[Evolution of chronic pulmonary tuberculosis and the possibility of preventing chronicization (in the Iaşi judicial district)]

The instantaneous prevalence of patients with pulmonary tuberculosis has been evaluated; the patients were included in the dispensarization group I between 1974 and 1980. Initially there was a decrease of the prevalence of the patients in Group I B but over the last years this was stable at 11.7-13.5 0/0000 inhabitants. The decrease which had been obtained at first was due to the immediate effect of repeated treatments with new tuberculostatic drugs resulting in sterilization and inclusion in the Group II of dispensarization of many of the preexisting patients while the ceiling which occurred later was determined by the quantitative balance of therapeutic failures and relapses entering the Group I B and cases which left the Group as a result of medical solutions, death or change of address. It was also noted that most of the patients in whom presence of the bacilli had been determined by microscopic techniques and by cultures constituted a relatively stable group over the entire period of the study, and oscillated between 11 and 17.5%, and 56.5 and 65.9% respectively. The quantitative balance established over the last years between the "entrances" and the "exits" from Group I B may be altered firstly by lowering the number of failures and relapses after the first treatment. The nature of unfavourable factors which influence the prognosis may be classified as follows: bio-psycho-social implications (males--81.5%, age--between 30 and 50 years, 51.4%, lack of occupation, 31.5%, low educational level, 80.1% chronic ethyl intoxication 51.4%, psychoses, 12.7%, other associated diseases, 34.3%, and primary drug resistance, 7.1%); consequences of a late detection; deficiencies in the rhythm and the duration of the first treatment with tuberculostatic drugs (non-cooperation--64.2%, irregularities--38.5%, interruptions--42.8%, secondary drug resistance--14.2%).

[The value of bacteriological controls in the epidemiological studies of tuberculosis]

The authors make an analysis of bacteriological data concerning patients with tuberculosis from a certain area (the Jassy County) which have been recorded between 1971 and 1980. An analysis is presented of the instantaneous and of the maximal prevalence of tuberculous bacilli carriers in the urban and the rural environments, and the incidence of tuberculosis in children and adults, also in the urban and the rural media. Some other aspects are studied of primary drug resistance, as well as of secondary resistance. The data presented in the paper stress the major role of the bacteriological investigation in the epidemiological follow-up of tuberculosis, as well as the fact that bacteriological indicators are capable to evidence essential aspects of the evolution of tuberculosis endemia in a certain area.

[Evolution of endemic tuberculosis in the Iaşi District: between 1972 and 1980]

Continuing our longitudinal study on the evolution of the tuberculosis endemic in the Iaşi district, the epidemiometric indicators recorded between 1972 and 1980 were estimated. It was noticed that the epidemiological state of tuberculosis has improved considerably. The instantaneous prevalence of the bacillary patients decreased with 72% and the maximum one with 66.4%. The limitation of the contagion sources was reflected on the prevalence of tuberculosis in children, which decreased in the same period with 87.2%. The epidemiological process regressed slowly in the adult population, while in children it regressed rapidly and substantially.

Plasma phosphorus and magnesium values during treatment of severe diabetic ketoacidosis

Plasma phosphorus and magnesium were determined in 76 diabetics, admitted with severe ketoacidosis (pH less than or equal to 7.20, total CO2 less than or equal to 10 mEq/l) before and 24 hours after beginning the treatment, which did not include supplementary phosphorus or magnesium. Phosphorus presented initially high values (1.76 + 0.69 mEq/l) which fell substantially 24 hours after beginning the treatment (0.87 +/- 0.26 mEq/l); magnesium values, initially low (0.76 +/- 0.19 mEq/l), fell still further within 24 hours of treatment (0.64 - 0.16 mEq/l). For phosphorus (and to a lesser extent for magnesium) calculation of the regression line indicated a direct positive relationship with both hydrogen ion concentrations (r = 0.67) and blood glucose (r = 0.73), the differences being statistically significant. The more rapid the decrease in glycemia and correction of acidemia and the greater the amount of glucose administered in the course of treatment, the more marked was the fall of plasma phosphorus and magnesium values.

Metabolic "responders" and "non-responders" to muscular exercise in diabetes

The metabolic effects of muscular exercise (bicycle ergometer, 75 watts, 15 min) were studied in 16 healthy controls and 49 diabetics distributed into three groups. The first two groups included insulin-dependent diabetics three hours after administration of insulin (group A, 24 cases) or 12--18 hours after the last insulin dose (group B, 18 cases). Group C included 7 non insulin-dependent diabetics. According to the glycemia response, the patients were listed as: high responders (greater than 20% below the initial values), low responders (10-20% fall) and non-responders (increase or less than 10% decrease). The data obtained show that, in most cases, in the presence of insulin, exercise has a hypoglycemic effect and, in its absence, a hyperglycemic one. To a lesser extent, the fall in glycemia may be attributed to an apparently insulin-independent mechanism. Exercise can only be indicated (in high-responders) or contraindicated (in non-responders) after a routine tolerance test.

Study of sodium and potassium intake in different categories of healthy subjects

The usual Na+ and K+ intake was investigated in 436 apparently healthy subjects, 370 men and 66 women, ranging in age from 19 to 56 years, distributed into three lots: 219 from a metallurgical plant, 100 from a military unit and 117 from an unselected population sample. The average Na+ intake amounted to 214 mEq/24 h in the first lot of study, to 224 mEq/24 h in the second and to 203 mEq/24 h in the third, the differences among them being not significant. K+ intake in the three lots was 38 mEq/24 h, 43 mEq/24 h and 49 mEq/24 h, respectively. Na+/K+ ratio reached 5.6 in lot I, 5.2 in lot II and 4.1 in lot III, compared to the unitary ratio in natural foodstuffs. The data obtained demonstrate that Na+ intake in the general population is excessive, while K+ intake is deficient. It is assumed that this might partly account for the great incidence of arterial hypertension.

[Informational system in prevention and integrated fight against tuberculosis]

The authors have sent out a special form to a total of 50 specialists and general practitioners, and their answers it appeared that these physicians consider necessary to review and to render more technical the system used for the information in view of the prevention and the integrated fight against tuberculosis. The authors recall the fundamental technical notions in this connection and present the generators and the recipients of information related to the fight against tuberculosis, the informational flow in the anti-tuberculous activity, the standardized informational instruments of the Ministry of Health and the informational channels which are accessible in the practice. In conclusion the authors present the stocking and the transfer of anti-tuberculous information, synthesized on a functional representation of the informational system in the prevention and the integrated fight against tuberculosis.

[Investigation concerning some organizational aspects of the care of chronic bronchitis patients]

The epidemiologic importance of chronic bronchitis is stressed, which justifies the preoccupation of the authors for finding the means of detection and diagnosis in view of the application of adequate therapeutical measures. An inquiry was used, taking the form of questionnaire concerning the various medical and social organizatory problems raised by chronic bronchitis. The questionnaire was sent for completion by the various sanitary directions in the districts. The answers were statistically processed and the results justify the necessity for a standardization of methods used in the detection and the diagnosis of patients with chronic bronchitis, as well as for other measures concerning these subjects.

Epidemiological investigations on viral hepatitis in preschool and school communities. Note I. Prevalence and incidence of viral hepatitis and the role of the community in transmission

A transversal and longitudinal epidemiological follow up was undertaken of the viral hepatitis cases occurring in two types of children communities (kindergartens and schools). The role of organized communities in the spread of hepatitis viruses and the contribution of external factors to the maintenance of hepatitis endemicity are discussed.

Epidemiological investigations on viral hepatitis in preschool and school communities. Note II. Evaluation of the prophylactic efficiency of standard gammaglobulin administration

At the beginning of the 1977--1978 schoolyear 10% standard gammaglobulin (0.03 ml/kg body weight) was administered to 974 preschool children and 530 schoolchildren. Representative groups of children were tested serologically and virologically before gammaglobulin administration and 3 months afterwards. No statistically significant reductions of viral hepatitis morbidity were recorded in the protected groups as against controls.

[Considerations on pleural puncturo biopsy, based on the results of an analysis of 100 samples]

Results are given on 100 cases in which pleural bioptic puncture (PBP) has been performed for diagnosis purposes. The data given in the study show the large possibilities to apply this method, readily acceptable by patients. The high diagnosis value of PBP method in based on strictly objective criteria. Stress is laid upon the contribution of the method in precising the etiology of pleural fluids, which, up to the application of PBP, were labelled as having an "undetermined" etiology. The right therapeutic measures to be taken on precise diagnosis are also stressed in the study.

Renal pathomorphologic aspects in cirrhogenic diseases of the liver

The pathomorphogenesis of renal lesions in the course of cirrhogenic diseases of the liver was studied on a human and experimental material. The development of membranoproliferative glomerulopathy, of tubular lesions, interstitial reactive infiltrates and sclerosis processes in the advanced stages of cirrhosis were observed. An important role in the determining of these lesions was played by immunologic perturbations in the entire organism.

Ultrastructural changes in cartilage after intra-articular administration of osmium tetroxide and the sodium salts of fish oil fatty acids (Varicocid)

A clinical and experimental study was carried out on knee joints of rabbits and in humans. In one knee joint of each rabbit 0.3 ml 1% osmic acid or 0.3 ml 5% Varicocid was injected, the remaining uninjected joints serving as controls. The animals were killed after 1 and 24 hours, 15, 45 and 90 days. Study with the electron microscope after osmic acid injection revealed necrosis of the chondrocytes in the superficial layer and upper middle zone. The articulations injected with Varicocid exhibited only slight lesions of the chondrocytes in the upper layer, consisting of dilated rough endoplasmatic reticulum, mitochondria lacking matrix and christae; the electron density of the layer seemed to be diminished. Biopsy of the non-weight-bearing cartilage of the lateral femoral condyle was performed in 4 patients with Rheumatoid Arthritis and arthritis of the knee in the onset stage. Two of these patients received one intra-articular injection of 10 ml 1% osmic acid, 5 ml 2% xylocaine and 50 mg hydrocortisone and the other 2 patients 6 ml 5% Varicocid. Biopsy of the cartilage in the areas adjacent to the site of the first biopsies 1 and 3 1/2 months after treatment with osmic acid and 2 and 3 1/2 months after treatment with Varicocid showed in the first two cases necrosis of the chondrocytes in the superficial layer and upper middle zone of the articular cartilage and depletion of the mucopolysaccharides in the ground substance, revealed by PAS and alcian blue staining. No lesion of the knee joint cartilage was observed in the other two cases. In view of the results obtained, chemical synovectomy with Varicocid can be considered as having received further support.

Ultrastructure of the lymph node after prolonged immunization

Changes in the fine structure of the lymph nodes were studied after prolonged immunization with heterologous sera. Hypertrophy of the lymph node cortex and paracortex frequently occurred, as well as development of the zone lying next to the lymphatic sinuses, postcapillary venules, veins and arteries in the cortex, paracortex and medulla, which is mainly bursa-dependent. Worthy of note was the presence of germinative centers characterized by large ribosomes, rich cells and macrophages. Similar aspects were observed in splenectomized animals undergoing prolonged immunization. Particular aspects of immunologic activity in the lymph nodes were noticed in the animals which had received an immunosuppressive treatment during immunization. The significance of the morphological alterations in the fine structure of the lymph nodes is correlated with the serological findings.