Clip Procedure Research Articles

The convex hull property and topology of hypersurfaces with nonnegative curvature

We prove that, in Euclidean space, any nonnegatively curved, compact, smoothly immersed hypersurface lies outside the convex hull of its boundary, provided the boundary satisfies certain required conditions. This gives a convex hull property, dual to the classical one for surfaces with nonpositive curvature. A version of this result in the nonsmooth category is obtained as well. We show that our boundary conditions determine the topology of the surface up to at most two choices. The proof is based on uniform estimates for radii of convexity of these surfaces under a clipping procedure, a noncollapsing convergence theorem, and a gluing procedure.

Fetal therapy: state of the art.

To review our experience with the use of sonography in evaluating potential candidates for in utero fetal therapy performed at The Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia. This review article was designed to discuss open hysterotomy for the 4 fetal surgical procedures that have been performed at our institution. The procedures included surgical repair of myelomeningocele, resection of sacrococcygeal teratoma in fetuses with nonimmune hydrops, resection of an enlarging congenital cystic adenomatoid malformation that is not amenable to thoracoamniotic shunting, and tracheal clip occlusion for severe left congenital diaphragmatic hernia. For each surgical procedure, the use of sonography in the prenatal diagnosis of the congenital anomaly was detailed, as were indications for surgery and surgical procedures, postoperative monitoring and finally delivery, postnatal treatment, and long-term follow-up. Three of the procedures have been reasonably successful with rather dramatic results in some cases such that these techniques are still being performed. The 1 exception was open hysterotomy for the tracheal clip procedure for congenital diaphragmatic hernia, which has been abandoned. Fetal therapy is a rapidly evolving specialty, which is being practiced at several centers in this country. Sonography is an integral part of this specialty practice and has been used extensively in the diagnosis of some congenital anomalies that have debilitating or lethal consequences for the fetus. Technologic improvements in both sonography and magnetic resonance imaging have assisted tremendously in the many advances herein reported in the diagnosis and treatment of the above-described 4 congenital anomalies.

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

OBJECTIVE AND IMPORTANCE: Aneurysms on the anterior surface of the internal carotid artery (ICA) have been shown to be somewhat different from ordinary berry aneurysms because they are rather small, grow rapidly in a short time, and easily lead to rupture, especially during surgery. The most difficult problem is that this type of aneurysm cannot be eliminated easily by an ordinary clipping procedure without causing apparent arterial stenosis or occlusion. CLINICAL PRESENTATION: A 52-year-old man experienced a subarachnoid hemorrhage because of a ruptured aneurysm located on the anterior surface of the ICA. The tiny aneurysmal body, which was covered with a layer of brain tissue, was successfully exposed. The ICA seemed to be atherosclerotic, and the aneurysmal portion was solitary and had a reddish color. TECHNIQUE: A large silicone sheet encircling clip (Vascwrap; Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) was selected for this patient. The proximal margin of the silicone sheet was incised with a V-shaped cut, and the middle part of the sheet, which covered the diagonal part of the ICA, was trimmed to make it shorter. The blade of the fenestrated clip was applied to obliterate the aneurysm and was attached to the normal arterial wall together with this modified Vascwrap sheet to create a small space between the normal arterial wall and the surrounding Vascwrap sheet. Then tiny pieces of Teflon fiber (E.I. duPont de Nemours and Co., Wilmington, DE) was inserted from both margins, and the whole Vascwrap sheet was sealed with fibrin glue to ensure good adhesion. CONCLUSION: This method seemed adequate in treating this difficult aneurysm without causing postoperative regrowth or occlusion of the patient's ICA.

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

Strategies for surgical management of cerebral aneurysms of special location, size and form--approach, technique and monitoring.

Special strategies are mandatory for optimal surgical management of aneurysms of special location, size and form. Approaches of extradural selective anterior clinoidectomy, partial occipital condylectomy, transpetrosal approach by anterior petrosectomy and supracerebellar transtentorial approach are discussed among them. Furthermore various types of temporary and permanent clipping procedures are discussed along with mention of intraoperative monitoring.

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report

Archives of the Dance (20): The Archive of the National Resource Centre for Dance

The archive of the National Resource Centre for Dance (NRCD) has a wealth of materials covering over a century of dance in the UK and abroad. Although most relate to theatre dance, these materials document the breadth of dance practice, in keeping with the centre’s remit to be a national support service for dance education and research. Like many performing arts collections, the NRCD’s archive holds a range of material types: all varieties of printed items, including books, periodicals, programmes, posters, newspaper cuttings, publicity, and scrapbooks combining these; items created by hand, such as manuscripts, letters, drawings, costume designs, and notation scores; photographs; film and video; audio recordings from open reel to CD; objects; costumes; and digital items. The NRCD’s archive has two strands: the special collections and the core reference collection. The special collections concern the work of an individual, company, or organisation, and have been donated as a cohesive entity. The core collection is all other materials, which may come in as single items, as a miscellaneous batch of materials, or as part of the NRCD’s off-air recording and newspaper clipping procedures. These resources, which are acquired solely through donation, are housed in a secure storeroom and are brought to the study room upon request. Before being made available to researchers, they undergo processing, which involves preservation and cataloguing. Routine preservation procedures involve transferring paper-based items to acid-free archival stationery (folders, boxes, etc.), placing photographs in protective transparent sleeves, and making ‘viewing’ and ‘listening’ copies of most of the videos, films, and audio materials. Since 1995, items have been catalogued on a custom-made electronic database using Microsoft Access, but in 2001, this data

Aneurysmal subarachnoid hemorrhage in Taiwan.

In 1993, the annual report about prospective survey and registry of stroke revealed there were 439 cases of ruptured intracranial aneurysms in Taiwan area. Thirty-two of them had multiple aneurysms; therefore, totally 476 aneurysms occurred in these cases. The anatomic distribution of these aneurysms were as the following: internal carotid artery-posterior communicating artery 32%, anterior communicating artery 30%, middle cerebral artery 18%, carotid bifurcation 6%, anterior cerebral artery 4%, carotid-ophthalmic artery 2%, intracavernous carotid artery 2%, and vertebrobasilar system 6%. 364 cases received surgical or interventional treatment, which 88% was clipping procedure, 8% was interventional procedure with coil, and 4% was wrapping. The surgical mortality was 13%.

Creutzfeldt-Jakob disease with florid plaques after cadaveric dural graft in a Japanese woman

The Japanese National Committee for Creutzfeldt-Jakob disease (CJD) reported there are 43 patients with CJD in Japan after implantation of cadaveric dura mater, and that no case of new-variant CJD (nvCJD) has been detected. We report a case with similar features to nvCJD. At the age of 38 years, a Japanese woman received a cadaveric dural graft (Lyodura, B Braun Melsungen AG, Germany) after a clipping procedure of the right middle cerebral artery aneurysm in September, 1985. In November, 1994, 110 months after the procedure, she became unsteady and had blurred vision. She was admitted to hospital because of progressing ataxia. Examination disclosed dementia, visual disturbance, hyperreflexia, and cerebellar ataxia. Blood chemistry and cerebrospinal fluid were normal. Brain computed tomography (CT) showed no abnormal lesions. There was slow activities without periodic discharge on her electroencephalogram (EEG). gradually decreased and could not be detected after 40 months. In the second patient, the IgA antibody value remained low. None of the remaining eight patients developed detectable IgA antibodies. Thus far, a total of 1707 infusions have been given and only six (0·4%) mild systemic adverse reactions (headache, nausea, and/or light dizziness) have been noted. Our preliminary experience indicates that prophylactic IgG replacement therapy can safely be given to patients with selective IgA deficiency including those with IgA antibodies by subcutaneous administration. The treatment seems to be effective as the frequency of bacterial respiratory tract infections was reduced. One possible explanation why administration of IgG is effective in IgA deficiency could be that the patients are given additional specific antibodies that they themselves are unable to produce in sufficient amounts. According to the estimated prevalence, the number of IgA deficient individuals is 20 000 in Sweden, 120 000 in UK, and at least 250 000 in the USA. Given that 30% of these have an increased susceptibility to infections, further studies are needed to decide whether to broaden the indications for administration of subcutaneous IgG.

Diffusion distances, total capillary length and mitochondrial volume in pressure-overload myocardial hypertrophy

We examined the relationships between blood pressure, coronary blood flow, cardiac output, myofiber growth, capillarity, mitochondrial content, and capillary and mitochondrial distributions in a pressure-overload model of myocardial hypertrophy. The Goldblatt one kidney-one clip (1K1C) procedure was performed on seven adult rabbits. After 1 month, mean blood pressure increased 50% and mean heart mass increased 30%. Coronary blood flow and cardiac output at rest were similar in control and 1K1C hearts; cardiac output fell 40% when 1K1C hearts were paced to 35% above basal heart rate. Capillary density in the left ventricular free wall (LV) decreased with increasing fiber size by as much as 30%. However, capillary-to-fiber ratio and total capillary length in the LV increased with heart size by up to 30% and 80%, respectively. This indicated that there was some proliferation of capillaries taking place, but not enough in comparison to fiber growth to prevent the lengthening of distances between capillaries. Mitochondrial volume density decreased by as much as 30% with increasing heart size, but total mitochondrial volume increased up to 80%. This indicated that there was some proliferation of mitochondria, but not enough to prevent dilution of mitochondria by the growing myofibrillar elements. Analysis of the distribution of mitochondria suggested that the new mitochondrial material was added to the center of myofibers, thereby further lengthening oxygen diffusion distances. There was a constant ratio of 10.4±0.3 km of capillaries per ml of mitochondria in 1K1C and control hearts, demonstrating that the structures for oxygen supply and consumption were remaining in fixed proportion to each other. There was no evidence that the decreased performance of paced 1K1C hearts was attributable to an oxygen diffusion limitation to mitochondria.

Menstrual function after tubal sterilization.

More than 10 million women in the United States have undergone tubal sterilization. There has been concern that this procedure may increase the risk of later menstrual dysfunction. The Collaborative Review of Sterilization (CREST) is a large, multicenter, prospective study of tubal sterilization in the United States. This report describes CREST participants who were interviewed immediately before sterilization and again in annual poststerilization interviews for up to 5 years between 1978 and 1988. The authors analyzed reported changes in six menstrual cycle characteristics for 5,070 women undergoing interval sterilizations. Longitudinal, multivariate regression was used to adjust for baseline menstrual function and other potential confounders. Five years after sterilization, 35% of the CREST participants reported high levels of menstrual pain, 49% reported heavy or very heavy menstrual flow, and 10% reported spotting between periods. In contrast to the fifth year, the first year of follow-up was similar to presterilization menstrual function; in the first year, 27% of participants reported high menstrual pain, 41% reported heavy menstrual flow, and 7% reported spotting. These findings may be affected by aging of the cohort and other study limitations, but they suggest that if tubal sterilization leads to changes in menstrual function, such changes may take some time to develop.

The template-directed synthesis of porphyrin-stoppered [2]rotaxanes

Two [2]rotaxanes, composed of (i) a polyether chain intercepted by (a) one centrally-located and (b) two symmetrically-located π-electron-rich hydroquinol rings and terminated by free-base and metallated (Zn) tetraaryl-porphyrin groups respectively and (ii) a tetracationic cyclophane constructed of two π-electron-deficient bipyridinium units linked by paraphenylenedimethyl residues, have been self-assembled by a clipping procedure.

Effects of the infusion of amino acids into the abomasum of sheep, with emphasis on the relative value of methionine, cysteine and homocysteine for wool growth

SUMMARYMerino sheep were given abomasal infusions of various amino acids or mixtures of amino acids. Effects on wool growth were measured using autoradiography or a clipping procedure and changes in the concentration of amino acids in plasma were measured in some experiments.Mixtures of five (28 g/day) or ten (45 g/day) essential amino acids (both mixtures containing 3 g methionine) stimulated wool growth of sheep receiving a maintenance ration; on average, the volume of wool grown increased 48% and 86%, respectively. When cysteine completely replaced methionine in these mixtures, wool growth was markedly reduced, but two-thirds of the methionine could be replaced by cysteine without affecting wool growth. Homocysteine was partially effective in replacing methionine and, when supplemented with betaine, folic acid and vitamin B12, the mixture was still significantly inferior to that containing methionine. In contrast, abomasal supplements of methionine or homocysteine alone were equivalent as supplements for wool growth. The results indicated a specific role for methionine in the control of wool growth, other than the provision of cysteine. This role was postulated to be related to some function of S-adenosylmethionine.Infusion often essential amino acids caused appreciable increases in the concentrations of cystine, methionine, cystathionine and taurine in plasma; total essential amino acids increased threefold whereas nonessential amino acids decreased in concentration. The replacement of methionine in the infusion by cysteine or homocysteine significantly altered the concentration of cystine, methionine and cystathionine in plasma.Evidence was obtained that the adverse effects on wool growth of high abomasal doses of methionine (10g/day) could not be reduced or prevented by provision of additional glycine and were not related to the supposed toxic effects of 3-methylthiopropionic acid, a metabolite of the transamination pathway.

Invertebrate communities on Western Australian eucalypts: A comparison of branch clipping and chemical knockdown procedures

AbstractChemical knockdown and branch clipping procedures were used in wandoo (Eucalyptus wandoo) woodland and jarrah (E. marginata)/marri (E. calophylla) open‐forest to sample arboreal invertebrate faunas on three species of Western Australian eucalypts. Jarrah was sampled in both habitats and had significantly lower invertebrate populations and a less diverse fauna than either wandoo or marri. The two procedures provided similar results with respect to the relative abundance of invertebrates on each plant species but the knockdowns sampled a more diverse fauna, including species sheltering in or on bark. Chemical knockdowns underestimated the abundance of sessile invertebrates, such as psyllids. Branch clipping sampled insufficient numbers of large, mobile, or cryptic invertebrates to estimate abundances, but provided a more accurate estimate of the abundance of sessile, leaf‐dwelling organisms. Neither procedure provides a complete sample of arboreal invertebrates, but they are complementary. When used in conjunction with each other a more complete estimate of arboreal invertebrate abundance and diversity is obtained. Both procedures can be used concurrently with only a small increase in field time.

Temporary clip部に発生したiatrogenic aneurysmの治療および直角型fenestrated clip使用時のpitfall

Temporary clip部に発生したiatrogenic aneurysmの治療および直角型fenestrated clip使用時のpitfall

Outpatient Laparoscopic Sterilisation: Comparison Between Electrocautery and Clip Application

In a personal prospective series of 504 day-case laparoscopic sterilisations in 1977-78, unipolar tubal electrocoagulation was compared with spring-loaded clip application. Two patients who had cautery required laparotomy because of serious bleeding and one because of accidental bowel diathermy. Clip application was free from serious complications, but caused more post-operative pain. The majority of patients were performing normal or light household duties within 24 hours of sterilisation.

Effects on wool growth of the infusion of mixtures of amino acids into the abomasum of sheep

SUMMARYMerino sheep were given abomasal infusions of either mixtures of amino acids or protein during periods of 8 or 12 days. Effects on wool growth were measured using autoradiography and a clipping procedure which allowed time for the emergence of the wool fibres. Estimates of volume growth rate, from the autoradiographic measurements, and of mass of wool grown, from clipping, were in good agreement.An infusion of a standard mixture of 13 amino acids, which included ten essential amino acids in approximately the proportions in casein, consistently stimulated wool growth. The mean increases in volume and mass of wool grown, during 30 infusions, were 66 and 67% respectively. A mixture of ten essential amino acids alone appeared to be as effective as the standard mixture for stimulating wool growth, and there were no significant differences between the effects on wool growth of casein and the standard mixture of amino acids.The omission of methionine from an infusion of the standard mixture of amino acids, or from a mixture of essential amino acids only, inhibited wool growth rate; both fibre diameter and length of wool grown per day were reduced to below the control values. In addition, the strength of the fibres was considerably reduced.Infusions of zein and of an amino acid mixture simulating the essential amino acid composition of zein both inhibited wool growth rate, due to a reduction in fibre diameter. Similar effects on wool growth were observed when any one of three essential amino acids (lysine, isoleucine or leucine) was omitted from an infusion of the standard mixture of amino acids. The omission of five other essential amino acids (arginine, histidine, phenylalanine, threonine or valine) from the infusion, or variations in the proportions of leucine, lysine or methionine, had no appreciable effects on wool growth.

A clip procedure for stenosis and eversion of the lacrimal punctum.

A clip procedure for stenosis and eversion of the lacrimal punctum.