Method for selective catheterisation and embolisation of umbilical arteries for treating patients with uterine fibroid or uterine bleeding

FIELD: medicine.

SUBSTANCE: endovascular embolisation of the uterine arteries are approached through a radial artery. Khair diagnostic catheter is inserted at the bifurcation of the abdominal aorta. Khair catheter tip is rotated to the right to provides sequential catheterisation of the right internal iliac and uterine arteries. That is followed by embolisation of the right uterine artery. Thereafter, Khair diagnostic catheter is pulled back up to the bifurcation of the abdominal aorta, and its tip is rotated to the left. That is followed by sequential catheterisation of the left internal iliac and uterine arteries. That is followed by embolisation of the left uterine artery. Khair diagnostic catheter and introducer are removed, and haemostasis is performed.

EFFECT: method enables reducing the length of the procedure, a radiation-absorbed dose and a rate of the following complications; it promotes early mobilisation of the patient after the procedure.

1 ex

 

The invention relates to medicine, namely to interventional cardiology, and is intended for the treatment of patients with uterine myoma or uterine bleeding.

Uterine fibroid is a benign tumor that develops from smooth muscle cells of the myometrium. According to statistics, the incidence of uterine fibroids is about 20-25% of all women. It most often it occurs in women of reproductive age (from 30 to 50 years), including planning to preserve reproductive function [Kjerulff, K. N., Langenberg P. W., Rhodes, J. S. et al. Effectiveness of hysterectomy. Obstet. Gynecol. 2000; 95: 319-326].

First uterine artery embolization was performed J. Oliver et al. in 1979 the patient with postpartum hemorrhage [Oliver J. A. Jr, Lance J. Selective embolization to control massive hemorrhage following pelvic surgery. Am. J. Obstet. Gynecol. 1979; 135: 431-432]. A c 1991 J. Ravina started using this technique in patients with uterine myoma. Since then, endovascular embolization of the uterine arteries has been widely developed and spread [J. H. Ravina, Herbreteau D., Ciraru-Vigneron N. et al. Arterial embolization to treat can myomata. Lancet. 1995 Sep 9; 346 (8976): 671-672]. It is based on the cessation of blood flow along the branches of the uterine artery supplying the fibroid. Thus there is a selective blockage of the arteries supplying the fibroids, while minimizing the impact on the unmodified vessels of the myometrium. This is due to the fact that the vessels, Kroos�ageusia uterine, several times more than the arteries of the myometrium. After the introduction of these vessels embolization particles of the blood supply to the fibroids is stopped and its replacement by connective tissue, which leads to a significant reduction in the size of fibroids and its clinical manifestations. As a material for embolization is currently the most commonly used particles of polyvinyl alcohol or acrylic gelatin microspheres [Spies J. V., Allison S., Flick, P. et al. Polyvinyl alcohol particles and tris-acryl gelatin microspheres for can artery embolization for leiomyomas: results of a randomized comparative study. J. Vase. Interv. Radiol. 2004; 15(8): 793-800].

Conducting uterine artery embolization shows patients in the presence of symptoms and exclusion of other possible causes of the disease. Contraindications to uterine artery embolization are: pregnancy, active or chronic infection, malignancy and an allergic reaction to iodine-containing drugs [A. Belenky, M. Cohen, G. Bachar Can arterial embolization for the management of leiomyomas. Isr. Med. Assoc. J. 2001; 3(10): 719-721; Simonetti G., Romanini C., Pocek, M. et al. Embolization of the artery can in the treatment of myoma can. Radiol. Med. (Torino). 2001; 101(3): 157-164].

The main result of uterine artery embolization is the disappearance of the symptoms that are observed in 80-90% of patients. In 6% of patients had a relapse requiring re-intervention. According to several ISS�of adavani in the remote period of observation of more than 98% of patients after uterine artery embolization does not need additional treatment for uterine fibroids [F. L. Hutchins, Worthington-Kirsch R., Berkowits R. P. Selective can artery embolization as primary treatment for symptomatic leiomyomata uteri. J. Am. Assoc. Gynecol. Laparosc. 1999; 6: 279-284; J. H. Ravina, A. aymard Jun, Ciraru-Vigneron N. et al. Arterial embolization can of myoma: results apropos of 286 cases. J. Gynecol. Obstet. Biol. Reprod. (Paris). 2000; 29(3): 272-275].

Standard procedure uterine artery embolization is performed via transfemoral vascular access and can be divided into several stages:

1. The provision of vascular access;

2. Selective catheterization and angiography of the contralateral internal iliac and uterine arteries. Embolization of the contralateral uterine artery;

3. Selective catheterization and angiography of the ipsilateral internal iliac and uterine arteries. Embolization of the ipsilateral uterine artery;

4. Remove Introducer and hemostasis [J. Golzarian, S. Sun, M. J. Sharafuddin Vascular Embolotherapy: A Comprehensive Approach, Volume 1: General Principles, Chest, Abdomen, and Great Vessels. Springer, 2006].

Currently, the most frequently used vascular access when performing uterine artery embolization is a puncture of the right common femoral artery. Typically, the vascular access allows you to perform selective catheterization of both uterine arteries. However, about 1.5% of the cases you cannot perform selective catheterization of one of the uterine arteries, and therefore it is necessary to resort to puncture of the contralateral femoral� artery [Worthington-Kirsch, R. L., Andrews R. T., G. P. Siskin et al. Can fibroid embolization: technical aspects. Tech. Vase. Interv. Radiol. 2002; 5: 17-34].

Bilateral puncture of the common femoral artery with subsequent simultaneous selective catheterization of both uterine arteries at the present time is rarely used. The main advantages of this approach are the lack of need for the catheterization of the ipsilateral uterine artery, as well as the possibility of simultaneous contrast of both uterine arteries, thus reducing radiation exposure to the patient. Among the drawbacks of this technique it should be noted increase twice the number of complications of the vascular access. In addition, bilateral setting of introducers and simultaneous use of the two intersecting in the distal aortic catheters increases the risk of thromboembolic complications and increases the cost of the intervention [V. Nikolic, Abbara S., Levy, E. et al. Influence of radiographic technique and equipment on absorbed ovarian dose associated with can artery embolization. J. Vase. Interv. Radiol. 2000; 11: 1173-1178; Worthington-Kirsch, R. L., Andrews R. T., G. P. Siskin et al. Can fibroid embolization: technical aspects. Tech. Vase. Interv. Radiol. 2002; 5: 17-34].

The second and third stages of uterine artery embolization is a consistent selective catheterization and embolization of the contralateral and ipsilateral uterine artery. Currently there are many methods catheters�tion of uterine arteries, the most commonly used ones are as follows:

1. The technique of selective catheterization of uterine arteries by catheter Cobra [J. Golzarian, S. Sun, M. J. Sharafuddin Vascular Embolotherapy: A Comprehensive Approach, Volume 1: General Principles, Chest, Abdomen, and Great Vessels. Springer, 2006.; Kandarpa K., J. E. Aruny Handbook of Interventional Radiologic Procedures. Lippincott Williams & Wilkins, 3rdedition, 2002].

The main disadvantages of this technique are: education of bending of the catheter in the formation of a loop of Waltman and poor handling of the catheter. All this leads to an increase in the duration of the procedure and the need for replacement of the catheter during the intervention.

2. The technique of selective catheterization of uterine arteries by catheter Roberts Can Curve [J. Golzarian, S. Sun, M. J. Sharafuddin Vascular Embolotherapy: A Comprehensive Approach, Volume 1: General Principles, Chest, Abdomen, and Great Vessels. Springer, 2006.; Interventional Radiology: A Survival Guide. Kessel d, Robertson I. Churchill Livingstone, 3rdedition, 2011].

The main disadvantage of this technique is the need for femoral access for catheterization of the uterine arteries, which leads to an increase in the duration of the procedure, radiation load on the patient and the frequency of complications of the vascular access.

3. The technique of selective catheterization of uterine arteries using microcatheter [J. Golzarian, S. Sun, M. J. Sharafuddin Vascular Embolotherapy: A Comprehensive Approach, Volume 1: General Principles, Chest, Abdomen, and Great Vessels. Springer, 2006; J. B. Spies Can artery embolization for fibroids: understanding the technical causes of faiure. J. Vase. Interv. Radiol. 2003; 14: 11-14].

The main disadvantages of this technique are the high cost of the microcatheter, and increases the duration of procedure in connection with the need for a stronger dilution of embolization of the drug to prevent its aggregation in the microcatheter.

The last stage of uterine artery embolization is to remove the Introducer, with subsequent manual compression of the puncture site for 20 minutes. After complete hemostasis at the puncture site is superimposed compression bandage for 24 hours.

The frequency of development of complications of the vascular access when using transfemoral access across studies ranges from 2% to 15%. The most common complication is a hematoma in the area of the puncture site. The incidence of hematomas with a diameter of 5-10 cm ranges from 2% to 5%. Other complications include: education pseudoaneurysm (0.7 to 5.3%) and arterio-venous fistula (0.1 to 0.4%), thrombosis or embolism of the femoral artery (0,2-0,4%) and infection of the puncture site (0.1 to 0.6%). The most severe complication when using the transfemoral access is retroperitoneal bleeding (0.2 to 6%), which in 4-12% of cases accompanied by the development of fatal outcome [V. Chandrasekar, S. Doucet, L. Bilodeau et al. Complications of cardiac catheterization in the current era: a single-center experiece. Catheter Cardiovasc. Interv. 2001; 52(3): 289-295]. Surgical treatment of complications of vascular access is necessary in 0.4% to 3.8% of cases [Sherev D. A., Shaw R. E., Brent N. B. Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention. Catheter Cardiovasc. Interv. 2005; 65(2): 196-202]. The use of devices for closure of arterial access according to some researches has allowed to reduce the frequency of development of complications of the vascular access by 42% [Piper W. D., Malenka D. J., Ryan, T. J. Jr et al. Predicting vascular complications in percutaneous coronary interventions. Am. Heart J. 2003; 145: 1022-1029; D. R. Tavris, Gallauresi B. A., B. Lin et al. Risk of local adverse events following cardiac catheterisation by hemostasis device use and gender. J. Invasive Cardiol. 2004; 16(9): 459-464].

The object of the invention is to reduce the duration of the procedure and facilitate catheterization of uterine arteries in the conduct of their endovascular embolization, reducing radiation exposure to the patient, early activation and increase the comfort of the patient after the procedure, reduce the cost and frequency of complications after the intervention.

The problem is solved in that in the method is carried out selective catheterization and embolization of uterine arteries for the treatment of patients with uterine myoma or uterine bleeding, which differ in that the access uterine artery embolization is performed through the radial artery by means of a diagnostic catheter Khair, the distal portion of which is bent at an angle of 45° and with�equipped atraumatic tip, put them on the level of the bifurcation of the abdominal aorta, while the tip of the catheter Khair rotating to the right side and perform sequential catheterization of the right internal iliac and uterine arteries, perform embolization of right uterine artery, after which, the diagnostic catheter Khair pulled to the level of the bifurcation of the abdominal aorta and its rotating tip to the left side, doing sequential catheterization of the left internal iliac and uterine arteries, then perform embolization of the left uterine artery, after which the diagnostic catheter Khair and Introducer sheath are removed, carry out hemostasis.

The use of transradial access can significantly reduce the frequency of complications of the vascular access. So, according to some randomized studies, the use of transradial access compared with transfemoral access leads to the reduction of over 75% in the incidence of bleeding and reduction of 63% in the frequency of complications of the vascular access [Jolly, S. S., Yusuf, S., J. Cairns et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011; 377(9775): 1409-1420]. The advantage of transradial access is maintained and in the case of devices for closure of arterial access. Frequency meet�ti hematoma after puncture of the radial artery is about 1-3%, while hematoma, leading to the development of a compartment syndrome, occur in less than 0.01%. Other complications include: education pseudoaneurysm (less than 0.1%), arteriovenous fistula (less than 0.1%) and infection of the puncture site (less than 0.1%) [Kanei Y., Kwan T., N. C. Nakra et al. Transradial cardiac catheterization: A review of access site complications. Catheter Cardiovasc. Interv. 2011; Agostoni p, Biondi-Zoccai G. G., de Benedictis M. L. et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J. Am. Coll. Cardiol. 2004; 44(2): 349-356]. The frequency of occurrence of thrombosis of the radial artery at the time of discharge from the hospital varies from 0.8% to 10% depending on instrumentation, techniques of vascular hemostasis and mode of anticoagulant therapy. Typically, thrombosis of the radial artery are asymptomatic. Surgical treatment of complications of transradial access is required in less than 0.1% of cases [Caputo, R. P., Tremmel, J. A., Rao S. et al. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc. Interv. 2011].

Endovascular embolization of uterine arteries carry out access via the radial artery. The intervention can be performed through right and through left radial artery. However, the use of the left radial artery is preferred. This is because the distance from the right radial artery to the orifices of the uterine arteries is greater than in is�olshanii left radial artery, which leads to an increase in the required length of the diagnostic catheter (average 7 to 10 cm) required for catheterization of the orifices of the uterine arteries. Furthermore, the use of left radial artery facilitates catheterization of the descending thoracic aorta and reduces the likelihood of possible thromboembolic complications associated with manipulation of the catheter in the region of the aortic arch and the mouths of the brachiocephalic trunk and left common carotid artery.

The recommended position of the patient during the puncture of the right radial artery is the same as when you puncture the femoral artery - the head of the patient is located at the head end of the operating table, the right hand is withdrawn from the body, the brush is flattened. When puncture of the left radial artery is the most appropriate next patient - the patient's legs are placed on the head end of the operating table, the left hand is reserved from the body, the flattened brush.

For the purpose of prevention of ischemia brush immediately before the intervention assess the pulsations of the radial and ulnar arteries, and perform the modified Allen test, assessing collateral blood flow on the brush. Absolute contraindications to the use of transradial access are: a negative Allen test, the presence of arteriovenous shunt for hemodialysis, syndrome �eyny and Buerger [Brzezinski by M., Luisetti, T., London, M. J. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth. Analg. 2009; 109(6): 1763-1781; Valentine, R. J., J. G. Modrall, G. P. Clagett Hand ischemia after radial artery cannulation. J. Am. Coll. Surg. 2005; 201(1): 18-22].

Puncture of the radial artery, perform a standard needle No. 18-22 G under local anesthesia lidocaine or novocaine. After the puncture needle having a wire diameter from 0.018 to 0.025 inches, which set Introducer diameter of 5 Fr. To prevent spasm and thrombosis of the radial artery sequentially administered 100-200 mcg nitroglycerin and heparin 5000 Units.

For selective catheterization of the orifices of the uterine arteries using a diagnostic catheter Khair, the distal portion of which is bent at an angle of 45° and is provided with an atraumatic tip, which is the standard diagnostic guide wire of 0.035 inch in diameter set at the level of the bifurcation of the abdominal aorta. The tip of the diagnostic catheter is rotating to the right side and consistently perform catheterization of the right common and internal iliac arteries, with subsequent angiography of the right internal iliac artery with the aim of determining the level of origin of the right uterine artery. Then advance the catheter to its mouth, perform selective catheterization and angiography. In case a satisfactory arrangement of the tip of the catheter to perform embolization of the right match�Oh artery, that is complete control angiography.

The next step the diagnostic catheter is pulled to the level of the bifurcation of the abdominal aorta. The tip of the diagnostic catheter is rotating to the left side and consistently perform catheterization of the left common and internal iliac arteries, with subsequent angiography of the left internal iliac artery with the aim of determining the level of separation of the left uterine artery. The further course of the procedure is similar to the embolization of the right uterine artery. After embolization of the left uterine artery diagnostic catheter is removed.

The removal of the Introducer is carried out immediately after removing the diagnostic catheter on the operating table. On the area of the puncture site applied compression pressure bandage for 6 hours. The duration of bed rest after the intervention is 1 hour, the patient is allowed to get up.

The method applied in the clinical setting in 15 patients with uterine myoma. The age of patients ranged from 25 to 48 years. In all cases underwent puncture of the left radial artery, and as a preparation for embolization were used embosphere. Uterine arteries were successfully catheterized and embolized 100% of patients. Duration of endovascular embolization of uterine arteries ranged in the interval�Les from 20 to 43 minutes (average 28 minutes) the time spent on catheterization of the right and left uterine arteries from the beginning of puncture of the left radial artery, averaged 5 minutes 25 seconds, and radiation exposure to 0.32 m3V. Duration of bed rest after the procedure was 1 hour, and compression compressive bandage was applied for 6 hours. Complications from the site of puncture of the left radial artery was identified.

An example of the practical use of the method is demonstrated on the patient.

Patient S., aged 46.

Diagnosis: Multiple uterine fibroids large size combined with the growth of nodes.

Was on treatment in the budgetary healthcare institution "CC BSMP №1" the city of Omsk in October 2013. At the time of admission had no complaints. Menstruation since the age of 14, was not installed immediately, for 5 days, in 28-29 days, moderate, painless, and regular. Pregnancies - 3, Rhoda - 1, abortion - 2, without complications. Uterine fibroids first diagnosed in 2009 in the period of 6 weeks.

According to a pelvic exam and ultrasound diagnosed four myoma node size from 2.6 to 7.4 cm (overall size of the uterus 12 weeks), one of which was located in the thickness of the myometrium, and the three had subserous location.

The treatment by the proposed method performed 10.10.2013. Transradial access left a puncture of the left radial artery and installed Fr Introducer. In the left radial artery through the Introducer introduced 100 µg of nitroglycerin and 5000 Units of heparin. Diagnostic catheter Khair standard diagnostic guidewire of 0.035 inch in diameter is installed at the level of the bifurcation of the abdominal aorta. The tip of the diagnostic catheter is rotated to the right side and made consistent catheterization of the right common and internal iliac arteries, with subsequent angiography of the right internal iliac artery with the aim of determining the level of origin of the right uterine artery. Further held catheterization and selective angiography of the right uterine artery. Performed embolization of the right uterine artery embosphere diameter of 700-900 microns. On the control angiogram of the blood flow in the right uterine artery was detected only in the proximal segment, intrauterine arterial network has been dramatically depleted.

The next stage of the diagnostic catheter Khair re-installed on the level of the bifurcation of the abdominal aorta. The tip of the diagnostic catheter is rotated to the left side and made consistent catheterization of the left common and internal iliac arteries, with subsequent angiography of the left internal iliac artery with the aim of determining the level of separation of the left uterine artery. Further held catheterization and selective angiography of the left �sharpening artery. Performed embolization of the left uterine artery embosphere diameter of 700-900 microns. On the control angiogram of the blood flow in left uterine artery was detected only in the proximal segment, intrauterine arterial network has been dramatically depleted. Next were sequentially removed diagnostic catheter and Introducer. On the area of the puncture site compression imposed compressive bandage.

Duration of endovascular embolization of uterine arteries was 32 minutes, the time spent on catheterization of the right and left uterine arteries, from the beginning of puncture of the left radial artery 6 minutes 35 seconds, and radiation exposure, 0.42 m3V. Duration of bed rest after the procedure was 1 hour. Compression the compression bandage is removed from the puncture site after 6 hours after surgery. Complications from the site of puncture of the left radial artery was not detected.

Next, we compared the obtained results with the data of the retrospective analysis of the results of patients in whom uterine artery embolization was performed according to standard methods. The control group consisted of 15 patients with myoma of the uterus, ranging in age from 24 to 52 years, which through the right transfemoral access was performed uterine artery embolization. In all cases the intervention was performed using the technique of selective �kateterizatsii uterine artery catheter Roberts Can Curve, as a preparation for embolization were used embosphere. Uterine arteries were successfully catheterized and embolized 100% of patients. Duration of endovascular embolization of uterine arteries varied in the range from 22 to 67 minutes (average 37 minutes), the time spent on catheterization of the right and left uterine arteries from the puncture of the right femoral artery, averaged 8 minutes 43 seconds, and radiation exposure - 0,51 m3V. Duration of bed rest after the procedure was 24 hours, compressive compressive bandage was applied also for 24 hours.

Thus, the use of transradial access has allowed, on average, be reduced by 24.3% of the length of the intervention, 37.8% of the time spent on catheterization of the right and left uterine arteries, and by 37.2% of the radial load on the patient. In addition, an analysis was conducted of the cost of consumable tools (Introducer sheath, diagnostic Explorer diagnostic catheters) required to perform the intervention of these methods, which showed that uterine artery embolization transradial access reduces the cost of the intervention at 8%, and in the case of devices for closure of femoral access 67.5%.

A method of selective catheterization and embolization of uterine arteries d�I treat patients with uterine myoma or uterine bleeding, characterized in that the access uterine artery embolization is performed through the radial artery by means of a diagnostic catheter Khair, the distal portion of which is bent at an angle of 45° and is provided with a traumatic tip, which is placed on the level of the bifurcation of the abdominal aorta, while the tip of the catheter Khair rotating to the right side and perform sequential catheterization of the right internal iliac and uterine arteries, perform embolization of right uterine artery, after which, the diagnostic catheter Khair pulled to the level of the bifurcation of the abdominal aorta and its rotating tip to the left side, doing sequential catheterization of the left internal iliac and uterine arteries, next, perform embolization of the left uterine artery, after which the diagnostic catheter Khair and Introducer sheath are removed, carry out hemostasis.



 

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16 cl, 9 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and can be used for surgical clipping of vessels and canals during a surgical operation. A surgical clip applier comprises a body with a release mechanism and a lengthening bar projecting from the body and comprising opposite clamps on its distal end. The clip applier can comprise a feed assembly arranged in the lengthening bar and used to feed one of a number of clips in the lengthening bar into the opposite clamps. A feed tray can be arranged in the lengthening bar and coupled to the feed assembly to prevent its displacement into the proximal position after displaced into the distal position to feed an extreme proximal clip into the opposite clamps. It can inform the user if the kit of clips into the surgical device for clipping is running low.

EFFECT: structural improvement.

9 cl, 29 dwg

FIELD: medicine.

SUBSTANCE: bronchus is separated from surrounding tissues. Bronchial forceps and a Kocher's clamp are applied. The bronchus is transected between two clamps. A 1 cm mucous membrane is stripped in the proximal direction from an intersection area. A bronchial cartilage is dissected in two points at 6-8 mm from a membranous portion in parallel thereto. The formed mucous tube is closed with an uninterrupted suture so that a needle passes through an outer layer of the mucous membrane. The suture direction is in parallel to a line of the membranous portion of a bronchial ring. After knotting, a mucous 'filling' is formed. A bronchial stump is pleurised. The bronchial stump is closed.

EFFECT: method provides preserving the blood supply, eliminating the tension and asepticity of the wound edges, adequate leak-tightness, reduces postoperative complications by forming the mucous filling and reliable fixation of the bronchial stump.

2 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to emergency medicine, and can be used with the need for temporary haemostasis from an injured extremity. The device represents an arresting bleeding tourniquet comprising a non-stretchable ribbon and a stretchable ribbon in the form of a rubber element connected with two steel rectangular rings from both sides. The stretchable ribbon is marked with image icons in the form of two rectangles and printed messages 'Hip', 'Shoulder'. When applying the tourniquet, the non-stretchable ribbon forms a double loop. Besides, the device comprises a screw stick, which has a notch in the middle and cone-shaped arrow-shaped ends.

EFFECT: invention makes it possible to apply the tourniquet with minimum physical efforts with more accurate dosage of required pressure on tissue, as well as to provide an unlimited possibility to reduce the tourniquet circle to be applied on the extremities of any circumference regardless of the presence of clothes, to avoid pinching the underlying tissues when applying the tourniquet.

5 dwg

FIELD: medicine.

SUBSTANCE: pulsatile haematoma is described by ultrasonic examination to assess the blood flow nature within its cavity. That is followed by aseptic local anaesthesia by infiltrating a region surrounding the postpunctional pulsatile haematoma and artery with local anaesthetic solutions. The method also involves further ultrasound-controlled puncture and blood aspiration from the postpunctional pulsatile haematoma with a syringe. That is combined with compression assisted by an ultrasonic sensor and covering a region above the arterial defect until observing the total absence of the blood flow in the aneurism cavity and a collapse of the postpunctional pulsatile haematoma. The compression length makes 10-20 min. A compression band is further applied for 5-12 hours.

EFFECT: method enables reducing the risk of complications and the length of treatment ensured by the integrated effect on the postpunctional pulsatile haematoma.

4 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: valve comprises a basic body, from one side of which there is a valve cap with a controlled clamping device for adjusting a flow area of the flexible pipeline, and a remote control drive unit is attached from the lower side for moving the clamping device, and there is also a valve control system. The valve base is represented by a spring-assisted three-port rocker and an actuator with controlled movement of the rod. The first port of the three-port rocker interacts with the flexible pipeline; the second port - with the actuator rod, and the third port - with photointerruptors of the control system.

EFFECT: applicability of the valve in separators and autoblood transfusion apparatuses with various characteristics and adjustability of the working characteristics of the valve itself.

7 cl, 4 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to devices applicable in surgery, traumatology and orthopaedics. The object in view is implemented with the use of a finger occlusion device in the Lukashevich-Oberst's anaesthesia. The device differs by the fact that it comprises a plastic pipe and a roller clamp of an intravenous infusion system; the plastic pipe is dissected away from both sides from the roller clamp so that its end of a lower length (7-10 cm) is kept from a flared end of a plastic body, while an end of a greater length (10-15 cm) is inserted back into the plastic body from its contracting end to form a loop of the plastic pipe, the diameter of which is adjusted by the traction of the plastic pipe ends; the pre-set position is fixed by the rotation of a roller occluding the plastic pipe and locking its position in the plastic body that provides the graduated finger occlusion by the plastic pipe loop, while the plastic pipe is unlocked by the back rotation of the roller that provides the distribution of the plastic pipe loop.

EFFECT: higher effectiveness and reduced length of treatment of the patients with finger and toe diseases and injuries.

FIELD: medicine.

SUBSTANCE: invention refers to medicine. An applicator for delivering surgical fasteners comprises a body, an elongated shaft, an ejective rod integrated into the elongated shaft and movable in the first plane between a retracted position and a projected position. The elongated shaft comprises a feed element movable in the second plane between the retracted position and the projected position, and an aligner used to align the surgical fasteners with a distal end of the ejective rod. The aligner is retained below the second plane by the feed element, when the feed element is found in the projected position. The aligner is configured to move into a position of at least partial alignment with the distal end of the ejective rod, when the feed element is found in the retracted position.

EFFECT: structural improvement.

27 cl, 29 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, particularly to devices for temporary haemostasis from an injured extremity. The arresting bleeding tourniquet comprises a tourniquet itself made of a flat band, and an applied tourniquet fixative. Two gapped parallel cords are provided for tightening the flat band and ensuring haemostasis within the flat non-elastic band. One end of the flat band is fixed on a locking clamp in the form of a rectangular frame, while the other end of the flat band is connected to a locking tongue which together with the clamp provides looping for the patient's extremity. The applied tourniquet fixative is arranged in the middle of the flap band and comprises a base, wherein there is a time indicator of the applied tourniquet and a coil with a lever mounted in the central hole. On the side surface of the fixative coil, on both sides of the lever there are radial axes with central slots and disk-like side guides. On both edges of the base, in front of the coil and behind it, there are radially directed slots. The flat band cords successively pass through the slot in front of the coil, in the slot of the radial axis of the coil and in the slot behind the coil respectively. The cord ends are fixed in the flat band cavity.

EFFECT: invention enables providing higher comfort and reducing the time of the tourniquet application on the injured extremity; makes it possible to perform the operation fast and with one hand with minimum physical effort; provides the haemostasis from the upper and lower extremities of the compressed tissues; the presence of the time indicator of the tourniquet application enables controlling the patient's injured extremity state, eliminating a possibility of the long-term (more than 2 hours) nerve compression followed by paralyses, as well as preventing tissue necrosis.

5 cl, 3 dwg

FIELD: medicine.

SUBSTANCE: rigidly guided 2-3-section hydraulic and pneumatic tampon with a closure valve is inserted into the nasal cavity. A coolant flow circulation is provided with using an outflow of a hydraulic section of the tampon. The coolant pressure and temperature are adjusted by varying the coolant supply pressure and temperature, and outflow from the hydraulic section of the tampon. A device for treating nasal haemorrhages involves the 2-3-section guided hydraulic and pneumatic tampon with individual canals for inflation of each section. The device for treating nasal haemorrhages comprises a device for intra-arterial blood transfusion connected to the hydraulic section of the tampon, the outflow from the hydraulic section of the tampon, and a device for outflow control from the hydraulic section of the tampon. The group of inventions provides higher clinical effectiveness in treating nasal haemorrhages as a result of a reflex vessel constriction and mechanical pressure by long-term local controlled hypothermia within the haemorrhage.

EFFECT: local hyperthermia enables reducing the pressure level desired to stop a haemorrhage, and reducing reactive changes of the mucosa following tamponade.

2 cl, 3 dwg, 3 ex

Cardiac occluder // 2514532

FIELD: medicine.

SUBSTANCE: invention relates to medicine, and can be used for occlusion of opening in heart tissue with self-centring mechanism. Device includes two separate wires of definite shape, each of which being mirror reflection of respective other wire. Each wire forms semi-discs or quarters of disc, which together form distal and proximal discs. In other versions device includes four separate wires, each of which is a mirror reflection of adjacent wire and forms proximal and distal quarters of disc. In versions with four wires quarters of disc of each wire together form proximal and distal discs. Distal disc and proximal disc are separated with self-centring interception. Proximal disc is attached to bushing, which includes screw mechanism. Such bushing is not obligatory on distal disc. Discs additionally include overlay, forming seal for closing opening in tissue.

EFFECT: wires, which form discs, possess shape-memory ability, so that they can be compressed and deformed in catheter during delivery, but take and preserve given shape after delivery.

21 cl, 15 dwg

FIELD: medical engineering.

SUBSTANCE: device has elongated body having operation end engageable with ligature loop, lateral slit for ligature to exit and movable rod, mounted in the device body, having operation end for holding the ligature. The elongated body has special purpose design to match endosurgical port or trocar lumen. The rod is spring-loaded and has nonworking end projecting from the device body as handle. The rod operation end is hook arranged in front of the lateral slit for ligature to exit and making displacement at a distance minimum equal to distance from operation body end to end face of slit for ligature to exit, oriented towards the handle.

EFFECT: improved tissue and organ engagement conditions; simplified maintenance procedure; accelerated operation process.

3 cl, 2 dwg

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