S38 Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112

After 1980 many governments applied restrictions to maintain a clearer atmosphere. Particulate matters are everywhere, they are inhaled, they enter the lungs, migrate through the blood stream and finally, they deposit in several organs which leads to severe consequences. Wind remains the only restraining factor of PM concentrations, but this is not the desired solution.Methods: The issue of atmospheric pollution and its influence on health are both the main aim of this study, which consists of monitoring and mapping the UFP (ultra fine particles) in six areas of Athens and examining the relation of the quantity inhaled by pedestrians and number of health incidents during an acute pollution episode in Athens in November 2008. In this empirical model, values of PM inhaled by humans at a height of two metres above ground are shown as number/ litre and g/m3.Results: In fact, a lot of patients appeared in the city’s hospital emergency centres needing assistance. Most of them exhibit the PM symptomatology which includes: dyspnea, dry cough, lacrimation, headache, arrhythmias. K.N.Grigoropoulos et al. 2008*.Conclusion: Although this situation is already widely known to everyone, governments continue to ignore it systematically. The time is probably right for the European Community to apply restrictions on PM1.*In this paper we present for first time worldwide, photos of PM, localized in side, in human cell.

GASTRIC PERFORATION INTO THE PERICARDIUM – CLINICAL CASE

Ana Maria Grilo1, Denise Pinto1, Margarida Lopes1, José Reina1, Paulo Jácome2, José Vaz3. 1Department of Internal Medicine I, ULSBA - José Joaquim Fernandes Hospital, Beja, Portugal; 2Department of Surgery, ULSBA - José Joaquim Fernandes Hospital, Beja, Portugal; 3Intensive Care Unit, ULSBA - José Joaquim Fernandes Hospital, Beja, Portugal

Background: Perforation is a rare complication of the gastric carcinoma (less than 1 % of all the cases of gastric neoplasia). It takes place normally in advanced stages, which does not contraindicate radical therapy.Methods and Results: The authors report a case of a 68-year-old male, with a partial gastrectomy (Billroth II) admitted to the hospital with epigastric pain. Endoscopy revealed a large perforated area at the gastric fundus, with a protruding and strongly pulsatile base, mobile and free in relation to the margins. Endoscopic findings suggested gastric perforation into the pericar-dium. At surgery, the gastric mucosa was invaded by neoplastic tissue, with the fundus adherent to the diaphragm, with invasion of the pericardium and protrusion of the cardiac tip into the gastric cavity. Total gastrectomy was car-ried out. After surgery the patient was transferred to the Intensive Care Unit, where he needed mechanical ventilation, renal replacement techniques and vasoactive amines, though with progressive worsening of the hemodynamic and respiratory status, and died.Conclusion: The perforation into the heart or pericardium is described as a rare complication in some cases of peptic ulcer. Cardiac involvement deter-mines the mode of presentation and clinical course. This clinical case is illus-trated by a rare endoscopic image which, although not useful as treatment, provided endoscopic findings suggesting a perforation into the pericardium and allowed the early diagnosis and guidance.

THE SELDOM-SEEN CASE OF SYNCHRONOUS BILATERAL SPORADIC RENAL CELL CARCINOMA

Pedro Guedes, Patrícia Gomes, António Figueiredo, Helena Sá Damásio, Ana Serrano, António Murinello. Internal Medicine 1 Unit, Hospital de Curry Cabral, Lisbon, Portugal

Background: Renal cell carcinoma (RCC) is by far the most frequent type of kidney cancer, but synchronous bilateral neoplasms are rare (1-4% of cases), even more so in sporadic RCC. An increasing number of tumours is being found spuriously while they are still small and yet to cause any symptoms, thus allowing less-invasive surgery with potentially brighter outcomes.Methods: The authors report a 49-year-old caucasian male with type 2 dia-betes, obese and heavy smoker. He presented to the Emergency Department with a one-week course of productive cough, worsening dyspnoea and anorexia. He denied fever or any pain, and showed no abdominal or urinary complaints whatsoever.Results: His physical exam was irrelevant apart from an enlarged liver. This prompted an abdominal ultrasound and a CT scan, both of which confirmed hepatomegaly while disclosing a right renal mass. Kidney function tests were

normal. Renal MRI ensued, revealing a solid tumour in each kidney. The renal biopsies diagnosed synchronous bilateral clear cell RCC and the patient underwent a successful total right nephrectomy with left tumorectomy. Four months on, his renal function remains normal and he is escaping the burden of dialysis.Conclusion: This case shows the seldom-seen coexistence of sporadic RCC in both kidneys. We stress the fact that the patients are frequently asympto-matic, which can delay the correct diagnosis and hinder treatment. Tumours found on an early stage can be dealt with using less drastic measures that spare nephrons and elude, or at least postpone, definitive haemodialysis.

CLINICAL PROFILE, ICU COURSE AND OUTCOME OF PATIENTS ADMITTED IN ICU WITH H1N1 INFECTION

Gina Guerreiro Mascarenhas1, Silvia Castro2, Maria Perez2, Maria Mel o2, Francisco Nunez2, Alexandre Baptista2, Arlindo Sousa2, Celso Estevens2, Rui Patraquim2. 1Internal Medicine Department -Hospital De Faro- Portugal; 2Intensive Care Unit - Hospital de Faro- Portugal

Aim: To assess the winter impact of severe cases of infection with H1N1 referred to ICU for mechanical ventilation on occupancy rates and on mortality.Methods: Patients admitted in the ICU between 15/12/2010 and 15/02/2011 with a diagnosis of H1N1 infection were studied to evaluate the mean length stay in ICU and the mortality rate. Characterization of the population studied consisted of; gender, age, co-morbidities and risk factors associated, severity of the disease on admission according to APACHE II score, any organ fail-ure (respiratory, cardiovascular, renal, neurologic); Progress during ICU stay: development of new organ failures, pneumothorax, myocardities symptoms, gastro-intestinal complications, nosocomial infection (suspected or con-firmed); treatment protocols implemented - antivirals (oseltamivir 1st line and zanamivir 2nd line), initial empirical AB and AF agents, steroids, curarization, alveolar recruitment techniques, ventral decubitus, thoracic drainage, para-centesis, broncho-fibroscopy, dialytic techniques and parenteral nutrition.Results: Eleven cases evaluated: 6 females and 5 males, mean age 41.9 years (range 19-66), mean length stay in ICU 15.1 days, 8 patients discharged from ICU (73%) and 3 deaths (27%) and. The APACHE score on admission ranged between 4 and 23. All 11 patients presented respiratory failure (ARDS in 6 patients), 8 patients developed cardio-circulatory failure, 2 patients convo-luted to pneumothorax, 5 patients had acute renal failure with the necessity of dialysis, 8 patients needed parenteral nutrition and 3 developed symptoms of myocardities. 7 patients had suspected nosocomial infection (bacterial and/or fungal infection) with one confirmed bacterial infection.Discussion: H1N1 infection leads to a high admission rate in ICU during winter what reflects in a bigger investment in human and technical resources. This type of patients justifies a strategy of action to develop an adequate antibio-therapeutical protocol due to the high rate of super infections. The protocol should include AB and AF antimicrobials according the local epide-miology and resistance profiles.The authors also stress the need to develop the IV formulations in current and future antiviral drugs.

CENTRAL CYANOSIS AND CHRONIC LIVER DISEASE – WHAT COULD IT BE?

Rodica Ioana Pavelescu, Mara Jidveian, Cosmin Diaconu, Roxana Dantes, Ioana Tudor, Adriana Gurghean, Dan Spataru, Ion Bruckner. Coltea Clinical Hospital Bucharest, Romania

Background: Up to 30% of the patients with chronic liver disease can develop hepatopulmonary syndrome characterized by portal hypertention, pulmo-nary vascular dilatation, and a defect in arterial oxygenation.Methods: A 56 year old pacient presented with asthenia, abdominal disten-sion and leg swelling. The symptoms progressed slowly over the last 3 weeks. He was diagnosed with hepatitis C in 2000 and cirrhosis in 2004. The patient has been complaining of dyspnoea on minimal effort, cyanosis and clubbing for 2 years. He does not smoke and drinks alcohol occasionally. His treatment includes hepatoprotective medication.On physical examination the pacient presents cyanosis, clubbing, spider angi-omata, leg swelling, abdominal distension with a small amount of ascites, hepatomegaly, tachicardia. Initial lab tests revealed normal haemoglobin with macrocytosis, thrombocytopenia, derranged LFT’s, positive anti-HCV antibodies, hypoxemia with orthodeoxia, partially corrected with oxygen, high A-a O2 gradient, normal spirometry.