Revista de igiena, bacteriologie, virusologie, parazitologie, epidemiologie, pneumoftiziologie. Pneumoftiziologia最新文献

The paper reports on 25 possible failure factors of antituberculosis chemotherapy in 262 cases recorded in 1982 and followed for 3 years. 58 of them were failures, relapses or bacteriological relapses under treatment. The failure factors analysed were subjected to a mathematical modelling method that yielded a number of codified predicting parameters. This prognostic calculation may be an efficient method for optimizing chemotherapy, reducing the failure rate.

The paper presents the clinical-functional manifestations in a group of 321 workers in a carbide department of a chemical combine works, professionally exposed to powders (calcium oxide, coke dust) and irritant gases (sulphur oxides, nitrogen oxides and ozone). Data processing, recorded on a questionnaire recommended by BMRC showed an incidence of 6.8% for simple chronic bronchitis, 14% for COPD and 39.8% for the disease of the small airways. The authors support the idea of the increased efficiency of the MEF50 test in comparison with MEVS for functional surveillance and early detection of broncho-obstructive ventilatory disturbances. In agreement with other dynamical observations of the authors the subjects found to suffer from simple chronic bronchitis have, in fact, obstruction, detectable by the MEF50 test.

100 patients at first treatment were investigated according to a complete questionnaire for explaining the causes of tardy diagnosis in pulmonary tuberculosis. The roles of the disease, patient and physician in this delay were followed. The insidious or atypical onset of the disease in 82% of these patients explains the long interval (107.2 days on the average) elapsed between the appearance of the first symptoms and the diagnosis determination. As a consequence of low cultural level, many patients cannot give a correct interpretation of the symptomatology and they seek the physician's help after 69.1 days (on the average) from the appearance of the symptoms. The medical causes are numerous and can be rapidly cured. In the dispensary of general medicine, 55% patients were examined only clinically, 45% clinically and radiologically but only 7% were subjected to the bacteriologic examination for bK and 4% were sent to the TB wards for consultation. As the registration of the patient, his admission into the hospital and the tuberculostatic treatment depend on the bK presence in sputum--sometimes waiting for the result of the culture tests--the average interval between consultation and admission is of about 34.7 days. On admission, high average values were registered: cavities of 4.2 cm in diameter, lesions of 2.8 points and bacteriologically 44 bacilli/100 fields. For improving this situation the following recommendations are made: increase of the health education on TB activity in the population, continuous education of the general practitioners in the TB diagnosis methods, use of the radiologic examination together with the bacteriologic one and the biological tests for the early detection of the pulmonary tuberculosis.

The paper reports on a comparative study of the conversion enzyme and plasmatic renin performed on a group of 55 patients, with clinical diagnosis of sarcoidosis and other lung diseases. Whereas the conversion enzyme showed important increases in active sarcoidosis and a tendency to the normal state after treatment with corticoids, the activity of the plasmatic renin remained the same, both before and after corticotherapy. The result obtained prove the practical usefulness of the dosage test of the conversion enzyme, in agreement with the literature data. They also point to the possible participation of the pulmonary SRA in the vascular and local enzymatic-chemical imbalances, suggesting the possibility of associating the conversion enzyme inhibitors to the treatment of sarcoidosis with corticoids.

In sarcoidosis and other granulomatous non-caseous diseases, the election treatment is immunosuppressive, mainly with cortisones that ensure more than 70% lasting remissions. Continuous use of cortisones for a long time (8-30 months) in high doses leads to serious side effects: gastric and intestinal ulcers, obesity, osteoporosis, suprarenal dysfunction, sensitivity to infections. Good results and elimination of the important side effects were obtained by treatment with Reprimum--a semisynthetic antibiotic with a wide spectrum and immunosuppressive properties--administered alone or with prednisone in small doses (15-20 mg once) in 6 weeks' series: 2 weeks--Reprimum 10/mg/kg daily +/- prednisone and for other 4 weeks--Reprimum 15 mg/kg twice a week +/- prednisone followed by two weeks' break. In 75 patients with histopathologically confirmed sarcoidosis (of whom 7-9.3% with outside-the-lung situs, too), the treatment with Reprimum gave: 94.7% lasting remission, only 5.3% failures, reduction of the treatment period to 6-12 months and the absence of any important side reaction. In other 37 sarcoidosis cases, failures of cortisone therapy (of which 11-30% relapses after 2-6 years), the treatment with Reprimum together with prednisone allowed recovery of 29 patients (78.4%). The same treatment with Reprimum, used in 22 patients with immunosuppressive treatment indication (dermatomyositis, Kaposi's syndrome, thrombocytopenias, nodose periarteritis, silicosis), of whom 18 (81.8%) were failures of the cortisone therapy, healed 20 of these cases (90.9%). Reprimum immunosuppressive property acts at the level of T4+ lymphocyte, involved in sarcoidosis pathogenesis. The functional blockage of T4+ lymphocyte can be also achieved by cyclosporine A.(ABSTRACT TRUNCATED AT 250 WORDS)