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PubMedDate not supplied

[Patent ductus arteriosus in premature newborns. Treatment with indomethacin (author's transl)].

The pharmacokinetic and pharmacodynamic effects of indomethacin were studied in 18 prematures with patent ductus arteriosus, treated either enterally (group I, n = 7), or intravenously (group II, n = 11). A definitive closure assessed by echocardiography was observed in 13 cases (72%), and it was only transient in 4 cases (21%). Assisted ventilation was discontinued between 1 and 6 days following therapy in 14 cases. In most cases, indomethacin induced a significant reduction of diuresis but the plasma creatinine level increased above 15 mg/l in 3 cases only. The elimination half life of indomethacin (t 1/2 beta), of 40.3 +/- 12.2 hours in group I and 33.9 +/- 11.7 hours in group II, is increased as compared with adults. The difference of the surface under the curve (AUC O leads to 24 h, ng.ml-1.h-1) between the infants who presented complete or transient closure, suggests a relationship between the biodisponibility of the drug and the effect on patent ductus arteriosus. Treatment with indomethacin is an interesting alternative to surgical ligation in prematures with patent ductus arteriosus. Because of its side effects, especially on the kidneys, it is recommended to use this treatment only in intensive care units. The intravenous route seems to be better than the enteral route.

Administration, Oral↗
PubMed1980

Intra-aortic closure of the calcified patent ductus: a new operative method not requiring cardiopulmonary bypass.

Diffuse and circumferential calcification of the patent ductus arteriosus is a rare finding frequently associated with severe pulmonary artery hypertension. Under this circumstance, closure of the patent ductus arteriosus by ligation in continuity or by division and suture is hazardous if not impossible. Endoaortic closure of the ductus with a prosthetic patch has been proposed as an alternate and safer procedure. This paper describes an improved operative technique for intra-aortic closure of a calcified patent ductus arteriosus employing a heparin-coated shunt to permit aortic cross-clamping and an intraluminal baloon catheter to control bleeding from the pulmonary artery. Extracorporeal circulation and systemic heparinization are avoided. Minimal manipulation of the ductus and pulmonary artery is required.

Aorta, Thoracic↗
PubMedDate not supplied

Quality patents.

Watermark Patent and Trademark Attorneys has recently been accepted by the Council of National Association of Testing Authorities, Australia as operating a Quality Management System that complies with the requirements of AS3901/ISO9001 for the creation and servicing of Australian and overseas patents, trademarks and designs and provision of related advice. It is believed that Watermark is the first firm of Patent Attorneys in the world to achieve this.

Australia↗
PubMed1994

[Residual shunt after percutaneous occlusion of patent ductus arteriosus by Rashkind's device. Echographic aspects, outcome, prognostic factors and management].

Percutaneous occlusion of patent ductus arteriosus with the double umbrella Rashkind prosthesis is an alternative to surgery. The authors report the results of a series of 40 patients aged 16 to 203 months, who underwent transcatheter occlusion of patent ductus arteriosus between January 1989 and March 1993. These children were followed up regularly, clinically and by echocardiography to determine the presence or absence of a residual shunt. Immediately after implantation, angiography showed a residual shunt in 75% of cases. However, the shunt progressively regressed during follow-up. Three types of shunt were described using colour Doppler based on the diameter of the transductal jet at its origin and its extension in the pulmonary artery: type I, a wide jet (> 3 mm), type II, or minimal shunt, with a jet diameter of 2 to 3 mm and an extension to the pulmonary valve (flame-like), and finally the type III, or punctiform shunt with a jet diameter < 2 mm and extension in the main pulmonary artery < 1.5 cm. During follow-up, a transition between the 3 types was observed in 37% of cases. Kaplan-Meier actuarial analysis showed a residual shunt rate of 33% at one year and 19% at 2 years after implantation. The search for predictive factors of residual shunt showed that very young patients at the time of catheterisation was the only indicator of a residual shunt (p = 0.03). Occlusion of a patent ductus arteriosus with a Rashkind device is a reliable method which gives good results. The essential problem remains that of a residual shunt but this disappears in 3/4 of patients during follow-up. When the shunt persists, a 1 to 2 year interval is advised before considering implantation of a second occluder.

Actuarial Analysis↗
PubMed1994

Patents and the nurse scholar, Part I: The basic philosophy of intellectual property.

Patenting intellectual property is important for a number of reasons. Health care products are designed to improve the effectiveness and efficiency of care. Without the patent, the property would most likely never enter into the public market for general use by either health care providers or clients. Products such as the specialized IV pole which also accommodates dependent drains (e.g. urinary drainage bags) (Rebar, 1991) or the premature infant pacifier (Engebretson & Wardell, 1991) are valuable assets to patient care. However, without patents to protect them as property, their value in the commercialization process would be nil. Therefore, the public benefits from this system for three reasons: (1) it encourages the inventor to make the invention; (2) the public is given the opportunity to use the invention; (3) the knowledge of the invention is made available to everyone; and (4) often royalties are returned to the institution for further research and development activities.

Clinical Nursing Research↗
PubMed1996

[Closure of patent ductus arteriosus by video thoracoscopy in 282 children].

Closure of patent ductus arteriosus by video thoracoscopy is a standardised procedure. The authors report their experience of closure of patent ductus arteriosus by video-thoracoscopy from May 1991 to December 1995. The series included 282 patients divided into 3 groups according to age: under 6 months (78 patients, 27.6%), from 6 months to 4 years (135 patients, 42.88%) and over 4 years of age (69 patients, 24.6%) with an average weight of 12.6 kg (range: 1.2 to 65 kg). Symptomatic pulmonary hypertension was observed in 39 cases and 9 children had associated intracardiac malformations (ostium secundum: 3; ventricular septal defect: 5; abnormal pulmonary venous drainage: 1) which were not corrected. The technique consisted of placing two titanium clips in position under video-thoracoscopy to close the ductus. An echo performed immediately afterwards confirmed closure of the ductus. The main complications were: persistence of a shunt (4 cases) at the beginning of our experience requiring immediate reoperation by video-thoracoscopy in 3 cases and by thoracotomy in one case; left recurrent laryngeal nerve palsy in 6 cases (2.1%) with regression in 5 and persistence in one case; one case of postoperative chylothorax which regressed rapidly. There were no fatalities or haemorrhages and no blood transfusions were required in this series. The average operating time was 20 +/- 15 minutes and the duration of hospital stay around 48 hours when the patients were over 6 months old and 72 hours when less than 6 months of age. Video-thoracoscopic closure of patent ductus arteriosus is rapid, safe, economical, it provides excellent results and may be used in children of all ages.

Age Factors↗
PubMed1998

[Videoscopic resection of a thrombosed aneurysm of a patent ductus arteriosus in a neonate].

Aneurysmal dilatation of a patent ductus arteriosus is a rare condition. One hundred and fifty three cases have been reported, of which 59 (39%) were operated, with an operative mortality of 16%. The authors report a case detected in a premature neonate on chest X-ray showing a mass in the mid-mediastinal region. Surgical resection was undertaken by video-thoracoscopy. Peroperative analysis of the resected specimen suggested a vascular structure and this was confirmed by histological study, which showed spontaneous aneurysm of a thrombosed patent ductus arteriosus or cystic residue of a patent ductus arteriousus. The authors underline the importance of peroperative puncture of structures of uncertain origin and the possibility of conversion of such a procedure to that of an extreme emergency.

Aneurysm↗
PubMed1998

From make believe to doomsday eve: or should we patent genes?

Patenting genes and its consequences and justifications in the context of law and ethics is a particularly controversial issue, with the potential to affect every aspect of our lives. If only a decade ago it seemed merely fiction that biotechnology would lead to inventions and progress beyond our imaginations, today, we have come to realize that this phenomenon--the art of make-believe--is close to becoming reality. In order to establish legal means to control these inevitable advances, and prevent a doomsday scenario from becoming fact, this paper is aimed at discussing, on the philosophical level, the contradicting moral and ethical concerns and justifications of the patenting of genes as well as accompanying environmental, constitutional and religious arguments. In order to better understand the arena of gene patenting, this paper commences with a brief introduction to the property debate of who owns human organs in general, and genes in particular. Its target is to confront us with the dilemmas arising in this field, as a starting point for finding legal solutions to override the gap presently existing, when science sets the rules and law is lagging behind.

Embryo, Mammalian↗
PubMed1976

Cine angiographic diagnosis of patent foramen ovale in paradoxical embolism,.

A case of paradoxical embolism is presented in which the antemortem diagnosis was facilitated by a new simple angiographic technique that demonstrated a patent foramen ovale. An additional 14 patients were studied by this technique, and one had a patent foramen ovale. The mechanism of reversal of the normal intraatrial pressure gradient and subsequent right to left shunt through a patent foramen ovale is discussed. This angiographic technique may be readily applied in any diagnostic catheterization laboratory and complements existing methods for detecting patency of the foramen ovale in patients with suspected paradoxidal embolism.

Adult↗
PubMed2003

Laparoscopic sentinel lymph node procedure using a combination of patent blue and radioisotope in women with cervical carcinoma.

BACKGROUND: The authors evaluated the feasibility of a laparoscopic sentinel lymph node (SN) procedure with combined radioisotopic and patent blue labeling in patients with cervical carcinoma. METHODS: Thirteen women (median age, 52.5 years) with cervical carcinoma (Stage Ia2 in 1 patient, Stage Ib1 in 10 patients, Stage Ib2 in 1 patient, and Stage IIa in 1 patient) underwent a laparoscopic SN procedure using an endoscopic gamma probe after both radioactive isotope and patent blue injections. After the procedure, all patients underwent complete laparoscopic pelvic lymphadenectomy and either laparoscopic radical hysterectomy (eight patients) or the Schauta-Amreich operation (five patients). RESULTS: SNs (mean, 1.7 SNs per patient; range, 1-3 SNs per patient) were identified in 12 of 13 patients. A median of 10.5 pelvic lymph nodes per patient (range, 4-17 pelvic lymph nodes per patient) were removed. No lymph node involvement was detected in SNs with hematoxylin and eosin staining. Immunohistochemical studies identified four metastatic SNs in two patients, with micrometastases in two SNs from the first patient and isolated tumor cells in two SNs from the second patient. No false-negative SN results were obtained. CONCLUSIONS: The results of this study suggest that SN detection with a combination of radiocolloid and patent blue is feasible in patients with cervical carcinoma. The combination of laparoscopy and the SN procedure permitted minimally invasive management of early-stage disease.

Adult↗
PubMed1993

A case of a closed partial cloacal septation defect with a patent urachus.

A boy with a closed partial cloacal septation defect with a patent urachus is reported. He had an intact abdominal wall, a patent urachus, a colovesical fistula, intact genitalia and urethra, imperforate anus, and a lipomyelocystocoele. Patients with similar constellation of findings have been reported as cloacal exstrophy variants. What distinguishes this case from the other reported variants is the intact abdominal wall with the patent urachus, the small and normally formed phallus and urethra, and the presence of a lipomyelocystocoele. We discuss the possible embryologic mechanism responsible for this boy's findings and possible relationship with the cloacal exstrophy spectrum. We also discuss new terminology for the epispadias-exstrophy spectrum. Furthermore this case reminds us that there is considerable variability within the epispadias-exstrophy spectrum.

Abnormalities, Multiple↗
PubMed1998

Preoperative contrast ultrasonographic diagnosis of patent urachal sinus.

A patent urachal sinus, as well as other congenital urachal anomalies, may be at risk of injury during laparoscopy. Leakage of fluid at the midline site of trocar entry is the usual postoperative sign of injury to a patent urachal sinus. Pre-operative diagnosis of this anomaly can prevent injury during laparoscopy. We describe a contrast ultrasound technique for diagnosis of patent urachal sinus.

Female↗
PubMed2006

Aortic operation after previous coronary artery bypass grafting: management of patent grafts for myocardial protection.

OBJECTIVES: Aortic surgery for progressive aortic valve disease or aortic aneurysm after previous coronary artery bypass grafting (CABG) is a challenging procedure. We report the outcome of aortic reoperation after previous CABG and evaluate our management of patent grafts and our methods for obtaining myocardial protection. METHODS: From February 2001 to July 2003, 6 patients with progressive aortic valve disease and aneurysm of the thoracic aorta were operated on. The group comprised 3 men and 3 women with a mean age of 67.6 years. There were 4 patients with an aneurysm of the aortic arch, 1 with chronic ascending aortic dissection, and 1 with progressive aortic valve stenosis. The interval between previous CABG and aortic surgery was 74.0 +/- 44.2 months. All reoperations were performed via median resternotomy. Myocardial protection was obtained by hypothermic perfusion of patent in-situ arterial grafts following cold-blood cardioplegia administration via the aortic root under aortic cross clamping. RESULTS: The operative procedure was aortic arch replacement in 4 patients, ascending aortic replacement with double CABG in 1, and aortic valve replacement in 1. All patients survived the reoperation. Postoperative maximum creatine kinase-MB was 49.2 +/- 29.8 and no new Q-waves occurred in the electrocardiogram nor were any new wall motion abnormalities recognized on echocardiography. There were no late deaths during a follow-up of 30.7 months. CONCLUSION: Reoperative aortic procedures after CABG can be performed safely with myocardial protection via hypothermic perfusion of a patent in-situ arterial graft.

Aged↗
PubMed2001

[The effect of volume status of the right-left shunt in a patient with a patent foramen ovale].

This is a description of the anaesthetic management of a patient with a flow patent foramen ovale undergoing intramedullary nailing of the femur. In order to detect the flow patent foramen ovale, we used transoesophageal echocardiography. During the ventilation maneuver with positive airway pressure of 20 cmH2O, a right-to-left interatrial shunt was observed. After the administration of 500 ml hydroxy-starch solution (6%) intravenously, detection of the right-to-left shunt flow was no longer possible. This case report shows that the volume status in a patient with a patent foramen ovale could influence the right to left interatrial shunt during general anaesthesia.

Anesthesia, General↗
PubMed2004

[Platypnea-orthodeoxia of a 69-year old woman with a patent foramen ovale].

Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a patent foramen ovale (PFO) or atrial septal defect. We describe the case of a 69-year-old woman with progressive dyspnea and hypoxia when standing, which was relieved by assuming the recumbent position. After detection of a PFO by transesophageal echocardiography the diagnosis was confirmed by transthoracic echocardiography using saline contrast injection while lying supine and standing upright. This maneuver demonstrated a large right-to-left shunt through a patent foramen ovale while the patient was in a upright position and no significant shunt while being in a recumbent position. The patient showed a rapid improvement after closure of the PFO. This case demonstrates that platypnea-orthodeoxia caused by a patent foramen ovale can be easily demonstrated by the technique of contrast transthoracic echocardiography and a simple positioning maneuver.

Aged↗
PubMed2006

Massive pulmonary embolism complicated by a patent foramen ovale with straddling thrombus: report of a case.

We report a case of massive right pulmonary embolism with a patent foramen ovale and straddling thrombus, occurring a few days after cesarean section in a 31-year-old woman. Preoperatively, a mass was seen echocardiographically in four cardiac cavities. We performed emergency surgery because of the patient's acute hemodynamic deterioration. Intraoperatively, we found a thrombus entrapped in the patent foramen ovale. Most of the thrombus was floating in the right atrium and a long end was found in the left atrium, in addition to the pulmonary emboli. We removed the thrombus, closed the patent foramen ovale by direct suturing, and performed pulmonary embolectomy. Histological examination confirmed thrombi. Doppler examination of the venous system did not reveal any possible source of the thrombus. The patient is now well and free from recurrence of embolic disease 1 year after surgery. We review the literature on this relatively unusual thromboembolic disease.

Adult↗
PubMed2000

The fate of a patent carotid artery contralateral to an occlusion.

The finding of carotid stenosis contralateral to a carotid occlusion is becoming more frequent. While the neurologic outcomes in this patient population have been described, the rate of disease progression measured by duplex examination and the eventual need for carotid endarterectomy has not been described. In this study, a computerized database of carotid duplex examinations was reviewed and clinical data were obtained from clinic records. From 9124 studies 117 patients were identified. Thirty patients had previous carotid surgery on the patent side and were excluded. Of 87 patients 33 required carotid endarterectomy on the patent side. The rate of disease progression and/or the performance of a carotid endarterectomy by life-table analysis was 85.9% over 8 years. There were 10 neurologic events during the follow-up period. Patients with carotid stenosis and contralateral occlusion are at significant risk for disease progression. Follow-up should be more frequent and of longer duration in this patient population. A significant number of patients with carotid artery occlusion will require a carotid endarterectomy of the patent contralateral carotid.

Aged↗
PubMed1982

Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics.

Peripheral M mode contrast echocardiograms were performed at rest and during the Valsalva maneuver in 11 patients with patent foramen ovale and normal right heart pressures documented by catheterization studies. Positive contrast studies (at least five clearly identifiable contrast echoes appearing in the left heart) were obtained in three patients (27 percent at rest) in six (54 percent) during the Valsalva maneuver and in seven patients (64 percent) either at rest or during the Valsalva maneuver. It is concluded that contrast echocardiography offers an opportunity to diagnose a patent foramen ovale noninvasively in patients with suspected paradoxical embolism or with questionable evidence of atrial septal defect. A positive study result does not specifically indicate heart disease since it occurs in healthy persons with patent foramen ovale, normal intracardiac pressures and no other abnormality.

Adolescent↗