A Rare Case of Metastatic Adenocarcinoma of Stomach Metastasizing into Metachronous Gist of Small Intestine.

Gastrointestinal stromal tumours (GIST) are rare mesenchymal neoplasms in the gastrointestinal tract. The metachronous existence of GIST and gastric adenocarcinoma, though are tumours of distinct histotype, and very rare, have been reported in medical case reports in recent years. We report a case of a 74 year old man who initially presented with moderately differentiated adenocarcinoma of the stomach, underwent Billroth 2 gastrectomy followed by chemotherapy. Subsequently, after 15 months he developed a GIST of small bowel with metastasis from adenocarcinoma of stomach. Taking into consideration the fact that metachronous occurrence of GIST of the gastrointestinal tract and adenocarcinoma of stomach is rare and further metastasis of one tumour into the other makes this case a rare one as per available literature.

Atendimento extra-hospitalar do paciente politraumatizado. / Extra-hostalar care of the patient with multiple injuries

Os autores tecem comentarios a respeito da necessidade de uma sistematizacao no atendimento extra-hospitalar do politraumatizado e, em particular, do traumatizado de torax e do abdome. Enfantizam a necessidade de um melhor treinamento para todos aqueles que se propoem a esse tipo de atendimento, alem das melhorias das ambulancias no tocante a seus recursos terapeuticos disponiveis.Chamam tambem atencao quanto a importancia da comunicacao, em tadas as fases do atendimento, do medico com o setor de emergencia