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

The main aim of the complex medical treatment in acute pancreatitis is the inhibition of exocrine pancreas secretion and decrease or annulment of the proteolytic effect, of autolysis, of its enzymes, both on the gland itself and on the neighbouring tissues. The authors introduced cytostatics of the 5-fluorouracil type (ftorafur) in the medical and/or medico-surgical treatment of 30 cases of acute pancreatitis admitted to the "Caritas" Surgical Clinic, during 1986-1987. The drugs lead to DNA-RNA inhibition and reduce significantly the pancreatic exocrine activity. Efficiency of 5-fluorouracil within the other therapeutic methods is proved by the results obtained, especially by the favourable rapid clinical evolution, blood amylase normalization in 48-72 hours, arrest in evolution of the pancreatic lesions. The treatment is economical and has no side effects. It may be also used for the digestive fistulae with pancreatic content or for the pure pancreatic fistulae.

The hypertensive cardiopathy is a controversial entity as regards the physiopathological mechanisms and clinical aspects. Defined as the hypertrophy of the left ventricle, secondary to the permanent tension increases, it accompanies not only the severe forms of arterial hypertension but also the medium and mild ones. In the authors' opinion, based on numerous experimental and clinical studies, the main factor that initiates the myocardial hypertrophy is the increased parietal tension (hemodynamic hypertrophy). The natural evolution is progressive, the myocardial hypertrophy initially adaptive becomes pathological and the cardiac performance is affected gradually, first in its diastolic and then in its systolic component, up to the final stage of congestive cardiac insufficiency. The structural changes of the myocardial fibre also document the adaptive and pathological hypertrophy, the alteration of the myocardial contractility consisting in the difficulty of transforming the chemical energy into mechanical work. The clinical aspects show an incipient myocardial hypertrophy, considered adaptive, since the cardiac performance is normal; an important hypertrophy affecting the diastolic component and the hypertrophy with dilatation that affects the overall performance. Of the evaluation methods, the echocardiography is the most accurate one in quantifying hypertrophy, evaluation of the cardiac performance and possibility of detecting several characteristic aspects of the hypertensive cardiopathy. The transition moment from the adaptive hypertrophy to the pathological hypertrophy cannot be exactly established but it is documented that the hemodynamic and nonhemodynamic hypertrophy is a supplementary cardiovascular risk factor.

The 237 cases of hypereosinophilia studied, ranging from 30 to 90% showed that, except for two cases that were not confirmed by the repeated blood leukograms, 22 had a parasitic origin, 6 appeared in certain pathologic states, or various severe diseases, 5 had an undetermined etiology and 2 were off the record. The authors draws the attention on the value of various methods of investigation which he used especially in the diagnosis of the parasitic diseases met with.

The authors studied 258 cases of deaths due to lung thromboembolization, totalling 13% of the necropsies. The patients' age ranged within 17-89 years, with the highest frequency between 70 and 75 years. The female sex was prevalent (56% of cases). According to the magnitude of the vessel occluded, the thromboembolisms were divided into: massive (35%), medium (50%) and small (15%). The lung infarctions were present in 42% of the cases investigated. The formation site of the thrombi was exactly established in 24% of the cases; the right side of the heart, the lung, the deep veins of the shank, periprostatic venous plexus, vena cava inferior, iliac veins. The lung thromboembolization was favoured by the cardiovascular affections (38.5%), neurologic affections (27%), malignant tumours (11.5%), postsurgery status (9%), lung diseases (9%), coma (3.5%), prostate affections (1.5%). The clinical diagnosis was established in 22% of cases. In the rest of them, thromboembolization was hidden or simulated by the coexisting affection.

Efficient esophageal clearance has an important defence role in the pathogenesis of the gastroesophageal reflux disease (GERD). Many GERD patients have esophageal disturbances associated with or secondary to reflux, producing delayed clearance. This delay exposes the esophageal mucosa to the reflux acid content. To determine esophageal transit we scanned the esophageal transit of a 15 ml bolus containing colloidal 300/cCi 99m Tc. The esophageal transit was calculated in seconds according to formula E.T. = T 1/2 x 5. The study included 74 GERD patients. The following investigations were carried out in all the cases: esophageal X-ray, GER scintigram, endoscopy, esophageal biopsy, Bernstein test and esophageal transit scintigram. Endoscopy revealed lesions of the esophagus (of 1st, 2nd and 3rd degree) in 39 patients, Barrett syndrome in 8 cases and normal in 27. Esophageal transit scanning was normal in 18 cases (24%), and prolonged in 56 cases (76%). Only 7 (39%) of the 18 patients with a normal transit presented lesions of the mucosa, the latter being more frequent in patients with a prolonged transit, i.e. 40 of 56 patients (71.5%). The mean value of the transit in different degrees of esophagitis (I, II, III) and Barrett syndrome were: 12.73 +/- 5.36; 13.30 +/- 7.90; 10.35 +/- 5.78; 17.25 +/- 11.17. In conclusion esophageal transit scanning is a useful test in GERD patients as it has a prognostic value. A prolonged esophageal transit is frequently associated with lesions, the more severe the slower is the transit. Moreover the test may indicate certain drugs acting upon the esophageal motor disturbances.