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This leaflet was last approved in . Detailed information on this medicine is available on the European Medicines Agency EMEA ; web site: : emea ropa . There are also links to other websites about rare diseases and treatments. following information is intended for medical or healthcare professionals only: Instructions for use reconstitution, dilution and administration Each vial of Cerezyme is for single use only. After reconstitution, each vial of Cerezyme contains 200 units of imiglucerase in 5.0 ml 40 units per ml ; . Determine the number of vials to be reconstituted based on the individual patient's dosage regimen and remove the vials from the refrigerator. Use Aseptic Technique Reconstitution Reconstitute each vial with 5.1 ml water for injections; avoid forceful impact of water for injections on the powder and, by mixing gently, avoid foaming of the solution. The reconstituted volume is 5.3 ml. The pH of the reconstituted solution is approximately 6.1. After reconstitution it is a clear, colourless liquid, free from foreign matter. The reconstituted solution must be further diluted. Before further dilution, visually inspect the reconstituted solution in each vial for foreign particles and discoloration. Do not use vials exhibiting foreign particles or discoloration. After reconstitution, promptly dilute vials and do not store for subsequent use. Dilution The reconstituted solution contains 40 units imiglucerase per ml. The reconstituted volume allows accurate withdrawal of 5.0 ml equal to 200 units ; from each vial. Withdraw 5.0 ml reconstituted solution from each vial and combine the withdrawn volumes. Then dilute the combined volumes with 0.9% sodium chloride intravenous solution to a total volume of 100 to 200 ml. Mix the infusion solution gently. Electromagnetic radiation isn't the only form of radiation used to treat patients. Energetic particles such as electrons and protons are also used. Like tiny billiard balls, these fast moving particles collide with the atoms inside tumors and knock them apart. As usual, this atomic and molecular damage tends to kill cell and destroy tumors. However, obtaining extremely energetic subatomic particles isn't easy. High voltage power supplies can be used to accelerate an electron or proton to about 500, 000 eV, but that isn't enough. When a charged particle enters tissue, it experiences strong electric forces and is easily deflected from its path. To make sure that it travels straight and true, all the way to a tumor, the particle must have an enormous energy. Giving each charged particle the millions or even billions of eV it needs for radiation therapy takes a particle accelerator. Charge that's sloshing back and forth in a magnetron not only creates microwaves, it also creates huge electric fields that change with time. In a particle accelerator, similar electric fields are used to push charged particles through space until they reach incredible energies. One important type of particle accelerator is the linear accelerator. In this device, charged particles are pushed forward in a straight line by the electric fields in a series of resonant cavities. Each of these cavities has charge sloshing back and forth rhythmically on its wall, just as charge sloshes back and forth in the cavities of a magnetron. When a small packet of charged particles enters the first cavity through a hole, it's suddenly pushed forward by the strong electric field inside that cavity. The packet accelerates forward and leaves the first resonant cavity with more kinetic energy than it had when it arrived-the electric field in that cavity has done work on the packet. If the fields in the cavities were constant, the electric field in the second cavity would slow the packet down. In the drawing you can see that the electric field in the second cavity points in the wrong direction. But by the time the packet reaches the second cavity, the charge sloshing in its walls has reversed and so has the electric field. The packet is again pushed forward and it emerges from the second cavity with still more kinetic energy. Each resonant cavity in this series adds energy to the packet, so that a long string of cavities can give each of the packet's charged particles millions or even billions of eV. This energy comes from magnetron-like microwave generators that are attached to the accelerator. Microwaves from these generators are what cause charge to slosh in the accelerator's microwave cavities. The linear accelerator then only has to inject charged particles into the first cavity, using equipment resembling the insides of a television picture tube, and those charged particles will come flying out of the last cavity with incredible energies. However there are a few complications to this acceleration technique. Most importantly, the cavities have to be built and operated so that their electric fields reverse at just the right moments to keep the packet accelerating forward. For simplicity of operation, the cavities have the same resonant frequency and all reverse their electric fields simultaneously. Since the packet spends the same amount of time in each cavity and it travels faster and faster as it goes from one cavity to the next, each cavity must be longer than the previous one and charcoal.

Liaison role is to enhance communication within the state chapters, and between the chapter leadership and the Section members. We would encourage all chapter liaisons to contact your State Chapter President to let him or her know you are available and interested in participating in the activities of the chapter as they relate to critical care. Try to find out if the chapter is doing any activities that relate to critical care. Share this newsletter with the chapter so they know what we are doing, and where our interests lie. See what works and what doesn't and let us know if you need additional information in order to serve your state chapter more effectively. Once again this year, our section program at the last NCE was superb, thanks in great part to the efforts of Jim Fortenberry, our Program Chair. We presented a well-received practice-management course as well as a half-day session on ventilator management. The Career Award was presented to Dr. Michael Dean, and we heard some wonderful and thought-provoking abstracts. In looking forward to next October's NCE, I wanted to let you know that we have decided to make some changes in our Section's program format. Notably, we are going to host a late-afternoon to early evening reception, in place of the lunch that we have traditionally held during our business meeting. The reception will offer time to network, review posters, and present an opportunity for the younger members to mingle with those more senior. We will be sending a special invitation to the former career award winners, hoping that they can join the reception, enhancing the networking opportunities. The Section update will be presented during that time, replacing the traditional business meeting. It will be held on October 8th from 4: 30-6 pm. At that time we will announce winners of the abstract awards and also hold a raffle for those in attendance. I hope you will make plans to attend the Section meeting next October in Atlanta. As always, we are eager to hear your thoughts. Please don't hesitate to contact myself, or any member of the Executive Committee, with your comments, concerns and ideas and chlorambucil.

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