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Yan S, Wang X, Lv C, Phan K, Wang Y, Wang J, Yang Y, Wu N. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage. J Thorac Dis 2016; 8:415-21. [PMID: 27076936 DOI: 10.21037/jtd.2016.02.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postoperative pleural drainage markedly influences the length of postoperative stay and financial costs of medical care. The aim of this study is to retrospectively investigate potentially predisposing factors related to pleural drainage after curative thoracic surgery and to explore the impact of mediastinal micro-vessels clipping on pleural drainage control after lymph node dissection. METHODS From February 2012 to November 2013, 322 consecutive cases of operable non-small cell lung cancers (NSCLC) undergoing lobectomy and mediastinal lymph node dissection with or without application of clipping were collected. Total and daily postoperative pleural drainage were recorded. Propensity score matching (1:2) was applied to balance variables potentially impacting pleural drainage between group clip and group control. Analyses were performed to compare drainage volume, duration of chest tube and postoperative hospital stay between the two groups. Variables linked with pleural drainage in whole cohort were assessed using multivariable logistic regression analysis. RESULTS Propensity score matching resulted in 197 patients (matched cohort). Baseline patient characteristics were matched between two groups. Group clip showed less cumulative drainage volume (P=0.020), shorter duration of chest tube (P=0.031) and postoperative hospital stay (P=0.022) compared with group control. Risk factors significantly associated with high-output drainage in multivariable logistic regression analysis were being male, age >60 years, bilobectomy/sleeve lobectomy, pleural adhesion, the application of clip applier, duration of operation ≥220 minutes and chylothorax (P<0.05). CONCLUSIONS This study suggests that mediastinal micro-vessels clipping during lymph node dissection may reduce postoperative pleural drainage and thus shorten hospital stay.
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Affiliation(s)
- Shi Yan
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Xing Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Chao Lv
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yuzhao Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Jia Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yue Yang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Nan Wu
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Kariyattil R, Panikar D. Scissoring of a Cobalt Alloy Aneurysm Clip causing Slippage during Cerebral Aneurysm Surgery: Case report and review of literature. Sultan Qaboos Univ Med J 2013; 13:179-82. [PMID: 23573404 DOI: 10.12816/0003217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 09/01/2012] [Accepted: 10/06/2012] [Indexed: 11/27/2022] Open
Abstract
Clip slippage is a rare occurrence, and the scissoring or torsional failure of aneurysm clips is rarer still. Titanium clips have been implicated in a few such reported cases. The authors report its occurrence while using a fenestrated cobalt alloy clip for an internal carotid artery aneurysm which was identified by intraoperative angiography and rectified by re-applying a non-fenestrated cobalt alloy clip. The possible mechanism of this complication, and measures that may prevent its occurrence, including meticulous dissection, decompression when possible, proper clip selection, and intraoperative angiogram are described.
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Choi SH, Park CW, Kim YB, Kim EY, You CJ, Kim WK. The Comparative Study of Microsurgical Cerebral Aneurysm Clip Implants; Titanium Clip vs. Stainless Steel Clip. J Cerebrovasc Endovasc Neurosurg 2012; 14:79-83. [PMID: 23210032 PMCID: PMC3471257 DOI: 10.7461/jcen.2012.14.2.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/14/2012] [Accepted: 06/04/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To perform a comparative study between two groups of populations, titanium (T) group versus stainless steel (S) group, who were clipped with titanium and stainless steel materials, respectively, the incidence of regrowth from the original aneurysms, the clip slippage, and post-clipping seizure attack were analyzed. The patients were followed more than 5 years after microsurgical cerebral aneurysms clipping. METHODS Data from 1986 through 2008 were extensively reviewed on a consecutive series of 3,770 patients who referred for ruptured/unruptured cerebral aneurysms. Forty-seven patients in the S group and 48 in the T group who met inclusion criteria, were selected for this study. RESULTS The incidence of regrowth were noted that two out of total 47 patients (4.3%) in the S group, and none in the T group. The clip slippage was not observed in both groups. And there was no statistical difference (p = 0.242) in terms of regrowth between two groups. Seven out of 47 cases (14.9%) developed post-clipping seizure in the S group. On the other hand, two (4.2%) of 48 patients presented the symptom in the T group. Also, there was no significant difference (p = 0.091) between two groups. CONCLUSIONS The metallic types of clip employed for the microsurgical cerebral aneurysm clipping does not have any significant clinical outcome differences in this study.
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Affiliation(s)
- Sung Ho Choi
- Department of Neurosurgery, Gil Hospital, Gachon University, Incheon, Korea
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HORIUCHI T, LI Y, SEGUCHI T, SATO A, AOYAMA T, HANAOKA Y, HONGO K. Clip Blade Scissoring With Titanium Bayonet Clip in Aneurysm Surgery. Neurol Med Chir (Tokyo) 2012; 52:84-6. [DOI: 10.2176/nmc.52.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yuhui LI
- Department of Neurosurgery, Shinshu University School of Medicine
| | | | - Atsushi SATO
- Department of Neurosurgery, Ina Central Hospital
| | | | | | - Kazuhiro HONGO
- Department of Neurosurgery, Shinshu University School of Medicine
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Otawara Y, Ogasawara K, Kashimura H, Kubo Y, Ogawa A, Watanabe K. Mechanical characteristics and surface elemental composition of a Yasargil titanium aneurysm clip after long-term implantation. J Neurosurg 2010; 112:1260-2. [DOI: 10.3171/2009.9.jns09827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The mechanical properties of titanium-alloy aneurysm clips after long-term implantation in the human cranium are unclear. The characteristics of a Yasargil titanium aneurysm clip were evaluated after long-term implantation for 12 years in a patient with a cerebral aneurysm. The closing forces of the retrieved clip before and after implantation were approximately equal. The bending test showed no differences between the retrieved and control clips. Titanium oxide and calcium were identified on the surface of the retrieved clip, which indicated the formation of corrosion-resistant layers. Titanium-alloy clips retain their mechanical properties in the human cranium for a long time.
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Affiliation(s)
- Yasunari Otawara
- 1Department of Neurosurgery, Iwate Medical University, Morioka; and
| | | | | | - Yoshitaka Kubo
- 1Department of Neurosurgery, Iwate Medical University, Morioka; and
| | - Akira Ogawa
- 1Department of Neurosurgery, Iwate Medical University, Morioka; and
| | - Kouichi Watanabe
- 2Division of Biomaterial Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Mamourian AC, Erkmen K, Pluta DJ. Nonhelical acquisition CT angiogram after aneurysmal clipping: in vitro testing shows diminished artifact. AJNR Am J Neuroradiol 2008; 29:660-2. [PMID: 18184847 DOI: 10.3174/ajnr.a0893] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Imaging of the cerebral vessels with use of CT angiogram (CTA) after placement of aneurysmal clips is often limited by clip artifacts. We used a phantom to demonstrate a visible reduction in metal artifact when using the axial technique, compared with the usual CTA helical acquisition. This approach may have some advantage when used for CTA with 64-section scanners in the specific circumstance of immediate postoperative imaging after placement of cerebral aneurysmal clips.
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Affiliation(s)
- A C Mamourian
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Mamourian AC, Pluta DJ, Eskey CJ, Merlis AL. Optimizing computed tomography to reduce artifacts from titanium aneurysm clips: an in vitro study. J Neurosurg 2007; 107:1238-43. [DOI: 10.3171/jns-07/12/1238] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
At many institutions digital subtraction angiography remains the standard imaging procedure for the postoperative evaluation of patients following placement of a cerebral aneurysm clip largely because of the artifacts produced by the clip on computed tomography (CT). The authors evaluated the effect of various imaging parameters on the quality of 3D reconstructions from CT scans while imaging a phantom to optimize the CT angiograms.
Methods
Using multidetector CT scanners with submillimeter detector collimation (0.625 mm), the authors scanned a silicone phantom with attached commercial aneurysm clips. Slice thickness, reconstruction overlap, kilovolt level, milliampere level, and pitch were varied. Neuroradiologists, who were blinded to the scanning parameters, rated the reconstructions for image quality and artifact reduction.
Results
Images of the titanium clip using 140 kV and 380 mA with 0.625-mm overlapping reconstructed slices provided excellent 3D visualization of both the clip and the aneurysm model, even when using two adjacent clips.
Conclusions
Overlapping reconstructions combined with thin-section acquisition can provide detailed images of titanium clips and surrounding tissues without the use of low-pitch values.
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Affiliation(s)
- Alexander C Mamourian
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
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Mamourian AC, Mahadevan N, Reddy N, Marra SP, Weaver J. Prototypical metal/polymer hybrid cerebral aneurysm clip: in vitro testing for closing force, slippage, and computed tomography artifact. J Neurosurg 2007; 107:1198-204. [DOI: 10.3171/jns-07/12/1198] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The aim of this study was to explore the possibility that a hybrid aneurysm clip with polymeric jaws bonded to a metal spring could provide mechanical properties comparable to those of an all-metal clip as well as diminished artifacts on computed tomography (CT) scanning.
Methods
Three clips were created, and Clips 1 and 2 were tested for mechanical properties. Clip 1 consisted of an Elgiloy spring (a cobalt-chromium-nickel alloy) bonded to carbon fiber limbs; Clip 2 consisted of an Elgiloy spring with polymethylmethacrylate (PMMA) jaws; and Clip 3 consisted of PMMA limbs identical to those in Clip 2 but bonded to a titanium spring. Custom testing equipment was set up to measure the aneurysm clip clamping forces and slippage. Clips 2 and 3 were visualized in vivo using a 64-slice CT unit, and the slices were reformatted into 3D images.
Results
According to the testing apparatus, Clip 2 had a similar closing force but less slippage than three similar commercial aneurysm clips. The artifact from the cobalt alloy spring on CT scanning largely offset the advantage of the nonmetal PMMA limbs, which created no artifact. The hybrid titanium/PMMA clip (Clip 3) created very little artifact on CT and allowed visualization of the phantom through the limbs.
Conclusions
It is feasible to build a potentially biocompatible hybrid cerebral aneurysm clip with mechanical properties that closely resemble those of conventional metallic clips. Further testing should be directed toward establishing the reliability and biocompatibility of such a clip and optimizing the contour and surface treatments of the polymer limbs.
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Affiliation(s)
| | - Namrata Mahadevan
- 2Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Nischala Reddy
- 2Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Steven P. Marra
- 2Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - John Weaver
- 1Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon; and
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Abstract
The authors evaluated the ferromagnetic properties of multiple nonferromagnetic aneurysm clips before and after long-term and multiple exposures to a 1.5-T magnetic resonance system. No alterations in the magnetic properties of these clips was observed. These findings suggest that repeated or chronic exposure of patients with implanted nonferromagnetic aneurysm clips to strong static magnetic fields is unlikely to result in any clinically significant alteration in the magnetic properties of these clips.
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Affiliation(s)
- E Kanal
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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