Síndrome de Guillain-Barré y anticuerpos antigangliósidos / Guillain-Barré syndrome and anti-ganglioside antibodies

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Estudio de la variabilidad glucémica en niños y adolescentes con diabetes tipo 1 en tratamiento con insulina glargina / A study of variability in glycaemia in children and adolescents with diabetes mellitus type 1 on treatment with insulin glargine

Objetivo: Determinar la utilidad de la insulina glargina (IG) en la disminución de hipoglucemias e hiperglucemias en niños y adolescentes con diabetes tipo 1. Pacientes y métodos: Se trata de un estudio retrospectivo/prospectivo, en el que 29 pacientes con hipoglucemias leves/moderadas frecuentes, con edades comprendidas entre 3 y 18 años, y HbA1c de 8 ± 0,7, recibieron tratamiento con IG una vez al día e insulina regular o un análogo de la insulina rápida antes de cada comida. Los criterios de inclusión fueron los siguientes: a) tratamiento previo con insulina de acción intermedia (NPH); b) más de 1 año de evolución de la diabetes, y c) más de tres controles de glucemia/día. Se recogió la incidencia de episodios de hipoglucemias (leves, moderadas y graves), hiperglucemias, los valores de HbA1c, el índice de masa corporal y la dosis diaria de insulina antes y después de iniciar el tratamiento con IG. Además, se realiza una encuesta de opinión directa a la familia sobre la calidad de vida. Resultados: Los resultados se obtuvieron a partir de 1.294 ± 411 glucemias/paciente. La incidencia global de hipoglucemias no se reduce (el 5,9 frente al 6,2 % de valores glucémicos/mes) y las hiperglucemias globales permanecen sin cambios. Sin embargo, se reduce de forma significativa la hiperglucemia en ayunas (el 4,3 frente al 2,6 %) con tendencia a la disminución de las hipoglucemias nocturnas. La HbA1c continúa también sin cambios al igual que los requerimientos totales de insulina diaria (0,8 ± 0,2 U/kg/día). Conclusiones: La IG consigue un control glucémico similar al que se logra con la NPH, con tendencia a la disminución de las hipoglucemias nocturnas y a la mejoría de los valores de glucemia en ayunas (AU)

Objective: To determine the usefulness of insulin glargine (IG) to reduce hipoglycaemias and hyperglycaemic events in children and adolescents with type 1 diabetes. Patients and methods: In a retrospective/prospective study, 29 patients with a high number of non-severe hypoglycaemias, aged 3-18, and an average HbA1c of 8 ± 0.7, received IG once daily plus regular insulin or rapid analogue before meals. Inclusion criteria were: a) previous treatment with NPH insulin; b) diagnosis of type 1 diabetes for at least 1 year before starting IG, and c) > 3 blood glucose controls within a day. Incidence of severe and non-severe hypoglycaemic events, hyperglycaemic events, HbA1c values, body mass index, daily insulin dose before and after the institution of glargine therapy, were collected. Additionally, family were asked to complete a diabetes quality of life survey. Results: 1,294 ± 411 glycaemias/subject were obtained. Hypoglycaemic episodes were not reduced (5.9 % vs 6.2 %) and hyperglycaemic events remained unchanged. Fasting blood glucose levels decreased from 195.3 ± 36.6 to 162.8 ± 25.8 in all patients (p < 0.05) and a tendency a decrease in nocturnal hypoglycaemias was observed. The average HbA1c and total daily insulin dosis also remained unchanged (0.8 ± 0.2 UI/Kg/day). Conclusions: Using IG achieves a glycaemic control similar to NPH, with a tendency to decrease the frecuency of nocturnal hypoglycaemias and an improvement in fasting glycaemia values(AU)

¿Quiste aracnoideo como causa de pubertad precoz? / Arachnoid cyst as a cause of precocious puberty?

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[A study of variability in glycaemia in children and adolescents with diabetes mellitus type 1 on treatment with insulin glargine]. / Estudio de la variabilidad glucémica en niños y adolescentes con diabetes tipo 1 en tratamiento con insulina glargina.

OBJECTIVE: To determine the usefulness of insulin glargine (IG) to reduce hipoglycaemias and hyperglycaemic events in children and adolescents with type 1 diabetes. PATIENTS AND METHODS: In a retrospective/prospective study, 29 patients with a high number of non-severe hypoglycaemias, aged 3-18, and an average HbA1c of 8+/-0.7, received IG once daily plus regular insulin or rapid analogue before meals. Inclusion criteria were: a) previous treatment with NPH insulin; b) diagnosis of type 1 diabetes for at least 1 year before starting IG, and c) >3 blood glucose controls within a day. Incidence of severe and non-severe hypoglycaemic events, hyperglycaemic events, HbA1c values, body mass index, daily insulin dose before and after the institution of glargine therapy, were collected. Additionally, family were asked to complete a diabetes quality of life survey. RESULTS: 1,294+/-411 glycaemias/subject were obtained. Hypoglycaemic episodes were not reduced (5.9% vs 6.2%) and hyperglycaemic events remained unchanged. Fasting blood glucose levels decreased from 195.3+/-36.6 to 162.8+/-25.8 in all patients (p<0.05) and a tendency a decrease in nocturnal hypoglycaemias was observed. The average HbA1c and total daily insulin doses also remained unchanged (0.8+/-0.2 UI/Kg/day). CONCLUSIONS: Using IG achieves a glycaemic control similar to NPH, with a tendency to decrease the frequency of nocturnal hypoglycaemias and an improvement in fasting glycaemia values.

[Otologic determining factors on infra-red tympanic thermometry in children]. / Condicionantes otológicos en termometría timpánica con infrarrojos en niños.

OBJECTIVE: To evaluate the influence of different otoscopic findings on body thermometry in children using an infra-red tympanic thermometer. PATIENTS AND METHODS: Body temperature was measured on healthy right and left ear canals with Thermoscan systems. Moreover, it was determined on children with altered otoscopy, companng to normal contralateral ear. To assess its diagnostic fiability, accuracy ratios were calculated in different temperatures. RESULTS: Temperature measured bilaterally did not offer differences, and intra/interassay variation ratios were always less than 0.34%. Acute otitis externa increased tympanic thermometry a mean of 0.36 degrees C (p < 0.001), and cerumen and previously radical surgery decreased a mean of 0.62 and 0.53 degrees C, respectively (p < 0.001). CONCLUSIONS: The conditions mentioned before modify body thermometry if measured by infra-red tympanic thermometer. So, this system must be avoided in these circumstances. Otitis media, fluid in middle ear, tympanic perforation and ventilation tubes did not modify thermometric results.

Teratoma ovárico gigante: un hallazgo casual / Giant ovarian teratoma: An incidental finding

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[True double dermoid cyst of the tongue]. / Doble quiste dermoide verdadero de lengua.

Dermoid cysts into ENT zone are specially infrequent--just the 7% of the organism--, and extremely rare if are located in the tongue. They are usually detected as midline acute swelling, and produce swallowing, speech and sleep disorders at neonatal period because of their congenital character. We present an eleven-year-old boy admitted at our Hospital bearing a submandibular and oral swelling, and dysphagia with odynophagia, finally diagnosed as an intralingual double dermoid cyst of the anterior two thirds. The history of frenulectomy due to a presumed ankyloglossia, the previous presence of a dorsal tumour in tongue with a difficult phonetic articulation, and the midline location of lesions made us to suspect on dermoid cysts of the tongue. Complete surgical excision were diagnostic and therapeutic, and the child recovered totally their mastication, swallowing and speech abilities. Pathophysiological aspects, treatment and the atypical course of the case are discussed.

Doble quiste dermoide verdadero de lengua / True double dermoid cyst of the tongue

Los quistes dermoides del entorno ORL son especialmente infrecuentes sólo el 7 por ciento de todo el organismo, resultando su localización en lengua particularmente rara. Comúnmente detectados por un proceso inflamatorio agudo de la línea media, su carácter congénito suele producir trastornos en la deglución, articulación de la palabra o en el sueño ya en el período neonatal. Presentamos el caso de un niño de 11 años que ingresó en nuestro Hospital por inflamación submandibular y de cavidad oral y disfagia con odinofagia, finalmente diagnosticado de doble quiste dermoide intralingual de los dos tercios anteriores. El antecedente de sección del frenillo por presunta anquiloglosia, la existencia de una tumoración en el dorso de la lengua previa al cuadro con dificultad en la articulación de algunos fonemas, y la localización medial de las lesiones hicieron sospechar en quistes dermoides congénitos de lengua. La exéresis completa de las lesiones resultó diagnóstica y terapéutica, y el niño recuperó totalmente su capacidad de masticación, deglución y conversación. Se discuten los aspectos fisiopatológicos, terapéuticos y la atípica evolución clínica de este caso (AU)

Dermoid cysts into ENT zone are specially infrequent--just the 7% of the organism--, and extremely rare if are located in the tongue. They are usually detected as midline acute swelling, and produce swallowing, speech and sleep disorders at neonatal period because of their congenital character. We present an eleven-year-old boy admitted at our Hospital bearing a submandibular and oral swelling, and dysphagia with odynophagia, finally diagnosed as an intralingual double dermoid cyst of the anterior two thirds. The history of frenulectomy due to a presumed ankyloglossia, the previous presence of a dorsal tumour in tongue with a difficult phonetic articulation, and the midline location of lesions made us to suspect on dermoid cysts of the tongue. Complete surgical excision were diagnostic and therapeutic, and the child recovered totally their mastication, swallowing and speech abilities. Pathophysiological aspects, treatment and the atypical course of the case are discussed (AU)

[Limitation in articular movement in diabetic children]. / Limitación de la movilidad articular en niños diabéticos.

The presence of limited movement articular (LMA) was examined in 58 insulin-dependent diabetic children 38 boys and 20 girls in a range of 1 to 18 years. The children were ill during a mean of 4 years and 7 months +/- 3 years and nine months. The MAL was present in 36.2% of diabetic children versus 2.08% in the control group (96 healthy children). The presence of MAL has a statistically significant correlation with: age (9 years or more) (p less than 0.01); poor metabolic control (specially in severe forms) (p less than 0.001) and retinopathy (p less than 0.02). The examination of LMA is very useful for the early diagnosis of retinopathy in high risk patients because of the very frequent association of both complications of diabetes.