CN112023151B - Postoperative suture-free drainage device - Google Patents
Postoperative suture-free drainage device Download PDFInfo
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- 230000002980 postoperative effect Effects 0.000 title claims abstract description 15
- 230000004888 barrier function Effects 0.000 claims description 7
- 229920002134 Carboxymethyl cellulose Polymers 0.000 claims description 6
- 229920000954 Polyglycolide Polymers 0.000 claims description 6
- 239000001768 carboxy methyl cellulose Substances 0.000 claims description 6
- 235000010948 carboxy methyl cellulose Nutrition 0.000 claims description 6
- 239000008112 carboxymethyl-cellulose Substances 0.000 claims description 6
- 239000004633 polyglycolic acid Substances 0.000 claims description 6
- 239000000463 material Substances 0.000 claims description 4
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- 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
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
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- A—HUMAN NECESSITIES
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- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
- A61L31/06—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
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- 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
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
- A61L31/148—Materials at least partially resorbable by the body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/84—Drainage tubes; Aspiration tips
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/90—Negative pressure wound therapy devices, i.e. devices for applying suction to a wound to promote healing, e.g. including a vacuum dressing
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Abstract
Description
技术领域technical field
本发明涉及医疗器械技术领域,具体为一种术后免缝合引流装置。The invention relates to the technical field of medical devices, in particular to a postoperative suture-free drainage device.
背景技术Background technique
临床应用引流系统引流体液、消化液、排泄物及脓液是外科的主要工作之一,外科引流是将人体组织间或体腔中积聚的上述液体导出体外,用以控制感染、促进创面愈合、减少术后并发症、减轻液体占位效应引起的不适症状。Clinical application Drainage system Drainage of fluid, digestive juice, excrement and pus is one of the main tasks of surgery. Surgical drainage is to export the above-mentioned liquid accumulated between human tissues or body cavities out of the body to control infection, promote wound healing, and reduce surgery. Post-complications, relief of discomfort caused by fluid mass effect.
随着微创技术的开展,腹腔镜下胆总管切开取石T型管引流术治疗肝胆管结石已经成为肝胆外科常规开展的术式,一般通过术后留置修剪后的T型管于胆管内并缝合胆管壁,创面再放置腹腔引流管协同引流,减少及预防术后并发症的发生。腹腔镜下缝合技术是该手术成功的关键点之一,对于部分患者胆管壁炎症较重,胆管壁厚达3mm以上的,腹腔镜下缝合更为困难,不缝合有非常高的术后胆漏可能性,而非常规缝合将导致多种术后近期、远期意外及并发症的发生,增加患者痛苦及住院的费用。术后在体壁两处带引流管给患者带来更多不便及痛苦,多引流管也增加了术后脱管的几率,即使引流管拔出后,放置引流管部位炎症瘢痕明显,患者术后恢复慢,远期来看造成引流部位皮肤不美观。With the development of minimally invasive techniques, laparoscopic choledocholithotomy and T-tube drainage for the treatment of hepatolithiasis has become a routine procedure in hepatobiliary surgery. The bile duct wall was sutured, and the peritoneal drainage tube was placed on the wound to cooperate with drainage, so as to reduce and prevent postoperative complications. Laparoscopic suturing technique is one of the key points for the success of this operation. For some patients with severe bile duct wall inflammation and a bile duct wall thickness of more than 3mm, laparoscopic suturing is more difficult, and there is a very high postoperative bile leakage without suturing. Possibility, non-conventional suture will lead to a variety of short-term and long-term accidents and complications after surgery, increasing the pain of patients and the cost of hospitalization. Having drainage tubes at two places on the body wall after the operation brings more inconvenience and pain to the patient. Multiple drainage tubes also increase the chance of tube detachment after the operation. The recovery is slow, and in the long run, the skin at the drainage site will be unsightly.
综上所述,现有的胆管壁炎症较重的患者在进行手术之后需要进行插管引流,并且在手术之后需要在体壁两处带引流管,患者手术之后身上两处插管会相互影响,也会使患者的术后痛苦加倍,同时也会增加脱管的几率,另外在术后引流管发出之后,患者身上两处放置引流管的部位炎症瘢痕非常明显,造成患者手术后恢复期较长,两处引流疤痕,在远期来看造成引流部位皮肤不美观,并且在对胆管创口进行缝合的时候非常困难,手术难度非常高。To sum up, the existing patients with severe inflammation of the bile duct wall need intubation and drainage after the operation, and after the operation, two drainage tubes need to be placed on the body wall. After the operation, the two intubations on the body of the patient will affect each other , it will double the postoperative pain of the patient, and it will also increase the chance of tube detachment. In addition, after the postoperative drainage tube is issued, the inflammatory scars on the two parts of the patient's body where the drainage tube is placed are very obvious, resulting in a longer recovery period for the patient after surgery. Long, two drainage scars, in the long run, the skin of the drainage area will be unsightly, and it is very difficult to suture the bile duct wound, and the operation difficulty is very high.
发明内容Contents of the invention
(一)解决的技术问题(1) Solved technical problems
针对现有技术的不足,本发明提供了一种术后免缝合引流装置,具备减少患者手术之后身上插管数量,降低脱管几率和缩短恢复期以及降低手术难度等优点,解决了背景技术中提出的问题。Aiming at the deficiencies of the prior art, the present invention provides a postoperative suture-free drainage device, which has the advantages of reducing the number of intubations on the patient's body after surgery, reducing the probability of tube detachment, shortening the recovery period, and reducing the difficulty of surgery, etc., which solves the problems in the background technology. proposed question.
(二)技术方案(2) Technical solution
为实现上述减少患者手术之后身上插管数量,降低脱管几率和缩短恢复期以及降低手术难度的目的,本发明提供如下技术方案:一种术后免缝合引流装置,包括引流主管,所述引流主管的一顿固定连接有接头,所述引流主管的另一端设置有S形管和上支管,所述引流主管的内部设置有主引流腔,所述主引流腔与S形管和上支管相连通,所述上支管的中部固定连接有伞状软翼,所述引流主管的侧面套接有梭形阻挡环,所述梭形阻挡环的外部包裹有方形网,所述方形网的材料为羧甲基纤维素,所述梭形阻挡环由生物可吸收性聚乙醇酸膜制成,所述引流主管的内部设置有弹性支撑环,所述引流主管的侧壁设置有弹性结构软胶膜,所述弹性结构软胶膜的内部开设有通道,所述通道的两端均贯穿引流主管的侧壁,所述通道的内部插接有附属管,所述S形管、上支管和附属管的侧面均开设有引流孔。In order to achieve the above-mentioned goals of reducing the number of intubations on the patient's body after surgery, reducing the chance of detachment, shortening the recovery period, and reducing the difficulty of surgery, the present invention provides the following technical solution: a postoperative suture-free drainage device, including a drainage main tube, the drainage One of the main pipes is fixedly connected with a joint, the other end of the drainage main pipe is provided with an S-shaped pipe and an upper branch pipe, and the inside of the drainage main pipe is provided with a main drainage cavity, and the main drainage chamber is connected with the S-shaped pipe and the upper branch pipe Generally speaking, the middle part of the upper branch pipe is fixedly connected with an umbrella-shaped soft wing, and the side of the drainage main pipe is sleeved with a shuttle-shaped blocking ring, and the outside of the shuttle-shaped blocking ring is wrapped with a square mesh, and the material of the square mesh is Carboxymethyl cellulose, the shuttle-shaped blocking ring is made of bioabsorbable polyglycolic acid film, the inside of the drainage main pipe is provided with an elastic support ring, and the side wall of the drainage main pipe is provided with an elastic soft film , the inside of the elastic structure soft film is provided with a channel, both ends of the channel run through the side wall of the drainage main pipe, the inside of the channel is inserted with an auxiliary tube, the S-shaped tube, the upper branch tube and the auxiliary tube There are drainage holes on the sides.
优选的,所述接头的一端接有负压机,所述附属管的一端与大气相通。Preferably, one end of the joint is connected with a negative pressure machine, and one end of the auxiliary pipe is connected to the atmosphere.
优选的,所述引流主管、S形管、上支管和附属管的内部均设置有加强线,所述伞状软翼由弹性材料制成。Preferably, the drainage main pipe, the S-shaped pipe, the upper branch pipe and the auxiliary pipe are all provided with reinforcement lines inside, and the umbrella-shaped soft wings are made of elastic materials.
优选的,所述附属管的外侧壁包裹有弹性软片,所述弹性软片与通道的端口处形成配合密封结构。Preferably, the outer wall of the auxiliary tube is wrapped with an elastic film, and the elastic film forms a sealing structure in cooperation with the port of the channel.
优选的,所述梭形阻挡环和方形网的中部均开设有与引流主管相适配的圆孔。Preferably, both the shuttle-shaped blocking ring and the middle part of the square mesh are provided with round holes suitable for the drainage main pipe.
优选的,所述弹性支撑环有若干个,若干个所述弹性支撑环在引流主管的内部等间距分布,所述弹性支撑环由金属或塑料制成。Preferably, there are several elastic support rings, the several elastic support rings are equally spaced inside the drainage main pipe, and the elastic support rings are made of metal or plastic.
优选的,所述S形管上的引流孔有若干个,若干个所述引流孔在S形管的两个弯曲处等间距分布。Preferably, there are several drainage holes on the S-shaped pipe, and the several drainage holes are equally spaced at the two bends of the S-shaped pipe.
优选的,所述附属管和上支管尾端的引流孔均有若干个,若干个所述引流孔在附属管和上支管的侧面等间距分布。Preferably, there are several drainage holes at the tail ends of the auxiliary pipe and the upper branch pipe, and the several drainage holes are equally spaced on the sides of the auxiliary pipe and the upper branch pipe.
优选的,所述引流主管的周径为18~22F,所述上支管的周径为12~14F,所述S形管和附属管的周径均为6~8F。Preferably, the circumference diameter of the drainage main pipe is 18-22F, the circumference diameter of the upper branch pipe is 12-14F, and the circumference diameters of the S-shaped pipe and the auxiliary pipe are both 6-8F.
三有益效果Three beneficial effects
与现有技术相比,本发明提供了一种术后免缝合引流装置,具备以下有益效果:Compared with the prior art, the present invention provides a suture-free drainage device after surgery, which has the following beneficial effects:
1、该术后免缝合引流装置,通过设置弹性结构软胶膜,能够使附属管插进引流主管的内部进行引流,在手术之后患者身上只需插入一个引流主管即可,能够有效的避免两根插管造成的诸多问题,减少了插管伤口数量,也能减少了患者的痛苦程度,同时降低了脱管的几率,由于患者身上只有一处插管,能够有效的缩短患者的恢复周期,在恢复之后也减少身上疤痕数量。1. The postoperative suture-free drainage device, by setting an elastic structure soft film, can make the auxiliary tube inserted into the inside of the main drainage tube for drainage. After the operation, the patient only needs to insert one main drainage tube, which can effectively avoid two The many problems caused by root intubation can reduce the number of intubation wounds, reduce the pain of patients, and reduce the chance of detachment. Since there is only one cannulation on the patient, it can effectively shorten the recovery period of the patient. It also reduces the number of scars on the body after recovery.
2、该术后免缝合引流装置,通过设置方形网,在手术时由于羧甲基纤维素网遇水形成凝胶,能够将内层聚乙醇酸膜粘连固定于胆管壁缺损处,并封闭其与主引流管之间的空隙,在手术的时候可以实现不缝合,降低手术难度,减少术后并发症的发生。2. The postoperative suture-free drainage device is equipped with a square mesh. During the operation, because the carboxymethyl cellulose mesh meets water to form a gel, it can adhere and fix the inner layer of polyglycolic acid membrane to the defect of the bile duct wall and seal it. The gap between the main drainage tube and the main drainage tube can be sutured during the operation, reducing the difficulty of the operation and reducing the occurrence of postoperative complications.
附图说明Description of drawings
图1为本发明结构示意图;Fig. 1 is a structural representation of the present invention;
图2为本发明结构示意图;Fig. 2 is a structural representation of the present invention;
图3为本发明结构示意图;Fig. 3 is a structural representation of the present invention;
图4为本发明结构示意图。Fig. 4 is a schematic diagram of the structure of the present invention.
图中:1、接头;2、引流主管;3、方形网;4、S形管;5、伞状软翼;6、上支管;7、引流孔;8、附属管;9、弹性支撑环;10、梭形阻挡环;11、通道;12、主引流腔;13、弹性结构软胶膜。In the figure: 1. Connector; 2. Drainage supervisor; 3. Square mesh; 4. S-shaped tube; 5. Umbrella-shaped soft wing; 6. Upper branch tube; 7. Drainage hole; 8. Accessory tube; 9. Elastic support ring ; 10. Shuttle-shaped blocking ring; 11. Channel; 12. Main drainage chamber; 13. Elastic structure soft film.
具体实施方式Detailed ways
下面将结合本发明实施例中的附图,对本发明实施例中的技术方案进行清楚、完整地描述,显然,所描述的实施例仅仅是本发明一部分实施例,而不是全部的实施例。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。The following will clearly and completely describe the technical solutions in the embodiments of the present invention with reference to the accompanying drawings in the embodiments of the present invention. Obviously, the described embodiments are only some, not all, embodiments of the present invention. Based on the embodiments of the present invention, all other embodiments obtained by persons of ordinary skill in the art without making creative efforts belong to the protection scope of the present invention.
请参阅图1-4,一种术后免缝合引流装置,包括引流主管2,引流主管2的一顿固定连接有接头1,引流主管2的另一端设置有S形管4和上支管6,引流主管2的内部设置有主引流腔12,主引流腔12与S形管4和上支管6相连通,上支管6的中部固定连接有伞状软翼5,引流主管2的侧面套接有梭形阻挡环10,梭形阻挡环10的外部包裹有方形网3,方形网3的材料为羧甲基纤维素,梭形阻挡环10由生物可吸收性聚乙醇酸膜制成,梭形阻挡环10和方形网3的中部均开设有与引流主管2相适配的圆孔,引流主管2的内部设置有弹性支撑环9,弹性支撑环9有若干个,若干个弹性支撑环9在引流主管2的内部等间距分布,弹性支撑环9由弹性良好的金属或塑料制成,引流主管2的侧壁设置有弹性结构软胶膜13,弹性结构软胶膜13的内部开设有通道11,通道11的两端均贯穿引流主管2的侧壁,通道11的内部插接有附属管8,接头1的一端接有负压机,附属管8的一端与大气相通,附属管8的外侧壁包裹有弹性软片,弹性软片与通道11的端口处形成配合密封结构,S形管4、上支管6和附属管8的侧面均开设有引流孔7,引流主管2、S形管4、上支管6和附属管8的内部均设置有加强线,伞状软翼5由弹性材料制成,S形管4上的引流孔7有若干个,若干个引流孔7在S形管4的两个弯曲处等间距分布,附属管8和上支管6尾端的引流孔7均有若干个,若干个引流孔7在附属管8和上支管6的侧面等间距分布,引流主管2的周径为18~22F,上支管6的周径为12~14F,S形管4和附属管8的周径均为6~8F。Please refer to Fig. 1-4, a postoperative suture-free drainage device, including a drainage main tube 2, a joint 1 is fixedly connected to the drainage main tube 2, and an S-shaped tube 4 and an upper branch tube 6 are arranged at the other end of the drainage main tube 2, The inside of the drainage main pipe 2 is provided with a main drainage chamber 12, the main drainage chamber 12 communicates with the S-shaped pipe 4 and the upper branch pipe 6, the middle part of the upper branch pipe 6 is fixedly connected with an umbrella-shaped soft wing 5, and the side of the drainage main pipe 2 is sleeved with Shuttle-shaped barrier ring 10, the outside of the shuttle-shaped barrier ring 10 is wrapped with a square net 3, the material of the square net 3 is carboxymethyl cellulose, the shuttle-shaped barrier ring 10 is made of bioabsorbable polyglycolic acid film, the shuttle-shaped The middle part of the barrier ring 10 and the square net 3 is provided with a circular hole suitable for the drainage main pipe 2, and the inside of the drainage main pipe 2 is provided with an elastic support ring 9, and there are several elastic support rings 9, and several elastic support rings 9 The interior of the drainage main pipe 2 is equally spaced, the elastic support ring 9 is made of metal or plastic with good elasticity, the side wall of the drainage main pipe 2 is provided with an elastic structure soft rubber film 13, and the inside of the elastic structure soft rubber film 13 is provided with a channel 11 , both ends of the passage 11 run through the side wall of the drainage main pipe 2, the interior of the passage 11 is inserted with an auxiliary pipe 8, one end of the joint 1 is connected with a negative pressure machine, one end of the auxiliary pipe 8 communicates with the atmosphere, and the outside of the auxiliary pipe 8 The wall is wrapped with an elastic film, which forms a matching sealing structure with the port of the channel 11, and the sides of the S-shaped pipe 4, the upper branch pipe 6 and the auxiliary pipe 8 are provided with drainage holes 7, the drainage main pipe 2, the S-shaped pipe 4, the upper The interior of the branch pipe 6 and the subsidiary pipe 8 is all provided with reinforcement lines, and the umbrella-shaped soft wing 5 is made of elastic material. The two bends are equally spaced, and there are several drainage holes 7 at the tail end of the
在使用时,首先将附属管8插进通道11的内部,接头1与外部的负压机连通,附属管8可以与大气连通实现自然引流,也可以与负压相连实现负压引流,手术的时候使上支管6和S形管4均放置在胆管内部,在进行手术的时候将伞状软翼5折叠之后填塞到胆管的内部,与上支管6之间配合作为第一级结构,从而阻挡胆汁外流,向外牵拉的时候伞状软翼5能够聚拢;同时S形管4也位于胆管内部,设置在S形管4弯曲内侧的引流孔7便于引流消化液及胆汁,并且能够避免负压吸引时胆管壁贴紧引流孔7,避免了影响引流,此结构为第二级结构;将S形管4和上支管6都放入胆管内部之后,利用方形网3和梭形阻挡环10对胆管创口进行闭合,由于方形网3和梭形阻挡环10的中部都有与引流主管2相适配的孔,能够使引流主管2从胆管内部穿出,并且能够利用羧甲基纤维素网遇水形成凝胶的特性,在手术的时候将内层的聚乙醇酸膜粘连固定于胆管壁创口处,并封闭其与主引流管之间的空隙,不需要对胆管壁进行手动缝合,从而降低了手术难度,也减少了术后并发症的发生,此结构为第三级结构;将附属管8带有引流孔7的一端放在手术区域靠近引流主管2出入胆管处,利用引流孔7吸引术区渗液及突破第三级结构而溢出胆管的胆汁及其他消化液,避免胆汁及其他消化液进入体腔,在手术之后患者身体上只插有引流主管2,将附属管8代替了第二根管,从而减少患者的痛苦,减少脱管几率;由于附属管8的外部有软片,能够保证附属管8与通道11之间成为封闭结构,使引流主管2内外不相通,在附属管8拔出的时候弹性支撑环9能够将弹性结构软胶膜13撑起,使通道11处于封闭状态;在经过几个月之后引流主管2周围会形成成熟的瘘道,此时可以将引流主管2拔出,此时可吸收材料基本已自行降解吸收。When in use, first insert the
综上,该术后免缝合引流装置通过设置弹性结构软胶膜13,能够使附属管8插进引流主管2的内部进行引流,在手术之后患者身上只需插入一个引流主管2即可,能够有效的避免两根插管造成的诸多问题,减少了插管伤口数量,也能减少了患者的痛苦程度,同时降低了脱管的几率,由于患者身上只有一处插管,能够有效的缩短患者的恢复周期,在恢复之后也减少身上疤痕数量,通过设置方形网3,在手术时由于羧甲基纤维素网遇水形成凝胶,能够将内层聚乙醇酸膜粘连固定于胆管壁缺损处,并封闭其与主引流管之间的空隙,在手术的时候可以实现不缝合,降低手术难度,减少术后并发症的发生。To sum up, the postoperative suture-free drainage device is equipped with an elastic structure
需要说明的是,在本文中,诸如第一和第二等之类的关系术语仅仅用来将一个实体或者操作与另一个实体或操作区分开来,而不一定要求或者暗示这些实体或操作之间存在任何这种实际的关系或者顺序。而且,术语“包括”、“包含”或者其任何其他变体意在涵盖非排他性的包含,从而使得包括一系列要素的过程、方法、物品或者设备不仅包括那些要素,而且还包括没有明确列出的其他要素,或者是还包括为这种过程、方法、物品或者设备所固有的要素。在没有更多限制的情况下,由语句“包括一个”限定的要素,并不排除在包括所述要素的过程、方法、物品或者设备中还存在另外的相同要素。It should be noted that in this article, relational terms such as first and second are only used to distinguish one entity or operation from another entity or operation, and do not necessarily require or imply that there is a relationship between these entities or operations. There is no such actual relationship or order between them. Furthermore, the term "comprises", "comprises" or any other variation thereof is intended to cover a non-exclusive inclusion such that a process, method, article or apparatus comprising a set of elements includes not only those elements, but also includes elements not expressly listed. other elements of or also include elements inherent in such a process, method, article, or apparatus. Without further limitations, an element defined by the statement "comprising a" does not exclude the presence of additional identical elements in the process, method, article or apparatus comprising said element.
尽管已经示出和描述了本发明的实施例,对于本领域的普通技术人员而言,可以理解在不脱离本发明的原理和精神的情况下可以对这些实施例进行多种变化、修改、替换和变型,本发明的范围由所附权利要求及其等同物限定。Although the embodiments of the present invention have been shown and described, those skilled in the art can understand that various changes, modifications and substitutions can be made to these embodiments without departing from the principle and spirit of the present invention. and modifications, the scope of the invention is defined by the appended claims and their equivalents.
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