The differential diagnosis of Cushing's syndrome is a major challenge to clinical endocrinologists, especially those infrequent cases referred to as occult ectopic ACTH syndromes. Although bronchial carcinoids are well known to be a cause of Cushing's syndrome due to ectopic ACTH secretion, very few cases of carcinoid tumourlets causing an ACTH ectopic syndrome have been reported, and their origin remains controversial. For some authors, tumourlets and typical carcinoids represent distinct pathological entities, whilst others hold that tumourlets are merely microscopic carcinoid tumours. We report a patient with an aggressive Cushing's syndrome that required bilateral adrenalectomy, diagnosed 22 years before a 3-cm lung nodule became apparent on routine chest X-ray. The biopsy after lung surgery revealed a typical peripheral bronchial carcinoid surrounded by tumourlets. Both tumourlets and carcinoid tumour showed strongly positive ACTH immunostaining. Recently, Arioglu et al. (1998) reported a case of Cushing's syndrome caused by pulmonary carcinoid tumourlets, concluding that this entity should be considered in the differential diagnosis of occult ectopic ACTH syndrome. Furthermore, we consider that the carcinoid tumourlets found in our patient, were the initial source of ACTH, leading to Cushing's syndrome with a rapid onset, and that a loss of cell proliferation control in one of such tumourlets many years later, could have resulted in the development of a typical carcinoid tumour, reinforcing the theory of a common origin of these lesions.

Having demonstrated the importance of forensic anthropology in the positive identification of human skeletal remains, we consider it relevant to learn a basic management of the techniques by the students of the Medical Degree, in the context of the subject "Legal Medicine and Ethics". The main objective was to apply theoretical and technical knowledge on physical and forensic anthropology to identify real cases through group work dynamics, concluding with justified decision making. Sixteen 2-hour workshops were organized for groups of 8 students, using skeletal remains of 4 individuals mixed with animal bones. After the human remains were identified, the four skeletons were isolated and an inventory of the available bones was made. The basic biological profile of each of them was analyzed: sex, age and height. These data were entered in a protocol form, which they delivered at the end of the practice. Subsequently, they conducted an anonymous questionnaire of 10 items about the degree of satisfaction on contents, methodology, and utility in their training.With a response rate of 78.4% (n = 125), the highest mean scores were given to items related to: teacher and subject (χ 4,98; Dt. 0.14), expository clarity (χ 4, 94, Dt. 0.24) and adequacy of methodology (χ 4,92, Dt. 0,28). In addition to the favorable results obtained, it was objectified through the protocolized forms, the adequate resolution of real practical cases, based on a joint decision making and justified on the theoretical contents learned.

The direct effects of ketoconazole on the secretion of ACTH by human pituitary adenoma cells from 2 patients with Nelson's syndrome were studied in vitro. Stereologically quantified, intracellular changes affect the surface density of the endoplasmic reticulum (it decreased by 73%), the volume density of the secretion granules (it decreased by 49%), and the volume density of lysosomes (it decreased by 67%). The hormone released in the culture medium decreased depending on the doses of ketoconazole used; 10 \g=m\mol/l decreased ACTH levels by Dpto. Ciencias Morfológicas1,

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