Paraesophageal hernia repair with bifacial mesh.

Background.The paraesophageal hiatus hernias (PHH) are relatively uncommon, but an increased incidence has been reported and they now account for 5-10% of all hiatus hernias. The surgical treatment is recommended for all the patients with this pathology because of high risk of complications: obstruction, incarceration, strangulation or perforation. The use of prostheses is recommended in the process of repairing the giant PHH because the main problem of this operation is the high rate of recurrence. Case presentation.The patient is a 44-year-old male with a large and symptomatic paraesophageal hernia. Diagnosis was confirmed by instrumental examination. An elective laparoscopic repair was carried out by using polypropylene bifacial anti adhesive synthetic mesh (Surgimesh XB Aspide Medical). The postoperative period passed without severe complications. Conclusions.The laparoscopic approach as a therapeutic option can be successfully used in the repair of paraesophageal hernia. A selective use based on clinical experience was recommended, as the technique appeared to be safe, and in case of large hiatus hernia with hiatal defect, greater than 5 cm, the application of synthetic material to minimize the recurrence rate was recommended.

[Peritoneal biofilms: microscopic features]. / Biofilme peritoneale: caracteristici microscopice.

Antibiotherapy remains one of the basic clinical tools, which can influence the evolution of severe peritonitis. Peritoneal biofilm formation may minimize the antibiotic effects due to dramatic growth of Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentrations (MBC) for matrix-enclosed bacteria. In this paper we demonstrate the presence and evolution of bacterial biofilms on the peritoneal surface during the course of severe secondary peritonitis using an experimental model and clinical material. Cecal Ligation Puncture was performed in 20 mice Swiss Webster. Peritoneal samples were studied at optic and electronic microscope at 10, 24, 48 and 72 hours postoperative. Clinical samples were taken from 10 patients with diffuse peritonitis. At 24 hours after the onset of the peritonitis bacterial colonies were detected on the peritoneal surface. The formation of mature multilayer polymicrobial biofilms with deep penetration in abdominal wall by 48-72 hours was documented. The bacterial biofilms appear in first 24 hours in the course of experimental generalized peritonitis. Our experimental and clinical data demonstrate formation of the mature polymicrobial biofilm in 48-72 hours after the onset of peritonitis. The possibility of resistant biofilm formation in secondary diffuse peritonitis should be taken into consideration in elaboration of treatment schemes.

[Antifungal activity of the components of the drug cerbiden of plant origin]. / Antyfunhal'na aktyvnist' komponentiv preparatu tserbidenu roslynnoho pokhodzhennia.

Complex drug cerbiden has been studied in vitro for the antifungal activity of its components. It has been established that the spectrum of antifungal effect and activity of cerbiden, with respect to fungi conditionally pathogenic for people, is determined by antibiotic compounds--aromatic carbohydrate phenylheptatryin and sesquiterpene phenol cernusol. They process a spectrum of antifungal activity analogous to cerbiden and activity close to Candida spp., some basidial yeast, dermatophytes, a number of Mucorales.

[The role of pneumonotomy with necrectomy in the therapy of gangrenous processes in the lungs]. / Mesto pnevmotomii s nékréktomiei v lechenii gangrenoznykh protsessov legkikh.

The authors discuss their experience in the performance of pneumonotomy in the treatment of gangrenous lung processes. They conducted 103 operations. It was established that up to 40% of patients with gangrenous diseases of the lungs must be treated by pneumonotomy. The technical and tactical variants of accomplishing pneumonotomy are described. The mortality rate was 31%.