US 2739585 A
Description (OCR text may contain errors)
J. E. AYRE March 27, 1956 INSTRUMENT FOR OBTAINING CELLS FOR CYTODIAGNOSIS lllnliilllllll vlllllllllllll .5 .IIIIIIII Filed June 4, 1953 R.E WR Y A VLT m5 E N Dn E s LL M M BY /Qm WMM l YQ@ ATTORNEYS INSTRNT FOR OBTAINING CELLS FOR CYTODIAGNSIS This invention relates to a new instrument for the medical profession and more particularly to an instrument for use in diagnosing the stomach for ydiseased conditions affecting the structure of the stomach tissue cells.
As a result of the observations by Papanicolou it is known that tissue cell structure changes in readily recognizable ways at the site of cancer incidence. Very small specimens of cells, sloughed oif the tissue in its normal process of regeneration, obtained from the site of cancer incidence give positive evidence of the developing neoplasm long before a lesion is Visually detectable even in exposed areas.
The present invention therefore contemplates the provision of an instrument designed to obtain tissue cell specimens from the stomach for subsequent examination by established methods of microscopy.
More specically the invention provides means for introducing into the stomach a brush device, the bristles of which may be controllably moved over the interior surface of the stomach to collect, in the bristles, specimen cells of the stomach tissue. Upon withdrawing the brush from the stomach the collected cells are transferred -to a glass microscope slide and processed for diagnosis in the conventional manner.
It is believed that the detailed description of t-he present invention will be more readily understood if it is preceded -by a brief general description of the instrument and method of operating same in the performance of collecting cell tissue specimens for accurately diagnosing diseased conditions affecting the stomach.
The principle covered by this invention includes a means of introducing a brush device, in a shielding tube suitable for convenient passage through the esophagus, into the stomach, then by mechanical means, at the tube and extruding from the oral or nasal cavity, causing the brush to be ejected from its shielded position in the tube so the bristles will spread and cover an area larger than the end of the shielding tube and be moved in a predetermined manner, over the interior surface of -the stomach thereby collecting specimens of stomach tissue cells. After the cell collection is complete the mechanical means previously used for ejecting the brush from the shielding tube is reversely operated to cause the expanded rush device to collapse and be retracted into thc shielding tube which is then Withdrawn from the patients esophagus and the cell specimens transferred to slides for processing and diagnosis.
Further objects of the invention are to provide means for shielding the brush device for convenient passage through the esophagus into the stomach; means to cause the brush or specimen collecting elements, to be moved from such shielded position to an open or spread position within the stomach and then moved into contact with the interior surface of the stomach to cause specimens of stomach cells to adhere to the brush or collecting elements; and means for protecting the stomach tissue cell specimens from coming into contact with or being connited States Patent taminated by other tissue surfaces during removal of the specimen ladened brushes from cavity of the patient.
Other objects of the invention will be pointed out in the following description and claims and illustrated in the accompanying drawing, which discloses, `by way of example only, the principle of the invention and the best mode, which has been contemplated, of applying that principle.
In the drawing:
Fig. 1 shows the instrument in within the stomach of a patient and with the brushes spread for collecting specimens of stomach cell tissue;
Fig. 2 is an elevational View partly in section of the instrument shown in actual scale with a portion of the flexible tube and flexible driving shaft removed due to lack of space and with the specimen collecting elements or brushes collapsed within the shielding tube for convenient passage through the esophagus;
Fig. 3 is a View similar to Fig. 2 but showing the specimen collecting brushes pushed from their shielding tube and spread into a V-relation relative to one another and with a negative pressure device inserted into the filter pad receptacle for use in drawing additional cell speci- -mens from the patients stomach, and,
Fig. 4 is an enlarged fragmentary longitudinal section illustrating constructional details of the instrument.
Referring now to the drawing wherein one embodiment of theinvention is illustrated, reference numeral 5' designates a flexible tube approximately thirty-six inches long and one quarter inch outside diameter which may be made of a suitable plastic material. As shown in Fig. 2 one end of flexible tube 5 is attached to the reduced end 6 of a shielding tube or sleeve 7 and the opposite end is attached to one end of a reducing coupling 8. A metal tube 9, approximately three and one half inches long and live-sixteenths of an inch outside diameter, has one end threadedly secured to coupling 8 and its opposite end reduced to frictionally receive hub 10 of a knurled disc 11.
Inside the tube assembly above described is a second assembly which comprises a pair of brushes 1'2 dimensioned for complete enclosure within shielding tube 7 as clearly illustrated in Fig. 2. The ferrules 13 of brushes 12 are pivoted upon a pin 1d mounted within a clevis 15, as shown at Fig. 4, and a spring 16, encircling the pin 14 and having its ends anchored to the ferrules 13 respectively, acts to spread the brushes 12 into a V-relation relative to one another when they are pushed or ejected from the shielding tube 7 to the position illustrated in Fig. 3. Spreading movement of brushes 12, under the influence of spring 16, is limited when the angular ends 17 of ferrules 13 engage pin 18 (Fig. 4) which pin is also mounted in the clevis 15.
One end of a flexible drive shaft 19, such as the wellknown Bowden wire (a hollow, ilexible tube), is screwed into one end of a short tubular union 2@ and the other end of this union is threadedly attached to clevis 15 as best illustrated in Fig. 4. The other endof drive shaft 19 is screwed into a second tubular union 21 which in turn is threadedly secured within one end of a metal tube 22. Tube 22 is telescopically received for axial slidingI movement within tube 9 and its outer end is externally threaded to receive a disc 23 near the periphery of which is attached a small rod or rotor handle 24. Formed integral with the handle side of disc 23 is an open ended receptacle 25 externally threaded to receive a hollow nut 26 provided with a centrally disposed orifice 27 for reasons presently made clear. A filter pad 28 ts within the receptacle 25 and a gasket 29 is inserted between the outer edge of receptacle 25 and hollow nut 26 as clearly illustrated in Fig. 2.
the operative position the esophagus and oral vBesides the cell ytissue specimens collected by the briisdrawn to lter pad 2S during the time the brushes are still in the patients stomach by a means that will establish a l negative pressure .throughout the tube system above de# scribed. 'One .form of such negative pressure frneans(par tial vacuum) may be obtained by inserting the -nos'e -end 3i) of any conventional glass syringe, 'ofthe type used with hypodermic needles as Yindicated at '31, y"into the oritice 27 of hollow nut'26'and drawingoutwardlyuponthe plunger end 32.
Althougl'r use of the instrument -will be apparent from the foregoing description and from the drawing, 'it may be supplemented briefly for the sake of clarity. lWhen `the brushes -lZ-arexenclosed within'the shielding tub'eeor sleeve 7 ('Fig. 2), the instrument becomes for a'substantial "portion `of yits length a flexible tube -which may be introduced into the stomach 'with ease. `Control of the instrument is maintained through the rotatable Yhandle 24, knurled disc ll and metal tube9. Before linserting the brush end of the instrument into the patients stomach it is advisable, with each individual, to measure the distance 'from the mouth to the approximate pyloric region or area. The tubing 5 may then be marked at the point opposite 'the teeth to which the instrument will be passed 'to reach the important pyloric area. An appropriate jelly or an equivalent `lubricant may be applied to the metal tip or'shielding tube '7 prior to insertion, but itis important to keep the bristles of tbe brush l2 dry. v
To insert the brushes l2 into the stomach, thepatient 9 is instructed to open the mouth and the operator places two .tlngers far back onto the tongue, which causesslight gagging. This is the signal `to pass the Vshielding tube 7 through the glottis using gentle pressure. It is, therefore, not actually necessary for the patient Vto swallowthe'metal shielding tube 7 volitionally. The patient is vnot aware that .the tube 7 has been passed into 'theesophagua but is only conscious of the discomfort of gagging. Once the shielding tube 7 is passed, the patient is instructed t0 breath deeply and regularly, and the Vflexible tube '5 may then be quickly passed down to the region of the pylforus as vshown in Fig. l. This entire procedure'usually'requires very few minutes.
When the shielding tube 7 and flexible tube 5 arefully inserted, they are withdrawn about oneinch as `the brushes 12 are gently forced out of the tube 7 by pushing metal tube 22 into the outer metal tube 9. Rotation of the brushes l2 may now begin by rotating'the handle 24, :and the instrument is slowly withdrawn the length of the stomach before drawing the brushes back into the Vshielding tube 7. Rotation of the brushes l2 iscontinuedthrough the entire length of the stomach so that fundallesions may be reached as well -as pyloric. As soonas'the 'brushes I2 have been retracted within the shielding tube 7, `bydr`aw ing loutward upon handle 24 or disc 23 tubes S and`7 'may then be gently withdrawn from the stomach Withoutfurther discomfort.
The length of shielding tube 7 is such 'that when clevis is drawn into contact with the reduced end of tube"7, the brushes l2 are fully enclosed'within'tube/7thusilimitinfthe outward movement of -tube 22 relative 't'o'tube`9.
The embodiment of the present'invention illustrated and described herein is by way of example only,'andthe's`cop'e of the present invention is not llimited to the 'same or to the particular details thereof. Accordingly Vthe appended claims are to be Vconstrued as vdeningthe inventionwithin the full spirit and scope thereof.
The invention claimed is:
l. Apparatus for obtaining'specimensforcytodiagnosis comprising in combination, a pair of longitudinally extending hollow flexible members, one housed withn'the other, specimen collecting elements attached to oneencl of thefinner flexible member aforesaid, a'housingattachedto one end of the outer flexible member aforesaid,tl1e collecting :elements being normally -contained iin saidihousing, means attached to the other end of the inner flexible `member-alioresaid for .effecting -rotation -of the .same `and moving the aforesaid inner flexible member axially relative to the outer flexible meniber to displace said elements from said housing, and means acting to spread said elements as they are displaced from said housing.
2. Apparatus for collecting specimens for cytodiagnosis comprising in combinatiomalpairof longitudinally extending hollow llexible members, lone rhoused Within lthe other, specimen collecting elements pivotally connected to one end oi the inner flexible member aforesaid, a housing attached to oneend -ofthe outer 'lex'ible'member aforesaid, the collecting elements being normally contained in said housing, means attached to the other end of the inner flexible member .aforesaid for iimparting simultaneous rotation of said inner liexible member andsaid elements, said last named means also acting to move the said ilexible members axially relative to one another to displace said elements from the said housing, and Ispring means serving to spread said elements Iinte `V-formation, as 'they are ydisplaced from saidhousing.
3.- Apparatus for c'ollectingrspecimens for'cytodiagnosis comprising: a pair .of longitudinally 4extending hollow flexible members, one housed 'within the other, a pairof brushes '.pivotally 'connected to oneen'd Iof the inner ilexible member aforesaid, said pivotal connect-ion includinga clevis and a-pivotpin, a housing attached to one end 'of the -outer `lflexible member aforesaid, the brushes `being norma'lliy contained in said housing, frneans attached to the other end of said inner flexible member for simultaneously rotating said :member and brushes 'and projecting said brushes from said housing, and 'spring means acting to move -said brushes into 'V-relation 'relative to one another as they are pushed from saidihousingibysaid inner llexible member.
4. Apparatus forcollecting specimens 'for cytodiagnosis comprising: a pair of longitudinally extending hollow exible members, one telescoped :within the other for axial sliding movement, a shielding tube attachedto one end of the outer of said pair of flexible members, a ynonexible tube secured to 4the other end of said outerA ilexible member, a pair of brushes 'pivotally connected to one lend .of theinner-of said'liexible members the brushes being normally 'housed in said shielding tube, a non-ilexible atube .connected to the opposite end of said rinner ilexibleimem'ber, adisc secured, at yone side, to the free end of the last named non-flexible tube, a rotor handle carried by said disc, and spring means acting tofspread said brushes when they areejected from said shielding tube upon axial displacement of said inner member relative to .said outerrmember.
5..Apparatus as claimed in '.claim 4-whereinan fopenended receptacle `is formed upon the fother side of lsaid disc and externally threaded to receive .a hollow nut l-having a centrally disposed orifice; anda yiilter pad housed within said receptacle.
6. Apparatus `according to claim 4 wherein the .pair-of brushes are pivotally mounted upon a :pin mounted in a clevis, the clevis beingattached 'to one .end'of lthe inner member; and a second pin mountedin theclevis acting to limit spreading movement of said brushes when theyare ejected from said shieldingtube.
7. .Apparatus for collecting vspecimens forrcytodiagnosis comprising: .fallexible tube, a'hollow flexible shaft housed within said tube, specimen collecting elements attached to one end of'said shaft, la housing attached to one end ofsaidexibletube for .normally containing said `collecting `elements, .means attached tothe other end of Vsaid shaft for effecting .rotation of .thesame and said elements and moving the shaft axially relativetosaid flexible tube to .displace -said elements from saidhousing, and means acting to spread said elements as 4they are .displaced .from
- said housing.
within said tube, specimen collecting elements pivotally connected to one end of said shaft, a housing attached to one end of said exible tube for normally containing said collecting elements, means attached to the other end of said shaft for imparting simultaneous rotation of said shaft and said elements, said last named means also acting to move the shaft to displace said elements from said housing, and spring means serving to spread said elements into V-formation as they are displaced from said housing.
9. Apparatus for collecting specimens for cytodiagnosis comprising: a flexible tube, a flexible hollow shaft slidably housed within said tube, a pair of brushes pivotally connected to one end of said shaft, a housing attached to one end of said tube for normally containing said brushes, means attached to the other end of said shaft for simultaneously rotating said shaft and brushes and projecting said brushes from said housing, and spring means acting to move said brushes into V-relation relative to one another as they are pushed out from said housing by said shaft.
10. Apparatus as in claim 9 wherein the pair of brushes are pivotally mounted upon a pin mounted in a clevis, the clevis being attached to one end of the shaft, and a second pin mounted in the clevis acting to limit spreading movement of said brushes when they are ejected from said housing.
11. Apparatus for obtaining specimens for cytodiagnosis comprising in combination, a pair of longitudinally extending hollow exible members, one housed within the other, a specimen collecting element attached to one end of the inner ilexible member aforesaid, a housing attached to one end of the outer exible member aforesaid, the
6 collecting element being normally contained in said housing, means attached to the other end of the inner exible member aforesaid for effecting rotation of the same and moving the aforesaid inner flexible member axially relative to the outer ilexible member to displace said element from said housing.
l2. Apparatus for obtaining specimens for cytodiagnosis comprising in combination, a longitudinally extending hollow exible member, a longitudinally extending ilexible member housed within said hollow flexible member, a specimen collecting element attached to one end of the inner flexible member aforesaid, a housing attached to one end of the outer flexible member aforesaid, the collecting element being normally contained in said housing, means attached to the other end of the inner flexible member aforesaid for effecting rotation of the same and moving the aforesaid inner exible member axially relative to the outer flexible member to displace said element from said housing.
References Cited in the lile of this patent UNITED STATES PATENTS 1,711,352 Jeireys Apr. 30, 1929 2,655,154 Richter Oct. 13, 1953 FOREIGN PATENTS 96,035 Germany Feb. 3, 1898 OTHER REFERENCES Journal of the American Medical Association, August 12, 1950; pp. 1308, 1309. (A copy of this publication is available at the Scientific Library of the Patent Oice.)