Title of Invention

DISTAL HUMERUS AND ELBOW JOINT PROSTHESIS WITH OSCILLATING MECHANISM

Abstract

A surgically implantable distal humerus and elbow joint prosthesis with oscillating mechanism consists of a distal humeral component, a sleeve bearing, condylar component, oscillating guide ring, two collared bushes, pivot pin locating screw and a proximal ulnar stem. When assembled together, the upper end of the distal humeral component forms the bone-anchoring component. The lower end of the distal humeral component accommodates the sleeve bearing, and this assembly along with the oscillating guide ring fits onto the condylar component, which is connected to the proximal ulnar component by the pivot pin with two collared bushes and pivot pin fixing screw. The lower end of the proximal ulnar stem forms the intramedullary- anchoring component. This prosthesis permits a flexion movement of 0-170˚ and an oscillating motion of 0-50˚.

Full Text

Field of invention This invention in general relates to the field of medical technology. Further, this invention relates to a novel custom-built endoprosthesis namely the Distal Humeral Prosthesis Elbow Joint. More particularly this invention relates to custom-built endoprosthesis Distal Humeral with Elbow Joint and Oscillating Mechanism. Introduction Management of patients with musculoskeletal neoplasms has always been one of the most challenging areas in oncology. Prior to 1970, almost every patient with a primary malignant tumour of musculoskeletal system would have any surgical treatment. They would not have adjuvant chemotherapy or irradiation and surgical treatment was almost an amputation with a five-year survival rate of 20%. For benign lesions such as Giant Cell Tumours, the treatment was curettage with 40-60% recurrence rate. Patients with painful metastatic lesions were managed palliatively until they were mercifully relived by death. Prior Art Technique and Practice The conventional treatment for bone tumours over the years has been amputation, which is surgical removal of the affected part of the body. Amputation led to severe disability and psychological problems. The patient was made to lose not only part of the physical human body, but also a part of the personality of the patient. By the advent of limb salvage, the technique of removing the tumour only and saving the limb of the patient was developed. The aim of limb salvage in bone tumour management is to eradicate the disease, retain the integrity of the skeletal system and preserve the limb with useful functions using metallic prosthesis. The early methods of reconstruction after limb salvage used the patient's own bone from another part of the body, but were associated with severe disability due to the lack of knee motion. The technique of endo-prosthetic replacement revolutionized limb salvage by providing a method of reconstruction that provides stability and mobility. The endoprostheses that is used after excision of bone tumours around the Elbow Joint differs from other joint replacement prosthesis because of the amount of mobility required at the site for good function. The prosthesis is fabricated according to the anatomical dimensions of the patient and is therefore termed as the Custom Prosthesis. The custom prosthesis was designed by us to meet the anatomical and functional demands after excision of bone tumours. Different types of Custom Prosthesis have been developed by us to replace bone defects after limb salvage surgery for bone tumours of the elbow, distal radius, distal femur (Thigh bone) and proximal tibia (Leg bone). Our Patent No. 198872, which has already been awarded, is a Proximal Tibial Prosthesis with a Pivotal Hinge Mechanism. Our Patent No. 198869, which has already been awarded, is a Proximal Tibial Prosthesis with Trust Bearing Pad Mechanism. Our application No: 898/MAS/2001, is a Distal Femoral Prosthesis with Pivotal Hinge Mechanism and our Patent No. 196333, which has already been awarded, is a Distal Femoral Prosthesis With Thrust Bearing Pad And Rotating Axis Mechanism. Even though all these patent applications are for prostheses around the knee joint, the anatomical part replaced by Patent Nos. : Patent No. 198872 and Patent No. 198869 are the Knee and below knee joint of the leg bone (Proximal Tibia), whereas the patent Application No: 898/MAS/2001, and Patent No: 196333 replace the thigh bone and the knee (Distal Femur). Our other similar Patents that has been awarded are the Distal Radial Prosthesis with Wrist - Patent No. 202044 and the Distal Tibial Prosthesis with Ankle Joint - Patent No. 201520, while our co-pending applications that have been filed is Patent No. 1023/CHE/2003, the Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism. This patent application that is being addressed is the Distal Humerus with Elbow Joint Oscillating Mechanism. It differs from all the above applications and the current This patent application that is being addressed is the Distal Humerus with Elbow Joint Oscillating Mechanism. It differs from all the above applications and the current patent application because of the unique structural and functional features of the joint replaced, namely the elbow joint. Objects of Invention It is the primary object of the invention to invent and construct a novel - Distal Humerus with elbow joint prosthesis. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint, which is unique. It is yet another object of the invention to invent and construct a novel, which mimics the physiological action of the distal part of the humeral bone. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint, which would retain the functional aspects of the distal part of humeral bone along with the elbow joint. It is yet another object of the invention to invent and construct a novel - Distal Humerus with Elbow joint, which would take care of the structural loading which were encountered by the distal part of the humerus before the lesions. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint, which would preserve the distal part of the humeral bone. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism, which matches in profile the anatomic region of the distal humerus. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint, which is economical. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint, which is safe in usage. It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint and Oscillating Mechanism, wherein It is yet another object of the invention to invent and construct a novel endoprosthesis - Distal Humerus with Elbow joint and Oscillating Mechanism, wherein the said device is provided with an oscillating mechanism to assist the rotational movements occurring at the shoulder joint. Further objects of the invention will be clear from the following description. BRIEF DESCRIPTION OF THE DRAWINGS The following specification will describe in detail with reference drawings accompanying the specification. The nature of the invention and the manner in which it is to be performed is clearly and sufficiently described in the complete specification. The final portion of the complete specification ends with a statement of claims, which defines the invention. Figure 1. Frontal view of the Distal Humeral Prosthesis in un-flexed position Figure 2. A). Posterior view of the Distal Humeral Prosthesis in un-flexed Position B). Oscillating Guide Screw - Component (d). Figure 3. A) Side view of the Distal Humeral Prosthesis in un-flexed position B) Pivot Pin Locating Screw - Component (h). Figure 4. Side view of the Distal Humeral Prosthesis in flexed position. Figure 5. Exploded frontal view of the Distal Humeral Prosthesis. Figure 6. A). Anterior View of the Condylar Component ( c ) B) Oscillating Guide Ring - Component .(e). Figure 7. A) Posterior View of the Condylar Component (c) B) Oscillating Guide Ring - Component (e). Basic components of the device are designated by numerals in the illustrated drawings and are referred in the description of the complete specification. The designations of various parts of the device are as follows. LEGEND OF PARTS This Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism have the following components as per drawing sheet No:l to 7. 1. The Distal Humeral Component ( a) - (features 1 to 10) 2. Sleeve Bearing ( b ) - ( features 11 to 18) 3. Condylar Component ( c) - (features 19 to 32) 4. Oscillating Guide Screw ( d ) - ( features 65 to 69) 5. Oscillating Guide Ring ( e ) - ( features 33 to 40) 6. Collared Bushes ( f ) - ( features 41 to 45) 7. Pivot Pin ( g) - ( features 46 to 48) 8. Pivot Pin Locating Screw ( h ) - (features 49 to 53) 9. Proximal Ulnar Stem Component (i) - ( features 54 to 64) All the components are made of surgical stainless steel of AISI - 316L, 317L Grade or Titanium alloy of ASTM - B 348, Grade 5, except the collared bushes sleeve bearing and the cushioning bearing pad, which are made of Ultra High Molecular Weight Polyethylene provided to avoid metal-to-metal friction providing smooth movements and preventing wear and tear. DETAILED DESCRIPTION OF INVENTION The Distal Humeral Component (a) comprising of features 1 to 10 as in Figure 5 of 7) consists of an Hollow shaft (a of fig. 5) with oval or circular cross-section, whose upper end evolves in the tapered anchoring stem ( feature 3 of fig.5) known as the bone-anchoring component, which has a coarse finish (feature 1 of fig. 5) and is provided with three radial grooves running longitudinally (2 of fig.5) to increase the anchorage with the bone intermeduUary canal of the humeral bone. The junction between oval or cylindrical humeral shaft and the intramedullary-anchoring component (feature 10 of fig.5) has serrations comprising of small rectangular or triangular troughs and pits, (8 of fig 5) which facilitates good integration with the bone and also increases the boundary strength of the prosthesis. The humeral shaft also has a concentric stepped bore (features 5 & 6 of fig 5), to accommodate the bearing sleeve (b) consisting of features 11& 12 of fig.5). A radial threaded hole located on the shaft of humeral component (4 of fig.5) on which the oscillating guide screw (d) is positioned as in fig.2. The Sleeve Bearing (b) mates with this stepped bore concentrically with the axis of the humeral shaft ( a ), with the lower face of the humeral component (feature 7 of fig 5) butts with the upper surface of the collar (feature 14 of fig.5) of the sleeve bearing, The sleeve bearing (b) comprising of features 11 to 18 is a stepped hollow cylindrical shell with collar. The posterior part of the sleeve bearing has a radial hole (16 of fig.5) for accommodating the Oscillating guide screw component (d) of fig.2. In the assembled condition, the outer surface of the narrow portion of the sleeve bearing (11 of fig.5) is in contact with the inner surface of the bore in the humeral shaft, (5 of fig.5) and the outer surface of the expanded portion of the sleeve bearing (12 of fig. 5) is in contact with the inner surface of the expanded portion (6 of fig.5) of the distal humeral component. The anterior portion of the collar (feature 13 of Fig 5) mates with the posterior face of the feature 7 of the humeral component, and the posterior portion of the collar (feature 14 of Fig 5) makes contact with the upper face (27 of fig.5) of the axial bearing feature of the condylar component and the radial face of the collar (13 of fig.5) is visible sandwiched between the humeral and condylar components when the device is in assembled condition (b in fig. 1 & 2). The inner surface of the of the sleeve bearing (18 of fig.5) is in contact with the collars (21 of fig. 6) of the cylindrical portion of the condylar component and the outer surface (35 of fig.6) of the oscillating guide ring. The junction between the expanded and constructed portion of the sleeve bearing (15 fig.5) is in the form of a horizontal plane, that rests on the upper platform on the cylindrical portion of the condylar component.(27 of fig.5 & 6). The Condylar Component ( C ) with features 19 to 32) has a cylindrical shaft (19), a cylindrical central portion (21) and an expanded lower portion (25). The extension shaft (19 of fig.5 & 6), fits in to the inner surface (17 of fig.5) of the sleeve bearing. The extension shaft rests on the face (20 of 5 & 6) below, and the condylar component expands in to a cylindrical portion with two raised collars (21) with a groove between them (22), which is bound by the two edges (23 & 24 ) of the collars. This groove seats the curved portion of the oscillating guide ring component (V of fig.6 & 7). The cylindrical portion of the condylar component meets the expanded portion of the condylar component at the platform (27 of fig. 6) on the upper end of the expanded portion. The expanded portion of the condylar component has a deep groove on the anterior, (25 of fig.6) which is curved backwards in its lower aspect. From the floor of this groove, arise two circular walls, which project anteriorly on either side (30 & 31 of fig.5 & 6). The walls have holes (28 of fig.6), to accommodate the collared bushes 41 to 45 of fig.5. The Oscillating Guide Ring, Component No: e has two extensions posteriorly, (33 & 37 of Fig 6 & 7) that fit in-between the two collars (26 of fig. 6) on the posterior aspect of the cylindered portion of the condylar component. The two protrusions (37 & 33 of fig. 7) of the oscillating guide ring seats into the corresponding cavity like feature on the two collars (26 of fig. 5 & 6) on the posterior aspect of the cylindered portion of the condylar component .The outer surface of the oscillating guide ring (35 of 6 & 7) lies in contact with the inner surface (18 of fig.5) of the lower broader portion of the sleeve bearing. The inner surface of the oscillating guide ring (36 of fig. 6 ) lies in contact with the groove (22 of fig.6 & 7) on the cylindrical portion of the condylar component and the height of the curved portion of the ring (38 of fig.6) is such that it fits accurately in the space between the edges (23 & 24 of fig.6) of the cylindrical portion of condylar component. The curved portions of the oscillating guide ring, end posteriorly has two free edges, (39 & 40). the space between accommodating the tip (66 of fig.2) of the oscillating guide screw Component No: d (fig.2 part B of 66), and has a gap on either side of the screw to allow oscillation between the screw tip fig.2 part B of 66 and the edges of the oscillating guide ring (39 & 40 of fig. 6&7). This oscillation stimulates the normal rotational movements of the forearm towards the right and the left. This oscillation is limited on either side by the contact between the edges of the oscillating guide ring (39 & 40 of fig.6 & 7) and the lower imthreaded portion of the oscillating guide screw component No: (d) (69 of fig.2). The oscillating guide screw fig.2-B, component ( d.) has a round head (68 of fig.2) with a slot (67 of fig.2) and a threaded portion (65 of fig.2), which passes through the hole on the posterior aspect of the lower expanded portion of the humeral component (4 of fig.5) and then into the hole in the expanded lower part of the sleeve bearing (16 of fig.5) and the lower part of the rotating guide screw,(66 of fig.2B) engages in the space between the free edges of the curved portions of the oscillating guide ring (39 & 40 of fig.6 & 7) and the edges of the (23 and 24 of 6 & 7). The tip of the rotating guide screw (66 of fig 2B), not touching the surface of the groove (22 of 6 & 7) of the cylindrical portion of the condylar component. This arrangement, leaves a small gap on either side of the lower part of the screw (66 of fig.2B) and the free edges of the curved portion of the oscillating guide ring (39 & 40 of fig.6 & 7) so that the humeral component, (1 of fig. 1 & 2) the sleeve bearing (b of 1 & 2) and the oscillating guide screw, move as a single unit, permitting oscillation, as mentioned earlier, due to the space between the lower unthreaded part (69 of fig.2B) of screw and the free edges of the curved portion of the oscillating guide ring (39 & 40 of fig. 6 & 7), the amount of oscillation being determined by the space between the fi-ee edges of the curved portion of the oscillating guide ring (39 & 40 of fig.6 & 7). This arrangement stimulates the rotatory movements of the forearm. The collared bush is a hollow cylinder with a collar. The outer surface of the cylindrical bush (44 of fig.5) makes contact with the inner surface of the groove in the circular raised walls 30 & 31 of fig.5 of the expanded portion of the condylar component. The outer face (45) of the collar is in contact with the inner face of the margins of the radial groove (30 & 31 of fig.5). The inner surface of the collars (41 of fig.5), make contact with the outer surfaces of the upper portion of the proximal ulnar component (55 & 56 of fig 5). The collared bushes have a central bore through which the pivot pin passes (43 of fig.5). The proximal ulnar stem component (i) fig.l, 2, 3 & 5 (54-64) has a circular loop at its upper and anterior end, which has a central hole (54 of fig.5). The sides of the circular portion (55 & 56 of fig.5) make contact with the inner collar of the collared bushes (41 of fig. 5). The anterior aspect of the circular head of the proximal ulnar component has a threaded hole (57 of fig.5), that accommodates the pivot pin locating screw component (g) - B of Fig.3. The stem extends distally as the extension portion of the proximal ulna (58 of fig.3), which ends in a raised platform, which is the bone seating area (61 of fig.3). The tapered stem of the intramedullary part of the ulna originates eccentrically from this platform and extends distally (59 of fig.3). The stem has slotted grooves of variable length, for cement anchorage (60 of fig.3). The pivot pin component (g), (46 to 48 of fig 5) is a cylindrical in shape, the outer surface of which (46 of fig.5) passes in the inner hollow of the collared bushes (43 of fig.5) and the bore in the upper circular portion of the proximal ulnar stem (54 of fig.5). The pivot pin has a hole anteriorly (47 of fig.5), which accommodates the tip of the pivot pin locating screw component No: h of (49 to 53 of fig.3B). The two ends of the pivot pin are provided with slots (48 of fig.5) that are placed parallel to the central bore for the pivot pin locating screw (47 of fig.5). This slot helps to align the bore in the anterior part of the circular portion of the proximal ulnar stem (57 of fig.5) and the coimter hole in the pivot pin (47 of fig.5) in a straight line for the pivot pin locating screw to pass through. The pivot pin locating screw component (h) fig.3B (49-53) has a threaded portion (49 of fig.3B) fits in to the threaded bore in the circular portion of the proximal ulnar component (57 of fig.3 A). The upper end of the screw has a transverse slot, (50 of fig 3B) and the circumference of the screw head (53 of fig.3B) fits accurately in to the bore (64 of fig.3) in the proximal ulnar component and the interior surface of the screw head (51 of fig.3) comes into contact with the floor of the counter screw hole (54 of fig.3) in the proximal ulnar stem. The tip of the pivot pin locating screw (52 of fig 3) fits in the counter hole in the pivot pin (47 of fig.5). The oscillating guide screw makes contact with the condylar component assembled with sleeve bearing and humerus component with oscillating ring in one sub assembly. The pivot pin locating screw make component with the ulnar component with the collared bushes, pivot pin and the head of the contacting component make a complete unit assembly of a Distal Humerus Prostheses with Elbow Joint and Oscillating Mechanism. This joint has two sub assemblies, which permit movements in two planes. The flexion movement of the elbow is stimulated by the sub assembly comprising of the condylar component, collared bushes, pivot pin and pivot pin locating screw wherein the pivot pin links the two major components namely the Condylar Component and the Proximal Ulnar Component, the contact between these metallic surfaces prevented by the Collared Bushes, the entire assembly being held together by the Pivot pin fixing screw. This assembly functions as the elbow joint allowing movement in the anterior direction of 0^ to 170^ thus its stimulating the normal movements of the elbow joint. The subassembly comprising of the distal humeral component, the sleeve bearing, the oscillating guide ring, the cylindrical portion of the condylar component, and the oscillating guide screw, function as a single unit, allowing movements in the space between the sides on the oscillating guide screw and the edges of the curved portions of the oscillating guide ring permitting about 0 - 500 of oscillating which stimulates the rotatory movements of the forearm. It is to be noted that the complete specification discloses salient features of the invention. The scope and ambit of the invention is defined in the following statement claims. We Claim 1. An implantable Distal Humeral Prosthesis with Elbow Joint and Oscillating Mechanism for replacement of the Distal part of the Humerus along with the Elbow Joint, the invention is characterised that the Distal Humeral Prosthesis with Elbow Joint and Oscillating Mechanism is surgically fixed into the inter-medullary canal by reaming the Humerus and the Ulna and cementing the two intermedullary stems of the humeral and the ulna components and the said prosthesis comprises of a distal humeral component which is a cylindrical shaft with a tapered intermeduUary stem on one end and a stepped bore on the other end, this stepped bore mates with the sleeve bearing and the condylar component to form a rotating fit, an unique oscillating guide ring is locked into this system by a oscillating guide screw and forming the Oscillating mechanism, while the other end of the condylar component has two symmetrical hub like features rising on the anterior side with a radial cavity in between and with two concentric holes to accommodate two collared bushes and the pivot pin passes through them and through the threaded bore on the head of the ulnar component and locked by the pivot pin locating screw thus constituting the elbow joint with a action of 0 to 170°. 2. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the condylar component resembles the anatomy of the condylar region of the distal humerus bone. 3. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the humeral component is a hollow cylindrical shaft with the tapered intermedullary stem on one end and a hub with a stepped bore feature on the other end designed to mate with the condylar component and the bearing sleeve. 4. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 3, wherein the inner surface of the stepped hollow feature of the humeral shaft forms a rotating fit with the outer surface of the sleeve bearing and the collars of the sleeve bearing makes contact with face of the cylindrical portion of the humeral component. 5. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the oscillating guide ring is seated in the cavity between the two collar like features on the protrusion of the condylar component and forms a rotating fit with the inner surface of the broader portion of the sleeve bearing. 6. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the oscillating guide ring has a curved arm extending anteriorly up to the middle line on the right side and a mutilated arm on the left side for a left sided prosthesis and vice versa for right sided prosthesis. 7. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 6, wherein the cavity in-between the two edges of the guide ring provide a small degree of freedom for the action of the Oscillating guide screw, the result of this movement corresponds into the rotary movements of the forearm. 8. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the oscillating guide screw passes through the threaded hole in the humeral shaft and then into the hole in the sleeve bearing and the tip of this screw emerges into the space in-between two edges of the oscillating guide ring. 9. Distal Humeras and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 8, wherein the tip of the oscillating guide screw does not make any contact with the surface of the cavity in-between the two collar like feature on the hub of the condylar component. 10. Distal Humeras and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the condylar component has a stepped shaft at its upper end with two collars on the section of the shaft with larger diameter along with a keyway like feature on each collar to seat the oscillating guide ring. 11. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the distal humerus component, sleeve bearing and Oscillating guide screw move as a single unit in the space between the free edges of the oscillating guide ring, stimulating the rotatory movements of the forearm. 12. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the expanded portion of the condylar component has two symmetric hub like feature arising on either side of the condylar component on the anterior side with concentric holes to accommodate the collared bushes. 13. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the radial groove in-between the two hubs on the anterior side of the condylar component accommodates the head of the ulnar component with two collared bushes sandwiched in-between. 14. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the collared bushes have a axial bore through which the pivot pin passes from one hub to the other through the bore in the head of the proximal ulnar stem and through the bores of the collared bushes thus holding these components together and constituting the elbow joint. 15. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the threaded portion of the pivot pin locking screw fastens into the threaded hole on the head of the proximal ulnar component and the cylindrical tip of the said screw fits in to radial blind hole of the pivot pin, thus ensuring positive locking. 16. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the assembly comprising of the condylar component, collared bushes, pivot pin and pivot pin locating screw form a joint allowing to and fro movement in the anterior direction giving full flexion, thus its stimulating the normal movements of the elbow joint. 17. The Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein subassembly comprising of the distal himieral component, the sleeve bearing, the oscillating guide ring, the cylindrical portion of the condylar component, and the oscillating guide screw, function as a single unit, allowing movements in the space between the sides on the oscillating guide screw and the edges of the curved portions of the oscillating guide ring permitting a radial movement required to stimulate the radial movements of the forearm. 18. Distal Humerus and Elbow Joint Prosthesis with Oscillating Mechanism as in Claim 1, wherein the hub of the humeral component mates with the shaft of the condylar component sandwiching the sleeve bearing and the oscillating guide ring to make a rotating fit and held in position by a pivot locking screw and this assembly is known as the Oscillating Guide Ring Mechanism. Dated : Chennai, at the day of 19th November 2004.

Documents:

1240-che-2004-abstract.pdf

1240-che-2004-claims.pdf

1240-che-2004-correspondnece-others.pdf

1240-che-2004-correspondnece-po.pdf

1240-che-2004-description(complete).pdf

1240-che-2004-drawings.pdf

1240-che-2004-form 1.pdf

1240-che-2004-form 19.pdf

1240-che-2004-form 3.pdf