CA2107961C - Injectable mesna solutions - Google Patents
Injectable mesna solutions Download PDFInfo
- Publication number
- CA2107961C CA2107961C CA002107961A CA2107961A CA2107961C CA 2107961 C CA2107961 C CA 2107961C CA 002107961 A CA002107961 A CA 002107961A CA 2107961 A CA2107961 A CA 2107961A CA 2107961 C CA2107961 C CA 2107961C
- Authority
- CA
- Canada
- Prior art keywords
- solution
- mesna
- parts
- weight
- injectable
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
- 229960004635 mesna Drugs 0.000 title claims abstract description 31
- XOGTZOOQQBDUSI-UHFFFAOYSA-M Mesna Chemical compound [Na+].[O-]S(=O)(=O)CCS XOGTZOOQQBDUSI-UHFFFAOYSA-M 0.000 title claims abstract 11
- 238000000034 method Methods 0.000 claims abstract description 5
- 239000000243 solution Substances 0.000 claims description 38
- WVDDGKGOMKODPV-UHFFFAOYSA-N Benzyl alcohol Chemical compound OCC1=CC=CC=C1 WVDDGKGOMKODPV-UHFFFAOYSA-N 0.000 claims description 30
- HEMHJVSKTPXQMS-UHFFFAOYSA-M Sodium hydroxide Chemical compound [OH-].[Na+] HEMHJVSKTPXQMS-UHFFFAOYSA-M 0.000 claims description 30
- 238000002347 injection Methods 0.000 claims description 19
- 239000007924 injection Substances 0.000 claims description 19
- 229940102223 injectable solution Drugs 0.000 claims description 13
- 239000003755 preservative agent Substances 0.000 claims description 11
- 235000019445 benzyl alcohol Nutrition 0.000 claims description 10
- 230000002335 preservative effect Effects 0.000 claims description 9
- 239000008139 complexing agent Substances 0.000 claims description 8
- 239000003002 pH adjusting agent Substances 0.000 claims description 7
- 239000000126 substance Substances 0.000 claims description 7
- ZGTMUACCHSMWAC-UHFFFAOYSA-L EDTA disodium salt (anhydrous) Chemical compound [Na+].[Na+].OC(=O)CN(CC([O-])=O)CCN(CC(O)=O)CC([O-])=O ZGTMUACCHSMWAC-UHFFFAOYSA-L 0.000 claims description 6
- 239000003814 drug Substances 0.000 claims description 6
- 238000002360 preparation method Methods 0.000 claims description 6
- 229940079593 drug Drugs 0.000 claims description 5
- 230000000694 effects Effects 0.000 claims description 5
- ZZVDXRCAGGQFAK-UHFFFAOYSA-N 2h-oxazaphosphinine Chemical compound N1OC=CC=P1 ZZVDXRCAGGQFAK-UHFFFAOYSA-N 0.000 claims description 4
- HOMGKSMUEGBAAB-UHFFFAOYSA-N ifosfamide Chemical compound ClCCNP1(=O)OCCCN1CCCl HOMGKSMUEGBAAB-UHFFFAOYSA-N 0.000 abstract description 6
- 229960001101 ifosfamide Drugs 0.000 abstract description 6
- 206010028980 Neoplasm Diseases 0.000 abstract description 2
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 abstract description 2
- 210000000056 organ Anatomy 0.000 abstract description 2
- 230000002485 urinary effect Effects 0.000 abstract description 2
- 238000004519 manufacturing process Methods 0.000 abstract 1
- ZNEWHQLOPFWXOF-UHFFFAOYSA-N coenzyme M Chemical compound OS(=O)(=O)CCS ZNEWHQLOPFWXOF-UHFFFAOYSA-N 0.000 description 21
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Chemical compound O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 14
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 description 12
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 11
- 239000001301 oxygen Substances 0.000 description 11
- 229910052760 oxygen Inorganic materials 0.000 description 11
- 239000008215 water for injection Substances 0.000 description 8
- 229960004217 benzyl alcohol Drugs 0.000 description 7
- 229910052757 nitrogen Inorganic materials 0.000 description 6
- 239000011521 glass Substances 0.000 description 5
- HUMNYLRZRPPJDN-UHFFFAOYSA-N benzaldehyde Chemical compound O=CC1=CC=CC=C1 HUMNYLRZRPPJDN-UHFFFAOYSA-N 0.000 description 4
- 238000001914 filtration Methods 0.000 description 4
- 239000000203 mixture Substances 0.000 description 4
- 238000003860 storage Methods 0.000 description 4
- KWYUFKZDYYNOTN-UHFFFAOYSA-M Potassium hydroxide Chemical compound [OH-].[K+] KWYUFKZDYYNOTN-UHFFFAOYSA-M 0.000 description 3
- KRKNYBCHXYNGOX-UHFFFAOYSA-N citric acid Chemical compound OC(=O)CC(O)(C(O)=O)CC(O)=O KRKNYBCHXYNGOX-UHFFFAOYSA-N 0.000 description 3
- 238000004140 cleaning Methods 0.000 description 3
- 239000012141 concentrate Substances 0.000 description 3
- 230000003647 oxidation Effects 0.000 description 3
- 238000007254 oxidation reaction Methods 0.000 description 3
- 229940037001 sodium edetate Drugs 0.000 description 3
- 238000004659 sterilization and disinfection Methods 0.000 description 3
- KCXVZYZYPLLWCC-UHFFFAOYSA-N EDTA Chemical compound OC(=O)CN(CC(O)=O)CCN(CC(O)=O)CC(O)=O KCXVZYZYPLLWCC-UHFFFAOYSA-N 0.000 description 2
- NBIIXXVUZAFLBC-UHFFFAOYSA-N Phosphoric acid Chemical class OP(O)(O)=O NBIIXXVUZAFLBC-UHFFFAOYSA-N 0.000 description 2
- 239000007864 aqueous solution Substances 0.000 description 2
- OSASVXMJTNOKOY-UHFFFAOYSA-N chlorobutanol Chemical compound CC(C)(O)C(Cl)(Cl)Cl OSASVXMJTNOKOY-UHFFFAOYSA-N 0.000 description 2
- 238000011109 contamination Methods 0.000 description 2
- 239000007857 degradation product Substances 0.000 description 2
- 229950009278 dimesna Drugs 0.000 description 2
- KQYGMURBTJPBPQ-UHFFFAOYSA-L disodium;2-(2-sulfonatoethyldisulfanyl)ethanesulfonate Chemical compound [Na+].[Na+].[O-]S(=O)(=O)CCSSCCS([O-])(=O)=O KQYGMURBTJPBPQ-UHFFFAOYSA-L 0.000 description 2
- 238000009472 formulation Methods 0.000 description 2
- 239000003978 infusion fluid Substances 0.000 description 2
- RLSSMJSEOOYNOY-UHFFFAOYSA-N m-cresol Chemical compound CC1=CC=CC(O)=C1 RLSSMJSEOOYNOY-UHFFFAOYSA-N 0.000 description 2
- -1 mesna acetal Chemical class 0.000 description 2
- QNGNSVIICDLXHT-UHFFFAOYSA-N para-ethylbenzaldehyde Natural products CCC1=CC=C(C=O)C=C1 QNGNSVIICDLXHT-UHFFFAOYSA-N 0.000 description 2
- 239000011734 sodium Substances 0.000 description 2
- 238000011146 sterile filtration Methods 0.000 description 2
- 238000003756 stirring Methods 0.000 description 2
- 229940090248 4-hydroxybenzoic acid Drugs 0.000 description 1
- 241000894006 Bacteria Species 0.000 description 1
- FEWJPZIEWOKRBE-JCYAYHJZSA-N Dextrotartaric acid Chemical compound OC(=O)[C@H](O)[C@@H](O)C(O)=O FEWJPZIEWOKRBE-JCYAYHJZSA-N 0.000 description 1
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 description 1
- 238000012369 In process control Methods 0.000 description 1
- VMHLLURERBWHNL-UHFFFAOYSA-M Sodium acetate Chemical compound [Na+].CC([O-])=O VMHLLURERBWHNL-UHFFFAOYSA-M 0.000 description 1
- FEWJPZIEWOKRBE-UHFFFAOYSA-N Tartaric acid Natural products [H+].[H+].[O-]C(=O)C(O)C(O)C([O-])=O FEWJPZIEWOKRBE-UHFFFAOYSA-N 0.000 description 1
- RXDLGFMMQFNVLI-UHFFFAOYSA-N [Na].[Na].[Ca] Chemical compound [Na].[Na].[Ca] RXDLGFMMQFNVLI-UHFFFAOYSA-N 0.000 description 1
- DHKHKXVYLBGOIT-UHFFFAOYSA-N acetaldehyde Diethyl Acetal Natural products CCOC(C)OCC DHKHKXVYLBGOIT-UHFFFAOYSA-N 0.000 description 1
- 239000013543 active substance Substances 0.000 description 1
- 239000012298 atmosphere Substances 0.000 description 1
- 230000001580 bacterial effect Effects 0.000 description 1
- 229960004926 chlorobutanol Drugs 0.000 description 1
- 239000012459 cleaning agent Substances 0.000 description 1
- 150000001875 compounds Chemical class 0.000 description 1
- ZPWVASYFFYYZEW-UHFFFAOYSA-L dipotassium hydrogen phosphate Chemical compound [K+].[K+].OP([O-])([O-])=O ZPWVASYFFYYZEW-UHFFFAOYSA-L 0.000 description 1
- 229910000396 dipotassium phosphate Inorganic materials 0.000 description 1
- 235000019797 dipotassium phosphate Nutrition 0.000 description 1
- BNIILDVGGAEEIG-UHFFFAOYSA-L disodium hydrogen phosphate Chemical compound [Na+].[Na+].OP([O-])([O-])=O BNIILDVGGAEEIG-UHFFFAOYSA-L 0.000 description 1
- 238000004090 dissolution Methods 0.000 description 1
- 239000002552 dosage form Substances 0.000 description 1
- 229960001484 edetic acid Drugs 0.000 description 1
- 239000003172 expectorant agent Substances 0.000 description 1
- 229910001385 heavy metal Inorganic materials 0.000 description 1
- 230000003301 hydrolyzing effect Effects 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-M hydroxide Chemical compound [OH-] XLYOFNOQVPJJNP-UHFFFAOYSA-M 0.000 description 1
- 239000012535 impurity Substances 0.000 description 1
- 238000010965 in-process control Methods 0.000 description 1
- 238000001802 infusion Methods 0.000 description 1
- 150000002500 ions Chemical class 0.000 description 1
- 239000012669 liquid formulation Substances 0.000 description 1
- 239000012528 membrane Substances 0.000 description 1
- 230000000813 microbial effect Effects 0.000 description 1
- 229940066491 mucolytics Drugs 0.000 description 1
- FJKROLUGYXJWQN-UHFFFAOYSA-N papa-hydroxy-benzoic acid Natural products OC(=O)C1=CC=C(O)C=C1 FJKROLUGYXJWQN-UHFFFAOYSA-N 0.000 description 1
- 239000002245 particle Substances 0.000 description 1
- WVDDGKGOMKODPV-ZQBYOMGUSA-N phenyl(114C)methanol Chemical compound O[14CH2]C1=CC=CC=C1 WVDDGKGOMKODPV-ZQBYOMGUSA-N 0.000 description 1
- 235000011007 phosphoric acid Nutrition 0.000 description 1
- 150000003014 phosphoric acid esters Chemical class 0.000 description 1
- 239000011148 porous material Substances 0.000 description 1
- 239000000843 powder Substances 0.000 description 1
- 150000003856 quaternary ammonium compounds Chemical class 0.000 description 1
- 150000003839 salts Chemical class 0.000 description 1
- 229910052708 sodium Inorganic materials 0.000 description 1
- 239000001632 sodium acetate Substances 0.000 description 1
- 235000017281 sodium acetate Nutrition 0.000 description 1
- 239000001509 sodium citrate Substances 0.000 description 1
- 239000002904 solvent Substances 0.000 description 1
- 230000001954 sterilising effect Effects 0.000 description 1
- 239000013589 supplement Substances 0.000 description 1
- 239000004094 surface-active agent Substances 0.000 description 1
- 208000024891 symptom Diseases 0.000 description 1
- 239000011975 tartaric acid Substances 0.000 description 1
- 235000002906 tartaric acid Nutrition 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- LENZDBCJOHFCAS-UHFFFAOYSA-N tris Chemical compound OCC(N)(CO)CO LENZDBCJOHFCAS-UHFFFAOYSA-N 0.000 description 1
- HRXKRNGNAMMEHJ-UHFFFAOYSA-K trisodium citrate Chemical compound [Na+].[Na+].[Na+].[O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O HRXKRNGNAMMEHJ-UHFFFAOYSA-K 0.000 description 1
- 229940038773 trisodium citrate Drugs 0.000 description 1
- 229960000281 trometamol Drugs 0.000 description 1
- 238000005303 weighing Methods 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/095—Sulfur, selenium, or tellurium compounds, e.g. thiols
- A61K31/105—Persulfides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P11/00—Drugs for disorders of the respiratory system
- A61P11/12—Mucolytics
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P13/00—Drugs for disorders of the urinary system
- A61P13/02—Drugs for disorders of the urinary system of urine or of the urinary tract, e.g. urine acidifiers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P15/00—Drugs for genital or sexual disorders; Contraceptives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
Landscapes
- Health & Medical Sciences (AREA)
- Pharmacology & Pharmacy (AREA)
- Veterinary Medicine (AREA)
- Chemical & Material Sciences (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Medicinal Chemistry (AREA)
- Animal Behavior & Ethology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Chemical Kinetics & Catalysis (AREA)
- Organic Chemistry (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- General Chemical & Material Sciences (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Epidemiology (AREA)
- Endocrinology (AREA)
- Pulmonology (AREA)
- Urology & Nephrology (AREA)
- Reproductive Health (AREA)
- Medicinal Preparation (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Nitrogen Condensed Heterocyclic Rings (AREA)
- Organic Low-Molecular-Weight Compounds And Preparation Thereof (AREA)
- Cosmetics (AREA)
- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
- Preparation Of Compounds By Using Micro-Organisms (AREA)
- Medicines Containing Material From Animals Or Micro-Organisms (AREA)
- Luminescent Compositions (AREA)
- Medical Preparation Storing Or Oral Administration Devices (AREA)
- Peptides Or Proteins (AREA)
- Filling Or Discharging Of Gas Storage Vessels (AREA)
- Superconductors And Manufacturing Methods Therefor (AREA)
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| DEP4233842.5 | 1992-10-08 | ||
| DE4233842A DE4233842A1 (de) | 1992-10-08 | 1992-10-08 | Mesna Injektionslösungen |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2107961A1 CA2107961A1 (en) | 1994-04-09 |
| CA2107961C true CA2107961C (en) | 2003-03-25 |
Family
ID=6469925
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002107961A Expired - Fee Related CA2107961C (en) | 1992-10-08 | 1993-10-07 | Injectable mesna solutions |
Country Status (28)
Families Citing this family (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6828415B2 (en) * | 1993-02-19 | 2004-12-07 | Zentaris Gmbh | Oligopeptide lyophilisate, their preparation and use |
| IT1284973B1 (it) * | 1996-10-11 | 1998-05-28 | A R D O Associazione Ricerca E | Uso del sodio 2-mercaptoetansolfonato (mesna) in chirurgia |
| US6031006A (en) * | 1999-10-21 | 2000-02-29 | Bionumerik Pharmaceuticals, Inc. | Method of treating diabetic nephropathy |
| TW201036529A (en) | 2009-03-25 | 2010-10-01 | Askey Computer Corp | A liquid crystal anti-freeze method and a liquid crystal module using the liquid crystal anti-freeze method |
| UA74097U (ru) * | 2012-07-24 | 2012-10-10 | Николай Иванович Гуменюк | Способ изготовления средства для лечения туберкулеза |
| WO2014180902A1 (en) | 2013-05-07 | 2014-11-13 | Auxin Surgery Sa | Device for chemically assisted dissection |
| CA3017403A1 (en) | 2016-03-14 | 2017-09-21 | Auxin Surgery Sa | Device, method and formulation for chemically assisted dissection |
| BE1024110B1 (fr) * | 2016-10-18 | 2017-11-16 | Auxin Surgery Sa | Dispositif, procédé et formulation pour dissection assistée de manière chimique |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE3111770A1 (de) * | 1981-03-25 | 1982-10-07 | Heyl Chemisch-pharmazeutische Fabrik GmbH & Co KG, 1000 Berlin | Verwendung von dimercaptopropansulfonsaeure und dimercaptobernsteinsaeure zur herstellung von pharmazeutischen mitteln |
| IT1185551B (it) * | 1985-04-15 | 1987-11-12 | Schering Spa | Composizioni farmaceutiche a base di acido mercaptoetansolfonico ad attivita' terapeutica,derivati salini organici dell'acido mercaptoetansolfonico utili per tali composizioni e relativo procedimento di preparazione |
| EP0334083B1 (de) * | 1988-03-19 | 1991-07-24 | ASTA Pharma Aktiengesellschaft | Ifosfamid-Mesna-Lyophilisat und Verfahren zu dessen Herstellung |
-
1992
- 1992-10-08 DE DE4233842A patent/DE4233842A1/de not_active Withdrawn
-
1993
- 1993-08-24 TW TW082106854A patent/TW279131B/zh not_active IP Right Cessation
- 1993-09-13 ES ES93114670T patent/ES2089661T3/es not_active Expired - Lifetime
- 1993-09-13 AT AT93114670T patent/ATE139693T1/de active
- 1993-09-13 EP EP93114670A patent/EP0591710B1/de not_active Expired - Lifetime
- 1993-09-13 DK DK93114670.8T patent/DK0591710T3/da active
- 1993-09-13 DE DE59303067T patent/DE59303067D1/de not_active Expired - Lifetime
- 1993-10-03 EG EG64293A patent/EG20308A/xx active
- 1993-10-05 SI SI9300525A patent/SI9300525A/sl unknown
- 1993-10-05 IL IL10718793A patent/IL107187A/en not_active IP Right Cessation
- 1993-10-05 CN CN93118643A patent/CN1071114C/zh not_active Expired - Lifetime
- 1993-10-06 KR KR1019930020576A patent/KR100364466B1/ko not_active Expired - Lifetime
- 1993-10-06 JP JP25042793A patent/JP3636372B2/ja not_active Expired - Lifetime
- 1993-10-06 UA UA93002240A patent/UA26134C2/uk unknown
- 1993-10-06 NZ NZ248873A patent/NZ248873A/en not_active IP Right Cessation
- 1993-10-06 BR BR9304151A patent/BR9304151A/pt not_active Application Discontinuation
- 1993-10-07 HR HRP4233842.5A patent/HRP931267B1/xx not_active IP Right Cessation
- 1993-10-07 NO NO933590A patent/NO303712B1/no not_active IP Right Cessation
- 1993-10-07 RU RU93048160A patent/RU2105550C1/ru active
- 1993-10-07 CZ CZ932097A patent/CZ284584B6/cs not_active IP Right Cessation
- 1993-10-07 FI FI934410A patent/FI111804B/fi not_active IP Right Cessation
- 1993-10-07 SK SK1079-93A patent/SK279609B6/sk not_active IP Right Cessation
- 1993-10-07 ZA ZA937458A patent/ZA937458B/xx unknown
- 1993-10-07 CA CA002107961A patent/CA2107961C/en not_active Expired - Fee Related
- 1993-10-07 AU AU48883/93A patent/AU667129B2/en not_active Expired
- 1993-10-07 HU HU9302837A patent/HU217123B/hu unknown
-
1995
- 1995-06-07 US US08/474,246 patent/US5728738A/en not_active Expired - Lifetime
-
1996
- 1996-04-23 US US08/636,821 patent/US5696172A/en not_active Expired - Lifetime
- 1996-07-31 GR GR960402027T patent/GR3020669T3/el unknown
-
1997
- 1997-01-16 HK HK7397A patent/HK7397A/xx not_active IP Right Cessation
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKLA | Lapsed |