[The growing resistance of bacterial strains to antibiotics]. / Narastajaca opornosc szczepów bakteryjnych na dzialanie antybiotyków.

Understanding the mechanisms of bacterial resistance to antibiotics made it possible to divide this phenomenon into natural and acquired resistance. The natural resistance of the bacteria is related to the lack of antibiotic ability to penetrate into the interior of the bacteria and limit the ability of penetration through the cell wall, as well as the poor affinity of the drug for the receptor or the lack of such a receptor. The acquired bacterial resistance is related to the changes occurring within the resistance genes and their rapid transfer, in which plasmids participate. The single- and multistage mutations of TEM (temoneira), SHV (sulfhydryl variable) and CTX-M (cefotaximase) lead to ESBL (extended-spectrum beta-lactamase) resistance. The main mechanisms responsible for shaping bacterial resistance to antibiotics are intracellular transformations determining internal resistance, acquisition of resistance in the process of mutation or transfer of horizontal resistance genes, and adaptive resistance, which is defined as a transient increase in resistance due to gene induction by the antibiotic itself, e.g. as a result of interaction with an antibiotic. Observed increasing resistance of bacteria to antibiotics is associated with their abuse without reasonable indications and with extensive use in veterinary and food industry. In Europe, about 25,000 people die every year due to antibiotic-resistant infections, which involves costs - about 1.5 billion euros a year.

Intradural disc herniation - report of two cases.

Intradural disc herniation is a very rare condition, which occurs in up to 0.3% cases of all disc herniations. It mostly develops at L4-L5 level, which is caused by the presence of strong adhesions between the posterior longitudinal ligament and dura mater. These rare cases are included in the classifications, however, they are associated with diagnostic difficulties, both in physical examination and in the image visible in magnetic resonance. REPORT OF 2 CASES: The presented patients were treated in the Neuroortopedic Department within the last two years. Despite previous examinations, the final diagnosis of intradural disc herniation occurred only during the surgery. CONCLUSIONS: Rarely occurring hernias of the intervertebral disc require increased vigilance among surgeon's spine physicians. Preoperative diagnosis of intradural lesion would make it possible to develop a better surgical strategy.

[Leczenie operacyjne zlaman zeba obrotnika z dostepu przedniego]. / Surgical treatment of the odontoid fractures from anterior approach.

The surgical treatment of the odontoid fractures is an important problem in the practice of medical teams involved in spinal surgery. There is still no consensus on dealing with fractures C2. The stabilization of the rodontoid with 1 or 2 cannulated screws (AOSF) is currently one of the options in the treatment of C2 unstable fractures since Bohler and Nakanishi introduced this method. AIM: The aim of the study was to assess the risk of complications in the early perioperative period of patients subjected to the stabilization procedure of the odontoid using AOSF. MATERIALS AND METHODS: Retrospective results of treatment of patients with odontoid fractures treated surgically with AOSF in the neuroortopedic ward in 2009-2018 were analyzed. The study also assessed the size of blood loss during surgery, the duration of surgery, the average time of hospitalization, the number of days in the ward after surgery. Perioperative complications, spinal cord injury, hematoma and wound area infection, the number of reoperations and intra- and perioperative mortality were also assessed. RESULTS: Most of the 47 patients treated with AOSF exceeded 50 years of age. The duration of the operation was on average 95 +/- 15 min. Only one patient required early reoperation on the second postoperative day due to a hematoma within the neck accompanied by dyspnea. Intra- and post-operative blood loss did not exceed 100 ml, and in 42 (89%) patients, there was no trace. There were no signs of surgical site infection. 19 patients (40%) from the operated group had additional fractures. The average time of hospitalization was 6.7 +/- 2.3 days, and the duration of stay after surgery 3.6 +/- 2.2 days. In the postoperative period, no cardiorespiratory complications were observed. CONCLUSIONS: A high safety profile of the stabilization of the odontoid was found using AOSF. Stabilization from the anterior approach enables early mobilization of the patients and shortening the time of hospital stay.

Post-traumatic bilateral scapular and thoracic vertebral body fractures - a case report.

The simultaneous fracture of both scapulae with coexisting fracture of the thoracic vertebral body is observed extremely rarely and is fully dependent on the mechanism that caused them. A CASE REPORT: The 59-year-old patient was admitted to the trauma and orthopedic department because of back pain and the inability to move independently. A few hours earlier he suffered bludgeoning trauma from a thick branch falling from a tree. During the physical examination significant limitation the range of motion in shoulder joints with was found. <15 ° flexion and <30 ° abduction, with limited external rotation in the right shoulder joint, and <15 ° flexion and <15 ° abduction, with significant external rotation deficiency. Normal range of motion in both hands was preserved. No sensory deficits or paresis were observed. Radiographic examination revealed the presence of a multifragmentary fracture of both scapulae and a fracture of the Th9 vertebral body, which was confirmed by computed tomography of the chest. The patient was qualified for conservative treatment of scapular fractures and was fitted with an abduction splint for the left shoulder. The Th9 vertebral body required surgical approach. The patient underwent transpedicular stabilization of the Th7,8,9,10 vertebrae with precontoured rods for the kyphotic deformation of the spine. After the procedure, the patient was provided with Javette's brace strengthening the spine correction and discharged for further outpatient observation. CONCLUSIONS: Fracture of the scapula is one of the most demanding fractures to diagnose in the classic radiological examination. CT scans with 3D reconstruction can be considered to be the "gold standard". Surgical procedures is indicated for patients with severe comminution of fracture fragments and neurological symptoms. Minor fracture displacements can be conservatively treated. Coexisting Th9 vertebra fracture in this case required surgery by posterior transpedicular stabilization.

Assessment of bone union in the cervical spine after the application of a spinal cage.

Background. The aim of our study was to assess interbody bone union in the cervical spine after discectomy and the use of a spinal cage. Material and methods. The clinical material consisted of 117 patients who underwent anterior cervical discectomy and fusion with a Solis cage, packed with bone graft. The subjects were operated in the Department of Neuroorthopedics at the STOCER Rehabilitation Center in 2001-2004. The follow-up ranged from one to three years. One-level fusion was performed in 50% of these cases, two-level in 48%, and three-level in 2%; thus 177 levels were examined. Radiological evaluation included bone union and stiffness of segments without bone union. In clinical examination, pain intensity was evaluated according to the ten-point VAS score. The Neck Disability Index (IND) self- assessment questionnaire was used to evaluate the patients" quality of life. Results. Union was achieved in 90% of the operated spaces. Bone fusion occurred more frequently in multi-level spondylodesis. All the operated interbody spaces in which nonunion occurred were rigid. There was no correlation between the radiological and clinical outcomes. Conclusions. The use of a Solis cage packed with autogenic bone grafts to replace a resected intervertebral disc allows union to be obtained.