Professor Rastislav Dzúrik MD, DSc. died after a long illness on February 27, 2014 (Figure 1). He was one of the most outstanding Slovak medical personalities who lived in the 20th and at the beginning of the 21st century. He left work that significantly influenced the development of general internal medicine, clinical nephrology, biochemistry and pharmacotherapy.

Professor Dzúrik was born on August 24, 1929 in Košice. He graduated from the High School in Bratislava in 1948.He finished his medical study at the Medical School of Comenius University in Bratislava in 1953. After graduation he began to work at the Institute of chemistry and biochemistry of the Medical School. As a young assistant he was immediately involved into pedagogical work and at the same time he tried to find a contact with clinical practice. In 1957 he went together with some assistants (Eva Brixová, MD, Jan Gvozdjak, MD) to the newly founded 3rd Internal Clinic and continued in working. Later the Clinic became the base of “Internal School of Professor T. R. Niederland“ with biochemical focusing [1]. He participated together with other assistants in the establishing of Research Laboratory of Pharmacobiochemistry at that Clinic, which became its experimental base. In these years started the developing of new clinical divisions. Clinical biochemistry had a prominent place among them. Dzúrik tried to support therapeutic activity by high-quality diagnostics. Until 1962, he received attestation of clinical biochemistry and of internal medicine of the 1st and 2nd degree. At the same time he defended his PhD thesis with a title “Contribution to the effect of the salyrgan in the kidneys”. Despite the time-challenging work at the Clinic as well as in the laboratory, he received the academic degree Associate Professor of internal medicine at the Medical School of Comenius University in 1965. His habilitation thesis “Experimental contribution to the metabolism of the glycides in the kidneys” clearly indicated his future scientific focus. This was also demonstrated in his dissertation thesis “Uraemia – pathophysiology of carbohydrate metabolism”, published in English in 1973 and he defended his academic title “Doctor of Medical Sciences (DSc)“. In 1987 he was appointed as a full professor of internal medicine.

Work in laboratory showed to the need for education of qualified laboratory technicians. Therefore, in 1961 he took care of the education of biochemical laboratory technicians, as the founder and head of the Department of medical laboratory technicians at the Institute for further education of medical staff. As a study aid he prepared a monograph “Enzymology” in 1967 [2], which became a valuable study material for them, and also for doctors of medicine who have completed courses at the Department of Clinical Biochemistry, at the Institute for further education of physicians and pharmacists, where he also lectured. In 1980 he became the Head of that department and in 1983 the Director of the Research Institute of Medical Bionics. The Institute under his leadership soon gained an international authority. Here, in the new environment with the need of rapid handling of computer technology problems and its applications, fully excelled his extraordinary inventions and realizing abilities. In the framework of the Research Institute of Medical Bionics he has created the conditions for the foundation of a Centre of Clinical Pharmacology. The Centre – the only one of this kind in the former Czechoslovakia, provided valuable assistance to the domestic pharmaceutical industry in monitoring the effect of new drugs. Nowadays the core of this centre forms a substantial part of the Institute of Preventive and Clinical Medicine in Bratislava.

He wrote several monographs i.e. “Diuretic Therapy” [3]; “Kidney metabolism and function“ [4]; “Disorders of the Internal Environment – Diagnostics and Therapy” [5] and other; and chapters in textbooks of Professors Dérer and Dieška “Internal Diseases”; of Professor Hořejší “Principles of Biochemistry in Internal Medicine”. He published together with Prof. Niederland “Clinical Aspects of Trials of New Drugs”. Professors Dzúrik and Trnovec were the main editors of two books “Standard Diagnostic Procedures“ [6] and “Standard Therapeutic Procedurs” [7] in 1998 and 2001.The most significant success of Professor Dzúrik was the important textbook “Nephrology“ which was published in 2004 [8] and he was its main editor. It is a complex work of clinical nephrology which completed his and co-authors clinical, pedagogical, scientific and research activities, but always in the context of internal medicine. His publishing activity was manifested in more than 500 scientific papers, most of them in international journals and more than 1,000 citations.

In addition to his scientific and research activities it is also necessary to underline his excellent organizing abilities and activities. He founded the Nephrological Section of the Slovak Internal Society in cooperation with Professor Jan Brod in 1967. This allowed to start the postgraduate scientific and research activity in nephrology. He was the first President of this Section. Later he became the President of the Slovak resp. Czechoslovak Nephrological Society, in which he alternated with Professor Albert Válek, especially in the organization of international nephrological congresses. He started cooperation with important foreign nephrologists, i.e. Professors Carmelo Giordano, Jonas Bergström, August Heidland, and others. He invited them to present their scientific papers at congresses in Bratislava, i.e. at the 8th Danube Symposium on Nephrology in 1987. Since then under the leadership of Professor Dzúrik and later under the leadership of his student Professor Viera Spustová, MD, DSc. [9], nephrology has developed still at a higher level. In the second half of the 20th century clinical nephrology recorded an unprecedential development that resulted in the formation of new clinical division “nephrology“ within internal medicine. Curative and preventive care of patients with kidney diseases, pre-and postgraduate education of medical students and doctors of medicine in nephrology, as well as scientific and research activity continued and have been further developed at the beginning of the 21st century.

In this context it should be noted that to manage the above mentioned activities within the Medical School and later the Slovak Medical University, such a universal personality as Professor Dzúrik was needed. He had an extraordinary theoretical, practical, clinical and biochemical erudition. We have to say that it was very difficult to separate his activities in the terms of general internal medicine, nephrology, clinical biochemistry and clinical pharmacology because they overlapped each other. Tremendous activity of Professor Dzúrik as an excellent organizer of numerous national and international congresses and symposiums resulted in fact that he became the President of the Slovak Medical Association. At the congresses he had with his co-workers still active participation, often as an invited speaker. He presented lectures in concise form in different languages and these were published in foreign journals or proceedings.

The main topics of his scientific work, in which he received many priority results, were: Isolation and characteristic of inhibitor of glucose utilisation and of inhibitor of renal gluconeogenesis[10] [11]; Isolation and identification of hippurate and pseudouridine [11] [12]; Effect of “middle molecular substances“ [13] [14], especially in the development of renal insufficiency. He developed a concept of “middle molecular substances” in the pathogenesis of renal insufficiency, which had a great response abroad. All of these works contributed to the clarification of the “uremic toxicity” and of the progression of kidney diseases. In the terms of our cooperation we consider as extremely important work on “middle molecular substances” – uremic toxins, which have significant participation in the development of uremic syndrome in acute and chronic renal failure [15] [16].

The scientific and research work that Professor Dzúrik has performed during his active life will remain as a stimulus for the next generation of nephrologists, biochemists and clinical pharmacologists. He left a historical impact in the international medical and scientific community.

Introduction

During the Warsaw Uprising, in 60 days 150 thousand civilians and 15-18 thousand insurgents, soldiers of the Home Army, were killed. Number of casualties would have been even larger if it had not been for the well prepared operations of medical services. It is estimated that medical services saved around 25 thousand lives. 1210 doctors and many medical students participated in the Uprising. We presented 3 of great nephrologists, pioneers of Polish nephrology and transplantology, who participated in Warsaw Uprising (1944) and after the war organized the clinics of nephrology, dialysis and renal transplantation centers in Poland.

Zygmunt Hanicki (1919-1995)

[Figure 1] He was a volunteer in Insurgent Medical Services. During the war, he studied medicine at the Secret University of Warsaw and worked in the Institute of Hygiene. He vaccinated civilians against typhoid fever using vaccines manufactured by Rudolf Weigl Institute in Warsaw. In conspiracy he worked as a courier for the Home Army (Polish resistance organization during World War II). During the Warsaw Uprising, similarly to other senior medical students, he gave first aid to the Insurgents and civilians at the first-aid post of Kolonia Staszica region. He participated in evacuation of the injured to the Dzieciatka Jesus Hospital. Before the fall of the Uprising, he left Warsaw towards Radom. After the war, he completed medical studies in Cracow and began work at the 2^nd Department of Internal Disease of the Jagiellonian University. In 1962 he organized the first dialysis centre of Southern Poland and performed the first hemodialysis using with Alwall dialysis machine. In 1969, after the creation of the Department of Nephrology, he became its the first head until he retired in 1989. He participated actively in organizing several dialysis centres in south-eastern Poland. He had many scientific and professional functions. He was a member of the Scientific Committee at the Polish Ministry of Health, member of the Commission on Nephrology and Metabolic Diseases of the Polish Academy of Science, regional consultant in Nephrology and the member of several Polish and foreign scientific associations. He was a honorary member of the Polish Society of Nephrology [1] [2] [3].

Andrzej Manitius (1927-2001)

[Figure 2] He was a soldier of the Warsaw District of the Home Army. His nickname was “Skała” (“the Rock”). He was assigned to Śródmieście – Południe headquarters and then delegated to the cover of OS-V district headquarters. As a medical orderly he gave aid to wounded soldiers at a medical point in a basement of one of Warsovian houses. He got through sewers to Mokotów district where he was arrested by German troops. He was a prisoner in Stalag X B POW camp in Sandbostel, West Germany, until liberated in 1945 by the US Army. He came back to Poland in 1947 and, continuing his family’s tradition, was enrolled at Medical Academy in Gdańsk. In 1964 he organized the first dialysis centre in Northern Poland. He was the first Head of the Department of Renal Diseases, Medical Academy in Gdańsk. He actively participated in organization of the new dialysis centers and renal transplantology in Poland. He was the regional consultant in nephrology in Northern Poland and national consultant for many years. He was the founder, vice-president and a honorary member of the Polish Society of Nephrology. Professor Manitius was a distinguished figure not only in the history of Polish nephrology but in Polish medicine in general [4].

Tadeusz Orłowski (1917-2008)

[Figure 3] In conspiracy since the beginning of the war, he was the officer of the Home Army. He was nicknamed “Justyn”. He completed medical studies in 1943 at the underground University of Warsaw. He trained medical orderlies at the Dzieciatka Jesus Hospital. He worked in counter-intelligence of the London Government Delegation. On the day of the outbreak of the Warsaw Uprising he became the commander of the Main First-Aid Point of “Odwet” battalion of Ochota district. After moving to Śródmieście district he organized an infirmary in the Faculty of Architecture building of the Warsaw University of Technology which he led until the fall of the Uprising. He left burning Warsaw together with civilians towards Piotrków. In the post-war period he worked at the Medical Academy and also at the Scientific Institute of Physical Culture of Warsaw. In 1953 he carried out the first peritoneal dialysis in Poland. He organized the first dialysis center in Warsaw. He was the chairman of the Department of Internal Disease at the Medical Academy in Warsaw, the first director of the Transplantation Institute and a professor in the Institute of Biocybernetics and Biomedical Engineering at the Polish Academy of Sciences. It has to be noted that he was involved in the first successful kidney transplant in Poland (1963), prepared and introduced immunotherapy for primary glomerulopathies and modified of ESRD therapy. He was the first President of the Polish Society of Nephrology (1983). Professor Orłowski was the honorary member of several associations and academies including the Polish-American Medical Society, Polish Society of Internal Medicine, Polish Immunological Society and many more. He was also a great university teacher and the national consultant in nephrology and transplantology in Poland for many years [5] (full text) [6] (full text) [7].

Associate Professor Eduard Neubauer, MD, PhD. (Figure 1) was born on October 24, 1910 in Nitra. He studied at the Faculty of Medicine in Bratislava, Comenius University, where he graduated on December 13, 1935. After graduation he worked at the Department of Internal Medicine in Nové Zámky and Trenčin. During the Slovak State he was in labor camps for four years from racial reasons, mostly in Baračka, Hungary. From July to December 1945, he worked at the 2nd Internal Clinic in Bratislava as a senior house physician. On December 1, 1945 he joined the Department of Internal Medicine of Professor Pór, later in 1948 Internal Clinic at the State Hospital in Košice. Eduard Neubauer was appointed assistant professor on January 1950. After qualifying in internal medicine in 1948 he began intensively to deal with kidney diseases, as the first nephrologist not only in Košice but also in Slovak Republic. He already wrote his first publication in 1946: “Tonsillectomy in chronic glomerulonephritis” [1].

He completed his postgraduate internship at the Nephrological Laboratory of the Faculty of General Medicine in Prague in 1950 and in 1956 and 1957 at the Nephrological Laboratory of the Institute of Blood Circulation Diseases in the Thomayer Hospital in Prague under the leadership of Professor Brod. These stays have led him to the foundation of the Nephrological Laboratory at Internal Clinic of the Faculty Hospital in Košice. This Nephrological Laboratory was fully working in 1954.

Associate Professor Neubauer and his colleagues introduced constantly new laboratory methods for examinations of renal functions, particularly clearance methods [2]. His main scientific interests were: extra-and intracellular electrolyte status in various diseases; hypertension and kidney damage; tubulointerstitial nephropathy; experimental studies in nephrology. In 1963 he introduced a method of investigating the acid-base balance using the apparatus Van Slyke. He was a very hardworking clinical as well as research worker. On July 1956 he became Associate Professor of internal medicine. He successfully passed attestation of laboratory methods in 1962. Even as the Associate Professor he defended his PhD. thesis in 1964.

Since 1961 until his departure to Canada at the end of 1964, the first author of this article had the opportunity to work with him at the bedside of the patient, in the Nephrological laboratory as well as in the experimental investigations. He was always very diligent, he did not recognize regular working hours and he was tolerant towards colleagues, but also strict to them. He had an extremely good relationship with patients, he was very favourite among them as well as among medical students. Several years before his departure to Canada he suffered from a hearing impairment, caused by toxic damage of the inner ear due to Neomycin.

Associate Professor Neubauer published more than 55 works in domestic and foreign journals until 1965. It was a respectable number at that time. Two publications were created during the cooperation of the first author of this article with him. One of them was: “Electrolyte composition of striated muscle in chronic renal insufficiency after the administration of alkalizing and acidifying substances” [3]. The authors of this study found out that intracellular sodium had increased after administration of 10 g NaHCO3 in 25 patients suffering from CHRI, but after the administration of ammonium chloride solution 40 mg/kg body weight they did not find significant change in its concentration. Neither alkalizing nor acidification substances have influence on the reduced concentration of extracellular potassium. In the experimental work: „Tissue metabolism in the atrophied dog kidney from the viewpoint of gluconeogenesis in vitro”[4], the authors deal with the gluconeogenesis in the athrofied kidney in 12 dogs under aerobic and anaerobic conditions. They found that under the anaerobic conditions of gluconeogenesis glucose did not form either after the addition of substances such as e.g. pyruvate, lactate or glucoplastic amino acids. Under the aerobic conditions of gluconeogenesis glucose is formed also without the addition of the above mentioned substances, but much less than in a healthy kidney. These findings gave evidence for impairment of gluconeogenesis in athrofied kidney tissue.

Neubauer was also interested in the diagnostics and treatment of chronic pyelonephritis and hypertension and their effects on renal function. He concluded that hypertension significantly damaged kidneys. He recommended for each hypertensive patient to investigate renal functions, which were in the fifties of the last century relatively simple and imperfect, but were very important for the detection of kidney damage and the following treatment [5] [6]. In addition he published several papers from cardiology, endocrinology, mostly together with other authors from the Faculty Hospital in Kosice, but always from the point of view of the kidney function.

Neubauer was married to Helen Winter. Their marriage was childless. His wife´s brother Pavel Mráz, lived in Toronto, Canada. At the end of 1964 they went to visit him and they have never returned back to Czechoslovakia. In connection with damage of his inner ear, which continued even after his emigration, he was handicapped as a clinician, despite of this fact he worked as an internist at a Psychiatric Hospital in Brockton.

Then, since January 1965 the Nephrological Laboratory at Internal Medical Clinic was under the leadership of Miroslav Mydlík, MD. Since 1969 Nephrological Laboratory at the Ist Internal, later IVth Internal and Nephrological Clinic was led by Dipl. Ing. Katarina Derzsiová until March 31, 2008, when it was cancelled as a result of privatization.

Associate Professor Neubauer remained our model as a clinical scientist till nowadays. He laid the foundations of nephrology in Košice and developed it at the level of that time. We, as his followers, have developed this unit within internal medicine and the Nephrological and Dialysis Department in Kosice has become one of the most important in the Slovak Republic. This resulted in formation of the Nephrological Clinic at the University Hospital of L. Pasteur and Medical School of P. J. Šafárik University in Košice 1997, the only one in the Slovak Republic [7], but privatization played again a negative role and the Clinic was cancelled in 2008. Associate Professor Eduard Neubauer, MD, PhD, after retirement lived in Ottawa, where he died in 1983.