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Pulmonary involvement is a severe manifestation of systemic sclerosis (SSc). The study was designed to determine the serum level of surfactant protein D (SP-D) in patients with SSc in relation to clinical and laboratory parameters as well as to analyze dynamics of changes of these indices within one year of observation. SP-D was assayed in 41 patients with SSc and 15 healthy controls. Additionally, pulmonary function tests, chest high-resolution computed tomography (HRCT), and inflammatory markers were assessed. All tests were performed twice: at entry and repeated after one year of observation. The serum level of SP-D was significantly higher in patients with SSc than in healthy controls. Serum concentration of SP-D was significantly higher in patients with systemic sclerosis-related interstitial lung disease (SSc-ILD) than in those without SSc-ILD. SP-D was found to correlate with lung involvement evaluated with the Medsger score (diffusing capacity of the lung for carbon monoxide (DLCO), forced vital capacity, radiological changes, and estimated pressure in the pulmonary artery in echocardiography). SP-D correlated with the honeycombing and/or reticular pattern in HRCT and ground glass opacification pattern. Serum concentration of SP-D was elevated in patients with a decreased DLCO. Furthermore, SP-D was higher in patients with diffuse cutaneous type (dcSSc) of the disease than in those with SSc limited type (lcSSc). Because of the small size of the group, it was not possible to perform a statistical analysis for patients who had different results in HRCT, VC, and Medsger score between the first and the second evaluation. SP-D seems to be an index for assessing lung involvement. It reflects the state of pulmonary fibrosis but not the dynamics of the pulmonary fibrosis progression. Further studies are needed to evaluate clinical application of the index, and currently, there is no evidence for the recommendation of the application of SP-D in routine evaluation of patients with SSc.

1 . The generalist versus the specialist During the last decades, new terminology has struggled to describe the changing trends in the practice of internal The 'hot debate' in internal medicine since its inception medicine. It has been suggested that the role of the has been the relationship between the general internist and traditional 'internist' can best be described by the term the sub-specialist. Since the early years of internal medi- 'generalist'. Lee (3) suggested that generalists and special- cine, internists have been medical scientists involved at ists take different attitudes towards the same medical every level of clinical and basic science research. As early problems and that they adopt different positions within any as 1895, Sir William Osler (1849-1919), the great Cana- health care system. The specialist tends to know more and dian internist, stated that the education of specialists in more about less and less, while the generalist knows a lot internal medicine should be based on pathology, bacteriol- about a lot. According to Lee (3), apart from the use of ogy, and chemistry and that they should pass through the different methods and equipment, there are other categori- laboratories to the wards, applying laboratory sciences cal differences between generalists and specialists. These directly to clinical medicine (1). This intimate connection include different boundaries and horizons to their clinical between science and bedside internal medicine produced care, as well as different clinical worries and attitudes enormous progress in understanding the pathophysiology towards risk. The generalist's view of a clinical problem of disease. This led to the development of numerous new and its relation to the external world includes the patient's diagnostic and therapeutic techniques, which, in turn, gave social and psychological predicament. It is more open and rise to new areas of interest based on their use (2). broader than the sub-specialist's, whose view is more Unfortunately, over the last 30 years, specialists have focused, narrower, and more limited. Moreover, since concentrated more and more on these areas of interest so generalists use less technical equipment, they can function that their practice has become more or less completely independently and without the need for expensive re- confined to their sub-specialty interest. At the present time, sources and support staff. in many countries, the general public now considers the Sub-specialists provide sophisticated forms of diagnosis terms 'sub-specialist' and 'specialist' to be synonymous. and therapy (4) and can solve many difficult medical Both are thought to be medical experts focusing on one problems, often providing dramatic cures. system or organ. According to this popular, but wrong, It is not surprising that the lay public, encouraged by the opinion, internists are not considered to be specialists. In media, find sub-specialty medicine fascinating and awe- Poland, for example, insurance companies' contracts no inspiring. Generalist medicine, on the other hand, is less longer pay internists as specialists. However, despite the spectacular and appears dull and uninteresting. Hence, oxymoron of being 'a general specialty', internal medicine their achievements appeal less to the mass media. General- was the original scientifically based medical specialty, the ists, however, have been responsible for a number of mastery of which requires more skill and experience than significant research achievements. These include scoring any of its sub-specialties.

Background: Interleukin-6 (IL-6) is a key cytokine in the initiation of the acute-phase reaction that accompanies myocardial infarction. The study was designed to evaluate changes in serum IL-6 in patients with myocardial infarction and to compare IL-6 alterations with serum creatine kinase (CK) activity. Methods: Serum IL-6 level and CK activity were measured in 19 males with acute myocardial infarction. Blood was taken on the 1st, 3rd, 5th, 7th and 21st days of the disease. Control values were obtained from 30 age-matched healthy males. IL-6 was determined according to the ELISA method and CK was measured with a routine procedure. Results: Serum IL-6 was found to increase on the 1st and 3rd days of the disease, followed by some decline on days 5–21. However, the last values measured were still higher than those in the controls. Patients with transmural myocardial infarction had higher IL-6 levels than those with non-Q myocardial infarction. There was no difference in serum IL-6 in patients with myocardial infarction of the inferior cardiac wall and of the anterior cardiac wall. A correlation was found between IL-6 level and CK activity in the patients, especially on the 1st and 3rd days of the disease. Conclusion: Serum IL-6 increases in patients with myocardial infarction, and this elevation seems to be related to the mass of the affected myocardium. The highest increase is found during the first days of the disease, although the enhanced IL-6 level lasts for at least 3 weeks, probably reflecting the healing process of the myocardium. The clinical value of IL-6 determination does not seem to exceed that of the indices commonly used.

The First and Second Solemn Meetings of Polish Internists were organized to celebrate the Centenary of the Polish Society of Internal Medicine. The aim of these educational conferences was to integrate the Polish national societies of various subspecialties related to internal medicine. More than one thousand participants took part in the First Solemn Meeting of the Polish Internists (Pierwsza Gala Interny Polskiej) held in Katowice on March 10–11, 2006. The conference was preceded by a solemn meeting of the Executive Board of the Polish Society of Internal Medicine with participation of the presidents of the Polish societies for several subspecialties and the Gala Dinner in the hotel Qubus (Fig. 1). During the dinner, the Centenary Medals were presented to a number of Polish internists. During the first day of the First Solemn Meeting of the Polish Internists the following lectures were presented: “Strategy of diagnostics and management of pulmonary embolism” (Adam Torbicki), “Treatment of cardiac arrhythmias” (Mary Trusz-Gluza), “The brain–heart–peripheral tissues” (Christopher Ziaja), “New strategies for management of patients with rheumatoid arthritis and osteoarthritis” (Witold Tlustochowicz), “Targeted therapy of proliferative hemopoietic disorders” (Andrew Hellmann), “Control tests after oncological treatment” (Marion Reinfuss), “New antithrombotic agents” (Cristina Zawilska), “Postprandial glycemia: clinical significance” (Hyacinth Sieradzki), “Thyroid diseases: modern view” (Barbara Jarząb), “Gastric and duodenal ulcer: what we currently know about” (Leszek Paradowski), “Management of acute and chronic infections

Rats were intoxicated with sodium selenite (0.3 mg kg body wt.) for 10 weeks. An increase in total collagen content in skin and a decrease in the lungs, liver and kidneys were observed. Enhanced serum and urine levels of collagen metabolites were found. Elastin content was shown to be increased in the lung, liver, heart muscle and kidney of selenium-intoxicated rats.

Background: Free radicals have been said to contribute to vascular damage in patients with systemic sclerosis. The aim of the study was to determine the level of lipid peroxidation products and antioxidative enzyme activity in patients with systemic sclerosis and in healthy controls. Methods: 10 women with definite systemic sclerosis and 10 age-matched healthy women were studied. Results: A significant increase in serum lipid peroxidation product levels (i.e. diene conjugates and thiobarbituric acid-reactive substances) was found in patients with systemic sclerosis. These changes were accompanied by a decrease in superoxide dismutase, catalase, and glutathione peroxidase activity in erythrocyte lysate. Furthermore, there was diminished activity of glutathione reductase and a depressed total serum level of antioxidants compared to the controls. Blood thiol group concentration in patients with systemic sclerosis was also found to be decreased. Conclusions: The results obtained indicate increased oxidative stress in patients with systemic sclerosis.

The Albanian Society of Internal Medicine (Shoqata Shqoiptare e Mjeksise Interne) was founded on October 23, 1996 by a group of internists from the Medical School of Tirana University who were working at the Mother Theresa University Hospital. Professor Bashkim Resuli, hepatologist and gastroenterologist, was elected the first president. The activities of the Society were focused on education, research, and editorial activity. Despite the political and economic difficulties of the late 1990s, under the leadership of Professor Resuli the Society organized five meetings. In 1998, Professor Resuli took part in the Third Central European Congress of Internal Medicine organized in Wisa (Poland), and there the Society signed the Declaration of Cooperation of Internists of Central Europe. Albanian internists took part in the next Congress in Vienna (1999) and in the Sixth Central European Congress of Internal Medicine in Igalo, Yugoslavia (2001) (Fig. 1). On April 3, 2006, Professor Resuli was succeeded by Professor Alfred Priftanji, an allergologist from Tirana. The current Executive Board includes Alfred Priftanji (President), Bashkim Resuli (Past President), Artan Goda (President-Elect), Mihal Tase (Vice President), Myftar Barbullushi (Scientific Secretary), Jovan Basho (Treasurer), and Fecor Agaci, Hektor Cocoli, Ana Koliqi, and Dhimiter Kraja (members). The Executive Board also includes section chairmen Perlat Kapisyzi (Pneumology), Kristo Pano (Infectious medicine), Spiro Qirko (Cardiology), Llukan Rrumbullaku (Family medicine), Argjend Tafaj (Rheumatology), Nestor Thereska (Nephrology), Ermira Vasili (Dermatology), Pal Xhumari (Hematology), and Agron Ylli (Endocrinology). The Sixth National Conference of the Albanian Society of Internal Medicine (Konferenca e VIte Kombetare e Mjeksise Interne. Epidemiologija e semundjeve te brendeshme) took

We recently visited the International Hippocratic Foundation of Cos. In its building, located on the island of Cos, there is a museum whose collection is mostly devoted to Hippocrates. In the corner of the museum is a small white marble statue, about 40-cm high, of a young man. Next to it is a sign with the contemporary description ‘‘Podaleirios. Son of Asclepios, god of internal medicine’’. We were quite surprised to find this, as the specialty of internal medicine has only been known since the 19th century. We therefore decided to carry out a short historical study on Podaleirios or Podalirius. We present our findings below. The most comprehensive collection of testimonies on Asclepius was published by Emma J. Edelstein and Ludwig Edelstein in 1948 and recently reprinted in Baltimore [1]. Podalirius (Podaleirios) (C:yaEe(UL:e) is mentioned in this book several times. Asclepius, the mythological god of the art of healing, was married to Epione, and they had two sons, Machaon and Podalirius. Machaon was a famous surgeon, and Podalirius was described as a very skilled physician who applied medical herbs. Podalirius is mentioned in Homer’s ‘‘Iliad’’, as well as in a few ancient works from post-Homeric times, in such descriptions as ‘‘for, as a physician, he was for the most part an herb-gatherer’’— Eustathius, Commentari as Homeri Iliadem [2]. The medical activities practiced by Asclepion’s sons were clearly distinguished, with those of Machaon being surgical methods and those of Podalirius non-surgical procedures. Of course, ancient Greeks did not know the term ‘‘internal

The effect of dibutyryl guanosine cyclic monophosphate (db-cGMP) on proliferation of an interleukin-2 (IL-2)-dependent T-cell line was investigated. Dibutyryl cGMP added to HT-2 cell cultures without IL-2 or in the presence of an optimal IL-2 concentration (60 U/ml) had no effect on proliferation. The same amount of db-cGMP (10 −5 M) added to cultures in the presence of suboptimal amounts of IL-2 (3–6 U/ml) produced significant increases in proliferation. In contrast, db-cAMP caused substantial inhibition of HT-2 cells cultured with IL-2. Similar effects were observed using human T-cell blasts produced after 72 h stimulation with phytohemagglutin. These results suggest that cyclic GMP may play a role in the cellular response of IL-2 responsive cells to IL-2.