European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie, 2014
Iatrogenic perforation of the oesophagus is life threatening, usually managed surgically. A 4 yea... more Iatrogenic perforation of the oesophagus is life threatening, usually managed surgically. A 4 year-old boy sustained an intra-operative oesophageal perforation while undergoing laparoscopic redo-Nissen Fundoplication for gastrooesophgeal reflux symptoms. After several failed attempts to manage the patients surgically and conservatively, he was successfully treated by deployment of a temporary covered stent. Although commonly employed as an alternative management option in adults, the use of temporary covered stents in the paediatric population is rare especially for nonmalignant disease. This technique can potentially reduce morbidity and surgical intervention.
Objective To assess the implementation of local and national guidelines concerning documentation... more Objective To assess the implementation of local and national guidelines concerning documentation of drug/clinical hypersensitivities.Design Audit with retrospective and prospective components used to assess the process of drug hypersensitivity documentation.Patients Fifty surgical inpatients’ notes were retrospectively analysed followed by 63 patients prospectively.Setting West London teaching hospital.Main outcome measures Drug hypersensitivity status correctly indicated on clinical notes, drug ‘Kardex’ charts, and anaesthetic records; these three documents were to concur. Hypersensitivities qualified according to symptoms experienced.Recommendations Standardization of preoperative clinical notes and multidisciplinary responsibility for records between doctor, nurse and pharmacist.Results Hypersensitivity documentation in clinical notes improved by 7% after the introduction of a formalized history sheet for preoperative clinics. These were based upon the anaesthetic charts, which had demonstrated 100% documentation previously. Considerable improvements (70.8%) in the clarification of adverse reaction symptoms post recommendation were shown; this was also attributed to the new history sheet. Concurrence improved by 2%.Conclusions The original study revealed areas for improvement and provided part of the solution – a more standardized preoperative assessment tool. Multidisciplinary cooperation in addition to formalizing the assessment process has led to a more efficient and safer service for patient and medicolegally for health care professionals.Key messages (1) Standardized forms, for the recording of clinical information preoperatively, ensure relevant guidelines are implemented in practice. (2) Multidisciplinary teams provide a vital safety net for their patients and colleagues.
We evaluated the potential and outcome of a preoperative percutaneous nephrostomy (PCN) in infant... more We evaluated the potential and outcome of a preoperative percutaneous nephrostomy (PCN) in infants and children with severe hydronephrosis (SFU grade IV) due to ureteropelvic junction obstruction (UPJO) focusing on pre-and postoperative splitfunction, histological findings of the UPJ and the reoperation rate.
Introduction and Objectives:
End-stage bladder disease is characterised by fibrosis and loss of c... more Introduction and Objectives: End-stage bladder disease is characterised by fibrosis and loss of capacity. The potential common pathway of this process is unknown but may include recurrent infection, inflammation, reactive oxygen species and hypoxia. Desferoxamine mesylate (DFO) a chemical hypoxic mimetic, is used here to model the “end stage bladder disease environment”, with the aim to understand the effects of such processes on barrier function and to identify possible treatment strategies. Materials and Methods The direct effect of a 72 hourly, non-cytotoxic dose, of DFO (25μM) on the proliferation and differentiation capacity of NHU cells in vitro was compared to NHU cells expanded and differentiated using published protocols with DMSO as a vehicle control. In addition the potential heritable effects created by DFO were investigated by treating NHU cells for one week with 25uM DFO and then continuing culture with control medium and DMSO for two subcultures prior to differentiation. Proliferation was assessed at each subculture and cumulative cell number analysed in all three treatment arms. Differentiation of these cells was then performed using published protocols. Barrier formation was assessed using trans-epithelial (TER) measurements, at a standard cell density (1x106cells) +/- addition of non-cytotoxic dose of epigenetic modifying drug. This was repeated in 4 different cell lines. Results Application of DFO resulted in a reduction in cumulative cell number in all 3 cell lines (p= <0.001), this was recoverable when DFO was removed from the cultures and replaced with control medium. Barrier function was markedly reduced in vitro (1908 ± 806 versus 4301 ± 1033 Ω.cm2) when DFO was repeatedly applied (p <0.0001, n=9). Unlike proliferation this compromise was not reversible by removing cells from the DFO 12 days prior to differentiation 1675 ± 349 versus 2774 ± 490 Ω.cm2 (p = 0.01, n= 10). Trichostatin A however did appear to ameliorate this compromise in the pre-treated group 2824 ± 483 Ω.cm2 (p=0.05, n=10). Conclusion DFO results in reduced proliferation in NHU cells, which is recoverable when placed in control conditions. However the detrimental effect on barrier function is not retrievable suggesting this compromise to be heritable or epigenetic in nature. Support for this is shown by the amelioration of the deficit with the addition of an epigenetic modifying drug.
European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie, 2014
Iatrogenic perforation of the oesophagus is life threatening, usually managed surgically. A 4 yea... more Iatrogenic perforation of the oesophagus is life threatening, usually managed surgically. A 4 year-old boy sustained an intra-operative oesophageal perforation while undergoing laparoscopic redo-Nissen Fundoplication for gastrooesophgeal reflux symptoms. After several failed attempts to manage the patients surgically and conservatively, he was successfully treated by deployment of a temporary covered stent. Although commonly employed as an alternative management option in adults, the use of temporary covered stents in the paediatric population is rare especially for nonmalignant disease. This technique can potentially reduce morbidity and surgical intervention.
Objective To assess the implementation of local and national guidelines concerning documentation... more Objective To assess the implementation of local and national guidelines concerning documentation of drug/clinical hypersensitivities.Design Audit with retrospective and prospective components used to assess the process of drug hypersensitivity documentation.Patients Fifty surgical inpatients’ notes were retrospectively analysed followed by 63 patients prospectively.Setting West London teaching hospital.Main outcome measures Drug hypersensitivity status correctly indicated on clinical notes, drug ‘Kardex’ charts, and anaesthetic records; these three documents were to concur. Hypersensitivities qualified according to symptoms experienced.Recommendations Standardization of preoperative clinical notes and multidisciplinary responsibility for records between doctor, nurse and pharmacist.Results Hypersensitivity documentation in clinical notes improved by 7% after the introduction of a formalized history sheet for preoperative clinics. These were based upon the anaesthetic charts, which had demonstrated 100% documentation previously. Considerable improvements (70.8%) in the clarification of adverse reaction symptoms post recommendation were shown; this was also attributed to the new history sheet. Concurrence improved by 2%.Conclusions The original study revealed areas for improvement and provided part of the solution – a more standardized preoperative assessment tool. Multidisciplinary cooperation in addition to formalizing the assessment process has led to a more efficient and safer service for patient and medicolegally for health care professionals.Key messages (1) Standardized forms, for the recording of clinical information preoperatively, ensure relevant guidelines are implemented in practice. (2) Multidisciplinary teams provide a vital safety net for their patients and colleagues.
We evaluated the potential and outcome of a preoperative percutaneous nephrostomy (PCN) in infant... more We evaluated the potential and outcome of a preoperative percutaneous nephrostomy (PCN) in infants and children with severe hydronephrosis (SFU grade IV) due to ureteropelvic junction obstruction (UPJO) focusing on pre-and postoperative splitfunction, histological findings of the UPJ and the reoperation rate.
Introduction and Objectives:
End-stage bladder disease is characterised by fibrosis and loss of c... more Introduction and Objectives: End-stage bladder disease is characterised by fibrosis and loss of capacity. The potential common pathway of this process is unknown but may include recurrent infection, inflammation, reactive oxygen species and hypoxia. Desferoxamine mesylate (DFO) a chemical hypoxic mimetic, is used here to model the “end stage bladder disease environment”, with the aim to understand the effects of such processes on barrier function and to identify possible treatment strategies. Materials and Methods The direct effect of a 72 hourly, non-cytotoxic dose, of DFO (25μM) on the proliferation and differentiation capacity of NHU cells in vitro was compared to NHU cells expanded and differentiated using published protocols with DMSO as a vehicle control. In addition the potential heritable effects created by DFO were investigated by treating NHU cells for one week with 25uM DFO and then continuing culture with control medium and DMSO for two subcultures prior to differentiation. Proliferation was assessed at each subculture and cumulative cell number analysed in all three treatment arms. Differentiation of these cells was then performed using published protocols. Barrier formation was assessed using trans-epithelial (TER) measurements, at a standard cell density (1x106cells) +/- addition of non-cytotoxic dose of epigenetic modifying drug. This was repeated in 4 different cell lines. Results Application of DFO resulted in a reduction in cumulative cell number in all 3 cell lines (p= <0.001), this was recoverable when DFO was removed from the cultures and replaced with control medium. Barrier function was markedly reduced in vitro (1908 ± 806 versus 4301 ± 1033 Ω.cm2) when DFO was repeatedly applied (p <0.0001, n=9). Unlike proliferation this compromise was not reversible by removing cells from the DFO 12 days prior to differentiation 1675 ± 349 versus 2774 ± 490 Ω.cm2 (p = 0.01, n= 10). Trichostatin A however did appear to ameliorate this compromise in the pre-treated group 2824 ± 483 Ω.cm2 (p=0.05, n=10). Conclusion DFO results in reduced proliferation in NHU cells, which is recoverable when placed in control conditions. However the detrimental effect on barrier function is not retrievable suggesting this compromise to be heritable or epigenetic in nature. Support for this is shown by the amelioration of the deficit with the addition of an epigenetic modifying drug.
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End-stage bladder disease is characterised by fibrosis and loss of capacity. The potential common pathway of this process is unknown but may include recurrent infection, inflammation, reactive oxygen species and hypoxia. Desferoxamine mesylate (DFO) a chemical hypoxic mimetic, is used here to model the “end stage bladder disease environment”, with the aim to understand the effects of such processes on barrier function and to identify possible treatment strategies.
Materials and Methods
The direct effect of a 72 hourly, non-cytotoxic dose, of DFO (25μM) on the proliferation and differentiation capacity of NHU cells in vitro was compared to NHU cells expanded and differentiated using published protocols with DMSO as a vehicle control. In addition the potential heritable effects created by DFO were investigated by treating NHU cells for one week with 25uM DFO and then continuing culture with control medium and DMSO for two subcultures prior to differentiation.
Proliferation was assessed at each subculture and cumulative cell number analysed in all three treatment arms. Differentiation of these cells was then performed using published protocols. Barrier formation was assessed using trans-epithelial (TER) measurements, at a standard cell density (1x106cells) +/- addition of non-cytotoxic dose of epigenetic modifying drug. This was repeated in 4 different cell lines.
Results
Application of DFO resulted in a reduction in cumulative cell number in all 3 cell lines (p= <0.001), this was recoverable when DFO was removed from the cultures and replaced with control medium. Barrier function was markedly reduced in vitro (1908 ± 806 versus 4301 ± 1033 Ω.cm2) when DFO was repeatedly applied (p <0.0001, n=9). Unlike proliferation this compromise was not reversible by removing cells from the DFO 12 days prior to differentiation 1675 ± 349 versus 2774 ± 490 Ω.cm2 (p = 0.01, n= 10). Trichostatin A however did appear to ameliorate this compromise in the pre-treated group 2824 ± 483 Ω.cm2 (p=0.05, n=10).
Conclusion
DFO results in reduced proliferation in NHU cells, which is recoverable when placed in control conditions. However the detrimental effect on barrier function is not retrievable suggesting this compromise to be heritable or epigenetic in nature. Support for this is shown by the amelioration of the deficit with the addition of an epigenetic modifying drug.
End-stage bladder disease is characterised by fibrosis and loss of capacity. The potential common pathway of this process is unknown but may include recurrent infection, inflammation, reactive oxygen species and hypoxia. Desferoxamine mesylate (DFO) a chemical hypoxic mimetic, is used here to model the “end stage bladder disease environment”, with the aim to understand the effects of such processes on barrier function and to identify possible treatment strategies.
Materials and Methods
The direct effect of a 72 hourly, non-cytotoxic dose, of DFO (25μM) on the proliferation and differentiation capacity of NHU cells in vitro was compared to NHU cells expanded and differentiated using published protocols with DMSO as a vehicle control. In addition the potential heritable effects created by DFO were investigated by treating NHU cells for one week with 25uM DFO and then continuing culture with control medium and DMSO for two subcultures prior to differentiation.
Proliferation was assessed at each subculture and cumulative cell number analysed in all three treatment arms. Differentiation of these cells was then performed using published protocols. Barrier formation was assessed using trans-epithelial (TER) measurements, at a standard cell density (1x106cells) +/- addition of non-cytotoxic dose of epigenetic modifying drug. This was repeated in 4 different cell lines.
Results
Application of DFO resulted in a reduction in cumulative cell number in all 3 cell lines (p= <0.001), this was recoverable when DFO was removed from the cultures and replaced with control medium. Barrier function was markedly reduced in vitro (1908 ± 806 versus 4301 ± 1033 Ω.cm2) when DFO was repeatedly applied (p <0.0001, n=9). Unlike proliferation this compromise was not reversible by removing cells from the DFO 12 days prior to differentiation 1675 ± 349 versus 2774 ± 490 Ω.cm2 (p = 0.01, n= 10). Trichostatin A however did appear to ameliorate this compromise in the pre-treated group 2824 ± 483 Ω.cm2 (p=0.05, n=10).
Conclusion
DFO results in reduced proliferation in NHU cells, which is recoverable when placed in control conditions. However the detrimental effect on barrier function is not retrievable suggesting this compromise to be heritable or epigenetic in nature. Support for this is shown by the amelioration of the deficit with the addition of an epigenetic modifying drug.