Method for surgical management of dacryocystitis in adults with implanting lachrymal surgical drain tube
SUBSTANCE: lower lachrymal point is expanded. A probe is projected along a lower lachrymal duct all the way to the bone. A light guide is delivered through the expanded lower lachrymal duct all the way to the bone and fixed manually. A nasal cavity is visualised with an endoscope. Bone tissue of a lateral wall of the nasal cavity is burned through with endoscopically controlled laser light until the laser light appears in the nasal cavity. That implies using a diode laser at wave length 970 nm, emission power 6-7 Wt, in the continuous mode. An endoscopically controlled drain tube is inserted into the formed fistula through the nasal cavity by means of a plastic injector 10.01 mm long, 2 mm in diameter. The drain tube is 8.4 mm long. An external diameter of the cylindrical portion is 3 mm, whereas an internal diameter is 2 mm with the length of 6 mm. For the purpose of fixation in the lachrymal sac, an implanted end of the drain tube has deformable fletching elements 5 mm in diameter, 1 mm wide from each side, and 3.2-3.5 mm in flexion diameter. At the opposite side of the drain tube, there is a pad 5 mm in diameter fixed in the nasal cavity. Along the entire drain tube, there are grooves 0.25 mm wide, 8-8.1 mm long for additional outflow of the lachrymal fluid.
EFFECT: method enables preventing recurrent atresias of the formed fistulas between the lachrymal sac and nasal cavity by long-term postoperative drainage of the formed fistula.
The invention relates to medicine, in particular to ophthalmology and otorhinolaryngology, and can be used in transcanalicular endoscopic laser dacryocystorhinostomy in patients with chronic, acute, or recurrent purulent dacryocystitis.
Dacryocystitis in adults continues to be one of the urgent problems of modern medicine, often causing long-term disability and disability of the population, are 2-73,5% of the whole number of ophthalmological diseases. Existing treatments are not always possible to avoid recurrence of the disease, manifested in the form of scarring, Sardinia nasolacrimal fistula in the postoperative period.
The known method of treatment of dacryocystitis (classic external dacryocystorhinostomy) in which external access quickly formed a fistula between the lacrimal SAC and the nasal cavity. An incision of the skin and soft tissue up to 3 cm, which start at 2-3 mm above the internal ligaments of the eyelids and lead downwards, slightly rounding ninepenny edge. Overlap the retractors. Soft tissue stupidly stratified to visualize the internal ligaments of the eyelids. The periosteum is cut and useprivate outwards by 0.5-1 cm medial to the internal ligaments. With the help of a chisel and hammer formed bone �CCW value(1,5-2)×(1,2-1,5) see Within the bore longitudinally cut the inner wall of the lacrimal SAC and the nasal mucosa. The flaps of the wall of the SAC and nasal mucosa are sutured with catgut, forming the front and rear lips formed stoma. Skin and soft tissue sutured in layers [Chirkunov B. F. Diseases of the lacrimal organs, Samara, 2001, p. 219-220].
Among the disadvantages of this method it is possible to note the high trauma, longer duration of surgery, presence of skin scar, frequent complications (including fusion formed stoma).
The known method of treatment of dacryocystitis endonasal approach (internal dacryocystorhinostomy). In the nose, ahead of the middle shell, produce the cutting out and removal of the flap of mucous by the projection of the lacrimal fossa. Anteriorly from the resulting defect is formed U-shaped flap of nasal mucosa. A chisel or boron form the bone window. An incision of lacrimal SAC and remove its inner wall. U-shaped flap is returned into place. Operation complete front nose tamponade [Chirkunov B. F. Diseases of the lacrimal organs, Samara, 2001, p. 272].
The use of this method may be limited by physiological or pathological narrowness of the nasal passage, as well as the presence of pathology in the proximal parts of the lacrimal drainage system. It should be noted that when the endonasal approach deletelines�ü transactions may increase due to intraoperative bleeding.
The closest analogue of the invention is a method of treatment of dacryocystitis using the solid-state laser Nd YAG, which has two variants of application. In the first exercise the expansion of the lacrimal punctum, the passage of the probe through the lower lacrimal canaliculus until it stops in the bone, conduction through the advanced lower lacrimal canaliculus of the fiber laser to lock into the bone, the visualization of the nasal cavity by the endoscope, control of location of the optical fiber produced by diaphanoscopy raying through the bone. Burning bone of the lateral wall of the nasal cavity is performed using laser radiation with the formation of a fistula between the lacrimal SAC and the nasal cavity to visualize the fiber in your course. In this case the lateral wall of the nasal cavity burn Nd YAG solid-state laser with a wavelength of 1.44 μm, with a pulse energy 300-440 MJ, a pulse frequency of 10-20 Hz, pulse width of 50 to 150 microseconds. The exposure time of the bone is 0.4-4 min fistula Formed inkubiruut through the lower lacrimal point with the conclusion in the nasal cavity drainage of silicone in the form of a hollow tube. In the second rendering of the nasal cavity by the endoscope and the burning of the bone tissue of the lateral wall of the nasal cavity by laser radiation. While summing up the fiber of the optical fiber produced from the nasal cavity. Burning bone lateral� wall of the nasal cavity is carried out contact 3 mm anterior to the middle turbinate in the projection of the lacrimal fossa Nd YAG solid-state laser with a wavelength of 1.44 μm with pulse energy 300-350 MJ, the pulse frequency of 10-12 Hz, pulse width of 50 to 150 microseconds. The effects on bone of 0.4-1 min Then produce sharp by passing through the lower lacrimal canaliculus until the probe into the fistula formed. This is followed by intubation of the fistula formed through the lower lacrimal point with the conclusion in the nasal cavity drainage of silicone in the form of a hollow tube [patent RU 2254843, 2005].
Despite the efficiency of this method it should be noted that intubation fistula formed using a silicone drainage through the lower lacrimal point with his conclusion in the nasal cavity partially occlusive duct lower lacrimal canaliculus, which further requires the removal of silicone drainage. This can lead to scarring and subsequent heals wounds formed fistula in the postoperative period, thereby causing the risk of recurrent dacryocystitis.
The technical problem solved by the invention is the achievement of patency of the lacrimal drainage system when dacryocystitis diode laser radiation and prosthetics formed fistula (dicristina) using drainage for lacrimile surgery "DCRYSTAL", which prevents fusion, while maintaining the normal flow of tears through the lacrimal drainage.
The technical result of the invention is reduced�e duration and traumatic way prevention of recurrence of Sardinia formed fistula between the lacrimal SAC and the nasal cavity in the postoperative period due to the long-term or permanent drainage in the postoperative period formed fistula between the lacrimal SAC and the nasal cavity.
The proposed method of treatment of dacryocystitis is as follows. Carry out the expansion of the lacrimal punctum, the extended lower the lacrimal canaliculus hold the optical fiber diode laser until it stops in the bone of the manual and fix it. Visualize the nasal cavity by the endoscope with the optical tip 0 degree. Burn laser under endoscopic control bone tissue of the lateral wall of the nasal cavity before the advent of the fiber laser in the nasal cavity. The radiation parameters of the diode laser was wavelength of 970 nm, the radiation power of 6-7 watts, continuous operation. Formed dacryocystorhinostomy washed with 3% solution of collargol. In a fistula formed through the nasal cavity under endoscopic control using plastic injector length of 10-12 cm, with curved at a 45 degree tip length 10,01 mm, diameter 2 mm, enter the hollow silicone drainage for lacrimile surgery "DCRYSTAL" with a total length of 8.4 mm, having a cylindrical portion with an outer diameter of 3 mm, an inner diameter of 2 mm, lengths�th 6 mm. For fixation in the cavity of the lacrimal SAC implantable end of the drain is provided with deformable elements of the type "fletching arrows with a diameter of 5 mm, a width of 1 mm on each side, diameter at bending a 3.2-3.5 mm at the opposite end of drainage made Playground with a diameter of 5 mm for fixing in the nasal cavity and the drainage is placed in the grooves of a width of 0.25 mm, a length of 8-8,1 mm for an additional outflow of tear fluid.
This method allows you to achieve patency of the lacrimal drainage system through effective controlled burning bone tissue diode laser with the proposed characteristics. Unlike all existing methods, this technique allows you to use the approach via the lacrimal canaliculus and through the nasal cavity. Significantly reduced the duration and trauma intervention and, consequently, the probability of postoperative complications. The size of the fibers allows the radiation through a natural way. The absence or significant reduction of recurrence of the fistula heals wounds is achieved by the introduction of shaped silicone fistula drainage "DCRYSTAL" using the injector. Drainage is designed for long-term drainage decreaseby providing throughout the postoperative period slezootdelenia.
Proposed�according to the invention features provide long-term drainage of the formed decreaseby using the proposed drainage "DCRYSTAL", to prevent or significantly reduce the frequency of recurrence.
The invention is illustrated by the following clinical examples.
Example No. 1. Patient S., 63 years. The number of medical cards 60168. Appealed with complaints of constant tearing from both eyes for 2 years. From history we know that for the last 2 years twice operated on for chronic dacryocystitis, OD - transcanalicular endoscopic laser dacryocystorhinostomy in 2012;
OS - transcanalicular endoscopic laser dacryocystorhinostomy with temporary silicone intubation stent During the 2012 survey: lacrimal drainage on both sides are not passable. According to x-ray study of the lacrimal ducts at both sides of the detected mechanical obstruction at the level of the lacrimal SAC. The right lachrymal SAC the size of 10.0×3.0 mm, left - contrast in the lacrimal canaliculi, the darkening of the maxillary sinus.
Diagnosis: OU - Chronic recurrent dacryocystitis. Mild myopia.
Given the history and findings, the patient was recommended dacryocystorhinostomy with the formation of a fistula between the lacrimal SAC and the nasal stroke with the introduction of silicone drainage "DCRYSTAL" in his right eye.
The government is processing the surgical field with 70% ethyl sleep�that twice. Epibulbar Saipan solution Inakaya 0.4% of the produced block anesthesia the lacrimal SAC lidocaine 2% - 2,0, 10% spray lidocaine intranasally. During the operation, after the expansion of the lower lacrimal point and passing through the tube to the nasal cavity through the lower lacrimal canaliculus under manual (through the skin) and endoscopic (by the nose) control was introduced fiber light guide with a diameter of 0.6 mm to the bone. Laser radiation under the control of the endoscope from the nasal cavity formed an artificial fistula between the lacrimal SAC and the nasal cavity. The radiation parameters of the diode laser was wavelength of 970 nm, the radiation power of 6-7 watts, continuous operation. In a fistula formed through the nasal cavity under endoscopic control introduced silicone drainage "DCRYSTAL" with the injector. Held the lacrimal lavage solution Collegare 3%, the permeability through drainage "DCRYSTAL free. Installation into the conjunctival cavity of a solution of levomycetin 0.3% and in the nose a solution of 2% epinephrine. Duration of intervention 10-15 minutes.
Recommended following post-operative appointments: instilled into the right eye:
1) a solution of Levofloxacin 0.3 percent to 6 times a day 3-4 days, 4 times a day for 10 days;
2) a solution of Dexamethasone 0.4 per cent to 2 times a day - 1 week, 1 day -1 week;
3) Drops � nose: Polymyxin b+Neomycin+Dexamethasone 4 times a day - 2 weeks;
4) Irrigation of the lacrimal ducts within 5 days after the operation.
At discharge, 5 days after surgery to outpatient treatment lacrimal drainage right passable, on drainage outflow "DCRYSTAL" is carried out. At the control examination after 3 months right lacrimal drainage passable. Drainage "DCRYSTAL operates, its position unchanged.
Example No. 2. Patient X., 52 years old. Appealed with complaints of constant tearing from the left eye over a year. From history we know that over the past year, twice referred to the clinic by place of residence, where he was prescribed a course of conservative therapy, which did not lead to a positive result. On examination: left lacrimal drainage is not drivable. According to x-ray study of the lacrimal ducts on the left side revealed a mechanical obstruction at the level of the lacrimal SAC. From left lachrymal SAC dimensions 11×3 mm.
The diagnosis: OS - Chronic recurrent dacryocystitis. OD - Healthy.
Given the history and findings, the patient was recommended dacryocystorhinostomy with the formation of a fistula between the lacrimal SAC and the nasal stroke with the introduction of silicone drainage "DCRYSTAL" in his left eye.
Processing the surgical field with 70% ethanol twice. Epibulbar Saipan solution Inocian� 0,4%, produced block anesthesia the lacrimal SAC lidocaine 2% - 2,0, endonasal introduced a solution of lidocaine 2% was 2.0. During the operation, after the expansion of the lower lacrimal point and passing through the tube to the nasal cavity through the lower lacrimal canaliculus under manual (through the skin) and endoscopic (by the nose) control was introduced fiber light guide with a diameter of 0.6 mm to the bone. Laser radiation under the control of the endoscope from the nasal cavity formed an artificial fistula between the lacrimal SAC and the nasal cavity. The radiation parameters of the diode laser was wavelength of 970 nm, the radiation power of 6-7 watts, continuous operation. In a fistula formed through the nasal cavity under endoscopic control introduced silicone drainage "DCRYSTAL" with the injector. Held the lacrimal lavage with a solution of Collargol 3%, the permeability through drainage "DCRYSTAL free. Installation into the conjunctival cavity of a solution of chloramphenicol 0.3% and in the nose a solution of 2% epinephrine. Duration of intervention 10-15 minutes Recommended following post-operative appointments: instilled into the left eye:
1) a solution of Levofloxacin 0.3% 6 times a day 3-4 days, 4 times a day for 10 days;
2) a solution of Dexamethasone 0.4 per cent to 2 times a day - 1 week, 1 per day - 1 week).
3) nose Drops: Polymyxin b+Neomycin+Dexamethas�n 4 times a day for 2 weeks;
4) Irrigation of the lacrimal ducts within 5 days after the operation.
At discharge, 5 days after surgery to outpatient treatment lacrimal drainage passable left, outflow on the drainage "DCRYSTAL" is carried out. At the control examination after 3 month left lacrimal drainage passable. Drainage "DCRYSTAL operates, its position unchanged.
Method of surgical treatment of dacryocystitis, including the extension of the lower lacrimal point, the passage of the probe through the lower lacrimal canaliculus until it stops in the bone, conduction through the advanced lower lacrimal canaliculus of the fiber laser to lock into the bone, the visualization of the nasal cavity by the endoscope, burning laser under endoscopic control bone tissue of the lateral wall of the nasal cavity with the formation of a fistula between the lacrimal SAC and the nasal cavity before the advent of the fiber laser in the nasal cavity, the introduction of the formed fistula drainage of silicone in the form of a hollow tube, characterized in that the radiation used diode laser with a wavelength of 970 nm, radiation power 6-7 watts, continuous operation, and as the drainage through the nasal cavity using a plastic injector length of 10-12 cm, with curved at a 45 degree tip length 10,01 mm, diameter 2 mm, enter drainage total length of 8.4 mm, having a cylindrical part with naru�tion with a diameter of 3 mm, internal diameter 2 mm, length 6 mm, with fixation in the cavity of the lacrimal SAC implantable end of the drain is provided with deformable elements of the type "fletching arrows with a diameter of 5 mm, a width of 1 mm on each side, diameter at bending a 3.2-3.5 mm at the opposite end of drainage made Playground with a diameter of 5 mm for fixing in the nasal cavity and the drainage is placed in the grooves of a width of 0.25 mm, a length of 8-8,1 mm for additional of the lacrimal fluid outflow.
SUBSTANCE: ciliary body thickness of an operated eye is measured by ultrasonic biomicroscopy. Maximum permissible Emax and minimum sufficient Emin total energy of the laser exposure is determined by formula: wherein N is the ciliary body thickness of the operated eye. wherein N is the ciliary body thickness of the operated eye, N1=0.2574*N+0.2332.
EFFECT: managing pain syndrome, reducing a rate of severe complications of contact transscleral diode-laser cyclophotocoagulation, preventing excessive thinning of the ciliary body by a differentiated approach to selecting the laser energy parameters taking into account the ciliary body state.
SUBSTANCE: keratotopogram is made. Then the eye cornea is influenced by the irradiation of an excimer laser with a wave length of 193-222 nm, energy in an impulse of 0.8-21.1 mJ, diameter of a laser spot of 0.5-1.5 mm, pulse duration of 5-8 nsec, pulse repetition rate of 30-500 Hz. A regular surface in the optical zone and surfaces of the transition zone are formed by the successive layer-by-layer removal of the cornea parts. The regular surface of the optical zone (03) is formed in the form of a concave ellipsoid of rotation with a negative conical constant from minus 0.1 to minus 0.4. The optical axis of the ellipsoid is shifted in such a way, that the centre of the optical zone corresponds to the position of the centre of the section of the maximal irregularity on the keratotopogram. The diameter of the optical zone is selected according to the diameter of the section of the maximal irregularity, determined by a map of heights on the keraotopogram. After that surfaces of the transitional zone are formed. The first surface of the transitional zone (STZ), adjacent to the zone, which is not subjected to influence, is formed in the form of a part of a convex external surface (PCES) of a circular toroid. An external edge of the first STZ is connected to the section of the cornea, which is not subjected to influence. The width of STZ constitutes 0.04-0.2 of the influence zone (IZ) diameter. The second STZ is formed in the form of a part of a concave internal surface (PCIS) of a circular toroid, adjacent to the optical zone. The width of the second STZ is equal to the width of the first STZ. An internal edge of the second STZ is connected to the external edge of the optical surface, an external edge - with the internal edge of the first STZ.
EFFECT: reduction of the time for carrying out the operation and error in recentring due to carrying out the operation in one stage, reduction of irregularity of the cornea surface with the preservation of physiological conical constant of the cornea and improvement of the patients' visual functions, minimisation of the volume of ablated tissues.
3 ex, 14 dwg
SUBSTANCE: invention can be used for the intraoperative pupillary dilatation and iris stabilisation during phacoemulsification (PE) or laser extraction (LE) if it is impossible to ensured a drug-induced mydriasis. That is ensured by inserting a ring onto an anterior surface of the iris through a corneoscleral incision 2.2mm long and 2.0mm wide. An outer diameter of the ring makes 6-11 mm, while an inner diameter is 4-6 mm with a thickness of no more than 1 mm. The ring is provided with 4-6 equally spaced support elements on its inner surface perpendicular to the plane of the ring. Besides, the ring has 5-7 manipulation through holes equally spaced on a circle concentric to the ring. The number of the manipulation holes is one more than that of the support elements. Long axes of these holes are parallel to the support elements. One of the manipulation holes is 12-o'clock positioned. Through the manipulation holes, the support elements are delivered behind the iris successively by means of a rotation hook. The cataract is extracted, and an IOL is implanted. The 12-o'clock positioned rotation hook is removed from the anterior eye chamber through the manipulation hole. The incision is sealed with normal saline.
EFFECT: method reduces the risk of vitreous body prolapse, formation of posterior capsule ruptures, iris injury and prolapse by stabilising it with the ring inserted into the anterior eye chamber and the more sparing mechanic pupillary dilatation due to the support elements delivered behind the iris, as well as postoperative complications related to induced astigmatism that provides achieving highest possible visual functions.
SUBSTANCE: vitreosynechiatomy is carried out by means of focused radiation of yttrium-aluminium garnet laser with energy in pulse 1.5-8.0 mJ, quantity of pulses 20-100. Synechia is cut perpendicularly to direction of synechia tension in section of its minimal thickness and vascularisation. Then released from concretion cupolas of detached retina are moved from the central zone to periphery by means of shock wave of de-focused radiation of yttrium-aluminium laser with pulse energy 1.0-2.0 mJ.
EFFECT: transformation of closed form of funnel-shaped detachment of retina into open one, with obtaining the most optimal optical and functional results, prevention of development of hemophthalmia, subatrophy of eye ball, death of eye as organ within the range of extreme functional abilities of visual-nervous system.
FIELD: physics, optics.
SUBSTANCE: group of inventions relates to medicine. An ophthalmic surgical laser system includes a laser device for generating a laser beam, a first Z scanner for receiving the generated laser beam and for Z scanning the focal spot of the laser system on a first interval along the optical axis of the laser system, an XY scanner for receiving the laser beam emitted by the first Z scanner and for scanning the focal spot of the laser system in a direction substantially transverse to the optical axis of the laser system, and a second Z scanner for receiving the scanned laser beam from the XY scanner and for Z scanning the focal spot of the laser system on a second interval along the optical axis of the laser system.
EFFECT: group of inventions enables to minimise optical distortions of the laser beam.
10 cl, 12 tbl, 19 dwg
FIELD: physics, optics.
SUBSTANCE: group of inventions relates to medicine. A laser system for ophthalmic surgery includes a laser source to produce a surgical pulsed laser beam, an XY scanner for XY scanning the surgical pulsed laser beam across the Z axis, a Z scanner for XY scanning the surgical pulsed laser beam along the Z axis, an objective lens for focusing the XYZ scanned laser beam on a target region and a computing controller for using a computational process in order to control at least one of the Z scanner and the XY scanner.
EFFECT: eliminating optical distortion of a focused laser beam.
20 cl, 19 dwg, 13 tbl
SUBSTANCE: invention refers to medicine, namely to ophthalmic surgery, and can be used for bienergetic fragmentation of a nucleus of crystalline lens. That is ensured by forming a tunnel approach and a corneal paracentesis. Viscoelastic is introduced. That is followed by performing a capsulorrhexis. The nucleus of crystalline lens is disintegrated by the combined exposure to Nd-YAG laser energy at wave length 1.44 mcm and ultrasound. A cortical layer of the crystalline lens is first disintegrated on the limited site. That is followed by forming a recess and exposing the most solid nucleus structure to laser light with preserving the cortical layer at the given stage of the operation. That is combined with disintegrating and aspirating all lens structures by means of an ultrasonic tip.
EFFECT: method enables minimising eye tissue injuries by fragmenting the nucleus of the crystalline lens covered with the cortical layer, as well as reducing the laser exposure while disintegrating the most solid nuclei with creating the minimum-size tunnel approach and using the ultrasonic needle with a lower-size cuff.
2 cl, 3 ex
SUBSTANCE: group of inventions refers to medical equipment. A laser system for ophthalmic surgery involves a laser device for pulse laser beam generation and an XY scanner for generated pulse laser beam reception and scanning laser beam release; the XY scanner comprises an X scanner comprising two mirrors scanning in the direction X, and a Y scanner comprising two mirrors scanning in the direction Y. The XY scanner can modify an angle made by the emitting scanning laser beam substantially independently with an optical axis, and a position, wherein the emitting scanning laser light transects a following control cavity perpendicular to the optical axis.
EFFECT: structural improvement of the optical system.
18 cl, 12 ex, 19 dwg
SUBSTANCE: laser system for ophthalmic surgery comprises a laser light source for generating a pulsed laser beam; an XY scanner for receiving the pulsed laser beam and emitting an XY scanning beam, scanned in two dimensions transversal to Z; Z-scanner in a scanner body configured to receive the XY scanning beam and to emit the XYZ scanning beam covering Z additionally, a mirror reflecting the XYZ scanning beam received from the Z-scanner; and an enclosed objective lens for receiving the reflected the XYZ scanning beam and for targeting the received XYZ scanning beam, wherein the scanner body is separated from the objective lens body.
EFFECT: invention enables performing the surgical interventions on a crystalline lens.
6 cl, 12 tbl, 19 dwg
SUBSTANCE: ophthalmic laser system comprises a laser light source for generating a laser beam; an XY scanner for receiving the laser beam and emitting the XY scanning beam in two dimensions substantially transversal to an optical axis; and a multifunctional Z-scanner configured to receive the XY scanning beam and to emit the XYZ scanning beam with the scanner having a NA numerical aperture and a focal spot in the target region and aiming at modifying the NA numerical aperture, substantially independently from scanning a Z focal depth of the focal spot along the optical axis.
EFFECT: performing the surgical interventions on a crystalline lens.
36 cl, 19 dwg, 12 tbl
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to medicine, namely to implanted medical devices. A device for drug delivery includes an implanted intra-lumen framework, which has a luminal surface and abluminal surface; a multitude of through hollows in the intra-lumen framework, where each of the multiple through holes contains a composition, selected from the following groups. Compositions of a mTOR inhibitor and base structure, which has the configuration, which will make it possible for the mTOR inhibitor in the composition of the mTOR inhibitor to elute, mainly in the abluminal direction for seven (7) to one hundred and twenty (120) days, with the composition of the mTOR inhibitor containing a polymer in a combination with the mTOR inhibitor and the base structure containing a multitude of polymer layers with the absence of mTOR inhibitors; compositions of a phosphodiesterase III inhibitor and an upper covering structure, which has the configuration, making it possible for the phosphodiesterase III inhibitor in the composition of the phosphodiesterase III inhibitor to elute, mainly in the luminal direction for five (5) to sixty-one (61) day, with the composition of the phosphodiesterase III inhibitor containing the polymer in a combination with the phosphodiesterase III inhibitor, and the upper covering structure containing a multitude of polymer layers in the absence of the phosphodiesterase III inhibitor.
EFFECT: invention makes it possible to provide independent on each other rates of sirolimus and cistazol release, simultaneously providing the targeted delivery of each of the medications.
6 cl, 30 dwg, 7 tbl
SUBSTANCE: femoral artery is punctured on the right to place an introducer therein. The radial artery is punctured to connect a roller pump for arterial blood sampling. The subclavian or internal jugular vein is punctured to approach the coronary sinus to place a retro perfusion balloon. The retro perfusion balloon is inserted into a proximal segment of the great or middle cardiac vein. The balloon is inflated, and retro perfusion is performed at 20 ml/min accompanying the balloon angioplasty and/or stent implantation. The balloon is blown off after an antegrade blood flow is recovered.
EFFECT: method enables reducing a risk of intraoperative and postoperative complications, reducing a risk of haemorrhages, thromboses and ischemia of an extremity by puncturing the radial artery.
SUBSTANCE: invention refers to medical equipment and can be used for the replacement of involved natural human cardiac valves. A frame for a biological cardiac valve prosthesis comprises a tubular insert 2, which bears a flexible element 5 having flexible supports 6, each of which comprises two flexible beams 7. Each flexible beam 7 is provided with a loop-shaped element 16 positioned on heads 8 of the flexible beams 7 and coupling support stands 9 and bridges 13 mounted between two support stands 9 of the flexible element 5 from different flexible supports 6; each loop-shaped element 16 is provided with a seating surface 17 facing the vertical plane 11 passing through the central axis 12 of the frame; the support stands are mounted in relation to the above vertical plane 11; the seating surface 17 lies in a plane extending in parallel through the central axis of the frame with the support stands 9 being mounted symmetrically in relation to the vertical plane 11. The seating surfaces 17 of two flexible beams 7 from the same flexible support 6 are configured symmetrically in relation to the plane 11 passing through the central axis 12 of the frame.
EFFECT: increasing the reliability by reducing a rate of potential cusp cutting-through by fastening threads.
3 cl, 5 dwg
SUBSTANCE: invention refers to medical equipment, namely to an implant delivery system to a segment of a body cavity, particularly to an expandable implant (e.g. stent) delivery systems. The stent delivery system comprises an expandable stent, an elongated inner element, a holding element and a coating. The stent has proximal and distal ends and a first fixing structure. The elongated inner element specifies a long axis. The holding element is fastened to the elongated inner element and comprises a second fixing structure configured to interact to the first fixing structure of the stent. The holding element is configured to move longitudinally in relation to the elongated inner element. The coating is mounted on the elongated inner element and configured to be arranged in the travelling position, wherein the coating covers the stent, and in the placing position, wherein the stent is opened at least partially. According to the second implementation, the system comprises a deformable holding ring surrounding the elongated element. The deformable holding ring sets a coating diameter so that if the coating is found in the travelling position, the deformable holding ring is compressed by the coating so that an outer end of the deformable holding ring is pressed into a proximal end of the stent, and after the coating is shifted into the placing position, the above outer end of the deformable holding ring is released from the coating contact to enable moving and opening the proximal end of the stent and releasing the above stent. According to the third embodiment, the system comprises an elongated element having a stent attachment section comprising a compressible material. In the travelling position, the coating compresses the stent so that the stent cells are pressed into the compressible material and entraps it, and in the placing position, which enables releasing the stent from the coating and providing the stent travelling into an expanded configuration released from the compressible material. According to the fourth embodiment, the system comprises the elongated inner element, the expandable stent, the generally ring holder and the coating. The stent tightly adjoins the distal end of the elongated inner element. The holder is fastened to the inner element and has a size adequate for the detachable connection with the expandable stent and for the longitudinal travel along the elongated inner element. The coating is mounted on the elongated inner element and configured to travel from the travelling position, wherein the coating covers the stent, into the placing position, wherein the stent is opened at least partially.
EFFECT: invention enables holding the stent on a catheter, even if a major portion of the stent is opened by driving back the coating, and enables the re-closing of the stent even after the major portion of the stent is opened by driving back the coating that makes it possible to adjust the stent position after it is partially released.
23 cl, 16 dwg
SUBSTANCE: invention refers to medicine. There are described implanted devices with various versions of biologically active ingredient loading with the version selectable and applicable for creating a prolonged-release profile or a release profile having a low initial ejection of the biologically active ingredient from the implanted device.
EFFECT: there are described the implanted devices with various versions of biologically active ingredient loading.
11 cl, 2 dwg
SUBSTANCE: invention refers to medical equipment, namely to stents representing intraluminal prostheses implanted into body vessels, e.g. blood vessels, for supporting and keeping the vessels closed and for fixing and holding other prostheses in the vessels. The stent comprises a basic coiled stent component and a brace holding the coiled structure of the basic stent component. The basic stent component comprises a first rough side edge, a second rough side edge, a first end edge and a second end edge. The first side edge is connected to the second side edge. Each of the end edges is wavelike-contoured and comprises straight cylinders on long ends of the stent. According to the first embodiment of the basic stent component, the first end edge has irregularities, first and second edges, connected to the first side edge and inclined at an oblique angle thereto. According to the second embodiment of the basic stent component, the first side edge has irregularities connected to the first end edge having irregularities. The first end edge extends at an oblique angle towards the above first side edge. The first side and first end edges has a wavelike contour braced cross bars. At least one bar has a cell structure, while a width of the above braces is less than a width of at least one bar containing the cell structure. A method for providing the basic stent component according to the first and second embodiments consists in coiling the basic stent component along the long axis and closing the first end of the first end edge with the second edge of the first end edge for forming the straight cylinder in relation to the long axis of the stent.
EFFECT: stent has a good radial strength and a high degree of longitudinal flexibility, while a making process is simple and low-cost with no increase of manufacturing defects.
38 cl, 9 dwg
SUBSTANCE: percutaneous coronary intervention is performed and Zotarolimus-coated second-generation stents are implanted. They are implanted into the infarct-related coronary artery and into basilar epicardial arteries and their branches having stenosis ≥70%. Multivascular revascularisation is performed as either a single-stage operation for the purpose of a primary percutaneous coronary intervention procedure, or in two stages 4-12 days apart.
EFFECT: method enables improving the accessibility of myocardial revascularisation in the patients with a high risk of ST-segment elevation myocardial infarction with underlying multiple coronary bed lesion, improving the percutaneous coronary intervention outcome, reducing the risk of unfavourable immediate and remote cardiovascular events.
2 cl, 2 tbl, 3 ex
SUBSTANCE: group of inventions refers to balloon catheters either with a corrugated stent or without it, the surface of which is coated with at least one antirestenosis therapeutic agent and at least one transport promoting molecular dispersing agent, as well as to a method for making these medical devices.
EFFECT: balloon catheter coating effectively reduces the premature release of the agents from the surface of the balloon catheters and provides the agent delivery from the balloon surface to a vascular wall in the highest effective form.
14 cl, 2 tbl, 25 ex
SUBSTANCE: falloprosthesis consists of proximal, intermediate, central and distal portions. The proximal and distal portions are made of soft silicone rubber. The central portion is integrated together with the intermediate portion in the form of a polyethylene rod. The proximal portion has a cylindrical socket 10mm deep. The proximal portion is presented in the form of a conical rod. The distal portion is presented in the form of a round shank with a rounded apex and has the cylindrical socket 10mm deep. The central portion has multiple holes along its full length, which enables eliminating a longitudinal displacement of the falloprosthesis when in use. Ends of the central portion are provided with cylindrical projections. The central portion comprises a dished intermediate portion, a section of which is less than the distal and proximal portions. After all the components are selected, they are connected together with a human body neutral glue.
EFFECT: higher manufacturability and reliability by eliminating a cross section area decrease in joints and avoiding injuries.
SUBSTANCE: invention refers to medicine. A catheter comprises a first tube, a second tube and a third tube. The catheter additionally comprises a handle enclosing a lengthwise slotted body and a first linearly movable actuating element integrated into the slot, and a closing device. The closing device comprising an expandable frame. The frame is formed by a number of wires extending from a proximal end to its distal end, and at least partially enclosed by a sealing element. The first linearly movable actuating element protracts or retracts the closing device, first tube or second tube independently. The handle additionally comprises a second actuating element releasing the closing device after the closing device unfolds.
EFFECT: closing device is applicable for healing cardiac or vascular defect or tissue opening, such as an open foramen oval or a cardiac or cardiovascular bypass, etc and particularly represents an occlusion device.
22 cl, 16 dwg
FIELD: medicinal equipment, in particular, expandable intravascular stents.
SUBSTANCE: stent has flexible tubular body with longitudinal axis. Tubular body wall is defined by interconnected closed carcass members equipped with at least two parts adjoining to each other around circumference. Carcass members have sides made from material comprising elongated threads, said material being capable of transmitting compression forces in axial direction of threads, said force being continuously transmitted from one carcass member directly into subsequent carcass member in longitudinal direction. Sides of part in individual carcass member include at least two elongated converging first sides of said member. Stent may be expanded from radially compressed state into state, wherein it has greater diameter. In expanded state of stent, two converging interconnected second sides of part opposite to two first sides of part have interconnection point oriented longitudinally with respect to interconnection point of two converging first sides of part. First angle α arranged between first sides of part and oriented into said part is ranging between 20° and 120°, and second angle β between second sides of part and oriented into said part is ranging between 210° and 320°. Stent body is manufactured from pipe or piece of plate equipped with openings.
EFFECT: increased efficiency, provision for radial compression and expansion of stent without substantially changing the length of body, high uniform flexibility and compression strength.
15 cl, 6 dwg