Case Report of a Rare Adrenocortical Oncocytoma Suspected to be an Adrenal Carcinoma.

An adrenal oncocytic neoplasm is an extremely rare tumour arising from the adrenal gland and it should be considered in the differential diagnosis of an adrenal incidentaloma, since it is frequently non-functioning. The suspicion for malignancy is high when an adrenal incidentaloma is >4 cm in size; however, adrenal oncocytomas are large, measuring an average of 8 cm, are round and encapsulated, and normally have a benign behaviour. We present a case of a 55-year-old male patient with dyslipidaemia, medicated with simvastatin. Upon complaints of abdominal pain, the general physician asked for an abdominal ultrasound that revealed an adrenal lesion, further characterized with a computed tomography scan, which showed an adrenal lesion measuring 49 × 64 × 56 mm and a calcification focus. The patient was referred to the general surgery and endocrinology department. The analytical study was negative for pheochromocytoma or Cushing's syndrome, which allowed surgery to be conducted, as is recommended. The aim of this case report is to contribute to the knowledge on adrenal oncocytomas, since there is scarce information based on singular experiences.

Screening for Hereditary Pheochromocytoma in a Patient with Neurofibromatosis Type 1: A Case Report.

Pheochromocytoma (PHEO) is a rare tumour that arises from adreno-medullary chromaffin cells and secretes catecholamines. These hormones are also secreted by paragangliomas, which derive from extra-adrenal cells of the sympathetic paravertebral ganglia. At least one-third of PHEOs are familial. Neurofibromatosis type 1 (NF1), or von Recklinghausen's disease, is diagnosed upon clinical criteria, and the study of PHEO is advised if hypertension is present. The incidence of PHEO in NF1 is 0.1-5.7% and explains hypertension in 20-50% of these patients. Recent advances in the treatment of this condition and preoperative preparation allow us to reduce its high cardiovascular morbimortality. Here we present the case of a 31-year-old female with known NF1 who presented with 5 months' history of non-specific symptoms and an episode of intraoperative hypertensive crisis. The workup detected a left sided PHEO, which was treated surgically. Our case illustrates the high prevalence of hereditary PHEO and how its presentation can go unnoticed. It reinforces the significance of screening for PHEO in patients with NF1.

Doctor, How Much Weight Will I Lose?-a New Individualized Predictive Model for Weight Loss.

Bariatric surgery is an effective treatment for weight loss, but the patient's ability to reach a sustained weight loss depends upon several technical and individual factors. Creating an easy model that adapts bariatric surgery's weight loss goals for each patient is very important for pre-surgery and follow-up evaluations.

Oral glutamine dipeptide prevents against prolonged hypoglycemia induced by Detemir insulin in rats.

The role of glutamine dipeptide (GDP) to prevent against prolonged insulin induced hypoglycemia (IIH) in overnight fasted rats was investigated. The glycemia was measured 0, 2, 4, 8, and 10 h after an intraperitoneal (i.p.) injection (1 U/kg) of Detemir insulin. Because the lowest glycemia was obtained 4 h after insulin administration, the experiments were done at this time. The hypoglycemia obtained 4 h after insulin injection was partially prevented with increasing oral doses of GDP (1.56, 3.12, 6.25, 12.5 mg/kg). The best result was obtained with 12.5 mg/kg. However, from this dose (25.0, 50.0, 100.0 mg/kg), the values of glycemia progressively decreased (p<0.05). The effect of GDP to prevent prolonged IIH was mediated, partly at least, by an intensification of liver gluconeogenesis. Moreover, the increased portal availability of GDP, L-alanine and L-glutamine after GDP administration also contributed to the IIH prevention, since the rate of gluconeogenesis progressively augmented with the infusion of increasing concentrations of these substances. However, after getting the maximal value, the rate of liver gluconeogenesis decreased (p<0.05) if a more elevated concentration of L-alanine or L-glutamine was infused. On the other hand, the liver gluconeogenesis during the infusion of increasing concentrations of GDP was unchanged. Because, GDP did not directly inhibit liver gluconeogenesis, but an inhibition of this metabolic pathway was observed with low ammonia concentrations (from 0.062 mM) it is possible that the ammonia from the catabolism of GDP by extra hepatic tissues could inhibit liver gluconeogenesis. This mechanism could help to explain the lower glycemia obtained with more elevated doses of oral GDP.

Aspectos clínicos e farmacológicos da associação sinvastatina-ezetimiba / Clinical and pharmacological aspects of the combination of simvastatin and ezetimibe

O objetivo do tratamento de pacientes hipercolesterolemicos deve ser o de alcançar concentração sangüínea de colesterol e LDL próximos ao de pacientes normais. Uma série de estratégias terapêuticas tem sido usada para obter um adequado controle da hipercolesterolemia. Dentre elas, destaca-se o emprego da sinvastatina que inibe a síntese hepática de colesterol e o ezetimiba que inibe a absorção intestinal de colesterol. A ausência de um adequado controle da colesterolemia com sinvastatina ou ezetimiba isoladamente abre a possibilidade de associação destes fármacos. Assim, a associação de sinvastatina e ezetimiba reduz com mais efi ciência a concentração sangüínea de colesterol e LDL do que o emprego separado de cada um destes fármacos. Portanto, podemos concluir que esta associação constitui a melhor opção terapêutica para pacientes nos quais a estatina isoladamente não alcança perfi l lipídico satisfatório.

The goal of hypercholesterolemic patient treatment should be obtaining both LDL and cholesterol blood level concentrations close to those of normal individuals. A number of therapeutic strategies have been carried out in order to achieve hypercholesterolemia proper control. Simvastatin stands out by preventing cholesterol synthesis in the liver as Ezetimibe prevents intestinal cholesterol absorption. The lack of proper cholesterolemia control regarding the single use of Simvastatin and Ezetimibe enables the possibility of combining such drugs. Thus, the combination of Simvastatin and Ezetimibe remarkably decreases the concentrations of both cholesterol blood level and LDL. Therefore, we conclude that such combination represents the best therapeutic choice for patients who isolated estatine does not reach a proper lipid profile.

Tuberculose e AIDS: revisäo atualizada / Tuberculosis and AIDS: current revision

Os autores apresentam aspectos epidemiológicos e os principais tópicos a serem considerados no diagnóstico e tratamento da tuberculose, quando incidente nos pacientes com Aids. Däo ênfase à importância de se estadiar a Aids, pois, como se verá adiante, as apresentaçöes podem diferir, francamente, de acordo com o grau de imunodepressäo em que se encontra o paciente. Ilustram o trabalho com cinco casos selecionados entre os pacientes por eles acompanhados.

Síndrome da redundância das raízes lombares: relato de um caso / Redundant lumbar nerve roots syndrome: report of a case

Um homem de 64 anos apresentava dor ciática crônica. A mielografia revelou compressäo extradural e tortuosidade das raízes lombares. Foi verificado tratar-se da síndrome da redundância das raízes lombares. Laminectomia e facetectomia foram realizadas com acentuada melhora dos sintomas no pós-operatório