many cutaneous manifestations of systemic disease and the use of potentially toxic systemic therapies were felt to be the most important reasons for possessing this qualification.In 1993, following the General Medical Council's recommendations, 2 new undergraduate curricula were introduced in all U.K. medical schools. However, undergraduate exposure to dermatology at the time remained highly variable 1 and our findings suggest that this still appears to be the case. Over the past decade significant work has been undertaken by the British Association of University Teachers of Dermatology (BAUTOD) to address and improve the teaching of dermatology within medical curricula. 3 However, the fact that such a high proportion of those surveyed wished for more exposure at both undergraduate and postgraduate levels continues to place a degree of responsibility on all dermatologists to respond to such requirements.Despite the drastic changes to postgraduate medical education that have taken place in recent times, dermatology has maintained its position as a core component of the curriculum of general internal medicine. Whether the graduate practises in hospital medicine or primary care, we would argue that the teaching of dermatology remains important as previous studies have noted that at postgraduate level little attention is given to the skin even when relevant to the general medical condition of hospital inpatients 4 and up to 15% of GP consultations are specifically related to the skin. 5 The lack of confidence displayed by junior doctors in their ability to describe a rash is somewhat alarming given the possibility of our cohort encountering a dermatological case in their PACES examination and beyond this, in real life medical practice. The recent transition to competency-based graduate training may address this, as well as issues relating to the performance of routine bedside dermatological investigations.Although U.K. graduates comprised one-third of those surveyed, we feel the findings remain very relevant to U.K. dermatology teaching and practice. Overseas doctors made up 33% of U.K. senior house officer posts and 14% of preregistration house officer posts in 2003 6 and continue to give invaluable service commitment to the NHS while working in training grades. Indeed, in many district general hospitals more than two-thirds of junior doctors have trained overseas. 6 In conclusion, the findings from our survey highlight the importance of retaining dermatology teaching as a core component of the undergraduate medical curriculum. In addition the findings would seem to strengthen the case for ensuring that dermatology posts are part of the 2-year foundation programme as well as part of core medical training. Only through increased exposure to the specialty at both undergraduate and postgraduate level can we hope to see an improvement in junior doctors' basic dermatology skills. Furthermore, we believe that an increased understanding of the specialty (ultimately through increased exposure) remains the most effective...

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INTRODUÇÃOO tratamento convencional da doença de Crohn (DC) é muitas vezes desapontador. Apesar da variedade de drogas disponíveis para o seu tratamento, tais como: salicilatos e seus derivados, corticosteróides, antibióticos e imunossupressores, nenhuma destas mostrou ser totalmente eficaz ou definitiva para o tratamento da doença e seus surtos de exacerbação. As drogas biológicas foram desenvolvidas com o objetivo de serem mais específicas para esse tipo de tratamento.Sabe-se que o fator de necrose tumoral (TNF) alfa está elevado nas fezes, mucosa e sangue dos doentes com DC, e que o desequilíbrio entre secreção e sua inibição está relacionado com a patogênese da doença 13 . Neste contexto, algumas drogas foram desenvolvidas com a estratégia de bloqueá-lo e, demonstraram potente atividade clínica, confirmando o seu papel na patogênese da DC e no tratamento de doentes de difícil manejo clínico 5,15,17 .Entre os variados tipos de anti-TNF alfa que surgiram para o tratamento da DC podemos citar: infliximabe, adalimumabe, CDP870, CDP571, etanercept e ornecept 17 . O infliximabe é um anticorpo monoclonal IgG1 quimérico constituído de 75% de proteína humana e 25% de proteína de camundongo. A porção de camundongo contém o sítio de ligação para o fator de necrose tumoral (TNF) alfa, enquanto a porção humana é responsável pela função efetora. O infliximabe liga-se ao TNF alfa solúvel e TNF ligado à membrana bloqueando as atividades biológicas da citocina 2,3 .O presente estudo visa avaliar os resultados obtidos com o uso do infliximabe no tratamento dos doentes com DC e observar se houve diferença na resposta clínica entre os grupos de doentes que variaram quanto ao tempo de doença e tratamento cirúrgico prévio relacionado. MÉTODO

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