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.

A longitudinal study, for 15 years, of the myocardial infarction, in a population of middle aged men.

The long-term evolution of the patients with incident myocardial infarction (MI) was studied in a group of 5,000 men ranging in age from 40 to 60 years, included in an action of primary prevention of arterial hypertension (AHT) and coronary heart disease, in comparison with a second group of 5,000 other men with similar age and occupation, selected at random, who received medical assistance without primary prevention. The incidence of MI was of 2.34% (111 cases) in the group of intervention, with a cardiovascular mortality of 46.84%, while in the control group it amounted to 2.88%, with an overall mortality by cardiovascular diseases of 52.7%. The highest mortality rate was recorded in the patients with recurrent infarctions (72.6% and 60% of deaths, respectively). During a follow-up period of 15 years, the presence of AHT before the occurrence of MI proved to be an aggravation factor for the cardiovascular mortality which, in the group of intervention, was two times more frequent in such patients than in those with pre-existent angina. The pathologic association angina--AHT as well as the AHT alone, preceding the MI occurrence, have significantly increased the risk of cardiovascular mortality. The action of primary prevention has evidently reduced the immediate mortality, as well as that of the patients with angina before the MI.

Ischemic heart disease in relation with the type of behavior and the emotional state.

The relationship between the cardiovascular state, on the one hand, and the type of behavior and emotional state on the other, was investigated in a professional type community of 550 subjects (280 men and 270 women) ranging in age from 20 to 64 years. The subjects were submitted to medical examination (clinical, electrocardiographic and biochemical) for the detection of ischemic heart disease and its risk factors (arterial hypertension, smoking, over weight, hypercholesterolemia) and concomitantly to a psychologic examination consisting of anxiety test as a state and as a trait, multiple affectivity test and the test of self-rating behavioral type, for the study of the emotional state and the type of behavior. The relation between the results of the two examinations showed that ischemic heart disease (irrespective of the form) and its risk factors are associated to various extents and in different manners to the psychologic factors. Thus, significantly, ischemic heart disease was proved four times more frequent in subjects with type A behavior than in those with type B; arterial hypertension was more frequent in anxious (1.6 times) and aggressive subjects (1.4 times); overweight was more often encountered in nondepressive (2 times) and adaptable subjects (1.4 times), and in subjects with type B (1.3 times); the anxious subjects were found to smoke less than the non-anxious ones (2 times).

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.

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%.

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.

The predictive value of some major ECG changes.

Out of a group of 5,000 men included in an action of primary prevention of coronary heart disease and arterial hypertension, started in 1971 in the "N. Gh. Lupu" Institute of Internal Medicine--Bucharest, the authors have selected the subjects presenting major ST--T changes and conduction troubles. The predictive value of some ST--T changes for the subsequent occurrence of major coronary accidents was also investigated in 3,000 male subjects of similar age and occupation, also selected at random, but who were not included in the action of primary prevention of the risk factors. The results obtained demonstrated the value of such an early intervention upon the risk factors of coronary heart disease, the incidence of coronary accidents (myocardial infarction, sudden death) being smaller in the group of intervention than in the control one.

The Bucharest Multifactorial Prevention Trial of Coronary Heart Disease--ten year follow-up: 1971-1982.

The trial begun in 1971 and the paper brings the results after a ten-year follow-up. Both the intervention and control group contained 5000 men with a similar socioeconomic and professional structure; the intervention group was examined every six months in the first 5 years and annually in the second phase. The control group was examined "only after" 5 years and a second time at the final moment. The decreases of the cumulative ten-year incidences were: for hard events--26.7%; for myocardial infarction--20%; for fatal myocardial infarction--52%; for stroke--31%; for cardiovascular mortality--38%; for total mortality--14%. The trend of serum cholesterol and cigarettes/day was downward, but the blood pressure had a rather flat evolution in the intervention group. The control group disclosed also some downward trends.

The Bucharest multifactorial prevention trial. The changes of morbidity and of general and specific mortality.

The paper presents the results of the Bucharest multifactorial prevention trial of coronary heart disease, concerning changes in cardiovascular morbidity and mortality during the first 5-year-period of follow-up. The age adjusted 5-year-rates disclose important reductions in the intervention group in comparison with the control one: for hard events (myocardial infarction, stroke, acute coronary insufficiency)--by 41%; for myocardial infarction--by 35%; for coronary mortality--by 38%; for stroke--by 39%; for cardiovascular mortality--by 30%. The decrease of hard events, myocardial infarction and stroke incidences are statistical significant. The evolution curves of cardiovascular morbidity and mortality show that both groups (the intervention as well as the control one) began with near the same values, but on the way and especially after 5 years they are differently located, those of the control group being higher than those of the intervention group.

The Bucharest multifactorial prevention trial of coronary heart disease. General methodology and risk factor correction after five year follow-up (1971-1977).

Both the intervention and the control group included each 5000 men aged 40-60 years, randomly selected by their home address in five districts of the city of Bucharest. The intervention group underwent an "at entry" examination for risk factor detection (high serum cholesterol, high blood pressure, overweight, diabetes, minor ECG abnormalities, family history) and subsequently a five-year multifactorial intervention aimed to reduce the risk factors. Both groups were followed up in this lapse of time for major end-points: myocardial infarction, stroke, sudden death. The qualitative analysis of the results used ten evolution indices based on a quantal counting and lead to a classification of risk factors which allowed the setting up of a strategy for their correction. The quantitative analysis showed the following decreases between the first and the last examination in the intervention group: for serum cholesterol greater than or equal to 250 mg/dl -17%; for cigarettes/day greater than or equal to 15-53%; for overweight greater than or equal to 30% - 13.57%; for high blood pressure -8%; for the overall risk computed by multiple regression -33.8%.

[Lower limb lymphography where there is no lymph circulatory disorder. Normal conditions and their limits (author's transl)]. / La lymphographie des membres inférieurs en l'absence de troubles de la circulation lymphatique.

Further lymphangiography for the lymphatic system dependent on the internal saphenous vein carried out on 70 patients to establish a lymphographical record of the pelvi-abdominal ganglia, simplified the counting of opacified vessels, and assessment of the development of the vascular system and the fragility of the walls and their calibre and pathway. The various aspects were assessed in relation to the anatomical situation (leg, thigh), age group and sex of the patients. Computerised analysis of the information lead to the conclusion that, even under normal conditions, there are statistical differences in the number of opacified vessels in the legs and in vascular fragility of the pre-inguinal region according to age group. The authors discuss the implications of the limits of the normal appearance of the lymphatic vessels.

Coronary heart disease and its risk factors in a group of 5,000 middle aged men in urban environment.

The results obtained at entry in the subjects included in a pilot study (Institute of Internal Medicine, Bucharest) for the detection and prevention of coronary heart disease and hypertension, are presented. These data are the prevalences of the risk factors of coronary heart disease (high serum cholesterol, hypertension, smoking, overweight, diabetes, nonspecific minor ECG signs, family history), as well as the prevalences of the various forms of coronary heart disease. The study of the frequency distribution of biologic parameters likely to become risk factors showed that in middle aged subjects the upper limit of the normal should be lowered from the 95th percentile to the 76th one.