Metástasis ganglionar mesentérica de neoplasia neuroendocrina: una causa infrecuente de obstrucción de intestino delgado / Small bowel obstruction caused by lymph nodes of a neuroendocrine tumor: a clinical case report

Small intestine neuroendocrine tumors (NET-SI) are relatively rare neoplasms. If encountered, the most common location is the ileum. Symptoms are usually non-specific, delaying the tumors diagnosis. NET-SI are often small in size and can be challenging to recognize on imaging studies. However, they have a tendency to induce a pronounced fibrotic reaction in the mesentery, often accompanied by large calcified mesenteric adenopathies. In some cases, the fibrotic reaction can produce rare complications, such as intestinal obstruction or vascular congestion with occasional secondary ischemia. This case report presents a 79-year-old male with a partial small bowel obstruction caused by a fibrotic reaction and mesenteric adenopathies of a well-differentiated neuroendocrine tumor of the ileum. The patient also presented multiple peritoneal metastases at diagnosis. Characteristic imaging findings of the tumor, allowed an accurate and early diagnosis. Once the acute episode was resolved, the diagnosis was confirmed with an image guided biopsy.

Ocorrencia de quedas em idosos nao institucionalizados: revisao sistematica da literatura / Falls in the non-institutionalized elderly: a systematic literature review

Revisão sistemática da literatura com o objetivo de identificar a ocorrência de quedas de idosos residentes na comunidade. Utilizando o portal CAPES, realizou-se busca nas bases de dados Academic Search (EBSCO), SciELO e Science Direct (ELSEVIER); e uma busca adicional na base de dados Lecturas Educación Física y Deportes, do site EFDEPORTES. Foram encontrados, com os descritores utilizados, 247 artigos publicados no período de 2000 a 2011. Foram excluídos 230 que não atenderam a um ou mais dos critérios de inclusão. Incluíram-se no estudo 17 artigos, sendo 12 transversais, dois de coorte prospectiva, dois de pesquisa de base populacional e um de coorte retrospectiva. A amostra total envolvida nos estudos foi de 114.911 sujeitos, com média de idade de aproximadamente 70 anos, distribuídos em sete países: Brasil, Estados Unidos, Espanha, Itália, Nigéria, Turquia e China. A ocorrência de quedas variou de 15,9 a 56,3%, com mediana de 28,50%. Embora apresente variação, a ocorrência de quedas na população idosa que reside na comunidade é alta.

This systematic literature review aimed to identify the occurrence of falls in elderly living in the community. On CAPES website, a search was conducted on the following databases: Academic Search (EBSCO), SciELO, and Science Direct (ELSEVIER). An additional search, on the EFDEPORTES website, was performed on the Lecturas Educación Física y Deportes database. Using the chosen descriptors, 247 articles published from 2000 to 2011 were identified. A total of 230 articles were excluded as they did not meet all the inclusion criteria. Hence, 17 articles were included in the study, 12 of which were cross-sectional studies, two prospective studies, two population studies, and one retrospective study. The whole sample involved in the studies consisted of 114,911 subjects with an average age of 70 years, distributed across seven countries: Brazil, United States, Spain, Italy, Nigeria, Turkey and China. The occurrence of falls ranged between 15.9% and 56.3%, with a median of 28.50%. Although presenting variation, the occurrence of falls in elderly living in the community is still high.

Nevus flammeus adquirido iatrogénico / Acquired iatrogenic naevus flammeus

Presentamos un caso de nevus flammeus adquirido. La lesión apareció tras manipulación quirúrgica de la zona afectada. Creemos que el trauma quirúrgico podría haber originado algún tipo de daño en la inervación simpática de los vasos cutáneos superficiales llevando a ectasia vascular progresiva

Actinomicosis torácica / Thoracic actinomycosis

Se discute el caso de una paciente de 37 años con un infiltrado persistente del lóbulo inferior izquierdo. La enferma tenía una historia de 6 meses de tos seca, anemia moderada y VHS muy elevada. Todos los estudios bacteriológicos en los cuales se incluyó muestras obtenidas por fibrobroncoscopía y por punción pulmonar resultaron negativas. Además no se encontró evidencia de infección micótica ni de cáncer pulmonar. Se consideró posibilidad de un secuestro pulmonar, sin embargo la aortografía fue normal. Se efectuó una toracotomía exploradora. Los cirujanos encontraron una masa con aspecto tumoral que se extendía desde el lóbulo inferior izquierdo hasta la pared gástrica atravesando el diafragma. El examen histológico reveló la presencia de actinomices. La paciente presentó una muy buena respuesta luego de ser tratada con penicilina durante 6 meses. Actualmente está asintomática y su radiografía de tórax sólo revela una elevación de su diafragma izquierdo