EP1796768A2 - Dispositif de trachéotomie - Google Patents

Dispositif de trachéotomie

Info

Publication number
EP1796768A2
EP1796768A2 EP05760495A EP05760495A EP1796768A2 EP 1796768 A2 EP1796768 A2 EP 1796768A2 EP 05760495 A EP05760495 A EP 05760495A EP 05760495 A EP05760495 A EP 05760495A EP 1796768 A2 EP1796768 A2 EP 1796768A2
Authority
EP
European Patent Office
Prior art keywords
cuff
distal end
tracheal
dilator
inflatable
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.)
Withdrawn
Application number
EP05760495A
Other languages
German (de)
English (en)
Inventor
Emilpaolo Manno
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Bioservice SpA
Original Assignee
Bioservice SpA
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Bioservice SpA filed Critical Bioservice SpA
Priority to EP05760495A priority Critical patent/EP1796768A2/fr
Publication of EP1796768A2 publication Critical patent/EP1796768A2/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0465—Tracheostomy tubes; Devices for performing a tracheostomy; Accessories therefor, e.g. masks, filters
    • A61M16/0472—Devices for performing a tracheostomy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/0445—Special cuff forms, e.g. undulated
    • A61M16/0447—Bell, canopy or umbrella shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/044—External cuff pressure control or supply, e.g. synchronisation with respiration
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B29—WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE IN GENERAL
    • B29C—SHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C45/00—Injection moulding, i.e. forcing the required volume of moulding material through a nozzle into a closed mould; Apparatus therefor
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B29—WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE IN GENERAL
    • B29L—INDEXING SCHEME ASSOCIATED WITH SUBCLASS B29C, RELATING TO PARTICULAR ARTICLES
    • B29L2022/00—Hollow articles
    • B29L2022/02—Inflatable articles

Definitions

  • the present invention relates to a tracheostomy apparatus.
  • Tracheostomy i.e. the operation wherein a stoma is opened through the tracheal wall, is sometimes required to treat patients suffering both from acute pathologies (traumas, burns, etc.) and from worsening of chronic pathologies (chronic obstructive bronchopathy, neurological syndromes and the like).
  • Tracheostomy is generally concluded by inserting a tracheal tube through the opening created in the tracheal wall. The tracheal tube prevents the opening from closing again, allows direct access to the trachea and permits ventilation.
  • the tracheal tube has a limited extension, generally a few tens of millimeters, typically extending between a distal end, that will remain inside the tracheal cavity, and an end with a flange, or provided with a connector, that will remain outside the cavity for a possible connection with medical instruments such as ventilation devices, humidifiers (artificial noses), speaking valves, etc..
  • tracheal tubes are curved to facilitate insertion into the trachea and to minimize risks of lacerating tissues, both during insertion and during the time the tube remains in the trachea. For this reason they are usually curved.
  • the tubes are provided with inflatable elements, for example one or more cuffs, with the function of holding the distal end correctly on the inner tracheal wall once the tube has been inserted, reducing the risk of possible damage to the trachea tissues by contact with said distal end.
  • the critical insertion step of the tracheal tube is the opening of a sufficiently large stoma in the trachea for the tracheal tube to be housed in.
  • One known method is to surgically create the required opening, i.e. to carry out an incision with scalpels of the tissues which, starting from the skin, cover the trachea progressively, until opening the trachea to form a stoma,.
  • This method is commonly recognized to be invasive and to be avoided in view of the peculiar elasticity of the tracheal tissues, that can be dilated rather than cut and that will close and heal faster if dilated than if surgically opened.
  • a first step is to make the incision in the skin at the site of a space identified between the tracheal rings.
  • a needle is then inserted into this incision to perforate the inner tracheal wall and access the tracheal cavity.
  • a metal guide wire generally flexible and coated in Teflon, is sliding housed inside the needle, with the function of guiding the insertion of a dilator tube through the small hole made by the needle.
  • the subsequent steps provide the insertion, into said hole, of dilators, i.e.
  • the tubes have a through hole along their entire length (lumen) so that they can slide on the guide wire.
  • the metal wire guides the various dilator tubes that are consecutively inserted into the hole and removed therefrom, ensuring that they do not interfere dangerously with the tissues around the opening that is created. When the opening is sufficiently wide, the tracheal tube is finally housed therein. Use of a guide wire is critical.
  • a device to perform dilation tracheostomy is for example described in European patent EP 0 784 989.
  • the apparatus comprises a tracheal tube slidingly coupled with a dilator tube, that is coupled to a flexible catheter, provided with a free distal end.
  • the catheter is inserted into the hole made in the trachea and is provided, at its distal end, with an inflatable cuff (or balloon).
  • an inflatable cuff or balloon
  • a pressurized fluid is fed to the cuff to expand it.
  • the cuff enlarges the hole made in the tracheal wall to define an opening sufficiently large to allow insertion of the tracheal tube.
  • a first drawback is the fact that it is difficult to position the flexible and soft catheter and to slide it on the guide wire in the insertion step into the needle hole in the tracheal wall. Often the catheter bends to interfere with the walls of the hole. In some cases, for example when the patient is robust in build and the external tracheal wall is covered with a thick layer of tissues, it is necessary to make several attempts before managing to correctly insert the catheter. In other cases it is necessary to resort to the series of tubes with increasing diameters in order to dilate the hole made in the tracheal wall before inserting the catheter.
  • US-A-6, 706,017 discloses a tracheostomy device that is said to alleviate the problems of the above discussed patents.
  • the device disclosed by the Dulguerov patent comprises a large diameter needle in which a fiberscope and at least three channels are housed.
  • the needle has a curved distal end portion (ending in a sharpened tip) and a straight handle portion.
  • An inflatable element that extends from the needle end to the straight portion is externally mounted on the needle. No guide wires are provided for and their use is expressly avoided (see e.g. col. 4, lines 30-31).
  • the device results in a method wherein the tracheal wall is perforated by the large-diameter needle and the lumen thus obtained is enlarged by radially expanding the inflatable element.
  • the needle is quite large: because it has to house one fiberscope and several ducts, its diameter is relatively large, i.e. a diameter similar to that of a pencil.
  • the inflatable elements yield at some parts and are rigid at others, for example due to unwanted variations in the thickness of the materials composing them. For this reason it may be difficult to make openings with an essentially constant diameter in the tissues, without any narrowing.
  • the inflatable cuffs of the known devices are almost always partially positioned within the tracheal duct; this means that the cuff portion that is not in contact with the tracheal wall but that is within the tracheal duct will expand more than the cuff portion that is contacting the tracheal wall. The result of this differential expansion is an insufficient dilatation of the lumen in the tracheal wall and a partial obstruction of the tracheal duct.
  • a further object of the present invention is to provide an inflatable cuff, associable with surgical instruments, which allows to uniformly dilate the surrounding tissues.
  • an apparatus for dilation tracheostomy comprising a rigid and hollow dilator element, that can be guided by an external guide wire, provided with a free distal end, tapered and dull, suitable to be inserted into a hole previously made in the tracheal wall of a patient, said guiding wire being positioned in said hole, said apparatus having a straight portion including a handle portion and a curved portion located between said tapered distal end and said straight portion, and at least one inflatable element externally located between said curved portion and said handle portion.
  • the apparatus according to the invention provides many advantages over the prior art: it allows the tracheostomy to be performed on a patient rapidly, without requiring the use of a series of tubes or of a catheter. Dilation of the tissues at a hole made in the tracheal wall may in fact be obtained by means of the inflatable element provided directly before the curved portion with respect to its direction of insertion, i.e. on the first part of the straight portion of the apparatus.
  • the inflatable element is a cuff, essentially cylindrical in its inflated configuration, positioned immediately upstream the curved portion of the dilator element, for example at a cross-sectional narrowing thereof.
  • the device does not include a catheter, or an equivalent instrument, which after use must be removed from the trachea through the distal end, it is possible to use substantial angles between the distal end of the device according to the invention and the straight portion, with evident advantages with regard to easy of use.
  • the angle formed by the distal end with the handle of the apparatus i.e. angle a between axis A-A of the device straight portion 2c and axis B-B of (straight) distal end 2a (see fig.
  • the distal end of the apparatus of the invention is close to coaxial or slightly inclined with respect to the axis of the tracheal cavity. This considerably reduces risks of contact with the posterior tracheal wall.
  • the cuff is located on the first part of the straight portion, close or adjacent to the curved portion, the correct positioning of the dilator is readily recognized by a condition of the apparatus axis A-A substantially perpendicular with respect to the trachea.
  • the dilator element is provided with one or more stop elements to limit insertion of said distal end in the trachea to one or more predefined positions.
  • the dilator element and the first cuff may be provided with a lubricating and, if necessary, antibacterial hydrophilic coating.
  • the device of the invention is extremely simple to operate.
  • the distal end is inserted through the tracheal wall for example into a hole previously made using a syringe needle, i.e. a traditional needle having reduced diameter.
  • the apparatus is associated with a guide wire of known type.
  • the apparatus is hollow, that is, it has a longitudinal through hole, or lumen, in which the guide wire slides.
  • the tapered distal end pushed through the tracheal wall, produces a first dilation of the surrounding tissues.
  • the device is then pushed further through the tracheal wall and positioned so that the first cuff is inserted into the thus made opening.
  • a pressurized fluid is supplied through to inflate the cuff and therefore dilate the tissues adjacent thereto.
  • the first cuff is deflated to allow insertion of a tracheal tube into the opening made in the tracheal wall.
  • the degree and speed of inflation of the first cuff may be adjusted by acting on the inflation pressure.
  • the present invention also relates to an inflatable element associable with surgical instruments of the type utilized to dilate tissues, characterized in that it is produced through injection molding of thermoplastic materials and has a portion with a first opening, a truncated-cone shaped portion with a second opening having a smaller diameter to the one of the first opening.
  • an inflatable element thus produced has walls with uniform and/or constant thickness between its different parts and, consequently, it also has essentially the same mechanical properties at all of its points.
  • the first cuff of the apparatus of the invention may be produced by injection molding of thermoplastic materials such as PVC.
  • the first cuff produced in this way has high mechanical properties which allow uniform dilation of the tissues on which the cuff acts, with minimum, or even negligible, yield at the intermediate sections of the cuff. Consequently, the risks of cross-sectional narrowing in the opening obtained with the apparatus of the invention are also decreased.
  • Figure 1 is a side view of a device according to the invention inserted through the tracheal wall of a patient;
  • Figure 2 is a side view of the device in Figure 1 during inflation of the inflatable element
  • Figure 3 is a side view of an auxiliary dilator element without cuffs;
  • Figure 4 is a perspective view of an inflatable element according to the invention.
  • Figure 5 is a sectional view of a preferred device according to the invention.
  • Figure 1 shows an apparatus according to the present invention partially inserted through the tracheal wall 11 of a patient undergoing tracheostomy.
  • the device 1 according to the invention is substantially rigid or semi-rigid and is provided with a dilating part 2 and a straight portion S including a handle 3, essentially cylindrical.
  • substantially rigid it is here meant a rigidity sufficient to allow the tapered end to dilate the small hole punctured into the trachea by the needle.
  • Suitable rigidity values are 70 shore A to 90 Shore D, preferably 80-90 Shore D.
  • the dilating part 2 comprises a distal end portion 2a that is tapered and dull, i.e. it does not comprise a sharpen point that could make an incision in the trachea tissues.
  • the dilating part 2a is tapered so as to have a smaller end to allow its insertion into a hole made by a needle in wall 11 of the trachea and a larger opposite portion to dilate the tissues around the hole.
  • Distal end portion 2a is preferably straight or essentially rectilinear and is connected to a curved part 2b.
  • Part 2b is connected to the straight portion S of the invention device, that is including a first straight, i.e. rectilinear, part 2c, and a second straight portion consisting in a handle 3.
  • the invention apparatus 1 is hollow, i.e. it has a through hole 4, the function of which is to allow a wire, of the type utilized to guide the tubes traditionally used for tracheostomy, to slide inside the apparatus body.
  • the apparatus body can be made of plastic or metallic materials, but is preferably produced in PVC or polyurethane (PU) or other resin materials having the above specified Shore values.
  • the distal end is provided with a hydrophilic coating of a known type and, if necessary, provided with antibacterial properties obtained by incorporating methyl blue or metallic silver (from AgNO 3 solution) in the material (PVC or PU) with which the element is produced.
  • the apparatus of the invention is provided with an expandable, that is, radially inflatable element, located between the curved portion 2b of dilating part 2 and handle 3, i.e. it is positioned on the straight portion 2c, which extends as a connection element between the curved portion 2b and the handle 3.
  • the inflatable element is fixed to portion 2c in correspondence with a throat or cross-sectional narrowing 6.
  • the inflatable element is located between the portion 2b of the distal end and the handle 3 and is a cuff 5, externally positioned around portion 2c which connects the dilating part 2 to handle 3.
  • the diameter of portion 6 is smaller than the diameter of the rest of portion 2c, to obtain an essentially uniform diameter of the dilator at the dilating end 2 and at the portion covered by the inflatable element 5.
  • the cuff or inflatable element 5 is coaxial to portion 2c and extends therearound through 360 degrees forming a sleeve inside which portion 2c is housed.
  • the ends of cuff 5 are held sealed on the apparatus 1 to allow the cuff to be pressurized and inflated to the dimensions of required dilation of the stoma in the trachea; in this condition, the diameter of the cuff 5 is greater than the diameter of the dilating part 2 8fig. 2 and 5.
  • the cuff is in fluid communication with external means to supply a pressurized fluid.
  • cuff 5 communicates, for example through a flexible duct 8, with a second cuff 7, which in turn can be supplied with a pressurized fluid, for example saline solution, or air.
  • a pressurized fluid for example saline solution, or air.
  • the second cuff 7 is provided with a valve 9 that allows coupling with a syringe or with an external line.
  • the cuff 5 is directly connected through duct 19 to a luer valve 9a and to a source of pressurized fluid (not shown), i.e. no second cuff or plenum is provided.
  • the cuff 5 has an essentially cylindrical extension. This form allows it to be positioned simply in the opening A produced in the tracheal wall 11 and also allows to engage opening A for its entire width.
  • the cuff 5 is of the type known in the art for use as a dilator, such as described in the cited European patent no. 0 784 989, and is obtained by injection molding or extrusion of thermoplastic materials, for example PVC, in tubular form and subsequently shaped by pressurization to obtain the desired conformation, that is, tapered at the ends, for fixing on the straight portion 2c of the dilator apparatus 1.
  • Figure 4 shows an alternative embodiment wherein the cuff 13 has a first cylindrical portion 14, a second truncated-cone shaped portion 15 having an essentially cylindrical end 16 with a second opening 18.
  • the diameter of the opening 18 is smaller than the diameter of the aperture 17 of the cylindrical portion, to allow this cuff to be injection molded and avoid subsequent deformation by pressurization.
  • the two ends 17 and 18 can be sealed to portions of the dilator with corresponding diameters.
  • two cuffs are positioned symmetrically against each other and overlapped and fixed to each other in correspondence of the openings 17 to obtain a final product with the same shape as the one in Figure 2.
  • the preferred material has a rigidity within the range of 50 to 65 Shore A, preferably of 60 Shore A.
  • FIG. 3 shows a dilator element 1A without any expansible element or cuff.
  • Element 1A has smaller dimensions, i.e. a smaller diameter than the apparatus 1 of Figures 1 , 2 and 5, and is intended for the purpose of performing, when necessary, a first gradual dilation of the ostomy obtained with the needle, before inserting dilator apparatus 1.
  • Figure 2 shows the apparatus during the dilation step through cuff 5.
  • a pressurized fluid is supplied to the cuff 5.
  • the fluid is injected for example with a syringe into the second cuff 7, through the valve 9, and from here passes into the first cuff 5 which inflates in the opening A, dilating it.
  • the pressure of the first cuff 5, which may not be completely visible when inserted into the wall 11 can be controlled through the second cuff 7, which acts as a control element.
  • acting manually on the second cuff 7 it is possible to increase or decrease the pressure inside the first cuff 5 and also adjust the speed with which said cuff 5 is inflated or deflated.
  • cuff 5 is deflated to allow insertion of a traditional tracheal tube (not shown) through the wall 11.
  • Operation of apparatus 1 of the invention is extremely simple.
  • the dilating part 2 is inserted through the tracheal wall 11 , in a hole previously made by means of a syringe and, if necessary, enlarged with first dilator 1A having a decreased diameter ( Figure 3).
  • the apparatus 1 may be associated with a guide wire of known type.
  • the apparatus 1 may be hollow, that is, it may be provided with a longitudinal through hole, or lumen, in which the guide wire can slide.
  • the dilating part 2, inserted through the tracheal wall 11 produces a first dilation of the surrounding tissues.
  • the apparatus 1 must be pushed further through the tracheal wall 11 and positioned so that cuff 5 is inserted into the opening A thereby produced.
  • a pressurized fluid gas or liquid
  • cuff 5 is supplied through duct 19 or through the second cuff 7, to inflate the first cuff 5 and therefore dilate the tissues adjacent thereto.
  • cuff 5 is deflated to allow insertion of a tracheal tube into the opening A produced in the tracheal wall.
  • the degree and speed of inflation of the first cuff 5 may be adjusted by acting on the inflation pressure of the fluid fed to cuff 5.
  • Operation of the apparatus 1 of the invention is therefore extremely simple, as it does not require the use of a catheter or of a series of tubes. Also, the time required to perform the tracheostomy is much shorter with respect to the typical time of traditional instruments.
  • the device 1 allows the tracheostomy to be performed with a high degree of safety, with minimum risks with regard to accidental lesions to the tracheal wall 10.
  • the dilating part 2 forms with the handle 3 a substantial angle, as no catheter is required to slide inside it.
  • the dilating part 2 forms with the straight portion 2c an angle within a range from approximately 90 degrees to 150 degrees.
  • the dilating part 2 once inserted into the trachea, is inclined or close to parallel with the tracheal cavityaxis. In this way, the risks of the dilating part 2 coming into contact with the wall 10 are minimized, together with the risks of lesions to said wall 10.
  • the dilating part 2 would not touch the wall 10 with the tip, but with a rounded portion, i.e. with the curved portion 2b.
  • the apparatus may be provided with one or more stop elements (not shown) the function of which is to prevent insertion of the dilating part 2 into the trachea beyond one or more predefined positions.
  • one or more flanges or stop surfaces may be provided on the handle 3, with an adjustable position on said handle 3, suitable to assure on the external tracheal wall 11.
  • the stop means simplify insertion of the dilating part 2 into the trachea, preventing it from erroneously being inserted beyond the useful length for the cuff 5 to dilate the opening A.
  • These means may for example be moved along the handle 3 according to predefined positions that take into account the expected thickness of the wall 11.

Landscapes

  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Emergency Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne un appareil de trachéotomie par dilatation comprenant un élément dilatateur (1) glissant sur un fil-guide, qui est muni d'une partie d'extrémité distale (2a) conique émoussée. L'appareil s'insère de manière appropriée dans un orifice pratiqué dans la paroi trachéenne (11) d'un patient et comporte un manche sensiblement cylindrique (3). L'appareil présente avantageusement au moins un élément gonflable situé entre l'extrémité distale (2a) et le manche (2c), après une partie bombée (2b).
EP05760495A 2004-07-12 2005-07-08 Dispositif de trachéotomie Withdrawn EP1796768A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP05760495A EP1796768A2 (fr) 2004-07-12 2005-07-08 Dispositif de trachéotomie

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
EP04425513 2004-07-12
PCT/IB2005/001938 WO2006008602A2 (fr) 2004-07-12 2005-07-08 Appareil de tracheotomie
EP05760495A EP1796768A2 (fr) 2004-07-12 2005-07-08 Dispositif de trachéotomie

Publications (1)

Publication Number Publication Date
EP1796768A2 true EP1796768A2 (fr) 2007-06-20

Family

ID=34932624

Family Applications (1)

Application Number Title Priority Date Filing Date
EP05760495A Withdrawn EP1796768A2 (fr) 2004-07-12 2005-07-08 Dispositif de trachéotomie

Country Status (3)

Country Link
EP (1) EP1796768A2 (fr)
AR (1) AR054297A1 (fr)
WO (1) WO2006008602A2 (fr)

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Publication number Priority date Publication date Assignee Title
ITBO20040420A1 (it) 2004-07-07 2004-10-07 Type S R L Macchina per taglio e formatura di piattine metalliche
ITBO20050481A1 (it) 2005-07-19 2007-01-20 Silicon Biosystems S R L Metodo ed apparato per la manipolazione e/o l'individuazione di particelle
ITBO20050646A1 (it) 2005-10-26 2007-04-27 Silicon Biosystem S R L Metodo ed apparato per la caratterizzazione ed il conteggio di particelle
ITTO20060226A1 (it) 2006-03-27 2007-09-28 Silicon Biosystem S P A Metodo ed apparato per il processamento e o l'analisi e o la selezione di particelle, in particolare particelle biologiche
ITTO20070771A1 (it) 2007-10-29 2009-04-30 Silicon Biosystems Spa Metodo e apparato per la identificazione e manipolazione di particelle
US8307824B2 (en) 2008-06-27 2012-11-13 Kimberly-Clark Worldwide, Inc. Method of performing a tracheostomy
IT1391619B1 (it) 2008-11-04 2012-01-11 Silicon Biosystems Spa Metodo per l'individuazione, selezione e analisi di cellule tumorali
US10895575B2 (en) 2008-11-04 2021-01-19 Menarini Silicon Biosystems S.P.A. Method for identification, selection and analysis of tumour cells
JP5834001B2 (ja) 2009-03-17 2015-12-16 シリコン・バイオシステムズ・ソシエタ・ペル・アチオニ 細胞を分離するためのマイクロ流体デバイス
ITTO20110990A1 (it) 2011-10-28 2013-04-29 Silicon Biosystems Spa Metodo ed apparato per l'analisi ottica di particelle a basse temperature
ITBO20110766A1 (it) 2011-12-28 2013-06-29 Silicon Biosystems Spa Dispositivi, apparato, kit e metodo per il trattamento di un campione biologico

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US4459984A (en) * 1982-09-15 1984-07-17 Liegner Kenneth B Speaking tracheostomy tube
US5653230A (en) * 1996-01-19 1997-08-05 Cook Incorporated Percutaneous balloon dilational tracheostomy tube
DE69731739T2 (de) * 1996-04-17 2005-12-15 Lasersurge Inc. Vorrichtung und kit zum expandieren von körpergewebe
US6637435B2 (en) * 1999-12-07 2003-10-28 Cook Incorporated Percutaneous dilational device
DE10065604C2 (de) * 2000-01-15 2002-05-29 Bernd Wolfgarten Stabförmiges Instrument zur Durchführung einer Tracheal-Bougierung
US6706017B1 (en) * 2000-09-18 2004-03-16 Pavel Dulguerov Percutaneous ostomy device and method for creating a stoma and implanting a canula
GB0119124D0 (en) * 2001-08-04 2001-09-26 Smiths Group Plc Introducers and assemblies

Non-Patent Citations (1)

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See references of WO2006008602A2 *

Also Published As

Publication number Publication date
WO2006008602A2 (fr) 2006-01-26
WO2006008602A3 (fr) 2006-04-06
AR054297A1 (es) 2007-06-20

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