Pneumotoraks i pneumomedijastinum – rijetke komplikacije laparoskopske kirurgije

Occurrence of bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during gynecologic laparoscopic procedure is very rare. We report a case of a 23-year-old woman who developed bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during laparoscopic ovarian cystectomy. Carbon dioxide extravasations outside the peritoneal cavity during laparoscopy may have fatal consequences. Careful monitoring, immediate diagnosis and proper treatment are crucial for patient safety.Razvoj obostranog pneumotoraksa, pneumomedijastinuma i supkutanog emfizema je iznimno rijetka komplikacija laparoskopske ginekološke operacije. U ovom radu prikazujemo slučaj 23-godišnje bolesnice u koje se razvio obostrani pneumotoraks, pneumomedijastinum i supkutani emfizem tijekom laparoskopske ovarijske cistektomije. Posljedice nakupljanja ugljičnog dioksida izvan trbušne šupljine tijekom laparoskopskih zahvata mogu biti fatalne. Brza dijagnoza i odgovarajuće liječenje su ključni za povoljan ishod

The effect of pentadecapeptide BPC 157 in the therapy of lesions of the tongue, esophagus, stomach and duodenum caused by 96% alcohol in rat

Nova citoprotekcija/adaptivna citoprotekcija: peroralni 96%-tni alkohol i njegova uloga u rješavanju poremećaja u prehrani i unosu tekućina te održavanju integriteta sluznice. BPC 157, L-arginin, L-NAME Korozivne lezije gornjeg gastrointestinalnog trakta imaju devastirajuće posljedice na ljudski organizam i kvalitetu života te predstavljaju važan medicinski i socioekonomski problem. S obzirom da nedostaju adekvatna faramkoterapijska sredstva za rješavanje ovog prvorazrednog kliničkog problema, prijeko su potrebna daljnja znanstvena istraživanja sa ciljem pronalaženja takvog sredstva koje bi bilo sigurno u svojoj primjeni i djelotvorno u atenuaciji korozivnih oštećenja te prevenciji većih i jačih oštećenja u cijelom gastrointestinalnom sustavu. Kao takav, u ovom je istraživanju predložen pentadekapeptid BPC 157 koji predstavlja jedan potentan peptid sa karakteristikama drugačijim od drugih peptida, za njegovo djelovanje nije potreban nosač, prepoznat je kao osnovni protektivni čimbenik u slini i želučanom soku, a izrazito je siguran (letalna doza nije postignuta) i stabilan (stabilan u želučanom soku duže od 24h). Već su ranije dokazani njegovi brojni učinci na cijeljenje različitih lezija i njegova interakcija sa brojnim sustavima u organizmu. Dokazan je i njegov citoprotektivan/adaptivno citoprotektivan učinak na različita tkiva i organe. U ovom istraživanju ispitana je uloga pentadekapeptida BPC 157 i NO sustava, samog ili u kombinaciji sa pentadekapeptidom BPC 157, u prevenciji i cijeljenju teških oštećenja organa gornjeg GI trakta. Uvod: U ovom istraživanju suprotstavili smo učinak peroralne primjene nasuprot učinka Robertove izravne intragastrične primjene 96 %-tnog alkohola na štakorskom modelu te smo promatrali posljedice u smislu neposredne i preklapajuće prezentacije citoprotekcije/adaptivne citoprotekcije te malih lezija na želucu u usporedbi sa inače velikim lezijama na želucu kod izravne intragastrične primjene nokse. Materijali i metode: 96 %-tni alkohol primjenjivan je na slijedeći način: (i) peroralno (1 ml/štakor izravno na jezik, žrtvovanje životinja nakon 1 min, 5 min, 15 min, 30 min, 1 h, 2 h i 24 h), jezik je promatran kao primarno mjesto djelovanja nokse, a posljedično su promatrane i promjene na jednjaku, želucu i dvanaesniku, što do sada još nije učinjeno; (ii) intragastrički (1 ml/štakor, žrtvovanje nakon 1h; (iii) peroralno 1 ml/štakor te odmah nakon toga intragastrički 1 ml/štakor (žrtvovanje nakon 1 h). Određivala se površina lezija (mm2) i vrijednosti tlakova donjeg ezofagealnog i piloričkog sfinktera (cmH2O). Testirali smo slijedeća sredstva (/kg intraperitonealno odmah nakon primjene 96 %-tnog alkohola): stabilni gastrični pentadekapeptid BPC 157 10 µg, 10 ng, NOS-blokator L-NAME, 5 mg, L-arginin, NOS-supstrat, 100 mg, primjenjivanih samostalno ili u kombinaciji. Rezultati: 96 %-tni alkohol doveo je do stvaranja: (i) peroralno, 1 min-24 h, široke ali minuciozne lezije jezika, jednjaka, želuca i dvanaesnika sa intaktnom mukoznom barijerom i značajno nižim vrijednostima tlakova sfinktera; (ii) intragastrički, ekstenzivne ulceracije želuca, široko crvenilo jezika, jednjaka i duodenuma, još izraženiji pad vrijednosti tlakova sfinktera posebice donjeg ezofagealnog tlaka sfinktera; (iii) peroralno i intragastrički u kombinaciji, male želučane lezije, manje crvenilo jezika, jednjaka i dvanaesnika, atenuacija pada vrijednosti tlakova sfinktera odgovara atenuaciji veličina lezija. Dodatni jaki pozitivni učinak na održavanje integriteta sluznice dogodio se kod primjene pentadekapeptida BPC 157 uključujući održavanje odnosno barem parcijalnu prevenciju smanjenja vrijednosti tlakova sfinktera, blagi pozitivni učinak L-arginina (protekcija) te negativni učinak L-NAME (agravacija) što govori u prilog uključenosti NO sustava u opisanu regulaciju, bez utjecaja na vrijednosti tlakova sfinktera. Zaključak: Učinci citoprotekcije i adaptivne citoprotekcije na modelu peroralne primjene 96 %-tnog alkohola uz primjenu pentadekapeptida BPC 157 i djelovanje na NO sustav mogu pomoći u rješavanju poremećaja i navika u prehrani i unosu tekućina te u održavanju integriteta sluznice uključujući atenuaciju korozivnih oštećenja cijelog gornjeg GI trakta.New cytoprotection/adaptive cytoprotection: peroral strong alcohol in rat to resolve the regular eating/drinking habits and mucosa maintenance. BPC 157, L-arginine, L-NAME. Corrosive lesions of the upper gastrointestinal tract have devastating consequences on human organism and the quality of life in general which means that they represent a very important medical and socio-economical problem. Since there are no adequate pharmacotherapeutical means in dealing with this first class clinical problem, new experiments are necessary in order to discover a new peptide which is safe and successful in prevention and attenuation of massive corrosive lesions of the whole upper GI tract. In this experiment we present pentadecapeptide BPC 157 as a new potent peptide with different characteristics when compared with other peptides (it doesn’t need carrier, it was recognized as a basic protective compound in saliva and gastric juice, it’s completely safe with no known lethal dose and extremely stable (ie. in gastric juice more than 24h). The effects of BPC 157 on healing different lesions and it’s interaction with many systems in the organism have been proven earlier, as well as the cytoprotective/adaptive cytoprotective effect of BPC 157 on different tissues and organs. We investigated the role of pentadecapeptide BPC 157 and NO system, alone or in combination with pentadecapeptide BPC 157, in prevention and healing of severe upper GI tract organ damage. Background. We reveal the peroral versus Robert’s intragastric strong alcohol in rats, and the consequences thereof, the immediate presentation of overlapping cytoprotection/adaptive cytoprotection, only the minute lesions in the stomach instead the huge post-alcohol stomach lesions. Methods. We challenged the strong 96 %-ethanol: (i) perorally (1 ml/rat at the tongue, sacrifice at the 1 min, 5 min, 15 min, 30 min; 1 h, 2 h and 24 h), the tongue as the first target, and subsequent esophagus, stomach and duodenum presentation, so far not tested; (ii) intragastrically (1 ml/rat, sacrifice at 1 h); perorally 1ml/rat, and immediately after intragastrically, 1 ml/rat, (sacrifice at 1 h); lesions area (mm2) and lower esophageal and pyloric sphincter pressure (cmH2O) assessment. Tested agents (/kg intraperitoneally immediately after alcohol) were: stable gastric pentadecapeptide BPC 157 10 µg, 10 ng, NOS-blocker L-NAME, 5 mg, L-arginine, NOS-substrate, 100 mg, applied alone and/or together. Results. 96 %- alcohol induced: (i) perorally, 1 min-24 h, widespread, but only minute lesions on the tongue, esophagus, stomach and duodenum with intact mucosa, but markedly fallen sphincter pressures; (ii) intragastrically, the extensive stomach ulcerations, widespread tongue, esophagus, duodenum redness; further fallen sphincter pressures, particularly failed lower esophageal sphincter; (iii) perorally, and then immediately intragastrically, only small stomach lesions, less tongue, esophagus, duodenum redness; the attenuated sphincter pressures drop resembles the attenuated lesions. The additional strong mucosal beneficial effect appeared with BPC 157 including at least partially rescued sphincter pressures, the slight effect with L-arginine (protection) and with L-NAME (aggravation) (and thereby, the NO-system involvement) however not involving change in sphincter pressures. Conclusion. These effects and the peroral strong alcohol model combined with the use of pentadecapeptide BPC 157 and NO system may resolve the regular eating/drinking habits and mucosa maintenance together with attenuation of the corrosive lesions of the upper gastrointestinal tract

Učinak pentadekapeptida BPC 157 u terapiji lezija jezika, jednjaka, želuca i dvanaesnika izazvanih 96%-tnom otopinom alkohola u štakora [The effect of pentadecapeptide BPC 157 in the therapy of lesions of the tongue, esophagus, stomach and duodenum caused by 96% alcohol in rat]

New cytoprotection/adaptive cytoprotection: peroral strong alcohol in rat to resolve the regular eating/drinking habits and mucosa maintenance. BPC 157, L-arginine, L-NAME. Corrosive lesions of the upper gastrointestinal tract have devastating consequences on human organism and the quality of life in general which means that they represent a very important medical and socio-economical problem. Since there are no adequate pharmacotherapeutical means in dealing with this first class clinical problem, new experiments are necessary in order to discover a new peptide which is safe and successful in prevention and attenuation of massive corrosive lesions of the whole upper GI tract. In this experiment we present pentadecapeptide BPC 157 as a new potent peptide with different characteristics when compared with other peptides (it doesn’t need carrier, it was recognized as a basic protective compound in saliva and gastric juice, it’s completely safe with no known lethal dose and extremely stable (ie. in gastric juice more than 24h). The effects of BPC 157 on healing different lesions and it’s interaction with many systems in the organism have been proven earlier, as well as the cytoprotective/adaptive cytoprotective effect of BPC 157 on different tissues and organs. We investigated the role of pentadecapeptide BPC 157 and NO system, alone or in combination with pentadecapeptide BPC 157, in prevention and healing of severe upper GI tract organ damage. Background. We reveal the peroral versus Robert’s intragastric strong alcohol in rats, and the consequences thereof, the immediate presentation of overlapping cytoprotection/adaptive cytoprotection, only the minute lesions in the stomach instead the huge post-alcohol stomach lesions. Methods. We challenged the strong 96 %-ethanol: (i) perorally (1 ml/rat at the tongue, sacrifice at the 1 min, 5 min, 15 min, 30 min; 1 h, 2 h and 24 h), the tongue as the first target, and subsequent esophagus, stomach and duodenum presentation, so far not tested; (ii) intragastrically (1 ml/rat, sacrifice at 1 h); perorally 1ml/rat, and immediately after intragastrically, 1 ml/rat, (sacrifice at 1 h); lesions area (mm2) and lower esophageal and pyloric sphincter pressure (cmH2O) assessment. Tested agents (/kg intraperitoneally immediately after alcohol) were: stable gastric pentadecapeptide BPC 157 10 µg, 10 ng, NOS-blocker L-NAME, 5 mg, L-arginine, NOS-substrate, 100 mg, applied alone and/or together. Results. 96 %- alcohol induced: (i) perorally, 1 min-24 h, widespread, but only minute lesions on the tongue, esophagus, stomach and duodenum with intact mucosa, but markedly fallen sphincter pressures; (ii) intragastrically, the extensive stomach ulcerations, widespread tongue, esophagus, duodenum redness; further fallen sphincter pressures, particularly failed lower esophageal sphincter; (iii) perorally, and then immediately intragastrically, only small stomach lesions, less tongue, esophagus, duodenum redness; the attenuated sphincter pressures drop resembles the attenuated lesions. The additional strong mucosal beneficial effect appeared with BPC 157 including at least partially rescued sphincter pressures, the slight effect with L-arginine (protection) and with L-NAME (aggravation) (and thereby, the NO-system involvement) however not involving change in sphincter pressures. Conclusion. These effects and the peroral strong alcohol model combined with the use of pentadecapeptide BPC 157 and NO system may resolve the regular eating/drinking habits and mucosa maintenance together with attenuation of the corrosive lesions of the upper gastrointestinal tract

The effect of pentadecapeptide BPC 157 in the therapy of lesions of the tongue, esophagus, stomach and duodenum caused by 96% alcohol in rat

Nova citoprotekcija/adaptivna citoprotekcija: peroralni 96%-tni alkohol i njegova uloga u rješavanju poremećaja u prehrani i unosu tekućina te održavanju integriteta sluznice. BPC 157, L-arginin, L-NAME Korozivne lezije gornjeg gastrointestinalnog trakta imaju devastirajuće posljedice na ljudski organizam i kvalitetu života te predstavljaju važan medicinski i socioekonomski problem. S obzirom da nedostaju adekvatna faramkoterapijska sredstva za rješavanje ovog prvorazrednog kliničkog problema, prijeko su potrebna daljnja znanstvena istraživanja sa ciljem pronalaženja takvog sredstva koje bi bilo sigurno u svojoj primjeni i djelotvorno u atenuaciji korozivnih oštećenja te prevenciji većih i jačih oštećenja u cijelom gastrointestinalnom sustavu. Kao takav, u ovom je istraživanju predložen pentadekapeptid BPC 157 koji predstavlja jedan potentan peptid sa karakteristikama drugačijim od drugih peptida, za njegovo djelovanje nije potreban nosač, prepoznat je kao osnovni protektivni čimbenik u slini i želučanom soku, a izrazito je siguran (letalna doza nije postignuta) i stabilan (stabilan u želučanom soku duže od 24h). Već su ranije dokazani njegovi brojni učinci na cijeljenje različitih lezija i njegova interakcija sa brojnim sustavima u organizmu. Dokazan je i njegov citoprotektivan/adaptivno citoprotektivan učinak na različita tkiva i organe. U ovom istraživanju ispitana je uloga pentadekapeptida BPC 157 i NO sustava, samog ili u kombinaciji sa pentadekapeptidom BPC 157, u prevenciji i cijeljenju teških oštećenja organa gornjeg GI trakta. Uvod: U ovom istraživanju suprotstavili smo učinak peroralne primjene nasuprot učinka Robertove izravne intragastrične primjene 96 %-tnog alkohola na štakorskom modelu te smo promatrali posljedice u smislu neposredne i preklapajuće prezentacije citoprotekcije/adaptivne citoprotekcije te malih lezija na želucu u usporedbi sa inače velikim lezijama na želucu kod izravne intragastrične primjene nokse. Materijali i metode: 96 %-tni alkohol primjenjivan je na slijedeći način: (i) peroralno (1 ml/štakor izravno na jezik, žrtvovanje životinja nakon 1 min, 5 min, 15 min, 30 min, 1 h, 2 h i 24 h), jezik je promatran kao primarno mjesto djelovanja nokse, a posljedično su promatrane i promjene na jednjaku, želucu i dvanaesniku, što do sada još nije učinjeno; (ii) intragastrički (1 ml/štakor, žrtvovanje nakon 1h; (iii) peroralno 1 ml/štakor te odmah nakon toga intragastrički 1 ml/štakor (žrtvovanje nakon 1 h). Određivala se površina lezija (mm2) i vrijednosti tlakova donjeg ezofagealnog i piloričkog sfinktera (cmH2O). Testirali smo slijedeća sredstva (/kg intraperitonealno odmah nakon primjene 96 %-tnog alkohola): stabilni gastrični pentadekapeptid BPC 157 10 µg, 10 ng, NOS-blokator L-NAME, 5 mg, L-arginin, NOS-supstrat, 100 mg, primjenjivanih samostalno ili u kombinaciji. Rezultati: 96 %-tni alkohol doveo je do stvaranja: (i) peroralno, 1 min-24 h, široke ali minuciozne lezije jezika, jednjaka, želuca i dvanaesnika sa intaktnom mukoznom barijerom i značajno nižim vrijednostima tlakova sfinktera; (ii) intragastrički, ekstenzivne ulceracije želuca, široko crvenilo jezika, jednjaka i duodenuma, još izraženiji pad vrijednosti tlakova sfinktera posebice donjeg ezofagealnog tlaka sfinktera; (iii) peroralno i intragastrički u kombinaciji, male želučane lezije, manje crvenilo jezika, jednjaka i dvanaesnika, atenuacija pada vrijednosti tlakova sfinktera odgovara atenuaciji veličina lezija. Dodatni jaki pozitivni učinak na održavanje integriteta sluznice dogodio se kod primjene pentadekapeptida BPC 157 uključujući održavanje odnosno barem parcijalnu prevenciju smanjenja vrijednosti tlakova sfinktera, blagi pozitivni učinak L-arginina (protekcija) te negativni učinak L-NAME (agravacija) što govori u prilog uključenosti NO sustava u opisanu regulaciju, bez utjecaja na vrijednosti tlakova sfinktera. Zaključak: Učinci citoprotekcije i adaptivne citoprotekcije na modelu peroralne primjene 96 %-tnog alkohola uz primjenu pentadekapeptida BPC 157 i djelovanje na NO sustav mogu pomoći u rješavanju poremećaja i navika u prehrani i unosu tekućina te u održavanju integriteta sluznice uključujući atenuaciju korozivnih oštećenja cijelog gornjeg GI trakta.New cytoprotection/adaptive cytoprotection: peroral strong alcohol in rat to resolve the regular eating/drinking habits and mucosa maintenance. BPC 157, L-arginine, L-NAME. Corrosive lesions of the upper gastrointestinal tract have devastating consequences on human organism and the quality of life in general which means that they represent a very important medical and socio-economical problem. Since there are no adequate pharmacotherapeutical means in dealing with this first class clinical problem, new experiments are necessary in order to discover a new peptide which is safe and successful in prevention and attenuation of massive corrosive lesions of the whole upper GI tract. In this experiment we present pentadecapeptide BPC 157 as a new potent peptide with different characteristics when compared with other peptides (it doesn’t need carrier, it was recognized as a basic protective compound in saliva and gastric juice, it’s completely safe with no known lethal dose and extremely stable (ie. in gastric juice more than 24h). The effects of BPC 157 on healing different lesions and it’s interaction with many systems in the organism have been proven earlier, as well as the cytoprotective/adaptive cytoprotective effect of BPC 157 on different tissues and organs. We investigated the role of pentadecapeptide BPC 157 and NO system, alone or in combination with pentadecapeptide BPC 157, in prevention and healing of severe upper GI tract organ damage. Background. We reveal the peroral versus Robert’s intragastric strong alcohol in rats, and the consequences thereof, the immediate presentation of overlapping cytoprotection/adaptive cytoprotection, only the minute lesions in the stomach instead the huge post-alcohol stomach lesions. Methods. We challenged the strong 96 %-ethanol: (i) perorally (1 ml/rat at the tongue, sacrifice at the 1 min, 5 min, 15 min, 30 min; 1 h, 2 h and 24 h), the tongue as the first target, and subsequent esophagus, stomach and duodenum presentation, so far not tested; (ii) intragastrically (1 ml/rat, sacrifice at 1 h); perorally 1ml/rat, and immediately after intragastrically, 1 ml/rat, (sacrifice at 1 h); lesions area (mm2) and lower esophageal and pyloric sphincter pressure (cmH2O) assessment. Tested agents (/kg intraperitoneally immediately after alcohol) were: stable gastric pentadecapeptide BPC 157 10 µg, 10 ng, NOS-blocker L-NAME, 5 mg, L-arginine, NOS-substrate, 100 mg, applied alone and/or together. Results. 96 %- alcohol induced: (i) perorally, 1 min-24 h, widespread, but only minute lesions on the tongue, esophagus, stomach and duodenum with intact mucosa, but markedly fallen sphincter pressures; (ii) intragastrically, the extensive stomach ulcerations, widespread tongue, esophagus, duodenum redness; further fallen sphincter pressures, particularly failed lower esophageal sphincter; (iii) perorally, and then immediately intragastrically, only small stomach lesions, less tongue, esophagus, duodenum redness; the attenuated sphincter pressures drop resembles the attenuated lesions. The additional strong mucosal beneficial effect appeared with BPC 157 including at least partially rescued sphincter pressures, the slight effect with L-arginine (protection) and with L-NAME (aggravation) (and thereby, the NO-system involvement) however not involving change in sphincter pressures. Conclusion. These effects and the peroral strong alcohol model combined with the use of pentadecapeptide BPC 157 and NO system may resolve the regular eating/drinking habits and mucosa maintenance together with attenuation of the corrosive lesions of the upper gastrointestinal tract

The effect of pentadecapeptide BPC 157 in the therapy of lesions of the tongue, esophagus, stomach and duodenum caused by 96% alcohol in rat

Nova citoprotekcija/adaptivna citoprotekcija: peroralni 96%-tni alkohol i njegova uloga u rješavanju poremećaja u prehrani i unosu tekućina te održavanju integriteta sluznice. BPC 157, L-arginin, L-NAME Korozivne lezije gornjeg gastrointestinalnog trakta imaju devastirajuće posljedice na ljudski organizam i kvalitetu života te predstavljaju važan medicinski i socioekonomski problem. S obzirom da nedostaju adekvatna faramkoterapijska sredstva za rješavanje ovog prvorazrednog kliničkog problema, prijeko su potrebna daljnja znanstvena istraživanja sa ciljem pronalaženja takvog sredstva koje bi bilo sigurno u svojoj primjeni i djelotvorno u atenuaciji korozivnih oštećenja te prevenciji većih i jačih oštećenja u cijelom gastrointestinalnom sustavu. Kao takav, u ovom je istraživanju predložen pentadekapeptid BPC 157 koji predstavlja jedan potentan peptid sa karakteristikama drugačijim od drugih peptida, za njegovo djelovanje nije potreban nosač, prepoznat je kao osnovni protektivni čimbenik u slini i želučanom soku, a izrazito je siguran (letalna doza nije postignuta) i stabilan (stabilan u želučanom soku duže od 24h). Već su ranije dokazani njegovi brojni učinci na cijeljenje različitih lezija i njegova interakcija sa brojnim sustavima u organizmu. Dokazan je i njegov citoprotektivan/adaptivno citoprotektivan učinak na različita tkiva i organe. U ovom istraživanju ispitana je uloga pentadekapeptida BPC 157 i NO sustava, samog ili u kombinaciji sa pentadekapeptidom BPC 157, u prevenciji i cijeljenju teških oštećenja organa gornjeg GI trakta. Uvod: U ovom istraživanju suprotstavili smo učinak peroralne primjene nasuprot učinka Robertove izravne intragastrične primjene 96 %-tnog alkohola na štakorskom modelu te smo promatrali posljedice u smislu neposredne i preklapajuće prezentacije citoprotekcije/adaptivne citoprotekcije te malih lezija na želucu u usporedbi sa inače velikim lezijama na želucu kod izravne intragastrične primjene nokse. Materijali i metode: 96 %-tni alkohol primjenjivan je na slijedeći način: (i) peroralno (1 ml/štakor izravno na jezik, žrtvovanje životinja nakon 1 min, 5 min, 15 min, 30 min, 1 h, 2 h i 24 h), jezik je promatran kao primarno mjesto djelovanja nokse, a posljedično su promatrane i promjene na jednjaku, želucu i dvanaesniku, što do sada još nije učinjeno; (ii) intragastrički (1 ml/štakor, žrtvovanje nakon 1h; (iii) peroralno 1 ml/štakor te odmah nakon toga intragastrički 1 ml/štakor (žrtvovanje nakon 1 h). Određivala se površina lezija (mm2) i vrijednosti tlakova donjeg ezofagealnog i piloričkog sfinktera (cmH2O). Testirali smo slijedeća sredstva (/kg intraperitonealno odmah nakon primjene 96 %-tnog alkohola): stabilni gastrični pentadekapeptid BPC 157 10 µg, 10 ng, NOS-blokator L-NAME, 5 mg, L-arginin, NOS-supstrat, 100 mg, primjenjivanih samostalno ili u kombinaciji. Rezultati: 96 %-tni alkohol doveo je do stvaranja: (i) peroralno, 1 min-24 h, široke ali minuciozne lezije jezika, jednjaka, želuca i dvanaesnika sa intaktnom mukoznom barijerom i značajno nižim vrijednostima tlakova sfinktera; (ii) intragastrički, ekstenzivne ulceracije želuca, široko crvenilo jezika, jednjaka i duodenuma, još izraženiji pad vrijednosti tlakova sfinktera posebice donjeg ezofagealnog tlaka sfinktera; (iii) peroralno i intragastrički u kombinaciji, male želučane lezije, manje crvenilo jezika, jednjaka i dvanaesnika, atenuacija pada vrijednosti tlakova sfinktera odgovara atenuaciji veličina lezija. Dodatni jaki pozitivni učinak na održavanje integriteta sluznice dogodio se kod primjene pentadekapeptida BPC 157 uključujući održavanje odnosno barem parcijalnu prevenciju smanjenja vrijednosti tlakova sfinktera, blagi pozitivni učinak L-arginina (protekcija) te negativni učinak L-NAME (agravacija) što govori u prilog uključenosti NO sustava u opisanu regulaciju, bez utjecaja na vrijednosti tlakova sfinktera. Zaključak: Učinci citoprotekcije i adaptivne citoprotekcije na modelu peroralne primjene 96 %-tnog alkohola uz primjenu pentadekapeptida BPC 157 i djelovanje na NO sustav mogu pomoći u rješavanju poremećaja i navika u prehrani i unosu tekućina te u održavanju integriteta sluznice uključujući atenuaciju korozivnih oštećenja cijelog gornjeg GI trakta.New cytoprotection/adaptive cytoprotection: peroral strong alcohol in rat to resolve the regular eating/drinking habits and mucosa maintenance. BPC 157, L-arginine, L-NAME. Corrosive lesions of the upper gastrointestinal tract have devastating consequences on human organism and the quality of life in general which means that they represent a very important medical and socio-economical problem. Since there are no adequate pharmacotherapeutical means in dealing with this first class clinical problem, new experiments are necessary in order to discover a new peptide which is safe and successful in prevention and attenuation of massive corrosive lesions of the whole upper GI tract. In this experiment we present pentadecapeptide BPC 157 as a new potent peptide with different characteristics when compared with other peptides (it doesn’t need carrier, it was recognized as a basic protective compound in saliva and gastric juice, it’s completely safe with no known lethal dose and extremely stable (ie. in gastric juice more than 24h). The effects of BPC 157 on healing different lesions and it’s interaction with many systems in the organism have been proven earlier, as well as the cytoprotective/adaptive cytoprotective effect of BPC 157 on different tissues and organs. We investigated the role of pentadecapeptide BPC 157 and NO system, alone or in combination with pentadecapeptide BPC 157, in prevention and healing of severe upper GI tract organ damage. Background. We reveal the peroral versus Robert’s intragastric strong alcohol in rats, and the consequences thereof, the immediate presentation of overlapping cytoprotection/adaptive cytoprotection, only the minute lesions in the stomach instead the huge post-alcohol stomach lesions. Methods. We challenged the strong 96 %-ethanol: (i) perorally (1 ml/rat at the tongue, sacrifice at the 1 min, 5 min, 15 min, 30 min; 1 h, 2 h and 24 h), the tongue as the first target, and subsequent esophagus, stomach and duodenum presentation, so far not tested; (ii) intragastrically (1 ml/rat, sacrifice at 1 h); perorally 1ml/rat, and immediately after intragastrically, 1 ml/rat, (sacrifice at 1 h); lesions area (mm2) and lower esophageal and pyloric sphincter pressure (cmH2O) assessment. Tested agents (/kg intraperitoneally immediately after alcohol) were: stable gastric pentadecapeptide BPC 157 10 µg, 10 ng, NOS-blocker L-NAME, 5 mg, L-arginine, NOS-substrate, 100 mg, applied alone and/or together. Results. 96 %- alcohol induced: (i) perorally, 1 min-24 h, widespread, but only minute lesions on the tongue, esophagus, stomach and duodenum with intact mucosa, but markedly fallen sphincter pressures; (ii) intragastrically, the extensive stomach ulcerations, widespread tongue, esophagus, duodenum redness; further fallen sphincter pressures, particularly failed lower esophageal sphincter; (iii) perorally, and then immediately intragastrically, only small stomach lesions, less tongue, esophagus, duodenum redness; the attenuated sphincter pressures drop resembles the attenuated lesions. The additional strong mucosal beneficial effect appeared with BPC 157 including at least partially rescued sphincter pressures, the slight effect with L-arginine (protection) and with L-NAME (aggravation) (and thereby, the NO-system involvement) however not involving change in sphincter pressures. Conclusion. These effects and the peroral strong alcohol model combined with the use of pentadecapeptide BPC 157 and NO system may resolve the regular eating/drinking habits and mucosa maintenance together with attenuation of the corrosive lesions of the upper gastrointestinal tract

Pneumothorax and pneumomediastinum as a rare complication of laparoscopic surgery

Occurrence of bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during gynecologic laparoscopic procedure is very rare. We report a case of a 23-year-old woman who developed bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during laparoscopic ovarian cystectomy. Carbon dioxide extravasations outside the peritoneal cavity during laparoscopy may have fatal consequences. Careful monitoring, immediate diagnosis and proper treatment are crucial for patient safety

Esophagogastric anastomosis in rats: improved healing by BPC 157 and L-arginine, aggravated by L-NAME

AIM: To cure typically life-threatening esophagogastric anastomosis in rats, lacking anastomosis healing and sphincter function rescue, in particular. ----- METHODS: Because we assume esophagogastric fistulas represent a particular NO-system disability, we attempt to identify the benefits of anti-ulcer stable gastric pentadecapeptide BPC 157, which was in trials for ulcerative colitis and currently for multiple sclerosis, in rats with esophagocutaneous fistulas. Previously, BPC 157 therapies have promoted the healing of intestinal anastomosis and fistulas, and esophagitis and gastric lesions, along with rescued sphincter function. Additionally, BPC 157 particularly interacts with the NO-system. In the 4 d after esophagogastric anastomosis creation, rats received medication (/kg intraperitoneally once daily: BPC 157 (10 μg, 10 ng), L-NAME (5 mg), or L-arginine (100 mg) alone and/or combined or BPC 157 (10 μg, 10 ng) in drinking water). For rats underwent esophagogastric anastomosis, daily assessment included progressive stomach damage (sum of the longest diameters, mm), esophagitis (scored 0-5), weak anastomosis (mL H2O before leak), low pressure in esophagus at anastomosis and in the pyloric sphincter (cm H2O), progressive weight loss (g) and mortality. Immediate effect assessed blood vessels disappearance (scored 0-5) at the stomach surface immediately after anastomosis creation. ----- RESULTS: BPC 157 (all regimens) fully counteracted the perilous disease course from the very beginning (i.e., with the BPC 157 bath, blood vessels remained present at the gastric surface after anastomosis creation) and eliminated mortality. Additionally, BPC 157 treatment in combination with L-NAME nullified any effect of L-NAME that otherwise intensified the regular course. Consistently, with worsening (with L-NAME administration) and amelioration (with L-arginine), either L-arginine amelioration prevails (attenuated esophageal and gastric lesions) or they counteract each other (L-NAME + L-arginine); with the addition of BPC 157 (L-NAME + L-arginine + BPC 157), there was a marked beneficial effect. BPC 157 treatment for esophagogastric anastomosis, along with NOS-blocker L-NAME and/or NOS substrate L-arginine, demonstrated an innate NO-system disability (as observed with L-arginine effectiveness). BPC 157 distinctively affected corresponding events: worsening (obtained with L-NAME administration that was counteracted); or amelioration (L-arginine + BPC 157-rats correspond to BPC 157-rats). ----- CONCLUSION: Innate NO-system disability for esophagogastric anastomoses, including L-NAME-worsening, suggests that these effects could be corrected by L-arginine and almost completely eliminated by BPC 157 therapy