Background: to provide a quality service is crucial to understand the need for change. A different approach of those procedures and results implies an involvement and a motivation of Health Care professionals. The performance of a Health Service is nowadays linked to the level of access and organization of the clinical information. In such context, a correct and complete documentation of the patient’s clinical data is essential for the practice of a quality Medical care, being the clinical record the basis of a hospital management and structure.Aim: the endpoint of this work was to compare 2004 and 2005 regarding the quality criteria of medical records, proposed with predefined variables, to determine the rate of achievement.Material and Methods: a descriptive and transverse observation study based on the medical record of each patient, referring to the year 2004 and to the year 2005. The predefined variables were the existence of a classic clinical history, the ward admission notice, the hospital discharge notice, the patient’s problems list, based on Weed’s method and the record of laboratorial analysis on a specific registration sheet. The reasons why the hospitalization was extended where also assessed not only measuring it but also identifying the causes of such delay. There were a total of 1031 (F554; M507) patients admitted in 2004 with a mean age was 70 years [15-103] and the average hospitalization period was 7,6 days [1-78]. In the year of 2005 there were a total of 1030 (F531; M499) patients admitted, with a mean age of 71 years [16-99] and the average hospitalization period was 8 days [1-101].Results: In both years, 2004 and 2005, the admission notice was recorded in 100% of patients, excluding the cases where the Clinical History was recorded. With exception of patients deceased and transferred to other services, the Discharge Notice was also complied with in 100% of cases. The classical clinical history was made in 213 patients (21%) in 2004 and in 87 patients (8.5%) in 2005. The laboratory analysis sheet and the Weed’s list were recorded in 866 (84%) and 847 patients (82%) in 2004 and in 898 (87%) and 863 patients (84%) in 2005, respectively. The extended hospitalization was verified in 11% and 9% of the patients (2004 and 2005), respectively; the social problems were the major causes in the first year and the clinical problems in the second.Conclusion: regarding the clinical record we consider very positive the results achieved. However it is a reason for concern the limited number of Clinical Histories recorded, as well as its reduction when compared to 2004. On the extended hospitalization on Medicine 1 ward, the clinical issues are as important as the social ones. We also find that the implementation of structured assessment forms impact the clinical practice promoting a higher standard quality

The involvement of extranodal sites is a common feature during the course of most non-Hodgkin lymphomas (NHL). However, some NHL emerge from different places other than the lymph nodes or spleen and are referred to as primary extranodal lymphoma (PE-NHL). The purpose of this study is to illustrate the clinicopathological features of patients presenting PE-NHL.Among 125 patients studied with NHL, 37 cases (30%) were PE-NHL. The ratio men/women was 1:1, with a mean age of 61 years old. There were 8 lymphomas (20%) of T-phenotype and 29 (80%) of B-phenotype. Skin and gastrointestinal tract were the most common sites, 32.4% and 29.7% respectively; 24% had B symptoms; 81% were localized (stage IE or IIE). Histologically (WHO classification), 3% of all cases had high aggressive features (Burkitt lymphoma), 68% aggressive and 29% indolent. Diffuse large B cell lymphoma (DLBCL) accounted for 51% and MALT lymphoma for 14% of all cases. According to International Prognostic Index (IPI), 7% of our patients were in the high risk group, 3% in the intermediate high, 20% in the intermediate low and 70% in the low risk group.In conclusion, PE-NHL is a heterogeneous group of diseases, most of them localized in the skin and gastrointestinal tract. We found a higher percentage of T phenotype cases than those for nodal NHL. DLBCL was the most frequent histological subtype lymphoma. IPI was predictive of survival, but its use is uncertain on PE-NHL, because it can not stratify patients homogeneously

Fahr’s Syndrome is a rare degenerative neurological disorder, which can be of hereditary or sporadic origin, characterized by the presence of abnormal calcium deposits and associated cell loss in certain areas of the brain, namely basal ganglia and cerebral cortex. Associated symptoms include progressive deterioration of cognitive abilities (dementia) and loss of acquired motor skills, speech impairment, seizures or headache.The authors present the Clinical Case of a 29 years old inpatient with a family history of hypocalcaemia, presenting a condition evolving for 5 days and characterized by prostration, refusing to eat, and generalized muscle stiffness, with progressive clinical impairment, associated to sudden aphasia secondary to hypocalcaemia. His study shows the existence of basal ganglia calcifications, and the conclusion this is a case of Fahr’s Syndrome

Clostridium difficile is a microbiological agent essentially nosocomial. In the last few years there have been important changes in its epidemiology. Nowadays Clostridium difficile associated disease is considered one of the most reported nosocomial diseases. There is also evidence of an increasing number of cases in the community, with data suggesting increasing pathogen’s aggressiveness.Antibiotics play a crucial role in the disease physiopathology. Clindamycin, cephalosporins and penicillins are the higher risk antibiotics, nevertheless, any antimicrobial agent can facilitate a Clostridium difficile infection.Given the theme relevance, the authors present a clinical report of a case of pseudomembranous colitis secondary to valaciclovir, a rare association according to literature.

Although rare, the association of Sweet’s syndrome and Crohn’s disease is established and considered an extra-intestinal manifestation of the disease.The authors describe a case of this neutrophilic dermatosis on a 65-year-old male with a background of ankylosing spondylitis and Crohn’s disease, under immunosuppressive therapy, who suddenly developed fever, arthralgias and widespread reddishpurple papular rash. Laboratory data revealed high inflammatory markers. No infectious cause was found. The biopsy of two skin lesions showed subepidermal edema and perivascular neutrophilic infiltrate with no signs of vasculitis. Both the symptoms and the rash gradually subsided about one week later, after initiation of ibuprofen alongside the continuation of immunosuppressive therapy. Clinical, laboratory and histological findings suggested the diagnosis of Sweet’s syndrome and extracutaneous manifestations were not found

Brucellosis is an endemic zoonosis in Portugal, progressing as a multisystemic disease with a broad spectrum of clinical manifestations, that can be caused by several species of Brucella, the most common being B. melitensis. Hematological abnormalities, including anemia, leukopenia and thrombocytopenia, may be found during the course of the disease.The authors describe the case of a 53 year-old man, native of Cape Verde and residing in Portugal for 25 years, with a condition of prolonged fever and had a dramatic evolution, with septic shock, severe thrombocytopenia and hemorrhagic dyscrasia. The disease was diagnosed as acute brucellosis, and confirmed through blood cultures. Despite the severity of the clinical situation, the prompt institution of hemodynamic support, blood transfusion, invasive ventilation and appropriate antibiotics led to a satisfactory clinical outcome. The diagnosis of brucellosis can be delayed, particularly when only less common manifestations are present. In this case it was our purpose to highlight the importance of maintaining a high degree of suspicion in order to correctly diagnose cases with less familiar clinical presentations

Atherosclerosis as a multi-systemic pathology affecting people all around the world, it is the main death cause in developed countries, through its acute clinical manifestations. The authors report a clinical case of a 52 year-old man, with a prior medical history of hypertension and dyslipidaemia, with a detected high blood pressure only in the right arm in a medical appointment. We studied the different vascular territories which are more frequently affected by the atherosclerotic disease, it was diagnosed left subclavian artery stenosis (related with the observed subclavian steal phenomenon), bilateral carotid occlusion, bilateral aorto-iliac lesions and left popliteal artery occlusion. The authors would like to emphasize the fact that despite the extension of the atherosclerotic disease, the patient had never had an acute vascular event, until now. They want also to emphasize the relevance of adequate and careful medical history and physical examination. That is why the internal medicine doctors must have a permanent alert attitude and consequently an active role in primary and secondary prevention of cardiovascular diseases.

Malignant mesothelioma is an invariable lethal neoplasia that arises from mesothelial cells from pleura, peritoneum, and pericardium or tunica vaginalis. It represents less than 1% of all tumors and its incidence is rising in the recent years. The typical clinical presentation is thoracic pain, dyspnea and recurrent pleural effusion. The authors present a clinical case of an 80 year-old man with a hydropneumothorax, which etiologic investigation culminated with the diagnosis of malignant mesothelioma.