MD620Z - Method for selective decontamination of gastrointestinal tract in the intestinal failure syndrome - Google Patents
Method for selective decontamination of gastrointestinal tract in the intestinal failure syndrome Download PDFInfo
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- MD620Z MD620Z MDS20120137A MDS20120137A MD620Z MD 620 Z MD620 Z MD 620Z MD S20120137 A MDS20120137 A MD S20120137A MD S20120137 A MDS20120137 A MD S20120137A MD 620 Z MD620 Z MD 620Z
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- Moldova
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- intestinal
- gastrointestinal tract
- failure syndrome
- intestinal failure
- selective decontamination
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- 238000000034 method Methods 0.000 title claims abstract description 14
- 208000011580 syndromic disease Diseases 0.000 title claims abstract description 12
- 210000001035 gastrointestinal tract Anatomy 0.000 title claims abstract description 10
- 238000005202 decontamination Methods 0.000 title claims abstract description 9
- 230000003588 decontaminative effect Effects 0.000 title claims abstract description 8
- 208000037112 Intestinal Failure Diseases 0.000 title abstract description 4
- ULGZDMOVFRHVEP-RWJQBGPGSA-N Erythromycin Chemical compound O([C@@H]1[C@@H](C)C(=O)O[C@@H]([C@@]([C@H](O)[C@@H](C)C(=O)[C@H](C)C[C@@](C)(O)[C@H](O[C@H]2[C@@H]([C@H](C[C@@H](C)O2)N(C)C)O)[C@H]1C)(C)O)CC)[C@H]1C[C@@](C)(OC)[C@@H](O)[C@H](C)O1 ULGZDMOVFRHVEP-RWJQBGPGSA-N 0.000 claims abstract description 14
- CBENFWSGALASAD-UHFFFAOYSA-N Ozone Chemical compound [O-][O+]=O CBENFWSGALASAD-UHFFFAOYSA-N 0.000 claims abstract description 9
- 229960003276 erythromycin Drugs 0.000 claims abstract description 7
- 238000002627 tracheal intubation Methods 0.000 claims abstract description 6
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims abstract description 5
- 239000011780 sodium chloride Substances 0.000 claims abstract description 3
- 230000000968 intestinal effect Effects 0.000 claims description 18
- 239000000523 sample Substances 0.000 claims description 6
- 239000002504 physiological saline solution Substances 0.000 claims description 2
- 230000002980 postoperative effect Effects 0.000 abstract description 7
- 238000011282 treatment Methods 0.000 abstract description 7
- 230000001154 acute effect Effects 0.000 abstract description 4
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 abstract description 2
- 239000003814 drug Substances 0.000 abstract description 2
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- 210000000683 abdominal cavity Anatomy 0.000 description 4
- 230000000844 anti-bacterial effect Effects 0.000 description 4
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- 238000002350 laparotomy Methods 0.000 description 2
- 230000000813 microbial effect Effects 0.000 description 2
- 230000007659 motor function Effects 0.000 description 2
- 230000008855 peristalsis Effects 0.000 description 2
- 210000003200 peritoneal cavity Anatomy 0.000 description 2
- 206010034674 peritonitis Diseases 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 238000011321 prophylaxis Methods 0.000 description 2
- 210000002966 serum Anatomy 0.000 description 2
- 210000000813 small intestine Anatomy 0.000 description 2
- 230000005945 translocation Effects 0.000 description 2
- 206010000060 Abdominal distension Diseases 0.000 description 1
- 208000009663 Acute Necrotizing Pancreatitis Diseases 0.000 description 1
- 206010012735 Diarrhoea Diseases 0.000 description 1
- CEAZRRDELHUEMR-URQXQFDESA-N Gentamicin Chemical compound O1[C@H](C(C)NC)CC[C@@H](N)[C@H]1O[C@H]1[C@H](O)[C@@H](O[C@@H]2[C@@H]([C@@H](NC)[C@@](C)(O)CO2)O)[C@H](N)C[C@@H]1N CEAZRRDELHUEMR-URQXQFDESA-N 0.000 description 1
- 229930182566 Gentamicin Natural products 0.000 description 1
- 206010020751 Hypersensitivity Diseases 0.000 description 1
- 241000736262 Microbiota Species 0.000 description 1
- 102000057413 Motilin receptors Human genes 0.000 description 1
- 108700040483 Motilin receptors Proteins 0.000 description 1
- 206010028813 Nausea Diseases 0.000 description 1
- 206010058096 Pancreatic necrosis Diseases 0.000 description 1
- 108010040201 Polymyxins Proteins 0.000 description 1
- 206010057190 Respiratory tract infections Diseases 0.000 description 1
- 206010046306 Upper respiratory tract infection Diseases 0.000 description 1
- 206010047700 Vomiting Diseases 0.000 description 1
- 238000012084 abdominal surgery Methods 0.000 description 1
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- 238000010521 absorption reaction Methods 0.000 description 1
- 239000000556 agonist Substances 0.000 description 1
- 239000003242 anti bacterial agent Substances 0.000 description 1
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- 229960002518 gentamicin Drugs 0.000 description 1
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- 230000003871 intestinal function Effects 0.000 description 1
- 230000008991 intestinal motility Effects 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 210000000566 lesser sac Anatomy 0.000 description 1
- 230000002906 microbiologic effect Effects 0.000 description 1
- 244000005706 microflora Species 0.000 description 1
- 230000008693 nausea Effects 0.000 description 1
- 229960000988 nystatin Drugs 0.000 description 1
- VQOXZBDYSJBXMA-NQTDYLQESA-N nystatin A1 Chemical compound O[C@H]1[C@@H](N)[C@H](O)[C@@H](C)O[C@H]1O[C@H]1/C=C/C=C/C=C/C=C/CC/C=C/C=C/[C@H](C)[C@@H](O)[C@@H](C)[C@H](C)OC(=O)C[C@H](O)C[C@H](O)C[C@H](O)CC[C@@H](O)[C@H](O)C[C@](O)(C[C@H](O)[C@H]2C(O)=O)O[C@H]2C1 VQOXZBDYSJBXMA-NQTDYLQESA-N 0.000 description 1
- 210000000496 pancreas Anatomy 0.000 description 1
- 230000001717 pathogenic effect Effects 0.000 description 1
- 230000002265 prevention Effects 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 210000000664 rectum Anatomy 0.000 description 1
- 230000009467 reduction Effects 0.000 description 1
- 238000002271 resection Methods 0.000 description 1
- 230000003248 secreting effect Effects 0.000 description 1
- 238000001228 spectrum Methods 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 208000024891 symptom Diseases 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 231100000331 toxic Toxicity 0.000 description 1
- 230000002588 toxic effect Effects 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- 238000002604 ultrasonography Methods 0.000 description 1
- 210000002438 upper gastrointestinal tract Anatomy 0.000 description 1
- 208000019206 urinary tract infection Diseases 0.000 description 1
- 230000008673 vomiting Effects 0.000 description 1
Landscapes
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la chirurgie şi poate fi aplicată pentru tratamentul sindromului de insuficienţă intestinală în perioada postoperatorie la pacienţii cu patologii chirurgicale acute. The invention relates to medicine, in particular to surgery, and can be applied for the treatment of intestinal insufficiency syndrome in the postoperative period in patients with acute surgical pathologies.
Sindromul insuficienţei intestinale reprezintă totalitatea dereglărilor motorii, evacuatorii, secretorii, digestiei, funcţiei de absorbţie cu dereglarea funcţiei de barieră a peretelui intestinal manifestându-se prin translocarea florei microbiene din lumenul intestinal în cavitatea peritoneală sterilă. Totodată, e cunoscut faptul că în cadrul parezei şi stazei intestinale are loc contaminarea segmentelor proximale ale intestinului subţire din contul microflorei convenţional patogene, ca urmare a translocaţiei retrograde a reprezentanţilor microbiotei colonice. Astfel, sindromul insuficienţei intestinale reprezintă o problemă majoră pentru chirurgi, care apare în perioada postoperatorie la intervenţiile chirurgicale în caz de peritonită. Intestinal insufficiency syndrome represents the totality of motor, evacuatory, secretory, digestive, absorption function disorders with disruption of the barrier function of the intestinal wall, manifested by the translocation of microbial flora from the intestinal lumen into the sterile peritoneal cavity. At the same time, it is known that in intestinal paresis and stasis, contamination of the proximal segments of the small intestine occurs due to conventionally pathogenic microflora, as a result of the retrograde translocation of representatives of the colonic microbiota. Thus, intestinal insufficiency syndrome represents a major problem for surgeons, which occurs in the postoperative period during surgical interventions in case of peritonitis.
Este cunoscută metoda de decontaminare a tractului digestiv cu utilizarea preparatelor antibacteriale cu spectru selectiv de acţiune, care constă în introducerea în lumenul gastrointestinal prin sondă a complexului de remedii antibacteriene (ghentamicină, polimixină, nistatină) timp de 7…10 zile. Investigaţiile microbiologice demonstrează că regimul de decontaminare selectivă diminuează semnificativ gradul de colonizare şi infectare a tractului gastrointestinal, căilor respiratorii superioare şi a uroinfecţiei [1]. The method of decontamination of the digestive tract using antibacterial preparations with a selective spectrum of action is known, which consists in introducing into the gastrointestinal lumen through a probe a complex of antibacterial remedies (gentamicin, polymyxin, nystatin) for 7…10 days. Microbiological investigations demonstrate that the selective decontamination regimen significantly reduces the degree of colonization and infection of the gastrointestinal tract, upper respiratory tract and urinary tract infection [1].
Dezavantajele metodei constă în posibilităţi limitate de aplicare din cauza reacţiilor alergice faţă de complexul de antibiotice, intoleranţă individuală la preparatele antibacteriene, efect toxic sau imunosupresiv al unor antibiotice în dozaj submaximal, antibioticorezistenţa naturală a florei microbiene. The disadvantages of the method consist of limited possibilities of application due to allergic reactions to the antibiotic complex, individual intolerance to antibacterial preparations, toxic or immunosuppressive effect of some antibiotics in submaximal dosage, natural antibiotic resistance of microbial flora.
Este cunoscută metoda de decontaminare selectivă a tractului gastrointestinal în sindromul insuficienţei intestinale în pancreonecroză, care constă în efectuarea laparatomiei, abdominizarea pancreasului, marsupializarea, drenarea bursei omentale, intubarea intestinală cu ajutorul unei sonde nasogastrale, administrarea prin sonda instalată a unei soluţii de ser fiziologic ozonat în volum de 200 ml cu concentraţia ozonului de 4…7 mg/l, de 2 ori pe zi, timp de 7 zile, concomitent se administrează per rectum ser fiziologic ozonat în volum de 300 ml cu concentraţia ozonului de 30 mg/l, de 7 ori cu un interval de 3…4 zile [2]. The method of selective decontamination of the gastrointestinal tract in intestinal failure syndrome in pancreatic necrosis is known, which consists of performing laparotomy, abdominization of the pancreas, marsupialization, drainage of the omental bursa, intestinal intubation using a nasogastric tube, administration through the installed tube of a solution of ozonated physiological serum in a volume of 200 ml with an ozone concentration of 4…7 mg/l, 2 times a day, for 7 days, simultaneously administering per rectum ozonated physiological serum in a volume of 300 ml with an ozone concentration of 30 mg/l, 7 times with an interval of 3…4 days [2].
Dezavantajele metodei constau în efectul bacteriostatic insuficient, nu acţionează asupra motoricii intestinale care necesită un timp îndelungat de restabilire a tranzitului gastrointestinal. The disadvantages of the method are the insufficient bacteriostatic effect, it does not act on intestinal motility which requires a long time to restore gastrointestinal transit.
Problema pe care o soluţionează invenţia constă în elaborarea unei metode eficiente de decontaminare, care ar acţiona concomitent asupra tuturor verigilor care provoacă sindromul de insuficienţă intestinală, ar restabili tranzitul intestinal într-un timp mai redus, ar micşora frecvenţa complicaţiilor postoperatorii, şi anume translocarea bacteriană din lumenul intestinal în cavitatea abdominală care ar agrava starea pacientului. The problem that the invention solves consists in developing an effective decontamination method, which would act simultaneously on all the links that cause intestinal insufficiency syndrome, would restore intestinal transit in a shorter time, would reduce the frequency of postoperative complications, namely bacterial translocation from the intestinal lumen into the abdominal cavity which would worsen the patient's condition.
Conform invenţiei metoda de decontaminare selectivă a tractului gastrointestinal în sindromul insuficienţei intestinale constă în aceea că se efectuează intubarea nasogastrică sau nasointestinală, apoi se administrează prin sondă sol. fiziologică ozonată în cantitate de 200 ml cu concentraţia ozonului de 5…7 mg/L şi sol. eritromicină 500 mg, de 2 ori pe zi, concomitent timp de 30 min se iradiază regiunea epigastrică cu unde electromagnetice în diapazon milimetric cu intensitatea de 10 mW/cm şi lungimea de undă de 7,1 nm, cura constituie 7 zile. According to the invention, the method of selective decontamination of the gastrointestinal tract in intestinal insufficiency syndrome consists in performing nasogastric or nasointestinal intubation, then administering through a probe ozonated physiological saline in an amount of 200 ml with an ozone concentration of 5…7 mg/L and erythromycin saline 500 mg, 2 times a day, simultaneously for 30 min the epigastric region is irradiated with electromagnetic waves in the millimeter range with an intensity of 10 mW/cm and a wavelength of 7.1 nm, the course is 7 days.
Rezultatul invenţiei este tratamentul efectiv şi profilaxia complicaţiilor condiţionate de colonizarea proximală a tractului gastrointestinal, rezolvarea ocluziei intestinale dinamice cu restabilirea peristaltismului şi tranzitului intestinal într-o perioadă scurtă de timp, ceea ce duce la profilaxia complicaţiilor postoperatorii severe şi restabilirea pacienţilor în perioada postoperatorie cu micşorarea duratei de spitalizare şi a sinecostului tratamentului. The result of the invention is the effective treatment and prophylaxis of complications caused by proximal colonization of the gastrointestinal tract, resolution of dynamic intestinal occlusion with restoration of peristalsis and intestinal transit in a short period of time, which leads to the prophylaxis of severe postoperative complications and the recovery of patients in the postoperative period with a decrease in the duration of hospitalization and the cost of treatment.
Avantajele metodei revendicate sunt: The advantages of the claimed method are:
micşorarea colonizării proximale a tractului gastrointestinal cu reducerea frecvenţei complicaţiilor postoperatorii, reducing proximal colonization of the gastrointestinal tract with a reduction in the frequency of postoperative complications,
restabilirea timpurie a tranzitului intestinal, care preîntâmpină translocarea bacteriană din lumenul intestinal în cavitatea abdominală, early restoration of intestinal transit, which prevents bacterial translocation from the intestinal lumen into the abdominal cavity,
micşorarea duratei de spitalizare şi a sinecostului tratamentului. reducing the duration of hospitalization and the cost of treatment.
Totodată în scopul amplificării acţiunii bactericide şi potenţarea funcţiei motorii se utilizează ozonoterapia în combinare cu eritromicină (antibiotic cu acţiune prokinetică - agonist al receptorilor motilinici, care accelerează evacuarea conţinutului gastric datorită creşterii amplitudinii contracţiei pilorului şi îmbunătăţirii coordonării antral-duodenale). Administrarea soluţiei de ozon cu eritromicină şi iradierea cu unde electromagnetice se efectuează până la restabilirea funcţiei motorii a tractului gastrointestinal. At the same time, in order to amplify the bactericidal action and enhance the motor function, ozone therapy is used in combination with erythromycin (antibiotic with prokinetic action - agonist of motilin receptors, which accelerates the evacuation of gastric contents due to the increase in the amplitude of the pyloric contraction and the improvement of antral-duodenal coordination). The administration of the ozone solution with erythromycin and irradiation with electromagnetic waves is carried out until the motor function of the gastrointestinal tract is restored.
Metoda se efectuează în modul următor. The method is performed in the following way.
Manifestarea sindromului de insuficienţă intestinală este cauzată de o patologie chirurgicală acută sau apare în perioada postoperatorie după o intervenţie chirurgicală abdominală. Dacă este cauzată de o patologie chirurgicală acută se efectuează examenul clinic şi paraclinic pentru depistarea cauzei ce a provocat sindromul menţionat. În perioada postoperatorie precoce se utilizează metoda dată. Se efectuează intubarea nasogastrică sau nasointestinală cu administrarea prin sonda instalată a soluţiei de ser fiziologic ozonat în volum de 200 ml cu concentraţia ozonului de 5…7 mg/l şi cu soluţie de eritromicină 500 mg, care se administrează de 2 ori pe zi, concomitent timp de 30 min se iradiază regiunea epigastrică cu unde electromagnetice în diapazon milimetric cu intensitatea mai mică de 10 mW/cm şi lungimea de undă de 7,1 mm, cura de tratament se efectuează timp de 7 zile. The manifestation of intestinal insufficiency syndrome is caused by an acute surgical pathology or occurs in the postoperative period after abdominal surgery. If it is caused by an acute surgical pathology, a clinical and paraclinical examination is performed to detect the cause that caused the aforementioned syndrome. In the early postoperative period, the given method is used. Nasogastric or nasointestinal intubation is performed with the administration through the installed probe of ozonated saline solution in a volume of 200 ml with an ozone concentration of 5…7 mg/l and erythromycin solution 500 mg, which is administered 2 times a day, simultaneously for 30 min the epigastric region is irradiated with electromagnetic waves in the millimeter range with an intensity of less than 10 mW/cm and a wavelength of 7.1 mm, the treatment course is carried out for 7 days.
Metoda dată a fost aplicată la 14 pacienţi. This method was applied to 14 patients.
Exemplu Example
Pacientul D., 57 ani a fost internat în secţia chirurgie generală cu diagnosticul la internare de peritonită generalizată. La internare acuză dureri pronunţate pe tot traiectul abdominal, balonare, absenţa tranzitului intestinal care se manifestă prin lipsa emisiilor de gaze şi lipsa scaunului, vome, greţuri. Din anamneză se determină că simptomele au apărut cu 10 ore în urmă şi au progresat în timp. S-a stabilit că provocări alimentare sau traumatism abdominal nu au fost. Stare generală gravă. La examenul radiologic se determină aer liber în cavitatea abdominală, la examenul ultrasonor se atestă prezenţa lichidului liber în cavitatea abdominală. S-a efectuat operaţie de urgenţă - laparotomie, rezecţia unui segment de ileon perforat, asanarea şi drenarea cavităţii peritoneale, intubarea intraoperatorie a intestinului subţire cu sondă nasointestinală. Perioada postoperatorie se manifestă cu semne clinice de insuficienţă intestinală, pareză. Prin sonda instalată se administrează soluţie de ser fiziologic ozonat în volum de 200 ml cu concentraţia ozonului de 5…7 mg/l şi cu soluţie de eritromicină 500 mg, care se administrează de 2 ori pe zi, concomitent timp de 30 min se iradiază regiunea epigastrică cu unde electromagnetice în diapazon milimetric cu intensitatea mai mică de 10 mW/cm şi lungimea de undă de 7,1 mm, cura de tratament durează timp de 7 zile. Patient D., 57 years old, was admitted to the general surgery department with a diagnosis of generalized peritonitis upon admission. Upon admission, he complained of severe pain throughout the abdominal tract, bloating, absence of bowel movement, which is manifested by the lack of gas emissions and the lack of stool, vomiting, nausea. From the anamnesis, it is determined that the symptoms appeared 10 hours ago and progressed over time. It was established that there were no food challenges or abdominal trauma. General condition is serious. The radiological examination determines free air in the abdominal cavity, the ultrasound examination attests the presence of free fluid in the abdominal cavity. Emergency surgery was performed - laparotomy, resection of a segment of perforated ileum, sanitation and drainage of the peritoneal cavity, intraoperative intubation of the small intestine with a nasointestinal probe. The postoperative period is manifested by clinical signs of intestinal insufficiency, paresis. Through the installed probe, ozonated saline solution in a volume of 200 ml with an ozone concentration of 5…7 mg/l and erythromycin solution 500 mg is administered, which is administered 2 times a day, simultaneously for 30 min the epigastric region is irradiated with electromagnetic waves in the millimeter range with an intensity of less than 10 mW/cm and a wavelength of 7.1 mm, the treatment course lasts for 7 days.
După aplicarea metodei date starea generală s-a îmbunătăţit, s-a restabilit funcţia intestinului obiectivizată prin apariţia mai timpurie a perstaltismului, emisiei de gaze, scaun desinestătător. After applying the given method, the general condition improved, the intestinal function was restored, objectified by the earlier appearance of peristalsis, gas emission, and loose stools.
1. Stoutenbeek C. P., van Saene H. K. F., Miranda D. R., and Zandstra D. F. A new technique of infection prevention in the intensive care unit by selective decontamination of the digestive tract. Acta naesthesiologica Belgia, 2983, vol. 34, nr. 3, p.209-221 1. Stoutenbeek C. P., van Saene H. K. F., Miranda D. R., and Zandstra D. F. A new technique of infection prevention in the intensive care unit by selective decontamination of the digestive tract. Acta naesthesiologica Belgia, 2983, vol. 34, no. 3, p.209-221
2. RU 2194513 C2 2002.12.20 2. RU 2194513 C2 2002.12.20
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| MDS20120137A MD620Z (en) | 2012-10-08 | 2012-10-08 | Method for selective decontamination of gastrointestinal tract in the intestinal failure syndrome |
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| MDS20120137A MD620Z (en) | 2012-10-08 | 2012-10-08 | Method for selective decontamination of gastrointestinal tract in the intestinal failure syndrome |
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| RU2709113C1 (en) * | 2019-02-19 | 2019-12-16 | Михаил Викторович Быков | Method of treating intestinal failure with an oxygenated saline enteral solution |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD888G2 (en) * | 1997-04-17 | 1998-10-31 | Gavril Boian | Method for postoperation complications prophylaxis at the planned proctological operations |
| RU2194513C2 (en) * | 2001-01-25 | 2002-12-20 | Красноярская государственная медицинская академия | Method for decontamination of gastrointestinal tract by using ozone in pancreonecrosis-suffering patients |
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Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD888G2 (en) * | 1997-04-17 | 1998-10-31 | Gavril Boian | Method for postoperation complications prophylaxis at the planned proctological operations |
| RU2194513C2 (en) * | 2001-01-25 | 2002-12-20 | Красноярская государственная медицинская академия | Method for decontamination of gastrointestinal tract by using ozone in pancreonecrosis-suffering patients |
Non-Patent Citations (1)
| Title |
|---|
| Stoutenbeek C. P., van Saene H. K. F., Miranda D. R., and Zandstra D. F. A new technique of infection prevention in the intensive care unit by selective decontamination of the digestive tract. Acta naesthesiologica Belgia, 2983, vol. 34, nr. 3, p.209-221 * |
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|---|---|---|---|
| FG9Y | Short term patent issued | ||
| KA4Y | Short-term patent lapsed due to non-payment of fees (with right of restoration) | ||
| MM4Y | Short-term patent definitely lapsed due to non-payment of fees |