Raquel Barrio Castellanos

Efectividad del sistema MiniMed 640G con SmartGuard® para la prevención de hipoglucemia en pacientes pediátricos con diabetes mellitus tipo 1.

INTRODUCTION/AIMS Treatment with the MiniMed 640G-SmartGuard® system (640G-SG, sensor-augmented insulin pump system with low predicted glucose suspension feature) has been shown to decrease risk of hypoglycemia without altering metabolic control in patients with T1DM. The study purpose was to assess the impact of 640G-SG on hipoglycemia frequency and on metabolic control in a pediatric population with T1DM. PATIENTS/METHODS A retrospective study on 21 children treated with 640G-SG. HbA1C, mean blood glucose (mg/dl), glucose variation coefficient, frequency of hypoglycemia (<70mg/dl) and hyperglycemia (>180mg/dl), daily capillary blood glucose measurements, ketosis/diabetic ketoacidosis, and severe hypoglycemic episodes were analyzed and compared before and during use of the system. Fasting blood glucose, frequency of sensor use and number and duration of system suspension events were also assessed in the last month of use of the system. RESULTS All patients used the system continuously (5.0±2.1 months), with a median sensor use of 92%. Significant decreases were seen in hypoglycemia frequency (10.4±5.2% to 7.6±3.3%, p=.044) and number of capillary blood glucose measurements (11.3±2,2 to 8.1±2,1, p<.001), and there was no increase in hyperglycemia frequency (p=.65). Mean system suspension time was 3.1±1.2hours/day (37.3% of overnight stops). Changes in HbA1c, mean blood glucose, and variation coefficient were not significant. No patient experienced diabetic ketoacidosis or severe hypoglycemia. CONCLUSIONS The sensor-augmented pump with the predictive low glucose suspension management system, as implemented in the 640G-SG system, can help avoid risk of hypoglycemia without significantly affecting metabolic control or causing diabetic ketoacidosis, and decrease the burden of additional capillary blood glucose measurements in our pediatric cohort.

Prolactinomas en la población pediátrica

disease, as there is no evidence of a decline in lung function following ABP, while reduced function has been observed following the use of other substances.4,5 The technique consists in the instillation through a chest tube of 1--2 mL/kg of blood previously extracted from the patient adhering to strict aseptic technique. After the blood is instilled, the cavity is rinsed with 10 mL of physiological saline solution and the chest tube is suspended 60 cm overhead for 30 min to prevent drainage of the instilled blood while allowing air to escape the chest.2,4,5 We recommend changing positions to facilitate a better distribution of the blood. While the exact closure mechanism is not understood, it has been postulated that the blood acts as a patch that directly seals the defect, followed by an inflammatory response in the pleural cavity.6 In the case presented here, treatment with vinblastine and corticosteroids promoted the persistence of pneumothorax, making the patch-like effect all the more relevant. The most frequent complications of ABP are fever, pneumothorax and empyema. Unlike other techniques, it is painless, does not require sedation or analgesia, and can be repeated. We did not observe any of the previously described complications in our patient. Autologous blood patch pleurodesis is a safe, inexpensive and efficacious treatment for persistent air leak. Larger studies need to be conducted in the paediatric population prior to recommending its routine use.

CARTA CIENTÍFICASíndrome «morning glory» asociado a encefalocele transesfenoidal y panhipopituitarismoMorning glory syndrome associated with transsphenoidal encephalocele and panhypopituitarism

ent diffusion coefficient (ADC), from necrotic tumors, which show a low diffusion signal with high ADC. The final diagnosis is usually histological after surgical drainage. Coagulase-negative Staphylococcus is the most commonly isolated microorganism. According to the different series, the ratio between Gram stain and positive cultures ranges from 0% to 64%, which may first be explained by the low activity of bacteria in pituitary abscesses, and second, by preoperative antibiotic therapy. The treatment of choice consists of transsphenoidal surgical drainage and antibiotic therapy for 3--6 weeks. However, conservative antibiotic therapy may be useful for early pituitary abscesses. Visual deficiencies usually improve after treatment, but endocrine deficiencies may persist and require permanent replacement therapy. The recurrence rate is low, but MRI monitoring is advisable in order to detect recurrent abscess. In conclusion, it can be said that preoperative diagnosis of pituitary abscess is difficult because of its insidious clinical signs and symptoms and poorly specific radiographic findings. Pituitary abscess should be suspected in a patient with a cystic sellar mass with ring-shaped enhancement, particularly when associated with clinical signs of infection and/or diabetes insipidus. Because of the low frequency of pituitary abscess, we would like to see a multicenter study with a larger patient sample being conducted, with the aim of furthering our understanding of this condition.

Síndrome «morning glory» asociado a encefalocele transesfenoidal y panhipopituitarismo

ent diffusion coefficient (ADC), from necrotic tumors, which show a low diffusion signal with high ADC. The final diagnosis is usually histological after surgical drainage. Coagulase-negative Staphylococcus is the most commonly isolated microorganism. According to the different series, the ratio between Gram stain and positive cultures ranges from 0% to 64%, which may first be explained by the low activity of bacteria in pituitary abscesses, and second, by preoperative antibiotic therapy. The treatment of choice consists of transsphenoidal surgical drainage and antibiotic therapy for 3--6 weeks. However, conservative antibiotic therapy may be useful for early pituitary abscesses. Visual deficiencies usually improve after treatment, but endocrine deficiencies may persist and require permanent replacement therapy. The recurrence rate is low, but MRI monitoring is advisable in order to detect recurrent abscess. In conclusion, it can be said that preoperative diagnosis of pituitary abscess is difficult because of its insidious clinical signs and symptoms and poorly specific radiographic findings. Pituitary abscess should be suspected in a patient with a cystic sellar mass with ring-shaped enhancement, particularly when associated with clinical signs of infection and/or diabetes insipidus. Because of the low frequency of pituitary abscess, we would like to see a multicenter study with a larger patient sample being conducted, with the aim of furthering our understanding of this condition.