[Behçet's disease - Infliximab in the treatment of mucocutaneous manifestations].

Behçet's disease (BD) is chronic, relapsing and multisystem inflammatory disorder, whose diagnosis is essentially clinical. In recent studies, the antagonists of tumor necrosis factor alpha have shown good results in the treatment of mucocutaneous manifestations of BD. The authors describe three cases of BD with serious mucocutaneous involvement treated with infliximab.

Characterizing performance profiles of ICUs.

Purpose Of Review: Benchmarking of the ICU was till last year based on the assumption that performance was independent of the severity of illness of the admitted patients. In the past years, this assumption has been challenged several times, but only last year a concrete method to evaluate the performance of individual ICUs through the calculation and visualization of risk profiles was proposed and experimentally tested in a cohort of 102 561 patients consecutively admitted to 77 ICUs in Austria, belonging to the Austrian Center of Documentation and Quality Assurance in Intensive Care Medicine.

Recent Findings: The demonstration, although using the New Simplified Acute Physiology Score (SAPS II), is independent of the specific general outcome prediction model used.

Characterizing the risk profiles of intensive care units.

Objective: To develop a new method to evaluate the performance of individual ICUs through the calculation and visualisation of risk profiles.

Methods: The study included 102,561 patients consecutively admitted to 77 ICUs in Austria. We customized the function which predicts hospital mortality (using SAPS II) for each ICU.

Autoimmune thyroiditis presenting as palmoplantar keratoderma.

Palmoplantar keratoderma is a heterogeneous group of hereditary and acquired disorders characterized by abnormal thickening of palms and soles. Hypothyroidism is an unusual cause of palmoplantar keratoderma, rarely reported in the literature. We report a case of a 43-year-old woman presented with a 3-month history of a diffuse palmoplantar hyperkeratosis unresponsive to topical keratolytics and corticosteroids.

[Mediastinal teratoma with malignant transformation of the somatic component. Clinical report].

Mediastinal germ cell tumours (M-GCT) are rare forms of neoplasms compared with other tumours of the same location. They are classified in seminomas, malignant non-seminomatous GCT and teratomas. The malignant transformation of the somatic component of the teratoma, with sarcomatous or carcinomatous degeneration, is even more uncommon.

[Churg-Strauss syndrome presenting with cutaneous vasculitis].

Churg-Strauss syndrome (CSS), also known as allergic granulomatous angiitis, is a rare disorder characterized by the presence of asthma, eosinophilia and small-to-medium sized vessels vasculitis. Vasculitis commonly affects lung, heart, skin and peripheral nerves. The authors report a case of a 47-year-old woman that was admitted with a 1-week history of painful purpuric lesions affecting extensor surfaces of lower extremities.

Merkel cell carcinoma: an unusual indication for isolated limb perfusion.

Isolated limb perfusion (ILP) is a surgical technique that enables the administration of high-dose chemotherapy while minimizing serious systemic side effects. The clinical value and indications are well established for skin and soft tissue tumors on limbs. For skin tumors, this technique is mainly indicated for melanoma with in-transit metastasis.

[Continuous sciatic nerve block].

Although perioperative pain is multifactorial, there are two main factors on which we can act upon: the central sensitization - using opioid analgesics - and the peripheral nociceptive stimulus - by means of a peripheral nerve block. The use of these techniques for anesthesia and post-operative analgesia is increasingly frequent in orthopaedic surgery because they provide excellent sensitive and motor block and offer advantages over other types of analgesia concerning pain relief and early mobilization in the post-operative period. We present a clinical case in which we made a continuous sciatic block (popliteal approach) in a fourteen years old girl with a Hyperactivivity Syndrome and Mental Re-tardation proposed for a club foot corrective surgery, allowing an effective perioperative analgesia with minimum side effects and a quick return to her familiar environment.

Incidence of sepsis in hospitalized patients.

In recent years, several epidemiological studies have helped expand our knowledge of the incidence of sepsis at the intensive care unit (ICU) and population levels. However, more data are needed from developing countries. Overall, even with a lack of standardized definitions--particularly of sepsis-associated organ dysfunction, hypoperfusion or hypotension, and septic-induced cardiovascular failure despite adequate fluid resuscitation--the incidence of sepsis seems higher in Brazil, the United Kingdom, and Portugal.

[Arachnoiditis ossificans].

Arachnoiditis ossificans is a uncommon disorder, is generally associated with neurologic deficits, but patients could be only mild sintomatic, regardless of the degree of ossification. Unenhanced CT has been well show to be sensitive for the disorder, useful to evaluate the full extenstion of the ossified mass and their remotion if surgical intervention is needed. On MRI imaging the manifestations could be minimal and variable, being important to access another pathologic conditions (arachnoid cysts, intramedullary cysts and syringomyelia).

[Prognostic value of the finding of blood/clots in the stomach at the emergency upper endoscopy].

Introduction: In the setting of upper endoscopy after upper gastrointestinal bleeding (UGIB), the presence of blood or clots in the gastric lumen precluding the complete mucosal examination is a frequent finding.

Aims: To define the prognostic value of this endoscopic finding and the need of a follow-up endoscopy.

Methods: Retrospective study of 100 consecutive patients with UGIB and the endoscopic finding of blood in the stomach (Group A) and 100 at the same conditions but without this endoscopic finding (Group B).

[Malignant peritoneal mesothelioma -- diagnostic and therapeutic difficulties].

Malignant Peritoneal Mesothelioma (MPM) is an uncommon tumour. Clinical presentation is indefinite and differential diagnosis with peritoneal carcinomatosis is difficult. It has a bad prognosis (survival of 6-12 months) due to the delay of the diagnosis and inefficacy of the conventional therapeutic.

New issues in severity scoring: interfacing the ICU and evaluating it.

Since the development of the first general outcome prediction models, these instruments have been widely used in the intensive care unit (ICU), both for patient evaluation and for ICU evaluation. Since some of these uses have been serious questioned, we assisted in the last years to the exploration of alternative paths for increasing the predictive power of the models and to enhance their applicability and utility in the real world. Part of these efforts focused on the exploration of more meaningful outcomes (clinical and non-clinical) with a strong tonic into the relation between outcomes and resources use.

[Favism].

Favism is an acute hemolytic syndrome occurring in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals after the consumption of fava beans. The authors report the clinical case of a 16 year-old boy admitted to hospital with an acute hemolytic episode after the ingestion of fava beans. Complementary studies revealed G6PD deficiency.

[Hemoperitoneum as the form of presentation of hepatocellular carcinoma. The contribution of computed tomography to the diagnosis].

Haemoperitoneum following rupture of hepatocellular carcinoma (HCC) is unusual. Two patients with secondary massive intraperitoneal haemorrhage due to spontaneous rupture of HCC diagnosed by Computed Tomography (TC) are discussed. The most important clinical and imagiological features of this pathology are presented.

[The Maffucci syndrome with axial bone lesions. A rare cause of low back pain].

The authors describe the case of a twenty-nine-year-old female with the diagnosis of Maffucci's syndrome, since the age of five, with lower back and lower limb pain. The diagnosis was made of bone axial lesions, which are seldom found in this syndrome. Sarcomatous transformation was found in one of them.

[Primary hyperaldosteronism: report of 2 clinical cases].

The authors report two cases of primary hyperaldosteronism (Conn's adenoma and hyperplasia). Based on available data, the authors discuss clinical laboratory and imagiologic evaluation, the factors influencing prognosis, strategy and the results of the proposed therapies.

Nursing staff in intensive care in Europe: the mismatch between planning and practice.

Objective: To test the use of a human resources-based classification of levels of care of ICUs; to evaluate the match between planned vs operative levels of care on a large sample of European ICUs.

Design: Analysis of the database of a multicentric, multinational, prospective cohort study, involving 89 ICUs from 13 European areas.

Setting: Database of EURICUS-I.

Evaluation of the uniformity of fit of general outcome prediction models.

Objective: To compare the performance of the New Simplified Acute Physiology Score (SAPS II) and the New Admission Mortality Probability Model (MPM II0) within relevant subgroups using formal statistical assessment (uniformity of fit).

Design: Analysis of the database of a multi-centre, multi-national and prospective cohort study, involving 89 ICUs from 12 European Countries.

Setting: Database of EURICUS-I.

Evaluation of two outcome prediction models on an independent database.

Objective: To evaluate the performance of the New Simplified Acute Physiology Score (SAPS II) and the admission Mortality Probability Model (MPM0) in a large independent database, using formal statistical assessment.

Design: Analysis of the database of a multicenter, multinational, prospective cohort study, EURICUS-I.

Setting: Eighty nine intensive care units (ICUs) from 13 European areas.

Validation of the simplified therapeutic intervention scoring system on an independent database.

Objective: To evaluate the performance of the Simplified Therapeutic Intervention Scoring System on an independent database and determine its relation with the Therapeutic Intervention Scoring System in the quantification of nursing workload in intensive care.

Design: Analysis of the database of a multicenter prospective Portuguese study.

Setting: 19 intensive care units (ICUs) in Portugal.

Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study.

Objective: To compare the performance of the New Simplified Acute Physiology Score (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE) II in an independent database, using formal statistical assessment.

Design: Analysis of the database of a multicentre, prospective study.

Setting: 19 intensive care units (ICUs) in Portugal.

[Fluorescent products in the crystalline lens of type ii diabetic patients].

A body of evidence suggests that glycation of proteins and the resulting fluorescent products take part in the late complications of diabetes. The purpose of this study was to analyse the fluorescence of lens soluble proteins from diabetic patients. Soluble proteins were obtained from lens with cataract from 20 type II diabetic patients and from 21 non diabetic controls with similar age.

[Limb amputations carried out in hospitals of the national health service in the years from 1990 to 1993].

This study was to assess the number of limbs amputations in Portugal State Hospitals over a four years period (1990 to 1993), analysing their incidence according to etiology, sex, average age, duration of hospitalization, level of amputation and mortality rate. The authors emphasise the levels of amputation which are mot favourable for an effective rehabilitation.