Liver disease in systemic lupus erythematosus.

The incidence of hepatic involvement was followed up in a retrospective study carried out in a group of 177 patients with SLE. The liver damage was estimated by clinical examination, the titer of hepatocytic enzymes and, in some cases by hepatic biopsy. The proportion of liver involvement was found reduced but that did not exclude severe hepatic inflammation in certain cases. A high incidence of hepatomegaly was noted in spite of the fact that the histopathologic examination often showed normal values. The entity "lupoid hepatitis" is discussed as well as its real relationship with SLE.

The systemic vasculitides.

The systemic vasculitides include a heterogenous group of diseases, characterized by inflammatory and necrotic lesions of the vessel walls, with subsequent ischemic changes in different organs. Various factors are incriminated in the vasculitides etiology, despite the fact that, in most of the cases, the etiologic agents are unknown. The pathogenic mechanisms are generally mediated through circulant immune complexes, which induce the inflammatory reaction at the vessel wall site, accompanied by complex immune reactions. A classification of vasculitides should take into account the type of the injured vessel, the elements of the inflammatory infiltrate and the triggering pathogenic mechanisms. The definition and monitoring of the therapeutic regimen are difficult but, generally, the main elements of medication are represented by corticosteroid and cytotoxic drugs.

Chromosomal alterations in scleroderma.

To bring some new arguments in support of the genetic theory regarding the etiology and pathogenesis of scleroderma 12 patients (2 males and 10 females, ranging in age between 13 and 64 years) with both localized and systemic scleroderma were studied. For each patient chromosomal preparations were made in cell cultures from peripheral blood. The structural cytogenetic aberrations, observed in proportion of 81.81%, were, in the order of frequency: chromatid breakage, gaps, acentric fragments, deletions. The alterations appeared both in the systemic scleroderma and in the localized one but cannot represent a factor of prognosis for the disease. The association of Raynaud's syndrome with cytogenetic aberrations may lead to an early diagnosis of the disease.

Observations on HBsAg positive systemic vasculitis.

The clinical and laboratory data regarding the presence of serum markers of hepatitis B virus (HBV) were studied in a group of patients with necrotizing vasculitis. A high incidence of skin and articular alterations, of cryoglobulinemia and rheumatoid factor, was observed in HBsAg carriers. The potential role of HBV in the pathogenesis of systemic vasculitis is discussed.

Immune mechanisms in the pathogenesis of chronic active hepatitis.

The present paper is a review of investigations concerning the pathogenesis of chronic active hepatitis (CAH). After a brief reexamination of the classification and etiology of CAH, details are given regarding the immunologic aspects of postviral CAH and of CAH considered as autoimmune. The work is a critical analysis of the mechanisms of both cellular immunity and humoral immunity, as well as of possible genetic disorders of the immune response.

Circulating immune complexes in collagen diseases.

In a group of 75 patients with collagen diseases a study was carried out for the structural characterization of the circulating immune complexes (CIC) and the eventual detection of a correlation between these complexes and various serum biologic parameters. The results obtained have demonstrated: (a) the great variability of the structure of immune complexes even in the same type of disease and (b) the lack of correlation between the concentration of components in the CIC structure and the level of the same components in the serum. The lack of correlation may be explained by the great variety of immune complexes formation and the increase of any of the serum immunoglobulins does not necessarily mean its total or partial aggregation in the CIC structure.

Pathogenic role of intravascular coagulation in immune diseases.

The tests for the detection of intravascular coagulation and of secondary fibrinolysis performed in 79 patients with systemic lupus erythematosus and 30 patients with other collagenoses were positive in over 63% of the cases. A highly significant correlation was found between the presence of fibrinolytic degradation products (FDP) and the incidence of nephropathy and renal insufficiency, as well as between the presence of fibrin monomers (Godal's ethanol-gelification test) and the evolutive signs of the primary disease (fever, accelerated ESR).

Use of the Romanian product Silimarina in the treatment of chronic liver diseases.

The Romanian product Silimarina (synonym Legalon) was administered in a randomized double-blind trial, to a group of 180 patients with chronic persistent hepatitis (CPH), chronic active hepatitis (CAH) and hepatic cirrhosis (HC). The trial lasted for 40 days. The results showed favourable effects similar with those obtained with other preparations produced by foreign drug industries. The Romanian product proved to have no toxic effect. The authors discuss the present possibilities of estimating the evolution of chronic liver disease.

HBsAg positive secondary autoimmune active chronic hepatitis. Immunogenetic aspects.

Observations were made in a group of 120 patients with active chronic hepatitis (ACH), using demonstration of HBsAg presence, structural study of the peripheral blood mononuclear cell population by means of scanning electron microscopy (SEM) and typing of HLA-A, B and C antigens. From the whole group 22 patients were proved to have an autoimmune form of ACH secondary to infection with hepatitis B virus (HBV). The authors consider that the diagnostic value of the ratio between B and T lymphocytes (studied by SEM) is relative but the demonstration of an increased percentage of monocytomacrophage cells and the presence of "killing phenomenon" clearly reflect a more severe hepatic inflammation. A higher incidence of the HLA-Bw35-Cw4 was observed particularly in the HBsAg positive forms of ACH and in the HBsAg positive secondary autoimmune forms. The authors discuss the utility of these observations when the opportunity of corticotherapy has to be established.

Pulmonary involvement in systemic lupus erythematosus.

In the course of an ample study of collagen diseases carried out in the "N. Gh. Lupu" Institute of Internal Medicine--Bucharest over a long period, a group of 608 patients with systemic lupus erythematosus (SLE) hospitalized between 1974 and 1986 formed the object of the present study. Of these patients 18% presented pulmonary alterations due to SLE and 3.9% lung diseases of other etiology. The types of pulmonary involvement due to SLE were: pleurisy, interstitial pneumonia, diaphragmatic myopathy. Latent pulmonary damage could also be diagnosed in 8 patients. Most of the patients (94.1%) were females and had been hospitalized several times. Concomitantly with pulmonary damage other organ involvements have also been observed. Complex investigation of respiratory function performed in a selected group of patients revealed: restrictive syndrome, decrease of the gas transfer factor, increase of elastic recoil, hypoxemia on exercise. In most of the cases (92%) the pulmonary diseases had a chronic evolution. The treatment used was corticosteroids in 60% of the cases investigated.

Cardiac involvement in progressive systemic sclerosis and polymyositis: a comparative study in 116 patients.

A comparative study was carried out in 116 patients-51 with progressive systemic sclerosis (PSS) and 65 with polymyositis (PM) to detect the cardiac involvements secondary to these two collagen diseases. Different forms of cardiac involvement could be detected in 51% of the patients with PSS and in 18.5% of those with PM. The most frequent cardiac dysfunctions were disturbances of rhythm and conduction probably due to the coronary vascular changes in PSS and to processes of fibrosis and degenerescence of the specific myocardial fibers in PM. Myocardial lesions expressed by myocarditis and cardiomyopathies are not infrequent and have important prognostic implications. In the group of patients studied the valvular cardiopathies and clinically evident pericardites were rare. Cardiac involvement clearly proved more frequent in PSS - in which the pathogenic mechanism is mainly vascular - than in PM. This emphasizes the great importance of coronary circulation disturbances in the pathogenesis of collagen heart diseases.

Albumin to creatinine ratios in early morning samples of urine from healthy persons and patients without clinical proteinuria.

Urinary excretion of albumin was determined in 133 clinically healthy subjects and 236 patients suffering from diabetes mellitus (150 cases), collagen diseases (45 cases), or arterial hypertension (41 cases) in whom there was no clinical or laboratory evidence of renal involvement. Urine albumin was measured by an improved single-radial-immunodiffusion technique and results were expressed as urine albumin to creatinine concentration ratio (mg/g). The geometric mean values in the patients were about 2 to 2.5 times higher than in controls. When considered on an individual basis, at least 40 per cent of the patients had values above the 99th-percentile value for controls. The results suggest that quantitative determination of urinary albumin may be useful for detecting early structural functional alterations of the glomerular filter.

The evolution of atherosclerotic risk factors in a primary prophylactic survey. Ten-year longitudinal epidemiologic study (1971-1982).

The present work is a study of the evolution of atherosclerotic risk factors in the course of ten years, in a group of 5,000 male subjects, aged 40 to 60 years, from an urban district, undergoing a programme of primary prevention against ischemic heart diseases. The general intervention methodology and the results after five years follow-up were published in earlier papers. The present work describes the ten year evolution of the prevalence of the main atherogenic risk factors studied, the yearly rate of prevalences, first appearance and correction potency of the risk factors detected.

Use of angioscintigraphy in the diagnosis of malignant tumors of the liver.

Dynamic hepatic angioscintigraphy, a method of estimation and follow up of the double (arterial and portal) circulation in the liver, was performed in association with static liver scanning in 20 patients with suspicion of primary or secondary tumors of the liver, and in 5 healthy controls, after administration of 113min colloid. This procedure allowed confirmation of primary neoplastic tumors of the liver in 3 patients and of hepatic metastases in 5. The method supplies additional diagnostic information in malignant tumors of the liver and reduces the irradiation of the patients by using a single radiopreparation.

Is cardiac involvement in collagen diseases important? A clinical study in 917 patients.

Cardiac involvement in collagen diseases was studied in 917 patients representing all the cases of collagen diseases diagnosed in the "N. Gh. Lupu" Institute of Internal Medicine between 1985 and 1987. The prevalence of the various cardiac disorders was studied within every disease or group of diseases diagnosed according to clinical, ECG, radiologic and when necessary echocardiographic data. Collagen heart disease was diagnosed in 38.2% of the patients. In the case of systemic lupus erythematosus, of polyarteritis nodosa and of progressive systemic sclerosis this proportion exceeds 50%. The most frequent cardiac disorders were the rhythm and conduction disturbances, detected in 112 patients (12.2%). The cardiomyopathies and myocarditis, not infrequent (7.4%) represented an element of severity influencing the evolution and prognosis of disease. Myocardial ischemia secondary to coronary vasculitis syndromes has proved to be an important pathogenic mechanism of cardiac disorders. By their frequency and severity, the cardiac involvements in collagen diseases have proved important, becoming sometimes a central diagnostic, therapeutic and prognostic problem.

Prevalence of arterial hypertension in a collectivity of adolescents.

Arterial hypertension in adolescents was studied in a group of 899 school boys aged 15-18 years from the vocational school No. 48 of the Bucharest Transport Enterprise (ITB) and the secondary school No. 19 ITB. Essential arterial hypertension in the group investigated was found in proportion of 2.7%, a percentage comparable with that of other European countries (1-3%).

The relationship between systemic lupus erythematosus and tuberculosis.

Investigation of 280 cases of systemic lupus erythematosus (SLE) admitted during 15 consecutive years to the "N. Gh. Lupu" Institute of Internal Medicine, Bucharest, revealed association of this disease with tuberculosis (tb) in 51 cases (19%). In most of these patients, tb onset preceded that of SLE; in the others it was either concomitant or it occurred later, in the course of SLE evolution. It is assumed that tb is favouring SLE development, probably by antigenic oversollicitation in patients with genetic immune deficiencies. When it occurs in the late stages of SLE, association of tb is of severe prognosis.

The evolution of essential hypertension in a primary prophylactic survey. Ten-year longitudinal epidemiologic study (1971-1982).

The present work presents the evolution over a ten-year period of subjects with essential hypertension (EH) detected in a group of 5,000 men, aged 40-60 years, randomly selected in an urban environment. The prevalence of EH in the group studied was 20.5%, whereas "borderline" hypertension presented a prevalence of 21.4% reported in an earlier study. A proportion of 76.6% of the hypertensive patients were cared for in an outpatient unit; normal blood pressure values were obtained in about one third of the cases. This result is consistent in itself and, all the more so, bearing in mind ageing of the patients in the course of the study. The study had in view the annual incidence of essential hypertension and the evolution of atherogenic risk factors in hypertensive patients. The incidence of cerebrovascular accidents during the follow up period in this group was 6.85%, sudden death 1.7% and myocardial infarction 6.2%.

Significance of T and B lymphocytes in different chronic internal diseases with immune processes.

The T and B lymphocytes were determined by the rosette test in the peripheral blood of 100 patients with internal chronic diseases with immune processes such as: chronic hepatitis, systemic lupus erythematosus, myasthenia gravis, chronic lymphocytic leukemia and lymphosarcoma. The values obtained were compared with those in 10 controls. The mean per cent values of the T lymphocytes in the controls were 33 (29-38%) and of the B lymphocytes 25.2 (16-43%). In the patients investigated the values varied, namely: in chronic hepatitis and systemic lupus erythematosus the T lymphocytes were generally low while the B lymphocytes were moderately high. In myasthenia gravis both T and B lymphocytes were below the control values. In chronic lymphocytic leukemias and lymphosarcomas the per cent values of the T lymphocytes were generally low while those of the B lymphocytes were high. The significance of these results for the immunologic implications of the lymphocyte populations is discussed and an attempt is made to correlate these data with the nucleologram variations.

Seasonal variations of serum cholesterol detected in the Bucharest Multifactorial Prevention Trial of Coronary Heart Disease. Ten years follow-up (1971-1982).

A group of 4800 men, aged fourty to sixty at entry, subjected to a multifactorial prevention trial of coronary heart disease for a ten-year period, showed spontaneous seasonal variations of serum cholesterol, characterized by increases in winter and decreases in summer. The authors discuss the relationship between the food changes and the seasonal variation of serum cholesterol values.