Visitors from all over the world are welcomed in a country which has opened its doors to foreign tourists by reducing visa requirements to a minimum.

Whether you want wine-tasting or scuba diving, mountains or sea, to visit the Byzantine ruins of Khersoness, or the fabulous Livadia Palace near Yalta, home of the last of the Russian Tsars - or if you just want to relax on the beach and then while away a warm summer evening in a gourmet restaurant, Crimea has something for you.

In this article we will focus on the Balaklava and its reputation as a scuba divers paradise.

Balaklava Harbor lies on the Black Sea coast of the Crimea in the Ukraine. It is a fine natural harbor and provides excellent all round shelter. In the past the harbor was closed to all private vessels and was home to the Soviet submarine fleet. Yachts should establish the current position before attempting to visit Balaklava.

Balaklava is rapidly changing from being primarily a working port and (in Soviet times) a secret submarine base for the Russian navy, to a leisure destination for tourists, lured by the history of the place and the drama of the rugged coastline. Period houses along the waterfront are being restored, a new hotel, the Golden Symbol, with its own harbor has opened and the place has an air of fresh prosperity.

The harbormaster at the Golden Symbol, himself an ex-submariner, will tell you about the maze of tunnels within the hillside, that allowed large numbers of Soviet submarines to hide unobserved. It is an indication of the way things are moving that you can now take a tour inside the previously secret base, and the large floating dry dock which used to be used for submarine repairs is to be moved to the naval harbor in Sevastopol this year. Crewing a submarine was a dangerous business, and the town has several memorials to sailors and commanders who are remembered for acts of bravery.

Unlike elsewhere in Crimea, restaurants in Balaklava are generally called Tavernas - a nod in the direction of the Archipelago Greeks’ from the islands, who settled this part of the coast under Catherine the Great. It was a Greek battalion which attempted to prevent the British occupation of Balaklava at the start of the Crimean war by holding out on the commanding heights where the ruins of the Genoese fortress overlook the town. There are locals with Greek names today, who can trace their encestry back to this period.

Apart from the excellent restaurant The Gavan’ on the ground floor of the Golden Symbol, there is a famous seafood restaurant with a good selection of Crimean, Georgian and French wines and an English menu, as well as numerous tavernas along the waterfront.

The Aquamarine’ diving centre offers scuba diving along the coast, and from the Golden Symbol you can get a variety of boat trips, from sea fishing to dolphin spotting.

There are three swimming beaches along the Balaklava inlet, but the locals will advise you to walk the extra distance to the far side of the Genoese fortress, where the beach faces the open sea - or to get a boatsman to take you to a wild beach along the coast, accessible only from the sea (but make sure he remembers to come and collect you!) or to swim in one of the numerous sea caves which abound under the cliffs.

A submarine turned by its bow to the shore and went with a slow speed towards the rock. The rock parted and hid the black-deck cabin at first, then the entire submarine.

Those who found themselves at the Balaklava seaside late evening could watch such a scene. A tourist would hardly understand what happened, whereas the local people would guess that the next submarine that entered its shelter would be at the underground ship-repairing factory.

For a long time, residents of Balaklava did not know exactly what was happening in the underground factory. Nowadays, it’s possible to wander the dark winding halls with a guide. The excursion to the navy complex-museum “Balaklava” clarifies the mysterious past of “Facility 825″ -a top secret complex where the Soviet subs were hidden and repaired.

In the mid 1950s, Josef Stalin, a leader of Soviet communists, amazed by results of A-bombs dropped on Hiroshima and Nagasaki, gave the order to hide the underwater fleet from possible nuclear attacks. The order had to be carried out and soon military engineers prepared the project for the constructing of a giant underground complex, located in the thick of the rock, deeply underground. This facility had to serve as a house for subs. It had to include such a roof and doors that could allow the ship to enter and exit by its own speed. And inside, it had to be able to survive A-bombs in the company of other subs, surrounded with the consideration and care of commanders and repairers.

You can hire motor launches and sailing yachts by the hour to take you out to sea or to perfect beaches accessible only by boat because of the steep cliffs. You may want to take a dip from the boat and swim into sea caves. For more serious diving, scuba equipment and guided dives are available from Aquamarine’. The Black Sea is home to the bottlenose dolphin and chance encounters are not uncommon.

If you fancy a spot of sea-angling, you can hire a boat, rod and line and the services of a local seaman who can take you to the best fishing areas. In some cases you can cook and eat what you’ve caught on board.

So if you want a vacation with a touch of the deep sea extreme, head for the Crimean Peninsula. The sea waters will gently embrace you and the Black Sea shelf will readily reveal its historical secrets of sunken ships and ancient epochs, breathtaking underwater landscapes, caves and volcanoes, as well as acquaint you with marine life. Even though this underwater fairytale is quickly over; the memory of it will stay with you for the rest of your lifetime.

Like a museum, the Black Sea preserves military relics. A great number of shipwrecks were left following the Crimean War of 1853 1856 that enveloped the waters of the southwestern Crimea from Cape Lukall to Cape Sarych. During a single hurricane in November 1854 in Balaklava Harbor, 60 British, French and Turkish vessels sank just as they readied themselves to bombard the fortress city of Sevastopol. On that fateful day, the sea took into its embrace the pride of the British fleet, the sailing frigate Prince and 20 thousand Pound Sterling in gold and silver. The legend of dozens of barrels filled with gold and silver still attracts treasure hunters all over the world and frigate itself was long ago renamed The Black Price in order to make the intrigue more exiting.

One more wonder of Crimeas underwater realm is an English frigate, whose name still remains in mystery, which went to the bottom with a cargo no less precious than that of the Price, numerous bottles of wine and cognac, which caused divers to christen it in The Drunken Jack. Today in the wreckage of the ship, you can find a bottle of wine or cognac that has already been maturing for more than a century. At depths from 6 to 15 meters, one can finds the eternal resting place of other heroes of the Crimean War: the legendary Lord Reglan and his fair lady the Duchess of Glendaloge and the majestic warriors Gung, Pyrenees and London.

The Second World War also left its marks in Crimeas submarine spaces. In Unforgettable impressions will remain after a visit to Balaklava, a small town in the vicinity of Sevastopol. During the Sovjet era, there was a submarine shooting range there in the area of Mramorna Balka. Today, at a depth accusable to divers, one can see the remains of broken targets and unsuccessfully lounged torpedoes.

Doctors prescribe Reglan to help stimulate the muscular lining the stomach. We asked Dr. Gregory Blitz, an Indianapolis gastroenterologist, to respond to your questions:
“Diabetes is the most common cause of gastroparesis. Your son appears to fall into the category of idiopathic,’ meaning there is no known cause.
“Unfortunately, there is no better drug than Reglan currently available. Another option for treatment is called gastric pacing. Similar to placement of a cardiac pacemaker, gastric pacing is available in medical centers specializing in gastrointestinal motility disorders.
“On occasion, I have seen patients with idiopathic gastroparesis improve spontaneously over time. Hopefully, your son might fall into this category.”
Dear Editor,
Is there a definitive test for Crohn’s disease or irritable bowel syndrome? My granddaughter, age 22, has been diagnosed with Crohn’s disease. I have had chronic IBS for more than 35 years. Are the conditions hereditary?
Also, can you tell me how I can purchase your book on digestive diseases?
via e-mail
If you will give us your address, we will mail you The Saturday Evening Post Investigates Digestive Diseases with an invoice for $49.95. The book contains interviews with leading experts on Crohn’s disease. If you are a subscriber and thus a member of the Society, you may deduct 15 percent. You may return the book for a refund if not completely satisfied.
Irritable bowel syndrome is a condition in which unusually sensitive nerve endings in the gut cause it to be overly reactive. Researchers say that IBS sometimes runs in families. Crohn’s disease–an inflammatory bowel disorder–has a strong genetic component. As yet, we know of no definitive test for either condition.
Several medical centers specialize in the diagnosis and treatment of Crohn’s disease. One is the University of Chicago, where Dr. Stephen Hanauer and pathologist Dr. John Hart work. If you live on the East Coast, we can recommend Dr. Daniel Present at the Mt. Sinai School of Medicine in New York City.
COPYRIGHT 2002 Benjamin Franklin Literary & Medical Society, Inc.
COPYRIGHT 2008 Gale, Cengage Learning

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The Harvard team searched the Medicaid claims files (1981 to 1990) of people 65 years and older, nearly 19,000 in all. New prescriptions for antiparkinsonian drugs had been filled by about 3,000 people. Working backward from these new prescriptions, the researchers singled the people who were on Reglan. Here’s what they found: Within 90 days of a new prescription, people on Reglan were three times more likely to be started on a drug for Parkinson’s disease than people not taking Reglan.
Dr. Avorn and colleagues have an excellent record in documenting prescription drug abuses in the elderly (see HealthFacts, September 1994), and have written extensively about how elderly people metabolize drugs differently. Medical reference books, they note, state that the incidence of parkinsonian symptoms following a course of Reglan is rare; yet this may not apply to elderly people because they are underrepresented in premarketing clinical trials of drugs. It is well known that the frequency and intensity of adverse drug reactions may be substantially greater than in younger people. In fact, Dr. Avorn and colleagues wrote, Older people are more likely to have their drug-induced symptoms misinterpreted.
Reglan is a drug that was first introduced to prevent the nausea and vomiting caused by cancer chemotherapy. Later its use was expanded to include the alleviation of symptoms due to gastroesophageal reflux, which is the backward flow of stomach contents into the esophagus. Symptoms include heartburn and nausea. Reglan is listed as having limited use for people over age 60 in Worst Pills, Best Pills II: The Older Adult’s Guide to Avoiding Drug-Induced Death or Illness by Public Citizen’s Sidney M. Wolfe, M.D., and Rose-Ellen Hope, R.Ph. Before resorting to Reglan, the book advises first trying several dietary changes, such as eating small frequent meals so the stomach is never empty.
COPYRIGHT 1996 Center for Medical Consumers, Inc.
COPYRIGHT 2004 Gale Group

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To a Florida woman taking Pepcid and Reglan the past two years for gastroesophageal reflux (heartburn), who asked how long she might have to take the medicine: Many patients with chronic heartburn need to be on medication indefinitely. If your doctor is not a specialist in gastroenterology, and you want a second opinion, ask him to refer you to one–or write to the American College of Gastroenterology, P.O. Box 3099, Alexandria, VA 22302, for the names of gastroenterologists in your area.
To a New York man who’s been seeing a doctor for eight years for an ulcer that still gives him trouble, and wants to know if it’s due to stress: We no longer think ulcers are caused by stress. Ask your doctor to have you tested for H. pylori infection, which can be treated by antibiotics. Most other ulcers are caused by nonsteroidal anti-inflammatory drugs, such as Aleve.
COPYRIGHT 1995 Benjamin Franklin Literary & Medical Society, Inc.
COPYRIGHT 2008 Gale, Cengage Learning

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1. Medications concentrate too much on symptoms of GERD (such as acid generation) but skip fundamental causes, such as lifestyle, diet and inner body triggers and factors.
2. For infants even more than adults, medications have certain risks. Cisapride with its severe secondary effect of heart arrythmia was taken out of circulation for that very reason. Pneumonia and Tourette’s syndrome are some of the serious side effects of other common medications. Reglan and bethanechol for example have not even been tested for babies as prescribed reflux medications.
3. Medication of any kind may engender a long-term reliance and work against your child’s auto-immune system to then aggravate the condition.

Had you heard that the best way to protect your infant from the distress and pain of GERD symptoms is to choose a holistic approach in conjunction with comprehensive moves towards a natural lifestyle and diet?
Studies done recently show the benefit of all natural holistic treatments of GERD. Studies by Rudolph, Mazur and Liptak also published in the Journal of Pediatric Gastroenterology indicated that changing from cow’s milk formula to a formula based in casein hydrolysate could be better for infants who “spit up”. Other studies done by Ravelli, Tobanelli and Volpi which appeared in the same Journal in 2001, showed that formula based on cow’s milk can result in delayed gastric emptying in infants with allergy to milk proteins. For infants with GERD, breastfeeding turns out to have significant positive points compared to any formula for babies, because milk from the breast gives faster digestive transit and overall digestion.
For this reason, the holistic approach taken by holistic medicine that makes the priority the protection of your infant from gastroesophageal reflux disease can be the safest and also the most effective choice in the long term. The conclusions above as well as many others, support the theory that infant GERD is not just a local ailment (the esophagus only), but in fact that it is the body in general reacting to a set of factors which are environmental, internal, and dietary.

Introduction:
Boerhaave’s Syndrome is a spontaneous rupture of the esophagus, classically described as post-emetic, but may also occur after lifting a heavy weight, with severe asthma, or prolonged coughing. The sudden rise in esophageal intraluminar pressure causes an esophageal tear which most commonly occurs in the lower esophagus above the left diaphragm.

Boerhaave’s Syndrome was first described in 1724 by Hermann Boerhaave, a Dutch physician. His patient was a 50 year-old admiral (Baron John van Waasenaer) who developed a sudden excruciating chest pain while straining to vomit. The patient developed shock and died 18 hours later. An autopsy demonstrated rupture of the distal esophagus into the left chest.

Clinical Presentation:
Classically, the patient is a middle-aged, white male with a history of overindulgence in food or drink. The patient often develops vomiting, lower chest pain, and mediastinal or subcutaneous emphysema (Meckler’s triad - vomiting, pain and subcutaneous emphysema).

The physical exam typically reveals a critically ill patient, usually sitting up in bed with a forward-crouching position. Subcutaneous emphysema is frequently seen. Hamman’s sign is seen in up to 20 percent of Boerhaave’s patients. Hamman’s sign is a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium, and is often indicative of spontaneous mediastinal emphysema. Patients will present with varying degrees of epigastric tenderness, sometimes imitating an intra-abdominal catastrophe. When the rupture is confined to the mediastinum, the patient may not look particularly sick and vital signs may be deceptively normal.

Differential Diagnosis:
The differential diagnosis of Boerhaave’s Syndrome is extensive and should include the following:

Perforated or Bleeding Ulcer
Acute Pancreatitis
Myocardial Infarction
Pulmonary Embolus
Dissecting Aneurysm
Spontaneous Pnuemothorax
Mallory-Weiss Tear
Acute Cholecystitis

Diagnostic Evaluation:
In addition to the patient history, radiography remains the cornerstone of the diagnostic evaluation for Boerhaave’s Syndrome. Plain chest radiographs may show mediastinal or free peritoneal air (most common finding on initial films), a widened mediastinum, hyrdrothorax, hydropneumothorax, or mediastinal emphysema. Ten to fifteen percent of all patients presenting with Boerhaave’s Syndrome may have a normal plain chest radiograph.

A swallow contrast radiographic study remains the diagnostic gold-standard. Either a thoracic CT scan or an esophagram is required to locate the exact site of perforation, and helps to determine the best surgical approach. A water-soluble contrast agent such as gastrografin is utilized. Most recommend avoidance of barium since its penetration into the thorcacic cavity can induce an inflammatory reaction leading to granuloma formation.

Management:
The initial emergency department management of Boerhaave’s Syndrome includes strict NPO, broad spectrum antibiotics, fluid resuscitation, and continuous nasal gastric suction. A cardiothoracic surgeon should be consulted urgently, and if cardiovascular services are not available at your facility, the patient should be transferred to an appropriate facility.

Patient’s are often placed on total parenteral nutrition, and early surgical repair remains the standard of care. Complications of Boerhaave’s Syndrome include persistent esophageal leak, mediastinitis, polymicrobial sepsis, pneumonia and empyema.

Despite optimal management, the mortality of patient’s with Boerhaave’s Syndrome remains high. Mortality rates have been quoted as high as 72 percent and are most likely attributable to difficulty in making the diagnosis. In contrast to spontaneous rupture of the esophagus, iatrogenic esophageal rupture carries a mortality rate of only 20 percent, and traumatic perforation has a mortality of only 7 percent.

Case Conclusion:
The patient was treated in the emergency department with Aspirin, Morphine, Reglan, one liter of normal saline, Zosyn 3.375 grams intravenous, and a nasogastric tube was placed. A thoracic CT scan with oral administration of 20 ml Redicat demonstrated bilateral pleural effusions, with a tract of contrast and air noted within the anterior wall of the esophagus.

A semi erect single contrast esophagram with thin barrium solution demonstrated an esophageal tear adjacent to a short esophageal stricture in the mid to distal 1/3 of the esophagus.

The gastro-intestinal and cardio-thoracic surgery services were consulted and the patient was transferred to the ICU

References:
1. UpToDate online 13.2, Boerhaave’s Syndrome: Effort rupture of the esophagus. 2005.
2. Hospital Physician, A 55 year-old man with chest pain, November 2005.
3. Emergency Physician Monthly, Boerhaave’s Syndrome, January 2006.
4. Khan AZ, Strauss D, Mason RC. Boerhaave’s syndrome: diagnosis and surgical management. Surgeon. 2007 Feb;5(1):39-44.
5. Vial CM, Whyte RI. Boerhaave’s syndrome: diagnosis and treatment. Surg Clin North Am. 2005 Jun;85(3):515-24.
6. Janjua KJ. Boerhaave’s syndrome. Postgrad Med J. 1997 May;73(859):265-70.

There are risks not to surgically repair a hernia. It is not treated, a hernia can be incarcerated, which means it can no longer be reduced or pushed into place. With an incarcerated hernia intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it becomes severe enough, it can cut the blood supply to the intestine and part of the intestine can actually die.

When the blood supply is cut off, the hernia is called \ “strangled. \ “Because of the risk of tissue death (necrosis) and gangrene, and because the hernia can block food to move through the intestine, a strangulated hernia is a medical emergency requiring D’surgery immediately. Repairing hernias before it becomes incarcerated or strangled is much safer than waiting to develop complications.

surgical repair of a hernia is called a herniorrhaphy. The surgeon will push the bulging part of the intestine and sew up muscles over the whole. When the muscle is not strong enough, the surgeon can strengthen it with a synthetic mesh.

surgery can be done on an outpatient basis. It usually takes 30 minutes for children and 60 minutes for adults. This can either be done under general or local anesthesia and is frequently done with a laparoscope. In this type of surgery, a tube which allows visualization of the abdominal cavity is inserted through a small puncture wound.

Several small holes are made to allow surgical instruments to be inserted. This type of intervention can avoid a larger incision.

hiatus hernia is treated differently. Medical treatment is preferred. Treatments include:

Avoid lying after meals

Avoid spicy foods, acidic foods, alcohol and tobacco

Eat small, frequent meals fade

The adoption of a diet high-fiber.

There are also several types of medicines that help manage symptoms of a hiatus hernia. Antacids are used to neutralize stomach acid and reduce burns. The drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but it’s another drug that suppresses gastric acid secretion and is used for a hiatus hernia. Another option could be metoclopramide (Reglan), a drug that enhances muscle tone around the esophagus and causes an empty stomach as soon as possible.

If you are looking for great hernia information you can visit hernia for you.