ABSTRACT Objective To describe the prevalence, clinical characteristics and outcome of adrenal lesions in long-term follow-up of Multiple endocrine neoplasia type 1 (MEN1) patients. Subjects and methods We retrospectively studied sixteen patients from six families of individuals with MEN1. Adrenal involvement was evaluated using clinical, biochemical and imaging data. Results Adrenal lesions were identified in nine of sixteen (56.3%) patients: seven women and two men (mean age: 52.2 years). Adrenal involvement was detected at MEN1 diagnosis in more than half of the patients. Eighteen adrenal nodules were founded (median of two nodules per patient) with mean adrenal lesion diameter of 17.4 mm. Three patients had unilateral adrenal involvement. Hormonal hypersecretion (autonomous cortisol secretion) was found in two patients. None of the patients was submitted to adrenalectomy, presented an aldosterone-secreting lesion, a pheochromocytoma, an adrenal carcinoma or metastatic disease during the follow-up. A predominance of stable adrenal disease, in terms of size and hormonal secretion, was observed. Adrenal lesions were evenly distributed between the germline mutations. Conclusion Adrenal tumours are a common feature of MEN1 that can affect more than half of the patients. Most of the tumours are bilateral non-functional lesions, but hormonal secretion may occur and should be promptly identified to reduce the morbidity/mortality of the syndrome. Periodic surveillance of these patients should be performed.

Algum tempo passado sobre a introdução dos Indicadores de Desempenho no processo de contratualização e avaliação de desempenho das USF, importa reflectir sobre a qualidade e seu o impacto na prestação de cuidados na Medicina Geral e Familiar (MGF), com a finalidade de contribuir para a melhoria da qualidade da avaliação de desempenho. Ao restringir a actividade avaliada pelos Indicadores a uma pequena área da prática clínica e ao contratualizar metas com valores muito elevados, pode conduzir ao afunilamento e à focalização da actividade clínica, com eventuais consequências negativas para os utentes. Uma das consequências possíveis é a prática de uma Medicina Baseada em Indicadores em vez de uma Medicina Centrada no Doente. Por outro lado, a fraca evidência científica de alguns Indicadores, a utilidade muito discutível de outros, bem como a dificuldade em medir ganhos em saúde podem originar excessos da Medicina, nomeadamente medicalização, consumismo e iatrogenia. São feitas, neste artigo, algumas sugestões sobre alguns aspectos a melhorar nos Indicadores. Outros aspectos relacionados, tal como o Sistema de Informação e a Contratualização terão de evoluir paralelamente. O Ideal seria que o pagamento por desempenho fosse baseado na medição de Indicadores que representem ganhos em Saúde para as pessoas, respeitando igualmente os princípios e a prática da Medicina Geral e Familiar.

Performance indicators have been in use in Portugal for some time now for performance assessment and contractualisation in Family Health Units (USFs). It is important to consider both the quality of the performance indicator and its impact on the delivery of health care in general practice in order to improve performance assessment. When performance indicators assess only a limited area of clinical practice or set very high targets, they may limit the focus of clinical activities with possible negative consequences for patients. One of these consequences may be the replacement of Patient-Centred Medicine with Indicator-Based Medicine. In addition, there is poor scientific evidence for the use of some of the indicators and controversial usefulness of others. The difficulty of measuring some health outcomes can produce medicalisation, consumerism, and iatrogenic disease. In this paper, the authors present some suggestions for improving existing performance indicators. Further developments of related matters, such as the medical information system and contract schemes, are also proposed. Payment for performance should be based on indicators that produce better health outcomes for patients while respecting the principles of family medicine.

La isla de San Andrés, en el Caribe colombiano, es una reserva de la biosfera y una región de gran importancia biológica y cultural. Su fauna y su flora cuentan, sin embargo, con algunas especies consideradas como introducciones recientes y voluntarias, que no han sido estudiadas y cuyos efectos deben ser evaluados con prontitud. Las babillas, Caiman crocodilus fuscus (Cope 1868), fueron introducidas a la isla en los años setenta y no se había realizado ningún trabajo previo sobre su ecología en la región. En este trabajo se ubicaron las diferentes localidades donde C. c. fuscus está presente durante la época seca en San Andrés, se estimaron los índices de abundancia por localidad por medio de censos nocturnos, y se realizó un estudio de su dieta usando la metodología de extracción de contenidos estomacales. También se observó la relación de la comunidad isleña con la especie. El estudio se realizó durante los meses de marzo a junio del 2002, en la temporada seca. La especie fue encontrada en cuatro lagunas de agua dulce permanentes, con abundancias locales de 8, 17, 34 y 22 individuos, y no fue encontrado ninguno en los manglares. Se capturaron veinte individuos y sus contenidos estomacales mostraron que consumen coleópteros, ortópteros, otros insectos, miriápodos, cangrejos, peces y aves. El elemento que apareció con mayor frecuencia fue el coleóptero del género Hydrophilus. Las babillas son utilizadas por la comunidad con fines turísticos y no se observó una explotación o extracción de animales.

The island of San Andrés, in the Colombian Caribbean, is a biosphere reserve and an important region due to its biological and cultural diversity. Among the species that make part of the fauna and flora of the island there are some that have been considered as recent, deliberate introductions. These species have not been studied yet and their effects should be evaluated as soon as possible. The "babillas" Caiman crocodilus fuscus (Cope 1868), were introduced to the island in the seventies and no study had been conducted on their ecology at this place. In this work we identified the different localities where C. c. fuscus occurs in San Andrés during the dry season, we estimated the abundance at each locality using nocturnal counts, and we studied their diet using the stomach flushing technique. We also studied the relation of this species with the community. The work was conducted from May to June of 2002, during the dry season. The species was found in four permanent freshwater ponds, with local abundances of 8, 17, 34 and 22 individuals and no animals were seen in the mangrove forests. Twenty individuals were captured and stomach contents showed a diet composed of coleopterans, orthopterans, other insects, myriapods, crabs, fishes and birds. The most frequent element was a coleopteran from the genera Hydrophilus. We found that the "babillas" are used for tourist purposes and there was no exploitation or extraction of animals observed.