[A metastatic muscle mass as the first manifestation of renal-cell cancer. A case report and review of the literature]. / Masa muscular metastásica como primera manifestación de un cáncer de células renales. Presentación de un caso y revisión de la literatura.

Although metastasis is relatively frequent in renal cell carcinoma (affecting mainly the lungs, lymphatic glands and bones), location of metastasis in muscles is extremely rare as in other oncological processes. The literature only offers isolated cases of renal cell carcinoma with metastasis in muscles, and no preferred muscular site is found in these cases nor is there any clear intrinsic relation to prognosis, having been described both at the onset an upon relapse of the oncological process. The intimate mechanism behind this infrequent metastatic site is unknown even today but it presents a series of specific and peculiar factors such as vascular flow, metabolism and oxygen tissue pressure which can negatively condition this process. We present the case of a 60-year-old patient who began with a mass in the triceps muscle. A biopsy confirmed its metastatic nature and indicated an asymptomatic renal cell carcinoma. Further complementary examinations showed metastasis in other muscle groups.

[Purulent meningitis in the elderly. Incidence in our area]. / Meningitis purulenta en el anciano. Incidencia en nuestro medio.

A retrospective study in patients over 65 years old with acute bacterial meningitis admitted to the internal medicine department of the "Hospital Provincial de Zamora" over the last 25 years, is presented. 43 cases (26.87%) over 65 years old were found, out of 160 cases admitted with ABM during this period. This high prevalence is partially explained because of the large elderly population in this area. The frequent atypical clinical features than can result in the diagnosis being confused with neurological pathology such as CVA (which is common at this age) is noteworthy. The most frequent etiology was meningococos (41.86%), followed by pneumococos (4.6%) and E. Coli (4.6%). We highlight the good prognosis of ABM in the elderly, early diagnosis and the right therapy necessary to achieve it.