IntroductionLipomas of the gastrointestinal tract are a rare condition. Only 5% are of gastric origin, and this corresponds to 2% to 3% of all benign tumors of the stomach and less than 1% of all gastric neoplasms. It is our purpose to report an unusual presentation of a giant gastric lipoma in an oligosymptomatic patient and highlight the importance of discussing differential diagnosis in this situation. A review of the literature has shown that this is one of the largest gastric lipomas described.Case presentationWe describe a rare case of a benign gastric tumor with uncommon features in a 63-year-old Caucasian woman. She was admitted with abdominal discomfort, nausea, and upper abdominal fullness after eating. The lesion was suspicious of malignancy because of its dimension and central contrast enhancement on computed tomography. Conventional upper digestive endoscopy revealed a large bulging mass in the gastric posterior wall and three ulcerated areas. In this procedure, a technical limitation due to the location of the mass in the submucosa prevented an adequate biopsy from being obtained. The fragments obtained from the ulcers revealed nothing but necrotic mucosa. Our patient underwent a subtotal gastrectomy and D1 lymphadenectomy with a Roux-en-Y reconstruction. Macroscopic findings revealed a 12 × 8 × 6cm mass with a volume of 576cm3, and the histological pattern demonstrated well-differentiated mature adipose tissue surrounded by a fibrous capsule, confirming the diagnosis of gastric submucosal lipoma.ConclusionsGastric lipoma is a rare benign disease that eventually simulates a malignant tumor.

RESUMOObjetivo: Avaliar a tendência secular da menarca de acordo com o índice de massa corporal (IMC). Sujeitos e métodos: Seiscentos e oitenta e cinco meninas (7-18 anos) ABSTRACTObjective: To evaluate the secular trend of menarche according to body mass index (BMI). Subjects and methods: Six hundred and eighty five girls (7-18 years) assessed in 2001 were compared with 750 evaluated in 2010. They were grouped by BMI Z-score: (thin + normal) and (overweight + obese). Menarche was reported by status quo and age at menarche estimated by a logit model. We used the Qui-square test, Mann-Whitney test, and Logistic Regression, at a 5% significance level. Results: Menarche advanced 3.24 months. There was an increase in obesity, and a decrease of the prevalence of normal girls. Menarche was anticipated by 1.44 month in the thin + normal group and by 5.76 months in the overweight + obese group. There was no interaction between the effects determined by the evaluated period and nutritional diagnosis. Conclusions: Although both the period and BMI influence the menarche, one cannot attribute this advance only to changes in the nutritional profile of the sample. Other factors that were not tested may also contribute to this finding. INTRODUÇÃO A menarca corresponde a um evento tardio da puberdade e é importante indicador da maturação sexual. A tendência à antecipação da idade em que ela ocorre, observada por décadas nos países desenvolvidos, sempre foi relacionada à melhora das condições de vida e saúde da população, particularmente do acesso aos alimentos (1-3).

BackgroundEsophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice.AimTo demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation.MethodsA retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon.ResultsEarly postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes.ConclusionsDespite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures.

Body composition did not change significantly, although overweight increased.

Objectives: To evaluate the efficacy of oral colistin-neomycin in preventing multidrug-resistant Enterobacterales (MDR-E) infections in solid organ transplant (SOT) recipients. Methods: Multicentre, open-label, parallel-group, controlled trial with balanced (1:1) randomization in five transplant units. SOT recipients were screened for MDR-E intestinal colonization (extended-spec-

(n¼1925). Mean levels of aggression, anger and fear were analysed by gender and alcohol involvement. Multinomial models estimated associations of drinking patterns with aggression to and from the respondent. Results The response rate was 49%. Men and women reported similar prevalence of victimisation and perpetration of aggression (11%e15%). Alcohol was involved in more than a quarter of incidents, and reported more often by women than men, particularly male-only drinking when the respondent was victimised. Women reported more severity, anger and fear accompanying victimisation than men, and these scores differed significantly by involvement of alcohol. Heavy episodic drinking by respondents was associated with a threefold increase in victimisation involving alcohol, and doubling of perpetration of aggression involving alcohol. Conclusion In a cross-section of households, "counts" of aggressive acts do not reflect the reality of gender differences. The frequency of heavy drinking episodes is associated with the occurrence of aggression involving alcohol within relationships, and the involvement of alcohol in an incident of aggression is associated with increased severity, fear and anger particularly for women. Objective To examine the association between socioeconomic status (SES) and eight selected surgical outcomes after hysterectomy and asses the role of lifestyle, co-morbidity and clinical conditions on the relationship. Methods All 22 150 women registered with a benign elective hysterectomy code in the national Danish Hysterectomy Database (DHD) from 2004 to 2008 were included in the study. Data from DHD were linked to several central registers providing information on education, employment, income, lifestyle factors, co-morbidities and surgical outcome. Data were analysed using multilevel logistic regression models. Results Overall 17% of the women experienced a clinical complication in relation to hysterectomy. Four per cent were re-operated, 6% readmitted and 6% experienced prolonged hospitalisation $5 days. Women with short education had a higher risk of complications than women with higher education after adjusting for patient characteristics (OR¼1.15, 95% CI 1.02 to 1.31). They also had a higher risk of peroperative bleeding after adjusting for lifestyle factors and comorbidity (OR¼1.60, CI 1.15 to 2.22). Furthermore, a higher risk of infection and readmission was observed however, these relations seemed fully explained by lifestyle factors and co-morbidity. Women out of employment had a higher risk of infection, organ lesion, prolonged hospitalisation and readmission than women in employment. We found no association between income and surgical outcome after hysterectomy. Conclusion This study suggests that women with low SES have a significant worse surgical outcome after hysterectomy than women with high SES when differences in lifestyle factors and co-morbidity are taking into account. Introduction Although already of high prevalence, overweight and obesity are still increasing in many parts of the...