Method for treatment of extensive peritonitis
SUBSTANCE: invention relates to medicine, particularly to abdominal surgery, and applied to treatment for extensive peritonitis. To do it during operative intervention the peritonitis source is eliminated, and abdominal cavity sanation is performed. Then 3% methylcellulose gel, preliminary saturated with 1200 mg/l sodium hypochlorite solution in proportion 3:1, is introduced.
EFFECT: preventing of parietal and visceral peritoneum mesothelium injury by microbial exo- and endotoxins, anti-microbial effect prolongation of sodium hypochlorite, and preventing inactivation of sodium hypochlorite by peritoneal toxic effluent.
The invention relates to medicine, namely to abdominal surgery, and can be used in the treatment of common forms of peritonitis.
There is a method of treatment of widespread peritonitis. namely, what is the median laparotomy, eliminating the source of peritonitis, peritoneal cavity washed with sodium hypochlorite solution at a concentration of 0.06 to 0.12% in the amount of up to 800-1200 ml is adequate drainage and closure of the abdominal cavity (Postyshev VK, N.M. Fedorovsky Indirect electrochemical detoxification in the complex treatment of purulent diseases in surgery /Surgery. - 1994. No. 4. - P.48-50).
The main disadvantages of this method are: 1) short-term antimicrobial activity of sodium hypochlorite, limited time sanation of abdominal cavity and rapid inactivation (10-20 minutes); 2) the damaging effect of sodium hypochlorite on mesotheli peritoneum causes adhesions, which can further lead to the development of adhesive intestinal obstruction and adhesive disease.
Object of the invention is the prolonged antimicrobial action of sodium hypochlorite and prevent the development of adhesions in the abdominal cavity during peritonitis.
This object is achieved in that during the execution of surgical intervention after the IP address is the source of peritonitis and sanitation of the abdominal cavity in it enter 3% methylcellulose gel. pre-saturated solution of sodium hypochlorite at a concentration of 1200 mg/l (0,12%) in the ratio 3:1. The solution in the hands of the surgeon is evenly distributed across the surface of the peritoneum.
Sodium hypochlorite is a universal antiseptic, which is produced by the electrolysis of 0.9% sodium chloride in the apparatus EDO-4.
Methylcellulose is a simple water-soluble cellulose ether and methyl alcohol. It is a white, slightly yellowish powder granulated or fibrous product is odorless and tasteless, soluble in cold water, benzyl alcohol, methylsalicylate, in mixtures of lower alcohols with water, hot glycols, glycerine, polyglycols and their ethers, insoluble in hot water. Aqueous solutions of methylcellulose stable at pH 2-12, storage racks and is not exposed to microorganisms. The gel based on methylcellulose pseudo-plastic, physiologically inert and has no toxicity.
Technology of production of sodium hypochlorite solution in the gel methylcellulose is the following. Take 8 mg of methylcellulose powder, pour 100 ml of purified water heated to 80-90°C. the Mixture is left to swell. After lowering the temperature of the mixture up to 18-20°add 100 ml of purified water having room temperature, mix thoroughly until smooth. P is obtained gel is filtered and bottled in bottles of 150 ml, sealed and sterilized at 120°C for 8 minutes and Then 150 ml of 3% methylcellulose gel add 50 ml of 0.12% of sodium hypochlorite solution. The concentration of sodium hypochlorite in the resulting solution is reduced to 0.03% and corresponds recommended for intracavitary applications.
When making prepared solution into the abdominal cavity ensures a constant and gradual release of the sodium hypochlorite within 24-48 hours and thus prolong its antimicrobial effect. In addition, the solution acts as a temporary artificial "barrier" between damaged serous surfaces, ensuring their efficient separation, reduces the adhesion of the surfaces of organs and tissues, contributes to the preservation of their mobility and prevents the formation of adhesions.
The method is as follows.
After performing a laparotomy with peritonitis, address underlying causes of the pathological process and sanation of abdominal cavity with antiseptic solutions in all of its divisions entered the prepared sodium hypochlorite solution in the gel, methyl cellulose, which is equally distributed over the entire surface of the peritoneum.
An example of the experimental run.
To study the effect of methylcellulose gel, saturated solution of sodium hypochlorite mixed with methylcellulose, on the course of RA is postroennogo peritonitis was used in two series of Wistar rats of 50 animals each. Peritonitis was simulated standard needle introduction into the abdominal cavity of 10% fecal suspension. After 24 hours under sterile conditions was performed laparotomy under ether anesthesia. In the first group (control) sanation of abdominal cavity was performed with sodium hypochlorite. In the second group after rehabilitation in the abdominal cavity was injected with sodium hypochlorite solution in methylcellulose gel. Surgical wounds were usuals tightly.
The animals were sacrificed experiment by overdose of ether anesthesia at 1, 4, 7, 10 and 14 days after surgery. Before the conclusion of the experiment was performed blood sampling for General analysis and counting of leukocyte index of intoxication. Opened the abdominal cavity. Estimated amount and nature of the effusion. The exudate was taken for bacteriological inoculation by counting the number of microorganisms in 1 ml of effusion. The severity of adhesions was evaluated visually (distribution of adhesions as a whole and for each type of adhesions separately, the deformation of the bodies, flatulence) and using the method of semantic differential (on a scale). Produced photographing of the object under study. The parietal peritoneum and abdominal organs were subjected to histological examination according to the standard technique involving the use of drugs in neutral formalin, fill in arafin and painting sections were hematoxylin-eosin and van gieson (picro-fuchsin). The data are processed statistically: calculated average values (arithmetic mean, mode, median), minimum and maximum value, standard deviation, reliability of results.
In the study of indicators of the General analysis of blood found that normalization of leukocytosis and leukocyte index of intoxication (LII) in the experimental group was already observed on the 4th day after surgery, while in the control - only 7-E. in Addition to 1 day post-operative period there was a statistically significant decrease LEAH 33.9% with the introduction of sodium hypochlorite solution in the gel methylcellulose (1,68±0,34 against 2,54±0,42 in control).
Bacteriological examination of the number of microorganisms in 1 ml of exudate from the abdominal cavity in the 2nd group on the 1st day after surgery was significantly decreased by 20.8%, and for 4 days by 43% compared with the control group (experimental group-1 day - 65 800±300 CFU/ml, 4-th day - 19650±2840 CFU/ml control 1-e day - 52100±3650 CFU/ml, 4 days - 11200±2350 CFU/ml).
The severity of adhesions, which was estimated by the method of semantic differential in scores in the control group was on the 10th day of 4.38±084; 14-th day - br4.61±1,06, in the experimental group 2,6±0,21 and 1.9±0,18 respectively (p<0,05). Thus, the formation of adhesions using R. the range of sodium hypochlorite in methylcellulose gel was reduced by more than 40%.
Histological examination reliably detected decrease as infiltrative inflammatory and proliferative processes. In the experimental group decreased infiltration due to both polymorphonuclear leukocytes, and at the expense of histiocytes and fibroblasts, decreased the number of threads of fibrin and immature connective tissue fibers in slices prepared from total abdominal cavity complexes and separate adhesions.
Postoperative mortality in the 1st group was 34%, in the second group 22%.
Example clinical implementation.
Patient S. 48 years, the case history No. 14844, was admitted to the Department of purulent surgical infection MUSES GB NSR gburski 10.11.06 with the clinic widespread peritonitis. After preoperative preparation of the operated urgently 11.11.06. Intraoperatively after midline laparotomy in abdominal cavity revealed about 1000 ml fibrinous-purulent effusion, marked adhesions. Loops of small intestine inflated, hypermonogenic will not peristaltic covered with fibrin. When the division of adhesions revealed multiple meritline abscesses. Further revision of the abdominal cavity of the source of peritonitis is not revealed. Intraoperative diagnosis of cryptogenic common fibrinous-purulent peritonitis, severe abdominal sepsis. Operation: laparotomy,intestinalis, the opening abscesses, abdominal resection of part of the small intestine and the large area of the packing, nasointestinal intubation of the small intestine, sanitation and drainage of the abdominal cavity, laparostomy. After sanation of abdominal cavity 8 l of 0.02% solution of furacin, it osushivaniya and drainage glove-pipe the drains of the four standard points (both podrebarac and both iliac regions) drains blocked. Into the abdominal cavity through laparotomic wound introduced 200 ml of the prepared solution of sodium hypochlorite in the gel, methyl cellulose, which are evenly distributed in the abdominal cavity. Superimposed laparostomy with zipper. Conduit drains above open in 3 hours. 13.11.06 and 15.11.06 ran landmark rehabilitation programmed relaparotomy, during which the abdominal cavity was injected with sodium hypochlorite solution in methylcellulose gel in a volume of 200 ml with the aforementioned method. The phenomenon of peritonitis were stopped. During rehabilitation relaparotomy noted rare easily separated by spikes. P/o period was uneventful. The patient was discharged in satisfactory condition, 8.12.06.
Thus, the survey results indicate a high anti-inflammatory and protivospaechnyj activity of sodium hypochlorite solution in methylcellulose gel. Advantages of the proposed method is the fast ease of use, effective relief of inflammation in the abdominal cavity and reliable prevention of adhesions with peritonitis. Therefore, the proposed method can improve the results of treatment of widespread peritonitis.
The method of treatment of widespread peritonitis, characterized in that during the execution of surgical intervention after elimination of the source of peritonitis and sanitation of the abdominal cavity in it enter the 3%methylcellulose gel, previously saturated solution of sodium hypochlorite at a concentration of 1200 mg/l in the ratio of 3:1.
FIELD: medicine; pharmacology.
SUBSTANCE: essence of the invention includes selection of the damaged organs from the dead nutrias from the local epidemical centre from which prepare suspension, perform bacterial inoculation in differenrial diagnostic mediums, separate pure cultures of originators of colibacillosis, salmonellosis and enterococcus infections, separately grow up cultures Escherichia coli. Salmonella typhimurium and Streptococcus, fecalis in a meat infusion agar with addition of 0.2% of a glucose with titer 4-5 billion microbic cells in 1 cm3, inactivate by entering of formalin to 0.4-0.6 % final concentration, condition at temperature 37°C within 72-96 hours, admix cultures in equal parities, then bring a solution of a aluminium hydroxide in amount of 20% to the volume, carefully admix, pack up and cork.
EFFECT: increase of an adjuvanticity of a vaccine.
FIELD: medicine; pharmacology.
SUBSTANCE: agent possessing wound-healthing, antiinflammatory, antibacterial, immunomodulating, anaesthetising and antitumoral activity on a basis of terpenoids, contains a capsule extract of plants of Pinaceae bloodline exposed to short-term stressful influence, enriched with monoterpenes, obtained from a capsule extract. The pharmaceutical composition possessing wound-healthing, antiinflammatory, antibacterial, immunomodulating, anaesthetising and antitumoral activity, contains the above described agent in effective quantity and the target additive. Application of the above described agent for preparation of a medicinal preparation for treatment of pyoinflammatory diseases.
EFFECT: increased wound-healthing; antiinflammatory; antibacterial; immunomodulating; anaesthetising and antitumoral activities.
8 cl, 1 dwg, 6 tbl, 8 ex
SUBSTANCE: agent contains Rifabutin sorbated in polymeric nanoparticles matrix, potassium cholesterylphosphate, or sodium glycocholate, or hexadecyl dihydrogen phosphate, or a-tocopheryl succinate, water-soluble polymeric stabiliser and bulking agents. Polymeric nanoparticles sized 100-800 nm include lactic acid polymer/polymers and/or lactic and glycolic acid copolymer/copolymers at glycolic acid content in specified copolymers up to 50 mole %. Molecular weight of specified polymers and copolymers is 5 to 300 kDa. Molecular weight of water-soluble polymeric stabiliser is no more than 70 kDa and is selected from the group including polyvinyl alcohol, polyvinylpyrrolidone, polysorbate and seralbumin.
EFFECT: new agent provides durable action of Rifabutin; higher bioavailability of Rifabutin and efficiency of bacterial infection treatment.
3 dwg, 1 tbl, 7 ex
FIELD: medicine; veterinary science.
SUBSTANCE: preparation consists of viral-bacterial polyvalent blood serum for diarrhea with antibody titre 1:300-1:600 and sodium hypochlorite solution concentrated 300-350 mg/l at ratio of serum: sodium hypochlorite 7:3. Additionally contains serum maral blood preparation in ratio 2:1, where 2 portions are serum maral blood preparation. Method implies that preparation is injected in dosage 4 ml preventively. Therapeutically preparation is injected intramuscularly in dose 4-5 ml per 10 kg 2 or 3 times every 48 or 48, 72 hours respectively.
EFFECT: medical product and application method allow for lowered consumption of hyperimmune serum while preserving high medical preventive efficiency.
4 cl, 4 tbl, 1 ex
FIELD: medicine; dermatovenerology.
SUBSTANCE: daily before each injection of benzylpenicillin sodium salt a patient gets intravenously within 15 minutes osmotic diuretic mannitol in the dosage 2 g/kg of patient's body weight. In 30 minutes after its completion they administer intravenously 12 million units of benzylpenicillin sodium salt, the course of treatment is 10 days. At this penetration of benzylpenicillin to the arachnoid cavity increases in the conditions of temporary osmotic burst of the hematoencephalic barrier by means of mannitol effect, also sanitation of the nervous system is provided.
EFFECT: method allows to increase efficiency of the specific therapy of advanced neurosyphilis; to minimise side effects; is easy in production and is widely available in hospitals.
4 tbl, 2 ex
SUBSTANCE: invention concerns topica of antimicrobic action for infected dermhelminthiasis and blennosis treatment. The declared antimicrobial agent contains compounding of fluoroquinolones group, metronidazole, 0.05-0.2% solution of chlorhexidine bigluconate and organosilicone glycerohydrigel with the composition Si(C3H7O3)4·xC3H8O3·yH2O, where 3≤x≤10, 20≤y≤40 as the basis. As antibacterial agent of fluoroquinolones group, it contains pefloxacine or ofloxacine or cyprofloxacine or norfloxacine or lomefloxacine or levofloxacine or moxifloxacine orsparfloxacine or enoxacine. The agent has broad spectrum of application, strong therapeutic impact and doesn't have frank side effects. The agent is characterised by strength, convinient storage and administration.
EFFECT: creation of effective antimicrobial agent.
2 cl, 11 ex, 1 tbl, 2 dwg
SUBSTANCE: invention was targeted at obtaining crystals of acetonitrile solvate of 6-fluor-1-methyl-7-[4-(5-methyl-2-oxo-1,3-dioxolene-4-yl)methyl-1-piperazinyl]-4-oxo-4H-[1,3]thiazeto[3,2-a]quinoline-3-carboxylic acid (compound B), which is an intermediate compound in obtaining crystals of 6-fluor-1-methyl-7-[4-(5-methyl-2-oxo-1,3-dioxolene-4-yl)methyl-1-piperazinyl]-4-oxo-4H-[1,3]thiazeto[3,2-a]quinoline-3-carboxylic acid of III type (compound A). Compound B crystals are mostly precipitated by regulation of super-saturation during crystallisation involving acetonitrile as a solvent. Then compound A crystals of III type are obtained crystal desolvation.
EFFECT: increased efficiency of compounds.
6 cl, 4 dwg, 4 tbl, 4 ex
SUBSTANCE: group of inventions concerns medicine and can be applied in treatment of bacterial infections caused by gram-positive bacteria. The methods involve administration of dalbavancin for treatment of bacterial infections, particularly of gram-positive bacterial infections of skin and soft tissues. Dosage schemes include administration of dalbavancin once a week, which would sustain therapeutic drug level in plasma for at least 1 week. The claimed pharmaceutical compositions include single dalbavancin dose sufficient for sustaining therapeutically effective level of dalbavancin in plasma.
EFFECT: prolonged therapeutic effect against gram-positive bacterial infection.
86 cl, 13 dwg, 17 tbl, 10 ex
FIELD: medicine; urology.
SUBSTANCE: method includes making a diagnosis, allocating originators from the primary and secondary centres of patient's infection, and, after definition , using cultural method, of their sensitivity to the most effective etiotropic preparation, injecting it to a patient. After taking the blood from the patient, separating it into plasma, suspension erythrocytes and phagocytes by means of consecutive rotation with the rate of 2100 rpm for 10 minutes, cooling them preliminary to the temperature of +5°C, the method further includes deleting toxic blood plasma and replacing, in peer quantity, with Ringer solution and, with the suspension of erythrocytes entered into this solution, driply parenterally injecting in a vascular bed of a patient. The suspension of phagocytes, after being irradiated with emission of helium-neon laser of λ=0.63 mcm for 10-15 minutes power to 15 MW, is saturated with a solution of etiotropic ofloxacin preparation in a dose of 400 mg and, being sustained for 30 minutes, the solution obtained is injected parenterally intravenously to a patient. Nifuratel is injected perorally to a patient in a dose of 400 mg. A course comprises 12 procedures daily.
EFFECT: raised efficiency of treatment; reduced terms of treatment and decreased by-effects.
SUBSTANCE: essence of the invention lies in a composition which, after introduction to an individual, is capable of inducing a humoral immune response at the given individual the humoral immune response performing bactericidal effect against two or three of supervirulent rows of generations A4, ET5 and a number of generations of the 3rd serogroup in N.meningitidis. of an external membrane. Five albuminous antigens are used, i.e. (1) protein "NadA"; (2) protein "741"; (3) protein "936"; (4) protein of "953" and (5) protein "287".
EFFECT: development of a vaccine against two or more rows of supervirulent meningococcus generations.
29 cl, 1 tbl
SUBSTANCE: method for preparation consists in solution in balanced saline with osmolarity of 306 m/osmol of water soluble cellulose derivatives hydroethylcellulose, glucasaminoglycan - sterile chondroitin sulphate. The balanced saline is brought to boil, after that chondroitin sulphate and hydroethylcellulose are added, then solution is mixed during 2 hours, induced for 24 hours, spilled to flacons and sterilised. Invention provides incease of reparative, protective, antiedemic and anti-inflammatory properties due to introduction of the components, actively governing cells proliferation and their metabolism, and solution preparation by way of conponents introduction with the definite succession, indicated methods.
EFFECT: incease of reparative, protective, antiedemic and anti-inflammatory properties of solution for keratoderma treatment.
2 cl, 1 tbl, 3 ex
FIELD: medicine, pharmacology.
SUBSTANCE: invention relates to pharmaceutical agents and applied to composition with local anesthetic activity, with the following formulation: 0.0125-0.05% dihydrochloride 1-(3-pyrrolidine propyl)-2-phenylimidazol[1,2-а]-benzimidazole, the rest amount is constituted by 1% Visiton-PEG.
EFFECT: composition increases and prolongs the local anesthetic activity.
FIELD: medicine; stomatology.
SUBSTANCE: composition for treatment of inflammatory process in paradontium contains metronidazole, dimexid, water, in addition, it contains silver ions received by electrolytic diffusion from silver electrode, gelling agent - sodium carboxymethyl cellulose, glycerin, methylene-blue stain, and all ingredients are taken in particular quantity.
EFFECT: composition reduces treatment period and has a bactericidal activity.
FIELD: medicine, surgery.
SUBSTANCE: immediately after operation one should intravenously inject serotonin adipinate at the dosage of 10 mg in 200 ml physiological solution for the period of 3 d. Operational wound should be covered with a filter cloth based upon dialdehyde cellulose that contains trypsin and mexidol being impregnated with 1%-serotonin adipinate solution. Above the filter cloth one should apply a layer of hydrogel based upon acryl compounds at 8 mg/sq. cm to carry out physiotherapeutic impact of impulse magnetic field at induction ranged 0.5-1.0 Tl through this filter cloth. The innovation provides the stimulation of reparative process, the reconstruction of the structure and the efficiency of soft tissues microcirculation and, thus, wound healing due to primary tension without applying antibiotics.
EFFECT: higher efficiency of prophylaxis.
FIELD: medicine, gynecology, chemical-pharmaceutical industry, pharmacy.
SUBSTANCE: invention relates to an anti-estrogenic and anti-proliferative agent used in treatment and prophylaxis of diseases of female reproductive system and represents a tablet covered with envelope and containing indole-3-carbonol and lactose, microcrystalline cellulose, butylhydroxyanisol, modified maize starch, magnesium or calcium stearate as accessory substances, and an enteric coating "AKRILIZ" as envelope. The tablet composition provides the enhanced therapeutic effect, high stability and bioavailability.
EFFECT: improved and valuable medicinal properties of agent.
6 dwg, 3 ex
FIELD: medicine, gynecology.
SUBSTANCE: the present innovation deals with the ways for applying the means of external application for preventing vaginal dysbacteriosis, in preparing the patients before gynecological manipulations. It is necessary to apply bacterial composition that normalizes vaginal microflora and contains lactose or lactulose and/or lactic or citric acid, a gel-forming agent, a moisturizing agent, a conservant and water at the following ratio of components, weight%: lactose or lactulose 25.00, not more; and/or lactic or citric acid 1.00, not more; a gel-forming agent 1.50, not more; a moisturizing agent 6.00-30.00, a conservant 0.30, not more; water - up to 100. The variant of vaginal composition can additionally contain: at least, one biologically active additive 0.01-2.00; an antiseptic component 0.50, not more. The innovation provides prophylaxis of vaginal dysbacteriosis due to normalizing the microflora of female reproductive organs; prolonged contact of this composition with mucosa additionally realizes regenerative, wound healing, protective, disinfective action; it, also, provides harmonization of intimate relations by removing unpleasant feelings during coitus due to the presence of moisturizing and lubricating action of the present composition.
EFFECT: higher efficiency of prophylaxis.
10 cl, 3 ex, 1 tbl
FIELD: chemical-pharmaceutical industry, pharmacy.
SUBSTANCE: invention relates to solid medicinal formulations covered by enterosoluble envelope. Enterosoluble envelope represents a polymeric derivative as conglomerate of hydroxypropylcellulose and acetatephthalatecellulose in the presence of wax and Tween. Envelope has 1-10 layers and its mass is 0.1-10% of the solid pharmaceutical composition mass in the definite ratio of component in envelope. Also, invention represents methods for coating a pharmaceutical composition by such enterosoluble envelope. Invention provides the required disintegration of envelope for capsules as a whole and expanding assortment of active components among medicinal agents useful for applying the claimed cover and with inclusion to this enumeration of thermolabile medicinal immunobiological preparations.
EFFECT: improved and valuable properties of envelope, improved coating method.
9 cl, 7 ex
FIELD: medicine, surgery.
SUBSTANCE: on the 1st d after operation a patient should be injected with mexidol intravenously by drops at the dosage of 300 mg, during the next 2 d mexidol should be injected intramuscularly twice daily at the dosage of 200 mg. Moreover, during 10 d after operation a patient should be perorally introduced with ADP-37 preparation a the dosage of 6 capsules daily and during 5 d one should affect the wound with impulse magnetic field at about 0.5-1.0 Tl intensity through Dalcex-trypsin filter cloth impregnated with 0.01%-serotonin solution, once daily. The innovation enables to accelerate the terms of wound healing up to 6-7 d and avoid therapy-induced complications.
EFFECT: higher efficiency of therapy.
FIELD: medicine, gastroenterology.
SUBSTANCE: additionally to general scheme of basic therapy it is necessary to apply FISHant-C preparation once weekly at the quantity of 200.0 g 60 min after light breakfast. Course duration corresponds to about 2-6 mo. Therapy should be carried out once annually. The innovation provides normalization of clinico-biochemical parameters without applying anti-viral therapy.
EFFECT: higher efficiency of therapy.
2 ex, 2 tbl
FIELD: medicine, surgery.
SUBSTANCE: the present innovation deals with treating osseous gunshot fractures due to fixing osseous fragments with the help of the apparatus of extrafocal osteosynthesis followed by their reposition and surgical treatment of the wound. After surgical treatment on the 1st d after operation a patient should be intravenously injected with mexidol by drops at the dosage of 300 mg once daily, and during the next 2 d - intramuscularly twice daily at the dosage of 200 mg, moreover during 10 d after surgical treatment a patient should be perorally introduced with ADP-37 at the dosage of 6 capsules daily and during 5 d it is necessary to affect the wound with impulse magnetic filed of 0.5-1.0 Tl intensity through Dalcex-trypsin filter cloth impregnated with 0.01%-serotonin solution in physiological solution once daily. The innovation enables to accelerate the terms for wounds healing, avoid complications due to complex pathogenetic approach during therapy conducted.
EFFECT: higher efficiency of therapy.
SUBSTANCE: invention concerns dentistry, particularly compositions for oral cavity hygiene improvement. The group of inventions includes composition for oral cavity care of increased stability and dental deposit fighting effect, as well as method for improving composition stability, and method for obtaining water composition for oral cavity care. The claimed composition includes carrier acceptable for oral cavity and containing a combination of ferment, cetylpyridinium chloride and reducing agent.
EFFECT: obtaining a composition with improved hygienic properties and dental deposit fighting effect.
37 cl, 2 ex, 11 tbl