The leukocyte migration inhibition test reveals in vitro the presence of lymphocyte sensitivity and, consequently, of cell-mediated immunity, to a given antigen. Applied in a variety of immune and allergic cases it proved to be useful for the positive diagnosis of the disease and/or for the detection of cell-mediated immune deficiency. The results obtained recommend the leukocyte migration inhibition test in the clinical practice.
Arterial hypertension in adolescents was studied in a group of 899 school boys aged 15-18 years from the vocational school No. 48 of the Bucharest Transport Enterprise (ITB) and the secondary school No. 19 ITB. Essential arterial hypertension in the group investigated was found in proportion of 2.7%, a percentage comparable with that of other European countries (1-3%).
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. The other 6 patients who did not benefit by the test were cases of organic diseases: 2 post caustic stenoses and 4 cases of eso-cardio-tuberal neoplasm. In the 3 cases of achalasia, treatment with nifedipine led to clinical improvement with relaxation of inferior esophageal contraction on radiologic examination. The study demonstrated the favourable contribution of calcium channel inhibitors to the diagnosis and treatment of esophageal motility disturbances.
Cardiac involvement in collagen diseases was studied in 917 patients representing all the cases of collagen diseases diagnosed in the "N. Gh. Lupu" Institute of Internal Medicine between 1985 and 1987. The prevalence of the various cardiac disorders was studied within every disease or group of diseases diagnosed according to clinical, ECG, radiologic and when necessary echocardiographic data. Collagen heart disease was diagnosed in 38.2% of the patients. In the case of systemic lupus erythematosus, of polyarteritis nodosa and of progressive systemic sclerosis this proportion exceeds 50%. The most frequent cardiac disorders were the rhythm and conduction disturbances, detected in 112 patients (12.2%). The cardiomyopathies and myocarditis, not infrequent (7.4%) represented an element of severity influencing the evolution and prognosis of disease. Myocardial ischemia secondary to coronary vasculitis syndromes has proved to be an important pathogenic mechanism of cardiac disorders. By their frequency and severity, the cardiac involvements in collagen diseases have proved important, becoming sometimes a central diagnostic, therapeutic and prognostic problem.
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.
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. The assumption that CUI are risk factors for the occurrence of DAtR is discussed and the following mechanisms are suggested in support of this assumption: enhancement of IgE secretion (by the drugs as allergens--complete or haptens--or by the inhibiting effects of some antibiotics on the T suppressor cells): nonimmunological mast cell degranulation (by the bacterial wall products--lectins and proteoglycans--or by the endotoxines with complement activation generating anaphylatoxines C3a and C5a): neurovegetative changes induced by infectious diseases.
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. The clinical follow-up revealed: The skin colour progressively changed from purple red to dark reddish or even brown in all the IFN-treated tumours and only in 3 of the untreated ones (p less than 0.001). The consistency of the nodules decreased in all the treated tumours and only in 2 of the untreated ones (p less than 0.001). The tumour thickness decreased in 9 of the treated tumours and in none of the untreated ones (p less than 0.001). The surface of the lesions decreased in 4 of the treated nodules but not in the untreated ones (p less than 0.05). The IFN-inoculated tumours were gradually cured even in the four cases in which during the treatment some other tumour progressed or even new lesions appeared. The histological examination showed that: all the IFN-treated tumours were either predominantly sarcomatous or predominantly angiomatous. The typical Kaposi aspect disappeared totally in 2 of the cases examined, and in 3 a fibrosclerotic massive change was obvious.(ABSTRACT TRUNCATED AT 250 WORDS)
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. In iron-deficit anemias responding to iron therapy the relatively low (about 90 gamma %) zinc values have a negative effect by blocking the iron in the iron reserve. In hemolytic anemia the very high zinc serum concentrations (over 200 gamma %) may lead to a shortening of the erythrocytes life span due to its "entatic state". In Biermer's anemia zinc by its high concentration has a positive role owing to carbonic anhydrase which eliminates more rapidly carbon dioxide from the organism.
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.
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 hair components assay permits to follow up the diabetics' metabolic balance on longer time periods than by determination of the HbA1 values.
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 association of these two diseases might suggest that the disturbance of even one organ specific immune lesion implies a wider disorder. Thus one might assume that the association of multiple organ-specific immune diseases represents an unsuccessful attempt to equilibrate the repertoire of idiotypes and anti-idiotypes belonging to the immune network.
A postmortem study was carried out on the whole coronary arterial bed of 430 selected apparently healthy subjects, aged 38 to 65 years, in an effort to reveal the influence exerted by coronary heart disease risk factors (CHDRFs) on the development of coronary obstructive plaques. A clear positive correlation was found in 31% of cases and in more than 50% of 28 selected topographic sites of the coronary arterial bed. On the other hand, the subgroup without CHDRFs also exhibited severe coronary narrowings. Each major CHDRF seems to exert its particular action on selected regions of the coronary arterial bed: proximal or intermediate segments of the major coronary arteries; branching points; nonbranched areas; vessels supplying the conduction system, etc.
The mercury concentration in the blood and urine as well as the IgA, IgD, IgE, IgG, and IgM serum concentration was assayed in 89 men working during varying time intervals in a chlorine production plant using a mercury electrolysis method. In none of the workers studied the blood mercury concentration exceeded 50 micrograms x 1-1 and only in two cases the mercury excretion in the urine exceeded 200 micrograms x 1-1. Low levels of IgA and IgG were observed only in workers exposed to mercury vapors for more than 20 years.
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. Urease activity is present in the gastric juice even in the absence of CP, probably due to other microorganisms present in the human stomach. This does not exclude the use of the urease test for the diagnosis of CP infection. However the test can only be used in the bioptically removed gastric mucosa samples, not in the gastric juice.
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. Group I (Slatina) included 22,839 workers and the program was applied in 15,740 randomly chosen subjects. Group II (Sibiu) included 14,874 workers of whom 2,838 were randomly chosen for study. From a total of 606 (6.20%) subjects aged 35 to 64 years with AH in both groups, 494 (81.51%) were older cases and 112 (18.48%) were newly detected. The prevalence of AH was found to increase with age and to be higher in women aged 55 to 64 years. The treatment in older cases from both groups was considered effective in 232 cases (46.96%) (of which 26 (11.2%) with overtreatment) and insufficient in 262 (53%). The reasons alleged by the patients for the late detection of AH were the absence of symptoms and a casual interest for their state of health. The risk factors were systematically checked. Smoking was found in 30.36% of the subjects in group I and in 31% of those in group II. The use of diagnostic laboratory procedures was corresponding to the present recommendations. The nonpharmaceutic therapy was frequently recommended, especially reduction of salt consumption. Besides that, pharmaceutic treatment was indicated in most of the patients (63% in group I and 90% in group II). Diuretics (41.26% in group I and 75% in group II), and beta blocking drugs (35.3% in group I and 70% in group II) were the most frequently administered and in a lesser proportion vasodilators with central or peripheral action, calcium blockers, Rauwolfia and angiotensin conversion enzyme inhibitors. The consumer inquiry showed satisfactory compliance of patients, most of them took their tablets regularly, were satisfied with the medical assistance and preferred to consult the same physician. The data of the physician inquiry regarding diagnosis treatment of AH and professional training also proved satisfactory. The use of the AUDIT project has allowed a complex estimation of AH in the groups studied and will prove useful for a more efficient control of AH in the whole population.
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. The recent concept of a bioartificial organ is an attempt to avoid such disadvantages. The present paper is a review of the main achievements of the experimental and the clinical trials in the above-mentioned directions of research work.
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. The advantages of using penicillin G i.v. in doses of 1-3,000,000 IU in bolus at 12 hour intervals are discussed. All the 36 patients with meningococcal meningitis and 3 of the 5 with pneumococcal meningitis recovered with this therapeutic scheme, under daily control of the CSF.
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. Of the biologic tests the decrease of serum fibronectin proved the most significantly correlated with evolutive tendency of sacroiliitis.
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.
