Method of endoscopic arrest and prevention of ulcerous bleedings from duodenum defects
SUBSTANCE: endoscopic installation of a covered metal self-extending stent is performed into a lumen of the duodenum with a source of bleeding or an ulcerous wall defect. Applied is the stent with a diameter of an opening of not less than 22 mm. In order to perform installation the delivery device of the stent is passed behind the area of bleeding. After that the stent is placed in such a way that its funnel-shaped extended edges tightly rest against walls of the duodenum, creating a closed cavity between the proximal and distal edges of the stent.
EFFECT: method makes it possible to ensure reliable haemostasis, effective sealing of the area of the tubular organ wall defect and prevent its contact with physiological liquids due to which ensure the prevention of development of complications, accompanying the main disease.
2 cl, 1 ex, 2 dwg
The endoscopic method for stopping and prevention of ulcer bleeding from defects in the wall of the duodenum 12.
The invention relates to medicine and can be used when you stop and prevention of recurrence of ulcer bleeding, localized in the 12-duodenum.
Despite the rapid development of medical technologies of bleeding gastro-intestinal tract (GIT) still pose a significant threat to patient's life and often involve a fatality.
A modern approach [1, 3, 4, 5] involves primarily the use of minimally invasive endoscopic methods of diagnostics and treatment of peptic ulcer bleeding. Existing endoscopic methods of physical, chemical, combined hemostasis in most cases allow you to achieve hemostasis and prevent bleeding recurrence.
In practice, however, known techniques are often or unable to effectively seal the defect region while maintaining miniinvasive impact or do not allow to solve the problem of bleeding. For example, when a jet of arterial bleeding endoscopic methods are ineffective due to the inability of a clear localization of the bleeding source, developed coagulopathy, lack of time for carrying out hemostasis[2, 3, 4, 5]. In t�such cases, endoscopic allowance is reduced to the findings of fact of the continued bleeding, while the patient is in a state of hemorrhagic shock is subjected to additional trauma during a forced surgery.
As the sealing device in literary sources mention the possibility of using covered self-expanding metal stents for the separation of the gaps in esophageal-tracheobronchial fistula, for the restoration of the lumen and maintain the patency of the tubular bodies in benign or malignant strictures.
As an analogue of the selected method of application sinus catheter Yamik-3  to stop the bleeding.
The principle of operation of the catheter is the presence of two latex cuffs at the proximal and distal end, the simultaneous inflation which allows you to create a closed cavity in the nasal cavity, limiting the amount of bleeding and contributing to its stop. In addition, balloon inflation, by itself, allows you to compress the bleeding vessel.
Achievable technical result is to ensure effective sealing area of the defect wall 12 duodenal ulcer in the conditions of a minimally invasive exposure. In addition, the resulting isolation of the defect area to prevent contact with body fluids (e.g., gastric juice), which ensures the prevention of the development related about�major disease complications.
The achievement of these results are based on the following.
12 duodenal same gut body malaclemys and tightly fixed to the surrounding tissues. Physiological limits of the bulb 12 duodenal ulcer presents two distinct entities - the pyloric muscle ring, ensuring a constant tone with the proximal side, and is rigidly fixed, there is little tensile region Bulbo-duodenal transition from the distal side. These two obturator portion at the inlet and outlet 12 duodenal ulcer, on the one hand, limited the use of conventional stents to create a complete compression on the bleeding area, and on the other, these anatomical features create conditions for effective tamponade in case of use of the procedures developed by us. According to our method the stent with a specially enlarged funnel-shaped edges is set so that these edges, tightly braced against the wall of the body with distal and proximal sides, creating a closed cavity and provide, on the one hand, the emergence of hematophagy and provide direct compression on the wall.
The use of the developed technique allows almost blindly, in the face of ongoing bleeding, work in this area, because there is clearly an ongoing�tonicheskie benchmarks (the gatekeeper).
In addition, after stent placement, it is possible to easily and safely clean the stomach from the blood and fully inspect both the stomach and the distal part 12-p of the colon.
Installation of a covered stent immediately terminate access to the aggressive ulceration of the gastric contents and thus effectively contributes to its healing.
Mounted stent allows you to monitor the effectiveness of the bleeding and, if necessary, is available to change the position of the stent.
The application of the method allows to reduce the duration of endoscopic intervention to stop the bleeding and, thus, significantly reduce the total volume of blood loss.
Afforded by the claimed method of rapid hemostasis allows you to stabilize the patient and to fully prepare him for a possible subsequent elective surgery.
This result is achieved through endoscopic installation of covered self-expanding metal prosthesis (stent) into the lumen of duodenum 12. The stent is positioned so that its funnel-shaped extended edges tightly abuts the wall of the intestine, creating a closed cavity between the proximal and distal edge of the stent. Thus the source of bleeding is localizo�EN in a closed cavity of small volume between the edges of the stent (not more than 20-50 cm 2). With continued bleeding, the blood from the cavity is not evacuated, accumulate, leading to tamponade the bleeding vessel, activation of factors of local hemostasis and eventually stop the bleeding.
Stent are possible, including, as preventive measures at high risk of rebleeding and difficult to apply standard methods of prevention of rebleeding is when a large callous ulcers, ulcers on the background of scar deformity, severe General condition of the patient.
The method is as follows.
When clinical signs of bleeding perform pre-inspection of the proposed site of bleeding a flexible endoscope with a wide instrumental channel diameter required for holding the carrier device must be at least 3.4 mm). When viewed from trying to determine the localization of the source of ongoing bleeding (pulsating stream, or the flow of bright blood
blood) or the localization of the ulcer with a high risk of rebleeding.
If it is impossible for a standard endoscopic tool or inefficiency of the decision on the placement of the stent in the area of bleeding or ulcer.
For the area of bleeding through Instrumentalnaya a flexible endoscope is a flexible string-the conductor (for example, string METH-35-480 firm Willson-Cook, Ireland). Through the inner sleeve (Fig. 1 item 4) on the wire conductor over the area of bleeding is held delivery device.
The safe holding of the device contributes to a distal soft protective cap (Fig. 1, item 6). External braiding (Fig. 1, item 3) delivery device is unlocked using the lock outer braid (Fig. 1, item 5) located on the handle (Fig. 1, position 1) and is shifted in the proximal direction so that the stent (Fig. 1, position 2) is straightened and fixed in the lumen of the intestine, capturing an area of the bleeding vessel and forming a closed cavity.
Given that the diameter of the lumen of the stent in the expanded state is at least 22 mm, immediately after the installation creates the possibility of holding the endoscope in the distal direction over the region of the stent. This allows you to inspect the distal and proximal edge of the stent, to assess the fit of the edges of the stent to the walls of the hollow body and to eliminate the dripping of the blood from under the edges of the stent.
If necessary, reposition the stent through the proximal and distal repositioning loops ("lasso") (Fig. 2, position 7, 8).
When properly installed, the stent blood flow in the body stops. After washing the blood and clots from the lumen of the tubular body, a sub�usual re-examination, and in the absence of bleeding blood the study is terminated.
Control study with the examination zone of the stent are scheduled once a day for three days from the moment of bleeding or emergency at the clinic of rebleeding.
The stent is left in the lumen of the body for the period up to 4 weeks to fully stabilize the patient's condition and scarring of the alleged defect. Next, the stent is removed by means of an endoscope. The area previously covered by the stent, re-inspected.
Patient S., aged 77, was hospitalized to the surgical Department after 7 days from the onset of the disease with a diagnosis of Exacerbation of calculous cholecystitis. The exacerbation of chronic pancreatitis. Biliary hypertension.
Admission: complaints of pain in the right upper abdomen, zoster character, dry mouth, nausea. Deterioration after errors in diet. Independently took pamprin, Pentalgin, Nurofen without effect. In response to continuing abdominal pain caused SMP. When inspecting the condition of average weight. Consciousness is clear. Blood pressure 150/90 mmHg. article Abdomen symmetrical, swollen, palpation soft, painful in the right hypochondrium, symptoms of peritoneal irritation no, gases depart.
Ultrasound: diffuse changes of a parenchyma of a liver, pancreas, GI�ARTESIA of the common bile duct - 14 mm in diameter.
Patients underwent infusion-inflammatory therapy with positive dynamics - abdominal pain decreased.
The morning 15.03.14 G. at 8.30 the patient's condition deteriorated. Complaints of pain in the chest, weakness, malaise. Blood pressure 90/60 mmHg. the article Examined the duty therapist, cardioreanimation. With suspected acute coronary syndrome, the patient was transferred to the NICU. The Department conducted a comprehensive conservative therapy. A troponin test is positive. Was diagnosed with acute myocardial infarction. Complications: unstable supraventricular arrhythmia.
19.03.14 G. at 09:50, the patient's condition deteriorated: profuse vomiting red blood, the condition is very serious, pale skin, heart sounds are weakened, heart rate 100 beats per min, BP 60/40 mmHg, art - clinic gastrointestinal bleeding.
Emergency endoscopy cavity of the bulb 12 duodenal ulcer is a fresh blood clot, clot is observed jet flow of red blood, to carefully examine the source of bleeding is not possible, attempts at injecting the hemostatic blind unsuccessful. For the purpose of stopping bleeding into the lumen of the bulb 12 duodenal ulcer delivered pyloro-covered duodenal self-expanding metal stent (Hanarostent, M. I. Tech South Korea). Achieved hemostasis.
The patient for further treatment was transferred to the UAR, which was continued intensive conservative therapy. When the control endoscopy 20.03.14 G. signs of recurrence of bleeding was not detected. When you try inspecting the lower horizontal branch of the duodenum 12 developed dislocation of the stent. Exposing the wall of the bulb 12 duodenal ulcer, presents a giant ulcer defect, occupying up to half the circumference of the duodenum, in the center of the defect pigment stain to 2-3 mm in diameter (the risk of rebleeding Forrest 2C). For the prevention of rebleeding produced repositioning of the stent to the area of the ulcer. On the background of conservative treatment gradual stabilization of the condition.
Control endoscopy was performed 21.03, 23.03 25.03 and, signs of recurrence of bleeding is not noted. 27.03 when the control endoscopy stent removed. Examined ulcerative defect decreased to 2 cm in diameter, the bottom of the defect covered with a grayish bloom (risk of rebleeding 3 Forrest).
For further treatment, the patient was transferred to cardiology Department.
1. The order of April 13, 2011 No. 320 on common tactics of diagnosis and treatment of acute surgical diseases of abdominal organs in health care institutions health Department of the city of Moscow.
2. Gastrodia�analnye bleeding ulcer etiology 2008, Gostishchev V. K., Evseev M. A., GEOTAR-media ISBN: 978-5-9704-0923-7, p. 384
3. Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding, Clinical Guidelines Alan Barkun, MD, PhD and John K. Marshall, MSc MDm, for the Nonvariceal Upper GI Bleeding Consensus Conference Group, Ann Inter Med. 2003:139-843-857.
4. Management of acute upper and lower gastrointestinal bleeding. A national clinical guidelines, Scottish Intercollegiate Guidelines Network, Sep. 2008 - Guidelines for Prevention of NSAID-Related Ulcer Complications, Frank L. Lanza, MD, FAGG, Francis K L Chan, MD, FRCP, FAGG, Eamonn M. M. Quigley, MD, FAGG and the Practice parameters Committee of American College of Gastroenterology, The American Journal of Gastroenterology, V/ 104, March 2009.
5. International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding, Alan N Barkun, MD, MSc (Clinical Epidemiology): Marc Bardou, MD, PhD: Ernst J. Kuipers, MD; Joseph Sung, MD; Richard H. Hunt, MD; Myriam Martel, BSc; and Paul Sinclair, MSc, for the Nonvariceal Upper GI Bleeding Consensus Conference Group, Arm Inter Med. 2010: 152-101-113.
6. Diagnosis and treatment of sinusitis by YAMIK sinus catheters. Kozlov VS, Markov GI. Rhinology. 1996 Jun; 34(2): 123-4.
1. The endoscopic method for stopping and prevention of ulcer bleeding from defects in the wall of the duodenum 12, including endoscopic installation in the lumen of duodenum 12 with a source of bleeding or ulcerative defect of a wall covered self-expanding metal stent, and using a stent with a diameter of disclosure not less than 22 mm, the delivery device of the stent is carried out for the area of bleeding and the stent is mounted so that its funnel-shaped extended edges tightly against the wall 12 duodenal ulcer, creating a closed�Yu cavity between the proximal and distal edges of the stent.
2. A method according to claim 1, wherein, after the establishment of the stent, conduct a field examination of bleeding or defect and, if necessary, perform reposition the stent.
SUBSTANCE: group of inventions relates to medical devices, containing highly-strong alloy, eventually subjected to degradation in human or animal organism, at adjustable degradation rate, without formation of emboli. Described is device for bone fixation, such as fixer, screw, plate, support or rod, made from alloy, as well as device for tissue fixation, such as staple, made from alloy. Dental implant or stent, made from alloy, is described.
EFFECT: alloy-containing devices possess required steel-associated properties, being simultaneously biodegradable.
22 cl, 8 ex
SUBSTANCE: invention relates to medical equipment, namely to suppository devices, applied against urine incontinence in women. A non-expandable intra-vaginal suppository device is made with a possibility to produce alternating pressure on the woman's urethra along its length, when introduced into the woman's vagina. The device has a top, a base and a lateral wall, extending between the top and base. The lateral wall, the top and the base form a closed outer periphery, determining the total area of the device. The device contains an internal part, in fact, closed by the top, base and lateral wall. The lateral wall contains a lower convex part, the middle section and a convex upper part. The convex upper part connects the base with the middle section, and the convex upper part connects the top with the middle section. The middle section has the maximal diameter, smaller than the maximal diameter of the convex lower and the convex upper part. The convex lower part and the convex upper part are made with a possibility to provide pressure on two different places on the woman's urethra, when the device is introduced into the woman's vagina. The suppository device is characterised by the length, measured along the longitudinal axis, shorter than 60 mm.
EFFECT: invention is suitable for the daily application, has a small size and, nevertheless, is sufficiently effective and more comfortable in application.
8 cl, 8 dwg
SUBSTANCE: invention relates to the field of medicine, namely to devices for the treatment of the vasculature and other ducts, which can be used for the treatment of the vasculature occlusion, as well as aneurisms, formed in the brain. A device for the treatment of the vasculature and ducts in an organism contains an elongated self-extending element, made with the possibility of extension from the first supply position into the second installation position. In the first position the elongated self-extending element is in a non-extended position and has the first diameter. In the second position the extending element is in an extended by radius position and has the second diameter, exceeding the first diameter. The elongated self-extending element contains a multitude of cellular structures. The elongated self-extending element has the proximal terminal section with the proximal end and a cylindrical section of the main case. Cellular structures on the cylindrical section of the main case pass on the circumference around the longitudinal axis of the elongated self-extending element. Cellular structures on the proximal terminal section do not pass along the entire circumference around the longitudinal axis of the elongated self-extending element. The proximal cellular structures on the proximal terminal section contain angle braces with the larger width than the angle braces of the cellular structures on the cylindrical section of the main case.
EFFECT: invention provides the improved device for the treatment of the vasculature and other ducts in the organism such as, for instance, aneurisms, stenoses, embolic obstruction, etc.
19 cl, 29 dwg
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.
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: anterior face tissue block is removed, and an orbital exenteration is performed. A plastic replacement of the face defect is conducted with using a periosteoaponeurotic flap. That involves forming a frontotemporal periosteoaponeurotic flap including a. frontalis, a. supraorbitalis, a. trochlearis. After the tissues are mobilised along the formed defect in the temporal, face bone and frontal regions, a tunnel is created with its origin in a helical root to an opposite eye brow. The flap is further turned over through the formed tunnel towards the defect, laid over it and sutured along the whole wound surface of the defect. The donor wound is closed.
EFFECT: method enables reducing an intraoperative injury rate, improving the blood supply of the used flap, shortening the patients' rehabilitation time.
6 dwg, 1 ex
SUBSTANCE: free-standing autograft containing connective tissue and epithelial layer of the mucosa is sampled from a maxillary tuber. A niche is formed by splitting throughout the mucosa surrounding the defect at a boundary of its lamina propria and periosteum from medial, distal and apical wound edges at a depth of 0.3-0.5 cm. The graft is transferred into the defect so that its de-epithelised portions are found in the niche; the transferred graft is fixed with U-sutures into projection of the niche and additionally fixed with a compression X-suture.
EFFECT: by simultaneous elimination of the postoperative defect and creation of the required volume of the attached jaw for the purpose of the successful rehabilitation of the patient, the method enables improving the aesthetic and functional effect.
SUBSTANCE: first stage involves the antegrade palpation-assisted insertion of a heavy-ended phlebextractor through an incision at the medial malleolus to straighten varicose segments. The phlebextractor is removed thereafter from the incision at the medial malleolus. Tumescence anaesthesia is applied along the vein trunk. That is followed by the coagulation of an inconsistent tibial segment of the great saphenous vein with the use of a laser light guide. The laser light guide is removed from the incision at the medial malleolus. A cosmetic stitch is applied on the wound. At the second stage: the heavy-ended phlebextractor is inserted palpation-assisted in the retrograde direction through a cross-ectomy incision to straighten varicose segments. The heavy-ended phlebextractor is used to remove any inconsistent valves, and an aiming beam controlled laser light guide is delivered along the phlebextractor. Thereafter, the phlebextractor is taken out of the cross-ectomy incision. Tumescence anaesthesia is applied. That is followed by the laser coagulation of an inconsistent femoral segment of the vein. The laser light guide is taken out of the cross-ectomy incision. The great saphenous vein stump is ligatured. The wound is closed. The whole surgical procedure is continuously ultrasound-controlled.
EFFECT: method enables the laser light guide coagulation of the inconsistent segments of the vein causing no paravasal inflammatory reaction, delivering the laser light guide precisely by using the heavy-ended phlebextractor.
SUBSTANCE: intratissue pressures (P) of the involved masseter (P1) and the intact masseter (P2) are measured synchronously, and a pressure difference (R) is determined. If R is equal to 15 mmHg or more, Z-fasciotomy of the fascial compartment of the involved masseter is performed through the oral cavity with each Z-incision length of 1 cm.
EFFECT: method enables reducing complications that is ensured by detecting acute tissue hypertensive syndrome and performing early radical decompression by the fasciotomy of the fascial compartment of the masseter.
SUBSTANCE: invention relates to medicine. A surgical instrument contains the first part and the second part. The first part is hermetically closed by a membrane. The second part contains a case of the surgical instrument and a cavity in the case of the surgical instrument. The cavity is made with a possibility of receiving the first part. The second part contains the first area, containing a hole, connected with the cavity, and a closing element, made with a possibility of travel between the first position and the second position. The closing element is in sealing contact with the second area, when it is in the first position, and at least partly is not in sealing contact with the second area, when it is in the second position. One or more electric contacts in the first part or in the second part are made with a possibility of passing through the membrane for creating connection between the first part and the second part, when the closing element moves from the second position into the first position.
EFFECT: part of the instrument can be used in sterile surrounding.
20 cl, 66 dwg
SUBSTANCE: invention refers to cardiosurgery and is applicable for the surgical repair of the aortic valve and ascending aorta. A device comprises a screw-on handle, which bears a replaceable working portion configured in different diameters. The working portion is cylinder-shaped with a truncated cone, which comprises streamline circular grooves. The grooves are provided to prevent the vascular implant displacement if narrowed when underrun. A base of the working portion has a circular support configured to hold the vascular implant on the device.
EFFECT: invention provides the intraoperative measurement of a true size of the aortic annulus and formation of a reference size of the proximal portion of the vascular implant.
SUBSTANCE: external wall of the attic is ablated. The posterior wall of the external acoustic duct is ablated with the exposure of mastoid cells. Revision of the middle ear cavities, chains of the acoustic ossicles is carried out. Bone shelves and pathologically changed tissues are ablated with smoothing the trepanation cavity wall. Autogenic bone flour is obtained from the mastoid cortical bone. The bone flour is covered with biological glue "BioGlue" from two sides with 1 mm thick layers. A 3-5 mm thick plate, corresponding in shape and dimensions to the bone defect of the posterior wall is formed and fixed on the cavity walls in the area of projection of the posterior wall of the external acoustic duct. Ossiculoplasty, myringoplasty are carried out. Plasty of the external wall of the attic is carried out by the autocartilage and perichondrium. The thinned autofascia of the temporal muscle or perichondrium is put above the transplant plate. A meatotympanic flap is laid above the autofascia/ perichondrium at a natural level. Tamponade of the external acoustic duct is carried out.
EFFECT: method ensures the effective treatment of chronic purulent otitis of the middle ear, complete restoration of the middle and external ear architectonics, makes it possible to avoid trauma of the auricle cartilage, displacement of the transplant in the post-operative period, post-operative complications due to the application of the autotissue as the transplant, formation of a specified plate of the transplant and application of biological glue BioGlue.
3 cl, 2 dwg, 2 ex
SUBSTANCE: preliminary marking in the area of the eyelid and forehead is performed. Skin minicuts are made in accordance with the marking: two cuts in the area of the eyelid and two cuts in the superciliary area, one cut in the central zone of the forehead. Tunnels are successively formed through the cuts with the simultaneous passing of a suspending material. A disposable needle 18G is used for spinal anaesthesia. Formation of the tunnels and passing of the suspending material are carried out under the orbicular muscle on the anterior surface of the tarsal plate and further along the levator. Ends of the suspending material are brought into the cut on the forehead skin. The upper eyelid is pulled to place its edge on the upper limbus. After that the ends of the suspending material are fixed to the frontal muscle. A polypropylene thread is used as the suspending material.
EFFECT: safety and accuracy of fixing material passing, reduction of a risk to injure surrounding tissues, preservation of the anatomical location of the upper eyelid tissues, improvement of the functional and cosmetic result of surgical treatment due to the small diameter of the tunnels, formation of a pentagonal closed contour, formation of the tunnels and passing the threads strictly under the orbicular muscle, application of the polypropylene thread.
4 dwg, 1 ex
SUBSTANCE: group of inventions relates to field of medical equipment, namely to implanted medical devices and methods, associated with them, in particular, to devices and methods for closing holes in vessel walls. Closing device for vessel contains supporting frame, capable of extending inside vessel, and closing membrane, at least, partially supported by extendable supporting frame. Supporting frame is located around closing membrane periphery. Device is configured with possibility of folding and unfolding along longitudinal axis, in fact, coinciding with vessel axis, and with possibility of intraluminal positioning, after extension of supporting frame inside vessel, closing membrane near place of puncture, made in vessel wall. Method of vessel closing includes introduction of closing device into vessel through place of puncture by means of cover, positioning and extension of supporting frame from folded configuration in, at least, partially unfolded configuration by means of its unfolding inside vessel along longitudinal axis, in fact, coinciding with vessel axis, providing in this way, at least, partial closing of puncture place with closing membrane. System for closing vessel puncture contains closing device, cover, made with possibility to accept closing device in folded configuration and facilitate introduction of closing device through puncture into vessel; and pusher-rod, made with possibility of passing closing device through cover.
EFFECT: group of inventions provides faster and more effective closing; reduces time and cost; requires only inconsiderable additional surgical manipulations by operator in the course of delivery.
30 cl, 11 dwg
SUBSTANCE: method involves a transanal Doppler controlled dearterialisation of internal haemorrhoids. Haemorrhoid vessel branches are underrun through an anoscope at the haemorrhoid base. A figure-of-eight non-traumatic absorbable suture is applied. The rectal mucosa and haemorrhoid are anchored with the same suture. A submucosal suture is applied in the distal direction towards an apex of the haemorrhoid. Then it is turned perpendicularly and encloses the submucosal layer. The suture is placed back towards the ligatured haemorrhoid and the second free end of the suture. After the needle pricks out, the suture ends are tied together. The haemorrhoid is ligatured to pull up and fixed to the point of vascular underrunning above the anorectal line.
EFFECT: method provides the minimally invasive treatment of the patients suffering from stages 3-4 chronic haemorrhoid by limiting the blood flow along the haemorrhoid arteries, fixing and preventing haemorrhoid prolapsed with the minimum deformity of the anal canal, preserving its function and observing the good functional and aesthetic effect.
3 ex, 1 dwg
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg