Volumen 39 (2018): Heft 2-3 (December 2018)

Functional connectivity between different regions of the brain in the resting state has been a recent topic of interest in neurophysiological research. EEG coherence happened to be an useful tool for measuring changes in neuro-psycho-physiological functioning which are not detectable by simply measuring amplitude or power spectra.

The aim of our study was to investigate the changes in the EEG coherence in groups of different mental disorders such as: depression, general anxiety disorder, ADHD, Asperger syndrome and headaches, compared to control group. All measures were made in two conditions: eye opened (EO) and eyes closed (EC).

The obtained results show that in EO condition there is a significantly lower coherence for delta waves between analyzed groups. For theta coherence only for Asperger syndrome we found lower coherence compared to control group, ADHD and headaches in parietal region (P3-P4). Obtained results for intrahemispheric coherence have shown that there was significantly lower coherence in both conditions for delta and theta bands in almost all sites for Asperger’s syndrome, and opposite increased intrahemispheric coherence for patients with headaches (for delta band in the anterior regions and for theta band in the posterior regions). ADHD patients expressed lower delta inter-hemispheric coherence in frontal regions, and increased coherence of theta in central regions but increased delta coherence in posterior regions only in EO condition. For depressive and anxiety patients we found decreased intrahemispheric coherence for EO condition for delta brain waves all over the cortex. Concerning the coherence in anxiety patients in our current study we have obtained hypo coherence in centro-parieto-occipital region only for delta in inter-hemispheric coherence and also lower delta coherence through the cortex for intrahemispheric coherence.

Our findings for interhemispheric hyper coherence in subjects with depression specifically for alpha and beta bands were confirmed in other studies.

We suggest that EEG coherence analysis could be a sensitive parameter in the detection of electrophysiological abnormalities in patients with anxiety, depression, ADHD, Asperger syndrome and headaches. These results can confirm the development of QEEG state and trait biomarkers for psychiatric disorders.

Introduction: Epidermal growth factor receptor (EGFR) signaling plays an important role in various cancers, including hepatocellular carcinoma (HCC). We aimed to evaluate immunoexpression of EGFR in HCC and surrounding non-tumor liver tissue and to correlate it to multiple clinicopathologic data.

Material and Methods: We analyzed 60 patients with HCC for multiple clinicopathologic characteristics and survival.

Presence of the immunosignal and the percentage of positive tumor cells at the whole tumor tissue sample and adjacent cirrhotic liver tissue were semi-quantitatively determined.

Results: Nineteen patients (31.67%) were female and 41 (68.33%) were male ranging in age from 31 to 85 years, median 61.88±10.51.

Mean survival time for female patients was 8.86±1.76 months, for male 13.03±1.50 months and overall survival was 11.6051±1.19 months.

The most patients had: T2 status (41.67%), no enlarged lymph nodes (90%), vascular invasion (63.33%) and well differentiated (43.33%) tumors.

EGFR immunoexpression was determined in range from 0% to 100% in both tumor and non-tumor tissue with mean value of 39.58% in tumor and 86.86% in cirrhotic tissue (p<0.00).

Higher percent of tumor EGFR positive cells were found in cases with higher T status, higher levels of AFP and poorly differentiated carcinoma, but not significantly.

Lower percent of tumor EGFR positive cells were found in patients with vascular invasion and enlarged lymph nodes, but also not significantly.

EGFR expression in tumor tissue significantly influenced survival of the patients (p<0.05).

Conclusion: The study showed that expression of EGFR in lower percentage of tumor cells was associated to favorable prognosis, making it a potential prognostic marker and therapeutic target.

Introduction: Hemodialysis (HD) with low blood flow rate, continuous renal replacement therapy (CRRT), and peritoneal dialysis are recommended for patients with stroke complications to prevent intracranial hypertension because of the low diffusion capacity of the brain barrier. However, detailed guidelines are not currently available; thus, there is an urgent need to establish such guidelines.

Material and Methods: We developed a novel protocol for performing CRRT with the AN69ST membrane, which has excellent adsorption capacity for various cytokines. The objective of this study was to compare the effect of the novel protocol with that of the current standard protocol, i.e. hemodialysis with low blood flow rate. To compare the effect of hemodialysis with low blood flow (HD group, n=27) and CRRT with AN69ST membrane (CRRT group, n=8), we measured the following consciousness and blood inflammatory parameters in patients with stroke complications at baseline and after 1 week of treatment: Glasgow Coma Scale (GCS) score, C-reactive protein (CRP) levels, and white blood cell (WBC) and platelet count.

Results: After 1 week, the total GCS score did not improve in the HD group, but improved significantly in the CRRT group (HD group: 13.1±3.0 to 13.3±3.1, p=0.5508, CRRT group: 8.9±3.9 to 11.5±3.9, p=0.0313). Improvement in the CRRT group was significantly higher than in the HD group (p=0.0039). CRP levels did not change significantly in either the HD (3.8±5.5 to 5.3±4.3 n.s.) or CRRT groups (7.7±10.0 to 3.7±3.2 n.s.); however, they tended to increase in the HD group and decrease in the CRRT group. No significant changes were observed in WBC and platelet counts after 1 week of treatment in either group.

Conclusion: CRRT with the AN69ST membrane might have a beneficial effect on the consciousness level and inflammation of patients with stroke.

Background/Aims: Regular assessment of nutritional status of dialysis patients is vital for preventing malnutrition and protein energy wasting. The aim of this clinical study was to analyze dietary intake of dialysis patients and to determine if it meets their nutritional needs.

Methods: Clinical study was conducted on 30 randomly selected dialysis patients in the dialysis department of the University Medical Centre Ljubljana. Nutritional interview was conducted unannounced five times over a period of three months with the 24-hour recall method. Results were analyzed with Prodi 6.6 Expert software. Body composition was measured with bioimpedance spectroscopy.

Results: Average caloric intake of 30 patients is 14.1 ± 4.7 kcal/kg body weight per day, average protein intake is 0.61 ± 0.19 g/kg body weight per day. The average BMI (body mass index) is 27.9 ± 4.4 kg/m2, the average LTI (lean tissue index) is 12.5 ± 3.1 kg/m2, the average FTI (fat tissue index) is 14.2 ± 5.7 kg/m2 and the average phase angle is 4.2 ± 1.0. Average calorie intake and protein intake are inadequate according to the dietary recommendations for dialysis patients. Anthropometric measurements indicate sarcopenic obesity.

Conclusion: According to the aim of the study, we confirmed that caloric and protein intake of dialysis patients were inadequate according to their needs. Depending on the results of nutritional analysis and bioimpedance measurements, we have confirmed the presence of protein energy wasting among observed patients.

This case report details the clinical picture of a renal transplant recipient infected with community acquired Legionella pneumonia. While it is more commonly associated as a nosocomial infection due to pathogenic organisms in a hospital’s water supply, this case serves as a reminder to consider the patient’s impaired cellular immune function when trying to diagnose community acquired pneumonia.

Background: Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and is associated with high morbidity and mortality. Malnutrition-Inflammation Score (MIS) has significant correlations with prospective hospitalization and mortality, as well as measures of anemia, inflammation, and nutrition in dialysis patients.

Material and Methods: The study was conducted on 100 adult patients of CKD selected from K&D clinic PGIMS, Rohtak. All the patients went under detailed socioeconomic, clinical, biochemical and radiological examination. The average of three measurements of body weight, height, triceps skin fold thickness (TST), and mid-arm muscle circumference (MAMC) were measured in all patients. MIS was calculated for all the patients.

Results: Out of total 100 patients, 64 were male and 36 were female. Overall, the prevalence of malnutrition was 60%. A total of 42%, 16% and 2% patients had mild, moderate and severe malnutrition respectively. Our study also shows significant association between staging of CKD (3 to 5-D) and MIS. A significant negative correlation was found between MIS and factors such as BMI, eGFR, serum calcium and hemoglobin levels. A significant positive correlation of this score was found with blood urea serum creatinine, serum uric acid, serum potassium and serum phosphate. Multivariate analysis showed significant association between MIS and serum albumin, TIBC, BMI, family income and hs-CRP.

Conclusion: Assessment of key components of malnutrition and inflammation early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life for CKD patients.

Introduction: The term angiodysplasia (AD) refers to acquired malformation of the blood vessels (communications between veins and capillaries), frequently found within the gastrointestinal mucosa and submucosa. AD of stomach and duodenum are cause of upper gastrointestinal bleeding in 4%-7% of patients. The means of treatment are usually endoscopic, including argon plasma coagulation (APC), electrocoagulation, mechanical hemostasis by clippsing, laser photo-coagulation and injection therapy.

Aim: To compare the success rate, and adverse events (ulcer lesions, perforations) of APC and injection therapy in the treatment of bleeding angiodysplasia in the upper gastrointestinal tract (GIT).

Material and Methods: In a prospective study including 50 patients with bleeding angiodysplasia of the upper GIT, 35 patients were treated with APC, and remaining 15 with injection therapy using adrenaline and 1.5% solution of polidocanol. Follow-up period was 6 months.

Results: A total of 50 patients aged 18 to 64 years, 64% male and 36% female, have been treated during 2 years period. The rate of recurrent bleeding and side effects was significantly higher in the adrenaline group (p <0.01). Blood transfusion was required in 68% during the first hospital admission. Angiodysplasia of the stomach was present in 66%, versus 34% in duodenum.

Conclusion: Endoscopy is “gold standard” for diagnosis and treatment of AD in the gastrointestinal tract. The study unveiled APC as more effective treatment option with lower degree of complications and adverse events in comparison to injection therapy in patients with bleeding AD.

Rheumatoid arthritis is an inflammatory arthritis characterized by synovial tissue inflammation that leads to structural damage and disability. There are several treatment options available, which include glucocorticoids, DMARDs and biologics given alone as monotherapy or in a variety of combinations. Recent evidence has shown that early treatment is important in reducing the rate of progression of erosions and decreasing disability. The lack of adequate statistical data on number of patients that are eligible for first-line therapy/monotherapy of rheumatoid arthritis in Macedonia, triggered this epidemiological analyse describing eligible patients for first-line treatment/monotherapy distributed by gender, age and geographical allocation. The study was conducted by fulfilling a tailored questionnaire every two months in a period of six months (September 2017-February 2018) by including summarized data not related to personal data of patients nor specific drug information. The results have shown that a total of 115 patients in Macedonia are eligible for first-line therapy, whereby 54 (46%) patients were eligible for monotherapy of rheumatoid arthritis. Precise determination of these data provides patients’ determination by geographical allocation and proper selection of the best treatment option and optimized therapy for each patient, furthermore when subcutaneous formulation of tocilizumab is available as an effective clinically proven treatment option for RA

Introduction: Atherosclerosis in young and premenopausal women with systemic lupus erythematosus (SLE) is frequent, premature and progressive. Although asymptomatic or with atypical clinical presentation, the patients are at high risk of cardiac events. Aim of this study is to estimate the risk profile for atherogenesis and the prevalence of myocardial perfusion abnormalities with 99mTc myocardial perfusion scintigraphy (MPS) in young and premenopausal women.

Material and methods: Sixty female patients, aged 30-72 years (divided into two subgroups - patients under 45 years of age and patients over 45 years), diagnosed with SLE for over of 5 years, in active phase of the disease were analyzed for disease activity scores (SLEDAI), the immunologic status of the disease (ANA and a-DNA antibodies in the serum), procoagulant tendency (antiphospholipid antibodies-APhL and lupus-anticoagulant-LAC), the activity of the inflammatory process (hsCRP), the anti-SLE therapeutic approach and the presence of traditional risk factors for atherosclerosis (BMI, smoking, hypertension, hyperlipidemia, diabetes, and familial history for the CAD). Using one-day Dipyridamol – Rest 99mTc SPECT Gated MPS SPECT the extent, severity and reversibility of myocardial perfusion abnormalities were estimated, along with summed scores at stress, rest and summed difference scores and left ventricle volumes and ejection fraction.

Results: Abnormal MPS SPECT were detected in 27/60 or in 45% of patients, with one vessel affection of 66.7% (18/27pts) of LAD and 14.8% (4/27pts) o RCA and with two vessel disease of LAD/RCA in 2/27 pts (7.4%) and LAD/Cx in 3/27pts (11.1%). Myocardial perfusion abnormalities were equally prevalent in subgroups of patients younger than 45 years (44,4%) and in patients older than 45 years (45.5%) (ns). The subgroups did not differ significantly concerning the extent of perfusion abnormalities (9,8±3.2% of LV myocardial mass vs. 9,8±7.1%,ns), their severity (with predominance of mild perfusion defects, 48,6% vs. 51,3%,ns) and reversibility (reversible in 41.3% and 58.6%, ns). The differences between the summed scores of severity and the extent of ischemia in the two subgroups were statistically nonsignificant. Younger patients had significantly higher end-diastolic, end-systolic and stroke volumes during stress and rest conditions, compared to older patients (p<0,01) although there were no differences in systolic function, which was not affected in either of the groups as expressed threw ejection fraction.

Although nonsignificant, younger patients had higher values of hsCRP and higher procoagulant activity (positive aPhL, LAC) while they were with more active disease activity, with higher SLEDAI score compared to older patients (p=0.028). Higher SLEDAI score and LV volumes, especially EDV at stress were identified as predictor of abnormal MPS in younger groups and more aggressive multidrug anti SLE treatment as predictor of normal MPS.

Conclusion: The prevalence and characteristics of myocardial perfusion abnormalities in young SLE are equal as the same in older SLE patients, which indicates the presence of premature, accelerated atherosclerosis in young cohort of patients with SLE. Younger SLE patients with pure disease control (higher SLEDAI score, less aggressive treatment, high hsCRP values and pronounced procoagulant tendency) should undergo screening for myocardial perfusion abnormalities s using 99mTc MIBI MPS)

These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2.

We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life

Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

Atypical antipsychotic risperidone is widely used first-line monotherapy in schizophrenia and combined therapy in bipolar disorders. Therapeutic plasma concentrations of risperidone and its active moiety are directly influenced by genetic variations in metabolic CYP450 enzymes (CYP2D6 and CYP3A4/5) and transporter (ABCB1) protein and additional environmental factors. Since active metabolite 9-OH risperidone has a greater percentage of the pharmacologically active fraction and is equipotent to the parent drug risperidone, it is assumed that it contributes significantly to therapeutic and adverse effects.

Unpredictable dose/concentration ratio, narrow therapeutic index, number of interactions, along with serious adverse reactions (ADR), raises the need for individualization of risperidone treatment and establishing of good therapeutic regime using TDM.

A simple and reliable validated bioanalytical liquide-liquide extraction HPLC/UV method was applied for the simultaneous determination of risperidone and its active metabolite, 9-OH risperidone, in human plasma and urine of 52 hospitalized schizophrenia/bipolar disorder patients treated with risperidone as monotherapy and in polytherapy. All the patients were previously genotyped for CYP2D6 (EM=30, EM/IM=14, IM=4 IM/PM=1 and PM=3) and ABCB1 using Real-Time PCR methods with TaqMan SNP genotyping suitable assays according to the guidelines of the manufacturer (Life Technologies, USA).The influence of CYP2D6 phenotype on metabolic ratio MR (Ris/9-OHRis) in plasma (p=0.012) and in urine (p=0.048) was confirmed. Statistically significant correlation (R2=55.53%, Rho=0.844, p<0,0001) for MR in both plasma and urine indicates that urine may be utilized as appropriate media for initial CYP2D6 phenotype identification and selection of patients on risperidone treatment with high risk for ADR.

Introduction: Postoperative pain presents a significant medical problem. It can create a considerable discomfort in the immediate postoperative period and thus increase patient’s morbidity. Multiple mechanisms are involved in its’ etiology, one of them being the method of tissue incision. The aim of this study is to compare the early postoperative pain following incision with two different methods, scalpel and electrosurgery in the facial regions.

Material and methods: Eighty patients with both benign and malignant skin lesions in the facial regions undergoing surgery were enrolled in this study. Patients were randomized in two groups. In group A, comprising 40 patients, cold steel surgical scalpel №15 was used for the surgical procedure. Electrosurgical microneedle with 0.06mm tip radius and generator unit KLS Martin Electrosurgical Unit ME MB 2 set on cutting mode, power 12 W was used for performing the surgery in group B including the same number of patients. After the surgery patients were given analgesics on their demand. The total number of on demand analgesics requirements was calculated. The patients were also asked to note the oral analgesics they were taking after being released from the hospital.

Results: Results of this study showed a statistically significant difference between the groups in the analgesics demand on the day of the operation (p=0.041). On the day of the operation 52.5% patients in the scalpel group and only 30% of the patents of the electrosurgery group received analgesics on demand. In all other analysed time points, the patients in the scalpel group received analgesics more often than the patients in the microneedle group, but with no statistically confirmed difference between the groups (p>0.05). Even more significant is the fact that patients treated with electrosurgery that needed analgesics, had significantly bigger excision area median 471 (rank 283-589) compared to the patients treated with the conventional method 289 (rank 177-432) (p=0.016).

Conclusion: In accordance with previous studies our results suggested a significantly reduced postoperative pain in the electrosurgery group.

Introduction: Multiple factors can cause infection and other pathological conditions in mothers during childbirth. These risk factors and diseases/complications can be prevented or timely detected through the implementation of special protocols/procedures. The aim of this paper is to identify the implementation of procedures/measures for the prevention and detection of infections and risk factors for morbidity and mortality in four hospitals in the Republic of Macedonia, before and during childbirth.

Material and Methods: A retrospective study was conducted in four hospitals in R. Macedonia, in December 2016, on certain days according to the same principle of selection in all institutions. The questionnaire used contained relevant and specific questions related to the application of procedures and protocols at the maternity clinic at the time of admission to the birthplace and immediately prior to delivery.

Results: The study analyzes the performed procedures from 137 obstetric histories. Cardiotocograph was taken after the admission in a hospital in 86% of the mothers; a temperature was measured at only 47.5%, and arterial tension at 89.8%. Immediately before delivery, the color and odor of the vaginal discharge in 98.5% of the mothers was checked, urine was analyzed only in 8% of the mothers, and the analysis of the time of rupture of the mammalian sheaths in 98.6% of the mothers.

Conclusion: The study showed that part of the analyzed procedures was not sufficiently implemented, and the percentage distribution varied between hospitals. There is a need for introduction of organized programs with standard procedures in maternity wards in order to protect against infections and other pathological conditions during childbirth.

Opioid free anesthesia (OFA) is deffined as anaesthesiological technique where opioids are not used in the intraoperative period (systemic, neuroaxial or intracavitary). Anaphylaxis caused by opioids (fentanyl) is very rare, and the reaction is presented with hypotension and urticaria. When we have proven allergy to fentanyl, patients’ refusal of placing epidural catheter and refusal of receiving bilateral ultrasound guided transversus abdominis plane block (USG TAPB), we must think of using multimodal nonopioide analgesia. The concept of multimodal balanced analgesia is consisted of giving different analgesic drugs in purpose to change the pathophysiological process which is included in nociception, in way to receive more effective intraoperative analgesia with less adverse effects. This is a case report of a 60-year-old male patient scheduled for laparotomic hemicolectomy, who previously had proven allergy to fentanyl. We have decided to give him an opioid free anaesthesia. Before the induction to anaesthesia, the patient would receive dexamethasone (dexasone) 0.1 mg/kg and paracetamol 1 gr intravenously. The patient was induced into general endotracheal anesthesia according to a standardized protocol, with midazolam 0.04 mg/kg, lidocaine hydrochloride 1 mg/kg, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg. Anaesthesia was maintained by using sevoflurane MAC 1 in order to maintain mean arterial pressure (MAP) with a value of +/- 20% of the original value. After tracheal intubation, the patient had received ketamine hydrochloride 0.5 mg/kg (or 50 mg ketamine) in bolus intravenously and a continuous intravenous infusion with lidocaine hydrochloride (lidocaine) 2 mg/kg/hr and magnesium sulfate (MgSO₄) 1,5 gr/hr. At the end of surgery the continuous intravenous infusion with lidocaine and magnesium sulfate was stopped while the abdominal wall was closed and 2.5 g of metamizole (novalgetol) was given intravenously. VAS score 2 hours after surgery was 6/10 and 1 gr of paracetamol was given and the patient was transferred to the Department. Over the next 3 days, the patient had a VAS score of 4-6/10 and only received paracetamol 3x1g and novalgetol 3x1 gr daily, every four hours.

Fibroepithelial stromal polyps of vulva are the type of mesenchymal lesion that typically occurs in women of reproductive period. They are common, usually small and hystologically benign. Larger lesions are rare and likely arise from proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower genital tract. We present a case of 16 year old female with a giant polypoid lesion of the vulva localized on the right labium. The mass measure was 18×12×3 cm. Total surgical resection of the lesion was performed. Histopathological examination reported a fibroepithelial stromal polyp of the vulva. The patient showed no evidence of recurrence four years after the resection. Fibroepithelial polyps of the vulvar region are benign lesions that have a wide range of morphologic appearances and may be misinterpreted as malignant. Total excision is the best treatment options and histopathological examination is strongly recommended to rule out a malignant neoplasm.

Objectives: Molecular characterization of a patient with BWS.

Clinical presentation and intervention: A 4-year-old boy with overgrowth (weight above 99th and height at 99th percentile) had longitudinal hemihypertrophy of the tongue and left cheek. In addition, there was a difference of one centimeter in the circumference of the left and right leg. Molecular genetic analysis revealed hypomethylation of KvDRM1 (LIT1) in the imprinting control region-2 (ICR2) on chromosome 11p15.5 and a normal methylation pattern of the H19-differentially methylated region (H19-DMR) in the ICR1. The estimated tumor risk was 1-5%.

Conclusion: This patient with clinical characteristics of BWS has an imprinting defect associated with a low risk of embryonal tumors.

More than 200 participants from Europe, Asia, Africa and South America attended the two days ICGEB Workshop on Next Generation Diagnostics, 22/03/2018-24/03/2018, at the Macedonian Academy of Sciences and Arts (MASA) in Skopje, Republic of Macedonia. The meeting provided an overview of the current and future use of next generation sequencing (NGS), proteomics and other high-throughput technologies in the diagnostic setup of malignant, inherited and communicable diseases. In addition, considerable emphasis was placed on the potential use of these techniques for disease prognostication, patient stratification and monitoring responses to therapy. Specific topics included NGS-based diagnostics of solid tumors, hematological malignancies, inherited and infectious diseases, proteomic-based approaches for biomarker discovery, predictive biomarkers for personalized treatment strategies, and bioinformatic analysis of NGS data. The meeting also provided a unique platform for fruitful discussions between internationally recognized experts and young researchers from developing countries, providing new perspectives and ideas on broader implementation of these techniques for personalized management and care.

Jakub Chlebowski (Jakub Frydman) (1905-1969) was a distinguished professor of internal medicine and skillful organizer of health care system in Bialystok region in the North east Poland. He graduated medicine in 1929 and worked at local university in prewar Vilnius. During World War Two, arrested by the Soviets and exiled to Siberian work camps he managed to return to Poland with Kosciuszko Division of Polish Army. Then, he continued to serve as a military and university medical doctor in Cracow and Lodz, finally to take over position of director of Internal Diseases Department in 1951 in Bialystok, holding an office of rector magnificus of Medical University of Bialystok from 1959 to 1962. Chlebowski trained generations of internal medicine specialists, who later became eminent representatives of emerging branches of internal medicine as distinct subspecialties in the field of cardiology, endocrinology and gastroenterology in Bialystok. In course of anti-Semitic campaign during March Events in 1968, he was disposed from the post of director of the university hospital department. Constantly harassed, he immigrated with the family to Israel to die in public traffic accident in 1969. Jakub Frydman, who survived not only hunger of food, but also metaphorical “hunger of humanity” during World War Two, turned out to be as good and useful as daily bread for Polish community after wartime. He was so devoted in this action, that he even changed his surname into Chlebowski (Polish: Chleb=English: Bread). In this way, due to similar experience and experience-shaped mentality, Chlebowski could be counted among medical authorities of the time, the individuals with such a high moral standard as Janusz Korczak (1878 or 1879-1942) or Julian Kramsztyk (1851-1926).