TO THE EDITOR:Thymomas and thymic carcinomas are rare, accounting for 20% of all mediastinal tumors. They are usually diagnosed as incidental findings on chest imaging performed for another reason or performed because of the presence of mass effect-related symptoms or paraneoplastic syndrome, such as myasthenia gravis. They have similar incidence in men and women and most commonly occur in the 40-to 60-year age group. There are no risk factors. (1,2) We would like to present the case of a 79-year-old female patient who presented to our facility with a two-month history of weight loss and constipation. She was admitted to the hospital with signs of intestinal obstruction, abdominal bloating, and vomiting. A nasogastric tube drained 3,000 mL of stool-like secretion. Abdominal X-ray and ultrasound revealed a dilated stomach with an air-fluid level ( Figures 1A and 1B). Upper gastrointestinal endoscopy revealed no points of mechanical obstruction; there was erosive reflux esophagitis, exuberant gastric dilatation associated with gastric stasis, and hypertrophic pyloric stenosis. Serology for Chagas disease was negative.The assessment continued with abdominal CT, which showed no evidence of any obstructive factor or tumor, and chest CT, which identified a well-demarcated anterior mediastinal mass with a maximum diameter of approximately 5 cm and no invasion of adjacent structures ( Figure 1C). Given the possibility of paraneoplastic syndrome, video-assisted thoracoscopic resection was performed, and pathological examination showed small cell neoplasm of uncertain malignant histogenesis and immunohistochemistry, confirming the diagnosis of type B1 thymoma.Following tumor resection, the patient experienced a lower frequency of vomiting and was able to tolerate the diet. Gastrography was performed which showed contrast progression and a normal-sized stomach with peristalsis ( Figure 1D). A second endoscopy revealed a normal stomach with strong peristaltic waves and no sign of previous hypertrophic pyloric stenosis. The patient was discharged on an oral diet. Serum antibody testing for myasthenia gravis and paraneoplastic syndrome was ordered.Gastroparesis consists of delayed gastric emptying of solids in the absence of mechanical obstruction. The A B C D Figure 1. In A and B, abdominal X-ray showing gastric bloating. In C, CT scan showing a well-demarcated anterior mediastinal tumor. In D, gastrography showing normal gastric emptying.

BackgroundHeadache is a common symptom that affects a significant portion of the general population. It constitutes a challenge for diagnosis in urgency and emergency care services, due to headache’s clinical variability and diverse possible etiologies, besides the limited time and resources of these facilities. Because of this insufficiency and the potential severity associated with the condition, headaches generate considerable expenditures to health systems, related to both diagnostic discrimination and treatment.ObjectiveEvaluating the diagnostic resources used on headache patients care, as well as its Public Health Relevanceand relation to cost in an Emergency and Urgency Care unit.MethodsCross-section study analyzing 450 medical records of patients with headache complaints in the time frame from January 1, 2019, and December 31, 2019. Patients were categorized according to the type of headache (primary and secondary), specialized evaluation, complementary exams used in the diagnosis, hospital observation time, and the final expenditure in each patient’s care.ResultsThe total estimated expenditures related to headache care equaled US$90,855.60 (average US$201.90 per patient). 38.9% of cases corresponded to primary headaches and 31.1% to secondary headaches. 30% of cases could not be classified. The resources utilized for secondary headaches diagnosis differed significantly from those used in primary headache diagnosis. However, the final expenditures were similar to both groups.ConclusionThe socio-economic impact caused by headaches is unquestionable. It is a highly frequent symptom and both its etiological distinction and adequate treatment require solid evaluation. Due to the resources spent in its evaluation and monitoring, headaches can be considered a public health problem. Therefore, this study suggests that resources should be allocated in the health education and professional training for the proper conduction of these patients, so that they may benefit from an optimized treatment of theircondition without overwhelming the health system.