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Increased intraocular pressure after glaucoma drainage implant surgery may be caused by obstruction of the tube. A case of obstruction of an Ahmed glaucoma valve tube after pars plana insertion due to kinking of the tube was treated with a Pars Plana Clip (New World Medical, Rancho Cucamonga, CA).
Bradycardia is commonly seen in high spinal anesthesia, however, evolution of cardiac arrest from sudden onset of severe bradycardia is infrequent. Prompt recognization and resuscitative measures are of paramount importance because they may insure a complete recovery without sequela as an aftermath. We report herein a case of severe sinus bradycardia induced by clipping of the appendix during appendectomy under spinal anesthesia with the sensory block up to T5 dermatome. Prompt intravenous atropine failed to regain normal sinus rhythm, and cardiac arrest ensued. Cardiac massage, manual ventilation with oxygen and low-dose epinephrine successfully resuscitated the patient. The possible mechanisms and management of this complication are also discussed.
The majority of anterior communicating artery(Acom) aneurysms can be approached via pterional craniotomy. When the fundus points superiorly, craniotomy in the side of A2 of posterior displacement may be advantageous for catching the aneurysm and both ACAs on the same plane. Sometimes, however, surgeons have to deliberately select a "contralateral" craniotomy to deal with other lesions in the same operative session. The first author has operated on 111 patients with Acom aneurysms during the last 8 years; 26 aneurysms projected superiorly, and 7 were approached via contralateral craniotomy because of the aneurysm multiplicity. We reviewed surgical problems in the 7 upward projecting aneurysms approached from the "contralateral" side. All aneurysms were successfully secured without any surgery related complication. However, in each case, aneurysm and both ACAs formed a straight line in the narrow surgical field, and it was difficult to handle the aneurysm behind the ipsilateral A2, particularly when it tightly adhered to the A2. Anticipating this prior to surgery allows the surgeon to know the possible problems in aneurysm dissection that may occur. Practically, wide separation of interhemispheric fissure with removal of the gyrus rectus, and dissection of the posterior aspect of the ipsilateral A2 facilitates the mobilization of A2 and exposure of the aneurysm neck. When the aneurysm is tightly adherent to the A2, however, isolation of the entire aneurysm risks tearing the aneurysm at its A2 junction. An aperture clip should be considered to avoid serious bleeding during dissection.
A 59-year-old female was found to be drawn in a swimming pool and transferred to our hospital. The patient was comatose on admission (Hunt & Kosnk: Grade IV). Computed tomography (CT) showed diffuse subarachnoid hemorrhage (SAH) with thick hematoma in the left ambient cistern. Conventional cerebral angiography and 3D-digital subtraction angiography revealed aneurysms (ANs) of the left posterior cerebral artery (P2), and bifurcation of the left internal carotid and posterior communicating arteries (IC-PC). Successful neck clipping was performed the same day through the temporal horn via the insula for ruptured P2 AN, and the non-ruptured IC-PC AN was also obliterated using a pterional approach. Postoperative course was uneventful except for initial disturbance of consciousness and aphasia. The patient was discharged with no neurological deficit 1 month after surgery. This approach may be preferable in cases involving high positioned PCA AN in the ambient cistern, particularly in the acute phase of severe SAH, as the brain is protected from the detrimental effects of strong temporal retraction and a wider working space is provided.
The adaptive filter is an effective method to dealing with such kind of non-steady random signal of the heart rate. The algorithm of clipped- error LMS algorithm with variable step size of segmenting type was proposed. We adopted auto-regression predict filter estimating the noise of heart rate signals through Doppler ultrasound sensor. We used it as the reference signal of the adaptive noise cancelling system, its result is to remove some noise of main input, it made SNR raise by about 36 dB, it realized the abstraction of the heart rate signals.
Surgery of giant internal carotid bifurcation aneurysms (GBICAA) is followed by high postoperative mortality and morbidity rate. One case of GBICAA successfully submitted to clipping at the neck is reported and the modifications of CT Scan and MRI pictures described.
Nail clippings from patients suspected of having onychomycosis were processed for histologic evaluation in the same manner as routine skin with the addition of a chitin-softening solution prior to processing. The sections were stained by the periodic acid-Schiff method and examined for fungal hyphae. The results were compared with the results of fungal cultures from the same nail. Our findings indicate that routine histopathologic analysis of the nail plate alone is a useful complementary method to fungal culture for diagnosing onychomycosis.
Different laparoscopic tube-saving operations after tubal pregnancies are reported in the literature, but they all entail specific problems. In 35 women with tubal pregnancies, the tubotomy incisions were done laparoscopically and then fixed using PDS clips. One of these women with a contralateral closed tube had an intact intrauterine twin pregnancy 7 months after this procedure. Thus, this case demonstrates that this new variant of a laparoscopic tube-saving operation leads to a functional tube.
We have previously found that chronic infusion of atrial natriuretic peptide (ANP) decreased mean arterial pressure (MAP) by 16% in two-kidney, one-clip (2K-1C) hypertensive rats, and we hypothesized that natriuresis might be modified through the pressure-natriuresis mechanism. We therefore decided to evaluate sodium balance in 2K-1C rats infused with ANP (0.5 micrograms/h for 4 days). The ANP infusion to the 2K-1C rats induced a significant decrease in MAP from 171 +/- 3 to a minimum value of 147 +/- 6 mm Hg after 2 days of treatment (p less than 0.001). Sodium excretion fell from 2,536 +/- 60 to 2,047 +/- 86 (p less than 0.001) and 2,211 +/- 96 mu Eq/24 h (p less than 0.05) by days 1 and 2 of ANP administration. Furthermore, fractional excretion of sodium intake decreased from 99.1 +/- 1.5 to 81.1 +/- 2.9 (p less than 0.001), 84.1 +/- 2.6 (p less than 0.05) and 85.9 +/- 5.15% (p less than 0.05) by days 1, 2 and 3 of ANP infusion, respectively, returning to basal values thereafter. The administration of vehicle (0.9% NaCl) did not induce any significant change in 2K-1C hypertensive rats. The infusion of either vehicle or the same dose of ANP to normotensive rats (0.5 micrograms/h, for 4 days) did not modify sodium balance throughout the experiment. These results strongly suggest that the ANP-induced decrease in MAP might be responsible for the transitory sodium retention observed in 2K-1C hypertensive rats during the administration of the peptide.
A simple technique for repair of peripheral arteriovenous fistula by clip application is presented. This procedure is rapid and effective, it minimizes the extent of dissection, and it eliminates the need for application of vascular clamps on the vessels and for anticoagulation. The safety of the procedure was confirmed in dog experiments and clinically applied successfully in four patients. It is suitable for simple, uncomplicated side-to-side fistulas amenable to this procedure.
A case of macroglossia following neck clipping of VA-PICA aneurysm is described. The etiology of this rare complication has been thought to be venous obstruction related to extreme flexion of the head in the sitting position. On the other hand, Moore et al recently proposed that the primary mechanism of macroglossia after posterior fossa exploration might be neurogenic origin. We consider that our case supports the latter hypothesis. In our case, the lingual swelling was aggravated for four consecutive days following the operation and then began to improve rapidly. The swelling resolved completely after 4 weeks. Glyceol and methylprednisolone sodium succinate were administered in an attempt to decrease the lingual swelling. But these drugs did not effectively minimize the swelling. It seemed that the lingual swelling resolved spontaneously. If macroglossia following posterior fossa exploration can be caused by abnormal autonomic nervous system discharges, stellate ganglion block, glossopharyngeal nerve block or vagus nerve block is thought to be indicated as treatment for the lingual swelling.
Among the various treatments of ruptured oesophageal varices two seem to be effective: oral propranolol therapy and ligation of the oesophagus on clip. In this controlled study these two methods were compared in a series of 55 patients hospitalized for ruptured oesophageal varices. After haemodynamic stability was obtained, the patients were allocated at random to either propranolol therapy (n = 28) or surgery (n = 27). Twenty-one per cent of these patients belonged to group C of Child's classification and 54 per cent to group A. The parameters studied were similar in both groups. Five patients were excluded from the study: 2 in the medical group when it appeared that propranolol was contra-indicated and 3 in the surgical group who died before the operation; however, these 5 patients were taken into account in a second statistical evaluation. Nineteen out the 26 patients under propranolol (73 per cent) had rebleeding (within the first 10 days in 3 cases). In the surgical group recurrent bleeding was observed in 4 out of the 24 patients (17 per cent), and 4 other patients died post-operatively. The difference in favour of the surgical group was highly significant (P less than 0.001), and it remained significant (P less than 0.05) when the 5 patients who could not be treated were included into the calculations. Cox's multivariate analysis showed that patients in Child's C group had a poorer prognosis.
The authors describe a case of a 39-year-old man with subarachnoid hemorrhage who developed symptoms of parkinsonism after clipping of bilateral aneurysms of middle cerebral arteries. Possible pathogenetic mechanisms have been discussed. It was concluded that the extrapyramidal symptoms were probably caused by disturbances of cerebral blood flow.
Lens implantation as a form of replacement surgery has some clear advantages over other forms of aphakic correction. The most feared complication of this type of operation is bullous keratopathy. A short-term study was carried out in two comparable groups of patients to assess corneal oedema and endothelial cell loss after simple cataract extraction and after iris-clip lens implantation following intracapsular extraction as a primary procedure. All patients were randomly chosen to have one or other procedure. The results indicate that lens implantation causes greater postoperative corneal oedema and greater endothelial cell loss. It is therefore important for implant surgeons to bear in mind the possible harm they may be inflicting and the need both for stringent criteria of selection and for the adoption of techniques which will minimize endothelial trauma.
MRI is sometimes of no value in investigating a region close to a metallic foreign body. Presentation of a patient with non ferromagnetic cerebral vascular clips where MRI did not allow for the study of the chiasmatic region because of major artefacts.
Ninety to 120 min after removal of the caudal arteries, vascular smooth muscle cells from one-kidney, one clip (1-K, 1C) hypertensive animals were depolarized relative to those in appropriate control animals but cells from reduced renal mass-saline (RRM-S) hypertensive animals were not. However, supernatants of boiled plasma from both of the hypertensive models depolarized vascular smooth muscle cells in arteries taken from normotensive animals. These studies suggest that an agent in the plasma of these animals depolarizes vascular smooth muscle cells. This could help to explain the vasoconstriction in these hypertensive animals.
In the rat, the intraventricular administration of ACTH (adrenocorticotropic hormone) has no effect upon the sleep-waking cycle. However, administration of two ACTH-derived peptides is followed by a selective and significant increase of each sleep state: Des-alpha-MSH (Des-acetyl-alpha-melanocyte stimulating hormone) administration induces an increase of slow wave sleep, while CLIP (corticotropin-like intermediate lobe peptide) is followed by an increase of paradoxical sleep.
From 1974 to 1979, a prospective controlled study was conducted in 100 patients with cirrhosis and bleeding esophageal varices. The patients were randomly allocated to either portal disconnection of the esophagus with a clip or medical treatment. Randomization and treatment were performed in emergency situation for 50 patients and electively in 50 patients. All survivors had at least 5 years of observation after randomization. Concerning rebleeding, in the group randomized in emergency, 33 p. cent of patients had recurrent bleeding in the surgical group (mean delay: 64.1 +/- 12.4 months) and 84 p. cent among the medically treated patients (mean delay: 10.6 +/- 4.7 months). This difference is statistically significant (p less than 0.001). For the group randomized electively, 25 p. cent of the surgical patients had recurrent bleeding (mean delay: 76.3 +/- 6.4 months) and 92 p. cent of the medically treated patients had recurrent haemorrhage (mean delay: 20 +/- 5.9 months). The difference is statistically significant p less than 0.001). Concerning survival, among the patients randomized in emergency, 20 died in the surgical group (mean survival: 38.9 +/- 9.3 months) and 22 in the medical group (mean survival: 10.8 +/- 4.6 months). Among the patients randomized electively, there were 19 deaths in the surgical group (mean survival: 46.6 +/- 6.8 months) and 21 in the medical group (mean survival: 32.2 +/- 7.6 months). The difference of survival between the medical and the surgical group is not statistically significant.