Osteoblastic Lesions as the First Presentation of a Gastric Mixed-Type Adenocarcinoma: A Case Report.

Bone metastasis might be associated with several tumors; however, the association between gastric malignant neoplasms and bone secondary lesions is very rare, with the osteoblastic form having the rarest presentation. In fact, osteoblastic lesions, as the first presentation of gastric adenocarcinomas, are even rarer and known to have a very poor prognosis associated with them. Therefore, we present a clinical case of a patient with lower back pain as the first symptom, which led to the diagnosis of osteoblastic lesions of the spine and iliac bones, suggested as secondary lesions. Later, the investigation of the primary tumor led to the diagnosis of a gastric adenocarcinoma (stage IV disease). In this report, we highlight the steps taken for the etiological study course and the challenges associated with them from the beginning. We also emphasize the very unfavorable evolution of our patient, with the inability to carry out targeted treatment, neither curative nor palliative, due to the advanced stage of the disease and the very poor survival time associated with it.

Lymphoepithelioma-Like Gastric Carcinoma and Gastric Involvement of Chronic Lymphocytic Leukemia: Two Rare Identities Coexisting in One Patient.

Lymphoepithelioma-like gastric carcinoma (LELGC) constitutes 1-4% of all gastric carcinomas and gastrointestinal involvement in leukemia can be present in up to 25%, being more common in acute than chronic leukemia, affecting most frequently the stomach, ileum, and proximal colon. LELGC is usually associated with a better prognosis than other gastric carcinomas, generally presenting with low T and N stages. The reports of chronic lymphocytic leukemia (CLL) involving infiltration of the gastrointestinal tract are relatively rare in the literature, and the estimated incidence ranges from 5.7% to 25%. We present the case of a 77-year-old female, on surveillance by a known CLL that was diagnosed with gastric carcinoma on an esophagogastroduodenoscopy (EGD) performed for epigastric pain. A subtotal gastrectomy was performed and the surgical specimen revealed simultaneous involvement of the stomach by LELGC and CLL. To the best of our knowledge, this is the first reported case of a LELGC and CLL simultaneously involving the stomach.

A possible role for oxidation stress in lymphoid leukaemias and therapeutic failure.

The aim of this study was to evaluate the role of oxidative stress in the pathobiology of lymphoid leukaemias and its involvement in leukaemic relapse. For this purpose the generation of peroxides by mononuclear cells, the erythrocyte activity of superoxide-dismutase (SOD) and glutathione peroxidase (GL-PX), and the plasma levels of reduced glutathione (GSH) and vitamin E (VIT E) were determined in 52 patients with two different types of lymphoid leukaemias, chronic lymphocytic leukaemia (CLL) and acute lymphoblastic leukaemia (ALL), 36 prior to chemotherapy and 16 treated patients. A decrease in SOD and GL-PX activities was observed in ALL patients prior to therapy, while a decrease in GSH and VIT E plasma levels was observed in untreated CLL, as compared to age-matched controls. An increase in peroxides formation occurred in both types of leukaemia, as compared to age-matched controls. There are significant differences for GSH, VIT E and peroxides generation between the different types of leukaemias. In relapsed ALL patients a decrease in peroxides generation was observed which may be due to the increase of the non-enzymatic defences GSH and VIT E. These data suggest the involvement of oxidative stress in acute and chronic lymphoid leukaemias and leukaemic relapse.

Perfil epidemiológico e genotípico da infecção pelo vírus da hepatite B no Norte de Portugal / Perfil epidemiológico y genotípico de la infección por el virus de la hepatitis B en el Norte de Portugal / Epidemiological and genotypic profile of hepatitis B virus infection in Northern Portugal

OBJECTIVO: Descrever o perfil epidemiológico e genotípico da infecção crônica pelo vírus da hepatite B na Região Norte de Portugal. MÉTODOS: Foram incluídos 358 indivíduos oriundos das consultas de especialidade que apresentavam resultados positivos para o antígeno da hepatite B durante pelo menos seis meses em dois hospitais do Norte de Portugal em 2008 e 2009. Os dados foram obtidos a partir dos processos clínicos, determinações laboratoriais feitas quando da genotipagem do vírus, ecografia e/ou ultra-sonografia e biópsia hepática. As características demográficas, marcadores víricos, carga viral e genótipos, e severidade da doença hepática foram avaliadas e comparadas entre sexos. RESULTADOS: Os genótipos A e D predominaram. A transmissão intrafamiliar ocorreu predominantemente nas mulheres. Um terço das mulheres apresentava ingestão alcoólica superior a 20 g/dia, aumentando para 58,9 por cento nos homens. A ausência do AgHBe foi semelhante nos dois sexos (p = 0,662). Os parâmetros bioquímicos em geral apresentaram-se com valores mais altos nos homens, assim como nos estágios necro-inflamatório e de esteatose hepática (p = 0,003). CONCLUSÕES: As diferenças relativas às vias de transmissão da infecção pelo vírus da hepatite B entre homens e mulheres podem ser conseqüência de comportamentos de risco associadas ao género. A ingestão excessiva de álcool é predominante nos indivíduos do sexo masculino, assim como maior severidade da doença hepática em relação às mulheres.

OBJETIVO: Describir el perfil epidemiológico y genotípico de la infección crónica por el virus de la hepatitis B en la Región Norte de Portugal. MÉTODOS: Se incluyeron 358 individuos oriundos de las consultas de especialidad que presentaban resultados positivos para el antígeno de la hepatitis B durante por lo menos seis meses en dos hospitales del Norte de Portugal en 2008 y 2009. Los datos fueron obtenidos a partir de los procesos clínicos, determinaciones laboratoriales hechas a partir del genotipaje del virus, ecografía y/o ultrasonografía y biopsia hepática. Las características demográficas, marcadores virales, carga viral y genotipos, y severidad de la enfermedad hepática fueron evaluados y comparados entre sexos. RESULTADOS: Los genotipos A y D predominaron. La transmisión intrafamiliar ocurrió predominantemente en las mujeres. Un tercio de las mujeres presentaba ingestión alcohólica superior a 20g/día, aumentando para 58,9% en los hombres. La ausencia del AgHBe fue semejante en los dos sexos (p=0,662). Los parámetros bioquímicos en general se presentaron con valores más altos en los hombres, así como en las fases necro-inflamatoria y de esteatosis hepática (p=0,003). CONCLUSIONES: Las diferencias relativas a las vías de transmisión de la infección por el virus de la hepatitis B entre hombres y mujeres poden ser consecuencias de comportamientos de riego asociada al género. La ingestión de alcohol excesiva es predominante en los individuos del sexo masculino, así como mayor severidad de la enfermedad hepática con relación a las mujeres.

Epidemiological and genotypic profile of hepatitis B virus infection in Northern Portugal.

OBJECTIVE: To describe the epidemiological and genotypic profile of chronic hepatitis B infection in Northern Portugal. METHODS: This survey comprised 358 subjects with positive serology for hepatitis B antigen for at least six months, recruited from specialist appointments in two hospitals in Northern Portugal between 2008 and 2009. Data were obtained from patient files, laboratory tests performed at the time of viral genotyping, echograms and/or ultrasonogram results, and liver biopsies. Demographic characteristics, viral markers, viral load and genotype, and severity of liver disease were evaluated and compared between sexes. RESULTS: Genotypes A and D were predominant in both sexes. Intrafamilial transmission occurred mostly among female patients. One-third of females and 58,9% of males showed alcohol intake above 20 g/day. Absence of AgHBe was similar in both sexes (p = 0.662). Elevated biochemical parameters and presence of necroinflammatory activity and steatosis in liver biopsies were more frequent among male patients (p=0.003). CONCLUSIONS: Differences in terms of route of HBV infection between men and women may be a consequence of gender-associated risk behaviors. Excessive alcohol intake is more frequent among males than females, as is more severe liver disease.

Alcohol consumption among patients with hepatitis B infection in northern Portugal considering gender and hepatitis B virus genotype differences.

Alcohol abuse is an important public health problem. In Portugal with a population of 10 millions of inhabitants, there are around 10% of alcoholics or excessive alcohol drinkers and 1% of chronically infected patients with hepatitis B virus (HBV). To examine the characteristics of patients with higher levels of alcohol consumption and to investigate the association between alcohol consumption and liver damage a total of 298 chronically infected individuals, with HBV genotyped and submitted to liver biopsy, were classified with Child's grading and separated by habits of alcohol intake, less and greater than 20g/day. No significant differences were observed about genotype but genotypes A and D were predominant in both of them. A higher percentage of males (P<.001) were observed in the group with alcohol intake above 20g/day, as well a lower proportion of patients with HBeAg negativity (P< or =.035). In this group, biochemistry parameters, such as alanine aminotransferase (P=.006), aspartate aminotransferase (P=.001), gamma-glutamyl transferase (P<.001) were elevated in a significantly higher proportion than in the other group. The analysis of hematological parameters showed significantly lower values of platelets (P=.042) and mean corpuscular volume (P<.001) and significantly higher values of prothrombin time (P<.001) in the group with higher levels of alcohol consumption. The characteristics of biopsy (P<.001) and Child-Phug's classification (P=.002) revealed more severe results in this group. Logistic regression showed a positive association between liver damage and alcohol intake, increasing with age. In female patients, a strong positive association between alcohol intake and liver damage was also found (odds ratio: 9.379; 95% confidence interval: 0.859-468.422; P = .037); however, the most severe cases were only observed in women older than 45 years. In patients with HBV infection, alcohol is associated with a more severe liver disease. No evidence was found concerning association with HBV genotype.

Epidemiological study of genotypes of hepatitis B virus in northern Portugal.

While the overall prevalence of hepatitis B virus (HBV) infection in Portugal is around 1%, there are no published studies examining HBV genotypes in this country. This study aimed to survey HBV genotypes in the northern Portugal and to examine the possible associations between genotypes and gender, viral transmission routes, viral markers, viral load, and biochemical tests of liver function. The study sample consists of 340 patients with HBV infection of whom 42.9% were women. Tests were carried out for HBV genotypes and biochemical liver function while demographic information, including alcohol intake, was obtained from the patient files. The results indicate the predominance of genotype D (60.3%) and genotype A (31.5%). Intrafamilial transmission was predominant in female patients, while males were infected in equal proportions by perinatal, sexual, and intrafamilial transmission. Absence of HBeAg was found in a significantly smaller proportion of female patients with genotype D as compared to A (56.6% vs. 82.1%, P = 0.028). High viral load was associated significantly and independently with genotype D and HBeAg. Both alanine and aspartate aminotransferases (ALT and AST) were associated with gender and HBeAg. Thus, genotypes A and D were found to be the most prevalent in the north of Portugal. Patients infected with genotype D had higher levels of HBV DNA. HBeAg was associated with genotype D, viral load, and ALT and AST.

Unexpected chromosomal alterations in Tayassu tajacu (Artiodactyla: Tayassuidae) in captivity

Os animais silvestres têm sido utilizados como bioindicadores quando o ambiente é exposto a estressores químicos. Em geral, os agentes químicos podem induzir às alterações cromossômicas dos tipos falhas e quebras. Tayassu tajacu, é uma espécie aparentada dos porcos verdadeiro e apresenta uma grande estabilidade cariotípica. As únicas alterações descritas são em relação a forma do cromossomo X. Foram observadas falhas e quebras cromossômicas durante as análise citogenética. Estas alterações foram detectadas em cromossomos autossômicos. Levantamentos realizados na literatura associados as dados observados nos exemplares estudados, indicam um vermífugo, a base de ivermectina, como o possível causador dessas alterações cromossômicas.