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At least 1,621 records · Page 90Linked to original sources
PubMed2005

Evaluation of survival rate and prognostic indicators for surgical treatment of left-to-right patent ductus arteriosus in dogs: 52 cases (1995-2003).

OBJECTIVE: To determine factors associated with long-term survival in dogs treated surgically for patent ductus arteriosus (PDA). DESIGN: Retrospective case series. Animals-52 dogs treated surgically for left-to-right shunting PDA. PROCEDURE: Data pertaining to age, breed, sex, body weight, clinical examination findings, type and duration of medical treatment, results of thoracic radiography and echocardiography, and surgical and postoperative complications were collected from records. Follow-up information was obtained from medical records or telephone interviews with owners or referring veterinarians. RESULTS: 22 dogs had mitral valve regurgitation. Mean weight and age were not significantly different between dogs with or without mitral valve regurgitation. Twenty-four (46.2%) dogs had clinical signs related to cardiac insufficiency. Left atrial dilatation was observed in 56.3% of dogs that were radiographed. Sonographic imaging was used to diagnose left atrial dilatation in 23 dogs and left ventricular dilatation in 25 dogs. The 1- and 2-year survival rates were 92% and 87%, respectively. Diagnosis of mitral valve regurgitation before surgery was not associated with the probability of survival. Age, weight, lethargy, preoperative treatment with angiotensin-converting enzyme inhibitors, and right atrial dilatation on radiographs at the time of surgery were negatively associated with probability of survival. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical treatment of PDA was curative in young dogs without clinical signs of heart failure. Surgical correction of PDA should be recommended as early as possible after diagnosis, and mitral valve regurgitation is not a contraindication for surgery.

Animals↗
PubMed2006

Septicemia in a young dog following treatment of patent ductus arteriosus via coil occlusion.

CASE DESCRIPTION-A 12-week-old female English Springer Spaniel was evaluated for lethargy, vomiting, and pyrexia 1 week after treatment of patent ductus arteriosus (PDA) via coil occlusion. CLINICAL FINDINGS-Test results were consistent with septicemia, and the assumption was made that the PDA occlusion coils were infected. Radiography revealed partial migration of the coil mass into the pulmonary artery and signs of congestive heart failure. TREATMENT AND OUTCOME-After successful treatment of the septicemia and heart failure, surgical removal of the coils and resection of the PDA were undertaken. Although the coil that embolized to the pulmonary vasculature was left in place, the dog's clinical signs resolved. CLINICAL RELEVANCE-This case highlights the fact that as PDA coil occlusion devices become more widely used in dogs, practitioners must be prepared to treat implant infections aggressively, with both medical and surgical interventions if necessary.

Animals↗
PubMed2006

Use of simultaneous fluoroscopic and echocardiographic guidance during transarterial coil placement for embolization of patent ductus arteriosus in dogs.

OBJECTIVE: To evaluate the use of simultaneous fluoroscopic and transthoracic echocardiographic guidance during transarterial coil placement for embolization of patent ductus arteriosus (PDA) in dogs. DESIGN: Descriptive report. ANIMALS: 3 dogs with PDA. PROCEDURE: Each dog was anesthetized, and a femoral artery was exposed for vascular access. By use of an introducer, a catheter was placed in the thoracic portion of the descending aorta with fluoroscopic guidance, and subsequently, a bolus of iodinated radiographic contrast material was injected to outline the ductus. Under fluoroscopic guidance, 1 coil was positioned in the ductus, but not released. Transthoracic echocardiography was used to ensure that 1 loop of the coil was located in the pulmonary artery. When > 1 loop or no loops were detected in the pulmonary artery, the coil was retrieved and repositioned; when 1 loop of the coil was detected in the pulmonary artery, the coil was detached. After catheter removal, the femoral artery was ligated and the wound was closed. RESULTS: In all 3 dogs, successful embolization of the PDA was achieved. Echocardiography prevented unintentional pulmonary artery embolization in 1 dog and suboptimal coil placement in the other 2 dogs. CONCLUSIONS AND CLINICAL RELEVANCE: In addition to fluoroscopic control, transthoracic echocardiography appears to aid the appropriate positioning of a transarterial coil for treatment of PDA in dogs. Although transesophageal echocardiography would likely provide better images of the ductus, transthoracic echocardiography is a much cheaper, less specialized, and more widely available alternative.

Animals↗
PubMed1997

Targeting technologies--the expanding patent literature.

Progress in the development of drug targeting technologies is advancing at an ever-increasing rate as we hurtle toward the new millennium. Examination of just the past three years of the drug delivery technology patient literature suggests that what was previously thought impossible may now be a reality. As one goes through this literature, the breadth and ingenuity of many of these approaches are obvious. As in the inaugural article, I have grouped information gathered from this search into areas of mucosal targeting, organ and/or tissue targeting, tumor targeting and focal delivery. The patent applications described in this article represent a sampling of the work in these areas, with particular attention being paid to a few of the more novel or intriguing claims.

Animals↗
PubMed1998

Adjuvants and delivery issues related to immunization: a survey of the recent patent literature.

Vaccines have provided generations of individuals with protection against a number of devastating childhood diseases and, in the case of smallpox, have eradicated the disease. Arguably, this preventive approach to health care may have saved more lives than all other therapeutic approaches combined. Being commonly composed of killed-whole or live-attenuated organisms, successful vaccines have been capable of not only presenting crucial epitopes required for protective immunity but also components which stimulate the immune system provide a response of sufficient intensity to provide sustained protection. It is unlikely, however, that these same vaccines would be approved in today's regulatory climate where manufacturers must validate a highly reproducible manufacturing process and demonstrate the exact composition of the final product through stringent quality control (Gupta, 1997). Therefore, companies involved in the identification of new vaccines and their production appear to be moving away from the ill-defined and poorly-controlled immunogens of the past. Instead, they have started employing recombinant biotechnology to produce large quantities of specific antigens with the hope that these antigens will provide protective immunity. Antigen identification can take years of investigation. This process could be speeded up, however, by understanding the mechanisms which pathogens such as viruses and bacteria use to infect the host, their replication cycle and the steps they frequently take to evade the host immune system. Such a rational approach to immunogen design results in what has been termed an "intelligent" vaccine (Plough, 1998). "Intelligent" vaccines will likely be completely composed of artificial or synthetically derived products using recombinant and cell culture technologies and hopefully will allow manufacturers to develop products with the desired efficacy and safety profiles required by regulatory authorities. But unlike the complex and ill-defined immunogens of the past, these specific antigens are frequently poorly antigenic by themselves when compared to whole organisms. Co-delivery with a variety of agents, known as adjuvants, has been shown to increase the antigenicity of these poorly antigenic immunogens. In this editorial, I review the recent patent literature as it pertains to targeting of specific antigens and the role played by various classes of adjuvants to enable or enhance such targeted deliveries.

Adjuvants, Immunologic↗
PubMedDate not supplied

Patent ductus arteriosus ligation and pulmonary artery banding in a kitten.

Patent ductus arteriosus (PDA) and ventricular septal defect were diagnosed in a 2-month-old, 0.9-kg, male kitten. This combination of PDA and ventricular septal defect in a cat has not been previously described. Surgical ligation of the PDA, together with palliation of the ventricular septal defect by pulmonary artery banding with a silastic band, successfully improved the kitten's condition.

Animals↗
PubMedDate not supplied

Retrospective evaluation of occlusion of patent ductus arteriosus with hemoclips in 20 dogs.

Twenty dogs with patent ductus arteriosus occluded with Hemoclips were evaluated with a mean follow-up time of 799.4 days (range, 83 to 3,580 days). Significant decreases were found between pre- and postsurgical means for vertebral heart size and for echocardiographic left atrial/aortic-root ratios and percent fractional shortening (%FS). Despite a good clinical outcome, six of 20 dogs had persistent cardiomyopathy of overload with diminished %FS (28% or less) at follow-up. One dog had residual ductal flow identified five days postoperatively. Subsequent evaluations in this case at 60, 144, 226, 344, and 560 days postoperatively demonstrated gradually diminishing ductal flow. The remaining 19 dogs did not recanalize.

Animals↗
PubMedDate not supplied

Is surgical closure of patent ductus arteriosus a safe procedure in premature infants?

Despite indomethacin therapy, many premature infants require surgical closure of their patent ductus arteriosus (PDA). Between January 1985 and December 1997, 176 premature infants underwent surgical closure of PDA by vascular clip after failure of medical treatment. The median gestational age and birth weight were 26 weeks (range 23-36 weeks) and 847.5 g (range 400-2300 g), respectively. The median age at diagnosis and at surgery was 4 days (range, 1-37) and 21 days (range, 4-60) respectively. The median weight at surgery was 982.5 g (range 475-2740 g). Of these infants, 168 (95%) were intubated prior to surgery and the median time to extubation was 21 days (range 1-273 days). There were no operative deaths but 11 infants (6.4%) died from complications of prematurity (sepsis, bronchopulmonary dysplasia and pulmonary hemorrhage). The frequency of chest tube insertion at surgery decreased from 41.7% to 10% between the 1985-88 and 1996-97 periods (P<0.01). Three infants (1.7%) developed vocal cord paralysis directly related to the position of the vascular clip. Echocardiography confirmed PDA closure in 43 infants (24.4%) while the remaining 133 had no clinical signs of PDA. Surgical closure of PDA by vascular clip carries a very low morbidity in premature infants.

Body Weight↗
PubMedDate not supplied

Proprietary ethics. Patent pursuits evoke calls for limits on commercial ventures.

Despite America's claim as the champion of capitalism, there does seem to be some ingrained sense of boundaries beyond which making money is viewed as not fair or proper. The following stories look at two very different cases in which the patent process came under attack for very different ethical reasons.

American Medical Association↗
PubMed1994

Intravascular ultrasound imaging of a patent ductus arteriosus in an adult.

A small patent ductus arteriosus (PDA) is compatible with a normal life span. A non-restrictive PDA may present with signs of heart failure, supraventricular arrhythmia's, bacterial endocarditis or endarteritis later in life. Fewer than 50% of patients, including those with small shunts, are symptomatic by the age of 50. Considering that 40% of patients with PDA's will die before the age of 45 as a result of bacterial endocarditis or heart failure, closure of the PDA is recommended. Exceptions are patients with a nondilated heart, a right-to-left shunt, or age greater than 60 years old. Because of the wider use of echocardiography, especially transesophageal echocardiography, many PDA's are now detected incidentally in patients without symptoms.

Ductus Arteriosus, Patent↗
PubMed1999

The anesthetic management of a preterm infant weighing 500 grams undergoing ligation of patent ductus arteriosus--a case report.

PDA (patent ductus arteriosus) is a common congenital heart disease. Usually surgical intervention through left thoracotomy or recently through video assisted thoracoscopy will be recommended if the preceding or intent medical treatment fails or is contraindicated. However, once surgical intervention is decided, various complications are still a real fear in the mind of the surgeon and the anesthesiologist, particularly if the infant is premature or very sick. Here we report an anesthetic management in a female preterm infant weighing 500 grams, who underwent PDA ligation. She was born at gestation age of 28 weeks at our hospital, and since her birth she was noted to have infant respiratory distress syndrome associated with renal dysfunction. She was admitted to the neonatal intensive care unit (NICU) straightaway. After thorough examination, a severe PDA was disclosed. The possibility of pulmonary hemorrhage and heart failure could be predicted in view of the large left to right shunt. Worst of all was that her poor renal function contradicted a medical treatment. So we decided to carry out the ligation procedure at once although she was premature and only 5 days old. The NICU was chosen as the operation theater for transferring concerns. General anesthesia was induced and maintained by atropine 0.01 mg, pancuronium 0.1 mg, fentanyl 2 micrograms, and ketamine 0.15 mg intravenously. Supplemental oxygen was given throughout the operation. The PDA was ligated through left thoracotomy and blood loss was minimal. The peri-operative course was uneventful. The patient recovered well following surgery and anesthesia.

Adult↗
PubMed1999

Transcatheter coil occlusion of patent ductus arteriosus.

Between May 1995 and October 1997, 17 cases of small patent ductus arteriosus (PDA) underwent percutaneous coil occlusion at the Department of Pediatrics, Chulalongkorn Hospital. The mean age was 5.3 +/- 3.6 years (range, 1 year 4 months to 12.0 years); mean weight was 18.9 +/- 11.7 kg (range, 9 to 48 kg). The mean minimum diameter of the PDA was 2.8 +/- 0.6 mm (range, 1.7 to 4.0 mm). PDA occlusion was achieved with one coil in 9 patients and two coils in 8 patients. One patient required the second coil occlusion procedure to occlude the residual PDA leakage. Of the 17 patients, coils were successfully implanted in 15 patients: complete closure of PDA was obtained in 14 patients, confirmed by aortography or by color flow echo imaging or both. In the two unsuccessful coil implantation cases, coils migrated to the distal left pulmonary artery (1 case) and the distal right pulmonary artery (1 case). They could not be retrieved. Both patients had surgical closure of PDA on the following day after the failed procedure. No clinical and chest X-ray showed any evidence of pulmonary complication from the migrated coils up to 1-year follow-up. PDA coil occlusion provides an alternative to surgical closure. The procedure is safe and has a good result.

Cardiac Catheterization↗
PubMed1999

Reduction in blood glucose values following indomethacin therapy for patent ductus arteriosus.

PURPOSE: To evaluate the effects of indomethacin on blood glucose values in premature infants with patent ductus arteriosus (PDA). METHODS: Twenty-five very low birthweight infants with PDA were given 0.2 mg/kg, i.v., indomethacin for up to three doses. We examined the relationship between blood glucose values and glucose infusion rate before and after indomethacin therapy. RESULTS: There was a significant reduction in blood glucose values between 12 and 96 h following i.v. indomethacin therapy. Eleven of 25 infants (44%) had blood glucose values below 40 mg/dL between 12 and 60 h (mean 32.7 h) after the initial dose. Although the glucose infusion rate during the first 12 h was constant (3.56 +/- 0.98 mg/kg per min), the blood glucose values decreased from 96 +/- 32 mg/dL at the starting point to 75 +/- 29 mg/dL at 12 h (P < 0.05). The maximum blood glucose reduction was 51.6 +/- 34.7 mg/dL and the maximum blood glucose reduction rate was 50.4 +/- 20.2%. CONCLUSIONS: The results suggest that blood glucose values should be measured at least every 6 h for 72 h until they stabilize in order to prevent unexpected hypoglycemia.

Cardiovascular Agents↗
PubMedDate not supplied

Indications, technique, results and clinical impact of reocclusion procedures for residual shunts after transcatheter closure of the patent ductus arteriosus.

PURPOSE: To assess the results of reocclusion procedures for late residual shunts after transcatheter closure of the patent ductus arteriosus. MATERIAL AND METHODS: Nineteen patients underwent reocclusion procedures either with Rashkind technique (2 patients) or with coils. Mean age was 96.5 months and mean interval between the initial and the additional procedure was 15.7 months. In 5 patients, the duct was balloon-dilated prior to occlusion. RESULTS: In 3 patients the procedure was unsuccessful because it was impossible to cross the duct using either a guide wire or a catheter. Immediate or late complete occlusion occurred in 13 patients. Two patients required a third procedure for complete closure. One patient developed severe intravascular hemolysis after coil implantation and was sent to surgery. The rate of final late residual shunting decreased from 17.1% to 6.6% (5/76) in the umbrella group and from 15.8% to 1.8% (1/56) in the coil group. CONCLUSIONS: Reocclusion procedures are indicated after one year of persistent shunting following the primary procedure. They are generally effective and reduce significantly the rate of late residual shunting. In patients with tiny shunts, the duct may need to be dilated. Coils are preferred because of their low cost.

Adolescent↗
PubMedDate not supplied

[Transcatheter closing of patent ductus arteriosus using detachable coils].

Various devices have been developed for the percutaneous closure of persistent patent ductus arteriosus (PDA). In recent years Gianturco coils have become increasingly widespread for this purpose. Poor control during positioning is a major disadvantage of Gianturco coils, with resultant embolization of coils and residual shunts. Modifications to improve the positioning of coils have been developed. Very recently a new screwing detachable coil is available (Cook Cardiology, Europe). Between January 1996 and March 1999, 24 consecutive patients with PDA underwent cardiac catheterization. Twenty cases were judged suitable for this procedure, on the base of diameter and morphology of the ductus. Three cases were excluded because of the ductal diameter was too large (> 4.2 mm) and one because of its morphology (type B). In 19 patients a single coil was positioned, while in 1 case 2 coils were simultaneously used. In 19 cases (95%) complete closure was obtained (in 15 cases immediately, in 2 after 24 hours, in 2 after 1 month). One case showed a residual shunt and a second coil was applied eighteen months later with complete closure. So, considering also this last case, the closure was achieved in 100%. There were neither embolization or other complications. In conclusion, screwing detachable coil for PDA closure is a safe, very effective and at low cost technique. Therefore nowadays this procedure represents the method of choice for occlusion of small PDA (minimal diameter < or = 4 mm).

Adolescent↗
PubMedDate not supplied

Patentability and perspectives of biotechnology large-scale applications.

This meeting has suggested many conclusions and opens many problems for the application of the biotechnologies. Patents are a useful legal instrument developed to protect intellectual property rights, thus allowing Society to promote and support the innovation and development of useful inventions.

Agriculture↗
PubMed1999

[Patent ductus arteriosus in neonatal intensive care].

OBJECTIVE: In this study we evaluated the prevalence of symptomatic patent ductus arteriosus (PDA) in newborns, admitted to a neonatal intensive care unit (NICU), as well as the clinical features and the outcome of medical or surgical treatment. METHODS: We carried out a retrospective medical chart review of 42 newborns admitted to an NICU between May 1996 and May 1998. Data regarding birth weight, sex, gestational age, prenatal corticotherapy and surfactant needs were gathered. Clinical evolution was assessed based on mechanical ventilation, morbidity and mortality. The therapeutic options and their results where analysed. RESULTS: Of the 1,195 newborns admitted to an NICU, 42 had symptomatic PDA. The prevalence was higher in newborns with a low birth weight. There was no significant difference regarding the administration of steroids prenatally in the newborns with PDA compared to the remaining newborns without PDA. Surfactant therapy, mechanical ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis and intraventricular hemorrhage were found to be more frequent in patients with PDA, especially among those with a lower birth weight, with statistical significance for newborns weighing less than 2,500 g (p < 0.05). The therapy most frequently used was indomethacin, with a success rate of 22/23 (95.6%) and with two cases of acute renal failure as side effects. Only one infant required surgical ligation of PDA. Mortality was similar in both groups (PDA vs. no PDA). CONCLUSION: PDA was probably underdiagnosed in our NICU. Morbidity, but not mortality, was higher in newborns with symptomatic PDA. We conclude that treatment with indomethacin is preferred to surgical ligation as an initial approach in those infants. Our data show the importance of early screening with echocardiogram for "silent" PDA in low birth weight neonates.

Birth Weight↗