[Therapeutic means and methods in recurrent pleurisy]. / Mijloace si metode de tratament în pleureziile recidivante.

During a 10-year interval (1981-1991), at the IIIrd Medical Clinic of Iasi 960 cases with pleural effusion, of which 768 (80%) non-recurrent and 192 (20%) recurrent, were diagnosed. The etiology in the latter cases was malignant (40%) and non-malignant (60%). Proper treatment methods for limiting or suppressing the recurrent pleurisies proved to be imperative. Thoracocenteses cause protein and electrolyte depletion which aggravate the general state and hasten the unfavourable evolution of the etiological affection. This is the reason why besides the general etiopathogenic treatment, a local pathogenic treatment (cytostatic, anti-inflammatory) and especially pleurodesis are compulsory. The intrapleural administration of cortisone is efficient in the case of recurrent autoimmune pleural effusions but is worthless in the malignant ones. In the latter situation, the intrapleural cytostatic treatment should be first attempted and, in case of failure, the development of pleural symphysis by external radiotherapy or injecting talc into the pleural space should be made. In the terminal stage of cardiac insufficiency or liver cirrhosis with recurrent pleural effusion, the pleurosymphysation is not indicated; a sever edematous-ascitic attack may occur or become aggravated by the pleural irritative process due to this method.

Diagnosis difficulties in multiple myeloma.

Some difficulties in the diagnosis of multiple myeloma are presented. The atypical onset (pseudorheumatismal, anaemic, renal or neurological one) as well as the presence of a biological syndrome during some other diseases which may generate the confusion with the multiple myeloma are discussed with reference to the personal casuistry (30 cases of multiple myeloma in a lapse of 12 years). Some peculiar cases of the two categories of difficulties are presented in detail. A careful clinical and biological examination should be performed in every case, as both situations may involve, affect, the prognosis quo ad vitam of the patient.

[Myelodysplastic syndromes. A clinico-biological analysis of 27 cases]. / Sindroame mielodisplazice. Analiza clinico-biologica a 27 de cazuri.

A series of 27 patients with myelodysplastic syndrome (MDS) was analysed to determine the clinical and pathologic features, the natural history and the prognostic factors. The clinical features of these patients included the following: mean age 53.77 years; symptoms due to cytopenias 100 per cent; hepatomegaly 44.5 per cent; splenomegaly 11 per cent. Almost all patients with MDS presented anemia; additional cytopenias were present in many patients. The bone marrow was hypocellular in 1/3 of cases. The patients have been classified according to the French-American-British (FAB) Group criteria: there were 11 patients with refractory anemia, 11 patients with refractory anemia with sideroblasts and 5 patients with refractory anemia with excess of blasts. The mean survival was 19 months, 9 patients died: death was due to infection or hemorrhage in 7 cases and to evolution to acute myelogenous leukemia (AML) in 2 cases (10.5%). Thrombocytopenia, the Bournemouth scoring system and FAB classification were independent prognostic factors.

[The experience of the 3rd Medical Clinic with lymph node pathology]. / Experienta clinicii a III-a medicala în patologia limfoganglionara.

In the last 8 years, 511 patients (267 men and 244 women) were investigated. It was found that 44 cases (8.6%) were false adenopathies (various types of tumoral masses) but placed in the nodes areas (localized, generalized or deep). There were 467 cases of true lymphadenopathies, 58 new cases yearly (2.32% of all admitted patients and 6.9% of those with blood diseases). Out of these 467 cases, 330 (70.6%) were malignant neoplastic diseases: malignant lymphomas--206 cases (62.4% of all malignancies), leukemias--99 cases (30%), carcinomatous metastases--25 cases (7.6%). Nonmalignant lymphadenopathies were found in 137 cases (29.4%): specific infections (tuberculosis) and nonspecific ones in 87 cases (63.5%), nonimmune diseases (SLE, PAN, sarcoidosis) in 50 cases. Generalized adenopathies were recorded in 47% of the cases, the involvement of a single node group in 21.8% of the cases, other types of distribution being rare. The general symptoms were absent in 20.5% of the cases, being present in the remainder of 79.5%, especially in the malignant lymphomas, leukemias, nonimmune diseases. The main complications occurring against the background of the etiological affections of lymphadenopathies were: infections (respiratory, urinary, tegumental) in 19.7% of the cases and cardiovascular disturbances (myocardiopathies, rythm and conduction disturbances) in 9.6% of the cases.

Lennert's lymphoma.

Four cases (3 M, 1 F) of Lennert's lymphoma were presented. The age (38-76 years), the clinical aspect and the morphopathological features were characteristic. Despite an intensive chemotherapy, 3 of the 4 patients died between 2 and 16 months (mean survival time 7 months). The controversies about the nosological delimitation and the cellular nature of Lennert's lymphoma are presented. Because of the poor prognosis, it should be considered as a high-grade malignant non-Hodgkin lymphoma.

Polycythaemia rubra vera. Analysis on 20 cases.

The authors presents her experience in polycythaemia rubra vera. A number of 20 cases have been studied, with a peak of polycythaemic values of 20.6/dl for the Hb, a Ht of 80%, an WBC count of 28,000/cmm and a platelet count of 1,400,000/cmm. The following peculiarities of the cases should be underlined: 1. the personal and hereditary collateral antecedents which reveal a significant pathological background; 2. the very slow evolutive potential of the malignant erythroid clone, which permitted a quasi-normal way of life for many years; 3. a careful therapy, differentiated with respect to the evolutive stage of disease, which resulted in a long survival (over 17 years).

[Pseudoadenopathies]. / Pseudoadenopatii.

The results of a study concerned with the etiology of some lymph node enlargement in 511 cases aged between 16-80 years, admitted to the III-rd Medical Clinic of Iasi during the last 7 years are presented. A thorough investigation, by histopathological, cytological, haematological, biochemical, immunological, lymphographic, echographic, radiological examinations, has been done. In 44 cases, the results of the above mentioned investigations indicated that there was no lymph node enlargement, but some other masses sharing the same sites with the lymph nodes, which generated the misdiagnosis in outpatient practice. It is important to note that in 28 cases (63% of the 44 cases) the pseudoadenopathies were localized in the cervical area. The pseudoadenopathies, which are the clinical expression of some tumoral diseases, could be classified as follows: a.--single peripheral; b.--generalized, peripheral; c.--deep. The symptoms which permit the differential diagnosis between the true and pseudoadenopathies are analysed.