[Tuberculosis in Romania (author's transl)]. / Der gegenwärtige Stand der Tuberkulose in Rumänien.

The incidence of tuberculosis in Romania has decreased considerably over the past years, particularly since 1972 when the combined rifampicin-ethambutol-pyrazinamide therapy was introduced. During the period 1968-1977 it fell from 127.9 per 100,000 to 73.4 per 100,000. The incidence of relapses fell at a slower rate. The most endangered are the 20-24 years age-group and old people; but here again the number of cases tends to fall. Childhood tuberculosis showed a yearly decline by an average of 20%. Bacteriological examinations and diagnosis are assuming increased importance.

[Chronic obstructive bronchopneumonia (COBP), a precancerous state through destabilization of body homeostasis and bioenergetics]. / Bronhopneumopatia obstructiva cronica (BPOC), stare precanceroasa prin destabilizarea homeostaziei si bioenergiei organismului.

Out of a number of 2113 of COLD ambulatory cases followed-up over 20 years, 170 cases of death were registered. The causes were: heart in 54%, cancer in 42% among which 37% lung cancer, exceeding 8 times the mean figures on the whole country. These diseases: COLD, atherosclerosis inducing heart disease and lung cancer have common risk factors which unbalance respiratory homeostasis. By obstructing the airways they lead to cellular O2 deficit. In this way the cell is compelled to shift to anaerobic glycolysis in order to supply the bioenergy necessary for life, resulting in malignancy mutagenesis. On a control group of 166 cases of lung cancer a ventilatory impairment was noted in the history: obstructive syndrome in 63.8%, restrictive syndrome in 28.3%, which means chronic respiratory insufficiency.

[Factors in the failure of tuberculosis chemotherapy studied in a Romanian county]. / Studiul factorilor de esec ai chimioterapiei antituberculoase pe un teritoriu judetean.

This work proposes to analyse the quality of the failure risks in the case of a short duration treatment applied in operational conditions on the territory of Constanta County as a premise for the application of a method of mathematical analysis on computer in view of predicting the failure cases. There were studied 262 eligible cases out of 290, which represent the total of the patients newly registered with pulmonary tuberculosis in 1982, on the territory of Constanta County and who were kept an eye upon for 3 years after finishing the treatment. There resulted 58 (22.1%) recurrencies, failures or corrected in course intratherapeutic positive reactions, on which were analysed 25 possible failure factors. The most representative have proved to be the organizational factors among which irregular treatment (67.2%) of the failure cases, a defective mobilizing to treatment, technical factors: late negativation of sputum (over 4-5 months from starting the treatment), and among the factors depending on the patients--noncooperation occurred in 60.33% of the failure cases. If the final frequency of failures on the territory of Constanta County does not exceed the average figures recorded here and abroad, the global frequency within the studied time period is not satisfactory and imposes an assessing of the failure factors and measures of improvement.

[The means for evaluating and optimizing antitubercular chemotherapy as a measure to prevent and combat tuberculosis in county territory]. / Modalitati de evaluare si optimizare a chimioterapiei antituberculoase ca masura de prevenire si combatere a tuberculozei pe un teritoriu judetean.

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.

[Clinical trial of amoxycillin in chronic bronchitis and bronchial dilatations]. / Experimentarea clinica a amoxycillinei în bronsita cronica si dilatatiile bronsice.

The therapeutic results were followed of amoxycilline after application in 57 cases of chronic bronchitis and bronchial dilatations that had been treated previously with antibiotics (including ampicillin--in 37 cases). The amount of amoxycilline was of 2 g per day, given in four 0,5 g doses. A total of 23,3 percent "very good" results were obtained (expectoration either disappeared completely or was reduced to 2--3 ml per day), and 40,4 percent "good" results (with expectoration down to less than one half of the initial amount). Thus in two-thirds of the cases the results were favourable. The cases that did not respond to ampicilline gave only 10,8 percent "very good" results but the "good" results represented 51,3 percent, indicating an increased efficiency of the new drug as compared with ampicilline. The serum levels of Amoxycilline (9,4 mg/ml after 2 hours, and 4,4 mg/ml after 4 hours), when a 0,5 g dose was given every 6 hours, assure a continuous and efficient bacteriostatic concentration. No significant adverse reaction were noted.

[Dynamics of the risk of tuberculosis infection and invalidity in Romania]. / Dinamica riscului de infectie si de îmbolnavire prin tuberculoza în R. S. România.

Analysis of epidemiological indicators is of particular importance, and relevant for assessing the efficiency of the prevention and fighting programs against tuberculosis. The most relevant epidemiometric indicators are the incidence of the infection and that of the disease itself. The annual risk of infection with tuberculous bacilli is considered as the most valuable indicator of extension or limiting tendencies of endemia, and of the efficiency of anti-tuberculosis programs. The annual incidence of the infection at the age of 14 years established by various methods, and improper conditions determined by mass allergizing of the infantile population by mandatory B.C.G. vaccination has decreased from 3,5% in 1960 to 0.8-1.0% in 1980. The level is still high, as compared with other european countries, but the rate of decrease has accelerated over the last years, a fact which demonstrates the efficiency of fighting measures applied. The incidence of contracting tuberculosis should be dealt with separately with regard to children and adults, since in children it is mainly related to primary infection, while in adults it is related to the presence of minimal lesions with phtysiogenic potential which can be traced to the post-primary stage, as well as to immuno-depressing influence of some environmental factors. In this connection the incidence of tuberculosis in children has been reduced in our country in the last 25 years from 297.2% to 10.3%. The risk of developing the disease has fallen from 1/230 in 1950 to 1/9 700 in 1980. The risk of developing the disease has decreased more rapidly in older children (between 5 and 9 years) than in the younger ones (0 to 4 years). The incidence of tuberculosis in the population aged above 15 years has fallen from 352.6% in 1955 to 70.5% in 1980. The risk of developing the disease in adults was of 1/284 in 1956 and 1/1 418 in 1980. The authors also make an analysis of the dynamics of some demographic risk factors, such as sex, age and environment.

[The late results of intensive chemotherapy (9 months) in severe forms of tuberculosis in children]. / Rezultatele tardive ale chimioterapiei intensive (9 luni) în formele grave de tuberculoza la copil.

The short-course chemotherapy (9 months) in the severe forms of tuberculosis in children is a very modern item. It was very few approached on an international level and relatively short time ago in our country. There were applied the following therapeutical regimens: 3 HRZ2 6 HR2 (in the experimental group) and 3 HR/3 HR2/6 H2 (in the control group). In the granulias and the caseous forms the late results, at 5 years after treatment end, were very good in 100% of cases in both groups. In meningitis clinical very good results (without sequellae) presented a proportion of 70.1% in the experimental group and of 68.2% in the control group (difference statistically non significant). The main advantage of the intensive short course regimens (9 months) comparatively with the "classical" ones (of at least 12 months) consists in reaching finally the same good results but in at least 3 months shorter time interval.

[Reasons for delayed diagnosis of pulmonary tuberculosis]. / Cauze ale întîrzierii diagnosticului de tuberculoza pulmonara.

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 efficacy of ethambutol compared to streptomycin in the initial quadruple phase of short-term regimens]. / Eficacitatea etambutolului comparativ cu a streptomicinei in faza initiala cvadrupla a regimurilor de scurta durata.

In order to test comparatively SM and EMB efficacies within quadruple regimens of short-term chemotherapy, two groups of patients with pulmonary tuberculosis at first treatment, sputum positive under microscopic examination, were constituted through randomization. One group (59 cases) was submitted to the standard regimen RHSZ 2/7, and the other (61 cases) to RHZE 2/7. Group structure was homogeneous from the standpoint of case repartition, according to the anatomo-radiological form, therapeutical regimen, and sensitivity to Tb drugs. Both bacteriological and radiological clinical evolutions show, even in the conditions of a short-time interval (2 months), a similar efficacy of SM and EMB within the quadruple regimens in the initially intensive phase of anti-Tb treatment. It is possible that the results may be dependent upon the concomitantly bactericidal action of: rifampicin, hydrazide and pyrazinamide. Therefore, a further testing of the comparative efficacy of the triple regimen RHZ 2/7 with the quadruple RHSZ 2/7 and RHZE 2/7 during a longer follow-up is required.

[Results of continuous treatment (3 years) with disodium cromoglycate of patients with bronchial asthma and spastic bronchitis]. / Rezultatele tratamentului continuu (3 ani) cu cromoglicat disodic la bolnavi cu astm bronsic si bronsita spastica.

A group including 36 patients with bronchial asthma and 8 with spastic bronchitis have been treated with disodium cromoglycate for a period of 3 years starting with July 1-st, 1978. Eight of these patients also had allergic rhinitis, and in these ones administration of the treatment was also made by nasal application. Partial results have been published after 3 and 18 months of treatment. Of the original 44 patients 23 are still followed and the other 21 had been followed for at least 2 years, an interval which was considered as sufficient for eliminating seasonal variations of the asthmatic manifestations, independent from the treatment applied. The results at 3 years are different from those at 3 months and are relatively similar to those at 18 months. In 41.2% of the cases necessities for steroid therapy had been reduced, and in 30.3% of the cases a durable suppression of corticoid therapy was possible. With regard to bronchial dilators the doses have been diminished in 32.1% of the cases, and completely abandoned in 20.3% of the patients. A synthetic evaluation of clinical and laboratory results showed that these were positive in 68.3% of all cases. The treatment was well tolerated and no undesirable side effects were noted over the period of the treatment.

[Current possibilities of echography in pneumological diagnosis (preliminary note)]. / Posibilitati actuale ale ecografiei în diagnosticul pneumologic (Nota preliminara).

Various types of echographies are presented, and it is concluded that the bi-dimensional echography, also called type B or echo-tomography is the most useful for the study of pulmonary affections, and of compact formations in contact with the pulmonary tissues. With the aid of Model E.D.B. Unirad sonograph (Technicare, USA), and of the Scintron 5 computer (Scintag, Berthold, Switzerland) 6 patients with pleurisy of various extension, one patient with fibrothorax, and 2 patients with pulmonary tumours have been examined. Five of the cases are presented. Echotomography has demonstrated its usefulness in measuring the thickness of the thoracic wall, in establishing by means of a non-invasive technique the solid or fluid character of pleural affections, in assessing the structure of pachypleuritis and in detecting changes induced by tumours, or atelectasia in the vicinity of the pleura. However, the method does not provide information on round peripheral tumours which do not come into contact with the pleura. Also this method cannot replace other methods already used in the pneumological practice, but can provide supplementary informations without any risks for the patient.

[Disodium cromoglycate treatment of bronchial asthma and spastic bronchitis (preliminiary results)]. / Tratamentul cu cromoglicat disodic în astmul bronsic si în bronsita spastica (rezultate preliminare).

After a short review of the mode of action of sodium chromoglycate, the results are presented, of the treatment carried out over a three months period in a group of 31 patients of which 23 had bronchial asthma and 8 had spastic bronchitis. In 19 cases the doses of steroids that the patients were receiving were either diminished or supressed, in 14 cases the doses of broncho-dilating drugs were diminished or supressed and in 15 cases the results of the respiratory function tests were improved or much improved. A synthetic evaluation of the clinical and laboratory results showed that in 3/4 of the cases (74.2%) these were either favourable or very favourable. The treatment was well tolerated and no side-effects were noted.

[Failures of standardized treatments in pulmonary tuberculosis. Possibilities of prevention and therapeutic recovery]. / Esecurile tratamentelor standardizate în tuberculoza pulmonara. Posibilitati de prevenire si recuperare terapeutica.

In view of a better knowledge of therapeutic failures in operational conditions four groups of patients were analyzed, which included a total of 1511 patients, both new cases and patients re-admitted for tuberculosis of the pulmonary apparatus, that had been treated according to standardized regimens. In three of these groups failures had been recorded at a rate of 3,9% intra-therapeutic failures and 7,6% post-therapeutic ones in the first 18 months after completing the therapy. Out of the four groups a lot was selected, which included 127 cases of therapy failure. This lot was studied under the aspect of causes of the failure and of the possibilities for recovery. The major causes of the failure were non-cooperation of patients (in 48% of the cases), the initial severity of the lesions, associated diseases, the re-admittance, the secondary resistance. Recovery of the intra-therapeutic failures was possible in 46% of the cases, and of patients with post-therapeutic failure in 72% of the cases. On the basis of an analysis of risk factors a series of proposals are made for preventing such failures.

[Study of adverse reactions in pulmonary tuberculosis patients treated with rifampicin]. / Studiul reactiilor adverse la bolnavii de tuberculoza pulmonara tratati cu rifampicina

The present study concerns the clinical appraisal of adverse reactions reported in the course of Rifampicin (RMP) treatment, reactions which have given rise to conflicting reports. The lot studied included 243 cases of pulmonary tuberculosis of which 57 were treated according to the 7/7 regime (600 mg RMP), 152 according to the 2/7 regimen (900-1200 mg RMP) and 34 according to the 7/7 followed by the 2/7 regimen. Tolerance to RMP was followed up by a series of adequate tests and close clinical surveillance. Adverse reactions developed in 31.5% to 41.5% of the cases in terms of the treatment scheme. In the intermittent treatment adverse reactions occurred in 17.1% of the cases.

[Tuberculosis in the elderly: sociomedical aspects]. / Tuberculoza la varstnici; aspecte medico-sociale.

A study on a group of 100 tb patients aged over 60 years registered between 1987-1991 in the district 4 of Bucharest has been carried out aiming at the evaluation of medical and social aspects. In order to increase the relevance of the obtained data, these were compared with a group of young tb patients aged 20-39 years, in the same territory and period of time. The results show: the case-finding predominantly passive, extrarespiratory forms in 25%, high contamination risk (63% acid fast bacilli eliminators on microscopy) non-compliance to treatment in 1/5 of cases. These aspects could be explained by psychic particular features in aged persons, associated diseases a.s.o., leading to treatment failures. The analysis of social and epidemiological aspects of tb in aged subjects evidences some lack of good results in this important public health problem of people.

[The Cu/Fe ratio and its significance in the pathogenesis, diagnosis and prognosis of bronchopulmonary cancer]. / Raportul Cu/Fe si semnificatia sa în patogenia, diagnosticul si prognosticul cancerului bronhopulmonar.

In 197 cases with various bronchopulmonary affections, iron was dosed in serum, according to Weippel's method, and copper, according to Cantarov's method. Cu/Fe serous ratio was found in the normal patients between 0.7 and 1.7 higher than the control sample were reached (1.2); in OCBP the ratio was twice versus the control sample (2.62 versus 1.2). In the disease diagnosis and prognosis, the determination of the Cu/Fe serous ratio is suggested in those suspected of bronchopulmonary cancer. The increase of the ratio shows the aggravation by metastases, and the improvement after operations indicates the lack of metastases. The advantages of the test are: sensitivity, specificity, predictability, economy.

[Contribution of pulmonary scintiscanning to the diagnosis of chronic obstructive bronchopneumopathy]. / Aportul scintigrafiei pulmonare in diagnosticul bronhopneumopatiei obstructive cronice

In a lot of 32 cases of chronic obstructive bronchopneumopathy, a correlation was established between the extent and location of the regional perfusion deficiencies (studied by scintigraphy) and overall functional disturbances Vmax MEVS X 100VC, residual volume, R, PaO2, PaCO2). In 85% of the cases regional perfusion disturbances were detected and grouped into six scintigraphic types. A good correlation was found between these disturbances and the MEVS X 100/VC index and modified partial pressure of the gases (O2, CO2) in the arterial blood. Unexpected was the absence of a mathematical correlation between perfusion disturbances and the residual volume and R, suggesting the great variety of the disturbances grouped under the general denomination of chronic obstructive bronchopneumopathy.

[Use and evaluation of radiophotography in the ambulatory care of lung diseases]. / Utilizarea si valorificarea radiofotografiei în asistenta ambulatorie de pneumologie

In the methodological cabinet for pneumology of the Institute of Phtysiology, radiophotography was employed in the following fields: a) screening of acute and chronic pneumopathies as appears from : the increase in the number of cases of non-specific pneumopathies as compared with cases of tuberculosis and the quantitative contribution of the method reflected in the fact that over 80% of the cases with non-specific pneumopathies were detected by radiophotography; b) diagnosis -- by comparing with the data recorded in the files, multiple incidences (front, posterior lordosis, profile); locally pointed (targeted) photographs, rf quantified functional tests in cases suspected of C.O.B.P.: c) follow-up of the evolution of dispensary cases and of the therapeutical effect; d) scientific research and teaching activities through epidemiological and pathogenesis studies, thus allowing for a valorification of the files over a 16 years period. The use of the radiophotographic method in the activity of a cabinet of pneumology is necessary especially because it allows for an early detection, a superior morphological diagnosis, as compared with radioscopy (fluoroscopy), for an objective and economical follow-up of the cases, providing at the same time material for scientific research and teaching demonstrations.