Abstract: A portable negative pressure wound therapy device adapted to be carried by a user, comprising an electrically actuated suction pump for draining wound fluids from a patient, at least one microelectronic controller, at least one electronic memory and a housing for containing the electrical and/or electronic components. The device further comprises at least one microelectronic impact sensor, wherein the impact sensor is adapted to detect an impact acting on the device.

Abstract: A canister lid (101) for a canister (102) includes an annular perimeter (103) surrounding an interior portion (104). Rather than completely surrounding the interior portion, the annular perimeter is instead interrupted by a suction conduit (112) defined by a suction conduit (112) separating a first lobe (117) and a second lobe (118). The suction conduit (112) intersects the annular perimeter such that the first lobe is disposed interior of the annular perimeter while the second lobe is disposed exterior to the annular perimeter. The canister lid can further include one or more ports (110,111) extending from the interior portion. A canister (102) can include a valve (401) and can optionally be coupled to a hub mount vacuum source (1200) or a hub mount stand (1800).

Abstract: This document describes, among other things, a computer-implemented method that includes receiving, by a computing system, data that represents a plurality of measurements associated with a mechanical circulatory support device connected to a patient over a period of time. The method can include determining, based on the plurality of measurements, respective trends for one or more operating characteristics of the device over the period of time, and generating a respective representation for each of the trends that is formatted for presentation to a user for assessing whether the trends indicate a likelihood of an operational defect associated with the device. The method can include providing the respective representations to the user.

Abstract: Aspects of the present invention are directed generally toward a graft for use with a blood flow device that allows the use of a single blood flow device to simultaneously provide blood flow to the systemic and pulmonary circulations. One aspect of the invention is directed toward a graft comprising a tubular inlet portion coupleable to the outlet of the blood-flow assist device and configured to receive a flow of blood therethrough. The graft has a tubular systemic portion connected the inlet portion and configured to be connected to the systemic circulation of the patient to direct the first portion of the blood flow into the systemic circulation at a first flow rate. The graft has a tubular pulmonary portion connected to the inlet portion and configured to be connected to the pulmonary circulation of the patient to direct a second portion of the blood flow into the pulmonary circulation substantially simultaneous with delivery of the first portion of the blood flow into the systemic circulation.

Abstract: The invention relates to a device and a method for detecting the direction of fluid flow through a dialyser 1 which comprises a blood chamber 4, through which blood flows, and a dialysate chamber 3, through which dialysate flows, which are separated from one another by a semi-permeable membrane 2. In addition, the invention relates to an extracorporeal blood treatment device comprising a device for detecting the flow direction. A first aspect of the invention is to measure the clearance in order to detect the flow direction and to compare the measured clearance with a specified limit value, a flow direction in countercurrent flow being concluded if the clearance is greater than the specified limit value. This aspect is based on the finding that in the case of blood treatment in practice with operation of the dialyser in co-current flow, clearance values above a certain limit value can no longer be achieved.

Abstract: A medical apparatus for the preparation of medical fluid is disclosed, comprising a support structure, a movable member, biasing means, and locking means. The movable member is mounted to the support structure and the biasing means are configured to operate in at least one of a repulsion mode and an attraction mode In the repulsion mode, the biasing means exert on the movable member a biasing force directing the movable member away from its retracted configuration, and in the attraction mode, the biasing means exert on the movable member a biasing force directing the movable member towards its retracted configuration. A blood treatment apparatus comprising the medical apparatus for the preparation of fluid, a method of setting up the medical apparatus, and a method for use of the apparatus are also disclosed.

Abstract: The present disclosure relates to a filter module for a medical fluid delivery system capable of removing cytokine inducing substances (CIS) from a medical fluid.

Abstract: Extracorporeal blood treatment systems and methods to display information related to an alarm issued during extracorporeal blood treatments. For example, when an alarm is issued, an alarm region may be depicted on a graphical user interface. The alarm region may be configured to be docked into another region of the graphical user interface to, e.g., expose an operations region, etc.

Abstract: The present invention relates to a method for removing fluid from a blood filter (19) for the blood treatment of a patient and/or for removing blood from the flood filter (19) after completing the blood treatment session. It further relates to a control and/or regulating device (29), a medical treatment apparatus having a control and/or regulating device (29) with which the method according to the present invention is executable, a digital storage medium, a computer program product as well as a computer program.

Abstract: A pump device for use with an operating table in an operating room. The pump device including: a pump for pumping a rinsing liquid through a pump tube, and a controller configured to determine a height adjustment of the operating table in the operating room and control the pump pressure of the pump based on the detected height adjustment.

Abstract: A system and method for cleansing a cavity in a living body is disclosed. The system uses pressurized water from a plumbing system and directs a portion of that water into a douche pipe for cleaning the cavity. The system includes a shower attachment member that is configured to collect water from the plumbing. Also included is a douche pipe configured to direct the flow of water toward the opening of the cavity in a rearward axial direction so as to let the pressure of the water pull bacteria or infections directly to the opening for removal. The douche pipe includes at least one port that is oriented in a non-perpendicular orientation.

Abstract: Some illustrative embodiments of an instillation assembly for treating a tissue site may include a fluid distribution lumen and a fluid hub that may define a fluid instillation pathway. The fluid distribution lumen may be defined by a first film layer and a second film layer, and the fluid hub may be positioned in fluid communication with the fluid distribution lumen. The instillation assembly may be used in combination with a reduced-pressure assembly that may define a reduced-pressure pathway separate from the fluid instillation pathway.

Abstract: A medical liquid vial is disclosed with a resilient inner bladder and a pre-stress member located with the bladder. Injector assemblies are also disclosed for injecting the vial contents into a patient by advancing the vial through a series of stages or positions. Methods of filling and use are also disclosed.

Abstract: Micro-fluidic chambers for use in a liquid medicament delivery system, include a bottom substrate and a top cover, the top cover being spaced from the bottom substrate so as to define a height of the chamber, wherein, one or more walls or fillings are positioned in the chamber, the walls or fillings defining a fluid channel there between such that the fluid channel extends from an inlet conduit to an inlet of the chamber to an outlet conduit connected to an outlet of the chamber, wherein, each of the walls or fillings has a height less than the height of the chamber so as to define a fluid gap between a top surface of each wall or filling and the top cover; and wherein, the dimensions of the walls or fillings and the chamber are such that the fluid gap will be filled with liquid by capillary forces via the fluid channel when liquid is introduced into the fluid chamber

Abstract: Systems and methods of micro-infusion of medical fluids are disclosed. Micro-infusion systems may include a pump, a patient interface, tubing between the pump and the interface, and a micro-infusion device along the tubing. A first portion of the tubing above the micro-infusion device is longer than a second portion of the tubing below the device. The micro-infusion device may include a chamber in-line with the tubing, a first valve between the chamber and the first portion of the tubing, a second valve between the chamber and the second portion of the tubing and a third valve between the chamber and a dump chamber. The second valve may be slidably disposed within the chamber. A medical fluid may be provided into the chamber that slides the second valve displacing another fluid in the chamber through the third valve into the dump chamber.

Abstract: [Object] To make it possible to firmly fix a mixing tip to a cartridge, and also remove the mixing tip from the cartridge by a simple operation.

Abstract: Syringe systems including barrels having lubricated portions and non-lubricated portions are provided. The non-lubricated portions may be configured to be loaded with injectable materials, such as embolic agents. The injectable materials may comprise polyvinyl alcohol. Also provided are methods of lubricating portions of barrels of syringe systems with lubricants including silicone or silicone-free lubricants.

Abstract: The present invention relates to a medicament delivery device comprising a drive means configured to act on a medicament container for expelling a medicament; a holding means configured to hold said drive means in a pre-tensioned state; an activation means configured to interact with said holding means for releasing said drive means from the pre-tensioned state; wherein the device further comprises feedback means configured to interact both with said holding means and with said drive means for generating an audible and/or tactile and/or visual signal indicating that the medicament has been completely expelled.

Abstract: Coverings for syringe plunger tips, as well as syringes and syringe components including such coverings, are disclosed. A material of the covering may have at least one different material property than a material of the plunger tip. The coverings may provide a reduced coefficient of friction between the covering and a surface of the syringe relative to the coefficient of friction between the plunger tip and the syringe surface. The coverings may also isolate a substance loaded in the syringe from the plunger tip. Methods for manufacturing a syringe assembly including such coverings, as well as methods for isolating a substance in a syringe from a syringe component, are also disclosed.

Abstract: A reciprocating syringe injector includes an inside arm and an outside arm pivotally mounted to the inside arm. A spring bias biases the inside arm away from the outside arm. A small syringe retainer is formed on the inside arm. A ratchet member extends from the inside arm toward the outside arm. The ratchet member has ratchet teeth protruding from the ratchet member. A ratchet engagement extension is pivotally mounted to the outside arm. The ratchet engagement extension has a ratchet engagement edge that engages the ratchet teeth formed on the ratchet member. The reciprocating syringe injector also optionally includes a large reservoir retainer mounted to the small syringe retainer. The large reservoir retainer could also be mounted anywhere on the inside arm.

Abstract: An add-on dose logging device for a pen device consumes energy when the sensors are operated and when the display is active. By using cap-off event to activate the sensor system only, and using cap-on event to de-activate the sensor system and activate the display for a given time to display a sensed dose, power consumption can be reduced without changing the user-interface and without adding any components apart from a switch.

Abstract: Medication dispensing apparatuses for dosing-up and delivering a pre-set dosage of a fluid product include a housing; a dosing element moveable relative to the housing between a starting position and a dosed-up position; a drive system coupled to the dosing element operable to initiate or perform a dispensing operation; and a sub-dose preventing system for preventing or blocking a dispensing operation of the drive system when the dosing element has not reached the dosed-up position and for allowing or unblocking a dispensing operation of the drive system when or after the dosing element has reached the dosed-up position, wherein the sub-dose preventing system is operable to block a rotational movement in a circumferential direction of the medication dispensing apparatus of a drive element of the drive system corresponding to a dispensing direction or a dial-down direction when preventing or blocking the dispensing operation of the drive system.

Abstract: A needle guard (10) for use with a needle assembly (12) having a needle (16) extending from a forward end of a needle block (18), the guard (10) comprises a hollow sleeve portion (26) having a front end (20) with an aperture (24) therein through which the needle assembly (12) may be retracted to a retracted position, in which the free end of the needle lies within the hollow sleeve portion. The guard (10) has a retaining portion into which at least a part of the needle assembly may be withdrawn to a retracted position, at least one locking mechanism (36) to retain the needle assembly in the retaining portion and at least one deflector (36, 102) that engages the needle (16) and/or the needle block (18) to deflect the needle (16) away from the aperture (24) when in the retracted position.

Abstract: A retractable needle assembly comprises a body portion, a needle having a patient end and being movable between an operational position in which the needle extends along a longitudinal needle axis with the patient end projecting forwardly from said body portion, and a safe position in which said patient end is retracted into said body portion, a deflector element rotatable about a deflector rotary axis generally perpendicular to said needle axis to move the needle to its safe position, and a manually operated deflector lever connected to or forming part of said deflector element, the deflector lever projecting from said body portion and intersecting a plane perpendicular to the deflector rotary axis and containing the needle axis.

Abstract: A device for inserting a blunt-tip cannula under the skin of a patient with a view to injecting a biocompatible product, including a central body equipped with a groove that extends along a sagittal plane while having a sharp distal tip projecting from a distal end of the body in order to pierce the skin, the groove being arranged to allow the cannula to slide along same beyond the distal tip towards at least one area to be treated located under the skin, the central body being provided with two lateral gripping arms that extend symmetrically on either side of the sagittal plane in a transverse direction that forms, with the sagittal plane, an angle (?) of between 30° and 85°, each gripping arm further having a finger grip surface that has a front central portion located at a distance between 8 mm and 30 mm from the distal end of the central body.

Abstract: A de-agglomerator comprises: a medicament chamber comprising an inlet and outlet and having a cross-section with a substantially circular inner perimeter; a conduit in pneumatic communication with said inlet; and a blower arranged to direct airflow at dry powder medication through said conduit. Another de-agglomerator comprises: a piezoelectric transducer; a pumping chamber: coupled to said transducer through a diaphragm, and having a outlet hole: in a wall opposing the transducer, in line with the transducer axis, and arranged to be in pneumatic communication with a flow channel of said inhaler through which a user can inhale; and a housing surrounding said pumping chamber, comprising a housing inlet in a wall facing the transducer; a housing outlet in a wall facing said outlet hole and in line with the outlet hole; and being spaced from the pumping chamber by an airflow channel in pneumatic communication with the housing inlet and outlet.

Abstract: A breathing mask which is convenient for enteral nutrition using a nasogastric feeding tube when the mask is in use may be provided. The breathing mask may include at least one nasogastric tube port. The port may allow a nasogastric tube to pass through the mask without substantially affecting the seal or pressure of the mask while accommodating enteral feeding. In addition, the breathing mask may incarnate the human-centered design to reduce discomfort in patients and is favorable for therapy and rehabilitation.

Abstract: Methods or systems (7000) are implemented for treatment with or monitoring use of respiratory pressure therapy device(s). The device may be for a respiratory disorder. A processor, such as a processor of a server communicating with the therapy device, may analyse data relating to respiratory therapy delivered by the device. The processor may generate data in the processor representing a prediction, such as compliance prediction(s), about progress of therapy based on the analysis. The processor may select an action to improve therapy based on data representing the prediction. The processor may take or prompt selected action to improve the therapy. In some cases, a processor may analyse usage data concerning a period of days with a therapy device and generate compliance prediction indicators based on the analysis. The indicators indicate whether compliance will be likely. The processor may recommend engagement action to improve compliance based on evaluation of the indicators.

Abstract: The anesthesia systems have an integrated, extendable clinical center and clinician/anesthesia office that accommodates for a physical separation of clinical and clerical functions. The anesthesia system includes an alarm reversion system which enables a predefined alarm limit to be set and then to be automatically reverted back to an alarm limit existing just before the predefined alarm limit was set.

Abstract: A novel nasogastric tube, that when properly inserted within a person, blocks the esophagus of the person to prevent gastric contents from being aspirated. The tube can be left in place during direct langroscopy and the device can include a preferably inflatable balloon for obstructing the person's esophagus. This balloon can be preferably provided on a slidable tube that allows for head movement/flexion without movement of the balloon placement. The tube can be a dual or single lumen device. With a duel lumen device, a first lumen can be connected to a suction tubing to suction gastric contents from the distal end of the tube, while the other lumen can open up above the cuff to allow for easier ventilation with a bag valve mask/BVM.

Abstract: A method involves using a camera tube in connection with a laryngeal mask. The camera tube cooperates with an intubation stylet. The camera tube is an elongate member having a length extending between opposite distal and proximal ends. The distal end of the camera tube has a camera. The camera tube has an exterior surface and an intubation stylet guide support surface extending radially outward from the exterior surface along a portion of the length adjacent to the distal end. The intubation stylet guide support surface is configured to cooperate with an intubation stylet. The user may manipulate the proximal end of the camera tube to change the orientation of the intubation stylet with in the laryngeal mask while using the camera to visualize the patient's laryngeal opening. Once the intubation stylet is aligned with the patient's laryngeal opening, the intubation stylet may be advanced therethrough.

Abstract: A mask assembly suitable for the treatment of sleep disordered breathing, comprising: a mask to provide pressurized air to a patient; upper and lower slot features located on each side of the mask; a headgear assembly, comprising: a back portion; a pair of upper straps provided to the back portion, each upper strap having a loop portion and a hook portion at a free end thereof for releasably attaching to the loop portion; a pair of lower straps extending away from the back portion, each lower strap having a loop portion and a hook portion at a free end thereof for releasably attaching to the loop portion; and a connection region of each loop portion of each strap, the connection region being adapted to receive a respective hook portion, the connection region being wider than each respective hook portion along each respective hook portion's entire length.

Abstract: Modular ventilatory support systems and methods are disclosed in which a user may transition the system between a stationary configuration, an extended range configuration, and a stand-alone configuration. The modular components of the system include a compressor unit, a ventilator which may dock with the compressor unit, and a patient interface which may be connected to either the compressor unit or the ventilator unit. By rearranging these modular components into different configurations, mobility and duration of use may be optimized to fit the present needs. In the stationary configuration, mobility is most restricted, but duration of use is maximized. In the extended range configuration, mobility is enhanced, with duration of use limited by the battery power of the ventilator. In the stand-alone configuration, mobility is maximized, with duration of use limited by battery power of the ventilator and the quantity of an external gas supply.

Abstract: A reaction and distribution system may include a distributor securable near or in a path correspond to a breathing passage such as the nostrils or the mouth of a user for delivering nitric oxide therapy thereto. The distributor may contain an internal reactor for creating the nitric oxide from reactants. Alternative embodiments may include an inhaler for delivering nitric oxide into the mouth of a user. The inhaler may contain a reaction chamber monolithic or contiguous with the inhaler for creating the nitric oxide from reactants.

Abstract: A breathing assistance unit for providing pressurized heated humidified air to a user is configured to increase user compliance. The breathing assistance unit comprises means for generating positive emotional and cognitive states of a user about the therapy.

Abstract: Described are methods and devices for therapeutic or medical gas delivery that utilize at least one proportional control valve and at least one binary control valve. The proportional control valve may be in series with the binary control valve to provide a valve combination capable of pulsing therapeutic gas at different flow rates, depending on the setting of the proportional control valve. Alternatively, the proportional control valve and binary control valve may be in parallel flow paths.

Abstract: Systems and methods for treating a lung of a lung of a patient. One embodiment of a method comprises positioning a leadless marker in the lung of the patient relative to the target, and collecting position data of the marker. This method further comprises determining the location of the marker in an external reference frame outside the patient based on the collected position data, and providing an objective output in the external reference frame that is responsive to movement of the marker. The objective output is provided at a frequency (i.e., periodicity) that results in a clinically acceptable tracking error. In addition, the objective output can also be provided at least substantially contemporaneously with collecting the position data used to determine the location of the marker.

Abstract: A fiber optic force sensing assembly for detecting forces imparted at a distal end of a catheter assembly. The structural member may include segments adjacent each other in a serial arrangement, with gaps located between adjacent segments that are bridged by flexures. Fiber optics are coupled to the structural member. In one embodiment, each fiber optic has a distal end disposed adjacent one of the gaps and oriented for emission of light onto and for collection of light reflected from a segment adjacent the gap. The optical fibers cooperate with the deformable structure to provide a change in the intensity of the reflected light, or alternatively to provide a variable gap interferometer for sensing deformation of the structural member. In another embodiment, the gaps are bridged by fiber Bragg gratings that reflect light back through the fiber optic at central wavelengths that vary with the strain imposed on the grating.

Abstract: A catheter insertion device and method for insertion. The catheter insertion device can include a housing, a needle attached to a needle carrier, a catheter including a catheter shaft attached to a catheter hub, and a guidewire. The guidewire can include a coil tip positioned in a lumen of the needle. The method for insertion can include inserting a distal end of the needle and the catheter shaft into a blood vessel of a patient, advancing the coil tip out of the needle lumen and into the blood vessel, advancing the catheter over the guidewire, and withdrawing the guidewire and the needle from the catheter. The coil tip can include a straightened configuration and a coiled configuration. The coil tip can transition from the straightened configuration in the needle lumen to the coiled configuration in the blood vessel.

Abstract: A coaxial draining tube, particularly for chest draining systems, includes an inner tube, which has a first opening, and an outer tube, which has a second opening. The inner tube is enclosed within the outer tube and has a smaller diameter than the second opening of the outer tube. The first and second tubes are mutually coupled by way of a supporting component and include one or more holes adapted to allow the passage of air from the chest cavity to the first opening of the inner tube and one or more holes adapted to allow the passage of liquids from the chest cavity to the second opening of the outer tube. The one or more holes are provided in the portion of the coaxial draining tube that is intended to be inserted in the chest cavity of a patient.

Abstract: A multi-section tubular member including a sleeve surrounding and bridging a joint between a first section and a second section of the tubular member, and a method of forming a multi-section tubular member are disclosed. A polymeric sleeve may extend over a portion of the first section and an adjoining portion of the second section. A length of heat shrink tubing may be placed over the sleeve and heated, thereby compressing the heat shrink tubing around the sleeve. The sleeve may then be thermally bonded to each of the first section and the second section. The heat shrink tubing may then be removed, leaving the sleeve securely joining the first section and the second section to form a multi-section tubular member.

Abstract: A guide wire control device and methods of use are described herein. A guide wire is retained by a lock mechanism to a sliding assembly. The sliding assembly controllably moves within a stationary assembly. The guide wire control device provides improved control of guide wires during transcatheter surgical procedures.

Abstract: A robotic surgical system configured for the articulation of a catheter comprises an input device, a control computer, and an instrument driver having at least one motor for displacing the pull-wire of a steerable catheter wherein the control computer is configured to determine the desired motor torque or tension of the pull-wire of a catheter based on user manipulation of the input device. The control computer is configured to output the desired motor torque or tension of the pull-wire to the instrument driver, whereby at least one motor of the instrument driver implements the desired motor torque to cause the desired pull-wire tension to articulate the distal tip of the catheter. The present embodiment further contemplates a robotic surgical method for the articulation of a steerable catheter wherein an input device is manipulated to communicate a desired catheter position to a control computer and motor torque commands are outputted to an instrument driver.

Abstract: A cannulation device is disclosed, having a fixed blade, a retractable wedge, and an adjustment nut for mating with a cannula or a cannula assembly. Another cannulation device is disclosed, having a tube with proximal and distal ends. The fixed blade, coupled to the distal end of the tube, comprises a transition edge configured to cover a lead edge of a cannula. The cannulation device has a control rod movable within the tube; a retractable wedge; an actuator coupled to the control rod; and is configured to move the retractable wedge from a piercing position, where the retractable wedge is aligned with the fixed blade, to a retracted position where the retractable wedge has been retracted within the tube. The cannulation device has a cannula adapter and an adjustment nut movable to change a distance between the adjustment nut and the fixed blade.

Abstract: An integrated vascular delivery system having a frame configured to receive a catheter insertable in a patient to deliver fluid at an insertion site. The frame includes a first hub, a second hub, and a pair of flexible lateral members extending between the hubs and including a tubular lateral member. The system also includes a fluidic channel that fluidically communicates with the catheter, wherein the fluidic channel passes through the tubular lateral member and at least one of the hubs, and includes a fixed turnabout portion in which fluid flows in a direction different from that within the catheter. The first and second hubs provide anchoring points on the patient distributed around the insertion site and on opposite ends of the catheter, thereby anchoring the frame to the patient and stabilizing the catheter. A method is provided for using an integrated vascular delivery system.

Abstract: Safety intravenous catheters (IVCs) are disclosed herein having a catheter hub with a catheter tube, a needle with a needle hub, and a needle guard. The needle guard is configured to be positioned at least partially within an interior space of the catheter hub and is retained thereto by mechanical engagement between the two. Following removal of the needle from the catheter hub, the needle guard is configured to disengage from the catheter hub and attach over a tip of the needle to shield the needle tip from inadvertent needlesticks. The needle guard having an angled end section configured with a length and a width to retain the needle tip within a tip holding space behind the angled end section.

Abstract: Implantable shunt devices and methods for draining cerebrospinal fluid from a patient's subarachnoid space include a shunt having opposed first and second ends, the second end being constructed to penetrate a wall of a sigmoid, transverse, straight, or sagittal sinus of the patient, a one-way valve, a hollow passageway extending between the second end and the one-way valve such that cerebrospinal fluid can be drained through the second end and out through the valve, and a mechanism coupled to the shunt and configured to anchor the shunt at a desired location proximal to the subarachnoid space.

Abstract: The present invention relates to an energy delivery device for expanding a tubular organ, the energy delivering device delivering energy to a tubular organ by an optical fiber for treatment and expanding a tissue in the tubular organ, the device comprising a light diffusing optical fiber connected between a laser device and a fixing tip and delivering light; a contraction unit having one end connected to the fixing tip and arranged in a circumference of an end of the light diffusing optical fiber; a movement unit closely adhered to the other end of the contraction unit, in which the light diffusing optical fiber is inserted; and an expansion adjustment unit adjusting a moving distance of the movement unit and expanding the contraction unit in a radial direction while contracting the contraction unit.

Abstract: A paranasal sinus access implant device to provide an artificial fluid path in fluid communication with the lacrimal apparatus may be implanted through a fistula opening into the lacrimal apparatus. The implant device may have a conduit with a first longitudinal portion having a larger minimum wall thickness than a minimum wall thickness of a second a second longitudinal portion of the conduit located distal of the first longitudinal portion. Various kits may include a paranasal sinus access implant device and one of more other components for a procedure involving implantation. A method involves use of a cutting tool to cut away tissue to prepare a fistula sized for implantation.

Abstract: An applicator 270 includes a stem 174 having an axially-formed slot delivery passage 200. A slot 350 is formed transaxially through the stem 174 and is in communication with the slot delivery passage 200. An extended side wall 350b is formed on one side of the slot 350. A flat surface 354, which is formed in the stem 174, is spaced and extends angularly away from an opposite side of the slot 176 and from the extended side wall 350b to provide for direct and lateral dispensing of a cream 280 onto a tissue 242 of a patient.