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Adipokines regulate glucose homeostasis, insulin sensitivity, lipids metabolism, reproduction, as well as endothelial and platelets function. The study compares the plasma and adipose tissue concentrations of total adiponectin, leptin, leptin receptor and leptin-to-adiponectin ratio (LAR) in morbidly obese patients. Additionally it evaluates selected adipokines (leptin, adiponectin), endothelial markers and LAR depending on the gender in morbidly obese and non-obese subjects. The study involved 51 patients (31 women aged 21 - 60 (mean age of 39) and 20 men aged 24 to 60 (mean age of 41)). The eligibility criterion included the BMI ≥ 40 kg/m2. The non-obese group consisted of 30 healthy volunteers with the BMI < 24.9 kg/m2; nineteen women, aged 24 - 53 (mean age of 41), and 11 men aged 21 - 52 (mean age of 38). In the plasma and adipose tissue, the concentrations of total adiponectin, leptin, leptin receptor and plasma soluble forms of E-selectin, P-selectin, thrombomodulin were measured applying immunoassay techniques. There were noted significantly higher plasma leptin and sE-selectin concentrations, leptin-to-adiponectin ratio, additionally lower concentrations of plasma leptin receptor and sP-selectin in obese subjects regardless of the gender. Significantly higher concentrations of total adiponectin, leptin, leptin receptor expressed per 1 mg of total protein in adipose tissue, as compared to plasma in morbidly obese patients, were observed. Significant positive correlations between the BMI and the concentration of leptin and between total adiponectin and sP-selectin were reported in the subject group. Similarly there were noted significant negative correlations between leptin receptor and the BMI and between leptin-to-adiponectin ratio and sP-selectin in obese patients. The study has shown that adiponectin has a positive impact on platelets through a possible reduction in sP-selectin, and thus on platelets activation. On the other hand an elevated sE-selectin reveals perspective about the endothelium stimulation and a higher risk of endothelial damage in morbidly obese patients. Also in morbidly obese the higher leptin level and leptin-to-adiponectin ratio and simultaneously lower concentration of leptin receptor are associated with leptin resistance, additionally in possible future risk of insulin resistance and diabetes type 2.

Introduction: Upper gastrointestinal tract bleeding (UGIB) remains a valid issue of modern medicine. The mortality and recurrence rates remain high and have not decreased as expected over the past decades., Aim of the Study: to assess the treatment outcomes of nonvariceal UGIB depending on the timing of endoscopy (urgent vs. elective) and to perform an analysis of risk factors for death in patients with nonvariceal UGIB., Material and Methods: Comparative evaluation of treatment outcomes in two groups of patients. Group A consisted of patients undergoing elective endoscopy (n = 187). Group B consisted of patients undergoing emergency endoscopy (n = 295). Moreover, the influence of selected factors on the risk of death and bleeding recurrence was analyzed in the combined population of the two groups. This was done by constructing a logistic regression model and testing dependence hypotheses., Results: In group A the mortality rate was 9.1%, and the recurrence rate was 18.2%. In group B the values were 6.8% and 12.2%, respectively. No statistically significant difference was found (p = NS). In group B the number of surgical interventions, blood transfusions and intensive care admissions was significantly lower (p < 0.05). An analysis of the combined material showed that the factors which correlated with an elevated risk of death included: old age, hemodynamic state (shock), elevated Charlson Comorbidity Index score, hemoglobin concentration, bleeding from a malignant lesion, recurrent bleeding and the need for surgery (p < 0.05)., Conclusions: The use of emergency endoscopy improves the treatment outcomes in patients with UGIB, although no statistically significant decrease in the mortality and recurrence rates could be observed.

Background: Obesity is a well-established risk factor for incisional hernia development. The exact causative factors have not been clearly defined, and development may result from structural disruptions in the connective tissue of the fasciae. The goal of this study was to compare the content of elastin in the rectus muscle sheath of obese patients and nonobese controls., Materials and Methods: The study group consisted of 20 patients with body mass index over 35 kg/m(2) and the control group included 19 patients with normal-range body mass index. The biopsy specimens harvested during surgery were subjected to histologic evaluation, an immunohistochemical reaction with monoclonal anti-elastin antibodies, and the DAB chromatic reaction. The photomicrographs were evaluated using ImageJ software and the percentage of the area affected by the color reaction was assessed. A statistical evaluation was performed., Results: The specimens harvested from persons in the control group showed in hematoxylin-eosin staining a high density of fibrous elements, arranged in regular bundles. In specimens obtained from the morbidly obese, the density of the fibers was lower and their architecture was disrupted; the bundles were thinner and less regularly arranged. Most photographs show adipose tissue infiltrating the structure of the fascia. Statistical analysis of the percentage of the area occupied by elastin showed a statistically significant difference in favor of the controls., Conclusions: The quantitative and qualitative changes in the elastin content of rectus abdominis muscle sheath fascia in the obese population may indicate a possible local mechanism influencing the development of incisional hernias., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Introduction: One of the most serious complications associated with the use of implants in hernia surgery is deep surgical site infection involving an implanted biomaterial. Among the major etiological factors of this complication are Staphylococcus aureus and Escherichia coli strains, which have the ability to form a biofilm on the surface of the mesh implant. This process is influenced by many factors, of which, according to current medical knowledge, the concentration of glucose may have a clinical significance. The aim of the presented study was to evaluate the effect of glucose on the formation of biofilm on the surface of monofilament polypropylene mesh., Methods: The study included 140 bacterial strains (70 S. aureus and 70 E. coli) from the collection of Department of Microbiology Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun. Evaluation of the effect of two glucose concentrations (0.1% and 0.2%) on biofilm formation was performed using a qualitative (2,3,5-triphenyltetrazolium chloride reduction) and a quantitative ( serial 10-fold dilutions) methods., Results: A qualitative analysis, performed after a period of incubation on substrates containing various concentrations of glucose, has revealed a statistically significant increase in the percentage of S. aureus strains with a very high potential for biofilm formation, while for E. coli an increase was observed in the percentage of strains with a low potential for biofilm formation. In a quantitative analysis of the biofilm of S. aureus forming after incubation on a substrate containing 0.1% and 0.2% glucose, significantly more colony forming units (CFUs) were isolated per one milliliter of the suspension (CFU/ml) than in the control group biofilm samples. On the other hand, the biofilm created by E. coli after a period of incubation on a substrate containing 0.2% glucose yielded significantly fewer CFUs per one milliliter than from the biofilm resulting from incubation on substrate with 0.1% glucose or the control group. No statistically significant difference was found between the numbers of CFUs per one milliliter isolated from E. coli strains after incubation on a substrate with 0.1% glucose and the control group., Conclusions: At concentrations of 0.1% and 0.2%, glucose increases biofilm formation by S. aureus strains on the surface of monofilament polypropylene mesh; at 0.2% glucose limits biofilm formation in E. coli.

Background: The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda's technique, presented in 2001, is an original hernia repair method using an undetached strip of external oblique aponeurosis. This randomized trial compared outcomes after hernia repair with Desarda (D) and mesh-based Lichtenstein (L) techniques., Methods: A total of 208 male patients were randomly assigned to the D or L group (105 vs. 103, respectively). The primary outcomes measured were recurrence and chronic pain. Additionally, early and late complications, foreign body sensation, and return to everyday activity were examined in hospital and at 7, 30 days, and 6, 12, 24, and 36 months after surgery., Results: During the follow-up, two recurrences were observed in each group (p = 1.000). Chronic pain was experienced by 4.8 and 2.9% of patients from groups D and L, respectively (p = 0.464). Foreign body sensation and return to activity were not different between the groups. There was significantly less seroma production in the D group (p = 0.004)., Conclusions: The results of primary inguinal hernia repair with the Desarda and Lichtenstein techniques are comparable at the 3-year follow-up. The technique may potentially increase the number of tissue-based methods available for treating groin hernias.

Background: Current research data indicate that a hernia is a manifestation of a generalized polyethiological connective tissue pathology. The goal of this study was to demonstrate ultrastructural differences in tissues distant from the hernial defect., Materials and Methods: Biopsy specimens harvested upon thigh surgery from 12 males aged 25-65 y were compared. Seven of these men had an inguinal hernia or a history thereof. Scanning electron microphotograms taken at a magnification of 50× were analyzed with the use of Image J software. For every patient, 100 thickness measurements were performed of the fibrous elements (cross-sections) visible in five consecutive photograms. The person performing the measurements had no means of identifying the patient from whom the specimen had been harvested., Results: The authors have found the thickness of the fibers to fall in the range from 23.441 u (ImageJ intrinsic units) to 94.878 u in the hernia group and 22.067 u to 303.681 u for the control group. A statistically significant difference was found between the mean values of thickness measurements of the fibrous elements in the study and control groups., Conclusions: The study has shown that in patients with an inguinal hernia, the mean diameter of fibers within the fascia lata is significantly smaller. This appears to indicate that the process is generalized and that one can expect the structural alterations to occur within the connective tissue of the entire organism. The authors speculate that they may result from a combination of external and internal factors., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: The etiology of inguinal hernia remains unclear. Research data indicate the presence of pathologic alterations within the connective tissue; their exact character remains the subject of dispute. The search for new methods to diagnose connective tissue abnormalities, and thoroughly explain the character of the ultrastructural alterations, continues., Materials and Methods: The study group included 10 male patients aged 18-60 y (five with primary inguinal hernia and five with acute appendicitis with no history of hernia). A specimen of the rectus muscle sheath was harvested from all of them upon surgery. The tissue samples were fixed and examined by spectrofluorometry and fluorescence microscopy, yielding fluorescence spectra and microscopic fluorescence images., Results: Both techniques have demonstrated significant differences between the biopsy samples harvested from hernia patients and healthy controls. The groups of fluorescence spectra were shifted relative to each other and showed maximum emission at different wavelengths after excitation with 350 nm light (arbitrarily chosen for one of the cross-link proteins). The spectra obtained for healthy controls were more homogenous, while the spectra of the hernia samples differed even between each other. In microscopic images, the difference was a more chaotic distribution of fluorophores in the samples obtained from hernia patients., Conclusions: The evidence of significant differences between the samples harvested from the same location from hernia patients and healthy controls, found by fluorescence techniques, indicates the presence of abnormalities in the connective tissue forming the rectus muscle sheath. This area is not a part of the hernial defect, therefore, we can assume that the changes can be attributed to a generalized process., (Copyright © 2011 Elsevier Inc. All rights reserved.)

A serious complication of hernioplasty with the use of a biomaterial implant is deep surgical site infection (SSI) encompassing the implant. Among the most common etiological factors of deep SSI in patients after hernioplasty are Staphylococcus aureus and Escherichia coli strains, which may create a biofilm on the surface of synthetic implants. The aim of this study was assessment of biofilm formation by S. aureus and E. coli on the surface ofpolypropylene mesh. The study included 108 strains (62 S. aureus and 46 E. coli) from the collection of Department of Microbiology Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun (CM UMK). Evaluation of biofilm formation was performed using the method of reduction of 2,3,5-triphenyltetrazolium chloride (TTC) and a scanning electron microscope. In the group of S. aureus strains, 88.7% isolates formed biofilm very strongly, 1.6% strongly, and 9.7% poor. Among E. coli strains, 54.3% isolates were characterized by very strong biofilm formation, while 45.7% strong biofilm formation. Strains ofS. aureus strongly than E. coli form a biofilm on the surface of monofilament polypropylene mesh.

Mesh hernioplasty is among the most frequently performed surgical procedures. The introduction of mesh implants has decreased recurrence rates, but the use of synthetic materials carries the risk of infection and biofilm formation. This paper presents the course of the disease in the case of biofilm formation on the surface of an implanted surgical mesh. Antimicrobial therapy and partial removal of the implant were unsuccessful. Recurring surgical site infection could be managed only through total excision of the infected implant.

In the last decade, in the search for abdominal-wall hernia etiology, attention has been brought to alterations in the connective tissue ultrastructure as the probable etiological factor. These may cause weakening of connective tissue, which in turn may form ground for hernia formation. To investigate this hypothesis in depth, we compared the ultrastructure of the connective tissue in hernia patients and the control group. The study group consisted of five patients with primary inguinal hernia (Nyhus II = 4, Nyhus IIIa = 1). Another five patients posted for emergency appendectomy created the control group. Tissue specimens, harvested intraoperatively from the rectus muscle sheath (RAMS) and fixed in 4% glutaraldehyde, underwent staining by the Masson, H-E and methylene blue techniques and were assessed by microscopy (light and scanning electron). The examinations showed significant differences in the rectus sheath ultrastructure. They included altered architecture, placement and quantity of collagen and elastic fibers, differences in the caliber of individual fibers and disrupted ground matter-to-fiber ratio. In patients with hernias, chaotic arrangement of collagen fibers was seen, as well as their thinning and a decrease in the general amount of elastic fibers, replaced by ground matter. Our research has shown significant differences in the structure of the RAMS between patients with hernias and healthy individuals. This supports the theory linking connective tissue alterations with the etiology of hernia, and stating that these alterations include connective tissue at locations distant from the hernia site as well, as the rectus sheath itself does not form a hernial defect.

Aim of the Study: The results of a survey designed to investigate abdominal wall closure techniques have been analyzed in this report., Material and Methods: The participants were asked to choose a method of abdominal wall closure in groups of patients with progressively increasing risk of wound healing complications., Results: Sixty-nine surgeons responded (median age 41 years), with a median professional life of 15 years. In low and moderate-risk patients, abdominal wall closure plan was similar; the peritoneum and fascia would be closed separately. Continuous absorbable sutures were most frequently picked. Treatment option choices were more diversified in the high-risk group. No dominant surgical method could be found; different suturing materials were proposed, mainly in the form of interrupted sutures. In almost every third patient antieventration sutures were taken as a option., Conclusion: A correlation was found between the risk group and surgical technique, the use of interrupted/continuous sutures and anti-eventration sutures. Dexon, Vicryl and PDS were most frequently selected sutures by surgeons who responded to the survey.

A comprehensive, up-to-date assessment of the incidence and treatment cost of inguinal hernias in Poland is made difficult by the lack of a central data registry and insufficient accuracy of the data available. Therefore, research was undertaken in order to evaluate the incidence and cost of inguinal hernia treatment in the years 2001-2002 in Poland. Survey-derived data was collected from Regional Health Funds operating similar data management systems in 2002 and the Regional Branches of the National Health Fund in 2003. The number of inguinal hernia repairs, length of hospital stay, as well as the cost of these procedures and the overall number of insured people in the region were assessed. Data was obtained from 11 units (Regional Health Funds, Branches of the National Health Fund). The length of hospital stay differed between individual Regional Health Funds. The annual cost of inguinal hernia treatment amounts to approximately 100 million PLN.

The ever-increasing use of biomaterials in many areas of medicine has led to a significant increase of reports concerning medical materials science. Much of the vocabulary used in English literature lacks proper unambiguous equivalents in the Polish language; inaccurate translations are frequent, leading to significant alterations of the meaning. The authors of this report have attempted to create a glossary of the terms pertaining to materials science most frequently encountered in herniological reports.

To study the influence of venous hypertension, which develops in lower limbs under pneumoperitoneal pressure, on microcirculation, plethysmographic measurements were performed in patients before and during laparoscopic and traditional (open) cholecystectomy. During laparoscopy, isovolumetric venous pressure (estimate of capillary pressure), and filtration coefficient (estimate of patent capillary surface) decreased, which was not the case during open surgery. These results indicates that venous hypertension during laparoscopic surgery does not extend to the microcirculation; vasoconstriction is a result of protective mechanisms, which disable excessive fluid filtration in microcirculation. Parameters of macrocirculation (ambient venous pressure, compliance of calf tissue) changed intraoperatively in both groups similarly, irrespectively of the surgical technique.

To study the influence of venous hypertension, which develops in lower-limbs under pneumoperitoneal pressure, on microcirculation-plethysmographic measurements were performed in patients before and during laparoscopic and traditional (open) cholecystectomy. During laparoscopy isovolumetric venous pressure (estimate of capillary pressure), and filtration coefficient (estimate of patent capillary surface) decreased, which was not the case during open surgery. Results indicates that venous hypertension during laparoscopic surgery does not extend to microcirculation; vasoconstriction is due to protective mechanisms, which disable excessive fluid filtration in microcirculation. Parameters of macrocirculation (ambient venous pressure, compliance of calf tissue) changed peroperatively in both groups similarly, irrespectively of the surgical technique.

Abstracts play an important role in medical literature as the carriers of synthetic information. Their significance grows as computerized data bases are in use in which whole information should comprise no more than 250 words. Critical appraisal the abstracts' standard resulted in a proposal for data presentation divided into significant parts (structured abstracts). The abstract of an original clinical trial should contain description of the objective, design, setting, patients, intervention, main outcome measures, results and conclusions. The abstract of the review article should provide information about the purpose, data identification, study selection, data extraction, results of data synthesis and conclusions. This form obliges the authors to precise, logical formulation draws out the essential aspects of the work, facilitates literature review, and critical appraisal.

Seven diagnostic tests were employed to detect the infection of gastric mucosa with the H. pylori bacteria, among patients with epigastric pain and dyspeptic complains. The tests' results were compared to the bacteriologic culture. For each test the following criteria were taken into consideration: sensitivity, specificity, positive and negative predictive values. The tests' accuracy was compared with the agreement expected by chance and beyond chance (kappa). For each test the likelihood ratio was calculated for its positive and negative results. The construction of so called diagnostic decision tree was presented, which allows on the evaluation of the diagnostic test and its utility. The best result were obtained from the test, in which the identification of bacteria took place in the histopathologic specimen after its Gram staining. The interpretation of clinical significance of diagnostic data is simplified with the use of likelihood ratio calculated for a positive test result.

The effectiveness of flexible endoscopes disinfection was evaluated. Since 1991 to 1994--157 inoculations were taken from endoscopic equipment--right after the examination and after their disinfection. Following the endoscopes examinations were contaminated by microorganisms normally resident in the throat, respiratory and digestive tracts, but also with bacteria (Acinetobacter, Pseudomonas, Proteus) which could be source of severe nosocomial infections. Three times there was Ps. aeruginosa on an endoscope after its disinfection, which demonstrates ineffectiveness of the whole sanitary process. Constant surveillance demands sterility of the fluids employed during the disinfection process. The improvement in sanitary level is achieved when endoscope exposition to glutaraldehyde has been elongated, to each endoscope a new solution of detergent has been applied, and sterile water handling (its production, storage, and use) has been polished up.