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Repercussions of the Drug Price Competition and Patent Term Restoration Act of 1984.

Recently enacted legislation involving patent terms and the approval of new generic equivalent drug products is described, and the law's potential repercussions are discussed. The Drug Price Competition and Patent Term Restoration Act of 1984 (PL 98-417) consists of two titles that affect introduction procedures and patent requirements for certain types of generic new drug products. Title I allows drug manufacturers to use an abbreviated new drug application when seeking approval to make generic copies of drug products that were approved by the FDA after 1962. Title II encourages drug manufacturers to assume the increased costs of research and development of certain products that were subject to premarketing clearance by restoring some of the time lost on patent life while the product was awaiting FDA approval. Legislative analysts continue to question whether the short-term gains of eased market access to the generic manufacturers will be outweighed by the long-term benefits of patent extensions to the pioneer drug companies. The potential difficulties in the implementation of the Act and unresolved questions of law surrounding the new law are discussed. The possible effects of the new law on the drug manufacturing industry and market composition are described. Since PL 98-417 was implemented in September 1984, little has been settled in the way of implementing its provisions or accurately measuring its nonregulatory impact. It seems certain that the bill will be difficult to regulate and that litigation will proliferate. Furthermore, the impact of the statute on the composition of the drug industry will undoubtedly be substantial.

Economic Competition↗

Transcatheter closure of patent ductus arteriosus in children and adults.

AIM: To describe the initial New Zealand experience of transcatheter patent ductus arteriosus closure in adults and children. METHODS: Twenty-three children beyond infancy and four adults with isolated patent ductus arteriosus were selected for transcatheter umbrella closure. Rashkind umbrellas were placed across the patent ductus arteriosus through a percutaneously inserted long venous sheath using the Mullins technique. RESULTS: In 25 of the 27 patients a Rashkind umbrella was placed accurately. In two patients the umbrella could not be placed accurately: in one the procedure was abandoned uneventfully and in one the umbrella embolised to the right pulmonary artery necessitating surgical removal of the device and patent ductus arteriosus closure. There were no other significant complications. A second umbrella insertion is planned in two children for a significant residual leak at 1-year follow up. CONCLUSIONS: Transcatheter patent ductus arteriosus closure is a low risk and usually effective alternative to surgical closure for the majority of patients beyond infancy.

Adult↗

Biotech patents: the world is your oyster--or mouse--or (you name it).

The general rule is that a "product of nature" is not patentable. However, living entities, such as multicellular living organisms including animals, may be patented if they result from human intervention and the patent application relating thereto meets the other requirements of the patent statute. In early 1995, the United States Patent Office adopted biotechnology guidelines making it easier to meet some of those requirements, thereby encouraging even greater activity in this field.

Biotechnology↗

[Closure of the patent ductus arteriosus by means of cardiac catheterization].

Authors report their results with transcatheter closure of patent arterial duct during a period of 1 year. Thirty patients underwent the procedure at the mean age of 5.22 yrs (range 5 mos-22.3 yrs) and mean bodyweight of 19.1 kg (range 5.8-73 kg). There were 9 males and 21 females. The diagnosis of the patent arterial duct was established by physical examination and noninvasive techniques. The procedures were attempted in all patients above 5 kg bodyweight with patent arterial duct and normal pulmonary artery pressure, irrespective of the shunt-size. All procedures were performed under general anesthesia in one session with the diagnostic cardiac catheterisation. Transcatheter closure was successful in 29 patients. In one patient the device embolized into the left pulmonary artery, snaring was unsuccessful, surgical closure of the patent duct and removal of the device took place uneventfully. Control aortography 15 minutes after the coil placement showed insignificant residual shunt through the patent duct in 8 patients (27%), while echocardiography at 1 month proved complete closure in all. The patients were followed by noninvasive methods. No mortality was observed. Authors emphasize the low risk and cost-effectiveness of the procedure. They stress the importance of the patients selection. Authors applied the technique for the first time and introduced it to the regular patient-care practice in Hungary.

Adolescent↗

Genomic patenting and the utility requirement.

This paper analyses the ways in which genomic knowledge is portrayed as useful knowledge in gene patenting in order to fulfil the 'utility'/'industrial applicability' requirement for patentability. It gives examples of utility claims in gene patents and asks whether genomics (as opposed to genetics) changes our ideas about what is useful and what can be patented. It puts forward a provisional classification of different types of utility and argues that merely identifying the physiological function of a gene diverges radically from our commonsense understanding of what it is for an invention to be useful. Furthermore, social, political and ethical issues inevitably arise when discussing the utility requirement, because an invention cannot be useful in isolation from a social context.

DNA↗

[Surgical treatment of atrial septal aneurysms with patent foramen ovale in patients with cerebral ischemia as an alternative to life-long anticoagulant therapy: surgical strategy and results in 5 patients].

There is a significantly higher incidence of cerebral ischemia among patients with an atrial septal aneurysm and/or a patent foramen ovale. According to the information provided by modern diagnostic procedures--and in particular by transesophageal echocardiography--two pathogenic mechanisms should be considered as possible causes of the cerebral ischemia. Thrombi may develop locally in the left atrium or atrial septal aneurysm and lead to embolization or, alternatively, thrombi from the inflow region of the inferior vena cava may become trapped in the atrial septal aneurysm and pass through the patent foramen ovale to bring about embolization in the arterial bloodstream. Current treatment consists of life-long anticoagulation with coumarin derivatives in order to prevent further neurological complications. With this treatment, however, the risk of producing hemorrhages cannot be regarded as trivial, especially in old people. Surgical intervention with the insertion of a button device has so far only been attempted in a few isolated cases, and it is in any case no use if there is only an atrial septal aneurysm without a patent foramen ovale. As an alternative to administering anticoagulants for the rest of the patient's life, we operated on five cases of atrial septal aneurysm with patent foramen ovale followed by the appearance of cerebral ischemia. As with the surgical treatment of atrial septal defects in general, the risk of the operation (or of subsequent complications) is very slight indeed. No such problems arose in any of our patients, no blood transfusions were necessary, and after short postoperative treatment they could all be discharged. For younger patients with little risk from the treatment itself, we regard surgical intervention in cases of atrial septal aneurysm with a patent foramen ovale and cerebral ischemia as an important therapeutic alternative.

Adult↗

Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients.

The prevalence of a patent foramen ovale was assessed by simultaneously performing transesophageal contrast echocardiography and transcranial contrast Doppler sonography (TCD) in 137 subjects (mean age 36 years) with stroke of unclarified etiology (n = 41), clarified etiology (n = 33), and in normal subjects (n = 63; mean age 32 years). Patent foramen ovale was found significantly more often in patients with unclarified than clarified strokes or in normal subjects (66% vs 33%, or 43%). Massive paradoxical embolism through a patent foramen ovale, identified by TCD, occurred significantly (p < 0.01) more often in patients with unclarified (64%) than clarified (27%) strokes or in normal subjects (3%). However, minimal shunts were typical in normal subjects (79%). Patent foramen ovale was detected indirectly by TCD when calculated on the basis of transesophageal contrast echocardiographic findings (sensitivity 89%, specificity 92%). Thus, TCD reliably detects paradoxical cerebral embolism through a patent foramen ovale, and provides important additional information for evaluating its clinical relevance by semi-quantification of embolic contrast material.

Adult↗

Patent foramen ovale: a cause of hypoxemia in patients on left ventricular support.

We describe 2 patients who experienced right-to-left shunting during support with a left ventricular assist device as a result of patent foramen ovale. In the first patient, the patent foramen ovale was not found until autopsy. In the second patient, fluctuations in continuous mixed venous oxygen saturations caused us to suspect a patent foramen ovale, which was confirmed with transesophageal contrast echocardiography. We promptly repaired the defect and this patient survived. When patients on assist devices experience unexplained arterial hypoxemia, a patent foramen ovale should be considered. If a patent foramen ovale is found, surgical correction should be done early.

Adult↗

Patentable invention in biotechnology.

Biotechnology is a rapidly advancing field of technology which offers many benefits to society. It is perceived that an important part of maintaining the momentum, and stimulating further advances, is to protect inventions in biotechnology, where appropriate, with a patent. Here, from the perspective of invention in biotechnology, we examine in brief, the critical elements of proper subject-matter, novelty, utility, non-obviousness and sufficiency of disclosure, as requirements of patentable invention for both the United States and Canada. Topical issues which have arisen in respect of these elements are also canvassed briefly. As will be seen, Canadian Patent Law, while still unresolved with respect to the patenting of higher life forms, is in other respects in step with the pro-patent model of the United States.

Journal Article↗

Comparison of outcomes in patients undergoing coronary bypass of patent versus restenosed bare metal stented coronary arteries.

It is unclear whether bypass of a patent stented artery affects clinical outcomes. We sought to compare the survival of patients who, as part of multisystem coronary artery bypass grafting, underwent revascularization of arteries with patent stents (<50% stenosis) or in-stent restenosis (>50% diameter stenosis). Of 550 consecutive patients with previously placed stents who underwent coronary artery bypass grafting from May 1995 to October 2003, we studied 399 who had only 1 stented vessel bypassed at surgery. Of these, 128 had coronary bypass to an artery with a patent stent and 271 had bypass to an artery with in-stent restenosis. Nonparametric survival estimates were obtained using the Kaplan-Meier method. A propensity-adjusted multivariate hazard model of group differences was generated using variables identified by bootstrap bagging. The unadjusted survival rate at 1 month, 1 year, and 5 years was 99.7%, 97.3%, and 89.1%, respectively, for the patent stent group and 96.6%, 93.9%, and 86.2%, respectively, for the in-stent restenosis group, a result of high early risk in the latter group. After adjusting for clinical variables, neither stent patency (p = 0.9) nor interval (p = 0.3) from stent placement was a risk factor, although advanced age, increased blood urea nitrogen, and preoperative atrial fibrillation were associated with poorer survival. In conclusion, survival after bypassing a patent stented coronary artery is comparable to that after bypassing a stented restenotic coronary artery.

Aged↗

Nonoperative management of a patent urachus.

Patent urachus accounts for 10% to 15% of all reported urachal abnormalities in the literature. Treatment in the past has relied on immediate surgery. Conservative therapy with bladder catheter drainage, resulting in spontaneous closure, has not been described. We report a case of patent urachus in a 6-day-old infant who presented with urine drainage from the umbilicus. Radiographic studies confirmed a patent urachus. One week of urethral catheterization resulted in spontaneous closure of the patent urachus. This case suggests that initial treatment should consist of urethral catheterization for 1 to 2 weeks, followed by repeat voiding cystourethrogram. If the patent urachus still persists, one should proceed to surgical correction.

Congenital Abnormalities↗

Timing of transesophageal echocardiography in diagnosing patent foramen ovale in patients supported with left ventricular assist device.

Left ventricular assist devices unload the left ventricle and decrease left atrial pressure. This hemodynamic change may cause a right to left atrial shunt and hypoxemia in patients with patent foramen ovale. We prospectively studied the best time for performing diagnostic transesophageal echocardiography in left ventricular assist device patients. Intraoperative transesophageal echocardiography was performed in 14 patients before cardiopulmonary bypass was initiated and after left ventricular assist device was implanted. No patent foramen ovale was detected when transesophageal echocardiography was done before bypass, but a patent foramen ovale was found in 3 patients when transesophageal echocardiography was performed after left ventricular assist device was activated. Patent foramen ovale was confirmed by inspection in all three patients and surgically closed during the same procedure. There were no patent foramen ovale closure-related complications.

Cardiac Surgical Procedures↗

Biplane transesophageal echocardiography in the diagnosis of patent foramen ovale.

Patent foramen ovale is associated with unexplained systemic embolic events or persistent hypoxemia. The diagnosis of a patient foramen ovale is based on the existence of an interatrial right-to-left shunt. Biplane transesophageal echocardiography with its increased ability to provide accurate anatomic detail may allow the visualization of the actual opening of the patent foramen ovale. In 19 patients with transesophageal positive contrast studies, we assessed the value of the vertical versus the horizontal plane in the diagnosis of a patent foramen ovale. The patent foramen ovale opening could be seen and sized in the vertical plane in 10 studies (53%). In none of these 10 cases was the opening seen also in the horizontal plane. We conclude that in a significant number of cases, biplane transesophageal echocardiography adds morphological detail to the diagnosis of patent foramen ovale. The ability to size the actual opening may have therapeutic implications.

Contrast Media↗

Accuracy of color Doppler transesophageal echocardiography for diagnosis of patent foramen ovale.

This study assessed the sensitivity of color Doppler as compared with contrast study during transesophageal echocardiography for detection of a patent foramen ovale. We also evaluated the incidence of patent foramen ovale in younger (less than age 50, group 1) as compared with older (greater than age 50, group 2) patients. A total of 114 patients were studied. A patent foramen ovale was found in 17 patients: 7 of 39 (17.9%) in group 1 and 10 of 75 (13.3%) in group 2 (NS). The sensitivity of color Doppler as compared with contrast study was 33%. Our data suggest that color Doppler is a poor method of assessment for the presence of a patent foramen ovale and that patent foramen ovale remains prevalent in older as well as younger patients.

Adult↗

An epizootic of patent iridescent virus disease in multiple species of blackflies in Chiapas, Mexico.

Simulium blackfly larvae (Diptera: Simuliidae) were collected from rivers and streams at 500-1500 m a.s.l. in Chiapas State of southern Mexico. Among 45 sites surveyed over an area of 2300 km2 (around 15 degrees 15'N 92 degrees 20'W), some Simulium larvae from three sites were opalescent violet-blue, interpreted as patent infection with invertebrate iridescent virus (IIV). Dissection confirmed the presence of putative Iridovirus particles, 130nm diameter, but no IIV isolates were obtained from homogenates injected into Galleria mellonella (L) larvae (Lepidoptera: Pyralidae). All Simulium with patent IIV infection died before metamorphosis, whereas approximately 60% of asymptomatic Simulium survived to adulthood in the laboratory. During 1997, standard monthly samples from two parallel rivers 42-50 km north-west of Tapachula comprised the following species proportions (and rates of patent IIV infection): 41.8% (47%) Simulium mexicanum Bellardi complex, 31.3% (31.4%) S. rubicundum Knab, 10.1% (13.1%) S. paynei, 6.5% (2.9%) S. callidum (Dyar & Shannon), 6.3% (5.1%) S. ochraceum Walker complex, 3.1% (0.7%) S. downsi Vargas et al., 0.7% S. samboni Jennings and 0.2% S. metallicum Bellardi complex, showing a strong correlation between blackfly abundance and the prevalence of patent infection. An epizootic of IIV in January and February (infection rates 41-100%) was followed by absence of larvae (March-August) until the end of the rainy season, when numbers collected on nylon strings rose to approximately 1/cm with patent IIV infection rates of 0-12.5% during September-December. Further investigations are underway to isolate this IIV and assess its potential usefulness for biological control of Simulium pests and vectors of onchocerciasis.

Animals↗

Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale.

OBJECTIVE: During recent years, transcatheter closure has become an alternative to operations for the treatment of atrial septal defects and patent foramen ovale. However, this procedure may be unsuccessful or complicated and requires surgical treatment. METHODS: We retrospectively analyzed the outcomes of patients who needed surgical treatment after failed or complicated transcatheter closure of an atrial septal defect or a patent foramen ovale. RESULTS: Between April 1994 and March 1999, 124 patients were treated with transcatheter closure of an atrial septal defect or a patent foramen ovale at our institution. We report the results of 10 (8%) patients of this series who required operations after transcatheter closure attempts. In 8 of these 10 patients a significant shunt caused by malposition or dislocation of the device persisted, leading to surgical closure of the defect. In 2 patients injury of the femoral artery at the puncture site required surgical repair. In one patient the device had to be removed surgically from the iliac vein after retraction. One patient died of left ventricular perforation after dislocation of the device and several surgical attempts to close the left ventricular rupture. All other patients recovered well. CONCLUSION: An operation was required after transcatheter closure of an atrial septal defect or a patent foramen ovale in 8% of patients. After device complications, the atrial septal defect and the patent foramen ovale can still successfully be closed surgically with good results and low morbidity. However, serious complications like cardiac perforation may have a fatal outcome. Residual shunt, dislocation, or vascular complications are the most frequent problems that require surgical interventions.

Adolescent↗

Sales practices of patent medicine sellers in Nigeria.

A survey was carried out among patent medicine dealers to evaluate their practices that militate against laws governing prescriptions-only medicines in Nigeria. Questionnaires were distributed to 46 patent medicine dealers and later collected from them on appointment. Analysis of the results showed that all the patent medicine dealers were aware of the law governing the sale of prescription drugs in Nigeria. Seventy-five per cent of them stock such drugs. Patent medicine dealers obtain their drugs largely from sales representative of pharmaceutical companies as well as from industries. Inappropriate use of sales boys and girls in patent medicine stores and defective government policies were all investigated.

Child↗

The low scrotal approach to the ectopic or ascended testicle: prevalence of a patent processus vaginalis.

PURPOSE: The scrotal approach to undescended testis has been described using a high scrotal incision and including hernia repair. We describe an approach that uses a low scrotal incision with an inguinal incision if a patent processus is identified. We retrospectively reviewed the likelihood of a patent processus in children selected to undergo this technique. MATERIALS AND METHODS: A total of 56 consecutive patients determined by history and physical examination to have ectopic or ascended testes underwent orchiopexy using an initial scrotal approach for a total of 71 undescended testes. Inguinal surgery had previously been done in 5 testes, which were not included in patent processus analysis. Charts were reviewed for testicular position, need for inguinal incision and demographic data. RESULTS: Of the patients 16 (19 testes) were younger than 2 years, 19 (26 testes) were 2 to 6 years old and 17 (21 testes) were older than 6 years. In 20% of the patients an inguinal incision was made for a patent processus vaginalis. The incidence of a patent processus was 26% in those younger than 2 years, 15% in those 2 to 6 years old and 19% in those older than 6 years (p = 0.17). All patients had satisfactory scrotal placement with at least 1 followup examination. CONCLUSIONS: Children with ectopic or ascended testes on physical examination findings may be treated successfully via a low scrotal approach with only 20% requiring concomitant inguinal hernia repair through a standard inguinal incision. Overall 80% of the children avoided an inguinal incision. This technique has become our standard approach to these testes.

Child↗