Ispiranje bronha surfaktantom kao metoda liječenja atelektaze u jedinici intenzivnog liječenja djece

The aim of this study was to assess the eff ect of fi beroptic aspiration and diluted surfactant administration on aff ected lungs in children with atelectasis. A convenience sample of 18 mechanically ventilated children were analyzed in this single center prospective study. The children had fi rst been treated unsuccessfully by respiratory physical therapy, after which they underwent fi beroptic aspiration. After aspiration, nine children were randomly selected to receive therapeutic lavage with diluted porcine surfactant; the remaining nine received the same quantity of saline solution. Several parameters of lung function, including positive end-expiratory pressure (PEEP) and oxygenation index (OI), as well as lung x-ray images were determined before aspiration and lavage, then at 6 and 12 h after lavage. In both groups, most of the measured parameters showed improvement from baseline at 6 h after treatment. Improvement was even more signifi cant 12 h after treatment. The surfactant group showed signifi cant improvement in comparison to the saline group. The impact of surfactant administration was most visible on the following parameters 12 h after treatment (p<0.001 in all cases): PEEP 5.22 (SD 0.44) in the saline group vs. 3.44 (SD 0.73) in the surfactant group; OI 3.84 (SD 1.13) vs. 2.1 (SD 0.38); and mean airway pressure (MAP) 8.56 (SD 0.88) vs. 6.33 (SD 0.5). In conclusion, fi beroptic aspiration is an effi cient treatment in pediatric intensive care patients. The observed benefi cial eff ects of therapeutic lavage with diluted surfactant should be confi rmed prospectively in a larger number of patients.Cilj je bio ispitati učinak bronhoskopske primjene razrjeđenog surfaktanta u liječenju atelektaze u djece. U ovu prospektivnu studiju je bilo uključeno 18 djece na mehaničkoj ventilaciji koja su neuspješno liječena fi zikalnom terapijom i bronhoskopskom aspiracijom. U devetoro bolesnika je nakon bronhoskopske aspiracije apliciran surfaktant u bronh zahvaćenog pluća, dok je u drugih devetoro aplicirana jednaka količina fi ziološke otopine. Mjereni su parametri plućne funkcije, PEEP, OI, a radiološka analiza rtg snimki provodila se prije aspiracije te 6 i 12 sati nakon ispiranja. U obje skupine većina mjerenih parametara pokazala je poboljšanje u odnosu na osnovne vrijednosti. Skupina kojoj je apliciran surfaktant pokazala je značajno poboljšanje u usporedbi s drugom skupinom. Najznačajniji učinak surfaktanta pokazao se na mjerenjima provedenim 12 sati nakon aplikacije (p<0,001 u obje skupine): PEEP 5.22 (SD 0,44) u skupini ispiranoj fi ziološkom otopinom prema 3.44 (SD 0,73) u skupini ispiranoj surfaktantom; OI 3,84 (SD 1,13) naspram 2,1 (SD 0,38); srednji talk u dišnom putu (MAP) 8,56 (SD 0,88) naspram 6,33 (SD 0,5). U zaključku, bronhoskopska aspiracija učinkovita je metoda u liječenju atelektaze u jedinici intenzivnog liječenja djece. Terapijski učinak ispiranja bronha razrjeđenim surfaktantom u takve djece mora se potvrditi u daljnjim istraživanjima na većem uzorku

Intraoperative volume restriction in esophageal cancer surgery: an exploratory randomized clinical trial

Aim To investigate whether the fluid volume administered during esophageal cancer surgery affects pulmonary gas exchange and tissue perfusion. Methods An exploratory single-center randomized clinical trial was performed. Patients with esophageal cancer who underwent Lewis-Tanner procedure between June 2011 and August 2012 at the Department of Thoracic surgery “Jordanovac”, Zagreb were analyzed. Patients were randomized (1:1) to receive a restrictive volume of intraoperative fluid (≤8 mL/kg/h) or a liberal volume (>8 mL/kg/h). Changes in oxygen partial pressure (Pao2), inspired oxygen fraction (FiO2), creatinine, and lactate were measured during and after surgery. Results Overall 16 patients were randomized and they all were analyzed (restrictive group n = 8, liberal group n = 8). The baseline value Pao2/FiO2 ratio (restrictive) was 345.01 ± 35.31 and the value six hours after extubation was 315.51 ± 32.91; the baseline Pao2/FiO2 ratio (liberal) was 330.11 ± 34.71 and the value six hours after extubation was 307.11 ± 30.31. The baseline creatinine value (restrictive) was 91.91 ± 12.67 and the value six hours after extubation was 100.88 ± 18.33; the baseline creatinine value (liberal) was 90.88 ± 14.99 and the value six hours after extubation was 93.51 ± 16.37. The baseline lactate value (restrictive) was 3.93 ± 1.33 and the value six hours after extubation was 2.69 ± 0.91. The baseline lactate value (liberal) was 3.26 ± 1.25 and the value six hours after extubation was 2.40 ± 1.08. The two groups showed no significant differences in Pao2/FiO2 ratio (P = 0.410), creatinine (P = 0.410), or lactate (P = 0.574). Conclusions Restriction of intraoperative applied volume does not significantly affect pulmonary exchange function or tissue perfusion in patients undergoing surgical treatment for esophageal cancer

TRANSPLANTACIJA PLUĆA U KLINIČKOM BOLNIČKOM CENTRU ZAGREB U HRVATSKOJ

Objective: Lung transplantation has become a standard of care for patients with a variety of non-malignant end-stage lung diseases. The aim of the study was to report on the safety and feasibility of lung transplantation at the Zagreb University Hospital Center. Methods: In this single center retrospective observational study, all consecutive patients undergoing lung transplantation at the Zagreb University Hospital Center from April 2021 until December 2022 were included. The only inclusion criterion was surgery for lung transplantation. Patient demographic and operative characteristics were reported, as well as early outcomes, including 30-day mortality, hospital stay, intensive care unit stay, duration of mechanical ventilation, and incidence of primary graft dysfunction. The degree of primary graft dysfunction was graded based on the International Society for Heart and Lung Transplantation criteria at 72 hours after transplantation with grades 0 to 3. Results: During the 21-month study period, 19 patients were successfully transplanted. There was no 30-day mortality. There was one late death at 18 months after transplantation. Median in-hospital stay was 32 days, ranging from 21 to 62 days. Mean mechanical ventilation duration was 105±58 h and median of intensive care unit stay was 6 days, ranging from 4 to 15 days. Only two (11%) patients had the highest grade 3 primary graft dysfunction. Of the remaining patients, 16 (84%) had none (grade 0) and one (5%) patient had mild primary graft dysfunction (grade 1). Conclusion: Our results suggest that lung transplantation is safely performed at the Zagreb University Hospital Center. Initial results with no operative mortality are encouraging. Further follow-up and experience are needed to make inferences on long-term outcomes of our lung transplantation patients.Cilj: Transplantacija pluća postala je standard skrbi za pacijente s nizom nemalignih plućnih bolesti u završnom stadiju. Cilj ovog istraživanja bio je izvijestiti o sigurnosti i izvedivosti transplantacije pluća u Kliničkom bolničkom centru Zagreb u Hrvatskoj. Metode: U ovu retrospektivnu opservacijsku studiju uključeni su svi uzastopni pacijenti koji su bili podvrgnuti transplantaciji pluća u Kliničkom bolničkom centru Zagreb od travnja 2021. do prosinca 2022. godine. Jedini kriterij za uključivanje bio je kirurški zahvat transplantacije pluća. Zabilježene su demografske i operativne karakteristike pacijenata, kao i rani ishodi, uključujući 30-dnevnu smrtnost, boravak u bolnici, boravak na jedinici intenzivne njege, trajanje mehaničke ventilacije i incidenciju primarne disfunkcije presatka. Stupanj primarne disfunkcije presatka ocijenjen je na temelju kriterija Međunarodnog društva za transplantaciju srca i pluća 72 sata nakon transplantacije ocjenama od 0 do 3. Rezultati: Tijekom dvadesetjednomjesečnog razdoblja istraživanja transplantacija je uspješno primijenjena u 19 pacijenata. Nije bilo 30-dnevne smrtnosti. Dogodila se jedna kasna smrt 18 mjeseci nakon transplantacije. Medijan boravka u bolnici bio je 32 dana, u rasponu od 21 do 62 dana. Prosječno trajanje mehaničke ventilacije bilo je 105±58 h, a medijanboravka u jedinici intenzivne njege bio je 6 dana, u rasponu od 4 do 15 dana. Samo dva (11 %) bolesnika imala su primarnu disfunkciju presatka najvišeg stupnja 3. Od preostalih bolesnika 16 (84 %) ih nije imalo nikakav (stupanj 0), a jedan (5%) bolesnik imao je blagi, stupanj 1. Rasprava: U ovom članku prikazujemo naše početno iskustvo s transplantacijom pluća. Transplantacija pluća bila je jedina od transplantacija solidnih organa koja se donedavno u Hrvatskoj nije rutinski izvodila, s napomenom da je prva transplantacija pluća u Hrvatskoj učinjena još 2003. godine u Klinici za torakalnu kirurgiju Jordanovac, ali se program transplantacije nije tada nastavio. Od travnja 2021. godine transplantacije pluća rutinski se izvode u našem centru i hrvatski pacijenti više ne moraju putovati u inozemstvo radi transplantacije pluća. Sveukupni nedostatak donora pluća i dalje je glavni ograničavajući čimbenik za broj transplantacija koje se izvode na godinu. Svega 20%-30% doniranih pluća iskoristi se za transplantaciju. Potrebno je kontinuirano unaprjeđenje i razvoj strategija koje će povećati broj donora i uporabljivih plućnih presadaka. Zaključak: Naši rezultati pokazuju da se transplantacija pluća sigurno izvodi u Kliničkom bolničkom centru Zagreb. Početni rezultati bez operativnog mortaliteta su ohrabrujući. Daljnje praćenje i iskustvo potrebni su za donošenje zaključaka o dugoročnim ishodima naših pacijenata s transplantacijom pluća

The effect of pentadecapeptide BPC 157 on tracheocutaneous fistula healing in rat

Uvod. Traheokutana fistula, patološki spoj dušnika i kože predstavlja jednu od kasnih komplikacija traheotomije. Prema podacima iz literature, incidencija traheokutane fistule je preko 40% u pedijatrijskih pacijenata. Do sada su opisane brojne kirurške tehnike zbrinjavanja traheokutane fistule, ali još uvijek nije pronađena tehnika i način zbrinjavanja koji bi predstavljao zlatni standard. Kirurško zbrinjavanje fistula sa sobom nosi i moguće komplikacije stoga je poželjno pronaći novo, bolje rješenje. Pentadekapeptid BPC 157 je izoliran iz humanog želučanog soka, a karakterizira ga stabilnost pri neutralnom pH i što za svoje djelovanje ne mora koristiti nosač što ga razlikuje od drugih peptida.U dosadašnjim istraživanjima nije utvrđena letalna doza što ga čini sigurnim za primjenu. BPC 157 pokazao je svoju djelotvornost u cijeljenju rana i fistula općenito stoga je poželjno utvrditi njegov učinak na modelu traheokutane fistule u štakora. ----- Materijali i metode. Mužjaci Wistar albino štakora, tjelesne mase 220-280 g podvrgnuti su standardnoj horizontalnoj traheotomiji prilikom koje je kreirana traheokutana fistula veličine 4 mm. Životinje su podijeljene u skupine: BPC 157 μg/ng, peroralna/intraperitonejska primjena, kontrolna skupina, L-NAME (i.p.), L-arginin (i.p.), L-NAME+ L- arginin (i.p.), L-NAME+ BPC 157 μg/ng( i.p.), L-NAME+ L- arginin+ BPC 157 μg/ng (i.p.), L- arginin + BPC 157 μg/ng (i.p.). Učinak ispitivanih agensa na proces cijeljenja promatran je kroz tri vremenska intervala- treći, peti i sedmi postoperacijski dan. Sedmi postoperacijski dan nastupilo je žrtvovanje životinja i vrednovanje rezultata. ----- Rezultati. BPC 157 doveo je do poboljšanja procesa cijeljenja traheokutane fistule kroz sve ispitivane vremenske intervale što je u konačnici rezultiralo gotovo potpunim zatvaranjem fistule. Njegov učinak je bio nepromijenjen neovisno o primjenjenoj dozi, 10μg/kg - 10ng/kg, kao i načinu primjene (p.o./i.p.). Uspješno je poništavao nepovoljni učinak L- NAME, a u zajedničkoj primjeni s L- NAME i L- argininom je pokazao rezultat sličan onome prilikom samostalne primjene. L- arginin je sedmi postoperacijski dan pokazao statitički značajan rezultat. Sve navedeno govori u prilog interakcije BPC 157 i NO sustava u ovome modelu. ----- Zaključak. BPC 157 ubrzava cijeljenje traheokutane fistule u štakora. Svoje djelovanje ostvaruje zahvaljujući interakciji s NO sustavom.Introduction. One of the common late complications of a tracheotomy is tracheocutaneous fistula. The surgical procedure is needed to close such fistulas. BPC 157 represents an anti-ulcer peptide (GEPPPGKPADDAGLV, M.W. 1419) successful in trials for inflammatory bowel disease, wound treatment, effective alone without a carrier. BPC 157 interferes with NO-system in vitro/in vivo on different models and different animal species. The impact of BPC 157 and NO-system on the gastrocutaneous, colocutaneous, and oesophagocutaneous fistulas healing process indicates the potential effect of BPC 157 in the tracheocutaneous fistula healing process, which has not yet been investigated. ----- Matherials and methods. Albino Wistar male rats were used in this experiment, 220-280 g. Tracheocutaneous fistula, 4 mm trachea and skin defect, was surgically made under anaesthesia. Animals were treated according to the experiment protocol: (a)) drinking water p.o., (b)) BPC 157 (10 μg/kg, 12 ml/rat/day) p.o., (c)) BPC 157 (10 ng/kg, 12 ml/rat/day) p.o., (d)) saline 5ml/kg/day i.p., (e)) BPC 157 (10μg/kg, 5ml/kg/day) i.p., (f)) BPC 157 (10 ng/kg, 5 ml/kg/day) i.p., (g)) L-NAME (5 mg/kg/day) i.p., (h)), L- arginine (100 mg/kg/day) i.p., (i)) L-NAME L- arginine i.p., (j)) L- NAME BPC 157 (μg) i.p., (k)) L- arginine BPC 157 (μg) i.p., (l)) L-NAME L- arginine BPC 157 (μg) i.p., (m)) L-NAME BPC 157 (ng) i.p., (n)) L- arginine BPC 157 (ng) i.p., (o)) L-NAME L- arginine BPC 157 (ng) i.p.. Seventh postoperative day animals were euthanized. Fistula specimens were harvested and macroscopic and histological analysis was made. ----- Results. A consistent counteracting beneficial effect was shown in all animals treated with BPC 157, alone and with (L-NAME) and/or L-arginine in a 7-day interval. BPC 157 accelerated the healing of tracheocutaneous fistulas and showed macroscopic and histological healing improvements. The tracheocutaneous fistulas healing was improved speedily (BPC 157 completely counteracted L-NAME effects (L-NAME+BPC 157 and L-NAME+L-arginine+ BPC 157 groups), or with delay and to less extent (L-arginine) or aggravated, rapidly and prominently (L-NAME). L-arginine reduces aggravation by NOS-blockade (L-NAME) to the control level. Also, BPC 157 more than nullifies the effect of L-NAME. ----- Conclusion. BPC 157 improved the healing of both tracheal and skin defects and mediated fistula closing. This effect was shared by L-arginine, with an opposite effect seen by L-NAME, thereby portraying BPC 157/NO-system involvement in the healing of tracheocutaneous fistula

The effect of pentadecapeptide BPC 157 on tracheocutaneous fistula healing in rat

Uvod. Traheokutana fistula, patološki spoj dušnika i kože predstavlja jednu od kasnih komplikacija traheotomije. Prema podacima iz literature, incidencija traheokutane fistule je preko 40% u pedijatrijskih pacijenata. Do sada su opisane brojne kirurške tehnike zbrinjavanja traheokutane fistule, ali još uvijek nije pronađena tehnika i način zbrinjavanja koji bi predstavljao zlatni standard. Kirurško zbrinjavanje fistula sa sobom nosi i moguće komplikacije stoga je poželjno pronaći novo, bolje rješenje. Pentadekapeptid BPC 157 je izoliran iz humanog želučanog soka, a karakterizira ga stabilnost pri neutralnom pH i što za svoje djelovanje ne mora koristiti nosač što ga razlikuje od drugih peptida.U dosadašnjim istraživanjima nije utvrđena letalna doza što ga čini sigurnim za primjenu. BPC 157 pokazao je svoju djelotvornost u cijeljenju rana i fistula općenito stoga je poželjno utvrditi njegov učinak na modelu traheokutane fistule u štakora. ----- Materijali i metode. Mužjaci Wistar albino štakora, tjelesne mase 220-280 g podvrgnuti su standardnoj horizontalnoj traheotomiji prilikom koje je kreirana traheokutana fistula veličine 4 mm. Životinje su podijeljene u skupine: BPC 157 μg/ng, peroralna/intraperitonejska primjena, kontrolna skupina, L-NAME (i.p.), L-arginin (i.p.), L-NAME+ L- arginin (i.p.), L-NAME+ BPC 157 μg/ng( i.p.), L-NAME+ L- arginin+ BPC 157 μg/ng (i.p.), L- arginin + BPC 157 μg/ng (i.p.). Učinak ispitivanih agensa na proces cijeljenja promatran je kroz tri vremenska intervala- treći, peti i sedmi postoperacijski dan. Sedmi postoperacijski dan nastupilo je žrtvovanje životinja i vrednovanje rezultata. ----- Rezultati. BPC 157 doveo je do poboljšanja procesa cijeljenja traheokutane fistule kroz sve ispitivane vremenske intervale što je u konačnici rezultiralo gotovo potpunim zatvaranjem fistule. Njegov učinak je bio nepromijenjen neovisno o primjenjenoj dozi, 10μg/kg - 10ng/kg, kao i načinu primjene (p.o./i.p.). Uspješno je poništavao nepovoljni učinak L- NAME, a u zajedničkoj primjeni s L- NAME i L- argininom je pokazao rezultat sličan onome prilikom samostalne primjene. L- arginin je sedmi postoperacijski dan pokazao statitički značajan rezultat. Sve navedeno govori u prilog interakcije BPC 157 i NO sustava u ovome modelu. ----- Zaključak. BPC 157 ubrzava cijeljenje traheokutane fistule u štakora. Svoje djelovanje ostvaruje zahvaljujući interakciji s NO sustavom.Introduction. One of the common late complications of a tracheotomy is tracheocutaneous fistula. The surgical procedure is needed to close such fistulas. BPC 157 represents an anti-ulcer peptide (GEPPPGKPADDAGLV, M.W. 1419) successful in trials for inflammatory bowel disease, wound treatment, effective alone without a carrier. BPC 157 interferes with NO-system in vitro/in vivo on different models and different animal species. The impact of BPC 157 and NO-system on the gastrocutaneous, colocutaneous, and oesophagocutaneous fistulas healing process indicates the potential effect of BPC 157 in the tracheocutaneous fistula healing process, which has not yet been investigated. ----- Matherials and methods. Albino Wistar male rats were used in this experiment, 220-280 g. Tracheocutaneous fistula, 4 mm trachea and skin defect, was surgically made under anaesthesia. Animals were treated according to the experiment protocol: (a)) drinking water p.o., (b)) BPC 157 (10 μg/kg, 12 ml/rat/day) p.o., (c)) BPC 157 (10 ng/kg, 12 ml/rat/day) p.o., (d)) saline 5ml/kg/day i.p., (e)) BPC 157 (10μg/kg, 5ml/kg/day) i.p., (f)) BPC 157 (10 ng/kg, 5 ml/kg/day) i.p., (g)) L-NAME (5 mg/kg/day) i.p., (h)), L- arginine (100 mg/kg/day) i.p., (i)) L-NAME L- arginine i.p., (j)) L- NAME BPC 157 (μg) i.p., (k)) L- arginine BPC 157 (μg) i.p., (l)) L-NAME L- arginine BPC 157 (μg) i.p., (m)) L-NAME BPC 157 (ng) i.p., (n)) L- arginine BPC 157 (ng) i.p., (o)) L-NAME L- arginine BPC 157 (ng) i.p.. Seventh postoperative day animals were euthanized. Fistula specimens were harvested and macroscopic and histological analysis was made. ----- Results. A consistent counteracting beneficial effect was shown in all animals treated with BPC 157, alone and with (L-NAME) and/or L-arginine in a 7-day interval. BPC 157 accelerated the healing of tracheocutaneous fistulas and showed macroscopic and histological healing improvements. The tracheocutaneous fistulas healing was improved speedily (BPC 157 completely counteracted L-NAME effects (L-NAME+BPC 157 and L-NAME+L-arginine+ BPC 157 groups), or with delay and to less extent (L-arginine) or aggravated, rapidly and prominently (L-NAME). L-arginine reduces aggravation by NOS-blockade (L-NAME) to the control level. Also, BPC 157 more than nullifies the effect of L-NAME. ----- Conclusion. BPC 157 improved the healing of both tracheal and skin defects and mediated fistula closing. This effect was shared by L-arginine, with an opposite effect seen by L-NAME, thereby portraying BPC 157/NO-system involvement in the healing of tracheocutaneous fistula

Lavage with diluted surfactant as a treatment option for atelectasis in pediatric intensive care patients

The aim of this study was to assess the eff ect of fi beroptic aspiration and diluted surfactant administration on aff ected lungs in children with atelectasis. A convenience sample of 18 mechanically ventilated children were analyzed in this single center prospective study. The children had fi rst been treated unsuccessfully by respiratory physical therapy, after which they underwent fi beroptic aspiration. After aspiration, nine children were randomly selected to receive therapeutic lavage with diluted porcine surfactant; the remaining nine received the same quantity of saline solution. Several parameters of lung function, including positive end-expiratory pressure (PEEP) and oxygenation index (OI), as well as lung x-ray images were determined before aspiration and lavage, then at 6 and 12 h after lavage. In both groups, most of the measured parameters showed improvement from baseline at 6 h after treatment. Improvement was even more signifi cant 12 h after treatment. The surfactant group showed signifi cant improvement in comparison to the saline group. The impact of surfactant administration was most visible on the following parameters 12 h after treatment (p<0.001 in all cases): PEEP 5.22 (SD 0.44) in the saline group vs. 3.44 (SD 0.73) in the surfactant group; OI 3.84 (SD 1.13) vs. 2.1 (SD 0.38); and mean airway pressure (MAP) 8.56 (SD 0.88) vs. 6.33 (SD 0.5). In conclusion, fi beroptic aspiration is an effi cient treatment in pediatric intensive care patients. The observed benefi cial eff ects of therapeutic lavage with diluted surfactant should be confi rmed prospectively in a larger number of patients.Cilj je bio ispitati učinak bronhoskopske primjene razrjeđenog surfaktanta u liječenju atelektaze u djece. U ovu prospektivnu studiju je bilo uključeno 18 djece na mehaničkoj ventilaciji koja su neuspješno liječena fi zikalnom terapijom i bronhoskopskom aspiracijom. U devetoro bolesnika je nakon bronhoskopske aspiracije apliciran surfaktant u bronh zahvaćenog pluća, dok je u drugih devetoro aplicirana jednaka količina fi ziološke otopine. Mjereni su parametri plućne funkcije, PEEP, OI, a radiološka analiza rtg snimki provodila se prije aspiracije te 6 i 12 sati nakon ispiranja. U obje skupine većina mjerenih parametara pokazala je poboljšanje u odnosu na osnovne vrijednosti. Skupina kojoj je apliciran surfaktant pokazala je značajno poboljšanje u usporedbi s drugom skupinom. Najznačajniji učinak surfaktanta pokazao se na mjerenjima provedenim 12 sati nakon aplikacije (p<0,001 u obje skupine): PEEP 5.22 (SD 0,44) u skupini ispiranoj fi ziološkom otopinom prema 3.44 (SD 0,73) u skupini ispiranoj surfaktantom; OI 3,84 (SD 1,13) naspram 2,1 (SD 0,38); srednji talk u dišnom putu (MAP) 8,56 (SD 0,88) naspram 6,33 (SD 0,5). U zaključku, bronhoskopska aspiracija učinkovita je metoda u liječenju atelektaze u jedinici intenzivnog liječenja djece. Terapijski učinak ispiranja bronha razrjeđenim surfaktantom u takve djece mora se potvrditi u daljnjim istraživanjima na većem uzorku

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