US3734100A - Catheter tubes - Google Patents

Catheter tubes Download PDF

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Publication number
US3734100A
US3734100A US00128898A US3734100DA US3734100A US 3734100 A US3734100 A US 3734100A US 00128898 A US00128898 A US 00128898A US 3734100D A US3734100D A US 3734100DA US 3734100 A US3734100 A US 3734100A
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United States
Prior art keywords
cuff
catheter
improved catheter
body portion
silicone rubber
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Expired - Lifetime
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US00128898A
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English (en)
Inventor
R Walker
S Bazell
E Goldberg
R Ostensen
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.)
MEDICAL PRODUCTS CORP
3M Co
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MEDICAL PRODUCTS CORP
Minnesota Mining and Manufacturing Co
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    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1027—Making of balloon catheters
    • A61M25/1029—Production methods of the balloon members, e.g. blow-moulding, extruding, deposition or by wrapping a plurality of layers of balloon material around a mandril
    • 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. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • 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. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/0443—Special cuff-wall materials
    • 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. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/0445—Special cuff forms, e.g. undulated
    • 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. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0475—Tracheal tubes having openings in the tube
    • A61M16/0477—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids
    • A61M16/0484—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids at the distal end
    • 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. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0486—Multi-lumen tracheal tubes
    • 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
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1027—Making of balloon catheters
    • A61M25/1034—Joining of shaft and balloon

Definitions

  • ABSTRACT Improved catheter tubes and their method of constructionhaving a comformable balloon cuff of silicone rubber of low' hardness, modulus, and stress values, and which results in less pressure necrosis and cuff failure in use.
  • Specific examples include endotracheal tubes, Foley catheters, tracheostomy tubes, urethral catheters, and catheters for use in gastric, esophageal, pharyngeal, nasal, intestinal, rectalcolonic, choledochal, arterial venous, cardiac and en dobronchial applications.
  • This invention is directed to improved cuffs for catheters, for example, endotracheal tubes, and to a method of construction of the improved catheters. More particularly, the invention is directed to a special molded silicone rubber conformable cuff having low values of hardness, modulus and stress, the latter expressed as a percentage of the breaking stress of the cuff.
  • catheters are extremely important and useful medical tools for the input or withdrawal of fluids from the body of a patient.
  • catheters are tubular in shape and have a retaining and/or sealing inflatable balloon cuff near the distal (intra corporeal) end of the tube.
  • the catheters must remain in place for substantial periods of time.
  • Present catheters have not been entirely satisfactory since they tend to cause tissue necrosis from pressure or biochemical incompatibility of the inflatable balloon cuffs.
  • standard rubber cuffs of endotracheal tubes in place for as little as 72 hours can cause severe pressure necrosis.
  • Latex material is chemically irritating and polyvinylchloride plastic cannot elongate sufficiently to provide adequate balloon volumes, has no memory and prunes upon deflation.
  • endotracheal intubation In cases of patients requiring general inhalation anesthesia, the quickest and easiest way to insure a clear upper airway for ventilation of the lungs is by endotracheal intubation. In the simplest of terms, this involves slipping a tube down to the trachea through the larynx to provide an air passage to the lungs. The patients head is supported and the neck is slightly flexed on the trunk to provide for a relatively straight-line approach to the larynx. The jaw is kept apart, and the tube is slipped directly down into the trachea. This process can be accomplished in a very few seconds, which in an emergency may be life-saving since the person who cannot breathe adequately will be dead within minutes. This also eliminates obstruction of the breathing passage by vocal cord spasms since the tube is directed through the larynx.
  • the excessive secretions causing lower airway obstruction can be easily removed by direct aspiration. Inhalation anesthesia can also be given easily, if required.
  • Use of the cuff provides a closed systern such that oxygen or other gases can be given in a controlled and measured manner and that carbon dioxide can be removed under controlled circumstances.
  • the method of alternating cuff sites also fails to prevent significant injury. lndeed, because the cuffs extend over a greater length of the tube, the injury is also more extensive and makes the operative repair of tracheal stenosis or tracheal-esophageal fistula more difficult.
  • the above authors devised a minimal" leak technique, in which the balloons were first inflated to a noleak position and then a sufficient amount of inflation air was withdrawn until an audible leak occurred with each inspiration. While this reduced the hazard of excessive cuff inflation, it does not prevent rotation, slipping or leakage of the tube, and may also permit a cer tain amount of aspiration of fluids into the lungs.
  • This cuff operates in a manner the reverse of the usual cuff, that is, the cuff is always in the extended shape with the latex sheath stretched over the ball of polyurethane foam through which the tube extends.
  • the pilot tube is attached to a vacuum, and the low pressure draws out some of the air in the polyurethane foam cells. The pilot tube is then pinched shut and the cuff in the relatively deflated form is then inserted through the larynx into the trachea.
  • the Kamen construction has two very serious drawbacks.
  • the deflated size of the cuff is substantially larger than the tube itself in view of the fact that the nature of the polyurethane foam prevents all of the cells from being open. Thus, it cannot be entirely evacuated, and the deflated volume is physically larger than the standard latex or polyvinylchloride empty balloon.
  • the endotracheal tube can become trapped in the patient and impossible to remove other than by surgical procedures when the external pilot tube becomes blocked, clogged, cut or separated from the latex sheath.
  • the polyurethane foam acts as a physical spring exerting an outward pressure against the latex sheath, and the spring must be collapsed by the vacuum.
  • the ability to collapse the polyurethane foam depends upon the integrity of the latex sheath. Where the integrity is disrupted or broken, it will be impossible to pull sufficient vacuum through the pilot tube to collapse the polyurethane foam to a diameter small enough to be able to remove the endotracheal tube through the larynx. Likewise, in field emergency situations, where no vacuum creating source is available, such tubes cannot be used. In contrast, the cuffs of our tubes can be breath inflated if necessary. While the Kamen polyurethane foam filled sheath type of cuff does have the advantage of relatively low pressure exerted between the cuff and the tracheal wall, the danger of impossibility of removal is a serious drawback. From the point of view of safety, it is far better if a rupture of the cuff causes deflation and a loss of securing pressure, rather than leading to impossibility of removal.
  • a Foley type urethral retention catheter is utilized for prolonged or chronic bladder drainage.
  • the catheter is retained within the bladder by inflating the cuff. This prohibits it from being withdrawn through the urethra.
  • the inflated cuff may cause undesirable pressure against the bladder wall or urethra.
  • FIG. I is a perspective view of one type of catheter, specifically an endotracheal tube, in accord with the invention.
  • FIG. 2 is a longitudinal sectional view along the line 2 in FIG. 1, showing the cuff in a substantially deflated position.
  • FIG. 3 is a crosssectional view along the line 3-3 of FIG. 2.
  • FIG. 4 is a longitudinal sectional view of the cuff area of the catheter showing it in partially inflated position.
  • FIG. 5 shows the method of insertion of an endotracheal tube in the trachea of a patient.
  • FIG. 6 shows one method of inflation of the cuff of the tube in position.
  • FIG. 7 shows in cross-section another embodiment of the invention where the main tube and cuff walls are of predetermined varying thickness to provide controlled balloon inflation, shape and size.
  • FIG. 8 shows partly in section the principles of this invention adapted to a Foley-type catheter in the inflated condition in use in the urinary bladder.
  • FIG. 9 shows, partly in longitudinal section, cuff walls that vary longitudinally in thickness to provide for differential expansion such as shown in FIG. 8.
  • the prior art cuffs specify a balloon material which has a relatively high tensile strength, on the assumption that this will prevent rupture of the balloon cuff under the stress which it encounters in use.
  • the balloon material has been chosen to have a relatively high hardness and low percentage elongation to provide for sufficient lifetime and mechanical strength against rupture.
  • these properties lead to relatively high intra-cuff pressures, a generally spherical balloon shape which is axially centered around the main catheter tube, and requires a relatively high inflation pressure. As a result, the pressure on the tissues contacted by the cuff upon inflation is sufficiently high to cause tissue necrosis.
  • the cuff material should have a definite strain rather than stress value and should be able to assume the given strain value at the lowest possible stress value.
  • the stress value should represent as low a percentage of the breaking stress as possible.
  • the low value of stress, based on the percentage of the breaking stress, and the softer silicone rubber composition permits the cuff to more completely conform to irregularities of the passage or body cavity, e.g., a trachea, without developing high areas of stress.
  • the conformability allows more equal pressure distribution when the cuff is subjected to pressure variations. This eliminates high point pressure loadings on the tissue.
  • any type of physiologically compatible plastic or rubber material which meets these criteria may be used.
  • a silicone rubber which meets the above critical parameters. Not only does this rubber have accepted physiological compatability, but it may be compounded and cured to the required degree of softness, low hardness, relatively low tensile strength, and high percentage elongation of breaking stress.
  • FIG. 1 shows a general perspective view of one embodiment of an endotracheal tube illustrating the principles of this invention.
  • a pilot tube 2 which connects with a cuff inflation lumen 3 in the wall 4 of the main body 34 of the endotracheal tube.
  • the lumen continues along the length of the tube to an opening 5 beneath the cuff 6.
  • the proximal end also has an adapter means 7 for connection with mechanical or hand aspiration means.
  • the adapter 7 may or may not be used depending upon the medical condition of the patient.
  • the adapter communicates with a central passageway 8, which is a ventilation passageway in the case of an endotracheal tube, and a drainage passageway in the case of a Foley-type catheter (see passage 9 in FIGS. 8 and 9).
  • the tube 1 is preferably made of a silicone rubber which is smooth throughout its entire length. Such tube may be made by an extrusion process in which the lumen 3 is extruded simultaneously with the central passageway 8.
  • the lumen 3 extends distally along the main body under the cuff 6 so that the lumen communicates with opening 5 and the intra-cuff space 11. It is an important aspect of this invention that the cuff silicone rubber material be relatively soft compared to the silicone rubber material used for the tip and shaft. The latter must be relatively hard to facilitate insertion while the cuff silicone rubber material must be relatively soft to provide conformability.
  • the distal tip 12 of the tube 1 may be bias or diagonal cut as at 13 and chamfered as at 14 so as to prevent tissue trauma upon insertion.
  • the diagonal cut 13 provides for a tip, oval in cross-section, the leading edge or point of which, 15, is sufficiently small and rounded to provide non-damaging; insertion through the larynx, (in the case of an endotracheal tube), or through the sphincter (in the case of a Foley-type catheter).
  • the tip may be integral with or otherwise secured to the main body 34 so it is not pulled off upon withdrawing the catheter from the patient. As shown best in FIGS.
  • the proximal and distal edges 16 and 17 of the cuff itself are flush with the outer surface of the tube 18, fit into recess 19 in the tube 1, and at each end abut against shoulders 20 and 21, respectively.
  • the tube 1 thus presents a smooth, continuous surface which does not have any projecting shoulders which would cause irritation of tissues upon insertion or use.
  • FIG. 2. shows the cuff in its deflated condition
  • FIG. 4 shows the cuff in a partly inflated condition.
  • FIG. 5 illustrates the method of insertion of the tube 1 with the aid of a laryngoscope 22.
  • air is injected into the cuff via pilot tube 2 by means of syringe 23.
  • clamp 24 seals off the pilot tube 2 retaining the balloon inflation. Ventilation of the patients lungs can then proceed through the adapter 7 and central passageway 8.
  • cuff balloons such as rubber latex, relatively hard, non-conformable silicone rubber, or polyvinylchloride plastics
  • relatively soft, conformable silicone rubber having a very low durometer and an elongation factor of in the range of from 1000-1500 percent.
  • a cuff balloon made from this material requires much less pressure per unit volumetric expansion than does the above presently used rubber or plastic materials.
  • a typical rubber or polyvinylchloride cuff material has a Shore A hardness on the order of 50, while the physiologically acceptable silicon of our invention should have a hardness on the order of less than about 2025.
  • the cuff material of our invention should also have a tensile strength, in pounds per square inch, of less than about 700-800, and preferably in the range of 500-700, as compared to the prior art rubber or polyvinylchloride which has a strength of l,200 psi and greater. Still another parameter critical to our invention is that the percentage elongation capability should be in the range of l,0001,500 percent. Prior art materials have had a percentage elongation of from 300-900 percent.
  • the stress value must represent as low a percentage of the breaking stress as possible.
  • a typical cuff balloon having a deflated diameter of 0.425 inches will be expanded to the average trachea size of 1.250 inches upon inflation.
  • the maximum extension required is thus 340 percent of the original, or 240 percent elongation as normally calculated.
  • the stress for prior art types of cuff materials having percentage elongation on the order of 600 percent is about 400 psi.
  • the stress is only 130 psi.
  • the prior art cuff rubber or plastic material is much nearer its rupture point than the cuff of our invention, and thus is more apt to break under mechanical deformation strains.
  • this stress value of the cuff should be kept below about percent, and preferably in the range of from 15-25 percent of the breaking stress.
  • FIG. 7 shows another embodiment in which the tube is generally a flattened oval in crosssection, more nearly conforming to the actual shape of the human trachea.
  • the wall 4 of the tube is flattened in a ventral-dorsal direction with the side walls 25,25 being thicker than the ventral wall 26 and the dorsal wall 27.
  • the central passageway 8 is shown in FIGS. 3 and 7 to be circular, it may also be generally oval and concentric with the outer surface shape 18 (FIG. 7) to provide for walls 4 of substantially equal thickness throughout.
  • the increased thickness of the side walls 25, 25 provide for convenient placement of the lumen 3 and the opening 5 into the recess 19 of the tube 1 for placement of the cuff balloon 6.
  • FIG. 7 also serves to illustrate a still further embodiment wherein the balloon wall itself is of preselected unequal or varying thickness.
  • the ventral portion 28 and the dorsal portion 29 are shown thickened relative to the lateral or side walls 30, 30. Since the side walls are thinner, the balloon tends to expand unevenly in a controlled fashion with the greater extension in a lateral direction as compared to that along the ventraldorsal axis of the cuff.
  • FIG. 3 shows a cuff having even wall thicknesses in conjunction with a generally round tube 4
  • uneven wall thickness cuffs as in FIG. 7 may also be used in conjunction with tubes round in cross-section.
  • the predetermined differential thickness of the cuff walls provides for excellent sealing of the tube in the trachea, even where the main body of the tube is round.
  • the differentially expansible wall portions of the cuff compensate for the natural out-of-roundness of the trachea or for tracheal irregularities in' the lateral as compared to the ventral-dorsal axial direction.
  • a plurality of inflation lumens 3 may be used. While one lumen is shown in the side wall 25' in FIG. 7, it should be understood that another inflation lumen communicating with an opening to the intra-cuff space may be placed in the side wall 25.
  • a cuff balloon In preparing the cuff balloon, we prefer to press mold an annular cylinder of silicone rubber to provide cuff balloon material of the specific characteristics described above.
  • the cuff is then placed over an extruded tube having the ventilation and inflation lumens therein, which tube has been incised to provide recess 19 for receiving the balloon, and the opening 5 from the recess to the inflation lumen 3.
  • the proximal and distal margins 16, 17, and transverse edges of the cylindrical balloon cuff are then coated with silicone rubber adhesive and placed in the recess, and the adhesive cured to provide an integral seal between the cuff and the main tube body 34.
  • FIGS. 8 and 9 show the principles of our invention adapted to use in an improved Foley-type urinary catheter with like parts having the same numbers as in FIGS. 1-5.
  • FIG. 8 shows the cuff 6' in expanded condition within the urinary bladder walls 31.
  • the cuff 6 contacts the wall along region 35 as distinct from typical point (in cross-section) contact of round balloons of the prior art.
  • the special properties of our silicone rubber permits the expanded cuff to conform to the walls of the bladder, thus resulting in a lower perpendicular component of the catheter weight per unit area of the bladder wall.
  • the conformability of our silicone cuff allows spreading the weight over a larger area leading to a lower pressure and less likelihood of severe tissue necrosis.
  • Eye 10 in the rounded distal tip 12 of the main catheter body communicates with drain lumen 9 for removal of urine. I
  • FIG. 9 shows the cuff 6 in normal, uninflated condition.
  • the cuff in longitudinal cross section, i.e., along its axis, is of a predetermined unevenness in thickness, with the distal end 32 being thinner than the proximal end 33. This provides for greater expansion of the balloon at the distal end than the proximal end, with the result that the balloon is generally triangular in shape, as seen in FIG. 8, conforming to the natural shape of the urinary bladder.
  • the cuffs of our invention may be adapted to any desired body cavity, vessel, tube, orifice or the like. While we have described the invention with respect to several embodiments above, it should be understood that many variations may be made within the spirit of our invention.
  • An improved catheter comprising:
  • Silicone rubber dypor i having an 5 wall thickness of said cuff is preselected to provide for outer surface and a central passage therein extending axially in said body from a proximal to a distal end, said distal end being shaped to provide a smooth, gently pointed tip for ease of insertion into contact with tissues, and said central passage communicating with an opening at the distal end thereof,
  • said inflation lumen communicating with a pilot tube disposed adjacent the proximal end of said body portion
  • said expansible cuff portion being substantially cylindrical in its initial deflated condition and having proximal and distal margins circumferentially secured to said body portion, and conforming generally to the outer surface shape of said silicone rubber body portion in its initial deflated condition,
  • said expansible cuff portion being composed of a low modulus silicone rubber having properties of a Shore A hardness of less than about 30, a tensile strength of below about 700 psi, an elongation of above about 1,000 percent, and a stress value upon sealing inflation of less than about 30 percent of the breaking stress of said cuff material, said properties of the silicone rubber cuff thereby resulting in pressures, at substantially complete seal, of less than vascular compressive pressures inducive of significant tissue pressure necrosis,
  • An improved catheter as in claim 1 having a plurality of inflation lumens disposed in said body portion walls.

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  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Veterinary Medicine (AREA)
  • Hematology (AREA)
  • Biomedical Technology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Emergency Medicine (AREA)
  • Child & Adolescent Psychology (AREA)
  • Biophysics (AREA)
  • Manufacturing & Machinery (AREA)
  • Materials For Medical Uses (AREA)
  • External Artificial Organs (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
US00128898A 1973-05-07 1971-03-29 Catheter tubes Expired - Lifetime US3734100A (en)

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GB2171573A GB1414344A (en) 1973-05-07 1973-05-07 Catheter tubes

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Cited By (108)

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US3884242A (en) * 1971-03-29 1975-05-20 Mpc Kurgisil Catheter assembly
US3890976A (en) * 1972-10-26 1975-06-24 Medical Products Corp Catheter tip assembly
US3926705A (en) * 1974-07-25 1975-12-16 Western Acadia Silicone catheter and process for manufacturing same
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DE2835823A1 (de) * 1977-08-25 1979-03-08 Matburn Holdings Ltd Katheter und verfahren zum herstellen desselben
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US5707355A (en) * 1995-11-15 1998-01-13 Zimmon Science Corporation Apparatus and method for the treatment of esophageal varices and mucosal neoplasms
US5709657A (en) * 1989-06-28 1998-01-20 Zimmon Science Corporation Methods for placement of balloon tamponade devices
US5791341A (en) * 1995-12-19 1998-08-11 Bullard; James Roger Oropharyngeal stent with laryngeal aditus shield and nasal airway with laryngeal aditus shield
US5904648A (en) * 1996-06-18 1999-05-18 Cook Incorporated Guided endobronchial blocker catheter
US5937860A (en) * 1997-04-10 1999-08-17 Cook; Daniel J. Laryngeal mask
US6206852B1 (en) 1999-12-15 2001-03-27 Advanced Cardiovascular Systems, Inc. Balloon catheter having a small profile catheter
US6228052B1 (en) 1996-02-29 2001-05-08 Medtronic Inc. Dilator for introducer system having injection port
US20030050531A1 (en) * 2001-09-08 2003-03-13 Field Stephen James Medico-surgical devices
US20030135231A1 (en) * 2002-01-17 2003-07-17 Goodin Richardf L. Catheter bond configuration
US20030136412A1 (en) * 2002-01-21 2003-07-24 Hiroaki Nomori Tracheostomy tube
US20030136413A1 (en) * 2002-01-23 2003-07-24 Brain Archibald I. J. Endotracheal tube which permits accurate determination of mucosal pressure
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AU479977A (enrdf_load_html_response) 1974-10-03
ATA290773A (de) 1978-01-15
AT345437B (de) 1978-09-11
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DE2322506B2 (de) 1976-07-22
DE2322506A1 (de) 1974-11-14
CH566145A5 (enrdf_load_html_response) 1975-09-15

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