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PubMed1992

[Treatment of a patent duct in neonates].

The authors analyze clinical and laboratory aspects of Indomethacin treatment of neonates with a patent ductus arteriosus. From June 1987 to November 1990 the authors treated 19 neonates with a patent ductus arteriosus with Indomethacin. The drug was administered, 0.1-0.3 mg/kg body weight, by the oral route three times/24 or 36 hours. In 17 infants after Indomethacin treatment the duct closed, in two infants the duct did not close during Indomethacin treatment, in three infants the authors observed oliguria which improved after discontinuation of treatment.

Ductus Arteriosus, Patent↗
PubMedDate not supplied

[Comparison of the efficacy of ibuprofen and indomethacin in the treatment of patent ductus arteriosus in prematurely born infants].

AIM: To assess the efficacy and safety of early treatment with ibuprofen (IBU) and indomethacin (INDO) of patent ductus arteriosus in preterm infants. Prospective study with blind trial. MATERIAL AND METHODS: We studied 35 preterm infants (19 treated with INDO, 16 IBU) (gestation age <33 and birth weight < 1500 g), who had an echocardiographicaly confirmed patent ductus arteriosus (PDA). The infants were randomly assigned in two groups to receive INDO (0.2-0.2-0.2 mg/kg) or IBU (10-5-5 mg/kg) in first 72 hours of life (average 2 days of life). The rate of ductal closure, the need for surgical ligation, side effects, complications, and the infants clinical course were recorded. RESULTS: The rate of ductal closure was similar in two groups (15/19, 80% INDO; 11/16, 69% IBU). 27 infants (15 INDO, 12 IBU) were treated per protocol (3 doses). For remaining 8 infants we stopped treatment due to side effects. In the IBU group the main reason to stop treatment was pulmonary hemorrhage (3/16, 19%) and pulmonary hypertension (1/16, 6%), but in the INDO group it was increased serum creatinine and urea nitrogen concentrations (3/19, 16%) and intraventricular hemorrhage (IVH IV) grade (1/19 5%). In IBU group vs. INDO, urine output decreased (p=0.02), but never before below the level of oliguria (defined as urine output below 1 ml/kg/h). Risk of necrotizing enterocolitis (NEC) grade II was similar in two groups, but only patients treated with INDO showed intestinal perforations (p=ns). They received also postnatal hydrocortisone and we showed near significant tendency (p=0.06) for intestinal perforation in patients treated with INDO and hydrocortisone. There were no significant differences with respect to IVH or PVL between the groups. CONCLUSIONS: The efficacy of ibuprofen and indomethacin in PDA treatment is similar. Treatment of ibuprofen and indomethacin may cause transient renal dysfunction: diminished urine output and increase of serum creatinine and urea nitrogen concentrations. Indomethacin, especially with concomitant treatment with hydrocortisone, may increase the risk of intestinal perforation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Predictors of failed closure of patent ductus arteriosus with indomethacin.

INTRODUCTION: The aim of this study was to determine predictors of failed closure of patent ductus arteriosus (PDA) following a single course of indomethacin in symptomatic preterm infants. METHODS: This prospective observational study was carried out on 60 preterm infants weighing less than 1,750 g with symptomatic PDA confirmed by echocardiography. At a median age of 7.0 days (interquartile range 4.0), they were given indomethacin of 0.1 mg/kg/day intravenously daily for six days. Closure of PDA was reassessed by echocardiography upon completion of therapy. RESULTS: The PDA of 40 percent (n=24) of these infants remained patent. Forward logistic regression analysis showed that the only significant predictors of failed PDA closure in these infants were: PDA size (adjusted odds-ratio [OR] is 7.0; 95 percent confidence interval [CI] of OR is 2.0, 24.8; p-value is 0.002), birth weight (adjusted OR is 0.996; 95 percent CI of OR is 0.993, 1.000; p-value is 0.03) and platelet count (adjusted OR is 0.987; 95 percent CI is 0.975, 1.000; p-value is 0.045). Gestational age, maternal age and left atrium/aorta ratios were not significant predictors. CONCLUSION: Larger PDA, lower birth weight and lower platelet count were significant predictors of high failure in indomethacin therapy given late at one week of life.

Cyclooxygenase Inhibitors↗
PubMed2006

Successful transcatheter coil occlusion of a right-sided patent ductus arteriosus with aberrant left subclavian artery.

Right aortic arch is a relatively rare congenital anomaly. The combination of a right aortic arch, a right patent ductus arteriosus, and an aberrant left subclavian artery in a child with an otherwise structurally normal heart is very uncommon. We report the successful transcatheter coil occlusion of a right-sided patent ductus arteriosus in a child with the above-mentioned anatomy. To our knowledge, such a case has not been reported in the English-language medical literature to date.

Aorta, Thoracic↗
PubMed1991

Patents for critical pharmaceuticals: the AZT case.

Patents and other statutory types of market protections are used in the United States to promote scientific research and innovation. This incentive is especially important in research intensive fields such as the pharmaceutical industry. Unfortunately, these same protections often result in higher monopoly pricing once a successful product is brought to market. Usually this consequence is viewed as the necessary evil of an incentive system that encourages costly research and development by promising large rewards to the successful inventor. However, in the case of the AIDS drug Zidovudine (AZT), the high prices charged by the pharmaceutical company owning the drug have led to public outcry and a re-examination of government incentive systems. This Note traces the evolution of these incentive programs--the patent system, and, to a lesser extent, the orphan drug program--and details the conflicting interests involved in their development. It then demonstrates how the AZT problem brings the interest of providing inventors with incentives for risky innovative efforts into a sharp collision with the ultimate goal of such systems: ensuring that the public has access to the resulting products at a reasonable price. Finally, the Note describes how Congress and the courts have attempted to resolve these problems in the past, and how they might best try to solve the AZT problem in the near future.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Transfemoral vein catheter occlusion of patent ductus arteriosus].

Between February 1988 and September 1989, 15 patients underwent closure of patent ductus arteriosus by the Rashkind technique modified by Mullins. The insertion of the occluder was achieved in all cases; however, in one patient, the prosthesis migrated to the abdominal aorta several hours after implantation. No other complications were observed. All patients were discharged from hospital under 24 hours after the procedure. The follow-up period ranges from 3 to 12 months. The rate of complete closure of the ductus was 50% 24 hours after implantation, 57% at 3 months, 66% at 6 months and 82% 12 months after the procedure. Our results suggest that the Rashkind technique for the closure of patent ductus arteriosus by the transvenous femoral approach is an effective and low risk procedure.

Adolescent↗
PubMed1990

[Non-surgical closure of patent ductus arteriosus in children with the Rashkind double disk occluder].

Since the first clinical application of transcatheter closure technique for patent ductus arteriosus in children and infants in 1977 by Rashkind and Coll., this technique is routinely performed only in a few major Pediatric Cardiology Centers. We report our successful series which is the first of its kind both in Italy and in Southern Europe. The series included 11 children aged 1.6 to 10 years (mean age 4.5 years) all affected with patent ductus arteriosus (PDA). Subaortic stenosis (1) and ventricular septal defect with pulmonary stenosis (1) were associated anomalies. In all of the cases, after the standard percutaneous cardiac catheterization, the Mullins method was attempted to advance and deliver the Rashkind PDA double-disk occluder. Successful closure was accomplished in 10 while almost complete closure was achieved in the 11th. Normal Doppler flow pattern after the procedure confirmed the successful results. No complications occurred. Although our experience is limited, non-surgical PDA closure provided an excellent alternative to surgical procedure.

Cardiac Catheterization↗
PubMed1990

[Trends in the development of research in the field of liposomes (review of patent literature)].

The review embraces major trends and tendencies in liposome studies and is based on the statistical and qualitative analysis of patent information issued in the period 1970-1988. Special attention is devoted to the analysis of patents in liposome production techniques, their lipid composition, and application in pharmaceutical and cosmetic industries and also for the diagnostic and therapeutic purposes. Liposomal preparations are shown to be superior to common drugs as concerns, in particular, liposomes containing medicinal agents for prolonged use (including hormones, antibiotics, cytostatics, and immunostimulants) and liposomes used in dermatological practice. Liposome-based assessment of application prospects is given.

Drug Carriers↗
PubMedDate not supplied

Indomethacin for the prevention of symptomatic patent ductus arteriosus in very low birth weight infants.

To assess the efficacy of prophylactic indomethacin in reducing the incidence of symptomatic patent ductus arteriosus, thirty two preterm infants weighing 750-1500 gm at birth were randomized to receive oral indomethacin or placebo. Fifteen infants received oral indomethacin with a dosage of 0.2 mg/kg at the 24th, 36th and 60th hour of age as the study group. The other 17 infants received 1 ml 0.33% saline in 5% G/W solution at the same schedule. Birth weight, gestational age, male/female ratio and severity of respiratory distress syndrome were similar for both groups. Nine of the 16 survivors of control group developed symptomatic patent ductus arteriosus. On the contrary, only two of the 14 survivors who received prophylactic indomethacin developed symptomatic PDA (P less than 0.05). There were no significant difference in the development of bronchopulmonary dysplasia, duration of oxygen therapy, duration of endotracheal intubation, days required to regain birth weight or complication between these two groups. The results indicated that the use of prophylactic oral indomethacin is beneficial in the prevention of symptomatic PDA in very low birth weight infant.

Ductus Arteriosus, Patent↗
PubMed1989

Institut Pasteur v. United States: the AIDS patent dispute, the Contract Disputes Act and the international exchange of scientific data.

In the case of Institut Pasteur v. United States, the Institut Pasteur (Pasteur) claimed that the National Cancer Institute (NCI) had breached express and implied contracts to share research on AIDS virus samples provided to NCI by Pasteur. NCI scientists allegedly used the samples to acquire information which allowed NCI to file patent applications for an AIDS blood test kit. The United States Claims Court dismissed the complaint by holding that the Institut Pasteur had not complied with certain administrative procedures required by the Contract Disputes Act before bringing its suit. The United States Court of Appeals for the Federal Circuit reversed the decision of the Claims Court by holding that the disputed contracts did not fit within the scope of the Contract Disputes Act. Soon after the Court of Appeals decision, President Reagan and Prime Minister Chirac announced a settlement agreement whereby the lawsuit was to be dropped, American and French scientists were to share credit for having discovered the AIDS virus, and both parties to the suit were to share the patent rights for the AIDS blood test kit. This settlement suggest that international legal disputes involving urgent scientific and medical matters may require dispute resolution techniques that serve as alternatives to national courts.

Academies and Institutes↗
PubMed1989

[Closure of patent ductus arteriosus in elderly cases].

A technique for closure of patent ductus arteriosus in the elderly cases is described. We have operated on eleven adult cases of patent ductus arteriosus cases in 10 years. In five cases cardiopulmonary bypass used and in the other six cases it was not used. The cardiopulmonary bypass was used especially for the patients with pulmonary hypertension (pulmonary artery mean pressure greater than 40 mmHg), or high aged (older than 40 years) patients. No operative death have occurred in both groups, and no complication from air embolism or hemorrhage have been encountered. The technique embodies the profound hypothermia, low flow, and direct suture of the pulmonary end of the ductus arterious through a pulmonary arteriotomy. The ductus has been obstructed by using a Hegar's dilator before core cooling was started. Hegar's dilator is useful for establishing profound hypothermia and satisfactory visualization of the operative field.

Adult↗
PubMed1987

[Treatment of patent ductus arteriosus in premature infants by indomethacin].

Over a 4-year period, 63 premature babies presenting with patent ductus arteriosus were treated with indomethacin at two different dosage levels (0.1 and 0.2 mg/kg). For all infants the permanent closure rate was 68% (56% with 0.1 mg/kg and 75% with 0.2 mg/kg - n.s.) and the positive response rate (i.e. permanent and transient closure) 84%. There was no difference between the two dosages in the incidence of side-effects, particularly on diuresis, and in mortality and morbidity rates; the overall mortality rate was 31%. Pharmacokinetic studies performed in 51 cases did not show any difference related to indomethacin dosage. The changes observed after 2 or 3 doses resulted from improvement in haemodynamics. This study confirms the effectiveness of indomethacin in the treatment of patent ductus arteriosus and suggests an advantage for the 0.2 mg/kg dose.

Diuresis↗
PubMed1986

[Interruption of the aortic arch without patent ductus arteriosus. Apropos of a case associated with partial atrioventricular canal].

The authors report a case of type A interruption of the aortic arch with the subclavian arteries arising from the descending aorta which was of special interest because of the absence of a patent ductus arteriosus. Therefore, the systemic circulation was assured from the carotid arteries which perfused the vertebral arteries retrogradely via the circle of Willis. The association of a partial endocardial cushion defect and hypoplasia of the ventricle explained the surgical failure. A review of the literature of interruption of the aortic arch without a ductus confirmed that this was a rare condition and, paradoxically, well tolerated in the absence of associated malformations. On the other hand, the left ventricular lesions, usually present in the classical forms with patent ductus arteriosus, operated in the neonatal period, increase the operative risk.

Aorta, Thoracic↗
PubMed1988

[Large patent ductus arteriosus and interventricular communication associated with congenital absence of the pulmonary valve].

A case of pulmonary valve agenesis with ventricular septal defect and large patent ductus arteriosus is reported in a neonate. Heart failure occurred at 10 days of life; clinical examination showed continuous murmur. Echocardiography and angiocardiography visualized a major dilatation of the pulmonary artery. At cardiac catheterization there was an important left to right shunt through a large ductus, and pulmonary hypertension. There was also marked pulmonic regurgitation. Because of respiratory distress, ligation of ductus arteriosus was performed at 5 weeks of life. Five years later the patient is still in good condition. Patent ductus arterious is rarely associated with pulmonary valvular agenesis and ventricular septal defect. Our case is not explained by the fetal circulation theory described in this heart malformation.

Abnormalities, Multiple↗
PubMed1988

[Remote results of the treatment of patients with patent ductus arteriosus by the method of endovascular occlusion].

The results of endovascular occlusion of the patent ductus arteriosus via transvenous access were followed-up for 1 to 5 years. Repeated angiography was conducted in 35 patients, central hemodynamic studies were done in 29, and echocardiography, in 59. Long-term follow-up results have demonstrated good clinical effectiveness of the technique which can therefore be used as an alternative to surgical treatment for patent arteriosus.

Adolescent↗
PubMed1987

Systemic to pulmonary shunting masquerading as patent ductus arteriosus: a pitfall in clinical diagnosis.

Patent ductus arteriosus (PDA) frequently complicates the course of respiratory distress syndrome in premature infants. A 920-g, 28 weeks' gestation infant with clinical and radiographic evidence of left to right shunting, was presumed to have a patent ductus arteriosus. Following ductal ligation the signs persisted. Aortic angiogram demonstrated multiple collateral vessels arising from the systemic circulation and communicating with pulmonary vessels. Accurate diagnosis of left to right shunting is imperative if such collateral shunting is not to go undiagnosed.

Arteriovenous Malformations↗
PubMed1986

[Echocardiographic diagnosis of infectious endocarditis on patent ductus arteriosus with involvement of the pulmonary artery and the pulmonary and aortic semilunar valves. Description of a case].

Infective endocarditis is one of the most rare complications of patent ductus arteriosus (PDA). Usually vegetations are localised at the level of the patent ductus and can involve the left branch and the trunk of the pulmonary artery. We report the case of a young woman with PDA, who was admitted to the hospital in severe congestive heart failure due to infective endocarditis. A 2D echocardiographic examination revealed vegetations into the ductus with extension to the pulmonary artery, pulmonary valve and aortic valve. The results of the echocardiographic study enabled us to evaluate the extension of the lesions, to avoid heart catheterization and to decide the most suitable surgical approach for repairing all the damage in one surgical operation.

Adult↗
PubMedDate not supplied

[Filing of microorganism strains for patent claims in the Soviet Union].

The modern state of depositing microorganisms with regard to patent procedure is considered. The main stages of depositing are described. Two questions of paramount importance for depositors are examined, i.e. what kind of microorganisms should not be deposited with regard to patent procedure, who and on what terms can get samples of deposited microorganisms from the collection. A number of recommendations for researchers potential depositors of microorganisms, are given.

Microbiology↗