Therapeutic effect of ghrelin in the course of ischemia/reperfusion-induced acute pancreatitis

BACKGROUND

Protective effect of pretreatment with ghrelin against different forms of acute pancreatitis (AP) has been recently reported. Moreover, the healing properties of this peptide have been proved in AP evoked by cerulein. However, no studies have investigated whether the administration of ghrelin affects the course of ischemia/reperfusion-induced AP.

AIM

The aim of this study was to evaluate the impact of ghrelin therapy on the course of necrotizing inflammation of the pancreas and to test its impact on peroxidation of lipids and antioxidant defense system in the acutely inflamed pancreas.

METHODS

Acute inflammation of the pancreas was triggered by pancreatic ischemia which was then followed by reperfusion of the gland. Ghrelin (8 nmol/kg/dose) was administered to intraperitoneally twice daily, 24h after the initiation of AP. The impact of ghrelin on the course of necrotizing pancreatitis was evaluated between 1 and 21 days, and involved histological, functional, and biochemical analyses.

RESULTS

Treatment with ghrelin ameliorated morphological signs of pancreatic damage including edema, acinar cells vacuolization, hemorrhages, acinar necrosis, leukocytic infiltration of the gland, and led to its earlier regeneration. These effects were accompanied by an improvement in pancreatic blood flow, enhanced DNA synthesis, reduced serum level of pro- inflammatory interleukin-1β, decreased levels of malondialdehyde and an enhanced superoxide dismutase activity in pancreatic tissue.

CONCLUSIONS

Ghrelin exerts a pronounced therapeutic effect against ischemia-reperfusion-induced pancreatitis. The mechanisms involved are likely multifactorial and are mediated by its anti-inflammatory, as well as anti-oxidative properties.

Reversal of severe cognitive impairment following medical treatment of cystic invasive giant prolactinoma

Giant prolactinomas are rare tumours of the pituitary, which typically exceed 40 mm in their largest dimension. Impairment of higher cognitive function has been noted post-operatively after transcranial surgery and as a long-term consequence of the radiotherapy treatment. However, there has been little that is reported on such disturbances in relation to the tumour per se, and to our knowledge, there has been none in terms of responsivity to dopamine agonist therapy and shrinkage in these tumours. We present a case of successful restoration of severely impaired cognitive functions achieved safely after significant adenoma involution with medical treatment alone.

The role of colonoscopic screening in acromegaly revisited: review of current literature and practice guidelines

INTRODUCTION

Acromegaly is a chronic, debilitating and disfiguring condition with a significantly increased morbidity and mortality due to cardiovascular, as well as respiratory complications. Patients with acromegaly are usually diagnosed at the age of 40, however, the duration of symptoms can vary from 5 to 10 years before the formal diagnosis is confirmed. Recent advances in the field of acromegaly have improved survival significantly. A strong association between acromegaly and premalignant colonic lesions and colon cancer has been highlighted. Furthermore, patients with acromegaly have a greater lifetime risk of malignant transformation and a far worse overall prognosis from colorectal cancer, which is now considered a major disease related complication.

MATERIALS AND METHODS

A comprehensive search strategy was applied for the Medline/PubMed electronic database from its inception until April 2014. We considered all human research articles published in English, not classified as case report, editorial, comment, letter, or news.

CONCLUSION

Specific recommendations for large bowel endoscopic screening in patients with acromegaly have been proposed. In this comprehensive review we discuss the current state of knowledge and evidence on colonoscopic screening in patients with acromegaly illustrated by a case of aggressive colorectal cancer presenting late in a young woman with difficult to control acromegaly.

Regan isoenzyme of alkaline phosphatase as a tumour marker for renal cell carcinoma

Alkaline phosphatase is an enzyme present in all tissues of the human body. Several isoforms of this enzyme have been described with different catalytic nature, stability and antigenic structure. Rises in the activity of alkaline phosphatase are recognised in various states including bone diseases, liver disease, pregnancy, hyperthyroidism and malignant processes. The Regan isoenzyme, a rare variant of placental alkaline phosphatase, has been identified circulating in association with various tumours. The reported case describes a rising Regan isoform of alkaline phosphatase concentrations that led to a new diagnosis of occult renal cell carcinoma and persistently elevated activity postoperatively signposting persistent or recurrent disease.