Customization and external validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) in Brazilian critically ill patients.

Purpose: To customize and externally validate the recently proposed Simplified Mortality Score for the ICU (SMS-ICU, a simple score for 90-day mortality that has no need for ancillary testing results) for in-hospital mortality and to compare its performance to SAPS 3.

Material And Methods: We used data from two distinct large cohorts of adult Brazilian patients with unplanned ICU admissions to perform a first-level customization (43,017 patients admitted to 78 ICUs) of the original SMS-ICU score for in-hospital mortality and, sequentially, externally validate it (313,365 patients admitted to 99 ICUs). Performance of SMS-ICU was assessed through measurements of discrimination and calibration and compared with SAPS 3.

Endovascular management of acute large vessel occlusion stroke in pregnancy is safe and feasible.

Introduction: Stroke is a leading cause of adult death and disability. Although acute ischemic stroke (AIS) in pregnancy is rare, it has devastating consequences on the life of the mother and fetus. Pregnancy was an exclusion criterion in endovascular thrombectomy (EVT) trials and so there are no evidence-based treatment recommendations in this subgroup.

A Novel Analysis via Micro-CT Imaging Indicates That Chemically Modified Tetracycline-3 (CMT-3) Inhibits Tooth Relapse after Orthodontic Movement: A Pilot Experimental Study.

Objective: To evaluate the effect of chemically modified tetracycline-3 (CMT-3) and simvastatin on tooth relapse after orthodontic movement in rats using a novel analysis method employing high-resolution micro-CT (Micro-CT) images. In addition, the correlation between bone density and orthodontic relapse was also evaluated for each experimental group.

Methods: Forty adult male Wistar rats had stainless steel springs installed on their left upper first molars in order to generate tooth movement for 18 days.

An elderly man with gastric cancer, Saint's triad and Heyde's syndrome.

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers.

LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLEEN PRESERVATION.

Background: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome.

Aim: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team.

Association of frailty with short-term outcomes, organ support and resource use in critically ill patients.

Purpose: Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients' physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.

Outcomes of teachers away from work forvoicedisorders, State Secretariat of Education, Federal District, 2009-2010.

Background: Voice is an important working tool for teachers. These professionals are often forced to stay away from work due to voice disorders, resulting in high frequency of sick leaves, function restriction and professional readjustment.

Objective: Toevaluate the epidemiological profile of teacher absenteeism due to voice disorders and the impact of dysphonia on reduction of work activities, function restriction and professional readjustment.

CRITICAL EVALUATION OF LONG-TERM RESULTS OF MALIGNANT HEPATIC TUMORS TREATED BY MEANS CURATIVE LAPAROSCOPIC HEPATECTOMY.

Background: Laparoscopic hepatectomy has presented great importance for treating malignant hepatic lesions.

Aim: To evaluate its impact in relation to overall survival or disease free of the patients operated due different hepatic malignant tumors.

Methods: Thirty-four laparoscopic hepatectomies were performed in 31 patients with malignant neoplasm.

Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: successful conservative management of a rare condition.

A 69-year-old male patient, smoker, was diagnosed with small cell lung cancer metastatic to lung, liver and central nervous system. He received chemotherapy with carboplatin AUC 5 on day 1 and etoposide 100mg/m2 on days 1, 2 and 3. During the first cycle, the patient presented with febrile neutropenia and abdominal distension.

Differing Connectivity of Exner's Area for Numbers and Letters.

There is a growing body of evidence indicating a crucial role of Exner's area in (hand-) writing symbolic codes such as letters and words. However, a recent study reported a patient with a lesion affecting Broca's and Exner's area, who suffered from severe peripheral agraphia for letters but not for Arabic digits. The authors suggested a speculative account postulating differential connectivity of Exner's area for numbers and letters in order to explain this dissociation.

Effects of caloric restriction and low glycemic index diets associated with metformin on glucose metabolism and cortisol response in overweight/obese subjects: a case series study.

Background: To determine whether cortisol secretion and glucocorticoid receptors in lymphocytes and monocytes are altered in patients with impaired glucose tolerance, and whether treatment with a hypocaloric diet and metformin could interfere with these aspects.

Methods: This is an analytical, interventional, case series study. Patients with impaired glucose tolerance were included.

Churg-Strauss syndrome: a case report.

Churg-Strauss syndrome is a rare systemic disease primarily characterized by hypereosinophilia, asthma and vasculitis. The lung is the organ most frequently involved. In the present report, the authors describe a relatively rare finding in this disease - the presence of a pulmonary nodule -, while recalling the main radiological findings and the most relevant differential diagnoses.

Amelanotic metastatic cutaneous melanoma.

Dermatoscopy of melanocytic lesions has guided the decision of when or not to biopsy a lesion. The use of this tool has increased clinical examination's sensitivity and specificity in 89% and 96% respectively. However, dermatoscopic evaluation of amelanotic or hypomelanotic melanomas, as well as metastases, can be difficult.

Quality assessment of inhospital patients unable to speak who use alternative and extended communication.

Objective: To implement the use of alternative communication boards in patients hospitalized and unable to communicate by speech.

Methods: A descriptive study with a sample of 30 patients hospitalized and unable to communicate by speech. Boards were made with Boardmaker® Software that consists of a graphical database containing Pictorial Communication Symbols.

Imaging features of chronic expanding hematoma in the soft tissues of the hand simulating an aggressive lesion: case report.

A chronic expanding hematoma can persist and increase in volume for more than 1 month after the first hemorrhage. It is rare, uncommon in the hand, little known among physicians, and an imitator of malignancy. Our purpose was to report a case of this condition in the soft tissues of an 8-year-old girl's hand that simulated an aggressive lesion, and to conduct a review on this subject.

Chronic diploic hematoma mimicking malignancy on imaging.

We present a case of an expansile diploic lesion involving the parietal bones in a 45-year-old man. Computed tomography, magnetic resonance imaging, and digital subtraction angiography were performed. The imaging findings strongly suggested the diagnosis of a malignant neoplasm.

[Renal resistance index predicting outcome of renal revascularization for renovascular hypertension].

Background: Renal artery stenosis (RAS) is a potentially correctable cause of hypertension and ischemic nephropathy. Despite successful renal revascularization, not all patients (pt) overcome it and some get worse.

Objective: This study was designed to assess the value of renal resistance index (RI) in predicting the outcome of renal revascularization.

Year in review 2007: Critical Care--intensive care unit management.

With the development of new technologies and drugs, health care is becoming increasingly complex and expensive. Governments and health care providers around the world devote a large proportion of their budgets to maintaining quality of care. During 2007, Critical Care published several papers that highlight important aspects of critical care management, which can be subdivided into structure, processes and outcomes, including costs.