PARAGANGLIOMA E ANGIOEDEMA

Paragangliomas or extra-adrenal pheochromocytomas are rare tumors that arise from chromaffin tissues and tend to occur either sporadically or in the context of complex genetic disorders. They are clinically heterogeneous in nature - symptoms deriving either from the secretory profile of the tumor or from the mass effect of the neoplasm. Dermatologic symptoms are quite seldom described in the literature and have been classified in acute or chronic. The case of a 40 YO Caucasian female that had been enduring for the last 2 years recurring self-limited episodes of angioedema, diarrhoea, chest pain, hypertension or hypotension, dyspnoea and anxiety is reported. Biochemical studies and further imagiologic work up and, later on, pathologic exam allowed to identify a paraganglioma that drained to the left renal artery. Upon surgery, during tumor manipulation, the patient developed an additional systemic crisis that required active life support. Recovery was regular, with a quick and sustained normalization of lab results as well as on the clinical side, with no further episode for the last 17 years.Paragangliomas ou Feocromocitomas extra-suprarrenais são tumores raros derivados do tecido cromafim que tendem a ocorrer esporadicamente ou no contexto de doenças genéticas complexas. São tumores com apresentação clínica variada, dependente do seu perfil secretório ou do efeito de massa determinado pela neoplasia. Sintomas dermatológicos são raros, tendo sido classificados como agudos/paroxísticos ou crónicos. É apresentado caso de uma Eurocaucasiana de 40 anos de idade que referia, nos últimos 2 anos, episódios auto-limitados de angioedema, diarreia, toracalgia, hiper ou hipotensão arterial, dispneia e ansiedade. Estudos laboratoriais e, posteriormente, avaliação imagiológica e exame patológico permitiram identificar um paraganglioma drenante para a veia renal esquerda, o qual foi extirpado com sucesso. Durante a cirurgia, a manipulação do tumor desencadeou uma nova crise grave, a qual exigiu, com carácter de emergência, a instituição de medidas de suporte avançado de vida. A recuperação decorreu sem incidentes, tendo-se verificado uma rápida regularização dos valores laboratoriais a par de uma remissão clínica completa, sem novos episódios verificados durante 17 anos

A Randomized Double-Blind Study Comparing the Efficacy and Safety of Orlistat Versus Placebo in Obese Patients with Mild to Moderate Hypercholesterolemia

INTRODUCTION: Obesity is a chronic disease and a serious health problem that leads to increased prevalence of diabetes, hypertension, dyslipidemia and gallbladder disease. OBJECTIVE: To evaluate the efficacy of orlistat for weight loss and improved lipid profile compared to placebo in obese patients with hypercholesterolemia, treated over a period of 6 months. METHODOLOGY: In a 6-month, multicenter (10 centers in Portugal), double-blind, parallel, placebo-controlled study, 166 patients, aged 18-65 years, body mass index (BMI) > or = 27 kg/m2, LDL cholesterol > 155 mg/dl, were randomized to a reduced calorie diet (600 kcal/day deficit) plus orlistat three times a day or placebo. Exclusion criteria included triglycerides > 400 mg/dl, severe cardiovascular disease, uncontrolled hypertension, type 1 or 2 diabetes under pharmacological treatment, and gastrointestinal or pancreatic disease. RESULTS: The mean difference in weight from baseline was 5.9% (5.6 kg) in the orlistat group vs. 2.3% (2.2 kg) in the placebo group. In the orlistat group 49% of patients achieved 5-10% weight loss and 8.8% achieved > 10%. The orlistat group showed a significant reduction in total and LDL cholesterol, with similar changes for HDL in both treatment groups. The frequency of gastrointestinal adverse events was slightly higher in the orlistat group than in the placebo group, leading to discontinuation in 7 patients. CONCLUSION: Treatment with orlistat plus a reduced calorie diet for 6 months achieved significant reductions in weight, BMI and lipid parameters

O Timor Gap e a economia de Timor Leste

Grande parte da riqueza mineral do Mar de Timor está localizada no chamado TimorGap. Estimativas sobre o seu valor variam, mas as três principais reservas petrolíferasno Gap — Sunset, Bayu-Udan e Elang-Kakatua (ver mapa) — contêm um total previstode 500 milhões de barris, no valor de 17 mil milhões de USD a preços actuais(The Economist, 02/10/2000). Só Bayu-Undan contém reservas recuperáveis estimadasem 400 milhões de barris de petróleo bruto e de LPG, e 3,4 triliões de pés cúbicosde gás natural (Dow Jones 27/06/2000). Estas projecções suportariam uma produçãode petróleo de aproximadamente 110 mil barris por dia (ver site http://www.nt.gov.au/ord).Calcula-se a duração das reservas para 25 anos, iniciando-se a exploração em2003, e gerando lucros na ordem dos 300 milhões de USD por ano, provenientesde direitos de exploração e impostos (Phillips Petroleum Company 12/03/1999)

Prevalence of obesity in Portugal

© 2006 The International Association for the Study of ObesityObesity is a serious health problem in developed countries. Knowledge of reliable and nationwide representative data is a must for any public health action. The dimension of this problem in Portugal was first assessed in 1995–1998. A similar populational survey using objective anthropometric measures is now being conducted (field work started in January 2003). A total of 6411 subjects aged 18– 64 years old have already been measured and their respective body mass indexes (BMIs) calculated. Results from 2003 to 2005 show 38.6% is overweight and 13.8% has obesity. The total of overweight and obesity is 52.4%. In 1995–1998 survey, overweight was 35.2% and obesity was 14.4%. The total was 49.6%. These results suggest an increase of the overweight/obesity (altogether) prevalence in the last 10 years. Actual results show that more than half of the adult sample has excessive weight and 2.4% of the sample has low BMI. Finally, 45.6% of the sample suffers increased health risks because of high waist circumference (≥ 80 cm for women; ≥ 94 cm for men). These results highlight the fact that, although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date.We would like to thank Roche Farmacêutica Química, Lda. for all logistical and additional financial support. Supported by: Sociedade Portuguesa para o Estudo da Obesidade. Contract grant sponsor: Fundação para a Ciência e a Tecnologia POCTI/ESP/40913/2001/FEDER