Permanent Tube Research Articles

Novel Surgical Techniques to Control Flow With PreserFlo MicroShunt for Late Hypotony After Baerveldt Drainage Device Implantation.

We report a new surgical technique for controlling flow with a PreserFlo MicroShunt, in patients with late postoperative hypotony, following a Baerveldt glaucoma drainage device implantation. We present 2 cases with late postoperative hypotony after Baerveldt-shunt implantations. In both cases, the outflow resistance of the Baerveldt tube was modulated by the insertion of a PreserFlo MicroShunt into the lumen of the Baerveldt tube. In the first case, the Microshunt was inserted through the distal opening of the tube in the anterior chamber. In the second case, an end plate, sided approach was chosen after opening the conjunctiva. In both cases, the hypotony was successfully treated. The intraocular pressure rose immediately after the procedure, and it remained well controlled within the targeted range during the first postoperative months without additional pressure-lowering medication. This novel surgical technique provided predictable flow reductions, according to the Hagen-Poiseuille equation. This approach offers a valuable alternative to permanent tube ligation.

Optimization Design of a Novel Flux-Switching Transverse-Flux Permanent Magnet Tube Linear Motor

A novel flux-switching transverse-flux permanent magnet tube linear motor (FSTFPMTLM) with oblique air-gap is proposed in this article, which combined the merits of the tube linear motor, the transverse-flux linear motor, and the switched-flux linear motor. The structure and operating principle of the FSTFPMTLM is presented first. Considering this motor has a 3-D magnetic circuit and designing the motor with high performance, this article proposes an optimization method for the FSTFPMTLM by decomposing the design of the motor into two steps to separate optimization using experimental design method. The first step is to optimize the cross-section part of the motor. After that the optimized motor is compared with the initial one by finite element method (FEM). The prototype is then manufactured and tested.

Mechanically flexible viscosity sensor for real‐time monitoring of tubular architectures for industrial applications

AbstractReal‐time monitoring of fluid viscosities in tubular systems is essential for industries transporting fluid media. The available real‐time viscometers for tubular systems have major drawbacks, such as using invasive methods with large pressure drops due to flow disturbances, destructive installation processes with permanent tube damage, and limited operability with laminar flows. Therefore, developing a viscometer to address the above‐mentioned concerns is required for industrial applications. In this study, a new application of a velocity‐dependent viscometer using a novel design for real‐time measurements with insignificant flow disruption is proposed. It involves a Poly (methyl‐methacrylate) microchannel bridge with a microfluidic flowmeter attached to a mechanically flexible Polydimethylsiloxane platform connected to the inner surface of the pipe, which can adapt to different pipe diameters and curvatures. Moreover, the proposed viscometer uses the pipe flow driving force to flow fluids into the microchannel for measurement without requiring a pumping system or any sample withdrawals. The results of the simulation analysis match the experimental results of the sensor performance. The sensor can measure different viscosities in the range of 4‐334 mPa s with a resolution higher than 2.7 mPa s. Finally, a stand‐alone system is integrated with the sensor for wireless data transmission.

Combined stomach and duodenal perforating injury following blunt abdominal trauma: a case report and literature review

BackgroundGastrointestinal injury following blunt abdominal trauma is uncommon; a combined stomach and duodenal perforating injury is even more rare. Because these two organs are located in different spaces in the abdomen, such injuries are difficult to identify.Case presentationA young woman involved in a motor vehicle crash presented to our emergency department with concerns of severe peritonitis. Contrast-enhanced computed tomography of the abdomen revealed pneumoperitoneum and retroperitoneal hematoma in zone 1. An emergency laparotomy was performed, revealing a stomach-perforating injury, which was resolved with primary repair. No obvious injury was observed on retroperitoneal exploration. However, peritonitis presented again on the second postoperative day, and a second laparotomy was performed, revealing a duodenum-perforating injury in its third portion. We performed primary repair with multi-tube-ostomy. The patient recovered well without permanent tube placement or internal bypass.ConclusionsAssessing associated injuries in blunt abdominal trauma is crucial because they may be fatal if timely intervention is not undertaken. These types of complicated injuries require a feasible surgical strategy formulated by experienced surgeons, which gives the patient a better chance of survival.

1656P Anti-angiogenic therapy induced pneumothorax (AIP) is associated with long-lasting response and survival benefit for paediatric and young adult sarcoma

AIP in sarcoma has been widely noticed as a hard to treat complication, leading to dismal outcomes. Although drug interruption is usually indicated, anecdotal evidence has identified some AIP patients continuing anti-angiogenic therapy (AAT) during AIP as exceptionally durable responders. A total of 131 sarcoma pts were treated with apatinib-containing therapy in our institution. From Sep. 2017, we implemented a non-stop strategy for 28 sarcoma pts with AIP using a multi-disciplinary approach to avoid interrupting AAT. Another 10 AIP pts treated with drug interruption strategy (pts decision or referral from other institution) served as a pragmatic control. AIPs were significantly enriched in young, heavily pre-treated, male patients with lung metastases with cavitary changes. AIPs with non-stop strategy were associated with drastically longer progression-free survival (PFS) (12.0 mo), compared to those without AIP (6 mo) or AIP with drug interruption (4.0 mo) (P=0.003), with the best even >3 yr. Such benefit was further translated into pts' overall survival, with a borderline statistical significance (AIP group 23.3 mo vs control 16.9 mo, P=0.099). There were no deaths directly related to the pneumothorax. Removal of chest tube was achieved in 31 (81%) of the pts, while 4 lived with permanent tubing and 3 died from complications of long-term tubing. Interestingly, cavitary lesions presented in all ages (rather than only in young pts) and the concurrence of AIP and cavitation accounted for only 54% of the cases, suggesting additional contributing factors of AIPs. To this end, 21 common SNPs were screened, and VEGFR2 A-to-G polymorphism (rs2071559) remained as the only biomarker for both the therapeutic efficacy and the risk of AIPs. RNA-seq data of 21 osteosarcomas suggest a different phenotype of the vasculature between the AA versus the A-to-G genotype. To test the generalizability of our result, we reviewed 31 previously published trials and found that there is a general correlation of the AIP incidence with the treatment efficacy, in terms of overall response rate (ORR) (r=0.64, P<0.001) and PFS (r=0.44,P=0.014), further supporting that AIP might be an efficacy related AE deserving attentions. Our multidisciplinary strategies assure sarcoma pts with AIP to remarkably benefit from AAT as durable responders. Further investigation of the germline biomarker of AIP for risk stratification and individualized regimens is warranted.

Current Practices for Outpatient Initiation of Levodopa-Carbidopa Intestinal Gel for Management of Advanced Parkinson’s Disease in the United States

In 2015, the US Food and Drug Administration approved levodopa-carbidopa intestinal gel (LCIG; also known as carbidopa-levodopa enteral suspension in the US) for the treatment of motor fluctuations in patients with advanced Parkinson’s disease. LCIG provides a continuous infusion of levodopa and carbidopa by means of a portable pump and percutaneous endoscopic gastrojejunostomy tube. The delivery system has a two-fold pharmacokinetic advantage over orally administered carbidopa/levodopa. First, levodopa is delivered in a continuous rather than intermittent, pulsatile fashion. Second, delivery to levodopa’s site of absorption in the jejunum bypasses the stomach, thereby avoiding issues with erratic gastric emptying. In blinded prospective clinical trials and observational studies, LCIG has been shown to significantly decrease “off” time, increase “on” time without troublesome dyskinesia, and reduce dyskinesia. Consistent with procedures in previous studies, LCIG initiation and titration in the pivotal US clinical trial were performed in the inpatient setting and followed a standardized protocol. In clinical practice, however, initiation and titration of LCIG have a great degree of flexibility and, in the US, almost always take place in the outpatient setting. Nonetheless, there remains a significant amount of clinician uncertainty regarding titration in outpatient clinical practice. This review aims to shed light on and provide guidance as to the current methods of titration in the outpatient setting, as informed by the medical literature and the authors’ experiences.FundingAbbVie, Inc.Plain Language SummaryPlain language summary available for this article.

Rumination syndrome after esophagectomy

Gastric conduit dysfunction after esophagectomy is a disabling condition that may require revisional surgery. Rumination syndrome is an uncommon and poorly recognized functional foregut disorder of unknown etiology characterized by effortless oral regurgitation of recently ingested food. Rumination is associated with increased intragastric pressure generated by an unconscious mechanism eliciting contraction of the abdominal wall and relaxation of the diaphragm. Rumination syndrome after esophagectomy has not been previously reported in the literature. Two female patients were referred for inability to eat and weight loss due to severe food regurgitation following esophagectomy and gastric conduit replacement. Their previous medical and psychiatric history was apparently unremarkable. Symptoms occurred within the first postoperative year and progressively worsened. High-dose proton pump inhibitors, erythromycin, metoclopramide, antidepressant medications, pneumatic pyloric dilatation, and laparoscopic pyloromyotomy failed to relieve symptoms, and both patients eventually required permanent tube jejunostomy for nutritional support. Subsequently, thoracoscopic implant of a neurostimulator and a laparoscopic Roux-en-Y gastrojejunostomy were performed and failed in both patients. All medical and surgical attempts to relieve symptoms were clinically unsuccessful in these patients in whom radiological and endoscopic investigations did not demonstrate trans-diaphragmatic hernia or mechanical obstruction of the gastric conduit. Eventually, the diagnosis of rumination syndrome was made based on the Rome IV criteria. In the absence of anatomical or other functional abnormalities of the gastric conduit, revisional surgery is contraindicated; rather, the diagnosis of rumination syndrome should be considered. The role of behavioral therapy integrated with diaphragmatic breathing training and biofeedback should be investigated in these patients.

Locally advanced cancer of the tongue base: A new method of surgical treatment

Introduction:Patients are characterized by locally advanced tumours in 70-80% of cases at presentation. Thus, the possibilities for curing and surgical treatment are limited. Total glossectomy, which involves tongue base resection, is associated with severe and permanent disabilities. Total glossectomy leads to severe dysphagia, alalia and social maladjustment. A number of issues motivated us to develop a new method of surgical treatment of locally advanced base of tongue cancer.Objective:To introduce new opportunities for surgical treatment of locally advanced cancer of the tongue base.Materials and Methods:Glossectomy was accomplished in five patients suffering from tongue cancer and admitted to N.N. Blokhin National Medical and Research Center of Oncology. Swallowing and speech were preserved in all 5 cases.Results:We developed a new technique of surgical treatment of locally advanced cancer of the tongue base.Conclusion:The developed surgical technique allows early rehabilitation. Patients are able to breath effortlessly, swallow and speak. Permanent tracheostomy and PEG tubes are not necessary. All patients remained socially active.

Biological effects of long term fine limestone tailings discharge in a fjord ecosystem

Benthic infaunal data collected from 1993 to 2010 were analysed to examine the effect of long term discharge of fine limestone tailings on macrofaunal species assemblages in a fjord. Relative distance from the outfall and proportion of fine tailings in the sediment were correlated with benthic community structure. Diversity decreased with increasing proportion of fine tailings. Biological Traits Analysis (BTA) was used to explore the temporal and spatial effects of the tailings gradient on macrofaunal functional attributes. BTA revealed that all stations along a pressure gradient of fine limestone tailings were dominated by free-living species. As the proportion of fine tailings in the sediment increased, there was an increase in fauna that were smaller, highly mobile, living on or nearer the surface sediment, with shorter lifespans. There was a decrease in permanent tube dwellers, those fauna with low or no mobility, that live deeper in the sediment and have longer lifespans (>5yrs).

Enterale Ernährung mit Sonden

Tube feeding is an integral part of medical therapies, and can be easily managed also in the outpatient setting. Tube feeding by the stomach or small intestine with nasogastral or nasojejunal tubes is common in clinical practice. Long-term nutrition is usually provided through a permanent tube, i. e. a percutaneous endoscopic gastrostomy (PEG). Modern portable nutrition pumps are used to cover the patient's nutritional needs. Enteral nutrition is always indicated if patients can not or should not eat or if nutritional requirements cannot be covered within 3 days after an intervention, e. g. after abdominal surgery. Industrially produced tube feedings with defined substrate concentrations are being used; different compositions of nutrients, such as glutamine fish oil etc., are used dependent on the the condition of the patient. Enteral nutrition may be associated with complications of the tube, e. g. dislocation, malposition or obstruction, as well as the feeding itself, e. g.hyperglycaemia, electrolyte disturbances, refeeding syndrome diarrhea or aspiration). However, the benefit of tube feeding usually exceeds the potential harm substantially.

ELIXYS - a fully automated, three-reactor high-pressure radiosynthesizer for development and routine production of diverse PET tracers

BackgroundAutomated radiosynthesizers are vital for routine production of positron-emission tomography tracers to minimize radiation exposure to operators and to ensure reproducible synthesis yields. The recent trend in the synthesizer industry towards the use of disposable kits aims to simplify setup and operation for the user, but often introduces several limitations related to temperature and chemical compatibility, thus requiring reoptimization of protocols developed on non-cassette-based systems. Radiochemists would benefit from a single hybrid system that provides tremendous flexibility for development and optimization of reaction conditions while also providing a pathway to simple, cassette-based production of diverse tracers.MethodsWe have designed, built, and tested an automated three-reactor radiosynthesizer (ELIXYS) to provide a flexible radiosynthesis platform suitable for both tracer development and routine production. The synthesizer is capable of performing high-pressure and high-temperature reactions by eliminating permanent tubing and valve connections to the reaction vessel. Each of the three movable reactors can seal against different locations on disposable cassettes to carry out different functions such as sealed reactions, evaporations, and reagent addition. A reagent and gas handling robot moves sealed reagent vials from storage locations in the cassette to addition positions and also dynamically provides vacuum and inert gas to ports on the cassette. The software integrates these automated features into chemistry unit operations (e.g., React, Evaporate, Add) to intuitively create synthesis protocols. 2-Deoxy-2-[18F]fluoro-5-methyl-β-l-arabinofuranosyluracil (l-[18F]FMAU) and 2-deoxy-2-[18F]fluoro-β-d-arabinofuranosylcytosine (d-[18F]FAC) were synthesized to validate the system.Resultsl-[18F]FMAU and d-[18F]FAC were successfully synthesized in 165 and 170 min, respectively, with decay-corrected radiochemical yields of 46% ± 1% (n = 6) and 31% ± 5% (n = 6), respectively. The yield, repeatability, and synthesis time are comparable to, or better than, other reports. d-[18F]FAC produced by ELIXYS and another manually operated apparatus exhibited similar biodistribution in wild-type mice.ConclusionThe ELIXYS automated radiosynthesizer is capable of performing radiosyntheses requiring demanding conditions: up to three reaction vessels, high temperatures, high pressures, and sensitive reagents. Such flexibility facilitates tracer development and the ability to synthesize multiple tracers on the same system without customization or replumbing. The disposable cassette approach simplifies the transition from development to production.

A further patient with van Maldergem syndrome

We report on a male patient with the proposed diagnosis of the rare but very distinct entity of van Maldergem syndrome.His parents are first cousins. At the age of 4 years the boy presented with severe developmental delay, talipes equinovarus, finger camptodactyly with interphalangeal pterygium, joint laxity, bilateral microtia, and a dysmorphic facies. He showed bilateral epicanthus, telecanthus, short palpebral fissures, broad flat nasal bridge, and dental malocclusion. The combination of the specific facial features with camptodactyly, interphalangeal pterygium, joint laxity and developmental delay led to the diagnosis of van Maldergem syndrome. The medical history was further on significant for pharyngeal instability requiring the placement of a tracheostomy tube, an inguinal hernia, hip subluxation, small kidneys and genital abnormalities (micropenis, bifid scrotum, cryptorchidism). Due to severe feeding difficulties permanent tube feeding was required. Metabolic tests (newborn metabolic screening, 7-dehydrocholesterol, amino acids, organic acids in urine) and chromosomal analysis (450–500 bands; 46,XY) were normal. Molecular karyotyping revealed two parental CNVs (paternal deletion of 9q33.1; maternal duplication of 11p15.1), which are unlikely to contribute to the patient's phenotype.Taken together, the report on a further patient with van Maldergem syndrome expands the clinical spectrum of the condition by adding genital malformations, hernia, pharyngeal instability, and subluxation of the hip.

Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma

Background and purposeWe sought to evaluate the nature and frequency of late toxicities in a cohort of nasopharyngeal cancer (NPC) patients treated with conventional radiotherapy alone. Methods and materialsSeven-hundred and ninety-six consecutive NPC patients treated using conventional radiotherapy at a single center from 1992 to 1995 were retrospectively analyzed. Patients with histology proven, completely staged, Stage I–IVB World Health Organization Type I–III NPC and completed radical radiotherapy were included. Patients with incomplete staging investigations, distant metastases at diagnosis, previous treatment, and incomplete radiotherapy were excluded. Radiotherapy-related complications were categorized using the RTOG Late Radiation Morbidity Scoring Criteria. ResultsMedian follow-up was 7.2years. The 5-year overall survival and disease free survival were 69% and 56%, respectively, and the corresponding 10-year rates were 52% and 44%. Among 771 patients with at least 3months of follow-up post treatment, 565 (73%) developed RT-related complications. Diagnosed neurological complications were cranial nerve palsies (n=70; 9%), temporal lobe necrosis (n=37; 5%), Lhermitte’s syndrome (n=7; 1%), and brachial plexopathy (n=2; 0.3%). Non-neurological complications included xerostomia (n=353; 46%), neck fibrosis (n=169; 22%), hypo-pituitarism (n=48; 6%), hearing loss (n=120; 16%), dysphagia (n=116; 15%), otorrhea (n=101; 13%), tinnitus (n=94; 12%), permanent tube feeding (n=61; 8%), trismus (n=45; 6%), second malignancies within treatment field (n=17; 2%), and osteo-radionecrosis (n=13; 2%). ConclusionsWhile radiotherapy is curative in NPC, many patients suffer significant late treatment morbidities with conventional radiotherapy techniques.

Perspectives of Community Members regarding Tube Feeding in Patients with End-Stage Dementia: Findings from African-American and Caucasian Focus Groups

Research has demonstrated that placement of permanent feeding tubes to provide artificial nutrition is more common among non-white populations, but there is a scarcity of research regarding why those differences may exist. The purpose of this study is to describe and understand community members' attitudes toward tube feeding and end-of-life decision-making. Four focus groups were convened in Greenville, NC. The 28 focus group participants were 11 African American and 17 Caucasian community members between ages 51 and 81. Two focus groups were held with Caucasian participants and two with African-American participants. Focus groups were recorded and transcribed, and qualitative analysis was performed using NVivo software. Seven themes resulted from the analysis of the transcripts. They included: "A feeding tube is," "Food is important," "They want to do the right thing," "To make a rational decision," "There are worse things than death," "There's a lot of good things," "It's out of my hands." There were more commonalities than differences in the views of African Americans and Caucasians on perspectives on tube feeding and elders with dementia. An unexpected emphasis was placed on the importance of food as a symbol of caring. Families tend to be oriented toward personal fidelity to the elder and the symbolic role of feeding in fulfilling that fidelity.

Rumen pH and NH3-N concentration of sheep fed temperate pastures supplemented with sorghum grain

The aim of this study was to evaluate the effect of sorghum grain supplementation on ruminal pH and NH 3 -N concentration of wethers consuming a fresh temperate pasture ( Lotus corniculatus) in metabolism cages. Sixteen Corriedale x Milchschaf wethers were fed temperate pastures ad libitum and were non-supplemented or supplemented with ground sorghum grain at 5, 10 or 15 g/kg of their body weight (BW). Rumen fluid samples were collected at 0, 1, 2, 3, 4, 5 and 6 h after supplementation through permanent tubes inserted in the rumen. Ruminal pH was measured immediately and NH 3 -N concentration was determined by direct distillation. Mean daily pH values for non-supplemented wethers and supplemented with 5, 10 and 15 g/kg of their BW were 6.45, 6.14, 6.09 and 5.43, respectively. Significant differences in pH were found between the 15 g/kg supplemented group and non-supplemented, 5 and 10 g/kg supplemented groups, while a trend was found between non-supplemented and 10 g/kg supplemented group. After 0 h, all mean pH values for the non-supplemented group were above 6.15, while values for the 10 and 15 g/kg supplemented groups were below 6.2 and 6.0, respectively. No differences in NH 3 -N concentration among groups (mean = 37.15 mg/100 mL), between time or interaction between time and treatment were found. There was a correlation between pH and NH 3 -N when all measurements were considered. Ground sorghum grain supplementation significantly reduced rumen pH when 15 g/kg of BW was provided to wethers fed temperate pastures, but it did not affect NH 3 -N concentration.

Rigless Tubing Repair Using Permanent and Retrievable Straddles on the North Slope, Alaska

Summary At Prudhoe Bay, Alaska, nonrig tubing repairs have become a viable alternative to rig workovers (RWOs). They provide economic remediation for wells with production tubing by "A" annulus communication. Electricline (EL)-set straddles can eliminate tubing communication at a significant cost savings. They are particularly attractive in areas in which RWO cost is significant, such as offshore, remote, or Arctic locations. The advantage of tubing-straddle repair over a conventional RWO is that there is no need to pull tubing, resulting in the well being returned to service faster. Typical straddle deployment costs are less than 5% of the costs for tubing replacement with an RWO. To date, 263 permanent and retrievable tubing straddles have been set in 181 wells at Prudhoe Bay. This paper discusses the history of conventional tubing straddles at Prudhoe Bay and the recommended prestraddle diagnostics. The paper also provides a systematic approach for their design and deployment.

Long term follow up data of a phase II study of concurrent radiotherapy (RT) and gemcitabine (Gem) for patients with stage III or IV squamous cell carcinoma of the head and neck (SCCHN)

5574 Background: RT with concurrent chemotherapy is superior to RT alone as treatment for locally advanced SCCHN. Gem is a potent radiosensitizer in vitro and in vivo and in addition has a good activity in SCCHN. Exploitation of these properties was the rationale for a single institution phase II study which evaluates the efficacy and toxicities of standard RT + weekly low dose Gem. Methods: Eligible were patients with primary inoperable or locally advanced stage III and IV SCCHN. Treatment: Planned RT was 70 Gy over 7 weeks with weekly Gem 100 mg/m2 within 2 hours prior to RT (Eisbrüch et al., ASCO, 1997, 1998). Presented endpoints are response rate (according to WHO), acute and late toxicity (according to NCICTC), disease free survival (DFS), local relapse free survival (LRFS) and overall survival (OS). Results: 26 patients (21 male, 5 female; performance status 0–2; no prior treatment) entered the study between November 1998 and September 2003. Median age was 56 years (range 48–78). Tumor sites were oropharynx (6), hypopharynx (17), glottis (1), paranasal sinus (1), unknown (1). Clinical stage was III (2) or IV (24). 7 Patients had T4N2 disease and 2 had T4N3 disease. Patients received a median of 7 Gem cycles (range 2–8) and a median of 70 Gy (66–84.75). 7 patients underwent radical neck dissection. Grade 3–4 acute toxicities included mucositis (22/26), dermatitis (18/26), pharyngitis and/or oesophagitis (21/26), pain (7/25), xerostomia (1/24), neutropenia (1/26) and anemia (1/26). 21/26 patients needed tube feeding and 21/26 needed to be hospitalized. After recovery from acute toxicity 6/23 could feed normally, 5/23 needed soft food, 5/23 were able to swallow liquid food and 2/23 required permanent tube feeding. Response was evaluable in 22 patients (11 CR, 11 PR). Intial relapse was at distant sites in 9/26 and local in 8/26. Median follow up of the patients still alive is 46 months. Median OS is 576 days, median DFS is 401 days, median LRFS is not reached. 7/26 remain free of disease more than 3 years after end of treatment. Conclusions: RT + Gem (100 mg/m2/week) is feasible but toxic. The combination is highly active in SCCHN and provides a good long term local control. [Table: see text]

Placement of a permanent endooesophageal tube

Placement of a permanent endooesophageal tube

Correct placement of a permanent endooesophageal tube

Correct placement of a permanent endooesophageal tube

Air insufflation test: a new method of assessing correct placement of a permanent endo-oesophageal tube.

Air insufflation test: a new method of assessing correct placement of a permanent endo-oesophageal tube.