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.     

Late reopening of patent ductus arteriosus after complete closure with the Rashkind prosthesis. Possible traumatic origin

We report a rare case of tracheal atresia, without fistula, in a 19 weeks' female fetus. The abnormality was detected by prenatal ultrasonography, which demonstrated a bilateral and uniform hyperechogenicity and enlargement of the lungs, associated with ascites and moderate oligohydramnios. We suggest that oligohydramnios may be helpful in distinguishing the upper respiratory tract obstruction from congenital cystic adenomatoid malformation of the lungs, type III. A morphometric study revealed a three-fold more dense pulmonary vasculature in comparison with two control cases of the same gestational age. The pathological finding of pulmonary and vascular hyperplasia as well as the pathophysiology of the syndrome are discussed.     

A rare case of patent ductus arteriosus in a dog with glomerular mesangiolysis

Rare case of patent ductus arteriosus (PDA) was observed in a 2-year and 9 month-old Miniature Dachshund which had been diagnosed as severe cardiac failure. Pulmonary artery from the right ventricle connected to dilated ductus arteriosus, and pulmonary artery-ductus arteriosus-descending aorta formed a continuous duct, which seemed to be the main route of bloodstream. Ascending aorta from the left ventricle was hypoplastic, and connected to the dilated ductus arteriosus. Glomerular mesangiolysis due to heart failure was also observed in the kidney.     

A method providing bidirectional control of coil delivery in occlusions of patent ductus arteriosus with shallow ampulla and Pott's shunts

A novel method using a snare and bioptome to provide bidirectional control of a Gianturco coil for occlusion of a patent ductus arteriosus with a shallow ampulla and Pott's shunts is presented. This method greatly reduces the risk of coil embolization and optimizes coil position in difficult cases.     

Transcatheter occlusion of patent ductus arteriosus with a new detachable coil system (DuctOcclud): a multicenter clinical trial

A comparison of two methods: analytical and calculation on an estimation of dietary intakes of nitrate and nitrite from six different types of general hospital diets was studied. Studies were performed in the winter season of 1996-1997. It was found that the mean daily intake of nitrates was 85 mg per person in the analytical method, and 65 mg per person in the calculated method. The estimation of average dietary intakes of nitrite was adequate: 1.67 mg per person (the analytical method) and 1.18 mg per person (the calculated method). The main source of nitrates were vegetables, whereas the main source of nitrites was meat and meat-containing products. We suggest that the different methodologies, analytical and calculation methods, for measuring dietary intakes of nitrate and nitrite from diets make it possible to make direct comparisons of intakes.     

Transcatheter closure of patent ductus arteriosus in children weighing < 10 kg with Gianturco coils using the balloon occlusion technique

An extractive membrane bioreactor (EMB) is described that used an undefined anaerobic culture to dechlorinate tetrachloroethene (C2Cl4) reductively in a synthetic wastewater. Comparable reactors described in the literature use set-ups where the bacteria are in direct contact with the wastewater, and thus would require the addition of significant quantities of nutrients to the wastewater stream in practical application. In the EMB, a silicone rubber membrane separates the microbial culture from the wastewater stream, so that addition of nutrients can be minimised. The EMB was operated continuously for 48 days and dechlorinated 359 micromol C2Cl4 (1 biomedium -1 day -1) on average. Lactate was fed as an electron donor and C2Cl4 dechlorination was verified by chloride measurements. Particular attention was paid to the reduction of transmembrane C2Cl4 flux caused by a membrane-attached biofilm. Following a start-up period, the reactor operation was stable and remained largely unaffected by biofilm thickness and oxygen contamination from the wastewater.     

Effect of multiple coil closure of patent ductus arteriosus on blood flow to the left lung as determined by lung perfusion scans

This paper describes a combined inpatient and partial hospital program, with a ten-bed short-term inpatient unit and a partial hospital program that can accommodate 24 patients. Inpatients and partial hospital patients are treated together by the same staff in a program located in the partial hospital. The authors highlight features of the program that address the five elements of continuity: place, personnel, program, patient-peers, and plan for treatment. The discussion focuses on the importance of continuity in sustaining a combined unit; potential benefits for patients, families, staff, and trainees; attractiveness to third-party payers; and impediments to fully realizing the potential of the unit.     

Residual shunts after application of the Rushkind occlusion system in closure of persistent ductus arteriosus. Insertion of a second device

From May 1991 to August 1994, we performed transcatheter closure of patent ductus arteriosus with Rashkind umbrella system in 25 patients. In one, the device had embolism, to the right pulmonary artery and was operated 24 hs afterwards without complications. Seven had residual shunts, two had subsequent surgery, two are being followed (one for mild and one for moderate residual shunt). In the other three cases we inserted a second device. We used a 12 mm device in two cases and a 17 mm device in the other. Two cases had total occlusion 24 hrs after and in one had mild residual shunt without clinical repercussion. There were no complications. All had electrocardiographic and clinical improvement, take no medication, and their cardiomegaly had decreased (Cardiac index pre 61 vs post 54%). In conclusion the insertion of a second device is safe and effective alternative for residual shunt after first Rashkind occluder.     

Newborn with congenital arteriovenous fistulas of the abdominal wall complicated by a ductus arteriosus aneurysm

A case of congestive heart failure in a neonate resulting from a congenital abdominal arteriovenous fistula is described; an aneurysm of the ductus arteriosus was also found in the patient. Abdominal aortography was performed and demonstrated dilated feeding arteries, including the hypogastric arteries, which communicated with a dilated umbilical vein. Ligation of the feeding arteries and the umbilical vein led to resolution of the heart failure. Transient liver dysfunction occurred, however. Symptoms improved dramatically upon removal of the ligature from the umbilical vein. Although there is one previous report of an arteriovenous fistula involving the umbilical vein, we know of no prior report of a congenital arteriovenous fistula in association with a ductus arteriosus aneurysm.     

Coil on the loop and selectively enhanced stiffness for improved control: feasibility study in the neonatal ovine model of the large patent ductus arteriosus

RATIONALE AND OBJECTIVES: Several devices have been suggested and tested for interventional closure of the persistent ductus arteriosus. Coils were found effective only in small ducts due to their lack of maneuverability and physical limitation of grip forces leading to risk of embolization. The authors evaluated the feasibility to place single coils with selectively enhanced stiffness into high shunting ductus arteriosus, the coils being deployed and controlled through a veno-arterial loop in a bovine model. METHODS: "Double-cone" shaped, stainless steel coils with enhanced stiffness of the outer rings were mounted on either end on a nitinol core wire. A snap-in mechanism attaches the coil to this delivery wire and is freed by a pusher system of coiled steel wire that is advanced over the core wire. Forming a veno-arterial loop across the patent ductus allows for repositioning into the pulmonary artery or aortic catheter. A chronic lamb model of large patent ductus arteriosus (PDAs) (> or = 9 mm) was used in which ductus patency was secured by a protocol of repetitive angioplasties. Different systems (n = 10) were placed having retrieved the previous coil by a snare after definitive release. RESULTS: Placement of coils was possible in all 10 attempts. The coils were pulled back into the catheters between five and eight times before definitive release. CONCLUSIONS: The device allows controlled placement of single coils in our model of large PDAs and may lead the way to overcome previous limitations of coils. Clinical trials are warranted.     

A new forceps for the safe and easier insertion of subdural catheter: technical note

A new forceps suitable for the safe and easier insertion of a silicon catheter into the subdural space is described. The use of this new tool has two advantages: Firstly, the insertion of the silicon subdural catheter is parallel to the brain surface and secondly, the movement of the catheter's end in the subdural space is controlled with greater accuracy. Thus, the surgeon has the opportunity to direct the catheter to the right position avoiding penetration or injury of the brain.     

Cardiac surgery by the safe and easy insertion method with the J-shaped left ventricular vent catheter

A 24-year-old white man had a six-month history of nontender nodules on the dorsal aspect of the right hand. The lesions were diagnosed as lymphocutaneous sporotrichosis based on clinical appearance, histopathologic examinations, and fungal culture. Therapy with itraconazole was started. Considerable improvement was recorded after two months, when all of the lesions diminished in size and were no longer nodular in appearance.     

A comparative study of mentoring among men and women in managerial, professional, and technical positions.

Linkages between a global measure of mentoring experiences, gender, and 4 outcome variables were investigated. Also, the moderating effects of gender were examined to determine whether mentoring is differentially associated with career outcomes for men and women. Business school graduates (147 women and 173 men) provided information about their backgrounds, companies, positions, mentoring practices, compensation, and compensation satisfaction. Individuals experiencing extensive mentoring relationships reported receiving more promotions, had higher incomes, and were more satisfied with their pay and benefits than individuals experiencing less extensive mentoring relationships. There were no gender differences with regard to the frequency of mentoring activities, and gender did not moderate mentoring–outcome relationships. The results are discussed within the context of a $7,990 income difference between men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

坚持技术改造 促进技术创新 实现企业又好又快发展

位于五岭之口、百越之冲的粤北重镇韶关,正崛起一座现代化钢城一广东省韶关钢铁集团有限公司(以下简称"韶钢").     

电转化和氢氧化钠滴定法从氯化铝溶液 中制备氧化铝及其性能对比研究

目前,我国存在许多以氯化铝溶液为原料制备氧化铝的方法.然而,这些方法均存在着许多不足之处,如产生废酸和废盐、制备条件要求较高、反应中涉及有毒有害物质等.基于这种情况,在氯碱工业的启发下,东北大学已经提出了一种电转化AlCl₃水溶液制备氧化铝的新方法.并且该方法已经得到了试验性验证.文中主要研究了电转化新方法和氢氧化钠滴定法制备的氧化铝前驱体在红外光谱及粒度分布方面的不同;同时研究了这2种方法制备的氧化铝在物相、形貌及粒度等方面的差异.结果表明,这2种方法制备的氧化铝前躯体均含有铝元素及Al-OH键,且其焙烧产物也均为氧化铝.与氢氧化钠滴定法制备的氧化铝相比,电转化法制备的氧化铝形貌较规整且为片状结构,而氢氧化钠滴定法制备的氧化铝形状不规则.同时,电转化法制备的氧化铝及其前驱体的粒径小于氢氧化钠滴定法制备的氧化铝及其前躯体的粒径,但前者的粒径分布比后者的粒径分布更为均匀.