Complications involving the central nervous system in patients suffering from hepatitis C virus (HCV) infection have been rare. Among them, it appears the transverse myelitis, which has already been reported in likely association with HCV. This paper presents the case study of a 65-year-old woman who developed cervical transverse myelitis linked to chronic HCV infection and anti-HCV antibodies in the spinal fluid, being excluded other etiologies for transverse myelitis. Current evidence has reinforced the likely association between chronic HCV infection and transverse myelitis, especially as recurrent manifestations of the disease. These findings reveal the need for more searching to establish the causal relationship between transverse myelitis and hepatitis C. Key-Words: Central Nervous System, HCV infection, transverse myelitis. The World Health Organization estimates that infection by the hepatitis C virus (HCV) affects around 3% of the world population [1], being one of the main causes of the chronic hepatic disease. In HCV-positive patients, extra-hepatic symptoms are reported in up to 74% of the cases, 10% to 15% of which regarding the neurological changes, mainly in the peripheral nervous system, and in this context associated to the cryoglobulinaemia. Manifestations observed in the central nervous system (CNS) include chronic forms of encephalopathy, epilepsy, normal pressure hydrocephaly, ischemic encephalovascular syndrome, Ekbom syndrome, and encephalomyelitis [2][3][4][5].Transverse myelitis (TM) is a demyelinating disease of the spinal cord. The disease is characterized by the emergence of acute or sub acute signs and symptoms of motor, neurological, and autonomic dysfunction related to the nervous tracts of the spinal cord [6]. TM often occurs due to inflammatory and infectious processes, rheumatologic, neoplastic, iatrogenic, demyelinating, compressive, actinic as well as idioapthic diseases [7,8]. TM associated to HCV infection has recently been reported, and although the causal mechanism has not been fully established yet, it is hypothesized that the virus may act directly in the development of TM, or lead to immune-mediated injury.This paper is a case study of a patient who suffered from cervico-dorsal spinal cord myelitis, In association with updated literature, this study case adds evidence about the association between HCV and TM. Case ReportThe patient was a nulliparous, non-smoker 65-year-old caucasian woman previously alcoholic but abstemious for eight years, with obesity degree 3, hypertension, diabetes mellitus type II, and with a metallic mitral valve for nine months. The patient was from the central region of the state of Rio Grande do Sul, Brazil, and had been taking warfarin, metphormin, glibenclamide, hydrochlothiazide, metoprolol, enalipril, and furosemide at the time of hospital admission.On admission, complaints reported by the patient included strong and progressive thoracolumbar pain for 30 days, which evolved with the loss of strength and sensitivity in lower limbs five days ...

-Background -Worldwide, gastric cancer is the fourth cancer in incidence and the second most common cause of cancer death. Gastric cancer is asymptomatic in the early stages and very often diagnosed at advanced stages, determining a dismal prognosis. Expression of the HER2 gene has been identified in about 20% of gastric cancer cases, and its hyper-expression is associated with poor prognosis. Objective -To investigate HER2 immunohistochemical expression in gastric adenocarcinoma and its relationship to the histological type and anatomic location. Methods -A cross-sectional retrospective study analyzed the immunohistochemical expression of HER2 in a sample of 48 specimens of gastric cancer. Immunohistochemical analysis were performed using avidin-biotin-peroxidase method with C-erb B2 (clone EP1045Y), as a primary antibody (Biocare Medical, USA). Standardized gastric adenocarcinoma's HER2 expression criteria has been used in the analysis of samples. Results -There were seven cases with reactivity for HER2. Five were of intestinal-type while two cases were of mixed-type in which the expression occurred in the intestinal component. It was identified a significant association of HER2 expression in the intestinal subtype of gastric adenocarcinoma (P=0.003).Regarding the anatomical site, HER2 was positive in only one (16.6%) of the six proximal cases and six (14.28%) of the 42 distal cases (P=0.88). Conclusion -HER2 immunoexpression was identified in 14.6% of the samples, and the expression was significantly associated to Lauren's intestinal subtype. HEADINGS -Immunohistochemistry. Stomach neoplasms. erbB-2 genes.

-Background -Peptic ulcer etiology has been changing because of H. pylori decline. Objective -To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. Conclusions -After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased.There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer. HEADINGS -Peptic ulcer. Helicobacter pylori. Non-steroidal anti-inflammatory agents. Stomach ulcer. Duodenal ulcer.

A 74-year-old white male who was a retired farmer, a nonsmoker and a former drinker presented with a one-year history of chest pain in the suprasternal notch, accompanied by edema and local erythema. His condition had worsened two weeks prior, aggravated by drainage of purulent material from a fistulous lesion. In addition, he reported evening fever, night sweats and weight loss (25 kg) in the last 12 months. The patient was under outpatient follow-up treatment in various sectors of the Santa Maria University Hospital, due to multiple comorbidities: systemic arterial hypertension; heart failure; mitral valve disease; pulmonary arterial hypertension; hypothyroidism; chronic renal failure; nonspecific colitis; and benign prostatic hyperplasia. He was being treated with furosemide, simvastatin, omeprazole, levothy- IntroductionThe extrapulmonary form of TB involving the sternum is quite rare. The most significant risk factor for the disease is open heart surgery.(1) Other risk factors include intravenous drug abuse, blunt thoracic trauma, closed cardiopulmonary resuscitation, subclavian vein catheterization, diabetes mellitus, HIV infection, alcoholism and BCG vaccination.(1) Sternal TB usually affects young adults living in areas where TB is endemic. Since the advent of modern antituberculous therapy, the number of cases of sternal TB has dramatically decreased, there having been fewer than 20 cases reported in the literature since that time.(2) We report the case of a male patient without active pulmonary disease who was under follow-up treatment at a clinical medicine outpatient clinic when he developed sternal TB. Sternal osteomyelitis caused by AbstractWe report the case of a 74-year-old male patient with a one-year history of chest pain in the suprasternal notch associated with erythema, edema and drainage of purulent material from a fistulous lesion. The patient was HIV-negative with no history of TB. A CT scan of the chest showed an osteolytic lesion in the sternum, and a biopsy revealed caseous granuloma, which, in the microbiological evaluation, was negative for fungi and acid-fast bacilli.The diagnosis of sternal osteomyelitis caused by Mycobacterium tuberculosis was confirmed using PCR.

-Background -The diagnosis of H. pylori infection can be performed by non-invasive and invasive methods.The identification through a fecal antigen test is a non-invasive, simple, and relatively inexpensive test. ) and negative predictive value 73,2% (CI95% 67.5-77.6); Positive likelihood ratio was 4.7 (CI95% 2.9-7.9) and Negative Likelihood Ratio 0.4 (CI95% 0.3-0.5). The prevalence odds ratio for a positive test was 12.3 (CI95% 5.7-26.3). The index kappa between FAT and histology/urease test was 0.53 (CI95% 0.39-0.64). Conclusion -Immunochromatographic FAT is less expensive than the other methods and readily accepted by the patients but its diagnostic performance does not recommend its use in the primary diagnosis, when the patient may have an active infection.

A neurofibromatose tipo 1 (NF1), também conhecida como doença de von Recklinghausen, é uma doença autossômica dominante com alto grau de variabilidade da expressão clínica, comumente envolvida na formação de tumorações na maioria das vezes de origem benigna, localizadas principalmente na região da cabeça e do pescoço, sendo a tireóide acometida raramente. Porém existe na literatura a associação com carcinoma medular da tireóide (CMT), necessitando sempre sua exclusão. Relatamos o caso de uma paciente com NF1, com um nódulo de tireóide não-funcionante e sintomas obstrutivos. Foi realizada ressecção cirúrgica da lesão, com achados histopatológicos compatíveis com neurofibroma em tecido tireoidiano. A importância desse caso deve-se não só à raridade dessa apresentação da NF1, mas também à possibilidade de associação desta com CMT, tumor agressivo com possibilidade de cura pela ressecção cirúrgica. The neurofibromatosis type 1 (NF1), also known as von Recklinghausen's disease, is an autosomal dominant disorder, with high degree of variability of clinical expression, usually involved with formation of tumors, with benign origin in the majority of cases mainly localized in the region of the head and neck and rarely incident in the thyroid area. However, the association with medullary carcinoma of the thyroid (MCT) exists in literature and needs to be excluded. We report a case of a patient with NF1, nonfunctional thyroid nodule and obstructive symptoms. Surgical resection of lesion was performed, with histopathologic findings compatible with neurofibroma in thyroid tissue. This case is relevant not only because of the rarity of the presentation of NF1, but also due to the likely association with MCT, an aggressive tumor that can be cured by surgery.

GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

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