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PubMed2006

Fixative method of carotid shunt using a Sugita's fenestrated aneurysm clip as a device in carotid endarterectomy technical note.

BACKGROUND: Difficulty for distal exposure of the ICA is sometimes encountered during CEA. A carotid shunt is used to maintain sufficient cerebral blood flow during CEA but requires fixative materials, such as a string or a metallic ring, which often restrict the operative field, especially that of the distal ICA. METHODS: Here, we describe a novel technique for carotid shunt fixation using a unique fixative device in CEA. In the method presented here, the carotid shunt is fixed with an inflated balloon and a conventional vascular tourniquet proximally, but distal fixation is achieved using a Sugita's fenestrated clip that catches the mid portion of the carotid shunt and surrounding tissue. RESULTS AND CONCLUSION: The device prevents the distal carotid shunt slipping out of the distal ICA. The present method allows mobilization of the shunt position during CEA and facilitates far-distal exposure of the ICA.

Brain Infarction↗

PubMed2006

How does spontaneous hemostasis occur in ruptured cerebral aneurysms? Preliminary investigation on 247 clipping surgeries.

BACKGROUND: Rupture of cerebral aneurysms results in subarachnoid hemorrhage. In many cases, bleeding from aneurysms spontaneously arrests. Although bleeding from cerebral aneurysms has been reported to arrest from outside, bleeding from some aneurysms can arrest in different ways. METHODS: Between April 2002 and March 2004, we prospectively investigated mechanisms of spontaneous hemostasis in ruptured aneurysms by macroscopic examination when performing craniotomy and clipping surgeries. RESULTS: Hemostatic mechanisms were investigated in 247 patients with ruptured aneurysm (77 men, 170 women; age range, 25-95 years). Hemostatic mechanisms were divided into 3 different patterns. In the most common pattern (79.4%), the surface of the aneurysm rupture point was sealed from the outside by a platelet plug or fibrin net (outside-arrest pattern). In some aneurysms (10.1%), a thrombus or platelet plug was attached to the rupture point from inside the aneurysm (inside-arrest pattern). In a very small number of aneurysms (1.6%), a naked thrombus covered the hole made on the arterial wall or small remnant of the aneurysmal dome (bursting pattern) The mechanism remained unclear in the remaining 8.9% of aneurysms. Multivariate analysis revealed that alert consciousness on admission (WFNS grade I) significantly associated with usual hemostasis (outside arrest pattern: OR, 3.8; 95% CI, 1.4-10.0; P = .008). Borderline association with usual hemostasis was found in aneurysms with a size of 5 or smaller than 5 mm (OR, 2.6; 95% CI, 0.99-7.1; P = .052). CONCLUSIONS: The present preliminary study revealed that arrest of bleeding from a ruptured cerebral aneurysm does not always occur from outside the aneurysm. Unusual mechanisms of hemostasis are seen in approximately 12% of ruptured aneurysm. The outside-arrest-pattern aneurysm was more common for smaller aneurysms, and these patients tended to be of better grade. Further studies are necessary to explore the mechanism of hemostasis for ruptured cerebral aneurysms.

Adult↗

PubMed2004

Use of Hem-o-lok clips effectively lengthens renal vein during laparoscopic live donor nephrectomy.

We retrospectively reviewed our last 12 laparoscopic donor nephrectomies (LDNs) in which both the renal artery and the renal vein were controlled using 2 Hem-o-lok clips (Weck Closure Systems, Research Triangle Park, NC, United States) on the proximal sides and the vessels were divided without securing the graft-side vessels (group 1). We compared the results with our 12 immediately preceding LDN donors in whom the arteries were controlled with 3 endoclips and the veins were controlled with staplers (group 2). The length of the vein was significantly longer (approximately 4 mm difference) in group 1, mainly due to trimmed staples from the graft vessels. Both cohorts of donors had uneventful surgery with no complications, and all the recipients recovered smoothly without any delayed graft function. Average operation time and warm ischemia time were similar among both groups (189 vs 207 minutes; 168 vs 149 seconds, respectively; both P > .1). We conclude that the use of Hem-o-lok effectively lengthens graft renal veins and is less costly during LDN.

Adrenal Glands↗

PubMed2006

HCV-NS3 Th1 minigene vaccine based on invariant chain CLIP genetic substitution enhances CD4(+) Th1 cell responses in vivo.

BACKGROUND: HCV is a major cause of chronic liver disease, cirrhosis, hepatocellular carcinoma and death of end-stage liver disease worldwide. Therapy regimen based on IFN-alpha combined with ribavirin can induce a sustained virological and biochemical response in 20-60% of treated patients depending on the HCV genotype, the virus load and the age of the patients. So the development of a preventive or a therapeutic vaccine is very desirable. METHODS: Thirty female BALB/c mice of 6-8 weeks old were randomly divided into five groups of six each to receive injection with experimental vaccine (pHCV-NS3, pHCV-NS3-Th1) and experimental controls (saline, pCI-neo, pCI-neo-Ii), respectively. After the fifth immunization, humoral and cellular immune responses were estimated. The therapeutic efficacy was also evaluated with BALB/c mice carried tumor cells expressing HCV-NS3 protein. RESULTS: Specific antibodies to HCV-NS3 could be detected only in pHCV-NS3 immunized group. The antibody titers reach up to 1/1024. For CD4(+) Th cell proliferation assay, only the pHCV-NS3 and pHCV-NS3-Th1 treated groups were positive according to absorbance assayed at 450nm. The absorbance of the pHCV-NS3-Th1 treated group was significant higher than that of pHCV-NS3 treated group (P<0.01, 0.002). Only the pHCV-NS3-Th1 immunized group produced detectable IFN-gamma, the concentration was 33.65pg/ml. For IL-4 detection, only pHCV-NS3 immunized group produced tiny IL-4 cytokine, the concentration was 4.55pg/ml. pHCV-NS3 and pHCV-NS3-Th1 immunized mice showed significantly lower tumorigenesis rate and higher survival rate compared to experimental controls, but no significant differences were observed in our experiment between the two vaccine immunized groups. CONCLUSIONS: Minigene vaccine based on invariant chain CLIP genetic substitution might be a potential candidate for HCV therapeutic vaccine development. The results might also have some inspiring significance for the therapeutic vaccine development against other chronic infectious diseases and tumor.

Animals↗

PubMed2002

Surgical clips to help identify anatomy after a Nissen fundoplication.

Laparoscopic fundoplication has had a remarkable growth in the treatment of gastroesophageal reflux disease. But a failure rate of more than 5% has led to increasing numbers of patients with recurrent symptoms presenting for corrective surgery. A simple technique of placing surgical clips on the sutures used to place the wrap helps identify the anatomy during contrast studies and helps plan for corrective surgery.

Esophagus↗

PubMed2001

Norwood-type operation with adjustable systemic-pulmonary shunt using hemostatic clip.

The postoperative course of a patient with hypoplastic left heart syndrome after a first-stage Norwood operation is governed to a large extent by the balance between the systemic and pulmonary circulations. Here we describe a simple and convenient technique for establishing an optimally sized systemic-pulmonary shunt by the application of a hemostatic clip. The method has been used in 6 patients.

Aorta, Thoracic↗

PubMed2002

Sternal closure using semirigid fixation with thermoreactive clips.

Sternomy represents the standard approach to the heart and great vessels in most cardiothoracic procedures. Closure of this incision is simple; however, healing complications such as dehiscence, osteomyelitis, mediastinitis, and superficial wound infection or fistula may occur. We describe an alternative technique for sternal closure using semirigid fixation with thermoreactive clips.

Alloys↗

PubMed2004

Dorsal minithoracotomy for ductus arteriosus clip closure in premature neonates.

We present a new surgical technique for patent ductus arteriosus (PDA) occlusion in premature neonates (PN). Through a dorsal minithoracotomy the PDA is dissected extrapleurally with q-tips and clipped. The short surgical time, avoidance of pleural drainage, and prevention of late breast deformity are the operation highlights.

Ductus Arteriosus, Patent↗

PubMed1997

Surgical clip for compression of the aortic wall during gluing.

An acrylic clip was developed to compress the dissected aortic wall during gluing. These small instruments have a concave-convex contact face adjusted to the most common graft size. There are several advantages to this method of treatment of acute aortic dissection.

Acute Disease↗

PubMed1997

The effect of angiotensin II receptor antagonists on kidney function in two-kidney, two-clip Goldblatt hypertensive rats.

The effect of blockade of the renin-angiotensin system on kidney function using non-peptide angiotensin AT1 receptor antagonists was investigated in renovascular hypertensive rats. An angiotensin converting enzyme inhibitor, captopril and two angiotensin AT1 receptor antagonists, losartan and GR138950 (1-([3-bromo-2[2-[[(trifluoro-methyl)sulphonyl]amino]phenyl]-5 benzofuranyl]methyl)-4-cyclopropyl-2-ethyl-1H-imidazole-5-carboxamide) were administered in Na+-deplete two-kidney, two-clip Goldblatt hypertensive rats over a 3-day period. Captopril, losartan (30 mg/kg body weight) and GR138950 (5 mg/kg body weight) significantly (P < 0.001) lowered the systolic blood pressure in the hypertensive rats from 290 +/- 5, 252 +/- 9 and 238 +/- 13 mmHg to 152 +/- 17, 148 +/- 9 and 123 +/- 6 mmHg, respectively. The magnitude of reduction in blood pressure in these three groups of rats was similar and occurred with comparable marked increases in plasma levels of urea and creatinine indicative of acute renal failure. These findings demonstrate an important role for angiotensin II in the maintenance of renal function during blood pressure reduction in renovascular hypertensive states during restriction of dietary Na+ intake.

Angiotensin II↗

PubMed1997

Effect of chronically infused adrenomedullin in two-kidney, one-clip hypertensive rats.

The hypotensive effect of chronically infused adrenomedullin, a potent vasodilator peptide, was examined in conscious two-kidney, one-clip (2K-1C) hypertensive and sham-operated rats. They were infused with 1.0 microgram/h of synthetic human adrenomedullin for 14 days by means of osmotic minipumps. Control groups were infused on the same schedule with 0.9% saline. Systolic blood pressure was measured before and during the infusion. Plasma renin activity, aldosterone and human adrenomedullin concentrations were determined at day 14 of the infusion. A significant reduction of systolic blood pressure was observed in the adrenomedullin-infused 2K-1C rats at day 4, and systolic blood pressure remained significantly lower throughout the experiment compared to that of the control 2K-1C. A similar hypotensive effect was seen in the adrenomedullin-infused sham-operated rats. Both the plasma renin activity and aldosterone concentrations of the adrenomedullin-infused 2K-1C and sham groups were significantly reduced compared to those of the respective control, whereas, the plasma human adrenomedullin concentration in the adrenomedullin-infused groups was found to be within the physiological range. These findings demonstrated that chronically infused adrenomedullin had a hypotensive effect accompanied by significant reductions of plasma renin activity and plasma aldosterone concentration in 2K-1C hypertensive and sham-operated rats.

Adrenomedullin↗

PubMed1997

Effects of niflumic acid on alpha1-adrenoceptor-induced vasoconstriction in mesenteric artery in vitro and in vivo in two-kidney one-clip hypertensive rats.

The influence of niflumic acid (3 and 10 microM), a Cl- channel antagonist, on cirazoline-induced vasoconstriction in isolated perfused mesenteric artery (5 ml/min) from two-kidney one-clip (2K1C) hypertensive and sham normotensive rats was examined. In addition, the effect of a single i.v. bolus injection of niflumic acid (3 mg/kg) on cirazoline-mediated reduction in vascular conductance in superior mesenteric artery was determined in pentobarbital-anaesthetized hypertensive and normotensive rats. Bolus injections of cirazoline induced a dose-dependent transient increase in the perfusion pressure in vitro. In the presence of niflumic acid, cirazoline-mediated vasoconstriction was significantly inhibited. Cirazoline-induced vasoconstriction in isolated mesenteric beds was also significantly inhibited following perfusion with Cl(-)-free buffer. Pre-perfusion of mesenteric blood vessels with Cl(-)-free buffer resulted in a significantly greater inhibition of cirazoline-mediated vasoconstriction in sham normotensive rats than in hypertensive rats. We found that in Cl(-)-free buffer, cirazoline-mediated vasoconstriction could be further inhibited by niflumic acid. Intravenous infusion of cumulative doses of cirazoline in vivo caused a dose-dependent decrease in superior mesenteric vascular conductance. Pretreatment with niflumic acid significantly impaired cirazoline-mediated decreases in vascular conductance. Our results indicate that chloride ions play an important role in alpha1-adrenoceptor-mediated vasoconstriction in mesenteric blood vessels. In addition, the contribution of chloride ions in alpha1-adrenoceptor-mediated vasoconstriction in blood vessels from hypertensive rats appears to be reduced.

Adrenergic alpha-Agonists↗

PubMed1986

Myocardial Na, K-ATPase in one-kidney, one-clip hypertensive rats.

Myocardial ventricular Na, K-ATPase activity of normotensive rats was compared with that of healthy rats with chronic benign one-kidney, one-clip hypertension. The yield of protein (mg/g wet wt left plus right ventricles) in microsomal and sarcolemmal membrane fractions was the same for both normotensive and hypertensive rat ventricles. However, the yield of protein (mg/ventricle) was 26% greater in the hypertensive relative to the normotensive animals, consistent with the presence of hypertrophy, as also indicated by an increase in the ratio of ventricular to body weight and a shift in the isomyosin composition. Na, K-ATPase activity, sodium-dependent phosphorylation and ouabain binding were significantly (P less than 0.05) decreased (by 20%, 40%, and 45%, respectively) in the hypertensive rat ventricles when the data were expressed in units/g tissue wet weight. However, when expressed in units per ventricle, values in normotensive and hypertensive animals were similar. The molecular activity or turnover number of ventricular (and also renal) Na, K-ATPase activity was the same in both groups of animals. These results suggest that the decrease in myocardial specific Na, K-ATPase activity in the rat made hypertensive by removing one kidney and constricting the renal artery of the other kidney is related to the presence of cardiac hypertrophy.

Animals↗

PubMed1996

Fetal endoscopic ('Fetendo') tracheal clip.

Fetal surgery can correct several life-threatening malformations before birth. Despite recent advances in fetal surgery, preterm labor remains a major problem directly related to the large uterine incision required for fetal exposure. Fetal endoscopic surgery ("Fetendo") obviates the need for a large uterine incision and may reduce the overall risks of fetal surgery by causing less uterine trauma and ultimately less preterm labor. Temporary tracheal occlusion is a promising strategy to enlarge the lungs in fetuses with congenital diaphragmatic hernia. Using the technology developed for laparoscopic surgery and for temporary tracheal occlusion, we have developed an endoscopic technique for tracheal occlusion with an endoscopic clip in a fetal sheep model. The evolution of this technique may allow temporary tracheal occlusion without incisional hysterotomy or maternal laparotomy.

Animals↗

PubMed1996

Avoidance of stomas and delayed anastomosis for bowel necrosis: the 'clip and drop-back' technique.

Necrotizing enterocolitis (NEC) and midgut volvulus (MGV) often are associated with extensive bowel necrosis. These cases may require extensive enterectomy and the formation of high or multiple stomas, and frequently are complicated by short bowel syndrome, excessive fluid losses, fistulas, stenosis, and skin breakdown. This report describes a "clip and drop-back" technique, followed by delayed anastomosis performed 48 to 72 hours later. The technique was successful in five severely ill infants (3 NEC, 2 MGV) with extensive necrosis, bowel perforation(s), and peritonitis, who required either a high stoma near the ligament of Treitz or multiple resections and enterostomies. This method removes obvious necrotic perforated bowel, controls contamination, avoids stomas (and their inherent complications in this age group), and preserves bowel length. All five babies survived. The technique is a useful addition to the pediatric surgeon's operative armamentarium in selective cases.

Anastomosis, Surgical↗

PubMed1997

An implant-supported fixed-removable prosthesis with a milled tissue bar and Hader clip retention as a restorative option for the edentulous maxilla.

Restoration of the edentulous maxilla with implant retained and supported prosthesis is challenging because of inherent anatomic limitations present after the loss of teeth. A fixed-removable prosthesis is one treatment choice for restoration of the edentulous maxilla with implants. This prosthesis meets the requirements for esthetics, phonetics, comfort, and hygiene, as well as favorable biomechanical stress distribution to the implants. This article presents a procedure for fabrication of a fixed-removable prosthesis with a precision milled bar, Hader clip attachments, and a superstructure prosthesis. The criteria for patient selection and the advantages and disadvantages of this prosthesis are discussed.

Centric Relation↗

PubMed1999

Replacement of a clip in one session.

Fracture of clips in implant-retained overdenture therapy is one of the most reported problems. This article describes an indirect method for repair that is reliable and can be carried out in 1 session.

Acrylic Resins↗

PubMed1992

Laparoscopic varicocelectomy: a simple technique for clip ligation of the spermatic vessels.

Less invasive laparoscopic surgery is replacing the conventional open operation for the treatment of several conditions. We performed laparoscopic clamping of the internal spermatic vessels in 12 subfertile patients to treat varicocele of the testis. Seven operations were performed with the patient under general anesthesia, whereas a local anesthetic was used in the 5 most recent patients. The internal spermatic vessels were successfully clipped in all 12 patients. Postoperative physical examination with a Doppler stethoscope showed that the venous reflux had disappeared in all patients. Semen quality was improved in 7 patients with a followup of 3 to 10 months. Neither hydrocele nor testicular atrophy was observed postoperatively. Laparoscopic varicocelectomy was effective and minimally invasive, especially when performed with the patient under local anesthesia.

Adult↗