[A survey of the perception of COPD by physicians (I)]. / Sondaj asupra perceptiei BPOC de catre medici (I).

Observing the great importance of COPD nowadays, the authors aimed to check the doctors' opinions concerning this matter. 300 questionnaires including 53 questions were mailed to doctors in the whole country. 103 filled-in questionnaires (34.34%) were recovered from 36 pulmonologists (PNF), 24 internal medicine specialists (Int) and 43 general practitioners (Gen). One could sometimes note important differences between the answers depending upon the specialty. Thus, the quality of the COPD assistance is considered unsatisfactory by many PNF. All doctors consider COPD as a concerning problem. The diagnosis is always established using clinical criteria (cough, dyspnea). There are differences between the doctors in using the X-ray and the lung function tests as diagnosis criteria, due to accessibility to these tests, but also to the interpretation. COPD may often be mixed up with other obstructive diseases, especially asthma, and many doctors include also the obstructive post-TB syndromes in COPD. All the doctors, no matter the specialty, consider themselves capable of diagnosis COPD. Despite the scarce participation to the questionnaire (due to lack of courage or of interest), the questionnaire can make up an image of the concern of the Romanian doctors for the COPD medical assistance, making also the consequences of the limited access to the newest informations.

[A survey of recommended measures in COPD (II)]. / Sondaj asupra masurilor preconizate în BPOC (II).

The authors aimed to test the doctors' opinion-general practitioners (Gen), internal medicine specialists (Int) and pulmonologists (PNF) about the therapeutic approach in COPD. 300 questionnaires including 53 questions were mailed; 103 filled-in questionnaires were recovered (33.34%). Most of the doctors consider necessary the initial diagnosis in hospital. The Gen send the patients mostly to the Int and less to the PNF. Most doctors accept that the treatment should be started in pulmonology clinics. All the doctors prescribe teophillins; the beta-agonists are prescribed twice as much by the PNF than Int, and very little by Gen. The oral corticosteroids are used by half of the doctors; the inhaled corticoids are prescribed seldom and only by PNF. The i.v. corticoids are used by half of Int. All the doctors recommend smoking cessation. Only the PNF drag the attention upon the bacterial infections. The kinesitherapy is seldom recommended, even by PNF.

[Research on the occurrence of functional anomalies of the peripheral bronchi (small bronchi disease) in workers in a factory with respiratory noxious substances]. / Cercetari asupra frecventei anomaliilor functionale în bronhiile periferice (boala bronhiilor mici) la muncitorii dintr-o întreprindere cu noxe respiratorii.

A group of 908 subjects has been studied, of which two-thirds were males, classified in 5 categories: unexposed, with light exposure, and severely exposed to inhalation of volatile substances, or various types of dust. A B.M.R.C. file was filled for each of the subjects. This file concerns respiratory symptoms. A forced expirogram was also performed, and FEV 25-75%, FEV 75-85%, and TEM were determined. The two expiratory flows (median and final) are frequently disturbed in subjects without respiratory symptoms, more frequently in smokers with a normal FEV 1. In those exposed to respiratory risk the proportion of alterations increases, but association of smoking with inhalation of noxious chemical substances will determine a modification of FEW 1 and anomalies of the peripheral bronchi occur more frequently in smokers. Between the criteria suggesting the presence of small airways disease, the ratio FEV 25-75% under 60%, with a FEV 1/FVC ratio within normal limits, this being the most sensitive of the criteria, also appears as the most reliable.

[Long-term study of the evolution of chronic bronchitis detected by questionnaire 10 years earlier]. / Studiu longitudinal asupra evolutici bronsitelor cronice, depistate prin chestionar cu 10 ani anterior.

The longitudinal study carried out in a group of inhabitants from Craiova showed that 16,2% of these, classified according to previously filled questionnaires as suffering from chronic bronchitis, and 10,7% of those classified as suffering from minor forms of bronchitis (sporadic symptoms) had died, and one third of them were not found when the investigation was repeated. Re-examination of 106 adults with chronic bronchitis showed that the symptoms had disappeared in two-thirds of them, especially in those who gave up smoking; in 19,8% of them the symptoms had become more severe due to repeated attacks. Bronchial obstruction was present in 36% of the cases, and alterations in the small bronchial ducts were present in two-thirds of the patients. In 18-24% of the patients with minor forms of bronchitis the symptoms were more severe and chronic, and they can be classified as chronically ill patients. Frequently there were altered spirographic values. This study demonstrates that chronic bronchitis may evolve to: a) remission of the symptomatology (especially after suppression of smoking); b) more or less unmodified persistence of symptoms; c) increased severity of the symptoms following repeated acute attacks. Almost 25% of cases with sporadic coughing and expectoration became chronically ill over a period of 10 years. The questionnaire was demonstrated as having retrospective value for making a diagnosis of chronic bronchitis, but cough and expectoration are not sufficient for a differential assessment of the evolution, the spirographic data being of decisive importance.

[Clinical and epidemiological significance of isolated cultures of Koch bacillus after conclusion of chemotherapy]. / [Cercetari asupra semnificatiei clinice si epidemiologice a culturilor izolate de b.K. ulterioare încheierii chimioterapiei.

In a group of 33 patients from the Gorj, Dolj and Mehedinti Districts positive cultures of Koch bacilli were found after various intervals following the end of chemotherapy. These positive cultures were found after negative cultures were obtained repeatedly during the usual bacteriological monitoring. The "isolated" positive culture was obtained after an interval of 11,7 +/- 8,1 months after the end of the treatment. The average number of colonies in each tube was of 3,8 +/- 3, in most of the cases (63%) there were 1--2 colonies in each tube, and in only 27% there were more than 4 colonies per tube. The development of the germs was slow and the colonies were noted 32 +/- 14 days after seeding in the Löwenstein medium. All the cases have been followed, bacteriologically as well as radiologically on the average for 16 +/- 10,9 months. Chemotherapy was not taken up again in this period. In 2 cases a new positive culture was found, and these patients were considered to have recidives, and were treated again. Of the 26 contacts under the age of 20 years 5 remained uninfected at the end of the cure and did not display allergy during the period of surveillance. None of the allergic contacts developed the disease. It is concluded that after a correct therapy the development of positive cultures during bacteriological surveillance, especially if only few colonies are noted, does not means that there is a recidive, making mandatory the sustained repetition of the bacteriological investigation without taking up again the chemotherapy.

[Strictly supervised antitubercular chemotherapy in district and plant medical dispensaries in the city of Craiova]. / Chimioterapia antituberculoasa strict supravegheata in dispensarele medicale teritoriale si de întreprindere din municipiul Craiova.

The mode of administration of chemotherapy is evaluated, in conditions of integration, and under strict supervision, in tuberculosis patients in 12 medical dispensaries and in 6 enterprise dispensaries from Craiova over a period of one year. A total of 88,54 +/- 17,99 per cent of the number of programmed doses was administered in the territorial medical dispensary, as compared with 81,9 +/- 21,3 per cent in the tuberculosis dispensary. In enterprise dispensaries 97,69 +/- 16,17 per cent of the doses was given effectively, as compared with 78,17 +/- 29,39 per cent of doses given to the same patients in the tuberculosis dispensary. During the sick-leave 92,14 +/- 9,19 per cent of the doses were given, in the medical territorial dispensary as against 86,98 +/- 17,58 per cent in the tuberculosis dispensary. The difference is not significant. After reinsertion 77,53 +/- 24,84 per cent of the programmed doses were administered in the tuberculosis dispensary, 88,2 +/- 19,84 per cent in the territorial medical dispensary and 97,12 +/- 5,66 per cent in the enterprise dispensary. The differences were not significant. The authors conclude that administration of anti-tuberculosis chemotherapy can be perfectly well carried out in integrated conditions in the urban environment, especially in interprise medical units, after reinsertion. The phtysiologist should make a periodical survey in these units in view of securing a strict administration of the treatment regimens.

[Current incidence and clinical significance of non-culturable bacilli or those culturable with difficulty]. / Frecventa actuala si semnificatia clinica a bacililor greu cultivabili sau necultivabili.

An analysis of 246 patients with positive smear present bacilli and negative cultures revealed that in only 9% of the cases no organized previous treatment had been applied, although almost half of these had benefited from short courses with streptomycin associated with penicillin before an exact diagnosis of tuberculosis had been made. Since the remaining 91% had had 1--2 months of chemotherapy, which frequently included rifampicin, the authors stress that microscopically detectable germs are frequently incapable to develop on culture media. These are frequently non-viable bacteria and in such conditions no subsequent modifications of the currently applied therapy scheme should be attempted. The authors show that only 26,2% of the germs from 519 positive cultures have developed after 21 days from the seeding. At 30 days the overall proportion increased to 71,2% while at 45 days 22,7% more positive cultures appeared and an additional 6,1% cultures became positive at 60 days. Tubercle bacilli become increasingly demanding and slower growing. If at 21 days only one colony was evident in 6% of the cases, while an infinite number of colonies were present in 58% of the cultures at 60 days a single colony was found in 42% of the cases, in contrast with only 9% cases with an infinite number of colonies (P less than 0,001). The delay in the growth of bacilli was parallel with the duration of chemotherapy. The results are compared with data from the literature.