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In high cardiovascular risk hypertensive individuals with type 2 diabetes, ED is highly prevalent as expected, but its presence is associated with neither echocardiographic variables, nor other cardiovascular risk factors.

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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.

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.

Since the sample size was small, the study was inconclusive and the results should be considered preliminary data of a study that needs to enroll 1626 patients to show a 0.5 mIU/L difference in TSH between the groups, with 90% power.

Intracardiac metastases of thyroid carcinoma are a rare event. Their incidence is low in large autopsy series, and antemortem diagnosis is even less common. We present the case of a woman with advanced poorly differentiated thyroid carcinoma who had extensive intracardiac metastases. This case highlights the usefulness of echocardiography and magnetic resonance imaging in the diagnosis and differential diagnosis of cardiac metastases.

The use of ABPM beyond the traditional cardiovascular risk stratification tools has limitations, but is still useful in high-risk patients. Longitudinal studies could better evaluate the role of the use of ABPM in this scenario. Cut-off points for normality of office and ABPM influence the prevalences of WCH and MUH.