Brain-gut Axis and Pentadecapeptide BPC 157: Theoretical and Practical Implications.

BACKGROUND: Brain-gut interaction involves, among others, peptidergic growth factors which are native in GI tract and have strong antiulcer potency and thus could from periphery beneficially affect CNS-disorders. We focused on the stable gastric pentadecapeptide BPC 157, an antiulcer peptidergic agent, safe in inflammatory bowel disease trials and now in multiple sclerosis trial, native and stable in human gastric juice. METHODS: Review of our research on BPC 157 in terms of brain-gut axis. RESULTS: BPC 157 may serve as a novel mediator of Robert's cytoprotection, involved in maintaining of GI mucosa integrity, with no toxic effect. BPC 157 was successful in the therapy of GI tract, periodontitis, liver and pancreas lesions, and in the healing of various tissues and wounds. Stimulated Egr-1 gene, NAB2, FAK-paxillin and JAK-2 pathways are hitherto implicated. Initially corresponding beneficial central influence was seen when BPC 157 was given peripherally and a serotonin release in particular brain areas, mostly nigrostriatal, was changed. BPC 157 modulates serotonergic and dopaminergic systems, beneficially affects various behavioral disturbances that otherwise appeared due to specifically (over)stimulated/damaged neurotransmitters systems. Besides, BPC 157 has neuroprotective effects: protects somatosensory neurons; peripheral nerve regeneration appearent after transection; after traumatic brain injury counteracts the otherwise progressing course, in rat spinal cord compression with tail paralysis, axonal and neuronal necrosis, demyelination, cyst formation and rescues tail function in both short-terms and long-terms; after NSAIDs or insulin overdose or cuprizone encephalopathies were attenuated along with GI, liver and vascular injuries. CONCLUSION: BPC 157, a gastric peptide, may serve as remedy in various CNS-disorders.

Stable gastric pentadecapeptide BPC 157 heals rectovaginal fistula in rats.

AIM: Rectovaginal fistula is a devastating condition providing more than 99% of patients for surgical treatment. We hypothesized that rectovaginal fistula may be healed by therapy with stable gastric pentadecapeptide BPC 157, in consistence with its initial clinical application and effect on external fistulas. MAIN METHODS: BPC 157 (10µg/kg or 10ng/kg) was given perorally, in drinking water (0.16µg/ml or 0.16ng/ml, 12ml/rat/day) till sacrifice, or alternatively, intraperitoneally, first application at 30min after surgery, last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). The assessment (i.e., rectal and vaginal defect, fistula leakage, defecation through the fistula, adhesions and intestinal obstruction as healing processes) was at day 1, 3, 5, 7, 10, 14 and 21. KEY FINDINGS: Regularly, rectovaginal fistulas exhibited poor healing, with both of the defects persisting, continuous fistula leakage, defecation through the fistula, advanced adhesion formation and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally, in µg- and ng-regimens rapidly improved the whole presentation, with both rectal and vaginal defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised till the values of healthy rats were achieved, there were no signs of defecation through the fistula. A counteraction of advanced adhesion formation and intestinal obstruction was achieved. Microscopic improvement was along with macroscopic findings. SIGNIFICANCE: BPC 157 effects appear to be suited to induce a full healing of rectovaginal fistulas in rats.

Spontaneous isolated dissection of the abdominal aorta.

Isolated spontaneous dissection of the abdominal aorta is such a rare entity and there are only a few cases reported in literature up to date. A 42-year old male was admitted to the hospital with mild pain in the lower abdomen and back that had began seven days prior to admission together with the sudden onset of the ischemic symptoms of the left leg (ischemic ulcers of the calf gangrenous toe and pallor foot). Patient denied any trauma, hypertension history was negative, while he was active cigarette smoker. MSCT and digital subtracted angiography have shown a dissection of the abdominal aorta approximately two centimeters below the origin of the inferior mesenteric artery extending in the left common iliac artery, with no sign of the aneurysmatic dilatation of the abdominal aorta. Emergent surgery was performed with aorto-biiliacal bypass graft interposition, amputation of the left toe and necrectomy of the left calf Postoperative follow up and local vascular condition were satisfied. Even though is rare entity, isolated abdominal aorta dissection accounts for approximately 2-4% of all aortic dissection. Nowadays therapeutic regimen includes endovascular, open surgery or conservative treatment.

[Wernicke's encephalopathy as a complication of bariatric surgery]. / Wernickova encefalopatija kao komplikacija u kirurgiji debljine.

Wernicke's encephalopathy is an acute, serious brain disorder resulting from thiamine deficiency, which is important as a cofactor in several enzymes associated with carbohydrate metabolism. The encephalopathy is most often associated with severe alcohol abuse, but thiamine deficiency can be caused by many other medical conditions. Bariatric surgery is listed among the causes of Wernicke's encephalopathy. This review provides a brief overview of the risk factors that cause thiamine deficiency, along with clinical features, diagnostic and therapeutic procedures important for timely recognition, therapy and prophylaxis of Wernicke's encephalopathy that occurs as a complication of bariatric surgery.

[Pyogenic liver abscess caused by Klebsiella pneumoniae]. / Piogeni jetreni apsces uzrokovan bakterijom Klebsiella pneumoniae.

Pyogenic liver abscess caused by Klebsiella pneumoniae is usually found in Southeast Asia, while in Europe Escherichia coli, Streptococcus or Staphylococcus are most common. In case of a failed ultrasound controlled abscess, aspiration surgical treatment is indicated. This paper reports the clinical case of pyogenic liver abscess caused by Klebsiella pneumoniae, which was treated by operative drainage. A 60-year-old patient was transferred to our institution from the University Hospital for Infectious Diseases with septic temperature, abdominal pain and finding of Klebsiella pneumoniae liver abscess (resistant to antibiotic therapy). Additional laboratory tests and abdominal MSCT scan confirmed the initial diagnosis. The localization of abscesses technically prevented ultrasound-controlled abscess aspiration and drainage; after appropriate preparation, operative liver abscess incision and drainage were performed. Microbiological examination of the abscess sample revealed Klebsiella pneumoniae as the cause of liver abscess.

[Video-assisted extirpation of breast fibroadenoma with immediate bilateral breast augmentation--a case report]. / Videoasistirana ekstirpacija fibroadenoma dojke s neposrednim obostranim povecanjem dojki--prikaz bolesnice.

BACKGROUND: Since mid 1990s video-assisted breast surgery (VABS) has been developed in the treatment of benign and malignant breast diseases. According to studies that are conducted mainly in Japan, this tehnique is safe, easy to learn and his main advantage is excellent cosmetic results on postoperative appearance of breasts that cannot be achived with standard surgical procedures. OBJECTIVE: To present a first case of video assisted breast surgery in Croatia applied to treatment of breast fibroadenoma and immediate bilateral breast augmentation. CASE REPORT: A 39 year old female patient was admitted to our hospital for elective procedure of breast augmentation. On this occasion video assisted extirpation of fibroadenoma was performed through inframammary incision and followed by immediate bilateral breast augmentation. CONCLUSION: VABS is feasible, cosmetic effects are evident and the VABS deserves attention as a possible surgical option in breast surgery. However further experience on this field must be gained and it remains to evaluate this tehnique on the additional studies.

Clinical presentation of a patient with localized acquired cutis laxa of abdomen: a case report.

Background. Cutis laxa (CL) is a rare disorder of elastic tissue characterized by loose, sagging skin with reduced elasticity, and resilience without resulting scarring. CL may be inherited as a dominant, recessive, or X-linked recessive disease, or acquired. The heritable forms of CL predominantly begin at birth, but it may be delayed until puberty or age of 30 years with extracutaneous manifestations including pulmonary emphysema, umbilical and inguinal hernias, and gastrointestinal and vesicourinary tract diverticuli. An acquired form of the disease occurs in adults with no evidence of internal organ involvement. Objective. The aim of this case report was to present our patient suffering from CL, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Case Report. A 30-year-old female patient was admitted to our Hospital due to localized loose and sagging skin of abdomen, induced by prior cesarean section 6 years ago. CL has been diagnosed based on the clinical picture and pathohistological appearance. Conclusion. Reconstructive surgery provides a dramatic cosmetic improvement with significant psychosocial benefit. Repeated surgical procedures may be required to correct the lax skin, which worsens with age.

[Trauma of the brachial plexus and associated vascular injury--a case report]. / Traumatska ozljeda brahijalnog pleksusa s ozljedom krvnih zila--prikaz bolesnika.

Acute vascular trauma in the axillary region is usually associated with brachial plexus injury and presents a great challenge to surgeon and formidable obstacle to restore a useful limb function. Interdisciplinary operative and postoperative approach is mandatory providing an optimal care of these severe patients. Here we present a case of neurovascular trauma that affected axillary artery and vein, complete transection associated with complete transection of the brachial plexus. Immediately after admission emergency surgery was performed and in postoperative follow up, after several operations and rehabilitation that continued for 24 months, entire functional recovery was achieved without any disabling consequences.