[The possibilities for improving the serological diagnosis of active tuberculosis by using new mycobacterial antigens and immunoblot and ELISA technics]. / Studiu asupra posibilitatilor de perfectionare a diagnosticului serologic al tuberculozei active prin utilizarea unor noi antigene micobacteriene si a tehnicilor imunoblot si ELISA.

The study concerns 264 cases among which: 119 active lung tb. eliminating and 11 cases not-eliminating M. Tuberculosis; 17 cases of extrarespiratory tb. confirmed by bacteriology and/or by anatomopathology; 18 cases of bone-joint non-tb disease; 38 cases of chronic lung disease other than tb; 61 healthy persons (controls). Sera from these cases were collected before treatment and submitted concomitantly to two different methods: (1) Mycodot test (immunoblot) with lipoarabinomannan (LAM) as antigen, on nitrocellulose discs (Dynagen, Cambridge, MA, USA); (2) ELISA test with antigen 60 (A60) (ANDA-Biologicals, Strasbourg, France) and with antigen I.C. (Cantacuzino Institute, Bucharest). The results were estimated on terms of sensitivity and specificity. As for sensitivity the results show 74-90%. the highest values were reached in ELISA with A60 IgA. The specificity of the Mycodot test was highest: 90-100% in the two successive experiments. The active tb diagnosis discrimination capacity of the studied methods allows the following classification: 1. Mycodot test with LAM antigen 2. ELISA with A60-Ig G complex 3. ELISA with I.C. antigen The Mycodot test is more advantageous being more rapid and more simple to perform.

[The possibilities of improving the serological diagnosis of active tuberculosis by using the technics of immunofluorescence and ELISA]. / Posibilitati de perfectionare a diagnosticului serologic al tuberculozei active prin aplicarea technicilor de imunofluorescenta si ELISA.

A group of 188 adult subjects has been studied as follows: 119 cases of pulmonary tb confirmed by smear and/or culture; 44 cases with other chronic lung diseases; 25 healthy persons. The following serological tests have been performed: immunofluorescence indirect test (FA) using mycobacterial total antigen; ELISA test using two antigens: PPD and a freeze dried crude sonicated extract from H37Rv strain (antigen "Prague"). The results show: sensitivity 77% for FA and 71% for ELISA; specificity 81% for FA and 86% for ELISA. If all positive results (to one or both tests) are being considered the sensitivity increases to 81% but specificity decreases to 77%. The ELISA test with both antigens succeeds in a good discrimination between lung active tb on one side and lung non-tb cases and healthy persons on the other side (p < 0.001). Using comparatively the two antigens in ELISA test a higher serological confirmation of active tb is reached with "Prague" antigen: 72.7% vs 62.8% with PPD (p < 0.025).

[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.

[Preliminary results of the use of a new derivative of rifamycin SV in the treatment of sarcoidosis]. / Rezultate preliminare privind utilizarea unui nou derivat de rifamicina SV in tratamentul sarcoidozei.

Seven patients with advanced forms of mediastino-pulmonary sarcoidosis (involvement of the pulmonary parenchyma, and restrictive respiratory syndrome), confirmed by histopathologic investigation, have been treated with a new SV-rifamycin derivative, 1246-EH, or "Reprimum" without any other association. Reprimun was given in daily doses of 10 mg/kg of body weight for a period of two weeks, then, for another 4-5 weeks, the drugs was given intermittently in doses of 15 mg/kg of body weight twice weekly. Between two cycles of therapy a period of 14 days was free of drug administration. In all patients the treatment with the new derivative was well tolerated. The treatment was not followed by adrenal deficiencies, neither was noted obesity, bone decalcification, gastric ulcers, etc., which are commonly associated with prolonged corticoid therapy. The treatment with "Reprimun" efficient for all patients. A clear clinical and X-ray improvement was noted after the first three months of treatment with the new drug. Respiratory function, as well as clinical and radiological signs improved, the serum immunologic parameters, and the biochemical ones were also significantly improved (Ig, C3 total serum proteins and gammaglobulins). All parameters which were tested were finally improved and became normal. In only two of the seven patients the radiological aspects of the lung suggested the presence of sequellae at the end of the treatment. In these two patients there was a persistant reduction in the respiratory volume, as well as a discret hypoxemia. However, both these patients had a more advanced form of the disease, with extensive pulmonary fibrosis, and in these cases prolonged corticoid therapy which had previously been applied had failed. Reprimun had an immunological-modulatory effect in all patients, resulting in normal levels of IgG, IgA, and C3 in the first three months of therapy. There was a direct correlation between the normalization of immunological indicators and the good evolution of the diseases, a fact which suggests once again the existence of some immune mechanisms involved in the maintenance of sarcoidosis.

[Immunological aspects of adverse reactions during treatment with rifampicin]. / Aspecte imunologice ale reactiilor adverse în cursul tratamentului cu rifampicina.

It has already been established that during the treatment with rifampicin severe adverse reactions may occur, especially mediated by immune mechanisms. The most severe are those followed by renal failure. This type of reactions usually occur in patients that have undergone previous long treatments with the drug (RMP), given intermittently, twice a week, who, after an intermission, take up again the treatment with rifampicin. The symptoms occur after the administration of the first dose of the second course. Three cases are presented in the paper, of renal failure that developed after a new course of rifampicin was started. In spite of the treatment applied, which included hemodialysis, two of the patients died. In all three the indirect Coombs test was positive for anti -- RMP antibodies, and the histopathologic investigation revealed extensive lesions, including necrosis, of the renal tubules. Diagnostic, prognostic, pathogenic and therapeutic aspects of the cases are discussed.

[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.