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Repeated injections of intradetrusor onabotulinumtoxinA as adjunctive treatment of children with neurogenic bladder
Abstracts / Journal of Pediatric Surgery 49 (2014) 1181–1185
cholesterol levels were similar. In the adriamycin-exposed fetuses from hyperthyroid mothers, the embryonal resorption rate and the prevalence of both EA/TEF and DA were significantly higher than in the other groups; maternal hypothyroidism during the same period did not have significant effect on the prevalence of atresias. Maternal hyperthyroidism during the embryonic window corresponding to foregut cleavage increased the prevalence of both EA/ TEF and duodenal atresia in fetal rats exposed to adriamycin. This suggests that maternal thyroid hormone status might be involved in the pathogenesis of foregut atresias and invites further research on this likely clinically relevant issue in humans.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.023
Effect of ozone on intestinal recovery following intestinal ischemia–reperfusion injury in a rat Haj B, Sukhotnik I, Shaoul R. Pediatr Surg Int 2014; 30(2):181-188 (Feb) Growing evidence suggests that ozone (O3) protects the host against pathological conditions mediated by reactive oxygen species by increasing the activity of antioxidant enzymes. The purpose of the present study was to examine the effect of O3 on intestinal recovery and enterocyte turnover after intestinal ischemia-reperfusion (IR) injury in rats. Male Sprague–Dawley rats were divided into four experimental groups: (1) sham rats underwent laparotomy; (2) sham-O3 rats underwent laparotomy and were treated with an ozone/oxygen mixture intraperitoneally and intraluminally (50 %/50 %); (3) IR rats underwent occlusion of both superior mesenteric artery and portal vein for 20 min followed by 48 h of reperfusion, and (4) IR-O3 rats underwent IR and were treated with an ozone/oxygen mixture similar to group 2. Intestinal structural changes, Park's injury score, enterocyte proliferation and enterocyte apoptosis were determined 48 h following IR. Western blot was used to determine ERK and Bax protein levels. A non-parametric Kruskal-Wallis ANOVA test was used for statistical analysis with p b 0.05 considered statistically significant. Treatment of IR rats with O3 resulted in a significant increase in mucosal weight in jejunum (70 %) and ileum (32 %), mucosal DNA (twofold increase) and protein (35 %) in ileum, villus height and crypt depth in jejunum (61 and 16 %, correspondingly) and ileum (31 and 43 %, correspondingly) compared to IR animals. IR-O3 rats also had a significantly lower intestinal injury score as
1185
well as a lower apoptotic index in jejunum and ileum compared and IR animals. A significant increase in cell proliferation rates in IR-O3 animals was accompanied by increased levels of p-ERK protein. The authors conclude that treatment with ozone prevents intestinal mucosal damage, stimulates cell proliferation and inhibits programmed cell death following intestinal IR in a rat.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.024
Genitourinary Tract Repeated injections of intradetrusor onabotulinumtoxinA as adjunctive treatment of children with neurogenic bladder Sager C, Burek C, Bortagaray J. Pediatr Surg Int 2014; 30(1):79-85 (Jan) This work evaluates the effects of repeated injections of onabotulinumtoxin A in children with neurogenic bladders refractory to conventional treatment. A total of 26 children with neurogenic bladder were prospectively studied. Some patients received up to four repeat injections. Patients were re-injected if they showed improvement in voiding diary, score of urinary incontinence and/or urodynamic studies; otherwise, augmentation cystoplasty was indicated. Of the 26 patients, 12 were re-injected a second time, 6 patients were re-injected a third time and 2 patients received a repeat injection for the fourth time. Six months after the first, second and third injection, the urinary incontinence score 0 (dry) was 50, 77 and 75 %, respectively. After each injection, the mean bladder capacity in voiding diary and the mean maximum cystometric capacity increased. The mean detrusor pressure at the end of filling decreased. Only compliance after the first injection improved significantly. Detrusor overactivity (n: 4), improved during 3 months and reappeared in three children after the first injection, but at greater cystometric volumes. In the fourth case, it reappeared 11 months after the third injection. Five patients underwent cystoplasty. After treatment with onabotulinumtoxin A, urinary continence achieved was 50–77 %. There were favorable changes in urodynamic variables, but they were insufficient. Detrusor overactivity was attenuated, but did not disappear completely.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.025
cholesterol levels were similar. In the adriamycin-exposed fetuses from hyperthyroid mothers, the embryonal resorption rate and the prevalence of both EA/TEF and DA were significantly higher than in the other groups; maternal hypothyroidism during the same period did not have significant effect on the prevalence of atresias. Maternal hyperthyroidism during the embryonic window corresponding to foregut cleavage increased the prevalence of both EA/ TEF and duodenal atresia in fetal rats exposed to adriamycin. This suggests that maternal thyroid hormone status might be involved in the pathogenesis of foregut atresias and invites further research on this likely clinically relevant issue in humans.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.023
Effect of ozone on intestinal recovery following intestinal ischemia–reperfusion injury in a rat Haj B, Sukhotnik I, Shaoul R. Pediatr Surg Int 2014; 30(2):181-188 (Feb) Growing evidence suggests that ozone (O3) protects the host against pathological conditions mediated by reactive oxygen species by increasing the activity of antioxidant enzymes. The purpose of the present study was to examine the effect of O3 on intestinal recovery and enterocyte turnover after intestinal ischemia-reperfusion (IR) injury in rats. Male Sprague–Dawley rats were divided into four experimental groups: (1) sham rats underwent laparotomy; (2) sham-O3 rats underwent laparotomy and were treated with an ozone/oxygen mixture intraperitoneally and intraluminally (50 %/50 %); (3) IR rats underwent occlusion of both superior mesenteric artery and portal vein for 20 min followed by 48 h of reperfusion, and (4) IR-O3 rats underwent IR and were treated with an ozone/oxygen mixture similar to group 2. Intestinal structural changes, Park's injury score, enterocyte proliferation and enterocyte apoptosis were determined 48 h following IR. Western blot was used to determine ERK and Bax protein levels. A non-parametric Kruskal-Wallis ANOVA test was used for statistical analysis with p b 0.05 considered statistically significant. Treatment of IR rats with O3 resulted in a significant increase in mucosal weight in jejunum (70 %) and ileum (32 %), mucosal DNA (twofold increase) and protein (35 %) in ileum, villus height and crypt depth in jejunum (61 and 16 %, correspondingly) and ileum (31 and 43 %, correspondingly) compared to IR animals. IR-O3 rats also had a significantly lower intestinal injury score as
1185
well as a lower apoptotic index in jejunum and ileum compared and IR animals. A significant increase in cell proliferation rates in IR-O3 animals was accompanied by increased levels of p-ERK protein. The authors conclude that treatment with ozone prevents intestinal mucosal damage, stimulates cell proliferation and inhibits programmed cell death following intestinal IR in a rat.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.024
Genitourinary Tract Repeated injections of intradetrusor onabotulinumtoxinA as adjunctive treatment of children with neurogenic bladder Sager C, Burek C, Bortagaray J. Pediatr Surg Int 2014; 30(1):79-85 (Jan) This work evaluates the effects of repeated injections of onabotulinumtoxin A in children with neurogenic bladders refractory to conventional treatment. A total of 26 children with neurogenic bladder were prospectively studied. Some patients received up to four repeat injections. Patients were re-injected if they showed improvement in voiding diary, score of urinary incontinence and/or urodynamic studies; otherwise, augmentation cystoplasty was indicated. Of the 26 patients, 12 were re-injected a second time, 6 patients were re-injected a third time and 2 patients received a repeat injection for the fourth time. Six months after the first, second and third injection, the urinary incontinence score 0 (dry) was 50, 77 and 75 %, respectively. After each injection, the mean bladder capacity in voiding diary and the mean maximum cystometric capacity increased. The mean detrusor pressure at the end of filling decreased. Only compliance after the first injection improved significantly. Detrusor overactivity (n: 4), improved during 3 months and reappeared in three children after the first injection, but at greater cystometric volumes. In the fourth case, it reappeared 11 months after the third injection. Five patients underwent cystoplasty. After treatment with onabotulinumtoxin A, urinary continence achieved was 50–77 %. There were favorable changes in urodynamic variables, but they were insufficient. Detrusor overactivity was attenuated, but did not disappear completely.—Federico G. Seifarth http://dx.doi.org/10.1016/j.jpedsurg.2014.05.025