Search

We report a case of biliary cyst type II which, independently of its a priori benign nature, caused numerous complications such as recurrent cholangitis and pancreatitis, as well as subsequent hepatic fibrosis and the potential danger of choledochocele perforation. Although they are benign, biliary/choledochal cysts can cause numerous disorders such as cholestasis, leading to cholangitis and pancreatitis and biliary sepsis, and due to chronic inflammation of the biliary system even cholangiocarcinogenesis. Our findings showed that sometimes this type of biliary cyst (according to the available literature the rarest and most benign type), as well as type I cyst, should undergo timely radical excision. In our patient, timely choledochocele resection would have certainly contributed to the reduction of subsequent complications, as well as to obviating repeated invasive diagnostic and surgical procedures.

Stable gastric pentadecapeptide BPC 157 was previously used to ameliorate wound healing following major surgery and counteract diclofenac toxicity. To resolve the increasing early risks following major massive small bowel resectioning surgery, diclofenac combined with nitric oxide (NO) system blockade was used, suggesting therapy with BPC 157 and the nitric oxide synthase (NOS substrate) L-arginine, is efficacious. Immediately after anastomosis creation, short-bowel rats were untreated or administered intraperitoneal diclofenac (12 mg/kg), BPC 157 (10 μg/kg or 10 ng/kg), L-NG- nitroarginine methyl ester (L-NAME, 5 mg/kg), L-arginine (100 mg/kg) alone or combined, and assessed 24 h later. Short-bowel rats exhibited poor anastomosis healing, failed intestine adaptation, and gastrointestinal, liver, and brain lesions, which worsened with diclofenac. This was gradually ameliorated by immediate therapy with BPC 157 and L-arginine. Contrastingly, NOS-blocker L-NAME induced further aggravation and lesions gradually worsened. Specifically, rats with surgery alone exhibited mild stomach/duodenum lesions, considerable liver lesions, and severe cerebral/hippocampal lesions while those also administered diclofenac showed widespread severe lesions in the gastrointestinal tract, liver, cerebellar nuclear/Purkinje cells, and cerebrum/hippocampus. Rats subjected to surgery, diclofenac, and L-NAME exhibited the mentioned lesions, worsening anastomosis, and macro/microscopical necrosis. Thus, rats subjected to surgery alone showed evidence of deterioration. Furtheremore, rats subjected to surgery and administered diclofenac showed worse symptoms, than the rats subjected to surgery alone did. Rats subjected to surgery combined with diclofenac and L-NAME showed the worst deterioration. Rats subjected to surgery exhibited habitual adaptation of the remaining small intestine, which was markedly reversed in rats subjected to surgery and diclofenac, and those with surgery, diclofenac, and L-NAME. BPC 157 completely ameliorated symptoms in massive intestinal resection-, massive intestinal resection plus diclofenac-, and massive intestinal resection plus diclofenac plus L- NAME-treated short bowel rats that presented with cyclooxygenase (COX)-NO-system inhibition. L-arginine ameliorated only L-NAME-induced aggravation of symptoms in rats subjected to massive intestinal resection and administered diclofenac plus L-NAME.

Piogeni apsces jetre uzrokovan bakterijom Klebsiella pneumoniae najčešće se nalazi u jugoistočnoj Aziji, dok u Europi kao uzročnici piogenog jetrenog apscesa prednjače Escherichia coli, Streptococcus spp. ili Staphylococcus spp. U slučaju neuspjele ultrazvučno kontrolirane aspiracije apscesa, indicirano je operacijsko liječenje. U radu je prikazan klinički slučaj piogenog apscesa jetre uzrokovanog bakterijom Klebsiella pneumoniae liječenog kirurškom drenažom. Šezdesetogodišnji bolesnik premješten je u našu ustanovu iz Klinike za infektivne bolesti u Zagrebu; septičan, bolnog trbuha s verificiranim jetrenim apscesom, koji nije reagirao na provedenu antibiotsku terapiju. Nakon prijma učinjena je dodatna laboratorijska i višeslojna kompjutorska tomografija (MultiSlice Computed Tomography – MSCT) kojom je potvrđena početna dijagnoza. S obzirom na lokalizaciju apscesa koja je tehnički onemogućavala ultrazvučno kontroliranu punkciju i drenažu apscesa, nakon adekvatne prijeoperacijske pripreme pristupilo se kirurškom zahvatu. Učinjena je laparotomija, incizija i drenaža jetrenog apscesa. Mikrobiološki pregled aspirata apscesa potvrdio je Klebsiella pneumoniae kao uzročnika jetrenog apscesa, 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.

U prikazu kliničkog slučaja riječ je o visokorizičnom kardijalnom sedamdesetjednogodišnjem bolesniku, koji je primljen u hitnoj službi sa simptomima visoke temperature, kontinuiranim povraćanjem i bolovima u epigastriju i pod desnim rebrenim lukom. Kompjuteriziranom tomografijom pronađena je patološka komunikacija žučnog mjehura s dvanaesnikom te veći žučni kamen koji opstruira silazni dio dvanaesnika ispred donjeg koljena. Bolesnik je podvrgnut uspješnom kirurškom liječenju., This is a case report of a 71-year-old man, who presented to emergency department with elevated temperature, vomiting and epigastric pain. Computed tomography of the abdomen revealed a large fistulous tract extending from the gallbladder to the duodenal bulb, as well as a large calculus obstructing the second part of the duodenum. The patient subsequently underwent successful surgical therapy.

Protection of gastrointestinal tract and an evident anti-inflammatory effect have been shown by a pentadecapeptide BPC 157, a fragment of organoprotective gastric juice peptide (BPC) (ip/ig) in comparison with several reference standards in various ulcer models (pre-/co-/post-treatment). Since an effect on mucosal healing was also noted, the BPC 157 effect on healing of colon-colon anastomoses was further investigated.

G A A b st ra ct s who tend to be non-ambulatory, older, and more frail, intolerance and thus, noncompliance with the bowel purge, is a critical factor influencing the quality of bowel prep during colonoscopy. Aims: To evaluate patient compliance, feasibility and efficacy of a split-dose PEG-based lavage in the inpatient setting. Methods: Single-center, prospective observational pilot study of a consecutive convenience sample comparing inpatients that received 4-L PEG solution versus split dose solution (2-L PEG the evening prior and 2-L after midnight on the day of the procedure). The Boston Bowel Preparation Scale was used to evaluate the quality of the bowel prep. Tolerability, patient preferences and adverse events were recorded using a self-administered patient survey completed prior to colonoscopy and through chart review. The Student's t test was used for continuous variables and the Fisher's exact test was used for all categorical variables. A p value less than 0.05 was considered significant. Results: Patient demographics are shown in Table 1. All patients in the split dose group (SPLIT) completed the bowel prep successfully while 4 patients in the full dose group (FULL) did not; resulting in cancellation of the procedure. The majority of patients in the SPLIT group (85%) would prefer split dose over full dose for future colonoscopies while 39% of patients in the FULL group would not choose full dose lavage again. There were no significant differences in adverse events or quality of bowel prep between the two groups (Table 2). Conclusions: This pilot study demonstrates that the split dose 4-L PEG solution is a well-tolerated, feasible bowel cleansing method among hospitalized patients. The higher rates of completion of the bowel prep among the split dose bowel cleansing group suggest that split dose lavage may enhance compliance with bowel prep before colonoscopy among hospitalized patients. Table 1. Baseline Characteristics of Patients

Mo2065 The Effect of Pentadecapeptide BPC 157 on Duodenocolic Fistula Healing Darko Vukusic, Ivan Zoricic, Zarko Rasic, Marko Baric, Marko Sever, Dalibor Crvenkovic, Nermin Lojo, Domagoj Drmic, Luka Brcic, Anita Zenko Sever, Tomislav Becejac, Danijela Olujic, Andro Gliha, Robert Klicek, Sven Seiwerth, Predrag Sikiric Duodenocolic fistula is one of complications in patients with Crohn's disease or intestinal malignancy, without proper pharmacological therapy. Aim We focused on the healing of internal fistulas, specifically duodenocolic fistulas known as complications of Crohn's disease or intestinal malignancy. The stable gastric pentadecapeptide BPC 157, tested in clinical trials for IBD therapy, has already resolved the healing of various external fistulas, colocutaneous (J. Pharmacol Sci 2008), gastrocutaneous fistulas (Dig Dis Sci 2009), duodenocultaneous (Gastroenterology 2012). Therefore, BPC 157 may be a successful therapy of duodenocolic fistulas MATERIALS AND METHODS In male Wistar rats, fistula length of 4mm was surgically created as a junction between the duodenum (1cm aboral from pylorus) and colon (2 cm aboral from ileocecalne valve). The pentadecapeptide BPC157 was regulary used in doses 10eˇg/kg and 10ng/kg ip. Control rats received 0.9% NaCl (ip). The rats were weighed once daily during the experiment (groups 1, 3, 5, 7, 14, 21 and 28 days). During the sacrifice the volume of water (V), required for leakage through the fistula (mLH2O), was measured. The body mass change, macroscopic changes of bowel at the fistula site(the diameter of the fistula at duodenal and colonic side) and microscopical evaluation of the fistula were also observed. RESULTS During our experiment all control animals from first experimental day were losing their weight(7th day: con -70 +/-15g vrs BPC 157 -20+/- 8.3g ; 14thday: con -43+/- 6.5g vrs BPC 157 -18 +/-5.2g). The diameters of duodenum and colon were similar in control and in pentadecapeptide BPC 157 groups (duodenal diameter: 6.2mm +/-1.6 mm (control group) vrs. 6.1 +/- 1.8 mm(BPC 157 groups), colon diameter : 9.1+/-1.6 mm (control group) vrs 8.8+/- 1.4 mm (BPC 157 group)). In pentadecapeptide BPC 157 rats, during 28 days the fistula was successfully healed, in control group the same was not noticed (0.0+/-0, 0 mm(duodenal), 0.0+/-0.0 mm(colon)diameter) vrs 2.1+/-0.3 mm(duodenal), 1.8+/-0.2mm(colon) diameter ; V: 8.3+/-0.5mL(BPC157) vrs 1.1+/-0.3ml(con)). The duodenocolic fistula healing was also microscopicaly confirmed. CONCLUSION Pentadecapeptide BPC 157 improved in our experiment all observed parameters of duodenocolic fistula healing, and could be pharmacological solution for this complicate clinical problem Key words: Pentadecapeptide BPC158, duodenocolic fistula, rat