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PubMed2006

[Modified CLIP score as a new prognostic index for patients with hepatocellular carcinoma].

BACKGROUNDS/AIMS: The prognosis of cirrhotic patients with hepatocellular carcinoma (HCC) depends on both residual liver function and tumor characteristics. The aims of this study was to construct a new prognostic index for HCC patients: the modified CLIP score, and to compare its discriminatory ability and predictive power with those of the CLIP score that is currently the most commonly used integrated staging score in patients of HCC. METHODS: A retrospective analysis of 237 cases of HCC diagnosed at Dong-A university hospital was performed. Prognostic analysis was performed for single variables by estimating survival distributions with the Kaplan-Meier's method, and statistically compared by the log-rank test. RESULTS: Patients had a mean age of 57.5 years and were predominantly males (79.7%). The overall median survival period was 25.7 months. It was correlated to ascites, portal vein thrombosis, AFP, tumor size, and Child-Pugh classification. The median survival period was 41.0, 25.2, 13.8, 13.4, and 6.5 months for CLIP scores 0, 1, 2, 3, and 4 to 6, respectively (P<0.001), and 42.1, 34.0, 25.7, 14.0, and 6.8 months for modified CLIP scores 0, 1, 2, 3, and 4 to 6, respectively (P<0.001). The Kaplan-Meier's curve showed that the modified CLIP score had additional explanatory power above that of the CLIP score. CONCLUSIONS: The modified CLIP score, compared with the CLIP score, particularly in the score 2- to 3- patient groups of HCC, had greater discriminant ability and survival predictive power, but was not able to discriminate 4- to 6- patient group.

Adult↗

PubMed1988

Effects of bacterial infection on absorbable vascular ligating clips.

Electron microscopic observations of two implanted absorbable clips, Absolok and Lactomer, infected with Escherichia coli and Streptococcus faecalis, were carried out. An overgrowth of bacteria was observed over the entire surface of the clips. The mating surfaces of the Lactomer clips and the locking mechanisms of both types of clip were more heavily infected--that is, provided better support for bacterial growth--than other areas of the clips in the initial postimplantation period. However, with longer periods (up to seven days), the initial bacterial deposits developed into a thick, plaquelike layer. This layer appeared to restrict access to the surfaces such that the infected clips degraded at a much slower rate than did the noninfected clips, particularly Lactomer clips, on which little morphologic change was detectable seven days after implantation.

Animals↗

PubMed1988

Tissue reactions to absorbable ligating clips.

Scanning electron microscopy was used in a comparative ultrastructural study of biodegradable ligating clips, the Absolok (polydioxanone) and the Lactomer (copolymer of glycolic and lactic acids), implanted subcutaneously in rabbits. The inflammatory response and tissue reactions to the implanted clips and their effects on clip breakdown were studied. By the first week after implantation, numerous inflammatory cells adhered to the clip surfaces, with occasional fibroblasts present. By two weeks after implantation there was a reduction in the number of inflammatory cells, but the number of fibroblasts gradually increased, resulting in encapsulation of the clips. The thickness of the fibrous tissue capsule, formed by a variety of collagen fibers, gradually increased 5-25 weeks after implantation. Residues from the Lactomer clips were still present within the encapsulating tissue at 25 weeks. In contrast, clips enclosed in nylon pouches were totally degraded, and no residues were detectable at 25 weeks. Tissue reactions similar to those observed for nonpouched implanted clips were seen over the entire external surface of the pouches.

Animals↗

PubMed1987

Study of renovascular hypertension in rats. IV. Renal arterial blood velocity in one-clip, two-kidney hypertensive rats.

In one-clip, two-kidney hypertensive models of rats, the renal arterial blood velocity was recorded using the bidirectional Doppler velocimeter before and at various times after clipping of the renal arteries. In all the rats, immediately after placement of a clip, the blood velocity of the stenosed artery was lowered significantly. Although the blood velocity remained low 2 weeks after clipping, it recovered to the pre-clip level at 6 and at 11 to 13 weeks after clipping. The plasma renin activity tended to decrease following the acute, high-renin stage of hypertension. If it can be assumed that the blood velocity is one of the indexes representing blood flow, its return to the pre-clip normal level in the chronic stage of renovascular hypertension may signify recovery of blood flow to the clipped kidney leading to a reduction in renal renin synthesis and consequently a decrease in plasma renin activity.

Animals↗

PubMed1982

Absorbable ligating clips.

Surgical clips have gained wide spread acceptance because of speed and utility in operative fields with difficult exposure. Certain disadvantages make metallic clips less than optimal for many operative situations. Such problems include difficulty in loading metallic clips into the applier, clips falling from the applier in the transfer from nurse to surgeon or while the surgeon is positioning the clip for application and clips coming off a vessel to which it was applied. The interference which metallic clips produce in computerized tomography and their permanency must be added as factors to be evaluated in comparison with absorbable clips.

Chemical Phenomena↗

PubMed1993

Renal function conscious one kidney-one clip hypertensive rats. Effect of indomethacin.

These experiments have analyzed: a) Blood pressure (BP) and renal function in one kidney-one clip rats two weeks after clipping; b) The effect of cycloxygenase (CO) inhibition on BP and renal function regulation during the hypertensive period. Using the unanaesthetized, unrestrained and chronically instrumented animal, three groups of rats were studied: Sham, Clip 0.31 mm lumen and Clip 0.29 mm lumen. The animals were examined before (Control period) and during the infusion of indomethacin (IND, 5 mg/kg via aortic cannula, n = 11 for each group) or the buffer vehicle solution (BUF, n = 7 for each group). Effective inhibition of CO by IND was confirmed using radioimmunoassay of prostaglandin E2 (PGE2) in urine. Control BP (mmHg, mean +/- SE) differed significantly among the groups (p < 0.001): Sham, 114 +/- 3; Clip 0.31, 135 +/- 2; Clip 0.29, 154 +/- 4 and did not change by IND infusion. Along with the BP, Control Glomerular Filtration Rate and Renal Plasma Flow did not change by IND infusion, which suggests that CO eicosanoids, particularly PGG2, contribute little to basal renal hemodynamics in sham and hypertensive rats. Sodium excretion was lower in the Control period of Clip 0.29 rats (p < 0.01). A significant natriuretic effect observed in this Clip 0.29 group by the infusion of IND suggests the contribution of an AA related metabolite in renal handling of sodium in more severe renovascular hypertension.

Animals↗

PubMed1994

Telemetric blood pressure monitoring in benign 2-kidney, 1-clip renovascular hypertension: effect of chronic caffeine ingestion.

In the present study we used radiotelemetry technology to investigate: 1) the time course for development of hypertension in 2-kidney, 1-clip (2K1C) rats and 2) the effect of chronic caffeine consumption on blood pressure in 2K1C rats. Rats received water or caffeine (0.1%) in drinking water and were instrumented with radiotelemetry devices to permit continuous monitoring of blood pressure. A clip was placed on the left renal artery of rats in both the water (WATER/CLIP) and caffeine (CAFFEINE/CLIP) groups. The clip was applied briefly to, then removed from, the renal artery of caffeine- and water-treated rats randomized to the sham-operated (SHAM) group. Mean arterial blood pressure (MABP) increased by approximately 35 mm Hg within 2 hr of clipping. MABP in the WATER/CLIP and CAFFEINE/CLIP groups differed significantly from the SHAM group, but not from each other, for the first 10 days after clipping. Thereafter, MABP was greater in the CAFFEINE/CLIP rats as compared to WATER/CLIP rats. At 4.5 weeks after clipping, MABP values differed significantly in the CAFFEINE/CLIP, WATER/CLIP and SHAM rats (140 +/- 4, 122 +/- 4 and 103 +/- 2 mm Hg, respectively). Involvement of the renin-angiotensin system was assessed by treatment with the AT1 receptor antagonist, losartan, and the converting enzyme inhibitor, captopril. Results from this study indicate: 1) hypertension develops rapidly after clipping in rats monitored with telemetry; 2) the renin-angiotensin system is involved in maintaining hypertension in 2K1C rats even beyond 4 weeks after clipping; and 3) caffeine augments the increase of blood pressure in 2K1C rats, apparently through the involvement of the renin-angiotensin system.

Angiotensin II↗

PubMed1997

[Postoperative three-dimensional CT angiography (3D-CTA) in evaluation of proximal clipping for ruptured vertebral aneurysms].

At present, intra-arterial angiography remains the gold standard for most cerebrovascular problems. Recently, three-dimensional computed tomographic angiography (3D-CTA) has been reported as a screening method for the diagnosis of cerebrovascular disease. This imaging modality uses the information obtained on a contrast-enhanced CT scan to generate three-dimensional images of the cerebrovascular system. We performed 3D-CTA in the preoperative and postoperative evaluation of patients undergoing proximal clipping of ruptured vertebral artery aneurysms in addition to conventional cerebral angiography. In this study, the value of 3D-CTA after proximal clipping of ruptured vertebral artery aneurysm was evaluated retrospectively. Six patients were examined with a spinal CT (HITACHI CT-W 3000) after intravenous bolus injection of 100 ml contrast material (Iohexhol 300 mgI/ml) at the rate of 2 ml/s with a 25 second pre-scanning delay. The images of 3D-CTA were reconstructed using a new 3D-volume-render (Voxel Transmission) technique. The ages of the six patients ranged from 33 to 61 years and five cases were males and one case was female. Only one patient had a saccular aneurysm and the other five had fusiform aneurysms. Two patients underwent emergency operations within 4 days, and the other four had delayed operations. The outcome was good recovery in five cases and severe disability in one case. Postoperative conventional cerebral angiography demonstrated no delineation of the aneurysms in five cases. These results correspond well to postoperative 3D-CTA. Postoperative conventional cerebral angiography could not be performed in only one patient, but the aneurysm was visualized on the third postoperative 3D-CTA. Proximal clipping is still one of the therapeutic options for ruptured vertebral aneurysms, but some reports emphasized the possibility of rebleeding after proximal clipping of vertebral artery aneurysms. The rebleeding occurred within 1 week after proximal clipping in 6 of 9 cases (66.7%), and the prognoses were extremely poor. Therefore, in patients selected for proximal clipping, it is necessary to undertake postoperative evaluation of the aneurysm within one week after proximal clipping. 3D-CTA is minimally invasive and can be easily performed repeatedly, even if the patients are in a poor condition. In conclusion, 3D-CTA is very useful especially for evaluation of ruptured vertebral artery aneurysms following proximal clipping.

Adult↗

PubMed1980

Morphology of Fallopian tubes removed from a patient after failure of clip sterilization.

A bilateral salpingectomy was performed at the time of vaginal hysterectomy in a pregnant patient sterilized 20 months earlier by application of Bleier clips to the fallopian tubes. Clip application to the left tube had been incomplete. Undisturbed tissue (left tube) and clipped tissue (right tube) were examined and compared by light and scanning electron microscopy. The segment of tube fully grasped by the clip had a completely detached lining epithelium with coarse and flattened mucosa, a loose stroma, and disorganized muscular bundles. The left tubal mucosa was normal, whereas the right tube was stenosed at the site of clip placement, with rigid walls and a 0.175 mm luminal diameter. With progressively greater stenosis toward the clip site, mucosal destruction increased. Polypoidal mucosal folds were seen, as well as fibrous adhesions between mucosal folds. These observations indicate that tissue damage is extensive enough after clip application to require excision of the damaged segment of tube and microsurgical re-anastomosis for reversal of sterilization.

Adult↗

PubMed1994

Use of multiple clips for tubal occlusion in interval laparoscopic sterilization: circumstances and consequences.

The use of multiple clips for the occlusion of the Fallopian tubes has been reported in interval laparoscopic sterilization, but the circumstances leading to the performance of the multiple-clip procedure and its effects on safety and efficacy have not been carefully studied. A data set from international multi-center clinical trials of Filshie clips and Wolf (Hulka) clips was used to examine the possible reasons for performing this procedure for 102 women. Their complications, complaints, and surgical and post-surgical events before discharge and during one month of follow-up were compared with those of the 408 women whose tubes were occluded by single clip. Results indicate that multiple clips were most often used when surgical difficulties (and to a much lesser degree, tubal and/or mesosalpingeal injury) were encountered during the sterilization procedure. No increased risk of short-term complications or complaints (including pelvic pain) was found at one-month follow-up for those patients who received multiple clips.

Adult↗

PubMed2000

Aneurysm clips: evaluation of magnetic field interactions with an 8.0 T MR system.

This study was conducted to evaluate magnetic field interactions for aneurysm clips exposed to an 8.0 T magnetic resonance (MR) system. Twenty-six different aneurysm clips were tested for magnetic field translational attraction (deflection angle test) and torque (qualitative assessment method) using previously described techniques. Six of the specific aneurysm clips (i.e. type, model, blade length) made from stainless steel alloy (Perneczky) and Phynox (Yasargil, models FE 748 and FE 750) displayed deflection angles above 45 degrees and torque measurements of +4, indicating that these aneurysm clips maybe unsafe for patients or individuals in an 8.0 T MR environment. The specific aneurysm clips (i.e. type, model, blade length) made from commercially pure titanium (Spetzler), Elgiloy (Sugita), titanium alloy (Yasargil, model FE 750T), and MP35N (Sundt) displayed deflection angles less than 45 degrees and torque that ranged from + 1 to +4. Accordingly, these aneurysm clips are likely to be safe for patients or individuals exposed to an 8.0 T MR system. Depending on the actual dimensions and mass, an aneurysm clip made from Elgiloy may or may not be acceptable for a patient or individual in the 8.0 T MR environment.

Electromagnetic Fields↗

PubMed1997

Initial experience with an absorbable laparoscopic ligation clip.

BACKGROUND: Laparoscopic surgery requires secure and safe methods of ligation and haemostasis. This study evaluated the efficacy of an absorbable ligation clip with a novel compression closure mechanism. METHODS: A new compression-closure absorbable clip was compared with currently available absorbable and non-absorbable clips used in a variety of laparoscopic procedures in 12 centres worldwide. RESULTS: At follow-up to 3 months after the procedure, no complications specific to the use of the compression-closure clip were detected. Operator satisfaction with the clip was high, with criticism directed at its relatively large size. CONCLUSION: This new clip is as safe and effective as presently available metal and absorbable clips in providing haemostasis and securing tubular structures.

Adolescent↗

PubMed1981

A new microvascular surgical clip system.

A new microvascular clip system has been designed that consists of 3 sets of different sized clips, an applicator, and an approximator. The basic clip is a one-piece design consisting of two blades extending from an annular base. Its construction is simple and durable. The blade closing force is predetermined for each size clip and is set at pressures that are non-traumatic to blood vessels. The tips of the applicator allow the clip to rotate through a wide arc. Two basic clips can be used with the approximator to form a double clip.

Humans↗

PubMed2001

CLIP-50 immunolocalization during mouse spermiogenesis suggests a role in shaping the sperm nucleus.

The spermatid nucleus and cytoplasm undergo dramatic morphological modifications during spermatid differentiation into mature sperm. Some of the external force causing this nuclear shaping is generated by a microtubular structure termed the manchette, which attaches to the perinuclear ring of the spermatid. Here, we report the isolation and characterization of a protein component of this perinuclear ring in an immunological screening of a mouse testis cDNA library. We termed this protein CLIP-50 because of its high similarity at the amino acid level to the C-terminal region of the microtubule-binding protein CLIP-170/restin. CLIP-50 lacks the characteristic microtubule-binding motif, but retains a portion of the predicted coiled-coiled domain and the metal-binding motif. The CLIP-50 transcript and protein are abundant in testis. The protein is also expressed in heart, lung, kidney, and skin. A distinct size variant exists in brain. In the spermatids, CLIP-50 protein localizes specifically to the centriolar region where the sperm tail originates and to the perinuclear ring from which the manchette emerges. CLIP-50 staining is retained in the ring throughout its migration over the surface of the nucleus which accompanies the nuclear shaping into its characteristic sperm configuration. This localization pattern indicates a very specific function for this novel CLIP derivative during mouse spermiogenesis.

Animals↗

PubMed1995

Prostaglandins are involved in the stimulation of renin gene expression in 2 kidney-1 clip rats.

This study was done to obtain information about a possible involvement of prostaglandins in the renal baroreceptor mechanism regulating renin secretion and renin gene expression. To this end the effect of the cyclooxygenase inhibition was examined on renin secretion and on renal renin gene expression in 2 kidney-1 clip rats. The influences of the cyclooxygenase inhibitors indomethacin (2mg/kg twice a day) and meclofenamate (8 mg/kg twice a day) on renal renin m-RNA levels, on plasma renin activity (PRA) and on blood pressure were measured 2 days after clipping the left renal arteries of male Sprague-Dawley rats with 0.2 mm clips. In sham-clipped animals, indomethacin and meclofenamate had no significant effect on basal PRA and renin m-RNA levels. In vehicle-treated animals unilateral renal artery clipping increased blood pressure from 120 +/- 4.1 to 150 +/- 6.1 mmHg, increased PR6A from 7.4 +/- 1.6 to 27.6 +/- 3.8 as expressed in nanograms of angiotensin I per hour per millilitre, increased renin m-RNA levels of clipped kidneys from 105 +/- 5.9% of standard to 482.6 +/- 56% of standard and decreased renin m-RNA levels of contralateral kidneys from 116 +/- 9.7% of standard to 34 +/- 9.0% of standard. While blood pressure, PRA and renin m-RNA levels of the contralateral kidneys were virtually unchanged by the cyclooxygenase inhibitors indomethacin and meclofenamate, renin gene expression in the clipped kidney was markedly influenced by inhibition of prostaglandin synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1980

Increase in plasma renin activity, water intake and blood pressure following application and reapplication of a renal artery clip.

Application of a renal artery clip in rats with an undisturbed contralateral kidney caused a sustained increase in blood pressure and a transient rise of plasma renin activity and water intake. The response of blood pressure, plasma renin activity and water intake was augmented after reapplication of the clip to normotensive declipped rats (renal hypertensive rats, from which the clip had been removed 24h before the reapplication). The time-course of the changes of blood pressure, plasma renin activity and water intake were similar after the initial application as after reapplication of the clip. Administration of an inhibitor (SQ 14.225) of the converting enzyme abolished the increase in blood pressure and water intake after reapplication of the clip. These data indicate a critical role of renin in the rise of blood pressure and water intake after initial application of a renal artery clip as well as after reapplication of the clip to declipped rats.

Animals↗

PubMed1994

Endoscopic resection of large colorectal polyps using a clipping method.

PURPOSE: In conventional endoscopic snare polypectomy, bleeding and perforation are the principal concerns. To prevent these complications, we employ an endoscopic clipping technique using the HX-3L clipping apparatus. METHODS: With this method, clips are used to clamp the base of a polyp. A snare is hung peripheral to the clips. The polyp is then resected by coagulating and cutting with an electric current. RESULTS: Neither bleeding nor perforation during or after polypectomy has occurred, nor have complications related to the use of clips developed. Gigantic polyps were not resected piecemeal, but rather were resected en bloc facilitating a clear determination of cancer on the surface of the resected site. Endoscopic clipping permitted site marking for colonoscopic surveillance. CONCLUSION: We conclude that the clipping method has many advantages and is a useful technique in colonoscopic polypectomy.

Adult↗

PubMed2006

The clipped intestinal non-perforating anastomosis of small bowel: a new technique.

In contrast to adult surgery, the neonatal small intestine confronts the surgeon, depending on the age of the patient, with variable diameters of the intestine. Therefore, anastomoses are usually performed by hand with interrupted sutures. In the presented study, a new technique is demonstrated. An anastomosis in the distal ileum of Sprague Dawley rats was performed with a single clamp applicator (Anastoclip). Small bowel anastomoses were performed in 32 rats. The clipped bowel anastomosis was evaluated concerning stenosis, leakage, and adhesions in comparison to the sutured anastomosis. Tension test and X-ray examination were performed to measure the stability. The rats were sacrificed at day 3 or 14 after laparotomy. The clipped anastomosis is feasible, and faster to perform than the conventional hand-sutured anastomosis (Operation time: control group: 18.5 min versus clipped group 4 min; p > 0.05). Furthermore, there were differences in the mechanical stability, with higher tension forces needed for rupturing the clipped anastomosis. There were fewer stenoses (16.5 mm stenotic diameter in the control group versus 20.6 mm in the clipped group) and fewer adhesions in the group of the clipped anastomosis. Histological examinations were performed and did not show significant differences between the two groups. In the animal model presented, the clipped, intestinal, non-perforating anastomosis (CINPA) shows advantages compared to the common hand-sutured anastomosis.

Anastomosis, Surgical↗