Transexual Tubes
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A Japanese group reported that a few patients who received ATRA by enteral tubes had significantly lower plasmatic levels of retinoic acid derivatives.10 However, two case reports discussed ATRA diluted in a manner similar to that described herein where patients achieved complete remission and it was suggested that the drug was absorbed in the gastrointestinal tract.9
Lastly, our experience is not absent of limitations and successful cases of ATRA administration through enteral tubes should be monitored regarding safety (control of the hypercoagulation state in APL, risk of bleeding and hepatotoxicity) and dosing requirements as different pharmacokinetic parameters may influence clinical response.9
However, PEG tubes are not completely free of complications. Fortunately, the bulk of the complications associated with PEG tube placement are minor and include wound infection, tube dislodgement or blockage, hernia or fistula formation, ulceration and granuloma formation [7]. Rare but more serious complications of PEG tubes are endoscopy related complications, bleeding, injury to internal organs, buried bumper syndrome, necrotizing fasciitis, tumor seeding and volvulus [7]. Injuries to internal organs are extraordinarily infrequent and represent the most dreaded complication of PEG tube placement. These have been described as isolated case reports in the medical literature and involve injury to the small intestine [8], colon [9, 10], mesentery [11] and liver.
Carbolite Gero's versatile new TS split tube furnace range incorporates high-quality heating elements and innovative thermal insulation design to achieve first class performance while maintaining both reduced case temperatures and power consumption. The TS furnace body is split into two halves and hinged at the rear; pneumatic dampening struts at either end provide a smooth opening action. The ability to open the furnace makes it easier for operators to exchange work tubes, or insert vessels, such as reactors, with end flanges that would make them difficult to insert into a non-split furnace. The TS split tube furnace range has been designed with flexibility in mind. Accessory work tubes and the use of tube adapters allow a single furnace to accommodate a variety of tube diameters, whilst the work tubes themselves can easily be exchanged to meet the different physical or chemical requirements of a process. Optional work tube packages enable users to equip the TS for operation under vacuum or modified atmosphere.
In Canada, Europe and Asia, the typical nomenclature for these closed steel sections or tubes has always been some variation of hollow structural section. In some places, there exist the variations of SHS (square hollow section), RHS (rectangular hollow section) and CHS (circular hollow section).
A Japanese group reported that a few patients who received ATRA by enteral tubes had significantly lower plasmatic levels of retinoic acid derivatives.1010 Takitani K, Nakao Y, Kosaka Y, Inoue A, Kawakami C, Kuno T, et al. Low plasma level of all-trans retinoic acid after feeding tube administration for acute promyelocytic leukemia. Am J Hematol. 2004;76(1):97-8. However, two case reports discussed ATRA diluted in a manner similar to that described herein where patients achieved complete remission and it was suggested that the drug was absorbed in the gastrointestinal tract.99 Bargetzi MJ, Tichelli A, Gratwohl A, Speck B. Oral all-transretinoic acid administration in intubated patients with acute promyelocytic leukemia. Schweiz Med Wochenschr. 1996;126(November (45)):1944-5.
Lastly, our experience is not absent of limitations and successful cases of ATRA administration through enteral tubes should be monitored regarding safety (control of the hypercoagulation state in APL, risk of bleeding and hepatotoxicity) and dosing requirements as different pharmacokinetic parameters may influence clinical response.99 Bargetzi MJ, Tichelli A, Gratwohl A, Speck B. Oral all-transretinoic acid administration in intubated patients with acute promyelocytic leukemia. Schweiz Med Wochenschr. 1996;126(November (45)):1944-5. 59ce067264
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