[Neurological manifestations on collagenoses]. / Manifestari neurologice în colagenoze.

Collagen diseases are precipitated by very different etiologic factors, but have a common pathogenic mechanism--autoimmune, which evolves chronically and progressively involving new territories. The initial and main pathologic lesions are vascular arterial ischemic (and, according to the prevalently involved territory, the type of disease results: PAN--medium-sized and small arterioles; scleroderma--small arterioles and capillaries), and the secondary ones are the result of ischemia with plurivisceral involvement. Neurological dysfunctions were detected in about 50% of collagen diseases diagnosed during a 25 year interval in the IIIrd Medical Clinic of Iasi. The neurological manifestations were inaugural in 10% (in SLE) to 46.4% (in PAN) of the cases, the remainder occurring during the course of collagenosis, more commonly at 3-5 years and before death. Peripheral nervous system involvement (mainly polyneuritis) has prevailed, the central nervous system involvement being more rare and often fatal. Long-term corticosteroid therapy was followed by full or partial remission of peripheral nervous dysfunctions, but had transient effects or was ineffective on the central nervous ones.

[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.

[The efficacy of electroversion in the treatment of tachyarrhythmia complications of the heart valves]. / Eficienta electroconversiei în tratamentul complicatiilor tahiaritmice la valvulari.

The results of electric cardioversion in the treatment of tachyarrhythmias in a series of 431 patients with valve diseases of the left heart admitted during the last 10 years are presented. Most patients presented atrial fibrillation (71.4%), the atrial flutter and paroxysmal tachycardia necessitating electric cardioversion in 24.5% and 4.1% of the cases, respectively. The restoration of sinusal rhythm was obtained in 90% of the cases, a single shock being delivered in most of them (74.5%). The patients' age, type of arrhythmia and the causal valvular heart disease did not influence the results, the essential factors of restoration and especially of maintaining the sinusal rhythm failure being the age of the valvular heart disease, the quality of atrial myocardium (which depends on the size of the enlargement and age of arrhythmia) and the association of a coronary or myocardial alcohol induced affection. The importance of estimating the resumption of atrial mechanic activity is underlined. The "regulation" embolism was rare (5 cases), while an embolism occurring during the preparation period raises the possibility of a possible coincidence between the embolic accident and the recurrence of atrial mechanical systole after electric cardioversion.