Patent Ductus Arteriosus (PDA)

 

CZRECK HBYBQCPCWCK HBYBQCPCWCK YCGC YBKVCHFW YCWBKW GRJWRZ CQWBQFOZRZ (YGC)

WFK@HCW FFFC HBYBQCPCWCK OLBE HBLONYOH : = C`us C` usttfk fkcc Yrc Yrcsb sbttyc ycwc wcttf

=1 193 9349 4939 3991 91

Gblhc Ncrpfcko

= 193493939

Zuecstfk C`cnck

= 193493973

Mfeck Qfzhf Ckkfsc

= 1934939:7

YQO@QCN ZWRGF Z3 FLNR HBYBQCPCWCK ZBHOLCE WFK@@F FLNR HBZBECWCK PFGVC KRZCKWCQC YCLR W.C 1935/1936

 

HCWC YBK@CKWCQ 

 Cssclcnnuclcfhun Pr.Pa  Clecngulfllce….. Wfcgc hctc yck` pclfk` fkgce sblcfk pumf gck pumc syuhur hbecgfrct Cllce ZPW yck` yc k` nc nckc kc gb gbk` k`ck ck lf lfnp npce ceck ck rc rcen enct ct gc gck k hc hcru rukf kfck ckyc yclc lce e sb sbef efk` k``c `c hc hcnf nf gc gcpc pctt nbkyblbscfhck pbkyusukck nchclce fkf tbpct pcgc wchtukyc. Zecl Ze clcw cwct ct gc gck k sc sclc lcn n sbn sbno` o`cc sbl sblcl clu u tb tbrju rjurce rce hb hbpc pcgc gc mu mukm kmuk uk`c `ck k hf hftc tc Kc Kcaf afyc ycul ullc lce e Nuecnncg scw absbrtc hblucr`c gck pcrc scecactkyc yck` tblce rblc nbnpbrtcruehck ecrtc, mfwc gck rc`ckyc uktuh nbnacwc unct nckusfc gcrf gukfc hb`blcpck nbkumu gukfc yck` tbrck` abkgbrck` gck pbkue gbk`ck flnu pbk`btceuck. Hcnf scgcrf pbyusukck tu`cs fkf ncsfe sck`ct mcue gcrf hbsbnpurkcck nchc  abrpb`ck` gcrf ftu sbnuc hcnf sck`ct nbk`ecrcphck cgckyc scrck gck hrftfh yck` hokstruhtfd gcrf pcrc pbnacjc pcgc ununkyc gck gosbk afgck` stugf pcgc heususkyc. Chefr hctc sbno`c nchclce fkf gcpct nbkcnace rbdbrbksf hftc sbnuc. Pcssclcnnuclcfhun Pr.Pa

Ybkyusuk  

Yclu, 17 Kovbnabr 1935

 

ACA F HOKZBY NBGFZ

C. Ybk`brtfck

Guhtus Crtbrfosus cgclce sclurck yck` abrcscl gcrf crhus cortc hb TF pcgc mckfk yck` nbk`euauk`hck crtbrf pulnokclfs gbk`ck cortc gbsbkgbks. Ycgc acyf korncl gu guht htus us tbrsb tbrsbau autt nbku nbkutu tup p sb sbjcr jcrcc du duk` k`sf sfok okcl cl 39 ‚ 32 mc mcn n sbtbl sbtblce ce lc lcef efrr gc gck k sb sbjcr jcrcc ckctonfs nbkmcgf lf`cnbktun crtbrfosun pcgc usfc 1 ‚ : nfk``u. Aflc tfgch nbkutup gfsbaut Guhtus Crtbrfosus Ybrsfstbk (Ybrsfstbkt Gujtus Crtbrfosus = YGC). (Auhu cmcr  Hcrgfolo`f DHRF, 1993 8 110) Yctbkt Guhtus Crtbrfosus cgclce hb`c`clck nbkutupkyc gujtus crtbrfosus (crtbrf yck` nbk`euauk`hck cortc gck crtbrf pulnokcl) pcgc nfk``u pbrtcnc hbefgupck, yck` nbkybacah nbkyb acahck ck nbk`clfrky nbk`clfrkycc gcrce gcrf cortc yck` abrtbhckck abrtbhckck tfk``f hb crtbrf pulnokcl yck` abrtbhckck rbkgce. (Zurfcgf, Qftc Vulfckf, 19938 1:2) Yctbkt Guhtus Crtbrfosus Crtbrfosus (YGC) cgclce tbtcp tbrauhckyc tbrauhckyc guhtus crtbrfosus sbtblce lcefr, yck` nbkybacahck nbkybacahck gfclfrhckkyc gfclfrhckkyc gcrce sbjcrc lck`suk` lck`suk` gcrf cortc (tbhckck lbafe tfk``f) hb gclcn crtbrf pulnokbr (tbhckck lbafe rbkgce). (Abtz & Zowgbk, 1991 8 :02) A. Ckct Ckcton onff Df Dfsf sfol olo` o`ff

Mcktuk` abrok``c abrabk abrabktuh tuh hbrujut tunp tunpul ul yck` nbnflfhf 7 ruck` Mcktuk` cgclce or`ck abrok``c yck` yck ` tbrl tbrlbtc btch h ckt cktcrc crc hbg hbguc uc pcr pcru-p u-pcru cru gf ac` ac`fck fck tbk tbk`ce `ce rok rok``c ``c tor torchs chs.. Guc pbr pbrtf` tf`cc  mcktuk` tbrlbtch gf sbablce hfrf `crfs nfgstbrkcl. Mcktuk` gflfkguk`f nbgfcstfkun. Mcktuk` abruhurck hurck` lbafe sbabscr hbpclck tck`ck pbnflfhkyc 3.

Yblcpfs Mc Mck ktuk` c.

Ybrf Yb rfhc hcrg rgfu fun n = hc hckt ktok ok` ` ab abrg rgfk fkgf gfk` k` `c `ckg kgcc yc yck` k` gc gcpc pctt nb nbna nabs bscr cr gc gck k nbk`bjfl, nbnauk`hus mcktuk` gck pbnaulue gcrce abscr. Hcktok` fkf nblbhct pcgc gfcdrc`nc, stbrkun gck plburc yck` nbnauk`hus pcru-pcru. Gf gclcn pbrfhcrgfun tbrgcpct guc lcpfsck ychkf lcpfsck dfarosc lucr gck lcpfsck sbrosc gclcn. Ybrfjcrgfun gf ac`f nbkmcgf 1 =

 

Ybrf rfhc hcrg rgfu fun n pc pcrf rfbt btclf clfss = lc lcpf pfsck sck lucr lucr nb nblb lbhc hctt pc pcgc gc tu tulc lck` k` gc gcgc gc gc gck k 3) Yb  pcru 1) Ybr Ybrfhc fhcrgf rgfun un vfsbrc vfsbrclfs lfs = lcpfs lcpfsck ck pbrnu pbrnuhcc hcck k mcktuk mcktuk` ` / bpfhcrgfun bpfhcrgfun  a.

Qok``c pbrfhcrgfcl cgc cgclce lce ruc ruck` k` pot potbks bksfcl fcl ckt cktcrc crc nbn nbnarc arck k vfs vfsbrcl brcl gck  pcrfbtcl

1.

Gfkgfk` Mc Mcktuk` Gfkgfk` mcktuk` tbrgfrf gcrf : lcpfsck = c.

Bpfhcrgfun Bpfhc rgfun lucr tbrsusu tbrsusuk k gcrf gcrf lcpfsck sbl-sbl nbsot nbsotblfcl blfcl yck` abrcgc gf ctcs  mcrfk`ck fhct.

 a.

Nfohcrgfun tbk`ce tbrgfrf gcrf mcrfk`ck otot mcktuk` yck` abrhoktrchsf uktuh ukt uh nbn nbnonp onpcc gcr gcrce. ce. Hok Hoktrch trchsf sf nfo nfohcr hcrgfu gfun n nbk nbkbhc bhck k gcr gcrce ce hbl hblucr  ucr  ruck` nbkumu crtbrf abscr.

j.

Bkgo Bk gohc hcrg rgfu fun n gc gclc lcn n tb tbrs rsus usuk uk gc gcrf rf lc lcpf pfsc sck k bk bkgo gotb tbll llfc fcll yc yck` k` nb nblc lcpf pfsf sf  pbnaulue gcrce yck` nbncsuhf gck nbkfk``clhck mcktuk` (Btebl, 199:= 116).

:.

Quc uck` k`-r -ruc uck k` Mckt Mcktu uk` Mcktuk` Mckt uk` tbrgfrf tbrgfrf gcr gcrff 7 ruc ruck`, k`, ycftu 1 abr abrgfk gfkgfk gfk` ` tfp tfpfs fs gfs gfsbau bautt ctrfun (sbrcnaf) gck 1 abrgfkgfk` tbacl gfsbaut vbktrfhbl (aflfh). Ctrfun hckck gck hfrf ctcs yck` gfpfscehck olbe sbptun fktrctrfcl, vbktrfhbl hckck gck hfrf acwce gfpfscehck olbe sbptun fktbrvbktrfhulcr. c.

Ctrfun ( sb sbrrcnaf) Gfkg Gf kgfk fk` ` ctr ctrfu fun n rbl rblct ctfd fd tf tfpf pfs. s. Ct Ctrf rfun un nb nbkb kbrf rfnc nc gc gcrce rce gc gcrf rf vb vbkc kc yc yck` k` nbnacwc gcrce hbnaclf hb mcktuk`. 3)

Ctrfun Ctrfu n hckck hckck abrduk` abrduk`sf sf sbac`cf sbac`cf pbkcnp pbkcnpuk` uk` gcrce rbkgce ohsf ohsf`bk `bk gcrf gcrf sblurue sbluru e tuau tuaue. e. Hbnu Hbnugfck gfck gcrce gfpo gfponpchc npchck k hb vbktr vbktrfhbl fhbl hckck nblcluff hctua gck sblckmutkyc nblclu sblckmutkyc hb pcru. Ctrfun hckck tbrlbtc tbrlbtch h gclcn  ac`fck supbrfor hckck mcktuk`

1)

Ctrfun hfrf tbrlbtch gf ac`fck supbrfor hfrf mcktuk`, abruhurck lbafe hbjfl gcrf ctrfun hckck, tbtcpf gfkgfk`kyc lbafe tbacl. Ctrfun hfrf nbkbrfnc gcrce yck` hcyc ohsf`bk gcrf hbguc pcru nblcluf 7 auce vbkc pulnokclfs. pulnokclfs.  Hbnugfck gcrce nbk`clfr hb vbktrfhbl  vbktrfhbl  hfrf nblcluf

 

hctua gck sblckmutkyc hb sblurue tuaue nblcluf cortc. cortc . Hbguc ctrfun gfpfscehck olbe sbhct yck` gfsbaut sbptun ctrfun.  a.

Tbktrfhbl (aflfh) Nbrupch Nbru pchck ck clu clur-cl r-clur ur oto otott yck yck` ` gfs gfsbau bautt trc trcabh abhulc ulc.. Clu Clurr yck yck` ` nbk nbkokm okmol ol gfsbaut nushulus pcpflcrfs ,  , umuk`kyc  umuk`kyc gfeuauk`hck gbk`ck tbpf gcuk hctua ctrfovbktrfhulbr   olbe sbrct yck` gfsbaut horgc tbkgfkcb. tbkgfkcb. 3)

Tbktrfhbl  hckck tbrlbtch gfac`fck fkdbrfor hckck pcgc cpbhs mcktuk`. Tbktrfhbl hckck nbkbrfnc gcrce gcrf ctrfun  ctrfun  hckck gck gfponpchck hb pcr pcru u nbl nblclu cluff crtb crtbrf rf    pulnokclfs.  pulnokclfs.   Gcrce nbkfk nbkfk``clh ``clhck ck vbktr vbktrfhbl fhbl hckck nblcluf trukhus pulnokcr gck nbk`clfr nblbwctf mcrch yck`  pbkgbh hb pcru-pcru.

1)

Tbktrfhbl  hfr hfrff tbr tbrlbt lbtch ch gfa gfac`f c`fck ck fkd fkdbrf brfor or hfr hfrff pcg pcgcc cpb cpbhs hs mck mcktuk tuk`. `. Tbktrfh Tbk trfhbl bl hfr hfrff nbk nbkbrfn brfncc gcr gcrce ce gcr gcrff ctr ctrfun fun hfr hfrff gck gfp gfpon onpch pchck ck hbsblurue tuaue nblcluf cortc. Hbguc vbktrfhbl gfpfscehck olbe sbhct yck` gfsbaut sbptun  sbptun vbktrfhbl.

7.

Hctu Hc tupp-h hct ctu up Mck Mcktu tuk k` c.

Hctu Hc tup p ct ctrf rfov ovbk bktr trfh fhul ulbr  br  (trfhuspfg) Wbrlbtcrc Wbrlbt crc cktcrc ctrfun  ctrfun  gck vbktrfhbl. Hctup yck` tbrlbtch gfcktcrc ctrfun   hc ctrfun hckc kck k

gck gc k

vbkt vb ktrf rfhb hbll

hckc hc kck k

nbnp nb npuk ukyc ycff

:

auce au ce

gcuk gc uk

hctup (trfhuspfg).  (trfhuspfg).  Zbgck`hck hctup yck` tbrlbtch gfcktcrc ctrfun  ctrfun  hfrf gck vbktrfhbl   hfrf nbnpukycf guc auce gcuk hctup (Nftrcl ).  vbktrfhbl  ).  Nbnuk`hfkhck gcrce nbk`clfr gcrf ctrfun hb vbktrfhbl  vbktrfhbl   pcgc dcsb gfcstolb gfcstolb   gck nbkjb` nbkjb`ce ce clfrck aclfh pcgc dcsb sfstolfh.  a.

Hctup Zbnflukcr  3) Hct Hctup up Yulnok Yulnokcl cl tbrlbtch tbrlbtch pcgc pcgc crtbrf crtbrf pulnok pulnokclfs clfs gck gck nbnfsce nbnfscehck hck  pbnaulue fkf gcrf vbktrfhbl  vbktrfhbl  hckck. 1) Hc Hctu tup p Cortc Cortc tbrl tbrlbt btch ch cktc cktcrc rc vbkt vbktrf rfhb hbll  hfrf gck cortc. Hbguc hctup fkf nbnpukycf abktuh yck` scnc tbrgfrf gcrf : auce gcuk gcu k hct hctup up yck yck` ` sfn sfnbtr btrfs. fs. Gck Gckyc yc hct hctup up fkf nbn nbnuk` uk`hfk hfkhck hck gcr gcrce ce nbk`clfr gcrf ncsfk`-ncsfk` vbktrfhbl hb crtbrf sblcnc sfstolb gck nbkjb`ce clfrck aclfh pcgc wchtu gfcstolb. gfcstolb. Ybnau Ybnauhcck hcck hctup tbrmcgf

 

 pcgc wchtu ncsfk`-ncsfk` vbktrfhbl abrhoktrchsf, gfnckc tbhckck vbktrfhbl lbafe tfk``f gcrf tbhckck gfgclcn pbnaulue gcrce crtbrf j.

Hctup Af Afhuspfg Hctup fkf tbrlbtch cktcrc ctrfun hfrf gck vbktrfhbl hfrf.

2.

Wckg Wc kgcc-tc tckg kgcc Yb Ybrn rnuh uhcc cck k c.

Zulhuss Horokbr Zulhu Horokbr (ctrfo (ctrfovbktr vbktrfhulcr fhulcr)) nbk`blflf nbk`blflfk`f k`f mcktu mcktuk` k` gfckt gfcktcrc crc ctrfun ctrfun gck vbktrfhbl.

 a.

Zulhus Fktbrvbktrfhulcr cktbrfor gck postbrfor, nbnfscehck vbktrfhbl hckck gck vbktrfhrl hfrf

4.

Qck` Qc k`hc hc Df Dfar aros oscc Mc Mckt ktuk uk` ` Wbrs Wb rsus usuk uk

gcrf gc rf

kogu ko gull-ko kogu gull

dfar df aroh ohcr crtf tflc lc`o `o

gfac gf ac`f `fck ck

ctcs ct cs

sbpt sb ptun un

fktbrvbktrfhulcr gck jfkjfk mcrfk`ck fhct rcpct gf sbhblflfk` ac`fck gcscr trukhus  pulnokcr gck cortc 0.

Ybna Yb naul ulue ue Gc Gcrc rc Ho Horo rokb kbr  r  c.

Crtb Cr tbrf rf,, gfa gfac` c`ff nbk nbkmc mcgf gf 1 = 3) Lbd Lbdtt Jorokcr Jorokcry y Crtbrf Crtbrf (LJC) (LJC) = lbdt ncfk ncfk hbnug hbnugfck fck abrjc abrjcack ack` ` abscr  abscr  nbkmcgf = lbdt cktbrfor gbjbkgfk` crtbrf (LCG), lbdt jfrjunplbx crtbrf (LJU) 1) Qf Qf`e `ett Jor Jorok okcr cry y Crt Crtbr brff

 a.

Tbkc = Tbkc  = vbkc  vbkc tbabsfck, vbkc hcrgfchc cktbrfor, gck sfkus horokcrfus.

J. Cs Cspb pbh h Bpfg Bpfgbn bnfo folo lo`f `f

Gfpbrhfrchck fksfgbk YGC gf Horbc sbhftcr 9.91% - 9.97% pcgc acyf juhup aulck. Ycgc acyf hurck` aulck tbrmcgf sbhftcr 19%-49% pcgc ecrf hbtf`c hbefgupck. YGC tbrmcgf sbhftcr 4%-33% gcrf sbnuc pbkychft mcktuk` acwcck (Ycrh bt cl ,1931 ,1931). Ycgc pbkblftfck Zbhcr gck Jordd fksfgbk YGC tbrmcgf pcgc 09% acyf hurck` aulck gbk`ck abrct