[Clinical and therapeutical considerations regarding odontogenic acute mediastinitis]. / Consideratii clinico-terapeutice în mediastinitele acute de cauza dentara.

Odontogenic acute mediastinitis is an polymicrobial infections caused in most cases by gram negative and anaerobic germs. The odontogenic origin of the cases in this study was based on anamnestic inquiry of the patients, which reveales a dental treatment 7-15 days before the diagnosis of acute mediastinitis was established. Clinical features are often nonspecific at the debut of this affection; septic shock could appear suddenly associated with multiple systems and organs failure. This is the explication why, some of these patients presented septic shock when are diagnosed. In this situations, when acute mediastinitis is suspected, based on clinical and imaging findings, it must be confirmed by surgical exploration and perioperative bacteriological evaluations. Positive diagnosis is based on clinical features associated with labs and imaging studies. Surgery plays an important role in therapy of acute mediastinitis: debridement and drainage of mediastinum with subsequently lavage of it, using antiseptic solutions. Broad spectrum antibiotherapy should be administrated immediately, before antibiogram is ready.

Reversing the tuberculosis upwards trend: a success story in Romania.

At present, no published evidence is available on the effectiveness of the DOTS (directly observed treatment, short-course) strategy in reducing the incidence of tuberculosis (TB) within a country in the European "hot spots". The present study aimed to demonstrate the effectiveness of the strategy implementation in reversing the epidemiological TB trend in Romania based on programmatic data analysis. Key programme indicators were analysed from 1998 to 2007, and included DOTS coverage, case-detection rate, treatment success and overall incidence of notified cases. Internationally agreed definitions were used. The key programme indicators began declining and the World Health Assembly targets were reached (79% case-detection of new sputum-smear positive cases and 85.5% success rate in new culture-positive TB cases), 7 yrs after initiation of the DOTS expansion. The success story in Romania suggests that other middle-income, high-incidence countries (i.e. those belonging to the former Soviet Union) might be able to reach the World Health Assembly Targets and curb the burden of tuberculosis.

Pulmonary tuberculosis in Romania at the dawn of the millennium--a major public health issue.

TB incidence in our country is still quite high compared to the average of the European Union countries (1st place among EU countries and 3rd place among WHO European Region countries), which means that a national coordinated response against this disease needs to become the priority of the current health care policy. The multi-factorial conditioning, which includes the social and economic dimensions of TB spreading, requires a multi-disciplinary and inter-sectorial approach to this pathology, going beyond healthcare services. The National Tuberculosis Control Strategy is a part of Romania's Country Strategy based on the guidelines set out in WHO's 2006-2015 Global Plan to Stop Tuberculosis (MDGs 2015) and it provides the necessary framework for refining and harmonizing the national legislation and regulations with the European laws after Romania's integration in the EU.

Life-long protein malnutrition in the rat (Rattus norvegicus) results in altered patterns of craniofacial growth and smaller individuals.

Dietary protein is a limiting factor in mammalian growth, significantly affecting the non-linear trajectories of skeletal growth. Young females may be particularly vulnerable to protein malnutrition if the restriction is not lifted before they become reproductive. With such early malnutrition, limited amino acids would be partitioned between two physiological objectives, successful reproduction vs. continued growth. Thus, the consequences of protein malnutrition could affect more than one generation. However, few studies have quantified these cross-generational effects. Our objective was to test for differences in skeletal growth in a second generation of malnourished rats compared with rats malnourished only post-weaning, the first generation and with controls. In this longitudinal study we modelled the growth of 22 craniofacial measurements with the logistic Gompertz equation, and tested for differences in the equation's parameters among the diet groups. The female offspring of post-weaning malnourished dams did not catch up in size to the first generation or to controls, although certain aspects of their craniofacial skeleton were less affected than others. The second generation's growth trajectories resembled the longer and slower growth of the first malnourished generation. There was a complex interaction between developmental processes and early nutritional environment, which affected variation of adult size.

[International standards for tuberculosis management]. / Standarde internationale pentru ingrijirea tuberculozei.

International Standards for TB Care describe the international accepted levels of care for TB patients and suspects. The basic principles are the same worldwide: early correct diagnosis, standardized treatment insuring support and supervision, monitoring of the treatment results and highlighting all the public health responsibilities. The Standards provide the possibility to adhere to policies and practices necessary for an efficient control of the disease by all factors involved, including private or other areas. The Standards do not intend to replace local guidelines, but are focused on the relationship between individual care and the control based on community intervention. The article presents briefly the standards for diagnosis and treatment and the responsibilities of public health domain.

[BOOP--a rare diagnosis in clinical practice]. / BOOP--un diagnostic rar în practica pneumologica.

The authors present the case of a patient diagnosed in the first place as an idiopathic pulmonary fibrosis with unfavorable evolution (clinical and functional decline under corticosteroid and immunosuppressive treatment). Lung biopsy established the diagnosis of bronchiolitis obliterans with organizing pneumonia (BOOP).

High blood glutathione levels accompany excellent physical and mental health in women ages 60 to 103 years.

Earlier we found a high percentage of subnormal total glutathione (G(T)) levels in blood from elderly subjects and patients with chronic diseases. These findings suggested a hypothesis that high levels of G(T) in the blood occur in old persons who are in excellent physical and mental health. To this end, we recruited 87 white women who ranged in age from 60 to 103 years and reported that they felt healthy. Their health was verified with physical examinations, clinical chemistry profiles, psychosocial assessments, and blood G(T) determinations. This evaluation was performed in three waves over a 5-year period. The values were compared with those from representative individuals in this region and with normal national data. The results verified that these healthy subjects were in top physical and mental health. We also found that subjects of all ages had very high blood G(T) levels in waves I and II but only normal levels in wave III. These findings confirm that high blood G(T) concentrations and excellent physical and mental health are characteristics of long-lived women.

[Pulmonary benign lymphocytic angiitis and granulomatosis--a benign lymphoproliferative condition]. / BLAG pulmonar--o conditie limfoproliferativa benigna.

BLAG--benign lymphocytic angiitis and granulomatosis is a granulomatosis disease which histologically presents a dense infiltrate of lympnoid cells that disturbes the normal alveolar architecture. Faint granuloma formation occur within the lympnoid infiltrate. A 32 years female patient was admitted for dry cough, exertional dispnea, low fever during last 11 month. Histological diagnosis was BLAG. The treatment was a combination of cyclophosphamide and prednisone. Follow up information after 9 month of treatment show a generally favorable evolution (clinical and radiological).

Immunotherapy with Mycobacterium vaccae in the treatment of tuberculosis in Romania. 1. Newly-diagnosed pulmonary disease.

In this study, 206 previously untreated patients with sputum culture positive pulmonary tuberculosis were randomized to receive an injection of killed Mycobacterium vaccae as immunotherapy, or of saline as placebo, after 1 month of a 6-month chemotherapeutic regime. Not surprisingly in a disease for which there is good chemotherapy, the difference in numbers which were culture negative at the end of treatment was small, and the final outcome at the latest post-treatment follow-up did not reach statistical significance between the two arms of the study. Nonetheless, those receiving immunotherapy showed better progression in every parameter measured, suggesting faster and more complete cure. Whereas seven of 97 patients receiving immunotherapy required a course of re-treatment and five still had active disease after a mean follow-up of 2 yr, 13 of 109 placebo recipients required re-treatment and nine still had active disease at the end of the study. Only one patient receiving M. vaccae plus chemotherapy died of tuberculosis, compared with four of those receiving chemotherapy alone. A degree of drug resistance was shown by the bacilli cultured from 25 of 175 (14%) patients, and seven of them (4.0%) were multi-drug resistant. Fourteen patients received immunotherapy of whom 13 were cured, including all three of those showing multi-drug resistance. Of the 11 patients with drug resistance in the control group, eight were cured, and one patient with multi-drug-resistant disease died of tuberculosis during re-treatment.

Immunotherapy with Mycobacterium vaccae in the treatment of tuberculosis in Romania. 2. Chronic or relapsed disease.

In this study of 102 patients with culture-positive chronic treatment failure or repeatedly relapsed pulmonary tuberculosis receiving chemotherapy, 56 received an injection of killed Mycobacterium vaccae as immunotherapy after 1 month of treatment. At the start of treatment, there was little difference between those receiving immunotherapy and the 46 patients in the control group receiving chemotherapy alone. Thereafter, the two groups diverged so that 1 yr later, 43 of 56 (77%) patients receiving M. vaccae had a successful outcome, in comparison with 24 of 46 (52%) patients receiving chemotherapy alone (P < 0.02). Successful results were obtained from patients infected with drug-resistant bacilli, 20 of 32 (63%) patients compared with 11 of 25 (44%) patients, respectively, as well as from fully drug-sensitive cases (23 of 24 compared with 12 of 21 patients; P = 0.004). At the final follow-up after 22 months, 13 of 56 patients receiving immunotherapy had an unfavourable outcome compared with 26 of 46 members of the control group (P = 0.0006). During the study, 16 patients died of tuberculosis (six after immunotherapy), and 12 were lost to follow-up. Not only was bacteriological success improved by immunotherapy, chest X-ray showed markedly better resolution of cavities and other radiological lesions, recovery of body weight was improved, and the mean erythrocyte sedimentation rate returned almost to normal (P < 0.001) in comparison with those receiving chemotherapy alone. These changes were seen even in those failing bacteriological cure, suggesting that the immunotherapy had been effective, but that bacilli were replicating in an extracellular situation, protecting them from its effects.

[The incidence and mortality of tuberculosis in children in Romania in recent years]. / Incidenta si mortalitatea prin tuberculoza la copii în România în ultimii ani.

The incidence and mortality by tuberculosis in children vary in connection with the tuberculosis in adults. The incidence by tuberculosis in children decreased from 300-313/1000 in 1955-1960 at 7-8%000 in 1985. After the year 1985 the risk of tuberculosis in children had a very clear tendency to increase, from 7.4%000 in 1986 at 12.7% in 1990 and to a maximum of 20.7%000 in 1993, an equal level to that from 17 years ago. Mainly, this increase is due to the deterioration of the living conditions of the population from the period 1980-1989, continued thereafter too, to the great number of cases of AIDS [correction of SIDA] recorded in children in Romania, that, associated to the high yearly risk of tuberculous infection, facilitated the appearance of new cases of infection HIV/AIDS [correction of SIDA] + tuberculosis. The most exposed to tuberculosis is the group of age 0-4 years. In the last years the percentage of the extrarespiratory settings of tuberculosis was of about 18%, and the percentage of severe cases was about 11% from the incidence. The mortality by tuberculosis in children increased from 4.5%000 in 1986 at 10.0%000 in 1993, but its lethality remained negligible.

[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.

[The problems of clinico-morphological diagnosis in a case of fatal hemoptysis]. / Probleme de diagnostic clinico-morfologic într-un caz de hemoptizie fatala.

28 children with bronchial asthma, between 6 and 18 years old, were followed by a varied period of time 3 months - 5 years. 7-8 functional tests were carried out. The cases were studied in different clinical phases: asymptomatic, manifest, crisis of bronchial asthma. The functional pulmonary investigation included: spirographic examination [vital capacity (VC), maximum expiratory volume per second (MEVS) the VC/MEVS ratio], plethysmographic examination (VGT, Raw), measurement of the maximum instantaneous expiratory flows on the flux-volume curve (MEF50). The average value, standard residual deviation and the variation coefficient were calculated for each parameter studied in different clinical moments. The results are presented on 3 groups: per total, symptomatic and asymptomatic. The analysis of the data found showed that the variation of the parameters measured during repeated functional examinations in children with bronchial asthma ranges within broad limits (2.9%-11.5%); the broadest variation was recorded for Raw followed by MEF50 and the slightest variation was that of the VC/MEVS ratio. This indicated the lower value of the information furnished by this ratio in children in appreciating the presence or severeness degree of the obstructive syndrome.