Ileal neuroendocrine tumor: diagnosis by endoscopic capsule / Tumor neuroendocrino ileal: diagnóstico por cápsula endoscópica

The diagnosis of neuroendocrine tumors of the small intestine is usually challenging. They are infrequent, and the clinical course is insidious with nonspecific manifestations. Routine endoscopic and abdominal imaging studies are more often unremarkable. Therefore, distant metastases are frequently detected at the time of diagnosis. The tumor markers chromogranin A, synaptophysin, and neuron-specific enolase, and capsule endoscopy, and device-assisted enteroscopy are useful resources to establish a diagnosis. The aim was to present a case of neuroendocrine tumor of small intestine diagnosed with base in findings of the capsule endoscopy and further open surgery.

El diagnóstico de tumores neuroendocrinos del intestino delgado suele ser un desafío. Son infrecuentes y el curso clínico es insidioso con manifestaciones inespecíficas. Los estudios de imágenes endoscópicos y abdominales de rutina suelen ser anodinos. Por tanto, las metástasis a distancia se detectancon frecuencia en el momento del diagnóstico. Los marcadores tumorales cromogranina A, sinaptofi-sina y enolasa neuronal específica, y la cápsula endoscópica y la enteroscopía asistida por dispositivo son recursos útiles para establecer un diagnóstico. El objetivo de este trabajo fue presentar un caso de tumor neuroendocrino de intestino delgado diagnosticado con base en hallazgos de la cápsula endoscópica y de una nueva cirugía abierta.

[Miliary tuberculosis: the role of necropsy studies].

This case study of generalized miliary tuberculosis in a Brazilian man without AIDS is reported in order to emphasize the role of histopathological study for diagnosis. We comment on a recent Indian study involving 40 cases of surgical and necropsy specimens in which the diagnosis of tuberculosis was made, as well as a previous Brazilian case report. The authors believe that non-specialists should be better informed about the possibility of miliary tuberculosis, which involves clinical diagnostic challenges. Despite limitations, minimally invasive necropsy may be an alternative to elucidate causes of death in low-income countries.

Comments on Saint's triad.

Yamanaka et al. described two case studies involving coexistent cholelithiasis, hiatal hernia, and umbilical hernias, and discussed clinical similarities with the classical features of the Saint's triad. Cholelithiasis, hiatal hernia, and colonic diverticulosis characterize the classical triad, but some authors have included any type of hernia due to herniosis-a developmental disorder of the extracellular matrix. The main features of this triad, which seem to be underdiagnosed and/or underreported, are discussed. Therefore, the commented manuscript contributed to better understanding the scarcely reported condition.

Weil's syndrome.

A case of leptospirosis in an 18-year-old white male was reported. Weil's syndrome was characterized by intense jaundice, acute renal failure, skin ecchymoses and conjunctival suffusion, in addition to meningitis. The polymerase chain reaction for Leptospira was negative, while the titers of the antibody microagglutination test against L. grippotyphosa rose higher than fourfold (up to 1:1,600) in the same blood sample. Patient's treatment consisted of rehydration and supportive care of acute renal failure, besides antibiotic therapy. Penicillin administration started after 6 days of disease. Patient improved without clinical sequelae.