Administration of antiemetic drugs significantly decreases the incidence of PONV in patients after laparoscopic cholecystectomy. The best decreases were achieved when ondansetron and dexamethason were applied together.

the aim of the study was to determine factors responsible for patient satisfaction after treatment at the surgical department. material and methods. The study was conducted in six health care units, which were divided into two groups: Group I: 3 hospitals with the number of beds exceeding 400, and Group II: 3 hospitals with the number of beds below 400. The study group comprised 180 patients, 30 from each of the hospitals. The authors' used the Servqual method and questionnaire with 30 questions relating to five areas characteristic of medical service. Apart from the above-mentioned we also took into consideration hospital personnel: their qualifications and salary, hospital equipment, patient hospitalization costs, and indicated by the patient -the reason for his/her satisfaction or dissatisfaction with hospitalization. Results were subject to statistical analysis. Results. The results indicated that the factors pertaining to costs, especially those related to living conditions and also those related to empathy, personnel competence, and their communication with the patient had very significant influence on patient satisfaction with his/her hospitalization. Fulfilling the patient's needs considering the functional quality increases the patient's comfort, and as a consequence translates into satisfaction with the hospitalization. conclusions. Considering both groups of hospitals the surgical departments did not entirely fulfill the patient's expectations, and there is a need for improvement in this area. The main reason for the negative feelings of patients included worse than expected living conditions, sporadic contact with physicians and lack of information concerning the course of therapy. key words: patient satisfaction, surgical department, quality of hospitalization POLSKI

IntroductionThe need to reduce pollution emissions in the operating room and to reduce treatment costs motivates more frequent use of general anaesthesia with a small or minimal fresh gas flow rate. Nevertheless, the reduction of the delivery of fresh gases should not influence the quality and safety of the anaesthesia.Material and methodsA total of 105 elective laparoscopic cholecystectomy patients were included in the study. There were 72 female (68.6%) and 33 male (31.4%) patients. Patients were randomized by a ‘closed envelope’ method into two groups. Group I included patients with low-flow anaesthesia and group II included patients with high-flow anaesthesia. In all patients the cerebral oximetry was measured separately for each cerebral hemisphere; the bispectral index (BIS), heart rate, blood pressure, end-tidal carbon dioxide concentration and haemoglobin oxygen saturation were monitored.ResultsHeart rate, blood pressure, end-tidal carbon dioxide concentration and saturation were similar in both groups and the differences between them were statistically insignificant. The BIS values were similar in both groups and indicated that patients who underwent low-flow anaesthesia were not exposed to a higher risk of awakening during the procedure than the high-flow anaesthesia patients. The changes in brain oximetry values were similar in both low-flow and high-flow anaesthesia.ConclusionsUse of both low-flow and high-flow rate general anaesthesia provided patients undergoing laparoscopic cholecystectomy proper oxygenation of the central nervous system, adequate sleep depth and haemodynamic stability.

Cornelia de Lange syndrome (typus degenerativus amstelodamensis, CdLS, Brachmann syndrome) is a complex, congenital, multi-gene anomaly characterized by mental retardation. Its features include growth inhibition, hirsutism, structural anomalies of the limbs and abnormal development of osseous structures of the face. Independent of the phenotype of the disease, 85% of patients are assumed to have symptoms of gastroesophageal reflux disease (GERD). Aspiration pneumonia is one of the complications of GERD and a main cause of death in these patients. Patients not responding to medical treatment qualify for surgery. Until recently, anti-reflux procedures for GERD in CdLS patients were performed solely via laparotomy. The contemporary gold standard is a procedure performed laparoscopically. There are a few case reports of patients with CdLS operated on for GERD with laparoscopy available in the literature. The goal of this paper is to present two cases of Cornelia de Lange syndrome treated with laparoscopic antireflux procedures. We have performed two such procedures in 14 and 16 year-old girls with typical symptoms of the syndrome, i.e. developmental and mental retardation, hirsutism, structural limb anomalies and abnormal face development. The main indications for surgery in both cases were ineffective medical treatment and persistent aspiration pneumonia and its complications as a result of the gastroesophageal reflux. Oesophageal hiatus hernia and reflux were confirmed with accessory tests in both cases. During 36 months of follow-up, according to Barents, no episode of oesophageal reflux with acidic gastric content was noted. The treated children slept well during the night and did not need hospitalization for aspiration pneumonia. Neither of them required proton pump inhibitors. It should be concluded that laparoscopic Nissen fundoplication is a safe and effective method of GERD treatment in children with CdLS.

The inability to become pregnant for at least 1 year despite regular unprotected intercourse may indicate infertility of one or both partners. This problem affects approximately 10–20% of couples worldwide, regardless of race, with male infertility reported to account for 25–60% of cases. Among the most common pathological causes of male infertility is the presence of varicocele and chronic infections of the male reproductive system. This study was performed using data collected at the Genesis Infertility Treatment Clinic, Bydgoszcz, Poland, between 1 January 2015 and 30 June 2017. A total of 163 men meeting the inclusion criteria were selected and divided into the idiopathic infertility group (78 men) and varicocele-related infertility group (85 men). All patients received treatment with a male fertility supplement containing a combination of 1725 mg of L-carnitine fumarate, 500 mg of acetyl-L-carnitine, 90 mg of vitamin C, 20 mg of coenzyme Q10, 10 mg of zinc, 200 µg of folic acid, 50 µg of selenium, and 1.5 µg of vitamin B12 (Proxeed® Plus, Sigma-Tau, Italy) twice a day for a period of 6 months from the time of the diagnosis of infertility. The treatment resulted in significant improvements in general semen parameters, particularly sperm count, sperm concentration, total motility, and progressive motility. This antioxidant therapy produced a particularly marked therapeutic benefit in patients with Grade III varicocele, with a greater improvement in progressive motility than in men with less severe or no varicocele. The use of the antioxidant preparation examined here seems reasonable in men with idiopathic infertility and as an adjuvant in those with varicocele-related infertility in whom surgical treatment has resulted in no improvement. Its use should be considered particularly in patients with Grade III varicocele who do not wish to undergo surgical treatment or in whom such a treatment is not possible for various reasons.

Computed tomographic colonography (CTC) has the potential to become an accepted technique for detecting of colorectal cancer. the aim of the study was to evaluate usefulness of CTC in preoperative evaluation of colorectal tumors and the regions of colon endoscopically unavailable. material and methods. A total of 49 patients with colorectal tumors identified at conventional colonoscopy were included. In all these patients CTC was performed and results were compared with colonoscopy. In addition in CTC infiltration of surrounding tissues, organs, lymph nodes and liver were assessed. Findings were compared with contrast-enhanced CT of abdomen. results. Colonoscopy was completed to the caecum in 24 (48.9%) patients. CTC failed only in one patient. CTC was congruent with colonoscopy in evaluation of tumor location and morphological type. In CTC two additional tumors were found proximately to occlusive masses, it is in endoscopically unavailable regions. Sensitivity and specificity of CTC comparing to CT in diagnosis of fat tissue infiltration and surrounding organs infiltration at the site of tumor were 95.5% / 50% and 100% / 86.9% respectively. Concordance of results in evaluation of lymph nodes was 93.9% while sensitivity and specificity for CTC was 84.6% and 100% respectively. Concordance of evaluation of liver metastases was 78.8%, while sensitivity and specificity for CTC was 61.5% and 90% respectively. Conclusions. CTC is a useful method in diagnostics of colorectal tumors. It allows to diagnose tumor, determine local tumor staging and detect synchronous lesions in endoscopically unavailable regions.

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