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At least 667 records · Page 37Linked to original sources
PubMed1998

Closure of persistently patent arterial duct and its impact on cerebral circulatory haemodynamics in children.

PURPOSE: Closure of a patent arterial duct (PDA) is suggested as a risk factor associated with intraventricular haemorrhage and/or cerebral ischemia in neonates. This study evaluate the effects of transcatheter closure of a patent arterial duct in children on cerebral blood flow velocity. METHODS: Twelve children, aged from one to eight years were enrolled. Anaesthesia induction consisted of thiopentone, fentanyl and diazepam. Tracheal intubation was facilitated with vecuronium. Anaesthesia was maintained with N2O 70% in O2 and a PaCO2 between 35 to 40 mmHg. No cerebral vasoactive agents were used. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate were continuously recorded. Systolic (Vs) and diastolic (Vd) cerebral blood flow velocity (CBFV) were recorded. Cerebral perfusion pressure (CPP) was calculated. The mean CBFV, the systolic-mean ratio and the cerebral blood volume were estimated from the area under the velocity-time curve (AUC) before PDA closure, immediately after and for 10 min following occlusion. RESULTS: The mean (+/- SD) age and weight were 30 +/- 22 mo and 13 +/- 5 kg, respectively. Continuous recording during duct closure showed an abrupt increase in Vd (P < 0.05) whereas Vs remained constant. The AUC increased after closure and persisted for 10 min (P < 0.05). CONCLUSION: This study confirms that closure of a PDA leads to acute changes in intracerebral diastolic flow and volume. This observation gives weight to mechanisms involved in IVH in smaller infants after arterial surgical duct closure. The anaesthetic technique used for arterial duct closure in these procedure could influence these observations.

Area Under Curve↗
PubMed2003

Balancing access to pharmaceuticals with patent rights.

It is generally recognised that public health problems in the developing world are dire and that the rest of the world has a moral commitment to provide assistance. Yet many of the world's poor are unable to access essential pharmaceuticals simply because products that are under patent are too expensive and cheaper generics are not available. One of the proposed solutions to this problem is to allow domestic manufacture of generic products in response to health crises. However, this solution will provide no assistance in countries that lack the capacity to manufacture pharmaceuticals. This article discusses the extensive international negotiations occurring during the last couple of years that seek to provide an appropriate balance between access rights and patent rights.

Developing Countries↗
PubMed2002

Transcatheter closure of a patent arterial duct in a patient on veno-arterial extracorporeal membrane oxygenation.

The presence of a patent arterial duct may complicate the course of the patient on veno-arterial extracorporeal membrane oxygenation (ECMO). While surgical ligation has been traditionally used as a definitive treatment for this problem, transcatheter closure may have advantages. This is the first report of transcatheter occlusion of a patent arterial duct in an infant on ECMO support.

Cardiac Catheterization↗
PubMed2002

Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial.

UNLABELLED: Indomethacin (INDO) and, more recently, ibuprofen (IBU) have been used to treat haemodynamically significant patent ductus arteriosus (PDA) in preterm infants. Both are cyclo-oxygenase blockers, but seem to have a different influence on regional circulation. In a prospective, randomised, controlled study, we compared INDO and IBU with regard to efficacy and safety for the early non-invasive treatment of PDA. Doppler echocardiography was used to study 232 preterm infants (gestational age 23-34 weeks) with respiratory distress syndrome of whom 175 had persistent, haemodynamically significant PDA at 48-72 h of life. They were randomised to receive three intravenous doses of either INDO (0.2 mg/kg, at 12 h intervals) or IBU (a first 10 mg/kg dose followed by two doses of 5 mg/kg at 24 h intervals), recording rate of ductal closure, need for additional treatment, side-effects and clinical course. The efficacy of the pharmacological treatment was similar in the two groups (56/81, 69% INDO; 69/94, 73% IBU). Patients treated with INDO showed a significant increase in serum creatinine (89 +/- 24 versus 82 +/- 20 mmol/l, P = 0.03) and a near-significant tendency for a lower fractional excretion of sodium (3 +/- 3 versus 4 +/- 2%, P = 0.08); moreover, 12/81 (15%) INDO patients versus 1/94 (1%) IBU patients became oliguric (< 1 ml/kg per h) during treatment (P = 0.017). CONCLUSION: Our findings confirm that, by comparison with indomethacin, ibuprofen has fewer effects on renal function in terms of urine output and fluid retention, with much the same efficacy and safety in closing patent ductus arteriosus in preterm infants with respiratory distress syndrome. In particular, no increased incidence of intracranial haemorrhage was observed after ibuprofen treatment.

Analysis of Variance↗
PubMed2004

A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus.

UNLABELLED: Ibuprofen (IBU) has previously been shown to be as effective as indomethacin (INDO) in closing the patent ductus arteriosus (PDA) of preterm infants, without severely affecting renal hemodynamics or basal cerebral blood flow. We conducted a meta-analysis of randomized trials to compare the efficacy and safety of IBU and INDO for treatment of PDA. Data from the nine relevant trials ( n =566), showed no significant difference in the efficacy of IBU and INDO in PDA closure ( P =0.70). However, five trials ( n =443) provided serum creatinine concentration data that revealed a significantly lower increase favoring IBU ( P < 0.001), and urine output data that showed a significantly lower decrease favoring IBU ( P < 0.001). In two trials ( n =188) the proportion of infants who required postnatal oxygen therapy at 28 days (defined as chronic lung disease) was significantly higher with IBU (52/94; 55.3%) than with INDO (38/94; 40.4%, P < 0.05). No statistically significant differences were found in mortality, intraventricular hemorrhage, necrotizing enterocolitis, surgical ligation, sepsis, retinopathy of prematurity, periventricular leukomalacia, length of hospital stay, gastrointestinal bleeding, re-opening of PDA, back-up treatment, surfactant therapy, or days on a ventilator. CONCLUSION: ibuprofen and indomethacin have similar efficacy in patent ductus arteriosus closure, but preterm infants treated with ibuprofen experience lower serum creatinine values, higher urine output, and less undesirable decreased organ blood flow and vasoconstrictive adverse effects.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

A patent ductus arteriosus is associated with reduced middle cerebral artery blood flow velocity.

UNLABELLED: The study objective was to determine the effect of a patent ductus arteriosus (PDA) on cerebral blood flow velocity in ventilated, very low birth weight neonates, in the first 5 days of life. Sonography of the right middle cerebral artery and ductus arteriosus was performed using a colour Doppler technique. Statistical analysis was by stepwise regression. Thirty-one neonates without and 43 with a PDA, mean (SD) birth weight 1004 g +/- 192 and 1071 g +/- 227 respectively, were studied. The end diastolic and mean velocities were reduced (P = 0.008 and P = 0.129) and the resistive index was increased (P = 0.047) by a PDA. pH was inversely related to end diastolic and mean velocities (P = 0.015 and P = 0.003), suggesting that low pH may increase cerebral artery blood flow velocity. CONCLUSION: A patent ductus arteriosus reduces middle cerebral artery blood flow velocity in very low birth weight neonates.

Blood Flow Velocity↗
PubMed2000

Prophylactic ibuprofen therapy of patent ductus arteriosus in preterm infants.

UNLABELLED: This study was aimed at evaluating the efficacy of ibuprofen in the prophylaxis of patent ductus arteriosus (PDA) in very preterm neonates and at detecting eventual side-effects. A total of 46 preterm neonates with gestational age under 31 weeks were randomly assigned at 2 h of life: 23 to the prophylaxis group and 23 to the control group. The prophylaxis group received intravenous treatment with ibuprofen lysine (10 mg/kg), followed by 5 mg/kg after 24 h and 48 h. No placebo was given to the control group. No PDA was demonstrated at 72 h of life in 20 of the 23 babies in the ibuprofen group (87%) nor in 7 of the 23 control neonates (30.4%). All neonates with PDA received treatment with indomethacin. One neonate in the prophylaxis group and three in the control group underwent surgical ligation. Prophylaxis with ibuprofen was not associated with any significant side-effect except for food intolerance. CONCLUSION: Ibuprofen prophylaxis seems to be efficient in closing patent ductus arteriosus and in reducing indomethacin treatment. No significant early side-effects were found due to ibuprofen.

Ductus Arteriosus, Patent↗
PubMed2006

Off-patent drugs in Italy. A short-sighted view?

The new Italian policy to off-patent products, although similar to recent reforms in other European countries, seems to use some interesting instruments and has achieved significant results in the past 2 years. In particular, the prices of branded products have been reduced for all active ingredients where a generic version is available. However, this strategy may raise some problems in the longer term. Our analysis identified two open issues that might limit the long-term sustainability of the present scheme: the limited diffusion of generics and the reallocation of demand. The first stems from the new regulatory schemes which equate generics to branded off-patent products and exploit their presence only to cut prices. The second is favored by tough price competition that induces large companies to divert demand towards more profitable "me-too drugs." Solutions exist, but they are not easy to apply because so many difficulties arise when certain aspects of a long-standing equilibrium are modified.

Drugs, Generic↗
PubMed2005

Asymptomatic patent ductus arteriosus in a 41-year-old woman.

Patent ductus arteriosus is a rare adult congenital heart disease, especially asymptomatic cases are uncommon in older ages. We report here the case of a 41-year-old woman, who was incidentally found to have a patent ductus arteriosus. The patient also was asymptomatic. For anatomical demonstration, computerized tomography angiography was performed and then surgical intervention was applied.

Adult↗
PubMed2005

Endovascular surgery using an original occluder for patent ductus arteriosus in an adult patient.

The patient was a 67-year-old woman in whom patent ductus arteriosus was diagnosed in childhood but not treated. In April 2000, she was hospitalized for exacerbation of heart failure. Marked restrictive impairment was seen: %VC was 36.1%, and FEV1% was 77.0% (respiratory function tests). As calcification was present, and since the aortic opening measured 20 mm, coil occlusion or thoracoscopic surgical interruption were considered difficult to perform. Because of concerns about postoperative respiratory complications associated with thoracotomy, the ductus was occluded under local anesthesia using an original occluder consisting of a vascular graft and modified Z-stent. Postoperatively, during more than three years of follow-up, the patient has remained well with no residual shunt or occluder migration. Consequently, patent ductus arteriosus occlusion using an original occluder appears to be a superior, minimally invasive technique that can successfully treat large ductus arteriosus complicated by calcification.

Aged↗
PubMed2000

Coronary anastomotic devices: theory and patented ideas on micromechanical fastening.

Coronary anastomotic devices are being designed to reduce the laborious, complex suturing approach to endoscopic coronary surgery. An anastomotic device should be safe and reliable, it should allow full view of the vessel parts to be bonded, it must provide a simple and rapid deployment, and should be hemodynamically adequate. Three anastomotic device categories found in the (patent) literature are discussed that use micromechanical fastening techniques. First, devices using individual bonding elements; second, devices using bonding elements anchored to extra-luminal frames; third, devices using an internal frame, often a stent-like structure. Anastomotic devices described in the (patent) literature to date fail to meet all requirements for endoscopic coronary application.

Anastomosis, Surgical↗
PubMed1988

Catheter occlusion of the persistently patent ductus arteriosus.

Catheter occlusion of a persistently patent ductus arteriosus was attempted in 40 patients (11 men and 29 women, mean age 7.2 +/- 8.3 years, range 244 days to 40 years), using a transvenously placed Rashkind umbrella occluder (USCI). Thirty-one 12-mm and six 17-mm diameter devices were successfully placed in the ductus (internal diameter average 3.9 mm, range 2 to 9 mm). One procedure was abandoned when fluoroscopy failed to visualize the device. There were 2 immediate embolizations subjected to surgical recovery. A residual shunt was present on the immediate postocclusion ventriculogram in 12 of 37 procedures (32%). Twenty-eight patients (75%) have had at least a follow-up at 3 months with Doppler study and 6 (21%) continued to have shunting into the pulmonary artery. Three of 4 patients have undergone successful placement of a second device and 1 patient's shunting spontaneously resolved at 1 year postimplant, leaving only 2 patients (7%) with persistent shunts. There has been 1 episode of probable prosthetic endarteritis and 1 patient has developed mild narrowing of the left pulmonary artery related to device placement. Catheter occlusion of the patent ductus arteriosus using the Rashkind umbrella appears to be a safe and effective method of non-surgical management.

Adult↗
PubMed1992

Congenital aortic stenosis and patent ductus arteriosus in the adult.

Concurrent aortic stenosis and patent ductus arteriosus are not infrequent in children but are rare in adults. An adult case is described with diagnosis by cardiac catheterization and magnetic resonance imaging and with management by combined aortic valve replacement and patent ductus ligation. Review of the English-language literature produced only 8 such cases in adults, 2 of which were managed by a single-stage operation. Successful diagnosis in the adult requires careful observation at cardiac catheterization, and simultaneous valve replacement and ductus ligation may be a useful option in patient management.

Aged↗
PubMed1993

Thoracoscopic clipping of patent ductus arteriosus in premature infants.

Patent ductus arteriosus is a frequent indication for surgical intervention in preterm infants. Commonly this operation is performed through a dorsolateral thoracotomy. In an animal trial (piglets smaller than 1,400 g) instruments and technique for thoracoscopic clipping of patent ductus arteriosus were developed. Since January 1993, 3 premature infants have been treated with this new minimally invasive procedure. The instruments and the surgical technique are demonstrated.

Ductus Arteriosus, Patent↗
PubMed1987

Patent ductus arteriosus after prolonged treatment with indomethacin during pregnancy: case report.

Indomethacin was administered to suppress premature uterine contractions in a twin pregnancy from the 27th until the 32nd week of pregnancy. Patent ductus arteriosus was diagnosed after delivery in one twin and persisted patent for a period of 4 weeks. A hypothesis of the constrictive influence of prostaglandin synthetase inhibitors on the fetal ductus arteriosus during intrauterine and neonatal periods is suggested.

Adult↗
PubMed1977

Survey of patented anti-stuttering devices.

Various types of devices have been patented to alleviate stuttering. Some prevent certain physical actions, such as clamping of the teeth, improper movement of the tounge and improper breathing. Others strengthen or incapacitate certain muscles. The devices and their alleged action on the body are described. United States as well as foreign patents are included. No attempt has been made to evaluate said devices

Europe↗
PubMed1987

Effect of dexamethasone on fetal lung 15-hydroxy-prostaglandin dehydrogenase: possible mechanism for the prevention of patent ductus arteriosus by maternal dexamethasone therapy.

Prenatal maternal glucocorticoid treatment has been reported to reduce the incidence of patent ductus arteriosus in prematurely born infants. Patency of the ductus arteriosus is thought to be maintained primarily by the vasodilatory effect of PGE2 both in utero and in prematurely born infants, and lung is a major source of PGE2 in fetuses and neonates. 15-Hydroxy-prostaglandin dehydrogenase (15-PGDH) catalyzes the initial reaction in converting biologically active PGE2 to its inactive analogue, 15-keto-PGE2. In the present study, effect of prenatal dexamethasone treatment on the activity of fetal rat lung 15-PGDH was studied at 20, 21 and 22 days of gestation. Activity of fetal lung 15-PGDH more than doubled from 20 to 22 days of gestation. Dexamethasone treatment at 0.4 mg/kg and 0.8 mg/kg significantly increased the activity of 15-PGDH in both 20- and 21-day fetuses but had no effect on 22-day fetuses. We speculate that the clinical observation that prenatal glucocorticoid treatment reduces the incidence of patent ductus arteriosus in premature infants may in part be due to the stimulatory effect of glucocorticoid on the activity of 15-PGDH in fetal and neonatal lung and possibly other organs.

Animals↗
PubMed1995

[Percutaneous occlusion of patent ductus arteriosus by the Rashkind double-umbrella device].

BACKGROUND: The transcatheter option consisting of implanting and releasing an occlusive device designed as a double-umbrella is an interesting alternative to surgery aimed to close persistently patent ductus arteriosus. POPULATION AND METHODS: Closure of a duct with the Rashkind device had been planned in 113 children. The procedure was abandoned in 12 with inadequately sized ducts (too large or too small). This study therefore included 101 attempts in patients aged 2.3 months to 18.5 years (m +/- 1 SD = 45.9 +/- 43.2 months) whose weights ranged from 3.3 to 87 kg (m +/- 1 SD = 15.7 +/- 11.7 kg). The narrowest dimension of the duct on the aortograms ranged from 1.2 to 6.2 mm (m +/- 1 SD = 2.9 +/- 0.9 mm). RESULTS: The procedure failed in seven patients because of a too large and/or tubular vessel, causing removal of the device prior to release in five patients, or surgical extraction after it had embolized into a pulmonary artery branch in two patients. An early acute hemolysis requiring again the surgical removal of an instable device in a tubular duct was seen in one case. Two patients had femoral artery occlusion successfully treated with thrombolytic agents. Complete occlusion was immediately proven in 32 (35%) of the 92 successful and stable implantations. These figures raised to 64% (59 cases) prior to discharge. At final follow-up (0.3-59 months, m +/- 1 SD = 13.8 +/- 14.4 months), another 16 total occlusions were observed and one patient was successfully managed by a second implantation. The final occlusion rate was 83% (76 cases). Of the 16 residual shunts, five were surgically suppressed and the remaining were minimal. CONCLUSION: Transcatheter occlusion of the patent ductus arteriosus is safe in children weighing more than 5 kg, having ducts with a narrowing ranging from 1 to 6 mm. It is efficient in five out of six cases and has less disadvantages than surgery.

Adolescent↗