Médecine Interne

The effects of interferon (INT) therapy in the chronic aggressive hepatitis of viral origin (CAVH) are critically reviewed. The main factor which favours the progress of acute viral hepatitis to chronic forms is the persistence of viral replication in conditions of immune deficit of the host. INT has antiviral, immunomodulating and antitumoral action. The INT alpha class proved to be the most adequate for the CAVH treatment. Many recent clinical trials have demonstrated the INT alpha effectiveness in CAVH. The results of such studies are separately analysed for each hepatitis virus...

The ever increasing incidence of diabetes mellitus has stimulated the immunologic investigations concerned with the role of heredity and the toleration rate of transplants of pancreas organ or islet structures. Concomitant or subsequent trials have attempted to define or avoid the apparently diabetogenic factors. With respect to the effectiveness of diabetes therapy, one cannot deny the contrast between the practical and the theoretical aspects. Besides the technical difficulties, the pancreas organ or islet cell transplants are confronted with the still limited possibilities of immunosuppression...

Supraventricular rhythm disturbances with aberrant intraventricular conduction are sometimes interpreted as ventricular dysrhythmias, an error with important therapeutic implications. In the two cases reported below, the ignorance of signs suggestive for a ventricular aberrance has led to confusions of diagnosis and therapy.

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In 43 adult patients with purulent meningitis receiving daily doses of 1-4,000,000 IU penicillin G i.v. in bolus, determinations were made, 1-6 hrs after administration, in 153 samples of cerebrospinal fluid (CSF), to ascertain the concentrations of penicillin that have reached the CSF. After 1 hour maximum levels of penicillin were noted, exceeding by far the meningococcus and pneumococcus minimum inhibitory concentration (MIC). Generally, high penicillin concentrations persisted in the CSF, in most of the cases at least for the following 6 hours...

A group of 103 patients with radiologic changes of sacroiliitis were investigated and followed up over a mean period of 3.5 years. The biologic explorations (nonspecific inflammatory tests, humoral immunologic determinations and serum fibronectin assay) as well as sacroiliac and spine radiographic examinations, were repeated every 6th-12th months. In 32 patients (31%) clinical, biologic and radiologic signs of evolutive disease, were detected. In such cases, sacroiliitis representing in fact a form of onset of ankylosing spondylitis, the HLA-B27 phenotype was also determined and was found present in 8 cases...

The biochemical changes induced in the gastric juice by the presence of Campylobacter pylori (CP) were followed up in 151 patients with various gastric and duodenal diseases. The diagnosis of CP infection was made by the urease test. In the presence of CP urea decreased in the gastric juice and ammonia increased. The sialic acid, fucose and hexoses, glucide components of the mucus glycoproteins dissolved in the gastric juice, underwent no change in the presence of CP. The hexosamines in the gastric mucus increased significantly in CP patients...

To assess the predictive value of microalbuminuria (M) for diabetic macro- and microangiopathy, neuropathy and some related risk factors studies were carried out in 105 diabetic subjects. All examinations were repeated after one year. Microalbuminuria was found to parallel all late diabetic complications, at the beginning of investigations and also after a one-year evolution. It also positively correlated with some risk factors for angiopathy, such as plasma lipid parameters, blood pressure, body mass index and duration of disease...

The hypertension AUDIT project (WHO) was used for the study of large populations of workers in two Romanian industrial centers, Slatina and Sibiu, constituted into two main groups. The objects of the study were: the detection of new cases of arterial hypertension (AH) and of their proportion as compared with older cases, the assessment of the quality of diagnosis control and treatment methodology as well as the estimation of the patient's attitude regarding the conditions of treatment and of the physician's knowledge and attitude regarding AH...

Peroxidase activity was assessed cytochemically in the peritoneal dialysate neutrophils of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis. In 22 patients cells were harvested for the second time after they developed peritonitis as a complication of the treatment. The results obtained were compared with those in the control group consisting of 30 patients with normal renal function. The patients treated by peritoneal dialysis showed both in the complication-free period and in the course of peritonitis significantly higher peroxidase activity in the neutrophils, as revealed by the semiquantitative score test...

The number of biological tumoral markers used in the diagnosis and therapy monitoring of hepatocellular carcinoma has increased, but their separate use is limited as none of them is specific, being only tumour-associated (proteins). But when in abnormal amounts and used in combination, they are of great help in the diagnosis and therapy monitoring. A combination of alpha-fetoprotein (AFP) and alpha 1-antitrypsin (AAT) data raises the diagnostic accuracy in hepatocellular carcinoma from 43% obtained with AFP alone, to 90...

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The effect of nifedipine (10-20 mg) on esophageal motility was tested in 18 patients with clinical esophageal syndrome and radiologic aspect suggesting esophageal spasm. The drug was administered 20-30 min prior to the second radiologic examination. In 3 cases of achalasia the drug was administered in doses of 10 mg/day for 10 days before the second X-ray examination. Fiber esophagoscopy was performed in all the cases. The initial radiologic aspect was favourably influenced by nifedipine administration in 12 cases confirmed as esophageal spasm...

Twelve patients with classical European Kaposi's sarcoma have been treated by intra- and peritumoral injections of human alpha leukocyte interferon (IFN)--Ginterferon ("V. Babeş Institute", Bucharest). All the patients were HIV negative their tumour appearing at least six months before. In each patient one tumour received 1 ml (50,000 IU) IFN twice a week during 6-7 weeks whereas another nodule considered as control remained uninjected. After treatment biopsies of both the IFN-treated and the untreated nodules were performed in 8 patients and histological examinations were carried out...

A randomized study in a group of 87 patients with drug-allergic-type reactions (DAtR) manifested by urticaria and or angioedema, revealed in 55 patients (63.2%) the presence of chronic urinary infections (CUI), significantly different (p less than 0.001) from the control group (80 patients without DAtR) in which the incidence of CUI was only 20% (16 patients). Among the drugs observed to induce allergic-type reactions were substances such as penicillins and aspirin which are not used in CUI. It was therefore assumed that it is not their frequent use in CUI (as is the case with antibacterial drugs and contrast iodide substances) that leads to DAtR but rather more the CUI proper...

A new method of long-term retrospective evaluation of the metabolic balance in type 1 diabetic was based on the variations of the hair biochemical components. Glucose, proteic sulfur and amino acid assays were performed in two consecutive hair segments, proximal and distal, of 1.5 cm each. The differences between the glucose and the sulfur values in the two segments correlated with the HbA1 levels (r = +0.971 and r = +0.957, respectively), being statistically significant in both situations (p less than 0.001)...

The association of hyperthyroidism and ulcerative colitis (UC) is presented in two cases: a 61-year-old man and a 54-year-old woman. In the first case the onset of hyperthyroidism was detected at the age of 25, and the onset of ulcerative colitis at the age of 36. The second case presented severe hyperthyroidism started at the age of 51. In the latter case ulcerative colitis had been detected ten year earlier. To our knowledge this report seems to be the first one considering this association from the endocrinological standpoint...

The bacterial immunofluorescence (BIF) in the intestinal juice was studied by the method of Virginia Thomas in a group of 26 patients with nonspecific chronic enteropathy (NCE). Our investigation revealed BIF in jejunal juice in 16 of 26 patients with NCE. The BIF test may be useful for the estimation of immune response to pathogenic germs at the level of the intestine.

The concentrations of three trace elements (iron, copper and zinc) involved in hematopoiesis were studied in 200 patients with iron-deficit anemia, hemolytic anemia and Biermer's anemia, in comparison with a group of normal subjects. The method used was atomic absorption spectrophotometry. The results obtained showed that in iron-deficit anemia resistant to iron therapy the copper and ceruloplasmin serum concentrations are at the lowest limit of normal. This copper deficit has a negative effect on the disease by preventing hemoglobin synthesis...

A short presentation is made of the investigations on chronic liver diseases carried out in the "N. Gh. Lupu" Institute of Internal Medicine--Bucharest from its foundation to the present day. The main courses of investigation (fundamental, diagnosis, prophylaxis, treatment) are specified, with emphasis on the achievements obtained within the general context of the progress of hepatology all over the world.