BackgroundThe 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.MethodsA 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.ResultsDuring 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).ConclusionsThe 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.

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Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018–1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%—neurovascular, 13.7%—neurodegenerative), 33.9% cancer (20.2%—head and neck, 11.7%—gastrointestinal cancer), 2.5%-gastroenterology, 1.5%—inherited diseases. Of new registrations in 2018—cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m2, NRS 2002 score—4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.

Background Due to limited number of studies, we tested feasibility of autologous epineural sheath conduit (ESC) in repair of 6‐cm median nerve gaps in a sheep—the large animal model. Materials and methods Eight ewes, 6–8 months old, 30–35 kg, were divided into three experimental groups: group 1—no defect repair (n = 4 nerves/group), group 2—autograft controls (n = 6 nerves/group), group 3—autologous ESC filled with saline (n = 6 nerves/group). ESC was constructed from a 6‐cm long segment of sheep median nerve and tested for expression of laminin B, Glial fibrillary acidic protein (GFAP), S‐100 and CD31 using immunofluorescent staining. At 6 months after nerve repair, nerve conduction velocity and somatosensory evoked potentials (SSEP) assessed neurosensory recovery, while histomorphometry tested nerve regeneration. Results Ex vivo characterization of ESC, before in vivo nerve gap repair, showed high laminin B expression, which supports axonal growth. At 6 months post‐repair, structural integrity of ESC was preserved. ESC was well‐vascularized and tissue adhesions were comparable to autograft controls. The maximal conduction velocities (29.80 ± 5.85 ms vs. 32.28 ± 6.75 ms; p = .44), action potential amplitudes (32.68 ± 17.44 mV vs. 44.14 ± 23.10 mV; p = .38) and SSEP amplitude values (6.18 ± 5.84 mV vs. 4.68 ± 2.53 mV; p = .28) were comparable between autograft and ESC groups. Presence of regenerating axons was confirmed in the distal segment of ESC at 6 months after repair. Conclusion The feasibility of ESC in restoration of 6‐cm long nerve defects in a sheep median nerve model was confirmed by nerve conduction assessments and correlated with axonal regeneration tested by histomorphometry. We confirmed ESC potential in support of regeneration of long nerve defects.

Objectives Patients on home parenteral nutrition (HPN) are prone to severe complications of SARS-COV-2 infection. The pandemic requires adaptation of the health care standards, including epidemiological surveillance, logistics of home supply and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of the analysis was to evaluate the medical staff resources in HPN units. Results The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first three months of the pandemic (March-May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for HAN (home artificial nutrition) was estimated. 14 of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75 per million citizens. 344 HCW are involved in patients’ care in Polish HPN units; 18.9% are physicians (49%-surgeons, 18.46%-internal medicine specialists, 15.38%-Anesthesiologists, 7.69%-Pediatricians, 1.54%- Palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN Patient to HCW ratios for physicians, nurses, pharmacists, dietitians were respectively: 49.5; 29.15; 111.6; 181.6. Medium age of physicians and nurses was: 45.6 and 44.15. 53.8% of physicians and 31.53% of nurses work parallelly in hospital wards. 31 Pharmacists overall are working in all HPN units (2.21 per unit) and 18 dietitians (1.3 per unit). 9 patients had a confirmed COVID-19 infection (4- HPN, 5-HEN). All the units introduced telemedical solutions in the first months of the pandemic. The number of new qualifications for HPN and HEN in the units did not significantly decline in March-May in comparison with a similar period in 2019. Conclusions A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health system may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental impact on HPN including serious issues with access to professional HCW.

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Splenic abscess is a potential complication of many disease entities which involve infections. Diagnostics are based on imaging studies. Treatment involves splenectomy and antibiotic therapy. In the case the abscess is limited, and particularly in young patients, percutaneous abscess drainage may be performed. This paper presents a case of a 66-year old female patient following coronary artery bypass grafting (CABG) complicated with sternum infection and cholecystectomy due to gallbladder abscess complicated with surgical site infection, who underwent long-term treatment in the ICU due to respiratory failure and persistent septic condition. Splenic abscess is a rare complication of abdominal cavity diseases and systemic infections.

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