Resumo O diagnóstico da síndrome compartimental em regiões que não são frequentemente afetadas, por possuírem uma boa relação continente-conteúdo, pode se tornar difícil, uma vez que o cirurgião terá dificuldades em alcançar um diagnóstico apenas por um sinal ou sintoma isolado. Assim, muitas vezes, pode-se protelar a conduta adequada, desencadeando danos ao paciente. A paciente era uma mulher, de 29 anos, que foi atendida com dor em mão esquerda por queimadura, com lesão em região anterior à tabaqueira anatômica de tamanho significativo. A paciente já havia sido submetida a cirurgia na sua cidade de origem com desbridamento de pele e tecido subcutâneo há 30 dias, com evolução sem melhora do quadro doloroso. Estava em uso de antibioticoterapia (ceftriaxona 1 g de 12 em 12 horas) e analgesia com dose terapêutica de morfina de 8 em 8 horas.

BACKGROUND: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases. AIMS: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes. METHODS: Two surgical procedures were scheduled. In the first procedure, body-caudal pancreatectomy with splenectomy was performed, associated with the resection of three lesions of the liver's left lobe. A right hepatectomy was performed 6 months later, progressing without complications. RESULTS: The patient continues without clinical complaints on the last return, and abdominal magnetic resonance performed 28 months after the second procedure does not show liver or abdominal cavity lesions. CONCLUSIONS: The knowledge on the biological behavior of tumors, evolution, and recurrence risks allows the indication of more rational surgical techniques that best benefit patients.

This study aimed to evaluate the association between muscle mass and vulnerability in institutionalized older adults. A cross-sectional study was carried out in eight philanthropic Long-Term Care Facilities (LTCF) located in the metropolitan area of Natal, Rio Grande do Norte, Brazil. The participants were individuals aged 60 years or older who were present in the institutions at the time of data collection. To assess muscle mass, the calf circumference was categorized into loss of muscle mass (<31 cm) and preserved muscle mass (≥31 cm). The vulnerability was assessed by The Vulnerable Elders Survey (VES-13). Of the 250 older adults evaluated, 46.1% presented loss of muscle mass, which was associated with the presence of physical limitation, vulnerability, and age group (p < 0.05). The presence of vulnerability was the main factor contributing to loss of muscle mass (R2 = 8.8%; B = 0.781; 95% CI 0.690–0.884; p < 0.001). Loss of muscle mass is associated with disability in institutionalized older adults.

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Context: Brain venous thrombosis (BVT) is uncommon and usually has a different clinic and treatment from cerebral arterial thrombosis. In this context, COVID-19 correlates with thrombogenesis with varied clinical repercussions. This report describes an unusual BVT case as a possible late complication of COVID-19. Case report: Male, 68 years old, athlete and healthy. April/2020: COVID-19 mild symptoms. February/2021: in road-running, he fell due to sudden left hemiparesis. Upon hospital admission: contacting, persistent headache. A week after, low level of consciousness and coma, when underwent right hemicraniectomy. Remains hospitalized. On examination: weak gestural communication, tracheostomy, enteral tube feeding, voluntary blinking. Maintains neutral cervical posture, masticatory automatisms, photoreactive isocoria, generalized rigidity, decorticated right hemiparesis, left hemiplegia. On imaging: hemorrhagic infarction on the right and mass effect due to obstruction of the Basal Rosenthal and Labbé veins and transverse sinus on the right, with venous blood flow in the rest of the hemisphere diverted to the ipsilateral internal jugular vein, by anastomotic veins of the occipital foramen and suboccipital venous plexus. Obstructed left internal jugular vein, with venous collateral flow from the left hemisphere via posterior intercavernous sinus and basilar plexus to the right internal jugular vein. Conclusions: To diagnose the venous etiology that resembled segmental occlusion of the right middle cerebral artery, CT angiography was required. Late evolution of COVID-19 has been identified by the persistence of symptoms for months. Although physical activity and possible dehydration may have contributed to BVT, a prothrombotic state correlated to COVID-19 cannot be discarded.