Method of surgical treatment of acute pancreatitis with early enteral intraoperative nutrition of patient

FIELD: medicine.

SUBSTANCE: in the process of preoperative preparation imunofan is introduced to a patient intramuscularly in a dose of 1 ml one time per day. After that, laparoscopy with revision of the abdominal cavity organs, opening of the omental bursa and its washing with solutions of antiseptics, and formation of the external cholecystoma are performed. Intraoperatively at the stage of the omental bursa drainage and before performing cholecyctomy, into the stomach introduced is a thin probe for enteral nutrition, through which early intraoperative nutrition is realised by introduction of liquid food "Diason" at a rate of 30 ml/hour in an amount of 450-500 ml on the first day of the postoperative period. In the postoperative period introduction of imunofan in the same dose is continued for 9 days. Introduction of "Diason" food through the thin probe is also continued on the second day of the postoperative period at a rate of 30 ml/hour in an amount of 450-500 ml, on the third day at a rate of 45-60 ml/hour in an amount of 700-750 ml, on 4 and 5 day at a rate of 80-90 ml/hour in an amount of 950-1000 ml, from 6 to 9 days at a rate of 125-150 ml/hour in an amount of 1500-2000 ml. On the 10-th day after operation the probe of enteral nutrition is removed. After that, a seeping type of nutrition is realised, in the process of which a drink supportan or nutridrink is introduced to the patient in an amount of 200 ml 3-4 times per day until complete recovery of the trophological status.

EFFECT: method provides prophylaxis of purulent-inflammatory complications due to the prevention of impairment of cellular and humoral immunity and sufficient correction of the trophological status, contributing to a considerable increase of life quality of the operated patient.

3 ex

 

The invention relates to medicine, namely to method surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient, and can be used in the surgical treatment of patients with acute pancreatitis in surgical hospitals.

There is a method of surgical treatment of acute pancreatitis, including performing laparoscopy with revision of the abdominal cavity, opening the stuffing bags and washing with antiseptic solution, the formation of the outer cholecystecomy (see RF patent №2334474, IPC AV 17/00, 2008).

However, the known method of surgical treatment of acute pancreatitis when its use has the following disadvantages:

- insufficient ensures the prevention of complications of pancreatitis in the form of pancreatic necrosis, purulent-septic complications, and sepsis

- does not provide sufficient correction trophological status

- does not provide sufficient activation of parts of humoral immunity,

- does not ensure the prevention of nutritional deficiency caused by impaired absorption of nutritious ingredients together with their inability adequate revenues in the gastrointestinal tract,

- does not prevent violations of the cellular and humoral immunity schastem the development of inflammatory complications, including peritonitis, a retroperitoneal abscess and sepsis.

The objective of the invention is to provide a method of surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient.

The technical result is the prevention of violations of the cellular and humoral immunity with frequent development of inflammatory complications including peritonitis, a retroperitoneal abscess and sepsis, prevention of complications of pancreatitis in the form of pancreatic necrosis, ensuring sufficient correction trophological status, ensuring sufficient activation of parts of humoral immunity, prevent the development of nutritional deficiency caused by impaired absorption of nutritious ingredients together with their inability adequate revenues in the gastrointestinal tract. In addition, the technical result of using this proposed method is a substantial improvement in the quality of life of the operated patient.

The technical result is achieved in that a method of surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient, comprising performing laparoscopy with revision of the abdominal cavity, opening the stuffing bags and washing with antiseptic solution, the formation of the W outer cholecystecomy, in the process of preoperative preparation of the patient is prescribed oligopeptides immunostimulator "Imunofan" in a dose of 1 ml intramuscularly once a day and continue his introduction to the same dose for 9 days in the postoperative period, in the process of surgical treatment of intraoperative phase drainage stuffing bags and before performing cholecystostomy in the stomach of the patient through the nose being thin probe for enteral nutrition and the right exercise early intraoperative food entering the stomach of the patient sterile liquid of clinical nutrition "Deaton", including "such as nutrizone advanced Deason containing protein in the amount of 43 g/liter, carbohydrates - 113 g/liter and fats 42 g/liter of solution, at a rate of 30 ml/hour in the number of 450-500 ml on the first day of the postoperative period, the introduction of which continue into the second day of the postoperative period at a rate of 30 ml/hour in the number of 450-500, in the third day of the postoperative period with the speed of 45-60 ml/h in the amount of 700 to 750 ml, 4 and 5 days at 80 - 90 ml/hour in the number of 950-1000 ml, 6 to 9 days with a speed of 125 to 150 ml/hour in the number of 1500-2000 ml, on day 10 after the operation is removed from the stomach of the patient probe enteral nutrition and perform shippingby power type, in which the patient takes supportan drink or nutrit the ng in 200 ml 3-4 times a day until complete recovery trophological status.

The method is as follows. Before performing surgical intervention for acute destructive pancreatitis patient during preoperative preparation oligopeptides immunostimulator "Imunofan" in a dose of 1 ml intramuscularly once a day and continue his introduction to the same dose for 9 days in the postoperative period. However, the imposition of imunofana exercise 2-3 hours after admission to hospital, or 2 hours before surgery.

The patient should receive preoperative intensive therapy, including procaine blockade, empirical antibiotics, antispasmodics, antifermentny drugs, analgesics, anti-shock and detoxifying infusion therapy.

After achieving stabilization of the General condition by filling the BCC and correction of peripheral hemodynamics under endotracheal type of anesthesia perform endoscopic laparoscopic sanitation and drainage stuffing bags and abdominal cavity with the aim of enzymatic treatment of peritonitis. Two drainage tubes connected to the tail of the pancreas through the packing bag for the subsequent creation of the leaching system. Two drainage tubes placed on the left side of the channel and two drainage tubes into the pelvis.

On the stage drainage stuffing bags and before performing cholecystostomy in the stomach of the patient through the nose to impose control of the laparoscope is a thin tube enteral nutrition and the right exercise early intraoperative food entering the stomach of the patient sterile liquid of clinical nutrition "Deaton", including "such as nutrizone advanced Deason containing protein in the amount of 43 g/liter, carbohydrate - 113 g/liter and fats 42 g/liter of the solution. The introduction of liquid sterile clinical nutrition "Deason carry out at a rate of 30 ml/hour in the number of 450-500, in the first day of the postoperative period and continue his introduction in the second day of the postoperative period at a rate of 30 ml/hour in the number of 450-500 ml, in the third day of the postoperative period with the speed of 45-60 ml/h in the amount of 700 to 750 ml, 4 and 5 days, with a speed of 80-90 ml/h in the amount of 950-1000 ml, 6 to 9 days with a speed of 125 to 150 ml/hour in the number of 1500-2000 ml On day 10 after surgery to remove from the stomach of the patient probe enteral nutrition and perform shippingby power type, in which the patient takes supportan drink or nutridrink in 200 ml 3-4 times a day until complete recovery trophological status.

Among the essential features characterizing the proposed method of surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient distinctive are:

the appointment process of the preoperative preparation of the patient oligopeptides of immunostimulatory "Imunofana" in a dose of 1 ml intramuscularly on the in once a day and the continuation of its introduction in the same dose for 9 days in the postoperative period,

introduction in the process of surgical treatment of intraoperative phase drainage stuffing bags and before performing cholecystostomy in the stomach of the patient through the nose thin probe for enteral nutrition and the right exercise of early perioperative nutrition introduction into the stomach of the patient sterile liquid of clinical nutrition "Deason>>, including "such as nutrizone advanced Deason containing protein in the amount of 43 g/liter, carbohydrate - 113 g/liter and fats 42 g/liter of solution,

- introduction into the stomach of the patient sterile liquid of clinical nutrition "Deaton", including "such as nutrizone advanced Deason" with a rate of 30 ml/hour in the number of 450-500 ml on the first day of the postoperative period, the introduction of which continue into the second day of the postoperative period at a rate of 30 ml/hour in the number of 450-500, in the third day of the postoperative period with the speed of 45-60 ml/h in the amount of 700 to 750 ml, 4 and 5 days, with a speed of 80-90 ml/h in the amount of 950-1000 ml, 6 to 9 days with a speed of 125 to 150 ml/hour in the number of 1500-2000 ml,

- removal on day 10 after surgery of the stomach of the patient thin probe enteral nutrition and execution siingapore the type of food, in which the patient takes supportan drink or nutridrink in 200 ml 3-4 times a day until complete recovery tropological hundred the USA.

Experimental studies of the proposed method of surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient showed its high efficiency. The method and its use ensures the prevention of violations of the cellular and humoral immunity with frequent development of inflammatory complications including peritonitis, a retroperitoneal abscess and sepsis, reduces the frequency of complications of pancreatitis in the form of pancreatic necrosis, provides a necessary and sufficient correction trophological status, provides sufficient activation of parts of humoral immunity, prevents the development of nutritional deficiency caused by impaired absorption of nutritious ingredients together with their inability adequate revenues in the gastrointestinal tract. In addition, when using the proposed method achieved a substantial improvement in the quality of life of the operated patient.

Implementation of the proposed method of surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient is illustrated by the following practical examples.

Example 1. Patient B., aged 57, is an urgent ambulance was admitted to the surgical Department of the city hospital HSS MSC Astrakhan on p the water acute destructive pancreatitis.

The patient complained of General weakness, dry mouth, strong girdle pain pain in upper abdomen, radiating pain in the left lumbar region, it was noted nausea, repeated vomiting. In General, the analysis of blood: leukocytes 16,0×109/l, stab neutrophils 11%, segmented neutrophils 86%, lymphocytes 6%, monocytes 1%; amylase urine - 2000 u/l.

Ultrasound and CT abdomen revealed an increase of the pancreas, areas of destruction in her head and body, as well as gallstones and dilatation of the common bile duct to 1.2, see

Before performing surgical intervention for acute destructive pancreatica the patient was prescribed during preoperative preparation oligopeptides immunostimulator "Imunofan" in a dose of 1 ml intramuscularly once a day and continued his introduction to the same dose for 9 days in the postoperative period. However, the imposition of imunofana carried out 2 hours after admission to the hospital. The patient was prescribed preoperative intensive therapy, including procaine blockade, empirical antibiotics, antispasmodics, antifermentny drugs, analgesics, anti-shock and detoxifying infusion therapy.

After achieving stabilization of the General condition by memory is in the BCC and correction of peripheral hemodynamics under endotracheal type of anesthesia performed endoscopic laparoscopic sanitation and drainage of the soft bags and abdomen to treat enzymatic peritonitis. Two drainage tubes were brought to a tail of the pancreas through the packing bag for the subsequent creation of the leaching system. The other two drainage tubes were placed on the left side of the channel and two drainage tubes into the pelvis.

On stage drainage stuffing bags and before performing cholecystostomy in the stomach of the patient through the nose introduced under the control of the laparoscope is a thin tube enteral nutrition and immediately made an early perioperative enteral nutrition introduction into the stomach of the patient sterile liquid of clinical nutrition "Deason containing protein in the amount of 43 g/liter, carbohydrate - 113 g/liter and fats 42 g/liter of the solution. The introduction of liquid sterile clinical nutrition "Deason realized with a speed of 30 ml/h in the amount of 475 ml on the first day of the postoperative period and was continued by his introduction in the second day of the postoperative period at a rate of 30 ml/h in the amount of 475 ml, in the third day of the postoperative period at 60 ml/h in the amount of 750 ml, 4 and 5 days at 80 ml/h in the amount of 950 ml, 6 to 9 days with a speed of 135 ml/h in the amount of 1750 ml On day 10 after surgery has removed from stomach of the patient probe enteral nutrition and performed shippingby power type, in which the patient took supportan drink at stake is the amount of 200 ml 4 times a day until complete recovery trophological status.

Further treatment of the patient continued in the intensive care unit, where on a background of traditional intensive therapy, including the immune correction with herbal products and nutritional support, noted positive dynamics of biochemical parameters of blood. In the subsequent (16 day) fluctuations of basic biochemical parameters of blood insignificant and almost came to the limit of the physiological norm.

On the 20th day of the hospital stay, the patient's condition has stabilized, normal vital functions of the body, were stopped multiple organ failure. The patient was discharged from the hospital after epithelialization of wounds.

Example 2. Patient R., 63, in case of emergency ambulance enrolled in the surgical Department of the city hospital NPH MSCH Astrakhan for acute destructive pancreatitis.

The patient complained of General weakness and strong girdle pain pain in upper abdomen, radiating pain in the left lumbar region, nausea, repeated vomiting. In General, the analysis of blood: leukocytes 15,0×109/l, stab neutrophils 12%, segmented neutrophils 85%, lymphocytes 6%, monocytes 1%; amylase urine - 2000 u/l.

Ultrasound and CT abdomen revealed an increase of the pancreas, areas of destruction in her head and body,as well as gallstones and dilatation of the common bile duct to 1.1, see

Before performing surgical intervention for acute destructive pancreatica the patient was prescribed during preoperative preparation oligopeptides immunostimulator "Imunofan" in a dose of 1 ml intramuscularly once a day and continued his introduction to the same dose for 9 days in the postoperative period. However, the imposition of imunofana carried out 3 hours after admission to the hospital. The patient was prescribed preoperative intensive therapy, including procaine blockade, empirical antibiotics, antispasmodics, antifermentny drugs, analgesics, anti-shock and detoxifying infusion therapy.

After achieving stabilization of the General condition by filling the BCC and correction of peripheral hemodynamics under endotracheal type of anesthesia performed endoscopic laparoscopic sanitation and drainage of the soft bags and the abdominal cavity with the aim of enzymatic treatment of peritonitis. Two drainage tubes were brought to a tail of the pancreas through the packing bag for the subsequent creation of the leaching system. The other two drainage tubes were placed on the left side of the channel and two drainage tubes into the pelvis.

On stage drainage stuffing bags and before performing cholecystostomy in the stomach of patients who NTA through the nose introduced under the control of the laparoscope is a thin tube enteral nutrition and immediately made an early perioperative enteral nutrition introduction into the stomach of the patient sterile liquid of clinical nutrition "Deason containing protein in the amount of 43 g/liter, carbohydrate - 113 g/liter and fats 42 g/liter of the solution. The introduction of liquid sterile clinical nutrition "Deason realized with a speed of 30 ml/h in the amount of 450 ml in the first day of the postoperative period and was continued by his introduction in the second day of the postoperative period at a rate of 30 ml/h in the amount of 450 ml, in the third day of the postoperative period, with a speed of 45 ml/h in the amount of 700 ml, 4 and 5 days, with a speed of 85 ml/hour in the number 975 ml, 6 to 9 days with a speed of 125 ml/hour 1500 ml On day 10 after surgery has removed from the stomach of the patient probe enteral nutrition and performed shippingby power type, in which the patient took supportan drink 200 ml 3 times a day until complete recovery trophological status.

Further treatment of the patient continued in the intensive care unit, where on a background of traditional intensive therapy, including the immune correction with herbal products and nutritional support, noted positive dynamics of biochemical parameters of blood. In the subsequent (16 day) fluctuations of basic biochemical parameters of blood insignificant and almost came to the limit of the physiological norm.

On the 20th day of the hospital stay, the patient's condition has stabilized, normalize is Alice vital functions of the body, stoped multiple organ failure. The patient was discharged from the hospital after epithelialization of wounds.

Example 3. The patient M, 43, in case of emergency ambulance enrolled in the surgical Department of the city hospital HSS Department, Astrakhan for acute destructive pancreatitis.

The patient complained of General weakness, dry mouth, strong girdle pain pain in upper abdomen, radiating pain in the left lumbar region, it was noted nausea, repeated vomiting. In the General analysis of blood leukocytes of 16.7×109/l, stab neutrophils 12%, segmented neutrophils 84%, lymphocytes 6%, monocytes 1%; amylase urine - 2000 u/l.

Ultrasound and CT abdomen revealed an increase of the pancreas, areas of destruction in her head and body, as well as gallstones and dilatation of the common bile duct to 1.2, see

Before performing surgical intervention for acute destructive pancreatica the patient was prescribed during preoperative preparation oligopeptides immunostimulator "Imunofan" in a dose of 1 ml intramuscularly once a day and continued his introduction to the same dose for 9 days in the postoperative period. However, the imposition of imunofana carried out for 2 hours before surgery. The patient was prescribed before perational intensive therapy, including procaine blockade, empirical antibiotics, antispasmodics, antifermentny drugs, analgesics, anti-shock and detoxifying infusion therapy.

After achieving stabilization of the General condition by filling the BCC and correction of peripheral hemodynamics under endotracheal type of anesthesia performed endoscopic laparoscopic sanitation and drainage of the soft bags and the abdominal cavity with the aim of enzymatic treatment of peritonitis. Two drainage tubes were brought to a tail of the pancreas through the packing bag for the subsequent creation of the leaching system. The other two drainage tubes were placed on the left side of the channel and two drainage tubes into the pelvis.

On stage drainage stuffing bags and before performing cholecystostomy in the stomach of the patient through the nose introduced under the control of FGDs thin probe for enteral feeding and immediately made an early perioperative enteral nutrition introduction into the stomach of the patient sterile liquid of clinical nutrition "such as nutrizone advanced Deason containing protein in the amount of 43 g/liter, carbohydrate - 113 g/liter and fats 42 g/liter of the solution. The introduction of liquid sterile clinical nutrition "Deason realized with a speed of 30 ml/hour in a quantity of 500 ml in the first day of polaprezinc the th period and continued his introduction in the second day of the postoperative period at a rate of 30 ml/hour in a quantity of 500 ml, in the third day of the postoperative period with a speed of 50 ml/h in the amount of 725 ml, 4 and 5 days, with a speed of 90 ml/h in the amount of 1000 ml, 6 to 9 days at 150 ml/hour and a total of 2000 ml On day 10 after surgery has removed from the stomach of the patient probe enteral nutrition and performed shippingby power type, in which the patient took nutridrink in 200 ml 3 times a day until complete recovery trophological status.

Further treatment of the patient continued in the intensive care unit, where on a background of traditional intensive therapy, including the immune correction with herbal products and nutritional support, noted positive dynamics of biochemical parameters of blood. In the subsequent (14 day) fluctuations of basic biochemical parameters of blood insignificant and almost came to the limit of the physiological norm.

On the 20th day of the hospital stay, the patient's condition has stabilized, normal vital functions of the body, were stopped multiple organ failure. The patient was discharged from the hospital after epithelialization of wounds.

A method of surgical treatment of acute pancreatitis with early perioperative enteral nutrition patient, comprising performing laparoscopy with revision of the abdominal cavity, opening the stuffing bags and p is washing with antiseptic solutions, the formation of the outer cholecystecomy, characterized in that in the process of preoperative preparation of the patient is prescribed Imunofan dose of 1 ml intramuscularly once a day and continue his introduction to the same dose for 9 days in the postoperative period, in the process of surgical treatment of intraoperative phase drainage stuffing bags and before performing cholecystostomy in the stomach of the patient through the nose being thin probe for enteral nutrition and exercise early intraoperative powered by introduction of liquid sterile clinical nutrition "Deason containing protein in the amount of 43 g/liter, carbohydrate - 113 g/liter and fats 42 g per liter of solution at a rate of 30 ml/hour in the number of 450-500 ml on the first day of the postoperative period, the introduction of which continue into the second day of the postoperative period at a rate of 30 ml/hour in the number of 450-500, in the third day with a speed of 45-60 ml/h in the amount of 700 to 750 ml, 4 and 5 days, with a speed of 80-90 ml/h in the amount of 950-1000 ml, 6 to 9 days with a speed of 125 to 150 ml/hour in the number of 1500-2000 ml on day 10 after surgery has removed the probe enteral nutrition and performed shippingby type of food in the process of which the patient took supportan drink or nutridrink in 200 ml 3-4 times a day until complete recovery trophological status.



 

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2 ex, 3 dwg, 2 tbl

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3 ex, 4 tbl

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1 ex, 1 tbl

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1 ex, 1 dwg

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Urine catheter // 2525221

FIELD: medicine.

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21 cl, 26 dwg

FIELD: medicine.

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14 cl, 9 tbl, 13 dwg

FIELD: instrumentation.

SUBSTANCE: invention relates to wireless monitoring of pH in oesophagus. Follow-up system incorporates internal transmitting hardware and external registration hardware. Note here that said internal transmitting hardware comprises pH-transducer, sampling circuit, first microprocessor, power supply, first module of wireless transceiver and first means. External registration hardware comprises second microprocessor, power supply, audio signal generator, memory, data interface, button switch, second module of wireless transceiver, light state indicator, housing and second means. Second means of external registration hardware can interact with the first means. If said interaction detects that internal registration hardware is no located at the preset body part then second microprocessor initiates audio signal generator and/it light state indicator. External registration hardware, in its turn, allows intermittent detection of the intensity of signal received by second module of wireless transceiver under control of second microprocessor. If signal intensity falls beyond preset range then second microprocessor actuates audio signal generator and/or light indicator for warning purposes. Method of positioning for wireless pH monitoring is realised with the help of follow-up system.

EFFECT: ruled out invalid measurements caused by unforeseen capsule departure.

8 cl, 7 dwg

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, in particular, to vascular and endovascular surgery. A device is made in the form of a hollow tube from nitinol. The tube has side holes and is made with a possibility of changing shape when introduced into an aneurysm and filling its entire internal space circumferentially with a possibility of connection by means of a separable hollow tube to a pressure sensor for measuring pressure between the vessel wall and the wall of the stent-graft implanted into the blood vessel, as well as with a possibility of supplying medications by means of the said separable hollow tube.

EFFECT: providing assessment of the state of the isolated space of the aneurysm sac between the vessel wall of the aneurysm and the wall of the stent-graft after its implantation.

1 dwg

FIELD: medicine.

SUBSTANCE: invention relates to devices and methods of determining a position of an object, placed in a living organism. A method of visualisation includes reception of an inlet signal, indicating correspondent visual coordinates of a multitude of points, located along the length of a probe inside a subject's body, and application of the model of the known mechanical properties of the probe to the visual coordinates in order to calculate an assessment function relative to shapes, which can be taken by the probe in the body. A shape is selected in accordance with the assessment function, with corrected coordinates of the points along the probe length being generated of the basis of the shape. After that, the probe image with application of the corrected coordinates is displayed. The device includes interface, receiving signals, pointing to the visual coordinates of the multitude of sensors, located along the probe inside the subject's body, and a processor, performing stages of the visualisation method.

EFFECT: application of the invention provides more accurate visualisation of the flexible probe in the subject's body.

22 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: at least 4 ultrasonography-controlled peripheral intravenous catheters are inserted along the vein. The upper one is arranged 1-1.5 cm from a saphenofemoral junction. Further, pairs of catheters are placed from bottom to top. A micro-foam form of a sclerosant in a dose specified by an original formula is introduced into the underlying catheter, and aspirated simultaneously with a syringe from a superjacent catheter until the foam is formed in the syringe. The underlying catheter is removed. Gauze swabs are fixed along the vein. The extremity segment is bandaged to the superjacent catheter with an elastic bandage. The procedure is successively performed for the following pairs of the catheters. Once the upper pair of the catheters is reached, the procedure of filling with foam is terminated by removing the catheters and elastic bandaging of the extremity above the catheter points.

EFFECT: method enables sclerosing the subcutaneous vein trunk completely with a minimum risk of complications.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to a method for making a flexible catheter having a central stand coupled with a catheter tip within a flexible section to form an integral composite structure of the tip which maximises an open internal volume of the catheter tip and a torsional rigidity of the catheter tip along with minimising an external diameter of the catheter tip and providing a uniform flexion of the tip in one plane. The method for making the distal tip for the flexible catheter involves the following stages: coating a cylindrical core having a diameter with the first layer of a thermoplastic material; covering the first layer of the thermoplastic material with a sheath layer; coating the sheath layer with the second layer of the thermoplastic material; removing the cylindrical core, and forming thereby a tubular member; placing a stand having a width substantially identical to the diameter of the cylindrical core, a length substantially greater than the width and a thickness substantially lesser than the width into the tubular member; providing semi-cylindrical cores from each side of the stand to form an intermediate assembly; and heating the intermediate assembly to create a thermal connection between the first layer and the stand.

EFFECT: method is simple and requires no valuable time.

11 cl, 14 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to endoscopic surgery, and may be used for endoscopic sanitation of bile ducts. A device for endoscopic sanitation of bile ducts comprises a catheter inserted into an endoscope for exudate (E) aspiration. The above catheter encloses a catheter for drug preparation (DP) delivery into a bile duct lumen. The catheters are connected to control handles. What is also provided is a cylinder used for DP delivery from a container into the bile duct lumen and coupled with a bracket arm regularly loaded for ensuring the DP pressure. There is also provided an aspiration cylinder coupled with a drive cylinder attached to a ruler with adjustable stops which impact a flatted valve lever and automatically switch the drug preparation delivery and aspiration. One flat connects pressurised water supply to the drive cylinder. The second one connects water drainage and releases the load on the DP cylinder and the ruler when the valve lever is in the other position. The drive cylinder, DP cylinder, E aspiration cylinder travel speeds are regulated by the valves. There are also provided valves for E delivery from the bile duct lumen and E delivery to the container.

EFFECT: invention provides automated endoscopic sanitation of the bile ducts by dispensing the drug preparations and exudate aspiration from the bile duct lumen; reduces the labour costs in treating patients with suppurative cholangitis by avoiding the medical personnel assistance of the sanitation procedure; controlled administration of the drug preparations enables avoiding a potential pressure increase in the biliary system followed by penetration of purulent bile elements into the circulatory bed (a biliovenous shunt) and as a consequence, developing common septic complications.

2 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine and concerns using a peptide conjugated with a protein representing a keyhole limpet hemocyanin (KLH) protein used as an immunogen for preparing antibodies specifically recognising any of prevailing versions of beta-amyloid peptide Aβ40 and Aβ42; or using an antibody, or an active fragment, or an antibody derivative of the above peptide in preparing a therapeutic agent for preventing and/or treating a disease characterised by amyloid accumulation in the patient's brain.

EFFECT: group of inventions provides effective immunisation, reduces an amyloid load and a quantity of brain amyloid plaques.

5 cl, 3 ex

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