Patent Application: US-65807110-A

Abstract:
a means is provided to make the capsules of cirrhotic or fibrotic livers relatively impermeable to liver tissue fluid or lymph in humans or other mammals suffering from severe chronic ascites or refractory ascites by application of collodion . the means will be useful to decrease the need for liver and combined liver and kidney transplantations

Description:
collodion in acetone as solvent was prepared by evaporation of the ether and alcohol in aliquots of collodion u . s . p . at room temperature no higher than 30 degrees celsius ( 86 degrees f .) for several hours and then redissolving the residual nitrocellulose to a concentration of 4 percent in acetone . [ this solution could be optimally made more syrupy by redissolving the nitrocellulose in less volume of acetone .] as a working small model to measure liquid flux through a membrane at high hydrostatic pressure , transparent vinyl tubing about 40 cm . in length and ½ inch in internal diameter was used . a short hard nylon barb as nozzle of ½ inch internal diameter inserted inside the lower end of the tubing . a sheet of leather chamois covered the lower opening of the tubing nozzle . the chamois was kept tightly in place outside the nylon nozzle by a rubber o - ring , of number 14 and of ¾ inch in its unstretched internal diameter . [ leather chamois may be obtained in textile stores .] the chamois serving as membrane at its lowermost surface had an area of 159 sq . mm . exposed to liquid flux . outflows of water were collected below this in a small beaker after water was placed into the superior end of the tubing distilled water was used as the liquid medium . it was poured into the top end of the tubing and membrane outflow was allowed for several minutes before initial measurements of outflux of transudate at 15 cm . water pressure . before outflux was measured initially and before topical application of collodion to the membrane , the flow of water was stopped by insertion of a number 13 glass stopper into the superior end of the tubing when the water length was about 16 cm . from the chamois membrane . [ this maneuver was analogous to hepatic artery ligation for only a brief period in cirrhotic patients with portal hypertension . taylor , rosenbaum 1953 .] just before transudate was to be measured , the lower surface of the chamois was gently dried by gauze application . two “ coats ” of collodion solution were applied by use of a saturated cotton swab or small paint - brush about 10 min . apart . solvent evaporation followed each application . [ the second application made the thin layer of nitrocellulose thicker and stronger .] transudates was collected initially for less than 3 seconds immediately after removal of the glass stopper and for a whole one minute period after the second applications of collodion about 12 to 14 min . before . the collected amounts of water were weighed and the transudate rates were converted to ml . per minute at 15 cm . of water head pressure . four runs were performed with a freshly used chamois membrane each time , both with use of collodion u . s . p . and with use of the collodion containing acetone as solvent . summary of the results are tabulated in the following two examples . transudation of water at 15 cm . hydrostatic pressure averaged 166 ± 13 ml ./ min . ( mean & amp ; standard error ) before collodion u . s . p . application . transudation was inhibited by 99 . 6 ± 0 . 2 percent ( mean & amp ; standard error ) afterwards . before use of nitrocellulose in acetone , the membrane transudate averaged 159 ± 45 ml ./ min . the transudate rate was inhibited by 97 . 2 ± 1 . 5 percent with use of nitrocellulose in acetone . the model demonstrations have clinical implications that the topical applications of collodion u . s . p . and collodion solution as nitrocellulose in acetone , after several minutes of allowed evaporation , are able to prevent soon almost completely transudation of liquid through chamois membranes at pressure gradient of 15 cm . water ( 11 mm . hg ). this inventor proposes that collodion solution put on to the visible capsular surfaces of cirrhotic livers in mammals suffering from severe chronic ascites or refractory ascites , with evaporation over several minutes , will result soon in attenuation or absence of the ascites : in vivo , complete impermeability to liver fluid transudation at pressure gradient of 11 mm . hg and higher may result from fibrotic reaction to the film of nitrocellulose in a few days , similar to renal capsule observations after cellophane . page 1939 ; page 1940 . to this end , a laparotomy operation , perhaps performed laparoscopically — beers et al . 2006 a —, would be done with syrupy collodion liquid swabbed on to visible surfaces of the liver capsules ( glisson &# 39 ; s capsules ) with collodion - saturated cotton - swabs or small paint - brushes , with allowed evaporation of the liquid . optimally , the application of collodion solution would be carried out during brief clamping of the hepatic artery to keep the capsular surfaces relatively dry of liver tissue fluid . avoidance of application on to the common bile duct , portal vein , and hepatic artery at the hilar region would be recommended . antecedently , a therapeutic paracentesis likely would be done . while there has been shown and described what is considered to be preferred embodiments of the invention , it will be understood that various modifications could be made without departing from the scope of the invention . it is intended that the invention be not limited to the exact forms described and illustrated herein , but should be construed to cover modifications that may fall within the scope of the appended claims . altschule , m . d ., physiology in diseases of the heart and lungs revised ed ., harvard university press , cambridge , mass ., ( 1954 ): p . 375 . angeli p ., merkel c . “ pathogenesis and management of hepatorenal syndrome in patients with cirrhosis ”. j . hepatology 48 : s93 - s103 ( 2008 ). baggenstoss a . h ., cain j . c ., “ the hepatic hilar lymphatics of man their relation to ascites ”. n . engl . j . med . 254 : 531 - 535 ( 1957 ). beers m . h . et al ., the merck manual of diagnosis and therapy 18 th ed ., merck res . labs . whitehouse station , n . j ., ( 2006 ): a “ laparoscopy ” p . 86 ; b “ ascites ” pp . 188 - 189 ; c “ cirrhosis ” pp . 215 - 219 ; d “ budd - chiari syndrome ” and “ veno - occlusive disease ” pp . 232 - 234 ; e “ liver transplantation ” pp . 1374 - 1376 . belli l ., [“ new possibilities of influencing surgically the formation of ascites through application of eastman 910 on the hepatic surface ”], l &# 39 ; ospedale maggiore 58 : 647 - 652 ( 1963 ). 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