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The purpose of this paper is to diagnose the patients with ocular sicca syndrome in major collagenosis, to evaluate the clinical and histopathological lesions, related to stage of the disease and to establish significant correlations between the different clinical tests for qualitative and quantitative determination of lacrimal tear and the severity of ocular disorders. Dry eye disease is a very common disorder of tear film in collagen diseases. The gender ratio is 6/1 female/man. The most severe dry eye symptoms are also presented at women. The diagnostic and the treatment of dry eye rest difficult because of lack of accepted diagnostic criteria and lack of standardized, specific diagnostic tests. The results of this study have revealed that the ophthalmologic examination is necessary to all the patients with collagenosis who present ocular symptoms. The ophthalmological exam will contain qualitative and quantitative tests of lacrimal evaluation and a methodic biomicroscopic examination of corneo-conjunctival surface without and with vital staining. Rheumatoid arthritis is the collagen diseases which most frequently associates ocular sicca syndrome in mild and medium clinical forms.

We studied 60 patients with collagen-vascular diseases with pulmonary manifestations (SLE-25; SSc-13; mixed connective tissue disease-12; RA-6; PD-DM-3; ankylosing spondylitis-1), 54 females and 6 males, mean age 42.4 +/- 9.9 years. We measured lung volumes (total lung capacity-TLC) by spirography (Flowscreen Jaeger) and body plethysmography (Bodyplethismograph Jaeger); compliance of the lungs (CL) and elastic recoil pressures at 100%, 80% and 70% TLC (PL,el 100%, 80%, 70% TLC) by the esophageal catheter method; diffusing capacity of the lungs by the single-breath method (DL,COSB) (Alveo-Diffusionstest Jaeger). DL,CO was diminished in 45 (75%) of cases. 11 patients (18.3%) had an increased elastic recoil, equally distributed between mild and severe decrease of DL,CO. Statistical significant correlations were found between TLC-DL,CO (r = 0.63; p0.001) and TL-CL (r = 0.49; p0.001). No correlations were found between DL,CO and PL,el 100, 80, 70% TLC. The results are expressed as percent of predicted value (% pred.). The mean values and standard deviation (X +/- sd) were calculated.I) DL,CO is the most frequent altered pulmonary function test in collagen-vascular diseases with pulmonary manifestations; it seems to be a sensible parameter for diagnosing these diseases. 2) The alteration of DL,CO,CL and PL,el appears to be rather as a result of "shrinking lungs" due to respiratory muscle involvement than to an interstitial lung disease. 3) Elastic recoil pressures and compliance should be considered as routine pulmonary function test, important for the evaluation of treatment and prognosis.

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 Iaşi. 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.

After 30 years since the synthesis of cyclophosphamide and 25 years since its first clinical utilization (V.Ciobanu), authors offer an actualized review of the data of pharmacokinetics, pharmacodynamics, pathopharmacology and clinical therapeutics, which make of cyclophosphamide an efficacious, manageable and safe drug in the treatment of the aggressive forms of collagenoses or inflammatory rheumatism. The criteria of therapeutic indication and clinical surveillance are mentioned.