Tobacco use among medical students in Europe: results of a multicentre study using the Global Health Professions Student Survey.

OBJECTIVE: To examine smoking prevalence, knowledge and attitudes, and tobacco cessation training among university students attending European medical schools using the Global Health Professional Students Survey approach. METHODS: A cross-country, cross-sectional study was performed among 12 medical schools in four countries in Europe (Germany, Italy, Poland and Spain). The survey was performed during the second semester of the third year of study from March to May 2009. RESULTS: In total, 2249 subjects entered the study (overall response rate 92%). The overall prevalence of smoking among medical students was 29.3% (95% confidence interval 28.1-34.7), with percentages ranging from 28% in Germany to 31.3% in Italy. This study found that more than two-thirds of medical students believe that health professionals are role models for patients, with different beliefs in Poland (89.6%) and Germany (77.7%) vs Italy and Spain (57.2% and 54.4%, respectively) (P < 0.001). Smoking cessation training at medical school was only reported by 16.5% of students (lowest proportion in Italy, 3.5%) (P < 0.001). In terms of smoking cessation methods, the vast majority (89.8%) of medical students were aware of nicotine patches and gum (highest prevalence in Spain, 96.3%), and 24.4% were aware of the use of antidepressants (highest prevalence in Germany, 33.6%). CONCLUSION: This European survey found that the prevalence of smoking was higher among medical students than the general population. There is a strong need to provide medical students with training in smoking cessation techniques.

ESWL in hemophiliac patients.

OBJECTIVE: To assess ESWL treatment of urolithiasis in patients with hemophilia, the frequency of hemorrhagic complications, and to determine the treatment outline. PATIENTS AND METHODS: From 1991 to 1997, eleven patients with hemophilia were treated by ESWL for urolithiasis. Substitution of deficient coagulation factors was started on the day of treatment. Ultrasound examination was performed in all cases on the 1st day after the procedure in order to discover any potential hemorrhagic complications. Substitution withdrawal depended on the patients' general status, lack of hematuria and the absence of signs of hemorrhage. Preliminary results were evaluated after 7-10 days on the basis of plain abdominal X-ray of the kidney, ureter and bladder and ultrasonography. RESULTS: In total, 25 ESWL sessions were performed, 1-6/patient. Nine patients (81.8%) discharged stones, and 2 patients are being followed up. No hemorrhagic complications were observed. CONCLUSIONS: Substitution of deficient coagulation factors makes ESWL a safe method of urinary stone management in hemophiliacs. No hemorrhagic complications were seen in our patients. Substitution withdrawal may be based on the patients' good general status, lack of hematuria and absence of signs of hemorrhage.

Collecting (Bellini) duct carcinoma of the kidney--clinical, radiologic and immunohistochemical findings.

We present clinical and radiological findings in a case of collecting (Bellini) duct carcinoma (CDC). This is a rare and aggressive kidney cancer originating from the distal renal tubule. The patient underwent radical nephrectomy and the pathological report showed trabeculopapillary, partially solid adenocarcinoma infiltrating the renal capsule and sinus. Immunohistochemical, as well as mucinocarminic and PAS staining studies are necessary for diagnosis of CDC. Surprisingly, one year follow-up studies were negative for recurrent disease. Chromosomal findings are usually different from most often diagnosed clear cell renal cell cancers. Findings from the literature are briefly discussed.

[The naloxone test in the degenerative changes of seminiferous tubules]. / Test naloksonowy w zmianach zwyrodnieniowych kanalików kretych.

AIM: Are there any changes in hypophyseal and gonadal hormones levels during the naloxone test in the degenerative changes of the seminiferous tubules? MATERIAL AND METHODS: The naloxone test (0.4 mg i.v.) was performed in 13 patients with degenerative changes of the seminiferous tubules. The plasma FSH, LH, prolactin, testosterone and estradiol levels were determined before and 30, 60, 90, 120 minutes after the administration of the drug. RESULTS: In the examined group of patients the plasma FSH, prolactin and estradiol levels were significantly higher, testosterone levels significantly lower and LH levels were in the same range compared with the patients with azoospermia and normal spermatogenesis. The plasma FSH, prolactin and testosterone levels did not change significantly their values during the test. The plasma estradiol levels decreased significantly and plasma LH levels increased significantly during the test. CONCLUSION: Elevated plasma FSH, prolactin and estradiol levels, diminished testosterone levels and the decrease of plasma estradiol levels and the increase plasma LH levels during the naloxone test indicate the degenerative changes of the seminiferous tubules in the cases of azoospermia.

[The naloxone test in patients with varicocele]. / Test naloksonowy u pacjentów z zylakami powrózka nasiennego.

AIM: Is there any influence of naloxone administration on plasma levels of hypophyseal and gonadal hormones in varicocele patients? MATERIAL AND METHODS: The naloxone test (0.4 mg i.v.) was performed in 15 varicocele patients The plasma FSH, LH, prolactin, testosterone and estradiol levels were determined before and 30, 60, 90, 120 minutes after the administration of the drug. RESULTS: The prolactin levels decreased significantly, and FSH, LH, testosterone and estradiol levels did not change their values. The similar results were obtained in patients with azoospermia and normal spermatogenesis. CONCLUSION: The treatment of varicocele patients with anti-opioid drugs is not recommended because the naloxone did not increase LH and testosterone plasma levels.

Long-term subjective results of Marshall-Marchetti-Krantz procedure.

OBJECTIVE: Retrospective, subjective evaluation of results of suprapubic vesicourethropexy (Marshall-Marchetti-Krantz procedure) for stress urinary incontinence. MATERIAL: A total number of 81 patient records operated between 1980 and 1994 at our institution were reviewed and questionnaires were mailed to them to estimate the success rate, period of continence, current complaints and patient satisfaction. Patients with primary incontinence constituted 73% of this group, the remainder of 27% being recurrent or persistent incontinence. RESULTS: The response rate was 75% (60 cases) and this group was evaluated. Mean postoperative time was 9.9 (2-15) years at the time of assessment. Mean duration of continence was 78.5 months and was not influenced by prior hysterectomy or parity. Weak correlation was found between patients' age and continence period. It was similar in patients operated in their 5th and 6th decades of life and was shorter in the 7th decade. Additional sutures placed between the anterior bladder wall and rectus fascia (Lapides modification) resulted in a longer continence period. Cure rates decreased with time and were 81, 77, 57 and 28% after 6, 12, 60 and 120 months respectively. In the incontinent group, 34% of patients described leakage degree as lesser than preoperatively and 65% required protection. As many as 90% of continent and 62% of incontinent women evaluated their urinary system status as better than preoperatively. 90% of continent and 69% of incontinent women would repeat surgery again. CONCLUSIONS: This procedure is characterized by a high 81% early postoperative success rate that decreases with time. Despite recurrence of stress incontinence, one third of patients declare lesser incontinence degree and do not require protection.

[Diagnosis and treatment of vesicouterine fistula occurring after cesarean section]. / Diagnostyka i leczenie przetok pecherzowo-macicznych powstalych po cieciach cesarskich.

Eleven cases of vesicouterine fistula were reported. The initial diagnosis was made when urinary incontinence was occurring. The diagnosis was best confirmed by cystoscopy and hysterography, which was positive in 9 cases. The ultrasonographic examinations allow to visualize the fistula in 5 out of 6 cases examined and to establish the diagnosis. If sonographic examination visualizes the fistula, the performing of hysterography is not necessary. The management consists of the cure of the infection of the urogenital tract and abdominal operation based on the excision of the fistula and closing of the bladder and uterus. All operated patients were cured.

Relationship between semen quality improvement after varicocelectomy and preoperative levels of hypophyseal and gonadal hormones.

Evaluation of serum levels of FSH, LH, prolactin, testosterone and oestradiol is not predictive of the increases of sperm count after varicocelectomy. Increased level of oestradiol reflects the lack of possibility of sperm motility increase after varicocelectomy.

[Urinary diversion to the large intestine in adults]. / Odprowadzenie moczu do jelita grubego u doroslych.

The paper presents the history of technique and concepts of urinary diversion to colon and rectum from the mid-XIXth century until today, including the contribution of Polish surgeons--Krynski, Laskownicki and Kielkiewicz. Contraindications and complications of this type of definitive urinary diversion is briefly discussed. Authors also present the outcome of ureterosigmoidostomy performed according to method proposed by Goodwin in 25 patients cystectomized for infiltrating transitional cell carcinoma of the bladder, who were operated on at the Department of Urology, Medical School in Warsaw. These patients were in poor general condition and short life expectancy, which depended upon tumour stage and grade as well as preoperative urographic evaluation of urinary tract.

[Congenital malformations of the epididymis and vas deferens as reasons for male infertility]. / Wady wrodzone najadrzy i nasieniowodów jako przyczyna meskiej nieplodnosci.

Between 1966-1991 330 patients where the semen analysis revealed azoospermia and the histopathological examination of biopsy specimen of testis shown retained spermatogenesis and spermiogenesis underwent the surgical intervention. In 80% of cases congenital malformations of epididymis and vas deferens were found. The types of malformations detected during the surgery are discussed.

[Ultrasonographic investigations in diagnosis of congenital malformations of epididymis in cases of azoospermia]. / Badanie ultrasonograficzne w diagnostyce wad wrodzonych najadrzy w przypadkach azoospermii.

Between 1984-1991 in 28 patients referred for the surgical treatment for the reason of obstruction of epididymis outlet ducts there was a suspicion of a congenital epididymis malformation put after the physical examination. The ultrasound examination of the scrotum which was performed in all cases revealed the proper view of the epididymis in 5 cases, the proper head of the epididymis with the broad tubules and the lack of the corpus and cauda in 19 cases and in 4 cases the residual head of the epididymis located in region of the upper pole of the testis. Intraoperative findings were consistent with the ultrasound results in 75.0% of cases. The highest consistency between the ultrasonographic and intraoperative findings was found in the cases with the proper view of the head of the epididymis with agenesis of corpus and cauda. In 32.1% of cases malformations of epididymis and vas deferens were associated with the malformations of the urinary tract.

[The puzzle of spontaneous regression of pulmonary metastasis of renal carcinoma (after many years of observing the patient)]. / Zagadnienie samoistnej regresji przerzutów raka nerki do pluc (na podstawie wieloletniej obserwacji chorego).

A case of spontaneous of pulmonary metastases of renal carcinoma RCC with 16-years follow-up was presented. Based on review of literature, current opinions on spontaneous regression of the pulmonary metastases in RCC after nephrectomy are discussed.

[Congenital abnormalities of the urinary tract in Mayer-Rokitansky-Kuster-Hauser syndrome]. / Wady wrodzone ukladu moczowego w zespole Mayer-Rokitansky-Kuster-Hauser.

Congenital abnormalities of the urinary tract were diagnosed in 28 per cent of authors' own cases of Mayer-Rokitansky-Kuster-Hauser syndrome. Different kinds of abnormalities were discussed and accurate diagnosis of urinary tract abnormalities before planned operation in that group of patients was emphasized.

Male infertility and its treatment: a review of over 4700 patients treated for male related infertility.

Changes in semen parameters are presented for 4708 patients treated for infertility. The largest group comprised patients with oligoasthenozoospermia of various grades (57.7%). Improvement in the seminal state was noted in 70.3%. The percentage of achieved normospermia increased proportionally to the initial semen state. Pregnancy rate also increased proportionally to the initial seminal state. Among the patients' wives 20.4% conceived: 28.2% of these pregnancies had occurred after having achieved normospermia, while in 71.8% the seminal states were still below the accepted normal values.

Urine and semen cytomorphology in patients with testicular tumors.

Our original technique of preparing urinary and seminal sediment was modified in order to identify neoplastic cells in cases of testicular malignancies. In a series of 24 patients with testicular tumor-like conditions, 18 tumors were diagnosed, 12 cytologically. In one case, the result of cytological examination was falsely positive since histopathology revealed necrosis of the testicle only. The morphology of neoplastic cells in the seminal sediment is demonstrated.

Detection of testicular neoplasms by cytological examination of seminal fluid.

The technique for detection of neoplastic cells in the seminal fluid of patients with testicular malignancies is presented. This preliminary study of 7 patients with testicular tumors and 50 controls demonstrates the possibility of using cytological examination of the sperm as the screening method for testicular tumors.