US3871376A - Combination absorbent dressing and flexible cooling device - Google Patents
Combination absorbent dressing and flexible cooling device Download PDFInfo
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- US3871376A US3871376A US450580A US45058074A US3871376A US 3871376 A US3871376 A US 3871376A US 450580 A US450580 A US 450580A US 45058074 A US45058074 A US 45058074A US 3871376 A US3871376 A US 3871376A
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- cooling device
- dressing
- combination
- absorbent
- flexible
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
- A61F7/10—Cooling bags, e.g. ice-bags
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F13/00—Bandages or dressings; Absorbent pads
- A61F13/02—Adhesive plasters or dressings
- A61F13/0203—Adhesive plasters or dressings having a fluid handling member
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
- A61F7/10—Cooling bags, e.g. ice-bags
- A61F7/106—Cooling bags, e.g. ice-bags self-cooling, e.g. using a chemical reaction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/22—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons containing macromolecular materials
- A61L15/26—Macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds; Derivatives thereof
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L15/00—Chemical aspects of, or use of materials for, bandages, dressings or absorbent pads
- A61L15/16—Bandages, dressings or absorbent pads for physiological fluids such as urine or blood, e.g. sanitary towels, tampons
- A61L15/42—Use of materials characterised by their function or physical properties
- A61L15/52—Water-repellants
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
- A61F2007/0001—Body part
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F7/00—Heating or cooling appliances for medical or therapeutic treatment of the human body
- A61F7/02—Compresses or poultices for effecting heating or cooling
- A61F2007/0244—Compresses or poultices for effecting heating or cooling with layers
- A61F2007/026—Compresses or poultices for effecting heating or cooling with layers with a fluid absorbing layer
Definitions
- the invention relates to improvements in adhesive bandages and is particularly concerned with the construction and assembly of adhesive bandages having cold transmitting properties integrally associated therewith.
- gauze-type dressings are widely employed in hospitals after major surgery and also in the home for minor accidental injuries.
- the gauze-type dressings are not without their disadvantages. For instance, frequent changes of such dressings are necessary in order to observe that the healing process is proceeding as desired. These frequent changes are accompanied by discomfort to the patient since some adherence to the wound or wound exudate normally occurs.
- the gauze-type dressings also require removal to renew medication.
- FIG. 1 is a perspective plan view partially cut away of the cold therapy adhesive bandage, exposing the constituents.
- FIG. 2 is a cross-sectional view taken along the lines 2-2 of FIG. 1.
- FIG. 3 is a bottom view with the release strips pulled away exposing the dressing composite.
- FIG. 4 is a view similar to FIG. 2 showing a broader aspect of the invention, i.e., without the outer covering and release strips.
- the present invention provides a combination absorbent dressing and flexible cooling device comprising:
- a dressing composite comprising in combination, a hydrophobic top sheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said top sheet;
- a cooling device associated with said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel
- a release strip on the lower surface of the device as protection against contamination.
- the present invention pro vides a combination absorbent dressing and flexible cooling device comprising:
- an outer sheet having two end segments containing an adhesive material on the lower surfaces thereof and a middle segment;
- a dressing composite comprising in combination, a hydrophobic top sheet 'for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said top sheet;
- a cooling device disposed between said outer sheet and said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel;
- the combination absorbent dressing and flexible cooling device generally depicted by reference numeral 10 (and hereinafter referred to as cold bandage,) includes an outer sheet 11 which serves as the upper, outer covering for the cold bandage.
- the outer sheet 11, is preferably fabricated from a liquid impermeable material, such as an olefinic or vinyl material.
- the outer sheet 11, has two end segments 12 and 13 which are adhesively treated on the bottom surface and a middle segment 14 constituting the area between opposing end segments 12 and 13.
- a dressing composite including an absorbent material (pad) 15 substantially centrally located and sandwiched between a thin, flexible backing sheet 16 of liquid imper meable material, such as polyethylene or polyvinylidene chloride film, and a thin flexible top sheet 17 also of a normally liquid impermeable material.
- Top sheet 17 has a plurality of valvular openings or slits 18 therein and a system of depressed areas (dimples) 19 (both as shown in FIG. 3) which slits and dimples will be described in greater detail hereinafter.
- Backing sheet 16 and topsheet 17 are of approximately equal size and are of a length and width slightly greater than the corresponding dimensions of absorbent pad 15.
- the edges of backing sheet 16 and topsheet 17 are sealed to each other around the entire periphery and just outside the outermost edges of. absorbent pad 15.
- the sealing can be accomplished by any convenient means, such as the use of an adhesive, but heat sealing is preferred and is indicated by heat seal 22 around the periphery of the topsheet and backing sheet.
- a cooling device containing a flexible packaging material 24 which encompasses and seals an insoluble hydrophilic gel 25.
- the cooling device when in the frozen state, is of the type which is easily moldable into various configurations without loss of dimensional stability, and when in the unfrozen state, the gel contained in said device does not flow.
- the cooling device is insulated from the atmosphere by provision of an insulating material 26 which is disposed between the cooling device and the outer sheet. It will be noted that the overall dimensions of the insulating material are greater than the backing sheet 16, the topsheet 17 and the cooling device so that the insulating material can effectively blanket the cooling device and dressing composite. In order to prevent substantial displacement of the insulating material and the cooling device, the edges of the insulating material are adhered such as by heat sealing and the like to the edges of the topsheet 17 and the backing sheet 16. It will, of course, be understood that this is a preferred embodiment and that the insulating material need not be adhered as shown.
- the cold bandage is provided with release strips 27.
- the release strips 27 are adhered to the lower surface of the end segments 12 and 13 and prior to affixing the cold bandage to a localized area, the release strips can be removed by pulling on end tabs 28 and 29 in a manner such as to remove the release strips from the cold bandage.
- the outer sheet 11 is preferably fabricated from a liquid impermeable material such as a polyvinylchloride, or polyethylene film.
- the thickness of the film can vary within a range of about 0.05 to 0.2 mils.
- Various other type materials can be employed such as non-woven cloth, treated paper and the like, but are not as preferred as the film materials.
- the adhesive utilized on the lower surface of the end segments 12 and 13 can be of the pressure-sensitive type conventionally employed in the pressure-sensitive tape art.
- the pressure sensitive adhesive has more self cohesion and adhesion to the end segments than to either release strip or to the skin so that it peels easily from the latter without depositing any adhesive.
- the material used in the fabrication of the topsheet and backing sheet of the dressing composite of the present invention are also not limited to any particular chemical composition since it is their physical properties rather than their chemical properties which are important in the articles of the invention.
- These materials should, of course, be thin, flexible, self-supporting, and substantially water impermeable films.
- they are thermoplastic materials which are capable of being heat sealed to each other.
- the backing sheet 16 is preferably an olefinic or vinyl film.
- Polyethylene or polyvinlidene chloride film of a thickness of from about 0.4 to about 1.5 mils are most preferred.
- any film which is useful as a backing sheet will also be useful as a topsheet for the absorbent dressing of the invention. It is preferable, however, to use a film for the topsheet which resembles cloth more closely in feel and appearance since it is this portion of the article which will come in contact with the skin of the user.
- a film which has been found particularly useful is ethyleneethyl acrylate film. This copolymer is cloth-like, and softer than polyethylene film.
- the film should have a thickness of from about 0.4 to about 2.0 mils with about 1.0 to 1.5 mils being preferred.
- the topsheet is made from a substantially liquid impermeable film and must be pro vided with openings to be effective as the absorbent dressing composite of the present invention. These openings in the topsheet must be capable of opening to permit passage of liquid to the absorbent material.
- the openings are preferably substantially straight slits as contrasted to circular openings, curved openings and the like.
- FIG. 3 it will be seen that the topsheet, has a system of openings (slits) identified by reference numeral 18 and a system of depressed areas 19 (dimples).
- the slits 18 are arranged in longitudinal rows in a manner such that each row constitutes a longitudinal array of substantially parallel straight slits each angularly disposed with respect to the longitudinal axis of the row. Adjacent rows are similarly disposed except that the slits are arranged in a manner such that the end points of each slit lie in a line substantially between the end points of corresponding slits in the adjacent alternate rows.
- the slits useful in the present invention are preferably substantially straight slits.
- the slits should each be from about 0.03 to about 0.50 inch in length. Preferably there are from about l0 to about 1,000 slits per square inch, each of such slits being from about 0.07 to about 0.20 inch in length.
- the most preferred film contains about 81 slits per square inch, each about 0.10 inch in length.
- the slits can be formed according to the methods and apparatus disclosed in US. Pat. No. 3,762,255 issued Oct. 2, 1973 and assigned to Union Carbide Corporation.
- the topsheet 17 contains a plurality of dimples arranged in staggered parallel rows along the surface of the topsheet l7 and which extend above the plane of the topsheet (FIGS. 2 and 3).
- These dimples can be circular, eliptical, rectangular, diamond shaped, and the like, the important criteria being that they be formed in a manner such that topsheet is not broken during or after fabrication.
- the dimples can be formed in the topsheet in a variety of ways. The easiest and therefore the most preferred method involves the use of a roller equipped with heating means and having a number of spikes or probes extending therefrom across the width of the roller and around its circumference.
- the spikes, pins, or probes which have smooth, rounded end points, can be spaced as desired on the roller in order to provide the desired number of dimples to the dressing composite.
- the dimples are provided on the dressing composite preferably after the openings, but prior to complete fabrication of the dressing composite, and this operation can be effected by passing the dressing composite containing the openings in contact with the heated roller.
- the dressing composite is supported on a resilient back-up member, such as an endless conveyor belt, or a resilient back-up roller.
- the depth of the dimple can be controlled by limiting the depth to which the probes depress the film. If desired,
- portions of the topsheet may be retained in their untreated (without the dimples) condition. This can be accomplished, for example, along a narrow strip near the periphery of the topsheet. Since the topsheet is thermoplastic, the amount of heat and pressure applied to the areas to be treated should be strictly controlled in order to avoid substantially puncturing the topsheet. As a general rule, the amount of heat required should be enough to soften the film, and the amount of pressure should be sufficient to plastically distort the film to the general contour of the probe. It will, of course, be understood that the correct heat and pressure conditions will depend (among other variables) upon the residence time of the treated dressing composite, i.e., the length of time the topsheet is in contact with the roller; the thickness of the dressing composite pad, etc. The correct conditions, however, can be easily ascertained by one skilled in the art and hence no further description of the conditions appears necessary.
- the dimples 19 extend above the plane of the topsheet 17 a short distance, and that the absorbent material 15 immediately above the dimples, is in a compressed state.
- that slit will be opened to a much greater degree than corresponding slits situated remote from the dimples 19.
- the slits disposed between corresponding dimples are opened to a greater extent than would be the case if no dimples were present. This is attributed to the fact that the pressure exerted on the surface of the topsheet by the dimples causes the slits to open slightly under the influence of the stretching of the topsheet.
- Portions of the compressed absorbent pad are associated with these opened slits, and because of this association, almost instantaneous wicking is achieved. As the liquid is transferred to the absorbent pad 15, the absorbent pad absorbs the liquid throughout its entire area until either partial or full saturation.
- the dimples can be arranged on the absorbent article in a variety of patterns.
- the overall design effect can be diamond shaped, curvilinear, herringbone and the like.
- the preferred design configuration is a system of substantially straight staggered, parallel rows along the surface of the topsheet.
- the number of dimples per square inch of absorbent pad area can be varied over a relatively wide range. Improvements have been noted utilizing as little as l dimple (having a diameter of 0.05 inch) per square inch of absorbent pad. I have further observed that good results are obtained when as many as dimples (0.05 inch diameter) per square inch of absorbent pad area are utilized. It will of course be understood that the number of dimples per square inch of absorbent pad area depends on the dimple size.
- the absorbent pad 15 can be one or more layers of absorbent tissue paper or wadding stacked to the desired thickness.
- absorbent non-woven pads can be fabricated to any desired thickness and substituted for the absorbent pads described above.
- One such absorbent pad which has been used extensively in disposable diapers is a wood pulp product commonly known as wood fluff and is prepared in the same manner as a non-woven fabric.
- foam materials having the desired degree of absorbency can also be employed.
- the material be absorbent, be capable of being fabricated in the form ofa pad, be compatible with the liquid with which it will come in contact and be nonirritating to the skin.
- the flexible packaging material of the cooling device can be a common plastic bag which is sealed'around the edges and is fabricated of a material which has appropriate heat transfer rates.
- suitable materials for this purpose include films fabricated from polyethylene or polyvinylidine chloride. Disposed within the flexible plastic material is an insoluble hydrophilic gel.
- insolubilization as employed throughout the specification and appended claims is utilized herein to define the formation of a gel which is essentially solid at temperatures below about 35C.
- the insolubilization can be effected by a wide variety of methods and includes, but is not limited to, ionizing and nonionizing radiation, and chemical cross-linking through covalent and ionic bonding.
- hydrophilic gels can be employed in the preparation of the cooling device of this invention.
- the only requirements of the particular gel chosen is that it be capable of retaining relatively large quantities of a liquid which can easily be transformed from the liquid to solid state by simple cooling procedures. If the liquid does not enter the solid state then it is impossible to take advantage of the latent heat of fusion.
- numerous liquids can be employed, water is preferred in order to take advantage of the large heat of fusion (144 B.t.u. per pound). Water can be employed as the sole liquid, other liquids such as alcohols can be used, or mixtures of water and other liquids or solutes can be employed.
- Illustrative hydrophilic gels which are useful in the cooling device of this invention can be prepared by appropriate techniques from the following starting materials, among others;
- Polyvinyl alkyl pyridinium halides e.g. polyvinyl-nbutyl-pyridinium bromide
- Poly-4-vinylpyridine polymerized monoesters of olefinic acids, polymerized diesters of olefinic acids, acrylamide and difunctional polymerizable materials, e.g., diacids, diesters or diamides, and the like.
- the starting materials are not only those listed above, but includes copolymers of one or more of either the aforementioned compounds or materials similar to these.
- copolymers of ethylene oxide and minor or major amounts of other alkylene oxides can also be used.
- the gel need only contain the insoluble swollen polymer and the liquid, e.g., water. If desired however, it can also include other materials to control the physical and chemical properties such as freezing point, chemical stability, color, smell, crystal size and growth rate.
- a single reinforced layer exhibits optimum comformability to the object being cooled, it is sometimes necessary or desirable to have a greater cooling capacity than can be conveniently obtained in a single layer. This can be achieved by the formation of a multilayer device.
- gels can be made of any practical thickness, width or length.
- gels have been prepared as a continuous tape which measures 3 inches wide by Vs of an inch thick.
- Dacron gauzes, both 9 and 20 holes per inch, which can be implanted in the material as it is being insolubilized lend strength to the resulting gel.
- the gels Before being packaged the gels may be swollen to their maximum liquid content.
- the product is then cut into predetermined lengths, stacked, if a multilayer device is desired, and then packaged in a polyethylene bag of the appropriate thickness. Optimum results are obtained when the gel layers have a separator to separate them. This film can be applied during the preparation of the gel. When cooling devices were made with gel without the backing, the result was some loss of flexibility when frozen.
- separator used to separate the gel layers is not necessarily critical and a wide variety of materials can be utilized.
- the only requirement of the separator is that they be flexible at reduced temperature and essentially unreactive with the gel. They do not have to be a continuous film but can be perforated.
- the separator can be a material which is applied to the surface of the gel and which effectively prevents adhesion of the layers when stacked-such materials include silicone surfactants, cetyl alcohol and the like. Any of the numerous products currently on the market can be employed with satisfactory results.
- separators can be composed of polyethylene, polypropylene, polystyrene, polyvinylchloride, polyethylene terephthalate, metal foils, and the like.
- the outer covering or enclosure in which the multilayers of gel are enclosed can be fashioned from commercially available films or other packaging materials.
- the flexible cooling device of this invention can be manufactured as a single use, disposable product or as a reusable device. If the device is meant to be disposable the outer enclosure can be a laminate with insulating material, such as cloth, polymer foams, paper and the like, on the outside.
- the inner portion of the laminate can be a common plastic such as polyethylene, polypropylene, and the like, to affect sealing or to protect the gel.
- a metal foil can be part of the laminate to prevent the device from drying out.
- the primary package can also have attaching devices at each end to provide a means of securing the cooling device to the area to be cooled.
- the product can be manufactured and shipped as a sterile item if desired.
- the outer enclosure can be a common plastic bag sealed around the edges.
- This unit can be supplied with an auxiliary bag into which the tape is placed.
- This outer bag would be of a material which has appropriate heat transfer rates and may have strings attached at both ends to be used to secure the tape to the area to be cooled.
- Both types of product can be packaged as a unitized structure for example, quilt like in character. Appropriate performations can be inserted so that the device can be divided into smaller pieces.
- novel cooling devices of this invention are comprised of a hydrophilic, polymeric gel of at least one insolubilized polymer of the formula:
- R and R are selected from the group consisting of hydrogen, alkyl radicals and alkyl substituted aryl radicals, and wherein R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, and R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, and n is greater than one.
- hydrophilic gels are polymeric compounds containing at least one of the structural units shown below:
- R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals; R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals; R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals; and wherein R is hydrogen whenR; is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals.
- hydrophilic polymeric gel compounds may include carbon to carbon cross-linking between straight ous water solution of at least one of the water soluble compounds selected from the following class of comwherein R and R are selected from the group consisting of hydrogen, alkyl radicals and alkyl substituted aryl radicals, R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl, and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the .group consisting of hydrogen, methyl, phenyl and vinyl radicals, and n is greater than one; submitting the solution to ionizing radiation for a period of time sufficient to cause insolubilization of the polymer.
- R and R are selected from the group consisting of hydrogen, alkyl radicals and alkyl substituted aryl radicals
- the pH of the solution apparently is not critical to the operability of the preparation of the polymeric gels although the time required to cause formation of the gel-like material can be considerably shortened by utilizing a starting solution having a pH of about 7.0.
- poly(ethylene oxide) having a molecular weight ranging from about 1X 1 0 to about 10; a starting water solution containing at least about 0.2 weight percent of poly(ethylene oxide); and submitting the starting solution to a total irradiation dosage of at least about S2.0 10 rads to produce the gel-like material.
- hydrophilic polymeric gels after the hydrophilic polymeric gels have been prepared, they can be used directly or further modified by the addition of or the incorporation of various agents, or other additives, as hereinafter indicated. Moreover if a higher degree of flexibility of the frozen hydrophilic polymeric gels is desired, it can be accomplished by addition of small amounts of glycol such as ethylene glycol and the like.
- the device itself can contain various strengthening materials throughout.
- nylon gauze, rayon mesh, dacron, cellulose or other textile products mesh can be embedded in the hydrophilic gel, or fibers can be embedded in a random orientation.
- the hydrophilic gel forming step employed in the preparation of the polymeric gels can be accomplished prior to, or simultaneously with the placement of the inert separators and/or the incorporation of an internal substrate or strengthening agent.
- An internal substrate can be incorporated by dipping a matrix prior to insolubilization into the aqueous poly- (ethylene oxide) solution and then exposing it to insolublizing conditions. Other methods for placement of the substrate will readily become apparent to those skilled in the art.
- the novel cooling device of this invention can be made with hydrophilic gels in a wariety of thicknesses ranging from one reinforced layer of I millimeter thickness or less, to 20 or more layers to give a total thickness of several inches, or more.
- the insulating material 26 should be of the type which is flexible, andhas good insulating properties so as to retard the effect of the difference in temperature of the atmosphere and the cooling device.
- the insulating material is a cellular material such as rubber foam, polyurethane foam, polystyrene and the like.
- the material is capable of being heat sealed to the backing sheet and top sheet of the absorbent composite.
- the thickness of the insulating material would of course depend upon the degree of protection required, the thickness of the cooling device, the desired flexibility of the cold bandage and other obvious considerations. For these reasons, exact figures for the thickness of the insulating material are not readily statable. Suffice it to state that the degree of thickness of the insulating material can be easily assertained by one skilled in the art depending on the above mentioned criteria.
- the release (or protection) strips 27 can be formed from materials commonly used inthe adhesive dressing art.
- the cold bandage of the present invention can be fabricated by a wide variety of techniques.
- the absorbent composite and cooling device can be independently fabricated and placed over each other with the cooling device on top of the absorbent composite.
- the insulating material thereafter can be superimposed over the two and adhered such as by heat scaling to the absorbent composite as explained previously.
- the middle segment of the outer sheet can be superimposed over the entire assembly and joined thereto.
- the release strip can be added as a last step.
- the cold bandage is particularly suitable for the intended purpose. There is very little tendency for the ice bandage to stick to the wound as in conventional dressings. This is partly attributable to the selection of materials for the top sheet with ethylene ethylacrylate being the preferred material. Moreover, absorption of body exudate through the slits by the wicking action of the absorbent material as enhanced by the dimples is extremely rapid. Pinpoint transmission of cold to the wound site is accomplished through the dimples on the absorbent composite. I have found that the cold transmission is extremely rapid when the dimple contains some liquid on its surface. Thus, it will be evident that the cold bandage of the instant invention has fluid absorbing as well as cold transmitting properties integrally associated therewith without experiencing any of the disadvantages characteristically prevalent in prior art devices.
- the cold bandage be provided with the outer covering or strip as shown.
- the outer strip or covering can be eliminated when the cold bandage is to be used with conventional gauze or other type coverings.
- FIG. 4 where like parts are designated by like reference numerals, and where the choice of materials and constructional details can be the same as those utilized in the device of FIG. 1, it will be seen that the outer covering has been eliminated together with the release strips. If desired, however, release strips can be added and their point of attachment can be at the ends of the cold bandage.
- valvular as used throughout the specification and in the claims is intended to refer to apertures in the top sheet which are capable of opening to permit passage of liquid under certain circumstances and reclosing to retard passage of liquid under certain other circumstances.
- dimples are employed to characterize the depressed areas and mean the depressed areas across the surface of the top sheet which extend below (or above) the plane of the top sheet and which are fabricated in a manner such that there is substantially no breaking, melting or cutting of the top sheet during or after fabrication in a manner which would hinder the controlled passage of liquid to the absorbent pad.
- a combination absorbent dressing and flexible cooling device comprising:
- a dressing composite comprising in combination, a hydrophobic topsheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said topsheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said topsheet;
- a cooling device associated with said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel
- a combination absorbent dressing and flexible cooling device according to claim 1 wherein said hydrophobic topsheet is an ethylene ethylacrylate film.
- a combination absorbent dressing and flexible cooling device wherein said valvular openings are substantially parallel straight slits disposed in longitudinal rows, each slit being angularly disposed with respect to the longitudinal axis of each row.
- a combination absorbent dressing and flexible cooling device according to claim 3 wherein said slits are from about 0.03 to about 0.20 inch in length.
- a combination absorbent dressing and flexible cooling device according to claim 1 wherein said dimples have a frequency of at least 1 per square inch of absorbent area.
- a combination absorbent dressing and flexible cooling device according to claim 1 wherein said dimples have a circular configuration with a diameter of from about 0.025 to about 0.25 inch.
- topsheet and said backing sheet are of substantially the same dimensions and are adhered to each other around their periphery to form an integral structure having the absorbent material substantially enclosed and sandwiched between the topsheet and backing sheet.
- a combination absorbent dressing and flexible cooling device according to claim 1 wherein said insoluble hydrophilic gel is insolublized poly (ethylene oxide) 9.
- a combination absorbent dressing and flexible cooling device according to claim 1 wherein said insulating material is adhered to said dressing composite and said cooling device.
- a combination absorbent dressing and flexible cooling device comprising:
- an outer sheet having two end segments containing an adhesive material on the lower surfaces thereof and a middle segment;
- a dressing composite comprising in combination, a hydrophobic top sheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples dis- I posed on said top sheet;
- a cooling device disposed between said outer sheet and said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel;
- a combination absorbent dressing and flexible cooling device according to claim 10 wherein said hydrophobic topsheet is an ethylene ethylacrylate film.
- a combination absorbent dressing and flexible cooling device wherein said valvular openings are substantially parallel straight slits disposed in longitudinal rows, each slit being angularly disposed with respect to the longitudinal axis of each 'row.
- a combination absorbent dressing and flexible cooling device according to claim 12 wherein said slits are from about 0.03 to about 0.20 inch in length.
- a combination absorbent dressing and flexible cooling device according to claim 10 wherein said dimples have a frequency of at least 1 per square inch of absorbent area.
- a combination absorbent dressing and flexible cooling device according to claim 10 wherein said dimples have a circular configuration with a diameter of from about 0.025 to about 0.25 inch.
- topsheet and said backing sheet are of substantially the same dimensions and are adhered to each other around their periphery to form an integral structure having the absorbent material substantially enclosed and sandwiched between the topsheet and backing sheet.
- a combination absorbent dressing and flexible cooling device according to claim 10 wherein said insoluble hydrophilic gel is insolubilized poly (ethylene oxide) 18.
- a combination absorbent dressing and flexible cooling device according to claim 10 wherein said insulating material is adhered to said dressing composite and said cooling device.
Abstract
A combination absorbent dressing and flexible cooling device which includes a cooling device superimposed over a dressing composite, and an insulating material covering said cooling device and dressing composite.
Description
United States Patent 1 1111 I 3,871,376
Kozak 1 Mar. 18, 1975 [54] COMBINATION ABSORBENT DRESSING 3,074,250 1/1963 Everett 128/403 X AND FLEXIBLE COOLNG DEVICE 3,463,161 8/1969 Andrassy 128/402 3,545,230 12/1970 Morse 128/403 X [75] Inventor: Theodore F. Kozak, Peekskill, NY.
[73] Assignee: Union Carbide Corporation, New
York, NY, Primary ExaminerLawrence W. Trapp Attorney, Agent, or FirmClement J. Vicari [22] Filed: Mar. 13, 1974 [21] Appl. No.: 450,580
52] US. Cl. 128/275.l, 128/403 [57] ABSTRACT [51] Int. Cl. A61f 5/44 [58] Field of Search 128/399 403, A ation a s r nt dressing and flexible cooling 128/2751, 82.1, 68,1, 155, 156 device which includes a cooling device superimposed over a dressing composite, and an insulating material [56] Reference Cit d covering said cooling device and dressing composite.
UNITED STATES PATENTS 2,573,791 11/1951 Howells 128/821 18 Claims, 4 Drawing Figures 'PATENTEU HAR I 8i9?5 sumlu z;
COMBINATION ABSORBENT DRESSING AND FLEXIBLE COOLING DEVICE The invention relates to improvements in adhesive bandages and is particularly concerned with the construction and assembly of adhesive bandages having cold transmitting properties integrally associated therewith.
A wide variety of products are currently available on the market in the field of wound dressings. For example, sterile and medicated gauze-type dressings are widely employed in hospitals after major surgery and also in the home for minor accidental injuries. However, in spite of their wide acceptance, the gauze-type dressings are not without their disadvantages. For instance, frequent changes of such dressings are necessary in order to observe that the healing process is proceeding as desired. These frequent changes are accompanied by discomfort to the patient since some adherence to the wound or wound exudate normally occurs. The gauze-type dressings also require removal to renew medication.
Various polymeric materials have also been investigated for use in the treatment of wounds, burns and other skin disorders. For example, collagen, polyvinyl alcohol, gelatin and a wide variety of polymeric materials have been disclosed in the literature as being useful in the treatment of accidental and surgical wounds. However, in most instances these materials are neither transparent, nor do they control the growth of bacteria. Moreover, many patients have been found to be allergic to these dressings which in many instances necessitated a return to the use of the gauze-type product.
Devices for lowering temperature at select sites are also widely employed in the treatment of animals and humans. lce has been employed for many years and is well known for relieving the discomfort of pain and swelling and for injuries suffered accidentally, in athletics or as a result of other endeavors. However, while the well known ice pack may have a degree of flexibility it requires the crushing of ice, is cumbersome to use and does not provide a uniform cooling surface. Moreover as the ice or the frozen water-alcohol mixtures attain room temperature, it reverts entirely to the liquid state and provides additional disadvantages in handling, particularly if the enclosing container is not completely leakproof. It has long been recognized that there is a need for combining the advantages of a conventional gauze-type wound dressing with a device for lowering temperatures in one overall dressing or bandage. Unfortunately however, prior art attempts have not been entirely satisfactory due to the attendant disadvantages which far outweighed any benefits received. For example, in the case where the absorbing material is placed directly over the wound with the cooling device over the absorbing material, there is a loss of cooling efficiency to the wound due to the insulating properties of the absorbent material. Where ice or frozen water-alcohol mixtures are utilized as the cooling medium, once the mixtures attain room temperature, they revert entirely to the liquid state and are subject to leakage in which case the absorbent dressing is also subject to saturation.
It is therefore an object of the present invention to provide a novel, flexible adhesive bandage having fluid absorbing as well as cold transmitting properties integrally associated therewith. Another object is to provide a novel dressing that can act as both an absorbent for body fluid exudate from a wound or injury as well as a cold therapy to the involved area.
These and other objects will become apparent from the following description of the invention taken in conjunction with the accompanying drawings in which FIG. 1 is a perspective plan view partially cut away of the cold therapy adhesive bandage, exposing the constituents.
FIG. 2 is a cross-sectional view taken along the lines 2-2 of FIG. 1.
FIG. 3 is a bottom view with the release strips pulled away exposing the dressing composite.
FIG. 4 is a view similar to FIG. 2 showing a broader aspect of the invention, i.e., without the outer covering and release strips.
Broadly contemplated, the present invention provides a combination absorbent dressing and flexible cooling device comprising:
a. a dressing composite comprising in combination, a hydrophobic top sheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said top sheet;
b. a cooling device associated with said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel; and
c. an insulating material covering said cooling device and said dressing composite.
Optionally, there is provided a release strip on the lower surface of the device as protection against contamination.
In a more specific aspect, the present invention pro vides a combination absorbent dressing and flexible cooling device comprising:
a. an outer sheet having two end segments containing an adhesive material on the lower surfaces thereof and a middle segment;
b. a dressing composite comprising in combination, a hydrophobic top sheet 'for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said top sheet;
0. a cooling device disposed between said outer sheet and said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel;
d. an insulating material disposed between said cooling device and said outer sheet; and
e. a release strip disposed on the lower surface of said combination absorbent dressing and flexible cooling device in adhesive engagement with said end segments.
For a clearer understanding of the invention, reference is made to the drawings and in particular to FIG. 1 thereof. The combination absorbent dressing and flexible cooling device generally depicted by reference numeral 10 (and hereinafter referred to as cold bandage,) includes an outer sheet 11 which serves as the upper, outer covering for the cold bandage. The outer sheet 11, is preferably fabricated from a liquid impermeable material, such as an olefinic or vinyl material. The outer sheet 11, has two end segments 12 and 13 which are adhesively treated on the bottom surface and a middle segment 14 constituting the area between opposing end segments 12 and 13.
Referring to FIG. 2, it will be seen that situated below the middle segment 14 of the outer sheet 11 is a dressing composite including an absorbent material (pad) 15 substantially centrally located and sandwiched between a thin, flexible backing sheet 16 of liquid imper meable material, such as polyethylene or polyvinylidene chloride film, and a thin flexible top sheet 17 also of a normally liquid impermeable material. Top sheet 17 has a plurality of valvular openings or slits 18 therein and a system of depressed areas (dimples) 19 (both as shown in FIG. 3) which slits and dimples will be described in greater detail hereinafter.
The cooling device is insulated from the atmosphere by provision of an insulating material 26 which is disposed between the cooling device and the outer sheet. It will be noted that the overall dimensions of the insulating material are greater than the backing sheet 16, the topsheet 17 and the cooling device so that the insulating material can effectively blanket the cooling device and dressing composite. In order to prevent substantial displacement of the insulating material and the cooling device, the edges of the insulating material are adhered such as by heat sealing and the like to the edges of the topsheet 17 and the backing sheet 16. It will, of course, be understood that this is a preferred embodiment and that the insulating material need not be adhered as shown.
In order to protect the lower surface of the cold bandage from contamination, the cold bandage is provided with release strips 27. The release strips 27 are adhered to the lower surface of the end segments 12 and 13 and prior to affixing the cold bandage to a localized area, the release strips can be removed by pulling on end tabs 28 and 29 in a manner such as to remove the release strips from the cold bandage.
As mentioned previously, the outer sheet 11 is preferably fabricated from a liquid impermeable material such as a polyvinylchloride, or polyethylene film. The thickness of the film can vary within a range of about 0.05 to 0.2 mils. Various other type materials can be employed such as non-woven cloth, treated paper and the like, but are not as preferred as the film materials. The adhesive utilized on the lower surface of the end segments 12 and 13 can be of the pressure-sensitive type conventionally employed in the pressure-sensitive tape art. Thus, the pressure sensitive adhesive has more self cohesion and adhesion to the end segments than to either release strip or to the skin so that it peels easily from the latter without depositing any adhesive. The material used in the fabrication of the topsheet and backing sheet of the dressing composite of the present invention are also not limited to any particular chemical composition since it is their physical properties rather than their chemical properties which are important in the articles of the invention. These materials should, of course, be thin, flexible, self-supporting, and substantially water impermeable films. Preferably they are thermoplastic materials which are capable of being heat sealed to each other.
The backing sheet 16 is preferably an olefinic or vinyl film. Polyethylene or polyvinlidene chloride film of a thickness of from about 0.4 to about 1.5 mils are most preferred.
Any film which is useful as a backing sheet will also be useful as a topsheet for the absorbent dressing of the invention. It is preferable, however, to use a film for the topsheet which resembles cloth more closely in feel and appearance since it is this portion of the article which will come in contact with the skin of the user. One film which has been found particularly useful is ethyleneethyl acrylate film. This copolymer is cloth-like, and softer than polyethylene film. The film should have a thickness of from about 0.4 to about 2.0 mils with about 1.0 to 1.5 mils being preferred.
As described above, the topsheet is made from a substantially liquid impermeable film and must be pro vided with openings to be effective as the absorbent dressing composite of the present invention. These openings in the topsheet must be capable of opening to permit passage of liquid to the absorbent material. The openings are preferably substantially straight slits as contrasted to circular openings, curved openings and the like. Thus, referring specifically to FIG. 3, it will be seen that the topsheet, has a system of openings (slits) identified by reference numeral 18 and a system of depressed areas 19 (dimples). The slits 18 are arranged in longitudinal rows in a manner such that each row constitutes a longitudinal array of substantially parallel straight slits each angularly disposed with respect to the longitudinal axis of the row. Adjacent rows are similarly disposed except that the slits are arranged in a manner such that the end points of each slit lie in a line substantially between the end points of corresponding slits in the adjacent alternate rows. The slits useful in the present invention are preferably substantially straight slits. The slits should each be from about 0.03 to about 0.50 inch in length. Preferably there are from about l0 to about 1,000 slits per square inch, each of such slits being from about 0.07 to about 0.20 inch in length. The most preferred film contains about 81 slits per square inch, each about 0.10 inch in length.
The slits can be formed according to the methods and apparatus disclosed in US. Pat. No. 3,762,255 issued Oct. 2, 1973 and assigned to Union Carbide Corporation.
The depressed areas (dimples) are distributed across 3. Thus, it will be seen that the topsheet 17 contains a plurality of dimples arranged in staggered parallel rows along the surface of the topsheet l7 and which extend above the plane of the topsheet (FIGS. 2 and 3).
The configuration of these dimples can be circular, eliptical, rectangular, diamond shaped, and the like, the important criteria being that they be formed in a manner such that topsheet is not broken during or after fabrication.
I have found that the full advantages of the present invention are not achieved if, during fabrication of the dimples, the topsheet is broken, cut or melted to any significant extent. I have found that the preferred form of the dimple is circular as shown in FIGS. 2 and 3.
The dimples can be formed in the topsheet in a variety of ways. The easiest and therefore the most preferred method involves the use of a roller equipped with heating means and having a number of spikes or probes extending therefrom across the width of the roller and around its circumference. The spikes, pins, or probes, which have smooth, rounded end points, can be spaced as desired on the roller in order to provide the desired number of dimples to the dressing composite. The dimples are provided on the dressing composite preferably after the openings, but prior to complete fabrication of the dressing composite, and this operation can be effected by passing the dressing composite containing the openings in contact with the heated roller. In this technique, the dressing composite is supported on a resilient back-up member, such as an endless conveyor belt, or a resilient back-up roller. The depth of the dimple can be controlled by limiting the depth to which the probes depress the film. If desired,
portions of the topsheet may be retained in their untreated (without the dimples) condition. This can be accomplished, for example, along a narrow strip near the periphery of the topsheet. Since the topsheet is thermoplastic, the amount of heat and pressure applied to the areas to be treated should be strictly controlled in order to avoid substantially puncturing the topsheet. As a general rule, the amount of heat required should be enough to soften the film, and the amount of pressure should be sufficient to plastically distort the film to the general contour of the probe. It will, of course, be understood that the correct heat and pressure conditions will depend (among other variables) upon the residence time of the treated dressing composite, i.e., the length of time the topsheet is in contact with the roller; the thickness of the dressing composite pad, etc. The correct conditions, however, can be easily ascertained by one skilled in the art and hence no further description of the conditions appears necessary.
Referring specifically to FIG. 2, it will be seen that the dimples 19 extend above the plane of the topsheet 17 a short distance, and that the absorbent material 15 immediately above the dimples, is in a compressed state. At the site where a dimple is formed over a portion of a slit, that slit will be opened to a much greater degree than corresponding slits situated remote from the dimples 19. However, because of the placement of the dimples, the slits disposed between corresponding dimples are opened to a greater extent than would be the case if no dimples were present. This is attributed to the fact that the pressure exerted on the surface of the topsheet by the dimples causes the slits to open slightly under the influence of the stretching of the topsheet. Portions of the compressed absorbent pad are associated with these opened slits, and because of this association, almost instantaneous wicking is achieved. As the liquid is transferred to the absorbent pad 15, the absorbent pad absorbs the liquid throughout its entire area until either partial or full saturation.
The dimples can be arranged on the absorbent article in a variety of patterns. Thus, the overall design effect can be diamond shaped, curvilinear, herringbone and the like. The preferred design configuration is a system of substantially straight staggered, parallel rows along the surface of the topsheet. The number of dimples per square inch of absorbent pad area can be varied over a relatively wide range. Improvements have been noted utilizing as little as l dimple (having a diameter of 0.05 inch) per square inch of absorbent pad. I have further observed that good results are obtained when as many as dimples (0.05 inch diameter) per square inch of absorbent pad area are utilized. It will of course be understood that the number of dimples per square inch of absorbent pad area depends on the dimple size.
As a general rule, dimple size can be in the range of about 0.025 to about 0.250 inch diameter. From the standpoint of functional and aesthetic qualities, it is preferred that the dimple size range from about 0.075 to about 0.150 inch diameter.
The absorbent pad 15 can be one or more layers of absorbent tissue paper or wadding stacked to the desired thickness.
Absorbent materials other than tissue and wadding will of course be useful in the diaper construction of the present invention. For example, absorbent non-woven pads can be fabricated to any desired thickness and substituted for the absorbent pads described above. One such absorbent pad which has been used extensively in disposable diapers is a wood pulp product commonly known as wood fluff and is prepared in the same manner as a non-woven fabric. In addition, foam materials having the desired degree of absorbency can also be employed.
The only criteria for utility in the present invention are that the material be absorbent, be capable of being fabricated in the form ofa pad, be compatible with the liquid with which it will come in contact and be nonirritating to the skin.
The flexible packaging material of the cooling device can be a common plastic bag which is sealed'around the edges and is fabricated of a material which has appropriate heat transfer rates. Merely as illustrative, suitable materials for this purpose include films fabricated from polyethylene or polyvinylidine chloride. Disposed within the flexible plastic material is an insoluble hydrophilic gel.
The term' insolubilization" as employed throughout the specification and appended claims is utilized herein to define the formation of a gel which is essentially solid at temperatures below about 35C. The insolubilization can be effected by a wide variety of methods and includes, but is not limited to, ionizing and nonionizing radiation, and chemical cross-linking through covalent and ionic bonding.
In practice a wide variety of hydrophilic gels can be employed in the preparation of the cooling device of this invention. The only requirements of the particular gel chosen is that it be capable of retaining relatively large quantities of a liquid which can easily be transformed from the liquid to solid state by simple cooling procedures. If the liquid does not enter the solid state then it is impossible to take advantage of the latent heat of fusion. Although numerous liquids can be employed, water is preferred in order to take advantage of the large heat of fusion (144 B.t.u. per pound). Water can be employed as the sole liquid, other liquids such as alcohols can be used, or mixtures of water and other liquids or solutes can be employed.
Illustrative hydrophilic gels which are useful in the cooling device of this invention can be prepared by appropriate techniques from the following starting materials, among others;
Poly(ethylene oxide),
Polyvinyl pyrrolidone,
Polyacrylamide,
Anionic polyacrylamide,
Polyvinylalcohol,
Maleic anhydride-vinylether copolymers,
Polyacrylic acid,
Ethylene-maleic anhydride copolymers,
Polyvinylether,
Dextran,
Gelatin,
Hydroxy propyl cellulose,
Methyl cellulose,
Carboxymethyl cellulose,
Hydroxyethyl-carboxymethyl cellulose,
I-Iydroxyethyl cellulose,
Propyleneglycol alginate,
Sodium alginate,
Polyethyleneimine,
Polyvinyl alkyl pyridinium halides, e.g. polyvinyl-nbutyl-pyridinium bromide,
Polyproline,
Natural starches,
Casein,
Proteins,
Polymethacrylic acid,
Polyvinylsulfonic acid,
Polystyrene sulfonic acid,
Polyvinylamine,
Poly-4-vinylpyridine, polymerized monoesters of olefinic acids, polymerized diesters of olefinic acids, acrylamide and difunctional polymerizable materials, e.g., diacids, diesters or diamides, and the like.
It should be noted that the starting materials are not only those listed above, but includes copolymers of one or more of either the aforementioned compounds or materials similar to these. For example, copolymers of ethylene oxide and minor or major amounts of other alkylene oxides can also be used.
In most instances, the gel need only contain the insoluble swollen polymer and the liquid, e.g., water. If desired however, it can also include other materials to control the physical and chemical properties such as freezing point, chemical stability, color, smell, crystal size and growth rate.
Although a single reinforced layer exhibits optimum comformability to the object being cooled, it is sometimes necessary or desirable to have a greater cooling capacity than can be conveniently obtained in a single layer. This can be achieved by the formation of a multilayer device.
It has been observed that the optimum flexibility and other desirable features are exhibited when the layers of gel are separated from each other by a thin film of an inert material. The frozen layers are then permitted to slide easily over each other and contribute even greater flexibility than that possessed by multilayers of LII the gel alone.
In practice, gels can be made of any practical thickness, width or length. In one embodiment gels have been prepared as a continuous tape which measures 3 inches wide by Vs of an inch thick. Dacron gauzes, both 9 and 20 holes per inch, which can be implanted in the material as it is being insolubilized lend strength to the resulting gel. Before being packaged the gels may be swollen to their maximum liquid content. The product is then cut into predetermined lengths, stacked, if a multilayer device is desired, and then packaged in a polyethylene bag of the appropriate thickness. Optimum results are obtained when the gel layers have a separator to separate them. This film can be applied during the preparation of the gel. When cooling devices were made with gel without the backing, the result was some loss of flexibility when frozen.
Devices of 20 layers of gel and higher have been made and found to have good flexibility.
The type of separator used to separate the gel layers is not necessarily critical and a wide variety of materials can be utilized. The only requirement of the separator is that they be flexible at reduced temperature and essentially unreactive with the gel. They do not have to be a continuous film but can be perforated. Moreover, the separator can be a material which is applied to the surface of the gel and which effectively prevents adhesion of the layers when stacked-such materials include silicone surfactants, cetyl alcohol and the like. Any of the numerous products currently on the market can be employed with satisfactory results. For example, separators can be composed of polyethylene, polypropylene, polystyrene, polyvinylchloride, polyethylene terephthalate, metal foils, and the like. Similarly, the outer covering or enclosure in which the multilayers of gel are enclosed can be fashioned from commercially available films or other packaging materials.
The flexible cooling device of this invention can be manufactured as a single use, disposable product or as a reusable device. If the device is meant to be disposable the outer enclosure can be a laminate with insulating material, such as cloth, polymer foams, paper and the like, on the outside. The inner portion of the laminate can be a common plastic such as polyethylene, polypropylene, and the like, to affect sealing or to protect the gel. A metal foil can be part of the laminate to prevent the device from drying out. The primary package can also have attaching devices at each end to provide a means of securing the cooling device to the area to be cooled. Finally, the product can be manufactured and shipped as a sterile item if desired.
As a re-usable cooling device, the outer enclosure can be a common plastic bag sealed around the edges. This unit can be supplied with an auxiliary bag into which the tape is placed. This outer bag would be of a material which has appropriate heat transfer rates and may have strings attached at both ends to be used to secure the tape to the area to be cooled. Both types of product can be packaged as a unitized structure for example, quilt like in character. Appropriate performations can be inserted so that the device can be divided into smaller pieces.
In one preferred aspect, the novel cooling devices of this invention are comprised of a hydrophilic, polymeric gel of at least one insolubilized polymer of the formula:
wherein R and R are selected from the group consisting of hydrogen, alkyl radicals and alkyl substituted aryl radicals, and wherein R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, and R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, and n is greater than one.
These hydrophilic gels are polymeric compounds containing at least one of the structural units shown below:
wherein R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals; R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals; R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals; and wherein R is hydrogen whenR; is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals.
These hydrophilic polymeric gel compounds may include carbon to carbon cross-linking between straight ous water solution of at least one of the water soluble compounds selected from the following class of comwherein R and R are selected from the group consisting of hydrogen, alkyl radicals and alkyl substituted aryl radicals, R is hydrogen when R, is selected from the group consisting of hydrogen, methyl, phenyl, and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the group consisting of hydrogen, methyl, phenyl and vinyl radicals, R is hydrogen when R is selected from the .group consisting of hydrogen, methyl, phenyl and vinyl radicals, and n is greater than one; submitting the solution to ionizing radiation for a period of time sufficient to cause insolubilization of the polymer.
The pH of the solution apparently is not critical to the operability of the preparation of the polymeric gels although the time required to cause formation of the gel-like material can be considerably shortened by utilizing a starting solution having a pH of about 7.0.
Temperature apparently is not critical to the operability of the process since the gel-like material has been formed in solutions having a temperature of just above the freezing pointof the starting solution.
In the treatment of polymers of ethylene oxide in accordance with the present invention it is preferred to utilize poly(ethylene oxide) having a molecular weight ranging from about 1X 1 0 to about 10; a starting water solution containing at least about 0.2 weight percent of poly(ethylene oxide); and submitting the starting solution to a total irradiation dosage of at least about S2.0 10 rads to produce the gel-like material.
In general, after the hydrophilic polymeric gels have been prepared, they can be used directly or further modified by the addition of or the incorporation of various agents, or other additives, as hereinafter indicated. Moreover if a higher degree of flexibility of the frozen hydrophilic polymeric gels is desired, it can be accomplished by addition of small amounts of glycol such as ethylene glycol and the like.
In addition to the use of an inert material as a separator in the cooling device of this invention, the device itself can contain various strengthening materials throughout. For example, nylon gauze, rayon mesh, dacron, cellulose or other textile products mesh can be embedded in the hydrophilic gel, or fibers can be embedded in a random orientation.
In practice, the hydrophilic gel forming step employed in the preparation of the polymeric gels can be accomplished prior to, or simultaneously with the placement of the inert separators and/or the incorporation of an internal substrate or strengthening agent. An internal substrate can be incorporated by dipping a matrix prior to insolubilization into the aqueous poly- (ethylene oxide) solution and then exposing it to insolublizing conditions. Other methods for placement of the substrate will readily become apparent to those skilled in the art.
The novel cooling device of this invention can be made with hydrophilic gels in a wariety of thicknesses ranging from one reinforced layer of I millimeter thickness or less, to 20 or more layers to give a total thickness of several inches, or more.
The insulating material 26 should be of the type which is flexible, andhas good insulating properties so as to retard the effect of the difference in temperature of the atmosphere and the cooling device. Preferably, the insulating material is a cellular material such as rubber foam, polyurethane foam, polystyrene and the like. Most preferably, the material is capable of being heat sealed to the backing sheet and top sheet of the absorbent composite. The thickness of the insulating material would of course depend upon the degree of protection required, the thickness of the cooling device, the desired flexibility of the cold bandage and other obvious considerations. For these reasons, exact figures for the thickness of the insulating material are not readily statable. Suffice it to state that the degree of thickness of the insulating material can be easily assertained by one skilled in the art depending on the above mentioned criteria.
The release (or protection) strips 27 can be formed from materials commonly used inthe adhesive dressing art.
The cold bandage of the present invention can be fabricated by a wide variety of techniques. Merely as illustrative, the absorbent composite and cooling device can be independently fabricated and placed over each other with the cooling device on top of the absorbent composite. The insulating material thereafter can be superimposed over the two and adhered such as by heat scaling to the absorbent composite as explained previously. Thereafter the middle segment of the outer sheet can be superimposed over the entire assembly and joined thereto. The release strip can be added as a last step.
I have found that the cold bandage is particularly suitable for the intended purpose. There is very little tendency for the ice bandage to stick to the wound as in conventional dressings. This is partly attributable to the selection of materials for the top sheet with ethylene ethylacrylate being the preferred material. Moreover, absorption of body exudate through the slits by the wicking action of the absorbent material as enhanced by the dimples is extremely rapid. Pinpoint transmission of cold to the wound site is accomplished through the dimples on the absorbent composite. I have found that the cold transmission is extremely rapid when the dimple contains some liquid on its surface. Thus, it will be evident that the cold bandage of the instant invention has fluid absorbing as well as cold transmitting properties integrally associated therewith without experiencing any of the disadvantages characteristically prevalent in prior art devices.
It will, of course, be understood that for certain uses, it is not necessary that the cold bandage be provided with the outer covering or strip as shown. For example, the outer strip or covering can be eliminated when the cold bandage is to be used with conventional gauze or other type coverings. Thus referring to FIG. 4, where like parts are designated by like reference numerals, and where the choice of materials and constructional details can be the same as those utilized in the device of FIG. 1, it will be seen that the outer covering has been eliminated together with the release strips. If desired, however, release strips can be added and their point of attachment can be at the ends of the cold bandage.
The term valvular as used throughout the specification and in the claims is intended to refer to apertures in the top sheet which are capable of opening to permit passage of liquid under certain circumstances and reclosing to retard passage of liquid under certain other circumstances.
The term dimples are employed to characterize the depressed areas and mean the depressed areas across the surface of the top sheet which extend below (or above) the plane of the top sheet and which are fabricated in a manner such that there is substantially no breaking, melting or cutting of the top sheet during or after fabrication in a manner which would hinder the controlled passage of liquid to the absorbent pad.
It will also be understood that while the present invention has been set forth in some detail and described with particularity, it is susceptible to changes, modifications and alterations without departing from the scope and spirit of the invention as defined in the appended claims. For example, although the cold bandage has been shown as having a generally rectangular configuration, it will, of course, be understood that it can be circular, eliptical, diamond shaped or of any other desired practical configuration.
What is claimed is:
1. A combination absorbent dressing and flexible cooling device comprising:
a. a dressing composite comprising in combination, a hydrophobic topsheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said topsheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said topsheet;
b. a cooling device associated with said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel; and
c. an insulating material covering said cooling device and said dressing composite.
2. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said hydrophobic topsheet is an ethylene ethylacrylate film.
3. A combination absorbent dressing and flexible cooling device according to claim 2 wherein said valvular openings are substantially parallel straight slits disposed in longitudinal rows, each slit being angularly disposed with respect to the longitudinal axis of each row.
4. A combination absorbent dressing and flexible cooling device according to claim 3 wherein said slits are from about 0.03 to about 0.20 inch in length.
5. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said dimples have a frequency of at least 1 per square inch of absorbent area.
6. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said dimples have a circular configuration with a diameter of from about 0.025 to about 0.25 inch.
7. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said topsheet and said backing sheet are of substantially the same dimensions and are adhered to each other around their periphery to form an integral structure having the absorbent material substantially enclosed and sandwiched between the topsheet and backing sheet.
8. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said insoluble hydrophilic gel is insolublized poly (ethylene oxide) 9. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said insulating material is adhered to said dressing composite and said cooling device.
10. A combination absorbent dressing and flexible cooling device comprising:
a. an outer sheet having two end segments containing an adhesive material on the lower surfaces thereof and a middle segment;
b. a dressing composite comprising in combination, a hydrophobic top sheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples dis- I posed on said top sheet;
c. a cooling device disposed between said outer sheet and said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel;
d. an insulating material disposed between said cooling device and said outer sheet; and
e. a release strip disposed on the lower surface of said combination absorbent dressing and flexible cooling device in adhesive engagement with said end segments.
11. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said hydrophobic topsheet is an ethylene ethylacrylate film.
12. A combination absorbent dressing and flexible cooling device according to claim 11 wherein said valvular openings are substantially parallel straight slits disposed in longitudinal rows, each slit being angularly disposed with respect to the longitudinal axis of each 'row.
13. A combination absorbent dressing and flexible cooling device according to claim 12 wherein said slits are from about 0.03 to about 0.20 inch in length.
14. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said dimples have a frequency of at least 1 per square inch of absorbent area.
15. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said dimples have a circular configuration with a diameter of from about 0.025 to about 0.25 inch.
16. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said topsheet and said backing sheet are of substantially the same dimensions and are adhered to each other around their periphery to form an integral structure having the absorbent material substantially enclosed and sandwiched between the topsheet and backing sheet.
17. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said insoluble hydrophilic gel is insolubilized poly (ethylene oxide) 18. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said insulating material is adhered to said dressing composite and said cooling device.
Claims (18)
1. A COMBINATION ADSORBENT DRESSING AND FLEXIBLE COOLING DEVICE COMPRISING: A. A DRESSING COMPOSITE COMPRISING IN COMBINATION, A HYDROPHOBIC TOPSHEET FOR PLACEMENT ADJACENT TO THE BODY AND HAVING A PLURALITY OF VALVULAR OPENINGS THEREIN, A SUBSTANTIALLY LIQUID IMPERMEABLE BACKING SHEET, AND AN ABSORBENT MATERIAL DISPOSED BETWEEN SAID TOPSHEET AND BACKING SHEET, AND BEING CHARACTERIZED BY ITS ABILITY TO ABSORB LIQUID PASSED THROUGH SAID OPENINGS, AND A SYSTEM OF DIMPLES DISPOSED ON SAID TOPSHEET; B. A COOLING DEVICE ASSOCIATED WITH SAID DRESSING COMPOSITE COMPRISING A FLEXIBLE PACKAGING MATERIAL ENCOMPASSING AND SEALING AN INSOLUBLE HYDROPHILIC GEL; AND C. AN INSULATING MATERIAL COVERING SAID COOLING DEVICE AND SAID DRESSING COMPOSITE.
2. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said hydrophobic topsheet is an ethylene ethylacrylate film.
3. A combination absorbent dressing and flexible cooling device according to claim 2 wherein said valvular openings are substantially parallel straight slits disposed in longitudinal rows, each slit being angularly disposed with respect to the longitudinal axis of each row.
4. A combination absorbent dressing and flexible cooling device according to claim 3 wherein said slits are from about 0.03 to about 0.20 inch in length.
5. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said dimples have a frequency of at least 1 per square inch of absorbent area.
6. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said dimples have a circular configuration with a diameter of from about 0.025 to about 0.25 inch.
7. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said topsheet and said backing sheet are of substantially the same dimensions and are adhered to each other around their periphery to Form an integral structure having the absorbent material substantially enclosed and sandwiched between the topsheet and backing sheet.
8. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said insoluble hydrophilic gel is insolublized poly (ethylene oxide)
9. A combination absorbent dressing and flexible cooling device according to claim 1 wherein said insulating material is adhered to said dressing composite and said cooling device.
10. A combination absorbent dressing and flexible cooling device comprising: a. an outer sheet having two end segments containing an adhesive material on the lower surfaces thereof and a middle segment; b. a dressing composite comprising in combination, a hydrophobic top sheet for placement adjacent to the body and having a plurality of valvular openings therein, a substantially liquid impermeable backing sheet, and an absorbent material disposed between said top sheet and backing sheet and being characterized by its ability to absorb liquid passed through said openings, and a system of dimples disposed on said top sheet; c. a cooling device disposed between said outer sheet and said dressing composite comprising a flexible packaging material encompassing and sealing an insoluble hydrophilic gel; d. an insulating material disposed between said cooling device and said outer sheet; and e. a release strip disposed on the lower surface of said combination absorbent dressing and flexible cooling device in adhesive engagement with said end segments.
11. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said hydrophobic topsheet is an ethylene ethylacrylate film.
12. A combination absorbent dressing and flexible cooling device according to claim 11 wherein said valvular openings are substantially parallel straight slits disposed in longitudinal rows, each slit being angularly disposed with respect to the longitudinal axis of each row.
13. A combination absorbent dressing and flexible cooling device according to claim 12 wherein said slits are from about 0.03 to about 0.20 inch in length.
14. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said dimples have a frequency of at least 1 per square inch of absorbent area.
15. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said dimples have a circular configuration with a diameter of from about 0.025 to about 0.25 inch.
16. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said topsheet and said backing sheet are of substantially the same dimensions and are adhered to each other around their periphery to form an integral structure having the absorbent material substantially enclosed and sandwiched between the topsheet and backing sheet.
17. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said insoluble hydrophilic gel is insolubilized poly (ethylene oxide)
18. A combination absorbent dressing and flexible cooling device according to claim 10 wherein said insulating material is adhered to said dressing composite and said cooling device.
Priority Applications (17)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US450580A US3871376A (en) | 1974-03-13 | 1974-03-13 | Combination absorbent dressing and flexible cooling device |
CA219,705A CA1046373A (en) | 1974-03-13 | 1975-02-10 | Combination absorbent dressing and flexible cooling device |
GB7129/75A GB1488413A (en) | 1974-03-13 | 1975-02-20 | Combination absorbent dressing and flexible cooling devic |
DE2508520A DE2508520C3 (en) | 1974-03-13 | 1975-02-27 | Flexible, exudate-absorbing and cooling dressing material |
IT48581/75A IT1032297B (en) | 1974-03-13 | 1975-03-12 | IMPROVEMENT IN ADHESIVE BANDAGES |
NO750834A NO136738C (en) | 1974-03-13 | 1975-03-12 | KJÆLEBANDASJE. |
NL7502945.A NL167316C (en) | 1974-03-13 | 1975-03-12 | Bandage provided with a device for cooling. |
SE757502780A SE406418B (en) | 1974-03-13 | 1975-03-12 | COMBINED ABSORBENT AND FLEXIBLE COOLING SCARF |
JP2999875A JPS532277B2 (en) | 1974-03-13 | 1975-03-12 | |
ZA00751536A ZA751536B (en) | 1974-03-13 | 1975-03-12 | A combination absorbent depressing and flexible cooling device |
BE154274A BE826607A (en) | 1974-03-13 | 1975-03-12 | SOFT COMPOSITE DRESSING WITH ABSORBENT AND COOLING ACTION |
FR7507702A FR2263788B1 (en) | 1974-03-13 | 1975-03-12 | |
DK99775AA DK136098B (en) | 1974-03-13 | 1975-03-12 | Cooling connection. |
AT190075A AT336777B (en) | 1974-03-13 | 1975-03-12 | FLEXIBLE, AT THE SAME TIME ADSORBENT AND COOLING BODY UNIT |
CH315575A CH600890A5 (en) | 1974-03-13 | 1975-03-12 | |
AU79047/75A AU482413B2 (en) | 1974-03-13 | 1975-03-13 | A combination absorbent dressing and flexible cooling device |
HK293/78A HK29378A (en) | 1974-03-13 | 1978-06-15 | A combination absorbent dressing and flexible cooling device |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US450580A US3871376A (en) | 1974-03-13 | 1974-03-13 | Combination absorbent dressing and flexible cooling device |
Publications (1)
Publication Number | Publication Date |
---|---|
US3871376A true US3871376A (en) | 1975-03-18 |
Family
ID=23788658
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US450580A Expired - Lifetime US3871376A (en) | 1974-03-13 | 1974-03-13 | Combination absorbent dressing and flexible cooling device |
Country Status (16)
Country | Link |
---|---|
US (1) | US3871376A (en) |
JP (1) | JPS532277B2 (en) |
AT (1) | AT336777B (en) |
BE (1) | BE826607A (en) |
CA (1) | CA1046373A (en) |
CH (1) | CH600890A5 (en) |
DE (1) | DE2508520C3 (en) |
DK (1) | DK136098B (en) |
FR (1) | FR2263788B1 (en) |
GB (1) | GB1488413A (en) |
HK (1) | HK29378A (en) |
IT (1) | IT1032297B (en) |
NL (1) | NL167316C (en) |
NO (1) | NO136738C (en) |
SE (1) | SE406418B (en) |
ZA (1) | ZA751536B (en) |
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- 1975-03-12 IT IT48581/75A patent/IT1032297B/en active
- 1975-03-12 FR FR7507702A patent/FR2263788B1/fr not_active Expired
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- 1975-03-12 JP JP2999875A patent/JPS532277B2/ja not_active Expired
- 1975-03-12 NL NL7502945.A patent/NL167316C/en not_active IP Right Cessation
- 1975-03-12 CH CH315575A patent/CH600890A5/xx not_active IP Right Cessation
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US3929131A (en) * | 1975-01-09 | 1975-12-30 | Thomas L Hardwick | Bandage and method of using same |
US4055188A (en) * | 1976-02-09 | 1977-10-25 | Divajex | Therapeutic wrap |
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US4534354A (en) * | 1982-09-29 | 1985-08-13 | Universal Medical Products, Inc. | Bandage |
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Also Published As
Publication number | Publication date |
---|---|
SE406418B (en) | 1979-02-12 |
ATA190075A (en) | 1976-09-15 |
GB1488413A (en) | 1977-10-12 |
AU7904775A (en) | 1976-09-16 |
NO136738C (en) | 1977-11-02 |
NL167316B (en) | 1981-07-16 |
BE826607A (en) | 1975-09-12 |
HK29378A (en) | 1978-06-23 |
NO136738B (en) | 1977-07-25 |
DE2508520B2 (en) | 1980-02-21 |
DK136098B (en) | 1977-08-15 |
NL167316C (en) | 1981-12-16 |
AT336777B (en) | 1977-05-25 |
DE2508520C3 (en) | 1980-10-09 |
CH600890A5 (en) | 1978-06-30 |
DK99775A (en) | 1975-09-14 |
FR2263788B1 (en) | 1979-05-11 |
DE2508520A1 (en) | 1976-02-05 |
SE7502780L (en) | 1975-09-15 |
CA1046373A (en) | 1979-01-16 |
JPS532277B2 (en) | 1978-01-26 |
JPS50127490A (en) | 1975-10-07 |
NL7502945A (en) | 1975-09-16 |
NO750834L (en) | 1975-09-16 |
DK136098C (en) | 1978-03-13 |
ZA751536B (en) | 1976-02-25 |
IT1032297B (en) | 1979-05-30 |
FR2263788A1 (en) | 1975-10-10 |
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