MD926Z - Method of laparoscopic treatment of spontaneous bacterial ascites-peritonitis in decompensated liver cirrhosis - Google Patents
Method of laparoscopic treatment of spontaneous bacterial ascites-peritonitis in decompensated liver cirrhosis Download PDFInfo
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- MD926Z MD926Z MDS20140120A MDS20140120A MD926Z MD 926 Z MD926 Z MD 926Z MD S20140120 A MDS20140120 A MD S20140120A MD S20140120 A MDS20140120 A MD S20140120A MD 926 Z MD926 Z MD 926Z
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- drain
- ascitic fluid
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- 238000000034 method Methods 0.000 title claims abstract description 15
- 206010003445 Ascites Diseases 0.000 title claims description 7
- 230000001580 bacterial effect Effects 0.000 title claims description 5
- 206010034674 peritonitis Diseases 0.000 title claims description 5
- 230000002269 spontaneous effect Effects 0.000 title claims description 5
- 208000019425 cirrhosis of liver Diseases 0.000 title claims description 4
- 210000003567 ascitic fluid Anatomy 0.000 claims abstract description 25
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims abstract description 15
- 239000003242 anti bacterial agent Substances 0.000 claims abstract description 9
- 230000005587 bubbling Effects 0.000 claims abstract description 8
- 238000002560 therapeutic procedure Methods 0.000 claims abstract description 6
- NNJVILVZKWQKPM-UHFFFAOYSA-N Lidocaine Chemical compound CCN(CC)CC(=O)NC1=C(C)C=CC=C1C NNJVILVZKWQKPM-UHFFFAOYSA-N 0.000 claims abstract description 5
- 229940088710 antibiotic agent Drugs 0.000 claims abstract description 5
- UREBDLICKHMUKA-CXSFZGCWSA-N dexamethasone Chemical compound C1CC2=CC(=O)C=C[C@]2(C)[C@]2(F)[C@@H]1[C@@H]1C[C@@H](C)[C@@](C(=O)CO)(O)[C@@]1(C)C[C@@H]2O UREBDLICKHMUKA-CXSFZGCWSA-N 0.000 claims abstract description 5
- 229960003957 dexamethasone Drugs 0.000 claims abstract description 5
- 239000002934 diuretic Substances 0.000 claims abstract description 5
- 229960004194 lidocaine Drugs 0.000 claims abstract description 5
- 230000000007 visual effect Effects 0.000 claims abstract description 5
- 150000001413 amino acids Chemical class 0.000 claims abstract description 4
- 239000004599 antimicrobial Substances 0.000 claims abstract description 4
- 230000003115 biocidal effect Effects 0.000 claims abstract description 4
- 229940124307 fluoroquinolone Drugs 0.000 claims abstract description 4
- 238000007911 parenteral administration Methods 0.000 claims abstract description 4
- 238000002360 preparation method Methods 0.000 claims description 9
- 230000003187 abdominal effect Effects 0.000 claims description 6
- 108010065073 lidase Proteins 0.000 claims description 4
- 230000000845 anti-microbial effect Effects 0.000 claims description 3
- 125000001271 cephalosporin group Chemical group 0.000 claims description 3
- 239000002689 soil Substances 0.000 claims description 3
- 229940030606 diuretics Drugs 0.000 claims description 2
- 239000003814 drug Substances 0.000 abstract description 3
- 229930186147 Cephalosporin Natural products 0.000 abstract description 2
- 229940124587 cephalosporin Drugs 0.000 abstract description 2
- 150000001780 cephalosporins Chemical class 0.000 abstract description 2
- 210000001015 abdomen Anatomy 0.000 abstract 1
- 229940079593 drug Drugs 0.000 abstract 1
- 208000004880 Polyuria Diseases 0.000 description 3
- 238000003745 diagnosis Methods 0.000 description 3
- 230000035619 diuresis Effects 0.000 description 3
- 230000004054 inflammatory process Effects 0.000 description 3
- 206010037660 Pyrexia Diseases 0.000 description 2
- 229960004755 ceftriaxone Drugs 0.000 description 2
- VAAUVRVFOQPIGI-SPQHTLEESA-N ceftriaxone Chemical compound S([C@@H]1[C@@H](C(N1C=1C(O)=O)=O)NC(=O)\C(=N/OC)C=2N=C(N)SC=2)CC=1CSC1=NC(=O)C(=O)NN1C VAAUVRVFOQPIGI-SPQHTLEESA-N 0.000 description 2
- 230000001882 diuretic effect Effects 0.000 description 2
- 230000002443 hepatoprotective effect Effects 0.000 description 2
- 208000004998 Abdominal Pain Diseases 0.000 description 1
- 102000009027 Albumins Human genes 0.000 description 1
- 108010088751 Albumins Proteins 0.000 description 1
- 206010030302 Oliguria Diseases 0.000 description 1
- 206010062070 Peritonitis bacterial Diseases 0.000 description 1
- 230000000844 anti-bacterial effect Effects 0.000 description 1
- 150000005693 branched-chain amino acids Chemical class 0.000 description 1
- 229960000484 ceftazidime Drugs 0.000 description 1
- NMVPEQXCMGEDNH-TZVUEUGBSA-N ceftazidime pentahydrate Chemical compound O.O.O.O.O.S([C@@H]1[C@@H](C(N1C=1C([O-])=O)=O)NC(=O)\C(=N/OC(C)(C)C(O)=O)C=2N=C(N)SC=2)CC=1C[N+]1=CC=CC=C1 NMVPEQXCMGEDNH-TZVUEUGBSA-N 0.000 description 1
- MYSWGUAQZAJSOK-UHFFFAOYSA-N ciprofloxacin Chemical compound C12=CC(N3CCNCC3)=C(F)C=C2C(=O)C(C(=O)O)=CN1C1CC1 MYSWGUAQZAJSOK-UHFFFAOYSA-N 0.000 description 1
- 230000006835 compression Effects 0.000 description 1
- 238000007906 compression Methods 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 206010016766 flatulence Diseases 0.000 description 1
- 238000001802 infusion Methods 0.000 description 1
- 238000007912 intraperitoneal administration Methods 0.000 description 1
- 238000007449 liver function test Methods 0.000 description 1
- 210000003622 mature neutrocyte Anatomy 0.000 description 1
- 229960000282 metronidazole Drugs 0.000 description 1
- VAOCPAMSLUNLGC-UHFFFAOYSA-N metronidazole Chemical compound CC1=NC=C([N+]([O-])=O)N1CCO VAOCPAMSLUNLGC-UHFFFAOYSA-N 0.000 description 1
- 230000004089 microcirculation Effects 0.000 description 1
- 230000008506 pathogenesis Effects 0.000 description 1
- 230000001717 pathogenic effect Effects 0.000 description 1
- 230000010412 perfusion Effects 0.000 description 1
- 208000007232 portal hypertension Diseases 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
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- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la hepatologie. The invention relates to medicine, in particular to hepatology.
Este cunoscută metoda de tratament al ascit-peritonitei bacteriene spontane, care constă în efectuarea laparocentezei de volum cu evacuarea lichidului ascitic contaminat şi administrarea i/v a antibioticelor, şi anume a preparatelor din grupa cefalosporinelor de generaţia III (ceftriaxonă, câte 1 g de 2 ori, timp de 5...7 zile), a preparatelor hepatoprotectoare, diuretice şi a aminoacizilor cu catenă ramificată [1]. The method of treatment of spontaneous bacterial ascites-peritonitis is known, which consists of performing volume laparocentesis with evacuation of contaminated ascitic fluid and i/v administration of antibiotics, namely preparations from the group of cephalosporins of the third generation (ceftriaxone, 1 g 2 times, for 5...7 days), hepatoprotective preparations, diuretics and branched-chain amino acids [1].
Dezavantajul metodei date constă în eficacitatea redusă şi procentul înalt de mortalitate din cauza progresării procesului septic intraabdominal şi a insuficienţei hepato-renale. The disadvantage of this method is its low effectiveness and high mortality rate due to the progression of intra-abdominal septic process and hepatorenal insufficiency.
Problema pe care o rezolvă invenţia constă în extinderea gamei metodelor de tratament laparoscopice al ascit-peritonitei bacteriene spontane, care ar face posibilă rezolvarea procesului septic inflamator intraabdominal, mărirea resorbţiei lichidului ascitic şi ameliorarea stării pacientului într-o perioadă scurtă de timp. The problem solved by the invention consists in expanding the range of laparoscopic treatment methods for spontaneous bacterial ascites-peritonitis, which would make it possible to resolve the intra-abdominal septic inflammatory process, increase the resorption of ascitic fluid and improve the patient's condition in a short period of time.
Conform invenţiei, metoda revendicată constă în aceea că se efectuează terapia intensivă, care include administrarea parenterală a antibioticelor, hepatoprotectoarelor, plasmei, aminoacizilor, preparatelor reologice, dezagregante şi diuretice, iar suplimentar se efectuează laparocenteza cu evacuarea a 3…5 L de lichid ascitic contaminat, apoi prin abord laparoscopic sub control vizual se instalează un dren în etajul abdominal inferior, prin care se insuflă CO2 în cantitate de 3000…5000 cm3, barbotându-l prin lichidul ascitic restant timp de 3…5 min, după care gazul administrat se evacuează prin trocarul superior, apoi prin dren se insuflă O2 în cantitate de 1000…3000 cm3, barbotându-l prin lichidul ascitic restant timp de 2…3 min, după care se evacuează tot lichidul ascitic restant, iar prin dren se introduce consecutiv sol. lidocaină 2% în cantitate de 20…30 ml, dexametazon 8…16 mg dizolvat în 100…200 ml de sol. NaCl 0,9%, lidază 370…640 U dizolvată în 200…500 ml de sol. NaCl 0,9%, un antibiotic din grupa cefalosporinelor şi un antimicrobian din grupa fluorchinolonelor, dizolvate în 200…500 ml de sol. NaCl 0,9%, procedura de administrare a preparatelor menţionate prin drenul instalat se efectuează zilnic, timp de 3…5 zile. According to the invention, the claimed method consists in performing intensive therapy, which includes parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological, disaggregant and diuretic preparations, and additionally performing laparocentesis with evacuation of 3…5 L of contaminated ascitic fluid, then through a laparoscopic approach under visual control, a drain is installed in the lower abdominal floor, through which CO2 is instilled in an amount of 3000…5000 cm3, bubbling it through the remaining ascitic fluid for 3…5 min, after which the administered gas is evacuated through the upper trocar, then through the drain, O2 is instilled in an amount of 1000…3000 cm3, bubbling it through the remaining ascitic fluid for 2…3 min, after which all the remaining ascitic fluid is evacuated, and soil is consecutively introduced through the drain. lidocaine 2% in an amount of 20…30 ml, dexamethasone 8…16 mg dissolved in 100…200 ml of sol. NaCl 0.9%, lidase 370…640 U dissolved in 200…500 ml of sol. NaCl 0.9%, an antibiotic from the cephalosporin group and an antimicrobial from the fluoroquinolone group, dissolved in 200…500 ml of sol. NaCl 0.9%, the procedure for administering the mentioned preparations through the installed drain is performed daily, for 3…5 days.
Rezultatul invenţiei constă în atenuarea procesului inflamator septic intraabdominal prin distrugerea florei patogene, micşorarea procesului inflamator intraperitoneal, ameliorarea microcirculaţiei peritoneului, reducerea presiunii intraabdominale, care duce la micşorarea compresiei parenchimului renal, sporirea proceselor de resorbţie a lichidului ascitic şi a perfuziei renale cu restabilirea diurezei şi ameliorarea stării generale a pacienţilor. The result of the invention consists in the attenuation of the intra-abdominal septic inflammatory process by destroying the pathogenic flora, reducing the intraperitoneal inflammatory process, improving the peritoneal microcirculation, reducing the intra-abdominal pressure, which leads to a decrease in the compression of the renal parenchyma, increasing the processes of resorption of ascitic fluid and renal perfusion with the restoration of diuresis and improving the general condition of patients.
Metoda se efectuează în modul următor. The method is performed in the following way.
Se efectuează terapia intensivă care include administrarea parenterală a antibioticelor, hepatoprotectoarelor, plasmei, aminoacizilor, preparatelor reologice, dezagregante şi diuretice, iar suplimentar se efectuează laparocenteza cu evacuarea a 3…5 L de lichid ascitic contaminat, apoi prin abord laparoscopic sub control vizual se instalează un dren în etajul abdominal inferior, prin care se insuflă CO2 în cantitate de 3000…5000 cm3, barbotându-l prin lichidul ascitic restant timp de 3…5 min, după care gazul administrat se evacuează prin trocarul superior, apoi prin dren se insuflă O2 în cantitate de 1000…3000 cm3, barbotându-l prin lichidul ascitic restant timp de 2…3 min, după care se evacuează tot lichidul ascitic restant, iar prin dren se introduce consecutiv sol. lidocaină 2% în cantitate de 20…30 ml, dexametazon 8…16 mg dizolvat în 100…200 ml de sol. NaCl 0,9%, lidază 370…640 U dizolvată în 200…500 ml de sol. NaCl 0,9%, un antibiotic din grupa cefalosporinelor şi un antimicrobian din grupa fluorchinolonelor, dizolvate în 200…500 ml de sol. NaCl 0,9%, procedura de administrare a preparatelor menţionate prin drenul instalat se efectuează zilnic, timp de 3…5 zile. Intensive therapy is performed, which includes parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological, disaggregant and diuretic preparations, and additionally laparocentesis is performed with the evacuation of 3…5 L of contaminated ascitic fluid, then through a laparoscopic approach under visual control, a drain is installed in the lower abdominal floor, through which CO2 is instilled in an amount of 3000…5000 cm3, bubbling it through the remaining ascitic fluid for 3…5 min, after which the administered gas is evacuated through the upper trocar, then O2 is instilled through the drain in an amount of 1000…3000 cm3, bubbling it through the remaining ascitic fluid for 2…3 min, after which all the remaining ascitic fluid is evacuated, and soil is consecutively introduced through the drain. lidocaine 2% in an amount of 20…30 ml, dexamethasone 8…16 mg dissolved in 100…200 ml of sol. NaCl 0.9%, lidase 370…640 U dissolved in 200…500 ml of sol. NaCl 0.9%, an antibiotic from the cephalosporin group and an antimicrobial from the fluoroquinolone group, dissolved in 200…500 ml of sol. NaCl 0.9%, the procedure for administering the mentioned preparations through the installed drain is performed daily, for 3…5 days.
Exemplu Example
Pacienta D., 45 ani, a fost internată în secţia chirurgie septică cu diagnosticul: ciroză hepatică decompensată HBV+HDV, Child “C”(12), hipertensiune portală, ascit-peritonită spontană bacteriană tensionată, dureri abdominale, meteorism, febră, oligourie. S-a efectuat terapia infuzională detoxifiantă, reologică, hepatoprotectoare, transfuzii de plasmă, albumină, diureza forţată, terapia antibacteriană parenterală cu ceftazidim 1 g de 2 ori zi şi metronidazol 100 mg de 2 ori pe zi i/v, care nu a avut efect de ameliorare a stării pacientului. S-a efectuat puncţia cavităţii abdominale cu examinarea lichidului ascitic la prezenţa de neutrofile polimorfonucleare (NPN), care s-a stabilit la nivelul de 320 mm3, ce a confirmat diagnosticul de peritonită bacteriană spontană. Patient D., 45 years old, was admitted to the septic surgery department with the diagnosis: decompensated liver cirrhosis HBV+HDV, Child “C” (12), portal hypertension, tense spontaneous bacterial ascites-peritonitis, abdominal pain, flatulence, fever, oliguria. Detoxifying, rheological, hepatoprotective infusion therapy, plasma transfusions, albumin, forced diuresis, parenteral antibacterial therapy with ceftazidime 1 g 2 times a day and metronidazole 100 mg 2 times a day i/v was performed, which had no effect on improving the patient's condition. Abdominal puncture was performed with examination of the ascitic fluid for the presence of polymorphonuclear neutrophils (PNF), which was established at the level of 320 mm3, which confirmed the diagnosis of spontaneous bacterial peritonitis.
S-a efectuat laparocenteza prealabilă cu evacuarea a 5 L de lichid ascitic contaminat. Apoi prin abord laparoscopic, după evacuarea suplimentară a 4,5 L de lichid ascitic din etajul abdominal superior, sub controlul vizual s-a instalat un dren în etajul abdominal inferior, prin care s-a insuflat CO2 în cantitate de 4000 cm3, care a fost barbotat prin lichidul ascitic restant timp de 4 min, după care gazul a fost evacuat prin trocarul superior. Apoi prin drenul menţionat s-a insuflat O2 în cantitate de 2000 cm3, care a fost barbotat prin lichidul ascitic timp de 2 min, ulterior a fost evacuat tot lichidul ascitic restant. Prin drenul menţionat s-a introdus consecutiv sol. lidocaină 2% în cantitate de 25 ml, dexametazon 16 mg în 200 ml sol. NaCl 0,9%, lidază 640 U dizolvată cu sol. NaCl 0,9% în cantitate de 500 ml, ceftriaxon 4 g şi ciprinol 200 mg, fiecare fiind dizolvat cu sol. NaCl 0,9% în cantitate de 200 ml. Procedura de introducere a preparatelor menţionate prin drenul instalat s-a efectuat zilnic, timp de 5 zile. A preliminary laparocentesis was performed with the evacuation of 5 L of contaminated ascitic fluid. Then, through a laparoscopic approach, after additional evacuation of 4.5 L of ascitic fluid from the upper abdominal floor, a drain was installed in the lower abdominal floor under visual control, through which CO2 was instilled in an amount of 4000 cm3, which was bubbled through the remaining ascitic fluid for 4 min, after which the gas was evacuated through the upper trocar. Then, through the aforementioned drain, O2 was instilled in an amount of 2000 cm3, which was bubbled through the ascitic fluid for 2 min, after which all the remaining ascitic fluid was evacuated. Through the aforementioned drain, 2% lidocaine solution in an amount of 25 ml, 16 mg dexamethasone in 200 ml of 0.9% NaCl solution, 640 U lidase dissolved with sol. NaCl 0.9% in an amount of 500 ml, ceftriaxone 4 g and ciprinol 200 mg, each dissolved with sol. NaCl 0.9% in an amount of 200 ml. The procedure for introducing the mentioned preparations through the installed drain was performed daily for 5 days.
După 72 ore starea generală s-a ameliorat, a dispărut febra, s-a restabilit diureza, ascita s-a micşorat, probele funcţionale hepatice s-au ameliorat. Pacientul a fost externat pentru tratament ambulator peste 7 zile. After 72 hours, the general condition improved, the fever disappeared, diuresis was restored, ascites decreased, liver function tests improved. The patient was discharged for outpatient treatment after 7 days.
1. Андреев Г.Н., Борисов А. В., Ибадильдин А. С. и др. Патогенез, диагностика и лечение циррозов печени, осложненных резистентным асцитом. Великий Новгород, 1999, с. 140-144 1. Andreev G.N., Borisov A. V., Ibadildin A. С. and others Pathogenesis, diagnosis and treatment of liver cirrhosis complicated by resistant ascites. Veliky Novgorod, 1999, p. 140-144
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| Application Number | Priority Date | Filing Date | Title |
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| MDS20140120A MD926Z (en) | 2014-09-11 | 2014-09-11 | Method of laparoscopic treatment of spontaneous bacterial ascites-peritonitis in decompensated liver cirrhosis |
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| MDS20140120A MD926Z (en) | 2014-09-11 | 2014-09-11 | Method of laparoscopic treatment of spontaneous bacterial ascites-peritonitis in decompensated liver cirrhosis |
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| MD926Y MD926Y (en) | 2015-07-31 |
| MD926Z true MD926Z (en) | 2016-02-29 |
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| MD1204Z (en) * | 2017-06-08 | 2018-05-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Laparoscopic method for treating refractory ascites in decompensated liver cirrhosis |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD774Y (en) * | 2013-09-12 | 2014-05-31 | Gheorghe Anghelici | Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| MD774Y (en) * | 2013-09-12 | 2014-05-31 | Gheorghe Anghelici | Endoscopic method for treating cirrhotic spontaneous ascites-peritonitis |
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| Title |
|---|
| Андреев Г.Н., Борисов А. В., Ибадильдин А. С. и др. Патогенез, диагностика и лечение циррозов печени, осложненных резистентным асцитом. Великий Новгород, 1999, с. 140-144 * |
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| MD926Y (en) | 2015-07-31 |
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