Revista de medicina interna, neurologe, psihiatrie, neurochirurgie, dermato-venerologie. Medicina interna最新文献

The paper presents a case of family oedema by shortage of C1-esterase inhibitor, characterized by appearance at an early age (8 months), participation in some attacks of nasal mucous membrane, with nasal obstruction and sinusal manifestations and also the abnormally long period, up to 9 days, of some localized oedemas. The crises were absent during pregnancy. The study of four generations of the family showed the predominantly hereditary character of the genetic transmission. Two cases in which the disease apparently "overleapt" a generation, as clinical manifestations, were presented.

Asymptomatic biliary lithiasis (discovered accidentally by paraclinical methods or intraoperatively) is, despite its hidden character, a state of disease. Asymptomatic lithiasis--having a frequency of 1.3%-7.5%--requires the use of several therapeutical measures. In this way some severe complications at the onset or at the turning of disease into a clinically manifest suffering, especially after the age of 60-70 years, or concomitantly with other affections, might be avoided. The conservatory therapeutical means have limited indications, or results dependent on several parameters, and some methods require a special equipment. The author pleads for cholecystectomy, which, if no complication appears, offers a radical solution with minimum morbidity and unsignificant postsurgical mortality indices.

A prospective study was made of 30 patients, admitted to the neurology ward with subarachnoidal hemorrhage (SAH), at its onset. The diagnosis was established on the basis of anamnesis, clinical examination, spinal puncture, anatomopathological examination. The patients with other cerebrovascular affections or with antecedents of ischaemic cardiac affections were excluded. ECG tracings, serum ionogram, AT and VA at the onset and in evolution, and their modifications were followed and assessed in all the patients. The conclusion is reached that SAH in acute phase is associated with transitory ECG and pressure anomalies which become elements of unfavourable prognosis when persistent and deeply altered. They are valuable, at hand, elements in the differential diagnosis, and in the opportune therapeutical intervention.

The method for determining glycosylate serum proteins is based on the ketoamines property (fructosamine) of reducing nitro-tetrazoline blue, in alkaline medium, to a coloured, photometric product. The technique is simple, rapid, reproducible and cheap. The method was used for investigation of 52 diabetics and 17 normal subjects. The normal values were between 1.50-2.70 mmol/l, uncertain between 2.70-3.00 mmol/l, and certainly pathological above 3.00 mmol/l. The level of serum fructosamines shows the glycemia variations for an average period of about two weeks, before determination. It is one of the valuable parameters for detecting and following the patients with diabetes mellitus, and has also a prognostic value in the evolution of the disease.

Drug-induced hepatitis still arouse many practical problems, as their pathogenesis has not been fully elucidated yet, given the absence of specific criteria. Drug-induced hepatitis are acute and chronic. Cytolytic hepatitis, cholestatic hepatitis and mixed hepatitis belong to the former category. Drug-induced hepatitis show various clinical and biological pictures, generally similar to those of viral hepatitis. In the most cases, the prognosis is good and their evolution favourable. Cytolytic hepatitis--the result of a wider hepatocytic necrosis--have a more severe prognosis. The most severe form is the fulminant acute hepatitis, a consequence of the substantial necrosis of the hepatic parenchyma. Chronic hepatitis appears after prolonged administration of some drugs with toxic action. Clinical and biological manifestations are not characteristic. Evolution towards cirrhosis is possible. Drug-induced hepatitis are treated by interruption of the drugs generating them. After removing the noxious agent, the disease resolution takes place in one or two weeks.

In a group of 1,025 cases of alcoholic liver the authors detected 28 cases (2.73%) of acute alcoholic hepatitis on the basis of the morphologic examination, 75% were males, mean age 45 +/- 18 years. The mean amount of alcohol consumed daily was 106.7 g for a mean duration of 19.78 years. The hepatic lesional substrate was hepatic steatosis and cirrhosis in 7 cases (25%) and steatofibrosis in the other 14 cases (50%). The triggering factors were the abuse of alcohol in 27 cases and a pneumonia in the last case. The disease was characterized by fever, encephalopathy, hepatomegaly, hepatocytolytic-cholestatic syndrome. The evolution was dictated by the gravity of the background hepatic lesional substrate.