Cilj ovoga rada je prikazati rijedak slučaj kožne i plućne tuberkuloze (TBC) u bolesnice s miješanom bolesti vezivnoga tkiva na imunosupresivnoj terapiji, kako bi se ukazalo na važnost rane ...dijagnostike, liječenja i prevencije komplikacija bolesti.
TBC je zarazna bolest uzrokovana bacilom Mycobacterium tuberculosis (MT). Prenosi se kapljičnim putem u kontaku s oboljelom osobom, dok su drugi oblici prijenosa izuzetno rijetki. S obzirom na lokalizaciju, bolest se dijeli se na plućnu i izvanplućnu TBC. 15% svih slučajeva TBC-a čine izvanplućni oblici, dok je kožna TBC rijedak izvanplućni oblik koja čini 0.5-2% svih izvanplućnihih TBC-a u razvijenim zemljama. Čimbenici koji pridonose razvoju i progresiji TBC-a su alkoholizam, loša ishrana, šećerna bolest, infekcija virusom humane imunodeficijencije (HIV)/sindrom stečene imunodeficijencije (AIDS), razvoj transplantacijske medicine, kronični program hemodijalize, sve veće liste bolesti i stanja koja zahtijevaju primjenu imunosupresivne terapije. Široki spektar simptoma i znakova TBC-a česti su uzrok nepravovremeno postavljenoj dijagnozi, što odgađa adekvatno liječenje, povećava broj i mogućnost komplikacija, te u konačnici dovodi do povećanja mortaliteta.
U ovom prikazu slučaja bolesnica je razvila kožni i plućni oblik TBC-a, a dijagnoza je postavljena tek nakon deset mjeseci od razvoja prvih simptoma. Provedeno je liječenje antituberkuloznim lijekovima (ATL) (izoniazid, rifampicin, etambutol, pirazinamid) u trajanju od godinu dana, nakon čega je došlo do potpune regresije kožnih promjena, kao i radiološkog nalaza plućnog infiltrata.
Amiloidoza je poremećaj lokaliziranog ili difuznog nakupljanja fibrilarnih proteina u izvanstaničnom prostoru, koji progresivno oštećuju strukturu tkiva i funkciju organa. Poremećaj može zahvatiti ...bilo koji organski sustav u tijelu. Prikazuje se slučaj lokalizirane amiloidoze dušnika u 62-godišnjeg bolesnika liječenog zbog aktivne tuberkuloze pluća. Između ostalih dijagnostičkih postupaka učinjena je i bronhoskopija, pri čem su uočene tumoru slične promjene na sluznici dušnika. Histološka pretraga uzorka dobivenog biopsijom sluznice sa zahvaćenog mjesta ukazala je na amiloidozu. Liječenje laserskom fotokoagulacijom rezultiralo je znatnim povlačenjem nastalih promjena.
We focused on the therapeutic effect of the stable gastric pentadecapeptide BPC 157 and how its action is related to nitric oxide (NO) in persistent colocutaneous fistula in rats (at 5 cm from anus, ...colon defect of 5 mm, skin defect of 5 mm); this peptide has been shown to be safe in clinical trials for inflammatory bowel disease (PL14736) and safe for intestinal anstomosis therapy. BPC 157 (10 μg/kg, 10 ng/kg) was applied i) in drinking water until the animals were sacrificed at post-operative day 1, 3, 5, 7, 14, 21, and 28; or ii) once daily intraperitoneally (first application 30 min following surgery, last 24 h before sacrifice) alone or with NG-nitro- L -arginine methyl ester ( L -NAME) (5 mg/kg), L -arginine (200 mg/kg), and their combinations. Sulphasalazine (50 mg/kg) and 6-α-methylprednisolone (1 mg/kg) were given once daily intraperitoneally. BPC 157 accelerated parenterally or perorally the healing of colonic and skin defect, leading to the suitable closure of the fistula, macro/microscopically, biomechanically, and functionally (larger water volume sustained without fistula leaking). L -NAME aggravated the healing failure of colocutaneous fistulas, skin, and colon wounds ( L -NAME groups). L -Arginine was effective only with blunted NO generation ( L -NAME + L -arginine groups) but not without ( L -arginine groups). All of the BPC 157 beneficial effects remained unchanged with blunted NO-generation ( L -NAME + BPC 157 groups) and with NO substrate ( L -arginine + BPC 157 groups) as well as L -NAME and L -arginine co-administration ( L -NAME + L -arginine + BPC 157 groups). Sulphasalazine was only moderately effective, and corticosteroid even had an aggravating effect.
The gastric pentadecapeptide BPC 157, which was shown to be safe as an antiulcer peptide in trials for inflammatory bowel disease (PL14736, Pliva), successfully healed intestinal anastomosis and ...fistula in rat. Therefore, we studied for 4 weeks rats with escalating short bowel syndrome and progressive weight loss after small bowel resection from fourth ileal artery cranially of ileocecal valve to 5 cm beneath pylorus. BPC 157 (10 μg/kg or 10 ng/kg) was given perorally, in drinking water (12 ml/rat/day) or intraperitoneally (once daily, first application 30 min following surgery, last 24 h before sacrifice). Postoperatively, features of increasingly exhausted presentation were: weight loss appearing immediately regardless of villus height, twofold increase in crypt depth and fourfold increase in muscle thickness within the first week, jejunal and ileal overdilation, and disturbed jejunum/ileum relation. In contrast, constant weight gain above preoperative values was observed immediately with BPC 157 therapy, both perorally and parenterally, and villus height, crypt depth, and muscle thickness inner (circular) muscular layer also increased, at 7, 14, 21, and 28 days. Moreover, rats treated with pentadecapeptide BPC 157 showed not different jejunal and ileal diameters, constant jejunum-to-ileum ratio, and increased anastomosis breaking strength. In conclusion, pentadecapeptide BPC 157 could be helpful to cure short bowel syndrome.
We focused on the therapeutic effect of the stable gastric pentadecapeptide BPC 157 and how its action is related to nitric oxide (NO) in persistent colocutaneous fistula in rats (at 5 cm from anus, ...colon defect of 5 mm, skin defect of 5 mm); this peptide has been shown to be safe in clinical trials for inflammatory bowel disease (PL14736) and safe for intestinal anstomosis therapy. BPC 157 (10 μg/kg, 10 ng/kg) was applied i) in drinking water until the animals were sacrificed at post-operative day 1, 3, 5, 7, 14, 21, and 28; or ii) once daily intraperitoneally (first application 30 min following surgery, last 24 h before sacrifice) alone or with NG-nitro-L-arginine methyl ester (L-NAME) (5 mg/kg), L-arginine (200 mg/kg), and their combinations. Sulphasalazine (50 mg/kg) and 6-α-methylprednisolone (1 mg/kg) were given once daily intraperitoneally. BPC 157 accelerated parenterally or perorally the healing of colonic and skin defect, leading to the suitable closure of the fistula, macro/microscopically, biomechanically, and functionally (larger water volume sustained without fistula leaking). L-NAME aggravated the healing failure of colocutaneous fistulas, skin, and colon wounds (l-NAME groups). l-Arginine was effective only with blunted NO generation (l-NAME + l-arginine groups) but not without (l-arginine groups). All of the BPC 157 beneficial effects remained unchanged with blunted NO-generation (l-NAME + BPC 157 groups) and with NO substrate (l-arginine + BPC 157 groups) as well as l-NAME and l-arginine co-administration (L-NAME + l-arginine + BPC 157 groups). Sulphasalazine was only moderately effective, and corticosteroid even had an aggravating effect.
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