 3H-proline into noncollagenous protein or collagen of mesenteric arteries were decreased by splanchnicotomy or beta-aminopropionitrile and hypertension was lowered. Captopril failed to reduce protein synthesis. CONCLUSIONS: An enhanced R-A system participates in the pathogenesis of the acute phase of 2K-1C hypertension while increased noncollagenous protein and collagen syntheses of small arteries appear to play some role in the etiology of the chronic phase of hypertension.

Acute Disease↗