Patent Application
20140148671
During various surgical procedures, it may become necessary to connect one tubular tissue section to another tubular tissue section. This type of surgical procedure can be referred to as an “anastomosis procedure”. As an example, during a colorectal surgery, it may be necessary to remove a diseased section of the colon and reconnect the two healthy end sections of the colon. In gastric bypass surgery, a section of the stomach is bypassed to minimize the volume of the stomach and the intestine is shortened. The ends of the tissue sections are then reconnected. The presence of leaks at the anastomosis site can result in significant health problems.
The foregoing summary is illustrative only and is not intended to be in any way limiting. In addition to the illustrative aspects, embodiments, and features described above, further aspects, embodiments, and features will become apparent by reference to the drawings and the following detailed description.
A method for detecting an anastomosis leakage in the tubular tissue of a subject is disclosed. The method can include applying a composition to an exterior of an anastomosis site in the tubular tissue of said subject and monitoring a urine color of the subject after the composition is applied. The composition can include a bioabsorbable binding medium and a biocompatible chromophore at least partially encapsulated in the bioabsorbable binding medium.
An implantable composition for detecting an anastomosis leakage in the tubular tissue of a mammal is disclosed. The composition can include a bioabsorbable binding medium and particles dispersed within the bioabsorbable binding medium. The particles can each include a biocompatible chromophore and a bioabsorbable layer at least partially encapsulating the biocompatible chromophore. The bioabsorbable layer can be configured to dissolve or degrade when exposed to fluids from the tubular tissue of said mammal.
An implantable film for detecting an anastomosis leakage in the tubular tissue of a mammal is disclosed. The implantable film can include a first layer and a second layer. The first layer can include a first bioabsorbable polymer and a biocompatible chromophore, wherein the biocompatible chromophore is embedded within the first bioabsorbable polymer. The second layer can include a second bioabsorbable polymer and can be substantially free of the bioabsorbable polymer.
The foregoing and other features of the present disclosure will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only several embodiments in accordance with the disclosure and are not to be considered limiting of its scope, the disclosure will be described with additional specificity and detail through use of the accompanying drawings.
In the following detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, drawings, and claims are not meant to be limiting. Other embodiments may be used, and other changes may be made, without departing from the spirit or scope of the subject matter presented here. It will be readily understood that the aspects of the present disclosure, as generally described herein, and illustrated in the Figures, can be arranged, substituted, combined, and designed in a wide variety of different configurations, all of which are explicitly contemplated and make part of this disclosure.
Disclosed herein are compositions and methods for detecting an anastomosis leakage at the tubular tissue of a subject. The method can include applying a composition to an exterior of an anastomosis site in the tubular tissue of said subject and monitoring a urine color of the subject after the composition is applied. The composition may include a bioabsorbable binding medium and a biocompatible chromophore at least partially encapsulated in the bioabsorbable binding medium. Also disclosed are implantable films including: a first layer having a first bioabsorbable polymer and a biocompatible chromophore; and a second layer having a second bioabsorbable polymer. The biocompatible chromophore can be embedded within the bioabsorbable polymer. The second layer can be substantially free of the biocompatible chromophore.
Disclosed herein are methods for detecting an anastomosis leakage.
At operation 100 “Apply composition to an exterior of an anastomosis site in the tubular tissue of a subject,” a suitable composition is applied to an anastomosis site for detecting leakages.
The amount of biocompatible chromophore that is applied to the anastomosis site is not particularly limited. The amount can be effective so that a color change can be observed in a subject's urine following a leakage at anastomosis site. The total amount of the biocompatible chromophore can be below amounts of the biocompatible chromophore that result in severe toxicity when intravenously administered to a subject at one time. The amount of biocompatible chromophore will vary depending on the particular chromophore. For example, at least about 50 mg (or at least about 100 mg) of methylene blue may be included in the composition.
The composition can be optionally cured to harden the composition at the anastomosis site. The procedure for curing the composition can vary depending upon the materials in the composition. Light, heat, or additional materials can be applied to cure the composition. For example, radiation can be applied to crosslink certain vinyl- containing polymers. As another example, isocyanate-containing crosslinking agents can be used to crosslink hydroxyl-containing polymers.
The method may also optionally include applying compositions to two or more anastomosis sites. A composition containing a first biocompatible chromophore can be applied to a first anastomosis site. A composition containing a second biocompatible chromophore can be applied to a second anastomosis site. Different biocompatible chromophores can be used for each of the two or more anastomosis sites. By applying different chromophores, the color of the subject's urine may indicate the location of the potential anastomosis leakage.
Returning to
As one specific example, the composition can include methylene blue as the biocompatible chromophore. The composition may include about 100 mg of methylene blue that can be released in the urine at a rate of about 1.5 mg per day in the absence of any leakage to produce a baseline color intensity of blue (e.g., C0 as depicted in
The urine color can be monitored by doctors, nurses, and/or lab technicians at a hospital following surgery. The patient may also periodically provide samples to doctors, nurses, and/or lab technicians after the patient has been discharged from the hospital for inspection. Alternatively, a doctor or nurse may instruct the patient to visually monitor the urine color and contact the doctor or nurse when a certain color is observed or the color significantly changes. The time period for monitoring the urine color is not particularly limited. The urine can be monitored for at least about 5 days (or at least about 10 days) and/or no more than about 30 days (or no more than about 20 days). The urine color can be monitored, for example, at least once a week, at least twice a week, or at least daily.
If the urine color indicates a potential leakage, appropriate procedures may taken when a leak is suspected, such as further testing to verify that a leak exists and/or repairing any leakage at the anastomosis site. In contrast, if the urine color remains below a threshold and/or does not significantly change, this can indicate that no leakage exists, and no further testing or procedures may be required. By monitoring the urine color according to some of the methods disclosed in the present application, the methods advantageously provide a procedure for identifying any potential leakage without performing invasive procedures.
Disclosed herein are compositions for detecting an anastomosis leakage. The compositions can be applied to an anastomosis site as described above with respect to the method for detecting an anastomosis leakage (e.g., applied to the anastomosis site during operation 100 depicted in
The composition can include a bioabsorbable binding medium and a biocompatible chromophore. The biocompatible chromophore (e.g., biocompatible chromophore 310 depicted in
As used herein, a “chromophore” refers to any molecule that has color or imparts a color to the urine of a subject under some conditions, for example, all of the time or after exposure to a certain wavelength (such as in a fluorescent substance). For example, a chromophore can be a fluorescent, phosphorescent, wavelength up-converting, or other substance that may normally be substantially invisible, but that emits ultraviolet, visible, or infrared wavelengths during and/or after exposure to wavelengths from a particular region of the electromagnetic spectrum. A chromophore can also be a substance that reversibly or irreversibly changes color spontaneously or in response to any stimulus.
Non-limiting examples of chromophores include Yellow No. 5, β-carotene, rifampin, Yellow No. 6, tetracycline, Red No. 40, Red No. 3, Blue No. 2, Evan's Blue, Green No 3, Blue No. 1, methylene blue, indocyanine green, and Betanin. The composition may optionally include two or more biocompatible chromophores having the same or different colors.
As discussed above, the amount of biocompatible chromophore within the composition is not particularly limited and can vary depending upon the specific materials and amount of composition that is applied to the anastomosis site. The total amount of the biocompatible chromophore may be an amount that does not cause severe toxicity when administer to a subject one time. As an example, the composition can include about 100 mg of methylene blue.
The biocompatible chromophore can optionally be at least partially encapsulated in a particle within the composition.
Bioabsorbable layer 620 can be configured to dissolve or degrade when exposed to fluids from the tubular tissue of the subject. For example, bioabsorbable layer 620 may dissolve or degrade when exposed to fluids leaking from the bowel of a subject. The specific materials in bioabsorbable layer 620 may therefore vary depending on the type of tubular tissue where the anastomosis site is located. Bioabsorbable layer 620 may dissolve or degrade due to exposure to pH change, bacteria, or gut proteases typically found in the bowel of a subject (e.g., a human). As one example, bioabsorbable layer 620 can include one or more carbohydrates, such as starch, pectin, cellulose, and hemicellulose, that can be metabolized by bacteria typically present in the bowel of a subject. As another example, bioabsorbable layer 620 can include one or more proteins, such as albumin, collagen, and fibrin, that can be degrades by proteases typically present in the bowel of a subject. As one more example, bioabsorbable layer 620 can include one or more pH-sensitive polymers that dissolve under acidic conditions typically present in the bowel of a subject.
By at least partially encapsulating the biocompatible chromophore in a bioabsorbable layer (e.g., as depicted in
The particles can be prepared using standard techniques. As an example, a mixture containing the matrix material and biocompatible chromophore can be injected into an anti-solvent through an appropriately-sized orifice to precipitate particles. The particles can then be dip-coated to form the bioabsorbable layer. As another example, a first composition containing the matrix material and biocompatible chromophore and a second composition containing material for the bioabsorbable layer can both be aerosolized and collided to form the particles.
The composition can optionally include two or more different particles. The first particle can include a first biocompatible chromophore and a first bioabsorbable layer. The second particle can include a second biocompatible chromophore and a second bioabsorbable layer. The first bioabsorbable layer may dissolve or degrade more readily than the second bioabsorbable layer when exposed to fluid from the tubular tissue. Thus, a urine color that corresponds to the second biocompatible chromophore may indicate a more severe leakage relative to urine color that corresponds to the first biocompatible chromophore.
The composition also includes a bioabsorbable binding medium. The bioabsorbable binding medium can be absorbed over time by the subject, and may have appropriate adhesive properties to limit or reduce release of the biocompatible chromophore in the absence of a leakage near the anastomosis site. The bioabsorbable binding medium may be configured to bioabsorb over a time period of at least about 5 days (or at least about 20 days) and/or no more than about 180 days (or no more than about 100 days). The rate of bioabsorption can be adjusted using standard techniques by, for example, selecting appropriate materials and/or certain chemical modifications. As an example, the rate of bioabsorption for polymers can be adjusted by modifying the molecular weight, degree of crosslinking, or amount hydrophobic monomer units in a polymer.
The bioabsorbable binding medium can include one or more polymers. Non-limiting examples of suitable polymers include polyethylene glycol (PEG), poly(lactic acid-co-glycolic acid) (PLGA), polyglycolic acid (PGA), poly-L-lactic acid (PLLA), poly-D-lactic acid (PDLA), poly-D,L-lactic acid (PDLLA), poly(ortho esterpoly(caprolactone), polylysine, polyethylene imine, polyhydroxyacids, polyanhydrides, polyhydroxyalkanoates, poly(L-lactide-co-L-lysine), poly(serine ester), poly(4-hydroxy-L-proline ester), and poly[α-(4-aminobutyl)-L-glycolic acid]. The polymer may also be a copolymer of any of the polymers disclosed.
The composition can be, for example, a gel or a hydrogel. The gel or hydrogel can be coated to the exterior of the anastomosis site (e.g., during operation 100 of the method depicted in
The composition may also be, for example, an implantable film. The implantable film can be secured to the exterior of the anastomosis site (e.g., during operation 100 of the method depicted in
Implantable film 700 can be secured to the anastomosis site so that chromophore-doped layer 710 is disposed between non-doped layer 720 and the anastomosis site (e.g., chromophore-doped layer 710 contacts the anastomosis site). Implantable film 700 can be secured using standard techniques, such as sutures, adhesives, staples, and the like, and may be configured to wrap around the perimeter of the anastomosis site. A leakage in the tubular tissue may increase the release of the biocompatible chromophore from implantable film 700, which can be detected by changes in the urine color of the subject. The implantable film may have a thickness of less than about 5 mm (or less than about 1 mm).
The implantable film can be prepared using standard techniques, such as solvent casting, injection molding, co-extrusion, machining, lamination, and the like.
The compositions (e.g., gels, hydrogels, and implantable films) can be suitable for implanting in a subject, such as a mammal, and particularly a human. The composition can be biocompatible, and may not cause severe toxicity to the subject. The composition may also be sterilized using suitable techniques, such as by radiation or ethylene oxide, for implanting into a subject. The compositions can also be sealed in a sterile container prior to use in surgery.
With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations may be expressly set forth herein for sake of clarity.
It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” andor “an” should be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, andor A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, andor A, B, and C together, etc.). It will be further understood by those within the art that virtually any disjunctive word andor phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms. For example, the phrase “A or B” will be understood to include the possibilities of “A” or “B” or “A and B.”
In addition, where features or aspects of the disclosure are described in terms of Markush groups, those skilled in the art will recognize that the disclosure is also thereby described in terms of any individual member or subgroup of members of the Markush group.
As will be understood by one skilled in the art, for any and all purposes, such as in terms of providing a written description, all ranges disclosed herein also encompass any and all possible sub-ranges and combinations of sub-ranges thereof. Any listed range can be easily recognized as sufficiently describing and enabling the same range being broken down into at least equal halves, thirds, quarters, fifths, tenths, etc. As a non-limiting example, each range discussed herein can be readily broken down into a lower third, middle third and upper third, etc. As will also be understood by one skilled in the art all language such as “up to,” “at least,” “greater than,” “less than,” and the like include the number recited and refer to ranges which can be subsequently broken down into sub-ranges as discussed above. Finally, as will be understood by one skilled in the art, a range includes each individual member. Thus, for example, a group having 1-3 articles refers to groups having 1, 2, or 3 articles. Similarly, a group having 1-5 articles refers to groups having 1, 2, 3, 4, or 5 articles, and so forth.
While various aspects and embodiments have been disclosed herein, other aspects and embodiments will be apparent to those skilled in the art. The various aspects and embodiments disclosed herein are for purposes of illustration and are not intended to be limiting, with the true scope and spirit being indicated by the following claims.
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/US2012/045527 | 7/5/2012 | WO | 00 | 10/3/2013 |
