[Spiritual ties of the Military Medical (Medical and Surgical) Academy].

Before the revolution in its educational, research and clinical potential of Military Medicine (medical and surgical) Academy was on the head position among European institutions. Not less outstanding position among all secular institutions Russian Academy held by the number and wealth of churches, chapels and baptisteries. In the temples of the academy was concentrated a significant number of miracle-working icons and of the particles holy relics, there served some of faith and piety devotees and some of them were canonized. The article presents a brief historical overview of the major Academy shrines--spiritual ties of the different generations.

University cardiology clinic.

In distant 1972, within framework of the Internal Clinic, a cardiologic department was organized which was soon, on 29.XII.1974, transformed into the Cardiology Clinic, later the Institute for Heart Diseases, and in 2008 was renamed the University Cardiology Clinic. The greater part of its foundation was possible owing to Prof. Dimitar Arsov and Prof. Radovan Percinkovski, who was the clinic's first director in the period from 1974 to 1984. In 1985, the Clinic moved into its own new building, and in that way was physically detached from the Internal Clinics. Until its move to the new building, the Clinic functioned in the Internal Clinics building, organized as an outpatient polyclinic and inpatient infirmary department with clinical beds, a coronary intensive care unit and a haemodynamics laboratory equipped with the most modern equipment of that time. Today the Clinic functions through two integral divisions: an inpatient infirmary department which comprises an intensive coronary care unit and fourteen wards which altogether have 139 clinical beds, and the diagnostic centre which comprises an emergency clinic and day hospital, a communal and consultative outpatients' clinic functioning on a daily basis, through which some 300-350 patients pass every day, and diagnostic laboratories with a capacity of nearly 100 non-invasive and 20-30 invasive diagnostic procedures daily. The Clinic is a teaching base, and its doctors are educators of students at the Medical, Dental and Pharmacy Faculties, and also of students at the High School for Nurses and X-ray technicians, but also for those in Internal Medicine and especially Cardiology. The Clinic is also a base for scientific Masters' and post-doctoral studies, and such higher degrees are achieved not only by doctors who work here, but also by doctors from Medical Centres both in the country and abroad. Doctors working in this institution publish widely, not only a great number of books and monographs, but also original scientific papers published in indexed medical journals.

Department of Nephrology at the Medical Faculty, Ss. Cyril and Methodius University, Skopje--creating nephrology protection for the citizens of the Republic of Macedonia.

In January 1975, de facto, the Nephrology Department was founded at the Medical Faculty in Skopje as the first institution of such a type in former Yugoslavia. The Nephrology Department was the driving force for the further development of nephrology in the Republic of Macedonia. D. Hrisoho was the first Director of the Department, and its subsequent Directors were G. Masin, M. Polenakovic, K. Zafirovska and currently A. Sikole. Prior to the establishment of the Nephrology Clinic there had been considerable experience in the diagnosis and treatment of renal patients. The first haemodialysis (HD) in the Republic of Macedonia (RM) was performed in 1959 on a patient with acute renal failure (ARF) using a Kolff-Brigham rotating drum artificial kidney at the Blood Transfusion Institute in Skopje. In 1965 the Renal Unit at the Department of Medicine, Medical Faculty, Skopje obtained a new, modern "Websinger" artificial kidney with a sigma motor pump and possibilities for the use of a disposable Kolff "twin coil" dialyser. Between 1959 and 1971, HD was performed only on patients with ARF. In May 1971, a Unit for Chronic HD was founded at the Renal Unit and the programme of maintenance haemodialysis (MHD) was started with five Stuttgart Fresenius machines and 12 patients dialysed on twin coil dialysers. That was a great incentive for the development of HD in the Republic of Macedonia enforced by the great number of patients with end stage renal disease. Thus in 2007 we have 18 HD centres in the Republic of Macedonia, with 1183 patients. Treatment of the patients with MHD is the greatest success achieved in the Republic of Macedonia in nephrology concerning patients with end stage renal disease. Prior to the treatment with MHD patients were destined to die, whereas now, with this type of treatment, they have a normal life and families. Patients with kidney diseases are examined in outpatients clinics as well as treated in the wards of the Department. All types of vascular accesses, renal biopsies, bone biopsies, kidney ultrasound, plasmapheresis and other investigations are performed every day at the Nephrology Department of the Medical Faculty. On the basis of the results of renal biopsy, a classification of parenchymal renal diseases has been established, as well as appropriate immunosuppressive and other treatments. The nephrology doctrine for primary, secondary and tertiary healthcare has been prepared and has been distributed to all medical centres in the Republic of Macedonia. The first (living donor) renal transplantation was performed in July 1977. Later, living and cadaver donor transplantations were performed, so the Department of Nephrology was complete concerning dialysis and renal transplantation, and it became part of the European centres for diagnosis and therapy of kidney disease. Doctors from the Nephrology Department are among the most productive scientific workers in the Republic of Macedonia and their papers can be found on the internet Pub Med. The Department of Nephrology, together with the Nephrology Association, was the source of knowledge in the area of nephrology and the transfer of knowledge from abroad into Macedonia and vice versa. The Nephrology Association has made a great contribution in the development of nephrology in our country. The most famous European and world nephrologists have participated in the work of our association and have contributed to the development of nephrology not only in Macedonia, but on the Balkans as well.

Development of the clinic of pulmonology and allergy.

University Pulmology and Allergy Clinic was founded in 1975 when the Depertment of Internal Medicine, directed by Prof. Dr. Dimitar Arsov, later member of the Macedonian Academy of Sciencies and Arts, was divided into eight separate and independent clinics. The first head of the Pulmonology and Allergy Clinic was Prof. Dr. Ljubomir Kotevski. He had a very difficult goal: to establish and further develop the newly formed clinic. The Clinic flourished and became one of the leading Clinics in the Clinical Centre during the directorship of Prof. dr. Dejan Dokic.. He completely rebuilt and refurbished the Clinic, which became a modern Clinic providing excellent working conditions for the employees and, most importantly, provided a first class service to the patients. During his mandate he obtained a grant from the Japanese Government worth $1,000,000 which was used to obtain a new, modern and sophisticated medical equipment. Since the establishment of the clinic, many national and international scientific projects were carried out and many scientific papers were published as well as many monographs, and chapters in scientific books. As a result of continuous education, of the total number of 24 doctors there are 16 subspecialists in respiratory medicine and 4 specialists in internal medicine. There are 9 professors in internal medicine at the University of Pulmonology and Allergy Clinic lecturing at the Medical Faculty in Skopje. The University Pulmonology and Allergy Clinic has an international reputation due to many contacts with famous European Institutions. All these international interrelations have resulted in honouring 3 professors: Prof. Dr. Gert Kunkel from Berlin, Germany, Prof. Dr. Robert Loddenkemper from Berlin, Germany and Prof. Dr. Peter Howard from Southampton, UK.

Haematology in the Republic of Macedonia: present situation and brief history.

The development of clinical haematology in Macedonia has taken place over the past nine decades. The greatest expansion of its development took place in the second half of the 20th century. The oficial start of clinical haematology dates from 1956, when the Department of Haematology was founded within the framework of the Internal Medicine Clinic in Skopje. In the beginning, haematology represented a form of virtual sub-specialty, but its expansion was so progressive and rapid that it reached the highest peaks of Yugoslav haematology in those times. The period from 1968 to 1979 was a period of integral development of haematology and blood-transfusion science in Macedonia. Nowadays, the autonomous Public Health Institution, the University Hematology Clinic, is a unique healthcare, educational and scientific establishment in the Republic of Macedonia in its field of work. The diagnostics algorithm comprises cyto-morphologic and cyto-chemical analysis, through immunologic characterization with the assistance of a flow cytometer, to sophisticated molecular analysis for detecting genetic abnormalities. The therapeutic approach is based upon modern poly-haemotherapeutic protocols, application of monoclonal antibodies, immuno-modulatory agents, molecular target therapy and the use of alogeneic and autologous transplantation of fresh bone-marrow and frozen haemopoietic stem-cells. The current motto of the Haematology Clinic is: always help those who seek help, provide precise and early diagnostics, and apply all up-to-date therapeutic strategies, scientific research, continual education and day-to-day implementation of the latest achievements in the field of haematology in daily practice.

Development of the Clinic of Endocrinology, diabetes and metabolic disorders.

The Clinic of Endocrinology, diabetes and metabolic disorders was founded in 1975 by Prof d-r Alexandar Plashevski. Healthcare, educational and scientific activities in the Clinic of Endocrinology are performed in its departments. The Department for hospitalized diabetic and endocrine patients consists of the metabolic and endocrine intensive care unit, the department for diagnosis and treatment of diabetics and endocrine patients, day hospital, the department for education of diabetic patients, and the national center for insulin pump therapy. The Center for Diabetes was established in 1972 by Prof d-r Dimitar Arsov. In 1975, Prof d-r Alexandar Plasheski broadened the activities of the Center for Diabetes. It was dislocated in 1980, with new accommodation outside the clinic. Since then the Center has consisted of several organized units: two specialist outpatient clinics for diabetic patients, biochemical and endocrine laboratory, sub-departments for: diabetic foot, cardiovascular diagnosis, ophthalmology, and urgent interventions. The Department of Endocrinology and Metabolic Disorders for outclinic endocrine patients was established in 1980, and it integrates the following sub-departments: thyrology, andrology, reproductive endocrinology, obesity and lipid disorders and sub-department for osteoporosis. The educational staff of the Clinic of Endocrinology organizes theoretical and practical education about Clinical Investigation and Internal Medicine with credit transfer system course of study of the Medical Faculty, Faculty of Stomatology, postgraduate studies, specializations and sub-specializations. Symposiums, 3 congresses, schools for diabetes and osteoporosis and continuous medical education were also organized. The Clinic of Endocrinology was initiator, organizer, founder and the seat of several medical associations.

University Clinic of Toxicology--historical note and present work.

The University Clinic of Toxicology (UCT) in Skopje was founded as the Clinic for Toxicology and Emergency Internal Medicine on January 15th 1976. Today UCT has a modern building with office space of 1,300 m2 on 4 floors, 40 hospital beds and 72 employees including 18 doctors. UCT works in accordance with the public healthcare services in the Republic of Macedonia through the use of specialist/consultative and hospital healthcare for people over the age of 14 years. The Clinic also provides services in the field of emergency internal medicine, acute poisoning with medications, pesticides, corrosives, poisonous gases and mushrooms, heavy metals and other chemicals. The Clinic takes an active part in the detoxification programme for users of opiates and psychotropic substances, protocols for enteral and parenteral nutrition and guides for home treatment. Yearly there are more than 14,000 ambulance admissions, over 1,400 hospitalized patients, over 4,000 urgent EHO checks, more than 1,000 urgent upper endoscopies and over 700 other toxicological analyses and other interventions. The educational services and activities are realized through the chair for internal medicine. The Clinic offers undergraduate and graduate level education for medical students and dentists, for medical nurses, radiology technicians, speech therapists and physiotherapists. Over 300 papers and reports have been published to date by the medical staff at the UCT in the form of abstracts and integrated projects in the Republic of Macedonia and aboard. 8 doctorates have been successfully completed by employees from the Clinic as well as 4 master's theses and 1 in-depth project. UCT employees are the authors of some textbooks and monographs. UCT have undertaken some scientific projects. Employees from the Clinic of Toxicology are members taking an active part in many domestic and international associations.

[Analysis of the transfer of the world medical scientific center until modern times].

Since the 16th century, the world medical scientific center has transferred from Italy, Netherlands, the United Kingdom, France and Germany to the United States. The standards by which the above-mentioned countries became the medical scientific center during a certain historical period were not only the number of achievements of the scientific research and the talents, what was more important was their position and function in the leading disciplines. The background of the transfer of the medical scientific center was the economic, cultural and political rise of these countries, and the most important foundation was the innovation of personnel training systems.

Alkmaion's discovery that brain creates mind: a revolution in human knowledge comparable to that of Copernicus and of Darwin.

Without special examination the brain offers no clue that it is the organ of the mind. From the dawn of time man thus either ignored the problem as to the source of thought, or attributed it to a variety of anatomical structures, usually the heart. The brain held no place in such intuitions, and in most languages it is analogized to bone marrow. Furthermore, nothing in early medical systems claimed any intellectual capacity for the brain; and the Egyptians, so fastidious in care for their afterlife, heedlessly discarded the brain in funerary practice. It was thus a unique event in world history when Alkmaion of Kroton (Alcmaeon, ca. 500 bc), based on anatomical evidence, proposed that the brain was essential for perception. Although no writings of Alkmaion survived, it was probably via a fortuitous linkage that his idea of the mental primacy of the brain was transmitted to, and preserved within, the teachings of the Hippocratic school. Nothing, of course, was secure as to mechanism, two millennia unfolding until the search for mind passed from the ventricles to the cerebral cortex. Nonetheless, Alkmaion was the beginning, and the ensuing understanding that he initiated is still transforming humanity's perception of the natural world, and their place within it.

Dean Milton C. Winternitz at Yale.

Milton Winternitz led Yale Medical School as its Dean from 1920 to 1935. An innovative, even maverick leader, he not only kept the school from going under, but turned it into a first-class research institution. Dedicated to the new scientific medicine established in Germany, he was equally fervent about "social medicine" and the study of humans in their culture and environment. He established the "Yale System" of teaching, with few lectures and fewer exams, and strengthened the full-time faculty system; he also created the graduate-level Yale School of Nursing and the Psychiatry Department, built numerous new buildings, and much more. It is a loss to 21st-century medicine that his dream of an Institute of Human Relations, envisioned as a refuge where social scientists would collaborate with biological scientists in a holistic study of humankind, lasted for only a few years, before falling victim to the more obvious triumphs of medical science and technology. It is sad, too, that he is remembered largely as a Jew presiding over a medical school that, like most others, restricted the number of Jewish students, rather than for his contributions to American medicine.

Preparing the osteopathic academic health centers for healthcare reform.

Healthcare reform proposals introduced in the House and Senate, put forward by foundations, professional associations and study groups, all call for medical schools to train more generalists. As these agents make recommendations for change, they are studying the osteopathic medical education model with fresh interest because of its success in maintaining more than 60% of its graduates in primary care practice. Most students of reform place the blame for producing too many specialists and sub-specialists squarely on the academic health centers. The authors trace the development of academic health centers and compare and contrast the models developed in the osteopathic and allopathic medical settings. They enumerate the strengths in the osteopathic education model which have contributed to our favorable balance of generalists to specialists. However, they argue that specific changes in the osteopathic academic health center are essential if we are to retain leadership in generalist education under healthcare reform.

Development of neurosurgery in Canada.

The development of neurosurgery in Canada is traced through an analysis of the contributions of key early figures in this specialty. The evolution of Canadian training standards is discussed against the background of socio-economic change in the nation at large.