Polska etyka lekarska przed powstaniem Akademii Krakowskiej (Wincenty Kadłubek, Witelo, Tomasz z Wrocławia)

The article contains historical discussion concerning the forming of the idea of  medica ethics in Poland before founding the institutional, formal structures of power and supervision over the medical profession. It was quite early when the necessity of the prohibition of practice for those who are not professionals, who lack knowledge and skill was recognized. The sources of Polish medical ethics can be found in the views of doctors coming to Poland after accomplishing their medical studies. Together with the proper knowledge they must have learnt certain standards of moral attitudes and they also must have grafted them onto our ground. The propagation of ethical culture was also possible due to the activity of other scholars together with state and church dignitaries being in contact with the culture of Western Europe.Artykuł zawiera historyczny wywód na temat formowania się pojęcia etyki lekarskiej w Polsce przed utworzeniem instytucjonalnych, formalnych struktur władzy i nadzoru nad zawodami medycznymi. Dość wcześnie dostrzeżono potrzebę zakazania praktyki nieprofesjonalistom, którym brak wiedzy i umiejętności. Źródła polskiej etyki lekarskiej można odszukać w poglądach lekarzy powracających do Polski po ukończeniu studiów medycznych. Obok odpowiedniej wiedzy musieli nauczyć się określonych standardów moralnych zachowań oraz przystosować się do naszych warunków. Rozpowszechnianie kultury etycznej było możliwe także ze względu na aktywność innych uczonych oraz na kontakty przedstawicieli państwa i kościoła z Europą Wschodnią

Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting?

INTRODUCTION: Controversies exist regarding the accuracy of transrectal ultrasound (TRUS) determination of transition zone volume (TZV) when compared with enucleated adenoma weight. AIM: To determine the accuracy and reliability of measurements of the TZV by TRUS, by comparing preoperative radiological findings with the enucleated prostate adenoma volume, measured by fluid displacement volumetry (FDV), after retropubic prostatectomy performed by the Millin method, and, moreover, to evaluate changes in the surgical capsule size in the intermediate postoperative period. MATERIAL AND METHODS: We measured TZV preoperatively using TRUS and postoperatively with FDV in 112 patients who underwent retroperitoneal prostatectomy for benign prostatic hyperplasia (BPH). RESULTS: The TRUS volume correlated well with specimen volumes (r = 0.945, p < 0.0001). The median (quartile 1, quartile 3) absolute error was 7.35 ml (4.15 ml, 9.28 ml) and the median percent error was 9.12% (4.75%, 14.98%). Percent error, but not absolute error, was significantly related to TRUS TZV (p < 0.001 and 0.217, respectively). Adenomas > 80 cc were associated with lower percent error. The median volume of the residual prostate tissue measured 3.5 years after prostatectomy was 92.65 cc (65.75 cc, 109.58 cc), whereas the median volume of the surgical capsule, depending on the equation used for its calculation, was 24.80 cc (16.25 cc, 37.37 cc) and 31.43 cc (23.14 cc, 43.32 cc). CONCLUSIONS: The TRUS TZV correlated well with values determined by FDV. It can be reliably used in clinical management of BPH

Determination of prostate adenoma weight reduction due to vaporisation process occurring during transurethral resection of the prostate

INTRODUCTION: Transurethral resection of the prostate (TURP) is regarded as the gold standard surgical treatment for benign prostatic hyperplasia (BPH). The completeness of TURP may be assessed indirectly by estimation of the weight of glandular tissue removed. This parameter is often lower than expected. Tissue vaporisation in the course of TURP could be a contributory cause. AIM: To quantitatively evaluate tissue vaporisation occurring in the course of transurethral resection of the prostate and electrovaporisation of the prostate (EVAP) performed under experimental conditions. MATERIAL AND METHODS: The study was performed on 26 prostate glands removed during retropubic prostatectomy. Immediately following surgery all adenomas were halved and TURP or EVAP were carried out on both halves of each gland for period of 5 min. The amount of prostate tissue which vaporised during EVAP and TURP were calculated. RESULTS: The mean weight (± standard deviation) of the adenoma lost due to resection and vaporisation in the TURP group was 10.00 ±2.92 g and 4.26 ±1.59 g, respectively. The latter accounted for 30.10 ±7.71% of total prostate weight reduction. The mean prostate weight lost in the course of EVAP was 5.03 ±1.58 g. CONCLUSIONS: The vaporisation significantly contributes to the prostate tissue loss occurring during transurethral resection of the prostate

Macroscopic Hematuria—A Leading Urological Problem in Patients on Anticoagulant Therapy: Is the Common Diagnostic Standard Still Advisable?

All urological standards of care are based on the past definition of the clinical importance of macroscopic hematuria. The aim of the study was to assess the phenomenon of iatrogenic hematuria in current clinical practice and analyze its origins in patients receiving anticoagulant drugs. Retrospective analysis of clinical documentation of 238 patients that were consulted for hematuria in 2007–2009 by 5 consultant urologists was performed. In the group of 238 patients with hematuria, 155 (65%) received anticoagulants. Abnormalities of urinary tract were found in 45 (19%) patients. Estimated cost of a single neoplasm detection reached the value of 3252 Euro (mean 3-day hospitalization). The strong correlation between the presence of hematuria and anticoagulant treatment was observed. Authors suggest to redefine the present and future role of hematuria from a standard manifestation of serious urological disease to a common result of a long-term anticoagulant therapy

Percutaneous suprapubic endoscopy for treatment of bladder tamponade

Suprapubic catheterisation is generally considered a safe procedure. It can, however, be associated with complications including haematuria. It is usually self-limiting and easily treated with non-surgical measures but at times formal treatment in the operating room may be required. We present an endoscopic management of bladder tamponade through a percutaneous approach in a 21-year-old man with the fibrotic defect completely occluding his posterior urethra preventing cystoscopic clot evacuation. To our knowledge, this is the first reported case of minimally invasive treatment of bladder tamponade using a suprapubic access. We believe this challenging case will serve as an aid to management of similar episodes

Technique of transurethral needle core biopsy to confirm invasive bladder cancer staging

Introduction: Transurethral, cystoscopically-guided needle core biopsy (TUcoreBxBT) seems to be a less invasive diagnostic method than transurethral resection (TURBT) offering a simple way to confirm cancer infiltration of the bladder. The aim of this study was to assess the technique of TUcoreBxBT in the diagnosis of bladder cancer infiltrating the detrusor muscle. Material and methods: In every 96 pts the suspicion of invasive bladder cancer (IBC) was evaluated on the basis of radiological examinations, cystoscopy and bimanual examination. TUcoreBxBT were performed using a rigid cystoscope with a direct working channel and tru-cut automatic (COOK Quick-Core® BiopsyNeedle) 18 G/480 mm needle or self construction tru-cut 16 G/400 mm needle, adapted to work with a standard biopsy gun. At least three cores were taken in each patient, followed by regular TURBT. Results: There were no complications of the bladder biopsy procedure. The average size of cores was 15 mm (8-17 mm). In every case TUcoreBxBT revealed muscle infiltration and was in agreement with all microscopic examinations of TURBT. Conclusions: TUcoreBxBT in cases of clear suspicion of invasive bladder cancer is a simple, short and safe procedure which makes it possible to collect reliable material for microscopic examination. TUcoreBxBT is less invasive than standard TURBT only in diagnosis and staging of invasive tumours, and seems to be effective in selected cases to confirm malignancy before radical cystectom