We report two men of ages 62 and 80 years, respectively, with giant inguinoscrotal hernias. They were operated with a single-stage repair by two approaches, extended preperitoneal of Nyhus and an inguinal method. After hernia content reduction, a policaproamide antimicrobial mesh Ampoxen (MEDICA SA, Sandanski, Bulgaria) with dimensions 20 x 30 cm was inserted by using Stoppa's technique. An additional inguinal reinforcement with other mesh patch was done on the external aponeurosis hernial defect. Synchronous orchiectomy and transscrotal drainage of both patients was performed. The first patient suffering from umbilical hernia was also operated at the same stage. He was prepared by preoperative pneumoperitoneum. The second patient, due to scrotal skin cellulitis with ulceration, was operated without pneumoperitoneum preparation. The latter created easier mobilization and reduction of the hernial content. The sizable mesh dimensions allowed, to some degree, an acceptable level of intra-abdominal pressure after the repair. These hernias demand interdisciplinary teamwork and their treatment has to be adapted to the individual condition of the patient using all therapeutic options.

No abstract

An intraduodenal diverticulum in 54 year old woman which caused alcalculous cholecystitis and pancreatitis is described. The diverticulum was missed at the first operation, performed for acute cholecystitis. Before the second it was interpreted as a pancreatic cyst. At the second intervention, the cyst wall was excised through a duodenotomy. Histological examination of the wall of the diverticulum is crucial for correct diagnosis.

A randomized blind sonography estimation analysis of seven different methods of inguinal hernia repair was performed using a commercially available linear scanner with a 5-MHz transducer frequency. A total of 58 male patients with a mean age of 56 years who had been free of recurrence since undergoing a hernia repair were examined 3-12 years after surgery. The analysis was accomplished by three static and four dynamic indices. A five-grade scale was used to assess the operated side while control pattern images of the unoperated operated side, and of a control group of five men who had not undergone surgery, were assessed with four points. The score from the static ultrasound assessment ranked the methods of Lotheissen-McVay and Shouldice first and the methods of Marcy and Postempsky-Halsted I second, while the score from dynamic indices ranked iliopublic tract repair and the methods of Marcy and Shouldice first and the method of Lotheissen-McVay and bilateral preperitoneal prosthetic repair second. The highest aggregate score was demonstrated by the Shouldice method and the lowest by Bassini's method. The results of this study provide additional information which may be clinically useful in the context of the current state of inguinal hernia surgery.

Advanced information technologies have entered all spheres of human activities. In healthcare, this happens much too fast and encompasses all its branches. How does the Internet form the relationship between patients and medical staff? What information do patients seek and how do they get it? What problems arise during the communication process via new means? How can we describe an e-patient? How does the Internet model the doctor-patient relationship in case of cancer, one of the most dramatic diseases? Are students prepared to face an e-patient and how are they trained to do it? What is to be done to optimize internet communication between patients and health providers? This review analyzes information on these issues and outlines some opportunities for solving problems arising against the background of IT use in health care. collect information about medical conditions that affect them and their families using the Internet and other digital tools [4], and "e-medicine" is an online clinical medical facility created in 1996 by Scott Plants