MD1569Z - Method for preventing variceal hemorrhages in patients with decompensated liver cirrhosis - Google Patents
Method for preventing variceal hemorrhages in patients with decompensated liver cirrhosis Download PDFInfo
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- MD1569Z MD1569Z MDS20210037A MDS20210037A MD1569Z MD 1569 Z MD1569 Z MD 1569Z MD S20210037 A MDS20210037 A MD S20210037A MD S20210037 A MDS20210037 A MD S20210037A MD 1569 Z MD1569 Z MD 1569Z
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- variceal
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- 208000032843 Hemorrhage Diseases 0.000 title claims abstract description 21
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 9
- 238000000034 method Methods 0.000 title claims description 15
- 102000008946 Fibrinogen Human genes 0.000 claims abstract description 16
- 108010049003 Fibrinogen Proteins 0.000 claims abstract description 16
- 229940012952 fibrinogen Drugs 0.000 claims abstract description 16
- VEXZGXHMUGYJMC-UHFFFAOYSA-M Chloride anion Chemical compound [Cl-] VEXZGXHMUGYJMC-UHFFFAOYSA-M 0.000 claims abstract description 15
- 108010039627 Aprotinin Proteins 0.000 claims abstract description 14
- 108090000190 Thrombin Proteins 0.000 claims abstract description 14
- 229960004405 aprotinin Drugs 0.000 claims abstract description 14
- ZPNFWUPYTFPOJU-LPYSRVMUSA-N iniprol Chemical compound C([C@H]1C(=O)NCC(=O)NCC(=O)N[C@H]2CSSC[C@H]3C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@H](C(N[C@H](C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](CC=4C=CC(O)=CC=4)C(=O)N[C@@H](CC=4C=CC=CC=4)C(=O)N[C@@H](CC=4C=CC(O)=CC=4)C(=O)N[C@@H](CC(N)=O)C(=O)N[C@@H](C)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C)C(=O)NCC(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CSSC[C@H](NC(=O)[C@H](CC(O)=O)NC(=O)[C@H](CCC(O)=O)NC(=O)[C@H](C)NC(=O)[C@H](CO)NC(=O)[C@H](CCCCN)NC(=O)[C@H](CC=4C=CC=CC=4)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CCCNC(N)=N)NC(=O)[C@H](CCCCN)NC(=O)[C@H](C)NC(=O)[C@H](CCCNC(N)=N)NC2=O)C(=O)N[C@@H](CCSC)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@@H](CSSC[C@H](NC(=O)[C@H](CC=2C=CC=CC=2)NC(=O)[C@H](CC(O)=O)NC(=O)[C@H]2N(CCC2)C(=O)[C@@H](N)CCCNC(N)=N)C(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCC(O)=O)C(=O)N2[C@@H](CCC2)C(=O)N2[C@@H](CCC2)C(=O)N[C@@H](CC=2C=CC(O)=CC=2)C(=O)N[C@@H]([C@@H](C)O)C(=O)NCC(=O)N2[C@@H](CCC2)C(=O)N3)C(=O)NCC(=O)NCC(=O)N[C@@H](C)C(O)=O)C(=O)N[C@@H](CCC(N)=O)C(=O)N[C@H](C(=O)N[C@@H](CC=2C=CC=CC=2)C(=O)N[C@H](C(=O)N1)C(C)C)[C@@H](C)O)[C@@H](C)CC)=O)[C@@H](C)CC)C1=CC=C(O)C=C1 ZPNFWUPYTFPOJU-LPYSRVMUSA-N 0.000 claims abstract description 14
- 229960004072 thrombin Drugs 0.000 claims abstract description 14
- 108010080379 Fibrin Tissue Adhesive Proteins 0.000 claims abstract description 13
- 108010088751 Albumins Proteins 0.000 claims abstract description 8
- 102000009027 Albumins Human genes 0.000 claims abstract description 8
- 239000000203 mixture Substances 0.000 claims abstract description 6
- 239000000243 solution Substances 0.000 claims description 41
- 238000011321 prophylaxis Methods 0.000 claims description 5
- 210000003462 vein Anatomy 0.000 claims description 5
- 239000000853 adhesive Substances 0.000 claims description 3
- 230000001070 adhesive effect Effects 0.000 claims description 3
- 238000002347 injection Methods 0.000 claims description 3
- 239000007924 injection Substances 0.000 claims description 3
- 206010046996 Varicose vein Diseases 0.000 abstract description 9
- 239000003814 drug Substances 0.000 abstract description 2
- 230000002265 prevention Effects 0.000 abstract 1
- 230000015572 biosynthetic process Effects 0.000 description 10
- 230000023597 hemostasis Effects 0.000 description 9
- 108010073385 Fibrin Proteins 0.000 description 8
- 102000009123 Fibrin Human genes 0.000 description 8
- BWGVNKXGVNDBDI-UHFFFAOYSA-N Fibrin monomer Chemical compound CNC(=O)CNC(=O)CN BWGVNKXGVNDBDI-UHFFFAOYSA-N 0.000 description 8
- 229950003499 fibrin Drugs 0.000 description 8
- 208000034158 bleeding Diseases 0.000 description 7
- 230000000740 bleeding effect Effects 0.000 description 7
- UCTWMZQNUQWSLP-UHFFFAOYSA-N adrenaline Chemical compound CNCC(O)C1=CC=C(O)C(O)=C1 UCTWMZQNUQWSLP-UHFFFAOYSA-N 0.000 description 4
- 238000006116 polymerization reaction Methods 0.000 description 4
- 230000002792 vascular Effects 0.000 description 4
- 208000000624 Esophageal and Gastric Varices Diseases 0.000 description 3
- 206010056091 Varices oesophageal Diseases 0.000 description 3
- 208000007232 portal hypertension Diseases 0.000 description 3
- 230000002269 spontaneous effect Effects 0.000 description 3
- 208000027185 varicose disease Diseases 0.000 description 3
- 108010071289 Factor XIII Proteins 0.000 description 2
- 108010067306 Fibronectins Proteins 0.000 description 2
- 102000016359 Fibronectins Human genes 0.000 description 2
- 108010010803 Gelatin Proteins 0.000 description 2
- 108010051456 Plasminogen Proteins 0.000 description 2
- 102000013566 Plasminogen Human genes 0.000 description 2
- 150000001875 compounds Chemical class 0.000 description 2
- 208000024170 esophageal varices Diseases 0.000 description 2
- 201000010120 esophageal varix Diseases 0.000 description 2
- 229920000159 gelatin Polymers 0.000 description 2
- 239000008273 gelatin Substances 0.000 description 2
- 235000019322 gelatine Nutrition 0.000 description 2
- 235000011852 gelatine desserts Nutrition 0.000 description 2
- 206010005144 Bleeding varicose vein Diseases 0.000 description 1
- 208000005489 Esophageal Perforation Diseases 0.000 description 1
- 208000007217 Esophageal Stenosis Diseases 0.000 description 1
- 206010051012 Gastric varices Diseases 0.000 description 1
- 206010030194 Oesophageal stenosis Diseases 0.000 description 1
- 208000034189 Sclerosis Diseases 0.000 description 1
- 230000001476 alcoholic effect Effects 0.000 description 1
- 230000015556 catabolic process Effects 0.000 description 1
- 229940105784 coagulation factor xiii Drugs 0.000 description 1
- 238000006731 degradation reaction Methods 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 210000003238 esophagus Anatomy 0.000 description 1
- 229940012444 factor xiii Drugs 0.000 description 1
- 230000002008 hemorrhagic effect Effects 0.000 description 1
- 230000000977 initiatory effect Effects 0.000 description 1
- 201000001231 mediastinitis Diseases 0.000 description 1
- 230000017074 necrotic cell death Effects 0.000 description 1
- 229940108461 rennet Drugs 0.000 description 1
- 108010058314 rennet Proteins 0.000 description 1
- 238000007632 sclerotherapy Methods 0.000 description 1
- 229960000776 sodium tetradecyl sulfate Drugs 0.000 description 1
- UPUIQOIQVMNQAP-UHFFFAOYSA-M sodium;tetradecyl sulfate Chemical compound [Na+].CCCCCCCCCCCCCCOS([O-])(=O)=O UPUIQOIQVMNQAP-UHFFFAOYSA-M 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 230000003612 virological effect Effects 0.000 description 1
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- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la hepatologie şi poate fi utilizată pentru profilaxia hemoragiilor variceale la bolnavii cu ciroză hepatică decompensată. The invention relates to medicine, in particular to hepatology and can be used for the prophylaxis of variceal hemorrhages in patients with decompensated liver cirrhosis.
Este cunoscută metoda de hemostază endoscopică a hemoragiilor variceale cirogene cu utilizarea soluţiei alcoolice de tetradecil sulfat de sodiu, care provoacă sclerozarea vasului [1]. The method of endoscopic hemostasis of surgical variceal hemorrhages using an alcoholic solution of sodium tetradecyl sulfate, which causes vessel sclerosis, is known [1].
Dezavantajele metodei de sclerozare a varicelor constau în neeficacitatea utilizării ei în cazul varicelor de calibru mare, provocând dureri pronunţate după utilizare şi în unele cazuri necroze locale cu complicaţii severe şi anume perforaţii ale esofagului, mediastinite, recidive frecvente de hemoragii repetate, iar la distanţă se poate complica cu stenoze esofagiene în rezultatul proceselor sclero-atrofice după manipulaţii repetate. The disadvantages of the varicose vein sclerotherapy method are its ineffectiveness in the case of large-caliber varicose veins, causing severe pain after use and in some cases local necrosis with severe complications, namely esophageal perforations, mediastinitis, frequent relapses of repeated bleeding, and at a distance it can be complicated by esophageal stenosis as a result of sclero-atrophic processes after repeated manipulations.
Mai este cunoscută metoda de hemostază a hemoragiilor variceale prin ligaturarea varicelor cu benzi elastice cu ajutorului unui dispozitiv de aplicare, care este fixat pe endoscop [2]. Another known method of hemostasis of varicose bleeding is ligating the varicose veins with elastic bands using an application device, which is fixed to the endoscope [2].
Dezavantajele metodei menţionate constau în aceea că ligaturile elastice nu pot fi aplicate în cazul sângerărilor din varicele gastrice fundice, din cauza posibilităţilor reduse de manevrare ale aplicatorului endoscopului, iar în cazul varicelor de calibru mare (>1 cm) în timpul aplicării ligaturilor poate fi lezat peretele varicelui cu provocarea unei hemoragii abundente. The disadvantages of the mentioned method are that elastic ligatures cannot be applied in the case of bleeding from fundic gastric varices, due to the limited maneuverability of the endoscope applicator, and in the case of large-caliber varices (>1 cm) during the application of ligatures, the variceal wall may be damaged, causing profuse bleeding.
Mai este cunoscută metoda de utilizare a adezivului fibrinic pentru hemostaza endoscopică a hemoragiilor variceale în ciroza hepatică, care este compus din fibrinogen, factorul XIII de coagulare, fibronectină, plasminogen şi aprotinină, care se amestecă cu soluţii de trombină şi clorură de Ca+2, în următorul raport al componentelor, la 1 ml: The method of using fibrin glue for endoscopic hemostasis of variceal hemorrhages in liver cirrhosis is also known, which is composed of fibrinogen, coagulation factor XIII, fibronectin, plasminogen and aprotinin, which are mixed with solutions of thrombin and Ca+2 chloride, in the following ratio of components, per 1 ml:
fibrinogen (mg) 70...110 factorul XIII (UI) 10...50 fibronectină (mg) 2...9 plasminogen (mg) 20...120 aprotinină (KIU) 3000 trombină (UI) 500 clorură de Ca+2 (µmol) 40 [3].fibrinogen (mg) 70...110 factor XIII (IU) 10...50 fibronectin (mg) 2...9 plasminogen (mg) 20...120 aprotinin (KIU) 3000 thrombin (IU) 500 Ca+2 chloride (µmol) 40 [3].
Dezavantajele adezivului fibrinic cunoscut constau în aceea că polimerizarea lui are loc imediat după combinarea componentelor, ceea ce nu permite introducerea lui în lumenul varicelui sângerând prin cateterul de injectare al endoscopului lung de 150 cm, datorită polimerizării rapide a compusului cu obturarea lumenului cateterului, aderarea slabă la peretele vascular şi risc de expulzare spontană al cheagului fibrinic. The disadvantages of the known fibrin glue are that its polymerization occurs immediately after combining the components, which does not allow its introduction into the lumen of the bleeding variceal vein through the injection catheter of the 150 cm long endoscope, due to the rapid polymerization of the compound with occlusion of the catheter lumen, poor adhesion to the vascular wall and risk of spontaneous expulsion of the fibrin clot.
De asemenea, este cunoscută metoda de hemostază endoscopică a hemoragiilor variceale prin utilizarea adezivului fibrinic, care conţine soluţie de fibrinogen, care se amestecă cu soluţii de aprotinină, trombină, clorură de Ca+2 şi adrenalină, în următorul raport al componentelor, la 1 ml: Also known is the method of endoscopic hemostasis of variceal hemorrhages by using fibrin glue, which contains fibrinogen solution, which is mixed with solutions of aprotinin, thrombin, Ca+2 chloride and adrenaline, in the following ratio of components, per 1 ml:
soluţie de fibrinogen (mg) 15...30 soluţie de aprotinină (KIU) 250...1000 soluţie de trombină (UI) 25...100 soluţie de clorură de Ca+2 (µmol) 15...30 soluţie de adrenalină (mg) 0,1...0,3 [4].fibrinogen solution (mg) 15...30 aprotinin solution (KIU) 250...1000 thrombin solution (UI) 25...100 Ca+2 chloride solution (µmol) 15...30 adrenaline solution (mg) 0.1...0.3 [4].
Dezavantajele metodei constau în aceea că la injectarea componentelor adezivului în varicele sângerând cu formarea cheagului fibrinic poate surveni expulzarea spontană a cheagului din lumenul vasului din cauza presiunii venoase mari, consistenţei gelatinoase moi a cheagului fibrinic format şi fixării reduse a lui de peretele vascular. The disadvantages of the method are that when injecting the adhesive components into bleeding varicose veins with the formation of a fibrin clot, spontaneous expulsion of the clot from the vessel lumen may occur due to high venous pressure, the soft gelatinous consistency of the formed fibrin clot and its reduced fixation to the vascular wall.
Cea mai apropiată soluţie de invenţia revendicată este metoda de hemostază endoscopică a hemoragiilor variceale, care constă în aceea că endoscopic concomitent se injectează în lumenul varicelui două componente ale unui adeziv fibrinic şi anume, primul component, care include o soluţie de fibrinogen, şi al doilea component, care include un amestec de soluţii de trombină cu gelatină polisuccinilată, aprotinină şi clorură de Ca+2, în următorul raport al componentelor, la 1 ml: The closest solution to the claimed invention is the method of endoscopic hemostasis of varicose hemorrhages, which consists in simultaneously endoscopically injecting into the lumen of the varicose vein two components of a fibrin adhesive, namely, the first component, which includes a fibrinogen solution, and the second component, which includes a mixture of thrombin solutions with polysuccinylated gelatin, aprotinin and Ca+2 chloride, in the following ratio of components, per 1 ml:
soluţie de fibrinogen (mg) 15...45 soluţie de trombină (UI) 25...100 soluţie de gelatină polisuccinilată (mg) 120...360 soluţie de aprotinină (KIU) 250...1000 soluţie de clorură de Ca+2(µmol) 15...30 [5].fibrinogen solution (mg) 15...45 thrombin solution (IU) 25...100 polysuccinylated gelatin solution (mg) 120...360 aprotinin solution (KIU) 250...1000 Ca+2 chloride solution (µmol) 15...30 [5].
Dezavantajul celei mai apropiate soluţii constă în aceea că nu este eficientă, deoarece cheagul format din adezivul fibrinic nu este stabil, capacitatea de retracţie este de scurtă durată şi nu are loc formarea colateralelor extraluminale, ceea ce poate duce la recidiva hemoragiilor variceale. The disadvantage of the closest solution is that it is not effective, because the clot formed from fibrin glue is not stable, the retraction capacity is short-lived and the formation of extraluminal collaterals does not occur, which can lead to recurrence of variceal hemorrhages.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de hemostază endoscopică a hemoragiilor variceale în ciroza hepatică decompensată cu utilizarea unui adeziv fibrinic, care permite o hemostază eficientă cu formarea unui cheag dur şi stabil, cu o capacitate de retracţie îndelungată şi cu formarea colateralelor extraluminale paraesofagiene, ceea ce ar duce la profilaxia hemoragiilor variceale. The problem solved by the invention consists in developing a method for endoscopic hemostasis of variceal hemorrhages in decompensated liver cirrhosis using a fibrin adhesive, which allows for effective hemostasis with the formation of a hard and stable clot, with a long retraction capacity and with the formation of extraluminal paraesophageal collaterals, which would lead to the prophylaxis of variceal hemorrhages.
Esenţa invenţiei constă în aceea că endoscopic concomitent se injectează în lumenul varicelui două componente ale unui adeziv fibrinic şi anume, primul component include o soluţie de fibrinogen, iar al doilea component include un amestec de soluţii de trombină cu soluţie de albumină de 10%, aprotinină şi clorură de Ca+2, în următorul raport al componentelor, la 1 doză de adeziv: The essence of the invention consists in the fact that two components of a fibrin adhesive are simultaneously endoscopically injected into the lumen of the varicose vein, namely, the first component includes a fibrinogen solution, and the second component includes a mixture of thrombin solutions with 10% albumin solution, aprotinin and Ca+2 chloride, in the following ratio of components, per 1 dose of adhesive:
soluţie de fibrinogen (mg) 15...45 soluţie de trombină (UI) 25...100 soluţie de albumină de 10% (ml) 10...20 soluţie de aprotinină (KIU) 250...1000 soluţie de clorură de Ca+2(µmol) 15...30.fibrinogen solution (mg) 15...45 thrombin solution (IU) 25...100 10% albumin solution (ml) 10...20 aprotinin solution (KIU) 250...1000 Ca+2 chloride solution (µmol) 15...30.
Rezultatul invenţiei constă în aceea că permite o hemostază eficientă cu evitarea expulzării spontane a cheagului fibrinic, unei aderări eficiente de peretele vascular, datorită obţinerii unui cheag de o consistentă dură cu o capacitate de retracţie îndelungată şi cu formarea colateralelor extraluminale paraesofagiene, ceea ce duce la profilaxia hemoragiilor variceale. The result of the invention is that it allows for efficient hemostasis by avoiding spontaneous expulsion of the fibrin clot, efficient adhesion to the vascular wall, due to obtaining a clot of a hard consistency with a long retraction capacity and the formation of extraluminal paraesophageal collaterals, which leads to the prophylaxis of variceal hemorrhages.
Avantajele invenţiei: Advantages of the invention:
- obţinerea unui cheag fibrinic de o consistenţă dură; - obtaining a fibrin clot of a hard consistency;
- fixare sigură de pereţii interiori ai varicelui; - secure attachment to the inner walls of the varicose vein;
- formarea unui dop fibrinic consistent; - formation of a consistent fibrin plug;
- datorită consistenţei dure, perioada de degradare biologică a cheagului este de lungă durată; - due to the hard consistency, the biological degradation period of the rennet is long;
- formarea colateralelor extraluminale paraesofagiene - formation of extraluminal paraesophageal collaterals
- evitarea recidivelor hemoragice. - avoiding hemorrhagic relapses.
Metoda se efectuează în modul următor. The method is performed in the following way.
Pacientul diagnosticat cu risc major de hemoragie din varicele esofagiene în cazul hipertensiunii portale, cauzate de ciroza hepatica, se supune unui examen endoscopic, după care prin intermediul unui cateter introdus prin canalul de lucru al endoscopului se injectează în lumenul varicelui concomitent două componente ale unui adeziv fibrinic, şi anume primul component include soluţie de fibrinogen, iar al doilea component include amestecul de soluţii de trombină cu soluţie de albumină de 10%, aprotinină şi clorură de Ca+2, în următorul raport al componentelor, la 1 doză de adeziv fibrinic: The patient diagnosed with a major risk of bleeding from esophageal varices in the case of portal hypertension, caused by liver cirrhosis, undergoes an endoscopic examination, after which, through a catheter inserted through the working channel of the endoscope, two components of a fibrin glue are simultaneously injected into the lumen of the variceal vein, namely the first component includes fibrinogen solution, and the second component includes the mixture of thrombin solutions with 10% albumin solution, aprotinin and Ca+2 chloride, in the following ratio of components, per 1 dose of fibrin glue:
fibrinogen (mg) 15...45 trombină (UI) 25...100 albuină de 10% (ml) 10...20 aprotinină (KIU) 250...1000 clorură de Ca+2(µmol) 15...30.fibrinogen (mg) 15...45 thrombin (IU) 25...100 10% albumin (ml) 10...20 aprotinin (KIU) 250...1000 Ca+2 chloride (µmol) 15...30.
Soluţia de fibrinogen se aspiră într-o seringă, celelalte componente în combinaţie - în altă seringă, care se injectează separat printr-un cateter trifurcat la capătul proximul. În interiorul cateterului ambele componente se combină, iniţiind procesul de polimerizare cu formarea unui compus geliform, iar în interiorul varicelui are loc finisarea procesului de polimerizare cu formarea cheagului fibrinic stabil şi bine fixat de peretele vascular, care obturează lumenul vasului cu realizarea unei hemostaze eficiente. The fibrinogen solution is drawn into a syringe, the other components in combination - into another syringe, which is injected separately through a trifurcated catheter at the proximal end. Inside the catheter, both components combine, initiating the polymerization process with the formation of a gel-like compound, and inside the varicose vein, the polymerization process is completed with the formation of a stable fibrin clot well fixed to the vascular wall, which occludes the lumen of the vessel with the achievement of effective hemostasis.
Metoda revendicată a fost utilizată la 46 de pacienţi cu ciroză hepatică şi hipertensiune portală cu risc major de hemoragii variceale. The claimed method was used in 46 patients with liver cirrhosis and portal hypertension at high risk of variceal bleeding.
Exemplu Example
Pacienta A., 45 de ani, spitalizată în secţia chirurgie cu diagnosticul: Ciroză hepatică decompensată Child C 10) de etiologie virală HVB şi HVC. Hipertensiune portală. Varice gastroesofagiene gr. III-IV. Risc major de hemoragie. La fibroesofagogastroscopie s-au determinat prezenţa de varice esofagiene de gr. III-IV în 1/3 inferioară al esofagului. S-a efectuat metoda revendicată de profilaxie a hemoragiilor prin injectarea în lumenul varicelui concomitent a două componente ale adezivului fibrinic şi anume, primul component include soluţie de fibrinogen, iar al doilea component include amestecul de soluţii de trombină cu soluţie de albumină de 10%, aprotinină şi clorură de Ca+2, în raportul cantitativ revendicat. După injectare s-a obţinut formarea unui cheag fibrinic dur şi stabil şi bine fixat în lumenul variceal cu umplerea completă a lumenului varicelui. Externată peste 8 zile în stare satisfăcătoare. Patient A., 45 years old, hospitalized in the surgery department with the diagnosis: Decompensated liver cirrhosis Child C 10) of viral etiology HBV and HCV. Portal hypertension. Gastroesophageal varices gr. III-IV. Major risk of hemorrhage. During fibroesophagogastroscopy, the presence of esophageal varices gr. III-IV in the lower 1/3 of the esophagus was determined. The claimed method of hemorrhage prophylaxis was performed by injecting into the lumen of the variceal vein simultaneously two components of the fibrin glue, namely, the first component includes fibrinogen solution, and the second component includes the mixture of thrombin solutions with 10% albumin solution, aprotinin and Ca+2 chloride, in the claimed quantitative ratio. After injection, the formation of a hard and stable fibrin clot was obtained and well fixed in the variceal lumen with complete filling of the lumen of the variceal vein. Discharged after 8 days in satisfactory condition.
1. Paquet K.J., Kuhn R. Prophylactic Endoscopic sclerotherapy in Patients with Liver Cirrhosis, Portal Hypertension and Esophageal Varices.- Hepato-Gastroenterology, 1997, no44, p. 625-636 1. Paquet K.J., Kuhn R. Prophylactic Endoscopic sclerotherapy in Patients with Liver Cirrhosis, Portal Hypertension and Esophageal Varices.- Hepato-Gastroenterology, 1997, no44, p. 625-636
2. Yoshida H., Mamada Y., Taniai N., Yamamoto K., Kawano Y., Mizuguchi Y, et al. A randomized trial control trial of bimonthly versus biweekly endoscopic variceal ligation of esophageal varices. Am. J. Gastroenterol., 2005, no100, p. 2005-2009 2. Yoshida H., Mamada Y., Taniai N., Yamamoto K., Kawano Y., Mizuguchi Y., et al. A randomized control trial of bimonthly versus biweekly endoscopic variceal ligation of esophageal varices. I have. J. Gastroenterol., 2005, no100, p. 2005-2009
3. AT 359652 A 1980.04.15 3. AT 359652 A 1980.04.15
4. MD 2328 F1 2003.12.31 4. MD 2328 F1 2003.12.31
5. MD 1511 Y 2021.03.31 5. MD 1511 Y 2021.03.31
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