Medecine interne最新文献

The paper presents the evolution of the levels of smoking, hypercholesterolemia, essential hypertension and obesity in the course of a prophylactic action carried out for 15 years (1971-1986) in a group of 5000 males aged 40-60 years. In the group still available after 15 years of follow up consisting of 2000 subjects, a decrease was obtained in the number of smokers, from 22.3% to 5.6% of hypercholesterolemia from 31.3% to 23.7%. The cumulated incidence of essential hypertension has increased from 15.5% to 36.7% and of obesity from 12.6% to 14.4%. At the same time the incidence of angina pectoris and myocardial infarction increased from 1.1% to 5.3%. For comparison are presented data obtained in a similar control group.

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.

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.

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 90.5% and if the combination includes the carcinoembryonic antigen (CEA) data too the accuracy increases to 100%, still without strict specificity for hepatocellular carcinoma.

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 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.

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.