Long-term outcome after bilateral adrenalectomy in Cushing's disease with focus on Nelson's syndrome

ABSTRACT Objective We analyzed the clinical, biochemical, and imaging findings of adrenalectomized patients with Cushing's disease (CD) in order to compare the characteristics of those who developed Nelson's syndrome (NS) versus those who did not develop this complication (NNS), aiming to identify possible predictive factors for its occurrence. Subjects and methods We performed a retrospective review of the clinical records of a group of patients with CD who underwent TBA between 1974 and 2011. Results Out of 179 patients with CD, 13 (7.3%) underwent TBA. NS occurred in 6 of them (46%) after a mean of 24 months from the total bilateral adrenalectomy (TBA). Age at diagnosis, duration of Cushing's syndrome (CS) until TBA, and steroid replacement doses were similar in both groups. Initial urinary cortisol levels (24-hour urinary free cortisol [UFC]) were significantly higher in the NS group than in the NNS group (p = 0.009). Four patients in the NS group and three of those in the NNS group received radiotherapy before TBA (p = 0.26). Three patients in the NS group presented residual tumors before TBA, compared with none in the NNS group (p = 0.04). At 1 year after TBA, the median ACTH level was 476 ng/L (240-1500 ng/L) in the NS group and 81 ng/L (48-330 ng/L) in the NNS group (p = 0.0007). Conclusion In conclusion, a residual tumor before TBA, higher 24-hour UFC at diagnosis, and increasing ACTH levels within 1 year after TBA emerged as predictive factors of development of NS.

In vivo and in vitro correlation of azithromycin cationic micron niosomes / 中国药理学通报

Aim To evaluate the correlation between in vitro release and in vivo absorption of azithromycin cat-ionic micron niosomes (ACMNS)by Wagner-Nelson method and deconvolution method. Methods The in vitro release behavior of ACMNS was studied by dy-namic membrane dialysis. After a single dose of intra-gastric administration with ACMNS and AM in rats,the AM concentrations in plasma were determined by high performance liquid chromatography(HPLC). Wagner-Nelson and deconvolution method were used to reveal the in vitro / in vivo correlation. Results X used as cu-mulative in vitro release and Fa as the absorption per-centage,the regression equation was established:F a =3. 0524X - 5. 7709,r = 0. 8976,and X used as cumu-lative in vitro release and R as input function,the re-gression equation was established:R = 2. 3413X -58. 687,r = 0. 5217. r < r( 2,0. 05) = 0. 9500 (P <0. 05). Conclusion There is no correlation between in vitro release and in vivo absorption of ACMNS.

Nelson Rockefeller e a atuacao da American International Association for Economic and Social Development: debates sobre missao e imperialismo no Brasil, 1946-1961 / Nelson Rockefeller and the activities of the American International Association for Economic and Social Development: the debate concerning mission and imperialism in Brazil, 1946-1961

Analisa a bibliografia sobre Nelson Rockefeller e a atuação no Brasil da American International Association for Economic and Social Development. Expõe interpretações otimistas sobre as ações de Rockefeller e da agência, bem como a corrente de pensamento que o caracterizou como um dos principais representantes do imperialismo norte-americano, seja como representante político na década de 1960, seja como idealizador de atividades de interesse privado. Procura demonstrar que as ações individuais ou da agência coadunavam com as elites locais, que influenciavam o remodelamento e a operacionalização dos projetos de cooperação técnica.

The article analyzes the bibliography on Nelson Rockefeller and the activities of the American International Association for Economic and Social Development in Brazil. It describes optimistic interpretations of Rockefeller's and the association's work, as well as the nationalist stream of thought, which characterized him as one of the chief representatives of U.S. imperialism, both as a political representative in the 1960s and as the mind behind endeavors of interest to the private sector. It is shown that at the individual and agency levels alike, these initiatives involved direct ties to the local elites, who influenced the reshaping and operationalization of technical cooperation projects.

Carlos Nelson Coutinho: a hegemonia como contrato / Carlos Nelson Coutinho: the hegemony as a contract

Este artigo propõe-se a examinar a originalidade do pensamento político marxista do filósofo brasileiro Carlos Nelson Coutinho (1943-2012), recentemente falecido. O mais audacioso projeto do autor brasileiro em teoria política, sugerido em uma série de ensaios, e na justaposição das démarches teóricas de Gramsci e Lukács, foi o de abordar a questão da hegemonia como contrato. Não se trata de uma abordagem comum: na tradição canônica da filosofia política, hegemonia e contrato atendem a tradições distintas e vistas em geral como antagônicas, respectivamente o realismo político e o contratualismo.

This article aims at examining the originality of the political Marxist thought of the Brazilian philosopher Carlos Nelson Coutinho (1943-2012), who died recently. This author's most daring project on political theory was to approach the issue of hegemony as a contract. Such a project was suggested in a series of essays, and it is in the juxtaposition of Gramsci and Lukács's theoretical démarches. It is not a common approach: in the canonical tradition of political philosophy, hegemony and contract are related to different traditions which are usually seen as opposite ones - political realism and contractualism, respectively.

Uma vida entre insetos e livros: entrevista com Nelson Papavero / A life among insects and books: an interview with Nelson Papavero

Nelson Papavero é um dos principais expoentes da zoologia brasileira. Sua contribuição para a ciência a partir da segunda metade do século XX é decisiva, com publicações nas áreas de zoologia, sistemática, biogeografia e história da ciência, atuação em cursos de pós-graduação e na formação de professores e alunos. Foi o principal introdutor e disseminador da sistemática filogenética hennigiana no Brasil. Sua participação ativa na criação dos Cursos Especiais de Sistemática Zoológica do Conselho Nacional de Desenvolvimento Científico e Tecnológico e os inúmeros cargos administrativos que acumulou durante sua trajetória acadêmica foram fundamentais para o desenvolvimento da zoologia e da biologia comparada no Brasil. Sua atuação alcançou ainda outros países da América Latina, como México e Argentina.

Nelson Papavero is one of the top representatives of Brazilian zoology. His decisive contributions to this science began in the second half of the twentieth century, when he started publishing in the areas of zoology, systematics, biogeography, and the history of science while also working at graduate courses and training teachers and students. He was key to the introduction of Hennig's phylogenetic systematics in Brazil and its chief advocate. His active participation in the creation of the Special Courses on Zoological Systematics within the National Council for Scientific and Technological Development and his work at numerous administrative posts which he held during his academic career were vital to the development of zoology and comparative biology in Brazil. His endeavors also reached into other Latin American countries, like Mexico and Argentina.

A restauração de Hipócrates inspirada na escultura de Nelson Gonçalves / The restoration of Hippocrates inspired by the sculpture of Nelson Gonçalves

Trata-se da palestra de abertura do V Congresso Paulista de História da Medicina na qual o autor usa recursos didáticos para despertar o interesse pelos problemas da medicina apresentando aspectos históricos de uma forma humorada e literária. Músicas são utilizadas pelo autor no sentido de correlacionar fatos da história da medicina, facilitando sua memorização. A música Escultura, conhecida do grande público na voz de um cantor conhecido, foi utilizada como base, tendo o autor feito uma paródia da letra da mesma para desenvolver informações sobre história da medicina.

Enfermedad de Cushing recidivada después de tratamiento quirúrgico exitoso: a propósito de un caso clínico / Relapse of cushing disease after excision of a pituitary adenoma: report of one case / Relapse of cushing disease after excision of a pituitary adenoma: report of one case

Cushing´s disease results from overproduction of glucocorticoids due to excessive corticotropin secretion by a tumor of the pituitary gland´s corticotroph cells and is the cause of 80 percent of all forms of ACTH dependent hypercortisolism. Both its diagnosis and treatment represent a challenge and transsphenoidal surgical resection is currently the treatment of choice.The success of the surgery depends on the tumor size and on the experience of the center which performs the intervention, achieving remission of the disease in around 70 percent of microadenomas and 15 percent of tumors larger than 1 cm. Among patients who achieved control of hypercortisolism, there is a relapse rate that fluctuates between 5 and 25 percent. The clash of these cases represents an even greater challenge than the previous one, especially with regard to the treatment. We report the case of a 30 years old woman with Cushing's disease, operated on and cured through a transsphenoidal resection, who relapsed 10 years after surgery.

Nelson's Syndrome

Nelson's syndrome is a potentially severe complication of bilateral adrenalectomy performed in the treatment of Cushing's disease, and its management remains difficult. Of all of the features of Nelson's syndrome, the one that causes most concern is the development of a locally aggressive pituitary tumour, which, unusually for pituitary disease, may occasionally cause death from the tumour itself. This feature is especially pertinent given the increasing use in Cushing's disease of laparoscopic bilateral adrenal surgery as a highly effective treatment modality to control cortisol-excess. Despite numerous studies and reports, there is no formal consensus of what defines Nelson's syndrome. Thus, some will define Nelson's syndrome according to the classical description with an evolving pituitary mass after bilateral adrenalectomy, whereas others will rely on increasing plasma ACTH levels, even in the absence of a clear pituitary mass lesion on MRI. These factors need to be borne in mind when considering the reports of Nelson's syndrome, as there is great heterogeneity, and it is likely that overall the modern 'Nelson's syndrome' represents a different disease entity from that of the last century. In the present paper, clinical and epidemiological features of Nelson's syndrome, as well as its treatment modalities, are reviewed.

A síndrome de Nelson (SN) é uma complicação potencialmente grave da adrenalectomia bilateral realizada para o tratamento da doença de Cushing e seu manejo permanece difícil. De todas as manifestações da SN, aquela que causa maior preocupação é o desenvolvimento de um tumor hipofisário localmente agressivo, que pode (pouco usualmente para a doença hipofisária) ocasionalmente causar a morte pelo próprio tumor. Este achado é especialmente pertinente, dado o uso cada vez mais freqüente na doença de Cushing, da adrenalectomia bilateral por via laparoscópica, uma modalidade terapêutica altamente efetiva para o controle do excesso de cortisol. Apesar de numerosos estudos e publicações, não existe um consenso formal sobre a definição da SN. Assim, alguns irão definir a SN de acordo com a descrição clássica, como uma massa hipofisária que evolui após a adrenalectomia bilateral, enquanto outros irão se basear nos níveis crescentes dos níveis de ACTH plasmático, mesmo na ausência de uma lesão ou massa hipofisária nitidamente visível à RM. Esses fatores precisam ser relembrados quando se avaliam as publicações sobre SN, na medida em que existe grande heterogeneidade, e é provável que no geral a "SN moderna" represente uma entidade patológica diferente daquela do século passado. Neste artigo, revisaremos achados clínicos e epidemiológicos da SN e também suas modalidades terapêuticas.

Some remark on Nelson's syndrome

A case of Nelson syndrome was presented. Male patient of 26 years old suffering from Cushing disease underwent an bilateral epinephrectomy, after that, Nelson syndrome developed and the patient was treated by Cobalt 60, the skin was discolored and head pain was relieved. Nelson syndrome is caused by total epinephrectomy E in Cushing disease’s patient, its clinical manifestation is typically a leader skin, head pain, high blood concentration of ACTH. The treatment of choice for this syndrome is an operation of pyfrophyse through sphenoidal bone or irradiation into hypophysal hole

A Case of Cushing's Syndrome / 대한비뇨기과학회지

Cushing's syndrome refers to a clinical pictures that develops in a patient who are exposed to excess quantities of cortisol like substances. A case of Cushing's syndrome in 62-year-old man who was followed by a Nelson's syndrome after bilateral adrenalectomy is presented with brief review of literatures.

Nelson's Syndrome: A Case Report

A case of Nelson's syndrome in 23 year-old female, developing 6 years after bilateral adrenalectomy for Cushing's syndrome, is reported. Presenting symptoms were headache and hyperpigmentation of the skin and mucous membrane. Serum ACTH level was markedly elebated above 1000 pg/ml, but serum cortisol level diminished markedly. Transsphenoidal approach (TSA) with removal of gushing out hematoma and tumor underwent. Postoperatively, headache subsided and hyperpigmentation of the skin markedly improved.