Tube Replacement Research Articles

Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children.

Constipation in pediatrics remains a common problem. Antegrade continence enema (ACE) procedures have been shown to decrease the distress of daily therapy. Patients are able to administer more aggressive washouts in the outpatient setting. Therefore, we hypothesize that patients following an ACE procedure would have reduced admissions for constipation. Patients who underwent an ACE procedure at a large children's hospital from 2015 to 2018 were included. Demographics, diagnosis, procedure, and preoperative/postoperative hospital admissions were analyzed. Forty-eight patients were included in the study. Over half were diagnosed with idiopathic constipation. Majority of patients underwent an appendicostomy (88%, n = 42). Preoperatively, 26 patients were admitted for a combined total of 63 times for constipation. Postoperatively, 4 patients were admitted for a total of 5 visits (P = .021). Twenty-eight patients required a nonscheduled appendicostomy tube replacement. This study demonstrates ACE procedures can improve constipation-related symptoms in children and are associated with decrease hospital admissions.

Factors Associated with The Incidence of Infection in Tracheostomy Stoma at Mohammad Hoesin Hospital

Introduction: Tracheostomy is a surgery to open the trachea to allow air to enter the airway. Tracheostomy cannot be separated from possible complications. Tracheostomy stoma infection is one of the complications of post-tracheostomy that occurs due to the activity of several bacteria. Many factros can cause the incidence of tracheostomy stoma infection.
 Objective: The aim of this study is to determine the factors associated with the incidence of tracheostomy stoma infection.
 Methods: Observational study with cross-sectional design. Data collection was carried out using medical record data on 71 subjects who underwent tracheostomy tube replacement from july 2019 to November 2020.
 Results: From 71 subjects, it was found that the subjects who had tracheostomy stoma infection were 54.9%. The results of bivariate analysis showed that age (p=0.031), comorbidities (p=0.009), the type of tracheostomy tube (p=0.015), the use of antiseptic in tracheostomy dressing (p=0.020), tracheostomy tube care (p=0.013), and the interval of changing the tracheostomy tube (p=0.041) are the significant factors. The results of multivariate analysis showed that tracheostomy tube care and the interval of changing the tracheostomy tube had a significant effect on tracheostomy stoma infection. Tracheostomy tube care has a risk of 9.362 times to experience infection with CI95%(1.535-57.086) and the interval of changing the tracheostomy tube has a risk of 10.669 with CI95% (1.074-105.985).
 Conclusion: There is a significant relationship between age, comorbidities, type of tracheostomy tube, the use of antiseptic in tracheosotmy dressing, tracheosotmy tube care, and interval of changing the tracheostomy tube with the incidence of tracheostomy stoma infection.

Factors Associated with The Incidence of Infection in Tracheostomy Stoma at Mohammad Hoesin Hospital

Introduction: Tracheostomy is a surgery to open the trachea to allow air to enter the airway. Tracheostomy cannot be separated from possible complications. Tracheostomy stoma infection is one of the complications of post-tracheostomy that occurs due to the activity of several bacteria. Many factros can cause the incidence of tracheostomy stoma infection.
 Objective: The aim of this study is to determine the factors associated with the incidence of tracheostomy stoma infection.
 Methods: Observational study with cross-sectional design. Data collection was carried out using medical record data on 71 subjects who underwent tracheostomy tube replacement from july 2019 to November 2020.
 Results: From 71 subjects, it was found that the subjects who had tracheostomy stoma infection were 54.9%. The results of bivariate analysis showed that age (p=0.031), comorbidities (p=0.009), the type of tracheostomy tube (p=0.015), the use of antiseptic in tracheostomy dressing (p=0.020), tracheostomy tube care (p=0.013), and the interval of changing the tracheostomy tube (p=0.041) are the significant factors. The results of multivariate analysis showed that tracheostomy tube care and the interval of changing the tracheostomy tube had a significant effect on tracheostomy stoma infection. Tracheostomy tube care has a risk of 9.362 times to experience infection with CI95%(1.535-57.086) and the interval of changing the tracheostomy tube has a risk of 10.669 with CI95% (1.074-105.985).
 Conclusion: There is a significant relationship between age, comorbidities, type of tracheostomy tube, the use of antiseptic in tracheosotmy dressing, tracheosotmy tube care, and interval of changing the tracheostomy tube with the incidence of tracheostomy stoma infection.

Abstract No. 215 Percutaneous cholecystolithotomy: a single-institution experience with SpyGlass DS cholangioscopy

Percutaneous cholecystolithotomy using cholecystoscopy can be an alternative to cholecystectomy in high surgical risk patients with calculous cholecystitis. The purpose of this study is to describe our experience of percutaneous cholecystolithotomy using Spyglass direct visualization cholangioscopy (SpyGlass DS, 10F, Boston Scientific). The Institutional Review Board approved this retrospective study with a waiver of informed consent. Between January 1, 2018, and September 9, 2020, 18 patients (M:F = 13:5, mean 73 years) underwent percutaneous cholecystolithotomy using SpyGlass DS cholangioscopy for calculous cholecystitis. Percutaneous cholecystolithotomy was performed with SpyGlass DS cholangioscopy after placement of 16F sheath. Stone fragmentation was performed with EHL probe and stones were removed using baskets or saline flushing technique. Procedure details, technical success, complications, and clinical follow up were retrospectively analyzed. Eighteen patients underwent 28 percutaneous cholecystolithotomy procedures using SpyGlass DS cholangioscopy including seven patients for a second and three patients for a third cholecystolithotomy session. Conscious sedation was used in the majority of cases 86% (n = 24) versus general anesthesia 14% (n = 4) for the procedure. The median time interval between cholecystostomy tube placement and 1st cholecystolithotomy was 78 days. Overall technical success rate (removal of all stones) was 78% (14/18 patients) after repeat cholecystolithotomy. The median time from cholecystostomy tube placement to final tube removal was 111 days. Cause of technical failure were large, impacted stones (n = 3) and cystic duct occlusion (n = 1). There were three procedure related complications (acute pancreatitis causing mortality (n = 1), fistula to the skin requiring surgical excision (n = 1), bile leak requiring replacement of cholecystostomy tube due to gallbladder dyskinesia (n = 1)). There is no recurrence of symptomatic cholecystitis in patients with technical success. Three patients died because of reasons unassociated with the procedure during follow up. Percutaneous cholecystolithotomy using SpyGlass DS cholangioscopy can be performed with smaller sheath (16F) than conventional cholangioscopy (24F sheath) and can be a very useful alternate minimally invasive technique for gallstone management with high technical success rates.

Image-derived mean velocity measurement for prediction of coronary flow reserve in a canonical stenosis phantom using magnetic particle imaging.

IntroductionAim of this study is to evaluate whether magnetic particle imaging (MPI) is capable of measuring velocities occurring in the coronary arteries and to compute coronary flow reserve (CFR) in a canonical phantom as a preliminary study.MethodsFor basic velocity measurements, a circulation phantom was designed containing replaceable glass tubes with three varying inner diameters, matching coronary-vessel diameters. Standardised boluses of superparamagnetic-iron-oxide-nanoparticles were injected and visualised by MPI. Two image-based techniques were competitively applied to calibrate the respective glass tube and to compute the mean velocity: full-duration-at-half-maximum (FDHM) and tracer dilution (TD) method. For CFR-calculation, four necessary settings of the circulation model of a virtual vessel with an inner diameter of 4 mm were generated using differently sized glass tubes and a stenosis model. The respective velocities in stenotic glass tubes were computed without recalibration.ResultsOn velocity level, comparison showed a good agreement (rFDHM = 0.869, rTD = 0.796) between techniques, preferably better for 4 mm and 6 mm inner diameter glass tubes. On CFR level MPI-derived CFR-prediction performed considerably inferior with a relative error of 20–44%.ConclusionsMPI has the ability to reliably measure coronary blood velocities at rest as well as under hyperaemia and therefore may be suitable for CFR calculation. Calibration-associated accuracy of CFR-measurements has to be improved substantially in further studies.

Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study

BackgroundWe investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection.MethodsWe retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: − 5 cm H2O), B (intermediate-pressure group: − 10 cm H2O), and C (high-pressure suction group: − 20 cm H2O). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage.ResultsIn total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986).ConclusionLow-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection.Trial registrationThis is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020–9).

Transient Empty Portal Vein With Gastric Emphysema

An 88-year-old man who underwent gastrostomy was admitted for aspiration pneumonia. The patient used glucocorticoid and immunosuppressants for rheumatoid arthritis and interstitial lung disease. Two days after the gastrostomy tube replacement, the patient experienced abdominal pain and vomiting. His vital signs were stable, and only mild epigastric tenderness was noted. Blood tests revealed a white blood cell count of 9700 /μL, elevated C-reactive protein of 3.85 mg/dL, aspartate aminotransferase of 40 U/L, and alanine aminotransferase levels of 28 U/L.

Experimental investigation on the airside heat transfer and pressure drop of the fin-and-tube heat exchangers having oval tubes

ABSTRACT It is well known that the replacement of round tubes to oval tubes in a fin-and-tube heat exchanger reduces the air-side pressure drop as well as the low-performance region behind the tube, which improves the thermal performance of the heat exchanger. However, experimental evidences are lacking, especially for generic heat exchangers. In this study, generic heat exchangers having oval tubes were tested, which included two different oval tube dimension and two different tube pitches. Round tube samples were also tested for a comparison purpose. The effect of fin pitch on j factor was negligible, whereas f factor increased as the fin pitch increased. Furthermore, both the j and f factor decreased as the number of tube row increased. A thermal performance comparison based on the ratio of thermal conductance per unit volume () to pressure drop per unit length () revealed that the oval tube samples yielded a higher performance than the round tube samples, except at a small number of tube row. Furthermore, the best performance was obtained from the oval tube samples having a smaller diameter tube. On the other hand, relatively poor performance was obtained from the oval tube samples having a larger diameter tube, probably due to the large pressure drops. The j and f correlations were developed based on the data.

Tracheoesophageal fistula with complex injury to the existing anomaly - Youngest neonate to survive: A case report

Background: Complex injury to the esophagus, trachea, and tracheoesophageal fistula in a case of esophageal atresia is rarely reported that requires prompt identification and management. Case Presentation: A very-low-birth-weight preterm with a tracheoesophageal fistula on ventilatory support for respiratory distress syndrome was transferred to our hospital. The baby developed air-leak through the tracheoesophageal fistula into the stomach causing gross distension of the stomach and reduction in oxygen saturation. Repositioning and reintubation failed to reduce the abdominal distension and to improve the saturation. Subsequent intubation with large volume, low pressure cuffed tube, and replacement of Replogle tube resulted in pneumothorax and further deterioration requiring emergency thoracotomy. Complex tracheoesophageal injury to the esophagus, trachea, and fistulous tract was repaired. Conclusion: The baby survived the early repair of the tracheoesophageal fistula and the iatrogenic complex tracheoesophageal injury. Pre-operative tracheo-esophagoscopy with stenting of the fistula with Fogarty catheter helped to carry out a successful repair technically.

Air-side heat transfer and pressure drop of the fin-and-tube heat exchangers having oval tubes under wet condition

It is well known that the replacement of a round tubes to an oval tube in a fin-and-tube heat exchanger reduces an air-side pressure drop as well as a low performance region behind the tube, and improves the thermal performance of the heat exchanger. However, experimental evidences are lacking, especially for generic heat exchangers. In this study, three generic samples with oval tubes were obtained and tested under wet condition. The samples had different oval tube dimensions and tube pitches. One interesting result was that the highest j factor was obtained at a two row configuration. Possible explanation was provided considering the effect of fin efficiency. The wet surface j factors were slightly lower and the wet f factors were significantly higher than those of the dry surface, probably due to the condensate on the fin surface. A thermal performance comparison (based on the conductance per unit volume (ηohoAo/Vo) to the pressure drop per unit length (ΔP/L)) revealed that, the oval tube samples yielded higher performances than the round tube samples with some exceptions at a large number of tube row. Furthermore, it was found that the oval tube geometry is more effective under wet condition than under dry condition. Correlations were developed, which predicted all the j factor and 98% of the f factor within ±20%.

Preliminary Study on the Development of In Vitro Human Respiratory Epithelium Using Collagen Type I Scaffold as a Potential Model for Future Tracheal Tissue Engineering

Pathological conditions of the tracheal epithelium, such as postoperative injuries and chronic conditions, often compromise the functionality of the respiratory epithelium. Although replacement of the respiratory epithelium using various types of tracheal transplantation has been attempted, there is no predictable and dependable replacement method that holds for safe and practicable long-term use. Therefore, we used a tissue engineering approach for ex vivo regeneration of the respiratory epithelium (RE) construct. Collagen type I was isolated from sheep tendon and it was fabricated in a three-dimensional (3D) scaffold format. Isolated human respiratory epithelial cells (RECs) and fibroblasts from nasal turbinate were co-cultured on the 3D scaffold for 48 h, and epithelium maturation was allowed for another 14 days in an air–liquid interface culture system. The scanning electron microscope results revealed a fabricated porous-structure 3D collagen scaffold. The scaffold was found to be biocompatible with RECs and fibroblasts and allows cells attachment, proliferation, and migration. Immunohistochemical analysis showed that the seeded RECs and fibroblasts were positive for expression of cytokeratin 14 and collagen type I markers, respectively, indicating that the scaffold supports the native phenotype of seeded cells over a period of 14 days. Although a longer maturation period is needed for ciliogenesis to occur in RECs, the findings suggest that the tissue-engineered RE construct is a potential candidate for direct use in tracheal epithelium replacement or tracheal tube reengineering.

Studying Enhanced Recovery After Surgery (ERAS\xae) Core Items in Colorectal Surgery: A Causal Model with Latent Variables

BackgroundPrevious Enhanced Recovery After Surgery (ERAS®) studies have not always taken into account that ERAS interventions depend on baseline covariates and that several confounding variables affect the composite outcomes.MethodA causal latent variable model is proposed to analyze data obtained prospectively concerning 1261 patients undergoing elective colorectal surgery within the ERAS protocol. Primary outcomes (composite of any complication, surgical site infection, medical complications, early ready for discharge (TRD), early actual discharge) and secondary outcomes (composite of late bowel function recovery, IV fluid resumption, nasogastric tube replacement, postoperative nausea and vomiting, re-intervention, re-admission, death) are considered along with their multiple dimensions.ResultsConcerning the primary outcomes, our results evidence three subpopulations of patients: one with probable good outcome, one with possibly prolonged TRD and discharge without complications, and the other one with probable complications and prolonged TRD and discharge. Epidural anesthesia, waiving surgical drainage, and early ambulation, IV fluid stop and urinary catheter removal act favorably, while preoperative hospital stay and blood transfusion act negatively. Concerning the secondary outcomes our results evidence two subpopulations of patients: one with high probability of good outcome and one with high probability of complications. Epidural anesthesia, waiving surgical drainage, early ambulation and IV fluid stop act favorably, while blood transfusion acts negatively also with respect to these secondary outcomes.ConclusionThe multivariate causal latent class two-parameter logistic model, a modern statistical method overcoming drawbacks of traditional models to estimate the average causal effects on the treated, allows us to disentangle subpopulations of patients and to evaluate ERAS interventions.

Comparison of Deep Sedation and General Anesthesia With an Endotracheal Tube for Transcaval Transcatheter Aortic Valve Replacement: A Pioneering Institution's Experience

Transcaval transcatheter aortic valve replacement (TC-TAVR) is an alternative approach to transcatheter aortic valve replacement involving deployment of the bioprosthetic valve via a conduit created from the inferior vena cava to the descending aorta in patients for whom the traditional transfemoral approach is not feasible. By analyzing the largest known cohort of TC-TAVR patients, the authors wished to compare hospital length of stay and post-procedure outcomes between patients who underwent the procedure under deep sedation (DS) and patients who underwent general anesthesia with an endotracheal tube. Retrospective, single-center study. Henry Ford Hospital in Detroit, MI. Patients undergoing TC-TAVR from 2015 to 2018. Seventy-nine patients were included in the analysis, which consisted of 38 under general anesthesia with an endotracheal tube and 41 under DS. The sample was divided into a general anesthesia (GA) group and DS group. There were no significant differences in implant success rate or post-procedure outcomes, including in-hospital mortality (p = 0.999) and major vascular complication rate (p = 0.481), between the two groups. Patients in the GA group stayed a median of 24 hours longer in the intensive care unit (ICU) (p < 0.001) and one day longer in the hospital (p = 0.046) after the procedure compared to patients in the DS group. The median procedure time was significantly lower (135 minutes) in the DS group compared to the GA group (167 minutes, p < 0.001). Patients undergoing TC-TAVR under DS had similar postoperative outcomes and shorter post-procedure hospital and ICU lengths of stay compared to general anesthesia. In the authors' experience, DS is the preferred anesthetic technique for TC-TAVR.

Endoscopic rescue of early percutaneous endoscopy gastrostomy tube dislodgement.

Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the most common methods for establishing durable enteral access. Early PEG dislodgement occurs in < 5% of cases but typically prompts urgent surgical intervention to reestablish the gastrocutaneous tract and prevent intra-abdominal sepsis. To date, there is a single case report in the literature where successful endoscopic "rescue" of an early dislodged PEG tube negated the need for operative intervention. Here, we report our experience with a series of endoscopic PEG rescues for early dislodged PEG tubes. A retrospective analysis of cases was reviewed from two institutions. Patients with early PEG dislodgements underwent PEG rescue using a gastroscope and standard Ponsky "Pull" PEG techniques through the original tract. Eleven patients were identified from the database and underwent PEG rescue after early PEG dislodgement. Mean operative time was 68min, and there were no complications related to PEG rescue. PEG rescue permitted safe re-establishment of the gastrostomy tract while avoiding laparoscopic or open surgical intervention in hemodynamically stable patients. All patients tolerated the procedure well and were able to resume use of the PEG tubes shortly after intervention. Endoscopic rescue represents a feasible noninvasive option for PEG tube replacement following early inadvertent PEG tube dislodgement in appropriate clinical settings.

Emergency Treatment and Nursing Care of a Patient with Multiple Injuries and Right Main Bronchus Rupture

Objective: To investigate the rescue and nursing process of a trauma patient with multiple injuries and rupture of the right main bronchus. Methods: A patient with multiple injuries and rupture of the right main bronchus admitted to the emergency department of the Shenzhen Hospital of the University of Hong Kong was selected as the research object on December 11, 2019. Results: In this case, the medical team treated the patient under the guidance of ATLS (Advanced Traumatic Life Support), and for the first time in our department, we used bronchoscopy to replace the double-lumen endotracheal tube for left lung single-lung ventilation, finally the patient was successfully treated. Conclusion: Through a literature search, it is found that the main bronchus rupture is less common in clinical practice. In the trauma group, the use of fiberoptic bronchoscopy and the replacement of a double-lumen tracheal tube for left lung single-lung ventilation can improve the treatment rate of such patients and is worthy of clinical application.

Aortic Root and Ascending Aortic Aneurysm Related to One Case. Reimplantation of the Right Coronary Artery by 8 mm Dacron Tube (Cabrol Hemi Mustache) and Review of the Literature

The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron&#174 tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.

Elective home replacement of gastrostomy feeding tubes is safe and cost-effective. Has hospital referral become obsolete?

BackgroundPercutaneous endoscopic gastrostomy (PEG) is the technique of choice for providing enteral nutrition in patients with functioning gastrointestinal tract. Available guidelines cover indications and procedural management for PEG placement, while there is no consensus about subsequent replacement with gastrostomy feeding tubes (GFT) and their management. We hypothesized that GFT replacement, according to a standardized protocol supervised by a trained gastroenterologist could be integrated into the home health care system. AimsTo evaluate the safety and cost-efficacy of home GFT replacement. MethodsAll consecutive patients who underwent elective home GFT replacements from July 2016 to December 2019 were prospectively enrolled; all procedural details and outcomes have been recorded. ResultsOverall, 235 GFT replacements in 84 patients [40.5% male, 79.5 (74–94) years] were included. Among these, 230 (97.8%) were completed at patients’ home while in five cases (2.2%) patients were referred to the hospital to confirm appropriate GFT placement. No adverse event occurred. An overall cost reduction of 46.8% was obtained, leading to €124 savings per procedure and up to €29,000 savings for the entire study period. ConclusionsWhen performed electively according to a standardized protocol, home GFT replacement is safe and effective, and leads to relevant cost reduction.

Mechanical behavior of SiC/SiC composites after exposure in high temperature liquid sodium for Sodium Fast Reactors applications

SiC/SiC composites have aroused interest for various nuclear applications. For example, the use of SiC/SiC components in Sodium-cooled Fast Reactors in replacement of steel wrapper tubes should improve the safety. However, the chemical compatibility between the liquid sodium and SiC or SiC/SiC composites and its effect on their mechanical properties remain unknown. Corrosion tests were conducted on CVD SiC and both undamaged and pre-damaged SiC/SiC in liquid sodium at 823 K up to 2000 h in two different sodium batches, a purified and an oxygen-rich. No strong corrosion of the CVD SiC and no degradation of the mechanical properties of SiC/SiC composites were observed in both conditions, even with mechanical pre-damaging prior to immersion. A strong increase in ultimate tensile strength was highlighted after exposure, only for the undamaged samples. This phenomenon is attributed to the healing by liquid sodium of the microcracks generated during the manufacturing process.

PEG J tube placement with optimization of J tube insertion.

We present a case series of 5 patients who underwent placement of a PEG tube followed by a J extension tube (PEG-J). PEG-J placement is usually performed as a 2-step procedure and is used for a variety of conditions such as gastroparesis. First, the PEG tube is placed using endoscopic transillumination, followed by tube placement with the pull method, and trimming of the PEG tube to approximately 20 cm. This is followed by insertion of the J extension tube through the PEG tube; the J extension tube is grasped by an endoscope and guided through the pylorus to a position distal to the ligament of Treitz. Two common problems related to the length of the PEG tube portion can occur when placing the J tube. A short PEG tube may not allow advancement of the J tube distal enough because of looping. On the other hand, a PEG tube that is too long can prevent adequate J tube insertion. Although the adverse events of PEG tubes are well documented, we did not find any published literature addressing problems with the placement of J tube extensions, although it is a frequently occurring problem in our clinical practice. Therefore, we have tried to address this problem. We present our technique for PEG-J tube placement, which allows optimal PEG tube length independent of the depth of J tube insertion. After PEG tube placement with the pull method, only the introducer is cut, and the entire length of the silicon PEG tube is left in situ. The tip of the J tube is lubricated and inserted into the PEG tube. In parallel, the J tube is grasped, in our cases with an endoclip, and gently maneuvered into the duodenum and eventually into the jejunum while the J tube is threaded into the PEG tube, matching the pull force from the J tube insertion by the endoscope. We use a pediatric colonoscope to achieve deep jejunal intubation; however, either the adult colonoscope or enteroscope are adequate alternative endoscopes. Once the J tube seal reaches the silicon portion of the PEG tube and further introduction is needed, a 5- to 10-cm portion of the silicon is cut using the sharp tip of the scissors provided with the PEG tube kit (Fig. 1). These steps of “peel and advance” are repeated until the J tube is advanced to the desired location and clipped to the jejunum mucosa. This technique allows optimal J tube placement without gastric looping or a too-short jejunal J tube insertion (Fig. 2). We followed all patients over 4 weeks. No PEG-J tube replacement adverse events were noted. Two patients had abdominal imaging at 4 weeks documenting optimal J tube placement without J tube loops or short J tubes resulting in proximal migration of the J tube (Video 1, available online at www.giejournal.org). All authors disclosed no financial relationships. https://www.videogie.org/cms/asset/9bec0238-72be-450f-8dbd-3862997703e4/mmc1.mp4Loading ... Download .mp4 (104.88 MB) Help with .mp4 files Video 1PEG-J tube placement with optimization of J tube insertion.

THE MEXICAN ASTROGRAPHIC CATALOGUE AND CARTE DU CIEL PROJECT

The participation of Mexican astronomers in international projects dates back to the eighteenth century, when they observed the 1769 transit of Venus. More than a century later, they again participated in attempts to establish a precise value for the astronomical unit through the transits of Venus that occurred in 1874 and 1882. In 1887 Mexican astronomers were invited to join efforts to develop a multinational initiative known as the Carte du Ciel and International Astrographic Project, collaborating with 17 other observatories worldwide. Mexican astronomers obtained support from their Government, and they ordered telescopes from the Irish firm of Sir Howard Grubb and Company. An astrograph was used to photograph stars in Mexico's assigned sky zone (between declinations -10° and -16°) down to a limiting magnitude of 11 for the Astrographic Catalogue, and down to magnitude 14 for the Carte du Ciel. The Astrographic Catalogue photography began in February 1900, and the first of the plates for the Carte du Ciel was exposed in 1905. The Mexican astronomers had to overcome a number of serious difficulties, such as the Mexican Revolution of 1910-1920, which caused several delays and the loss of many personnel from the National Astronomical Observatory of Mexico, and then World War I, 1914-1918, which hindered the arrival of the photographic plates and interrupted communication with the Carte du Ciel Commission in Paris. Women usually were employed as 'computers' to measure the Astrographic Catalogue star positions. Between 1921 and 1962, seven volumes were published listing Mexican Astrographic Catalogue star positions. Mexican astronomers finished taking all of the Carte du Ciel plates, except for the -12° declination zone, but because of financial constraints only 375 plates were printed. Afterwards, from 1941, photography of the -13° zone was repeated in order to obtain stellar positions for proper motion studies. In March 1970 the mounting of the historic 33-cm Grubb astrograph and accompanying 25.4-cm guidescope was used at Miahuatlán, Oaxaca, together with a replacement tube assembly and objective to observe a total solar eclipse. Then from 1976 to 1979 three Astronomy students from the National University of Mexico reconstructed and renovated the original Grubb twin-telescope, which is now at Tonantzintla, near Puebla, and is used mainly for educational purposes.