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[Prevention of pulmonary embolism using a vena cava filter and cava clip].

Surgical prophylaxis of pulmonary embolism by implantation of Vena-cava-filter (Greenfield) or Vena cava clip (Adams de Weese) was performed in 24 patients. The following indications were used: Recurrent pulmonary embolism under adequate anticoagulation, Pulmonary embolism in cases of contraindications to anticoagulation, Floating thrombus occurring late following deep vein thrombosis, After pulmonary embolectomy. In a retrospective study we recognized 0% recurrent pulmonary embolism, a vena cava occlusion rate of 4% and no clinically relevant signs of bilateral venous stasis in the lower limbs.

Adolescent↗

Clipping of the anterior communicating artery to eliminate the contralateral blood supply in supratentorial large AVM of the carotid system. A report of 22 cases.

Large supratentorial arteriovenous malformations (AVMs) of the carotid system are vascularized by the ipsilateral internal carotid artery (ICA) and often, in addition, by the contralateral ICA via the anterior communicating artery (ACoA). In these AVMs we have previously advocated (1981) multiple staged operations with the progressive reduction of the blood stream passing through the AVM. In twenty-two cases, starting in 1983, the reduction of the blood stream into the shunt has been performed as a first operation by placing a clip on the middle of the ACoA through a pterional approach on the opposite side of the AVM before radical open surgery. Results were excellent when considering the control angiogram and the measurement of the blood velocity in the ICA opposite to the AVM side. There were no neurological complications and no mortality.

Adolescent↗

Approach through the temporal horn of the lateral ventricle for clipping of large dorsal type basilar bifurcation aneurysms.

The authors describe an approach through the temporal horn of the lateral ventricle which proved to be useful for clipping of a large dorsal type basilar bifurcation aneurysms. It facilitates the preservation of the perforating arteries behind the aneurysm, because it gives sufficient working space to move the aneurysm dome. Furthermore this approach avoids many of the disadvantages of other approaches, especially the risk of iatrogenic injuries of the Sylvian or Labe's vein.

Aneurysm, Ruptured↗

Detection of a ruptured aneurysmal sac by MRI in a case of negative angiogram. Successful clipping of an anterior communicating artery aneurysm. Case report.

A case of a ruptured aneurysm is presented in which the angiograms did not disclose the sac. Rupture of an aneurysm of the anterior communicating artery was suspected from the distribution of subarachnoid blood on computerized tomography (CT), and the presence of a sac was highly suggestive on magnetic resonance imaging (MRI), which led us to open surgery. A non-thrombosed aneurysm was discovered at the suspected site, and successfully clipped. The necessity is discussed of MRI investigation in patients with subarachnoid haemorrhage (SAH) of unknown aetiology.

Adult↗

A strategy for analyzing multiple parameters with application to aneurysmal SAH patients all of them clipped but treated with and without cyclosporine.

The study evaluated the effectiveness of the combination of nimodipine and cyclosporine A vs nimodipine alone in the prevention of delayed neurologic deficit in 82 (31 plus 51) patients in whom intracranial aneurysms were clipped within 72 h after subarachnoid haemorrhage. The tests performed included examination of the neurological condition before and after operation, angiography of cerebral arteries to visualize vasospasm, and analysis of the distribution and amount of blood in the brain fluids and/or tissue according to Fisher's scale. Inclusion of cyclosporine A in the treatment was clearly beneficial for the neurological condition. While cyclosporine A did not appear to produce a statistically significant improvement as evaluated by the chi-square test, a positive result was obtained following analysis of the correlation coefficients after Pearson in combination with the logistic log-linear regression analysis. The results argue against the utility of the chi-square test for verifying clinical data obtained in a limited number of patients.

Adult↗

Titanium, silver, and tantalum clips in brain tissue.

The brain tissue reaction to a recently devised titanium haemoclip and to the conventional silver and tantalum clips were investigated in rabbit brain. Titanium, silver, and tantalum wires 5 X 0.5 X 0.5 mm in size were implanted into the white matter of the brain. After one and six months the brain specimens were sectioned, stained with haematoxylin eosin and with phosphotungstic acid Haematoxylin, and were studied by light microscopy. The examination revealed neither tissue reaction nor pigmentation in the case of titanium implant, while there was pigmentation surrounding the tantalum, and there was pigmentation as well as reactive gliosis around the silver wires.

Animals↗

Evoked potential monitoring and temporary clipping in cerebral aneurysm surgery.

Temporary occlusion of the parent artery greatly facilitates the dissection of large cerebral aneurysms, while much reducing the risk of intraoperative rupture and avoiding the use of profound arterial hypotension. Intraoperative somatosensory evoked potential (SEP) monitoring was carried out in 25 aneurysm cases where temporary clipping was employed electively under moderate hypothermia. Occlusion times ranged from 6.3 to 52 minutes at 28.7 degrees C to 32.5 degrees C. Among 15 middle cerebral artery (MCA) occlusion cases the SEP was lost within 5 or 6 minutes in two cases undergoing early surgery and in one case with marked vasospasm and was lost within 9 minutes in one case with pre-existing infarction in the territory of the MCA. The SEP persisted throughout MCA occlusion periods of 6.3 to 52 minutes in 8 cases. Occlusion of parent arteries of unruptured aneurysms was well tolerated. At least 2 minutes of MCA occlusion after loss of the SEP were tolerated without neurological sequelae, while transient new deficits were seen when MCA occlusion was continued for 4 and for 4 + 11 minutes and an increased deficit was seen when occlusion was continued for 7 minutes after loss of the SEP. In each of the internal carotid artery (ICA) occlusion and bilateral anterior cerebral artery occlusion groups the SEP was lost in one case and was absent for about one minute before reperfusion was instituted. The ICA case had a transient deficit lasting about 4 hours; no other complications were seen in these two groups. Complications were not seen in any case where the SEP was not lost during the occlusion period. Factors affecting collateral perfusion and possible means of increasing tolerance to ischaemia in this situation are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗

Usefulness of non-woven sheet (clip pad) on scalp incisions: technical note.

As an alternative to the gauze often used on scalp incisions, we prepared a pad made of non-woven sheets, coated with adhesive on one side. Unlike conventional gauze, the pad did not slip away from the incision line or become entangled with the scalp clips, thus demonstrating its high usefulness for this purpose.

Bandages↗

Experiences with Filshie clip sterilization.

Between June 1980 and April 1986 796 cases of female sterilization were performed in a private clinic in Malaysia using Mark IVa and Mark VI Filshie clips. There was one failure. Technical failure, surgical difficulties and complications were minimal.

Adult↗

Vascular reactivity in chronic Goldblatt two kidney-one clip hypertensive rats.

We studied the possible contribution of increased vascular reactivity in the chronic phase of Goldblatt two kidney-one clip hypertension. Vascular reactivity was evaluated in aortic strips from hypertensive rats (16 weeks after inducing hypertension) and age-matched control rats. The findings were: a) increased sensitivity to vasopressin in the aortic tissue of hypertensive rats, b) a similar response to angiotensin II, noradrenaline and KCl in hypertensive and control rats, and c) reduced maximal response to angiotensin II compared with other vasoconstrictors in both groups of rats. These results suggest a possible role for vasopressin in the chronic phase of this model of hypertension.

Angiotensin II↗

Methimazole treatment reduces cardiac hypertrophy and mortality without a concomitant reduction in blood pressure in established Goldblatt two-kidney one clip hypertension.

The effects of methimazole, an antithyroid drug, on blood pressure and other parameters were evaluated in the established phase of Goldblatt two-kidney one clip (G2K-1C) hypertension. Methimazole was administered via drinking water for five weeks, starting five weeks after hypertension had been induced. After this period of treatment, similarly high blood pressures were observed in methimazole-treated and non-treated G2K-1 C rats, despite the fact that a hypothyroid state had been achieved in methimazole-treated rats. Methimazole-treated G2K-1 C rats showed reductions in heart rate, ventricular weight, ventricular/body weight ratio and mortality in comparison with rats not treated with methimazole. These results clearly demonstrate that hypothyroidism induced by methimazole: a) does not reverse G2K-1 C hypertension, but b) improves the rate of survival and c) reduces relative cardiac hypertrophy, possibly by the reduction in cardiac work observed in Goldblatt hypothyroid rats.

Animals↗

Unusual complications caused by endo-clip migration following a laparoscopic cholecystectomy: report of a case.

We present herein the case of a woman who developed unexpected complications following a laparoscopic cholecystectomy. The clinical manifestations were unique in that symptoms of obstructive jaundice were in fact caused by endo-clips which had migrated into the common bile duct, and the resulting choledochoduodenal fistula presented as persistent cholangitis. While the overall safety of this new procedure appears to be superior to that of open cholecystectomy, the risk of bile duct injury seems more likely. This case stresses the need for caution by surgeons, and emphasizes the necessity for careful surveillance and strict follow-up to ensure the safety of this procedure.

Adult↗

Central noradrenergic neurons and vascular non-collagen protein in the initial phase of two-kidney, one-clip renovascular hypertension.

Rats had been given intraventricular injection of 6-hydroxydopamine (6-OHDA) before clipping the unilateral renal artery (2K-1C) that caused selective ablation of the central noradrenergic neurons. Central catecholamines and the in vivo incorporation of 3H-proline into vascular non-collagen protein were determined in 2K-1C rats in the acute hypertensive stage. It is suggested that increased non-collagen protein synthesis in the mesenteric artery and the low level of hypothalamic norepinephrine concentration may participate in the development of 2K-1C hypertension in rats.

Animals↗

Central catecholamine, sympathetic nerve and vascular protein in the acute phase of two-kidney, one-clip renovascular hypertension in rats.

Incorporation of 3H-proline into the non-collagenous protein in mesenteric arteries in two-kidney, one-clip hypertensive rats was greater than that in normotensive rats. Splanchnicotomy predominantly over the root of mesenteric arteries or intracranioventricular injection of 6-hydroxydopamine prevented the development of hypertension in 2K-1C rats concomitant with the reduction of incorporation of 3H-proline into the non-collagenous protein in mesenteric arteries. The content of norepinephrine in the hypothalamus in 2K-1C rats was lower than that in normotensive control rats. These findings indicate that increased non-collagenous protein synthesis in mesenteric arteries or low level of hypothalamic norepinephrine has facilitative effects on the development of 2K-1C hypertension.

Animals↗

Prophylactic inferior vena cava clipping in colonic surgery.

Incidental prophylactic inferior vena cava clipping (IVCC) has been used in 30 patients undergoing colonic operations. The results obtained compare quite favorably with other methods of preventing postoperative pulmonary embolism (PE). This procedure would be justified in patients with a postoperative PE risk greater than 5 to 10 per cent. Practical criteria to identify this group of patients are presented, and the value of utilizing a risk profile is emphasized. There is no mortality from the procedure itself, and the morbidity was limited to lower-extremity edema in three patients who otherwise could have been expected to develop PE. The edema lasted two months in one patient and cleared rapidly in the other two. Attesting to the procedure's effectiveness, there were no cases of recurrent PE. Caval partition is an appealing mode of prophylaxis in high-risk patients because of its safety, efficacy, and permanence.

Aged↗

Laparoscopic appendectomy using a clip applier.

The diagnostic worth and therapeutic value of laparoscopic surgery are known for ovarian cysts and ectopic pregnancies. Diagnosis of appendicitis is difficult, and laparoscopy is useful in these cases. The present study was done to assess the feasibility, efficacy, and advantages of a new laparoscopic appendectomy technique. Between August 1, 1989, and July 31, 1990, patients exhibiting right pelvic pain associated with fever were divided into three groups according to the pre-operative diagnosis: appendicitis, pelvic inflammatory disease (PID), and diagnostic doubt between appendicitis and PID. An intra-peritoneal appendectomy was performed if the diagnosis was not PID. Via three suprasymphyseal trocars, the appendix was exposed and the mesoappendix was coagulated. The appendix stump was closed using a clip applier (Ethnor T1300). In all, 20 patients underwent laparoscopic appendectomies. The mean duration of the procedure was 36.5 min; in no case was laparotomy necessary. There were no post-operative complications, and digestive transit returned on the 2nd day post-surgery. Both patients and nurses appreciated the technique. The subjects experienced comfortable post-operative periods and gained aesthetic advantages. The operative procedure could be completed on each attempt. We conclude that this technique is sure, quick, and easily reproducible in young patients presenting with right pelvic pain associated with fever.

Appendectomy↗

Local cerebral blood flow with prostaglandin E1 or trimethaphan during cerebral aneurysm clip ligation.

This study was performed to examine changes in local cerebral blood flow during hypotensive anaesthesia with either prostaglandin E1 (PGE1) or trimethaphan (TMP). Local cerebral blood flow (LCBF), mean blood pressure (MBP), heart rate (HR), and hourly urine output (UO) were studied in 51 patients undergoing cerebral aneurysm surgery with neuroleptanalgesia (NLA). The incidence of vasospasm after aneurysm surgery, and outcome (Glasgow Outcome Scale) at discharge were evaluated. Measurements of LCBF were made using a thermal gradient blood flow meter. The dose of PGE1 or TMP was adjusted to maintain MBP at about 70 mmHg, and LCBF was studied during and after PGE1 or TMP administration. Hypotensive drugs were discontinued at the completion of aneurysm clipping. After starting PGE1 or TMP, MBP decreased immediately, but HR did not change in either group. The LCBF decreased 30 min after the start of TMP administration and increased immediately after its discontinuation, whereas PGE1 did not affect LCBF. Urine output increased during PGE1 administration but was unchanged during TMP. Neither drug affected surgical outcome or the incidence of vasospasm. These results suggest that PGE1 may be preferable to trimethaphan for hypotensive anaesthesia in cerebral aneurysm surgery because LCBF is maintained.

Adult↗