L'invention porte sur des dispositifs implantables d'administration de medicaments concus pour avoir une forme de deploiement pour une implantation dans le corps et une forme de retention pour une retention dans le corps. Le dispositif peut avoir un ou plusieurs reservoirs de medicament allonges contenant un medicament, et le reservoir de medicament peut etre constitue d'un materiau deformable. Dans un cas, un premier filament est fixe a la premiere extremite du reservoir de medicament et un second filament est fixe a la seconde extremite du reservoir de medicament, un element de fixation etant positionne autour des premier et second filaments pour permettre un raccourcissement et empecher un allongement des filaments par rapport aux extremites du reservoir de medicament, en tant que moyen pour la transformation du dispositif de la forme d'implantation a la forme de retention.

Les modes de realisation de la presente invention concernent un ensemble seringue retractable en configuration double cylindre. L'un au moins de ces modes de realisation comporte des dispositifs anti-reemploi et des dispositifs empechant l'actionnement premature du mecanisme de rentree. L'invention concerne egalement des procedes pour l'aspiration et l'expulsion de liquide vers/depuis des dispositifs medicaux.

Background: ERCP is arguably the most technically demanding endoscopic procedure. Many attempts at ex-vivo ERCP simulation have been made over the years. Both computer and animal models have advantages, but cost and anatomic differences are significant limitations. If proven to be realistic and affordable, a reusable, mechanical model may provide the most cost efficient simulation. Hypothesis: A simple mechanical model can be used to familiarize inexperienced biliary endoscopists with the complexities of side-viewing endoscopy and ERCP. Methods: Four GI fellows (subjects A-D) with no prior experience of using a duodenoscope or performing ERCP were compared to a third year fellow (subject E) with experience of approximately 150 ERCPs. A prototype static desktop ERCP simulator developed by an American endoscopy accessory manufacturer was employed, using a standard 3.8 mm channel duodenoscope and commercially-available papillotomes. Times to deep cannulation from a variety of positions (easy, difficult, partially obstructed view) were recorded. After their experience, the fellows were polled for their opinions regarding the usefulness of the simulator for orienting to the duodenoscope and cannulating the papilla. Results: Novice endoscopists required significantly longer to achieve biliary cannulation (mean: 1min 21secs) when compared to experienced endoscopists (mean: 28secs). Over five repetitions of each challenge, the novices significantly decreased their time to biliary cannulation. All novices had initial difficulty understanding elevator function. In the novice group, some cannulation attempts were rapidly successful due to fortunate pre-positioning of the scope (“dumb luck.”) Extreme deflections of the scope tip required significant time to regain effective positioning. The experienced subject (E) felt strongly that the simulation of cannulation was realistic. The novices uniformly found the device a useful tool for understanding scope function and the mechanics of cannulation. They also found the experience enjoyable and a stimulus to learning ERCP in patients. Conclusion: This basic desktop device appears to provide a realistic simulation of basic duodenoscope movements and cannulation mechanics. Inability to put the scope in a “long” position is a limitation, but a minor one. Advantages include ease of set-up and operation, and ability to present different cannulation challenges (a variety of anatomic variants of the papilla are available and interchangeable.) The device is ideal for repetitive practice of basic skills with evaluation and feedback from mentors. Preliminary data are encouraging and further studies are planned.

L'invention concerne un catheter (10) destine a etre implante dans un patient ayant un tube de catheter (20) comprenant une extremite distale (22), un moyen permettant de couper (80) l'extremite distale du tube de catheter apres une introduction sous-cutanee de la pointe (24) de la lumiere de catheter dans une position souhaitee a l'interieur du patient pour former une partie d'extremite coupee ainsi qu'un moyen permettant de positionner, de facon selective, chaque lumiere respective de la partie d'extremite coupee du tube de catheter en communication de fluide avec la premiere extremite respective d'un tube de fixation (50). Le tube de fixation est choisi pour etre en communication de fluide avec un dispositif medical souhaite.

A fixing device of a suture lock comprising: an actuating handle (4); and a head attachment (2) operatively coupled to the actuating handle (4) including the fixing head (2), a body (20) is constructed and arranged to support a suture lock; and a retainer (23) is constructed and arranged to retain at least part of the suture lock in the body (20), wherein the retainer (23) is constructed and arranged to be deformed irreversibly to release the suture lock of the fastening head (2).