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Search Results: 1 - 10 of 466608 matches for " Mauro A.;Rollin "
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Síndrome de Cushing: é possível simplificar e padronizar sua abordagem diagnóstica?
Rollin, Guilherme A.F.S.;Czepielewski, Mauro A.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2003, DOI: 10.1590/S0004-27302003000400009
Abstract: the diagnosis of cushing's syndrome require an accurate clinical suspicion, information about hypothalamic-pituitary-adrenal axis, adequate use of functional hormonal tests and the indication of resolutive image examination with the objective of determining its etiology. in this paper, we discuss the diagnostic approach of the cushing's syndrome, the application of the hormonal tests used for the syndromic and etiologic definition, with special focus in the differential diagnosis of cushing's disease vs. pseudo-cushing's states and cushing's disease vs. ectopic acth syndrome. finally, we propose a standard approach for these patients, including suggestions about the application of sophisticated and invasive methods.
Síndrome de Cushing: é possível simplificar e padronizar sua abordagem diagnóstica?
Rollin Guilherme A.F.S.,Czepielewski Mauro A.
Arquivos Brasileiros de Endocrinologia & Metabologia , 2003,
Abstract: A síndrome de Cushing representa um desafio diagnóstico, requerendo suspeita clínica apurada, conhecimento adequado da regula o hormonal do eixo hipotálamo-hipófise-adrenal, aplica o precisa de testes funcionais que estimulam ou inibem este eixo e a indica o de exames de imagem resolutivos para as diversas etiologias investigadas. Neste artigo, discutimos a abordagem diagnóstica da síndrome de Cushing, analisando a aplica o dos diversos testes utilizados tanto para o diagnóstico sindr mico como para defini o da sua etiologia. Destacamos o diagnóstico diferencial entre a doen a de Cushing leve e os estados de pseudo-Cushing e entre doen a de Cushing e síndrome do ACTH ectópico. Baseados nestes conceitos e conhecimentos, e em nossa experiência, propomos um modelo de abordagem para pacientes com suspeita de síndrome de Cushing, ressaltando que, em algumas situa es, para um correto diagnóstico etiológico, s o necessários métodos invasivos e sofisticados.
Prospective evaluation of transsphenoidal pituitary surgery in 108 patients with Cushing's disease
Rollin, Guilherme;Ferreira, Nelson Pires;Czepielewski, Mauro A.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2007, DOI: 10.1590/S0004-27302007000800022
Abstract: transsphenoidal pituitary surgery (tss) remains the treatment of choice for cushing's disease (cd). despite the widespread acceptance of this procedure as the first line treatment in cd, the indication of a second tss in not cured or relapsed dc patients is not consensus. we report the results of tss in 108 patients with cd (a total of 117 surgeries). the mean postoperative follow-up period was 6 years. remission was defined as clinical and laboratorial signs of adrenal insufficiency, period of glucocorticoid dependence, serum cortisol suppression on oral 1-mg dexamethasone overnight suppression test and clinical remission of hypercortisolism. we evaluated 103 patients with cd by the time of the first tss. fourteen patients underwent second tss (5 had already been operated in others centers; in 5 patients the first surgery was not curative; in 4 patients cd relapsed). remission rates were 85.4% and 28.6% (p < 0.001) after first and second tss, respectively. in microadenomas, remission rates were higher than macroadenomas (94.9% vs. 73.9%; p = 0.006). in patients with negative pituitary imaging remission rates were 71.4% (p = 0.003; vs. microadenomas). postoperative complications were: transient diabetes insipidus, definitive diabetes insipidus, hypopituitarism, stroke and one death. only hypopituitarism was more frequent after second tss (p = 0.015). in conclusion, tss for cd is an effective and safe treatment. the best remission rates were observed at the first surgery and in microadenomas. the low remission rates after a second tss suggest that this approach could not be a good therapeutic choice when the first one was not curative.
Avalia??o do eixo hipotálamo-hipófise adrenal no diagnóstico e na remiss?o da doen?a de Cushing
Costenaro, Fabíola;Rodrigues, Ticiana C.;Rollin, Guilherme A. F.;Czepielewski, Mauro A.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2012, DOI: 10.1590/S0004-27302012000300002
Abstract: cushing's disease (cd) remains a medical challenge, with many questions still unanswered. successful treatment of cd patients is closely related to correct approach to syndromic and etiological diagnosis, besides the experience and talent of the neurosurgeon. pituitary transsphenoidal adenomectomy is the treatment of choice for dc. assessment of remission after surgery and recurrence in the long term is an even greater challenge. in this regard, special attention should be paid to the role of postoperative serum cortisol as a marker of cd remission. additionally, the postoperative use of exogenous glucocorticoids only in cases of adrenal insufficiency has been suggested by some authors as an essential practice to enable the use of serum cortisol in this scenario. in this article, we review the forms of evaluation of dc activity, and markers of remission and relapse of cd after transsphenoidal surgery.
Criteria of cure and remission in Cushing's disease: an update
Czepielewski, Mauro A.;Rollin, Guilherme A.F.S.;Casagrande, Alessandra;Ferreira, Nelson P.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2007, DOI: 10.1590/S0004-27302007000800023
Abstract: we review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of cushing's disease (cd). firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with cd. considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. in this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. our experience demonstrates that: (i) early cortisol < 5 to 7 μg/dl, (ii) a period of glucocorticoid dependence > 6 mo, (iii) absence of response of cortisol/acth to crh or ddavp, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of cd. in patients with undetectable cortisol levels early after surgery, recurrence seems to be low. finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15% of the patients in long-term follow-up. we recommended that patients with cd should have long-term monitoring of the crh-acth-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis.
Tumores n?o hipofisários da regi?o selar
Czepielewski, Mauro A.;Rollin, Guilherme A.F.S.;Casagrande, Alessandra;Ferreira, Marcelo Paglioli;Ferreira, Nelson P.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2005, DOI: 10.1590/S0004-27302005000500008
Abstract: the pituitary gland, sella turcica and the parasellar region can be involved by a wide variety of lesions, including benign and malignant neoplasms as well as a wide variety of non neoplastic tumor-like lesions. clinical and radiological aspects could help in the differential diagnosis of these lesions. nevertheless, in many cases only the histopathological analysis could establish the definitive diagnosis. in this paper, we review the nonpituitary tumors of the sellar region emphasizing the associated hormonal disturbances.
Octreotide-LAR + adrenalectomia bilateral no manejo de tumores carcinóides produtores de ACTH
Czepielewski, Mauro A.;Colli, Maikel;Harlos, Tatiana;Silveiro, Sandra Pinho;Maraschin, Jorge;Copette, Fabio;Leit?o, Cristiane B.;Rollin, Guilherme A.F.S.;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2005, DOI: 10.1590/S0004-27302005000500020
Abstract: cushing?s syndrome (cs) due to ectopic acth secretion has a high morbidity and mortality. thus, rapid treatment of ectopic cs is mandatory. carcinoid tumors associated with ectopic acth (ctu-acth) syndrome represent a more severe clinical picture, due to the carcinoid symptoms that worsen the hypercortisolism state. management of patients with ctu-acth should include the control of hypercortisolism, as well as the carcinoid disturbance. we report 3 patients (2f, 1m) with ctu-acth (2 pancreatic, 1 ocult) who presented with clinical manifestations of cs (n= 3) and carcinoid syndrome (2): 2 were initialy investigated for cs and 1 carcinoid syndrome. in all hypokalemia, hypertension and diabetes mellitus were associated with severe hypercortisolism and high acth levels. administration of octreotide-lar reduced acth levels from 230,000 to 30,000pg/ml in patient 1, and controlled symptoms of carcinoid syndrome and neoplasic lesions in patient 2; treatment with subcutaneous octreotide in patient 3 controlled carcinoid syndrome and partially reduced symptoms of hypercortisolism. all 3 patients were submitted to bilateral adrenalectomy to control cs. our data show that combined anti-neoplastic therapy may contribute to the stabilization and/or definitive control of ctu-acth.
Cardiac Coherence, Self-Regulation, Autonomic Stability and Psychosocial Well-being
Rollin McCraty,Maria A. Zayas
Frontiers in Psychology , 2014, DOI: 10.3389/fpsyg.2014.01090
Abstract: The ability to alter one’s emotional responses is central to overall well-being and to effectively meeting the demands of life. One of the chief symptoms of events such as trauma, that overwhelm our capacities to successfully handle and adapt to them, is a shift in our internal baseline reference such that there ensues a repetitive activation of the traumatic event. This can result in high vigilance and over-sensitivity to environmental signals which are reflected in inappropriate emotional responses and autonomic nervous system dynamics. In this article we discuss the perspective that one’s ability to self-regulate the quality of feeling and emotion of one’s moment-to-moment experience is intimately tied to our physiology, and the reciprocal interactions among physiological, cognitive and emotional systems. These interactions form the basis of information processing networks in which communication between systems occurs through the generation and transmission of rhythms and patterns of activity. Our discussion emphasizes the communication pathways between the heart and brain, as well as how these are related to cognitive and emotional function and self-regulatory capacity. We discuss the hypothesis that self-induced positive emotions increase the coherence in bodily processes, which is reflected in the pattern of the heart’s rhythm. This shift in the heart rhythm in turn plays an important role in facilitating higher cognitive functions, creating emotional stability and facilitating states of calm. Over time, this establishes a new inner-baseline reference, a type of implicit memory that organizes perception, feelings and behavior. Without establishing a new baseline reference, people are at risk of getting “stuck” in familiar, yet unhealthy emotional and behavioral patterns and living their lives through the automatic filters of past familiar or traumatic experience.
Constant scalar curvature Kaehler surfaces and parabolic polystability
Yann Rollin,Michael A. Singer
Mathematics , 2007,
Abstract: A complex ruled surface admits an iterated blow-up encoded by a parabolic structure with rational weights. Under a condition of parabolic stability, one can construct a Kaehler metric of constant scalar curvature on the blow-up according to math.DG/0412405. We present a generalization of this construction to the case of parabolically polystable ruled surfaces. Thus we can produce numerous examples of Kaehler surfaces of constant scalar curvature with circle or toric symmetry.
Non-minimal scalar-flat Kaehler surfaces and parabolic stability
Yann Rollin,Michael A. Singer
Mathematics , 2004, DOI: 10.1007/s00222-004-0436-6
Abstract: A new construction is presented of scalar-flat Kaehler metrics on non-minimal ruled surfaces. The method is based on the resolution of singularities of orbifold ruled surfaces which are closely related to rank-2 parabolically stable holomorphic bundles. This rather general construction is shown also to give new examples of low genus: in particular, it is shown that CP^2 blown up at 10 suitably chosen points, admits a scalar-flat Kaehler metric; this answers a question raised by Claude LeBrun in 1986 in connection with the classification of compact self-dual 4-manifolds.
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