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R Barrio Castellanos

Publications and source records attributed to R Barrio Castellanos.

16 recordsLinked to original sources
PubMed2006

[Continuous subcutaneous insulin infusion in pediatric patients with type 1 diabetes mellitus].

INTRODUCTION: To determine the efficacy and safety of continuous subcutaneous insulin infusion therapy in a group of children and adolescents with type 1 diabetes mellitus. PATIENTS AND METHODS: Data from 17 patients were collected during the first year of continuous subcutaneous insulin infusion treatment. All patients were followed-up at our diabetic pediatric clinic. HbA1c, body mass index, insulin dose, severe hypoglycemic episodes, and diabetic ketoacidosis events before and after initiation of pump therapy were compared. RESULTS: The mean age was 14.02 +/- 3.70 years and the mean diabetes duration was 5.81 +/- 3.31 years. HbA1c decreased from 8.12 +/- 1.46 to 7.52 +/- 0.87 % after 2 months of therapy and this decrease was maintained throughout the first year of continuous subcutaneous insulin infusion treatment. Insulin dose decreased from 0.99 +/- 0.24 to 0.84 +/- 0.18 U/kg/day after 1 year of treatment. Body mass index remained unchanged. There were fewer severe hypoglycemic events after the start of insulin pump therapy (0.47 +/- 1.23 events/patient in the 6 months before continuous insulin infusion, 0.29 +/- 1.20 episodes in the first 6 months of insulin pump therapy and 0.06 +/- 0.24 in the period from 6 to 12 months of the treatment). There were 3 ketoacidosis episodes, all in the same patient. CONCLUSIONS: Continuous subcutaneous insulin infusion is a safe and effective alternative in the treatment of children and adolescents with type 1 diabetes mellitus. It improves metabolic control and decreases the number of severe hypoglycemic episodes.

Adolescent↗
PubMed2005

[Graves' disease in preschool children].

Graves' disease, which is the main cause of hyperthyroidism in the pediatric age group, is very rare in pre-school children. We describe the cases of four girls, aged less than 6 years old, out of a total of 30 patients diagnosed with Graves' disease between 1985 and 2004. Investigations were motivated by tachycardia, chronic diarrhea, language development delay or thyroid nodules detected by cervical ultrasonography. In three of the four patients height and bone age were advanced. In all patients goiter was small or absent. None of the patients had ophthalmic disease. In all patients free T3 and T4 were elevated and thyroid-stimulating hormone was suppressed. Three patients were positive for thyroid-stimulating immunoglobulins (the method was not available for the oldest case). Two patients showed complete resolution after 5 years of treatment with carbimazole. The remaining two patients are still under treatment and no adverse effects have been documented.

Child, Preschool↗
PubMed2000

[Insulin Lispro (Lys B28, Pro B29) treatment in adolescents and young people with type 1 diabetes].

BACKGROUND: The human insulin analogue, Lispro (Lys B28, Pro B29), is more similar to normal pancreatic insulin response to ingestion. Therefore, it could provide an alternative to the classical treatment of type-1 diabetes in childhood. The aim of this study was to analyze the response to insulin treatment with this analogue during 1 year. PATIENTS AND METHODS: In a study group of twenty puberal diabetic patients (nine male and 11 female) with a mean age of 15.6 years (+/- SD) and with diabetes of a mean of 8.3 years (+/- 4.3 SD), classical intensive treatment, a combination of regular insulin (HR) and NPH insulin (Humulin NPH) was substituted for a new treatment with Lispro and NPH insulin in 3-4 doses. All patients had received diabetic education and performed at least four blood glucose tests daily and self monitoring. We analyzed the 6 months prior to the change in treatment (Group A) and the 12 months after the change (Group B). The amount of insulin (u/kg/day), the fast/intermediate insulin ratio in each dose, dietary modifications, the level of metabolic control given by the HbA1C average measured every 2 months, severe hypoglycemia and the patient s level of satisfaction with the new treatment were compared between the two groups. RESULTS: The number of daily doses, as well as the daily insulin intake, was the same in both groups (3.7 [+/- 0.6] doses/day; 0.9 [+/- 0.2] u/kg/day). With Lispro treatment the ratio fast/intermediate insulin was reduced. This reduction was statistically significant for the pre-breakfast dose (Classical = 65. 4 +/- 30% vs Lispro = 47.1 +/- 19.6%), and for the pre-lunch dose (Classical = 58.1 +/- 29.3% vs Lispro = 39 +/- 12.8%). Most patients did not need neither mid-morning or mid-afternoon doses. There were no modifications in body mass index. Although metabolic control improved slightly (Classical X A(b) A(1)c = 7 +/- 1.2 vs Lispro X A(b) A(1c) = 6.6 +/- 1.1), the difference was not statistically significant. Three patients had a severe hypoglycemic episode in the first 6 months with the new treatment pattern. All of them were satisfied with the new insulin. CONCLUSIONS: Intensive therapy with Lispro insulin combined with appropriate doses of basal insulin (NPH) can provide a good alternative in the treatment of diabetic teenagers.

Adolescent↗
PubMed2000

[Evaluation of gonadal function in post-pubertal patients after bone marrow transplantation during childhood objective].

AIM: To evaluate the effect of bone marrow transplantation during childhood on gonadal function in postpubertal patients. METHODS: We studied 19 post-pubertal patients (13 males, 6 females) aged 13-20 years, 2-9 years after bone marrow transplantation for diverse diseases. Fifteen patients had received multi-agent cytotoxic treatment and 6 had received cranial irradiation prior to transplantation; eleven patients received total body irradiation. Gonadal function was assessed by typifying Tanner's stages of pubertal development and by measuring testicular volume in males (Prader's orchidometer). Serum concentrations of luteinizing hormone, follicle-stimulating hormone, testosterone and 17-beta-estradiol were also measured. RESULTS: Twelve patients were found to have gonadal dysfunction of gonadal origin. Of these, three had not received total body irradiation. CONCLUSIONS: The results obtained show that gonadal dysfunction is frequent in patients treated with bone marrow transplantation. This damage can be attributed to both chemo- and radiotherapy but a synergistic effect between these treatments could not be excluded. The prepubertal status of patients at the moment of transplantation was not a protective factor against chemo- or radiotherapy-induced gonadal damage in our series.

Adolescent↗
PubMed1999

[The evaluation of gonadal function in postpubertal patients treated for cryptorchism in childhood].

OBJECTIVE: Descent of the testes is essential for normal function, with cryptorchidism being associated with defective spermatogenesis. The postpubertal function of cryptorchid testicles seems to be related to the original location of the undescended testis and the age at the moment of treatment. The objective of this study was to evaluate the pubertal development and gonadal function in postpubertal patients treated for cryptorchidism during childhood. PATIENTS AND METHODS: Twenty postpubertal males with a mean age of 17.35 years (range: 15-21 years) and treated for cryptorchidism during childhood were evaluated for pubertal development and gonadal function. A hormonal study which included basal determinations of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), testicular volume assessed by Prader's orchidometer and semen analysis was performed on each patient. RESULTS: Complete virilization was observed in all patients. The start and development of puberty were normal in all cases (except one patient that started puberty at 10 years of age). Basal studies in all patients showed normal levels of LH and testosterone. FSH levels were increased in 3 patients and normal in the other 17 patients. Fourteen patients achieved normal spermatogenesis with more than 20 million spermatozoa/ml. In the other 7 patients (35%), 5 with unilateral cryptorchidism and 2 with bilateral cryptorchidism, the sperm count remained below 20 million with a range of 0.8 to 18.4 x 10(6) spermatozoa/ml. The three males with elevated levels of FSH also presented oligospermia. CONCLUSIONS: The results obtained show that pubertal development is normal after cryptorchidism. Impaired spermatogenesis is a major factor in undescended testes. Basal SH levels can be useful in predicting germinal damage secondary to cryptorchidism.

Adolescent↗
PubMed1999

[Pubertal growth, final height and weight gain in girls diagnosed with IDDM during pre-pubertal period].

OBJECTIVE: Girls diagnosed of type 1 diabetes mellitus during the prepubertal stage may present reduced longitudinal growth and have a tendency to be overweight after puberty starts. Our objective was to evaluate the growth, pubertal growth spurt, final height and weight gain of diabetic girls diagnosed of insulin dependent diabetes during the prepubertal period. PATIENTS AND METHODS: We evaluated retrospectively the longitudinal growth and body mass index (BMI) of 17 girls diagnosed of type 1 diabetes before puberty, from the time of diagnosis until final height. The effects of age at diagnosis, evolution time, insulin therapy (conventional or intensified), insulin dose and metabolic control on growth were analyzed. RESULTS: The final height attained was 161 +/- 4 cm, which is within the target height range. The height at diagnosis (0.31 +/- 0.71) was normal in relationship to the reference population, showing a significant reduction upon reaching the final height (-0.18 +/- 0.77). The BMI was significantly increased when it was compared at final height (0.99 +/- 0.79) with the index obtained one year after the onset of diabetes (0.04 +/- 0.63). The insulin therapy regimen did not affect the evolution of the patients and no significant relationship existed between the age at diagnosis, duration of diabetes, daily insulin dosage or metabolic control and height or BMI. CONCLUSIONS: The final height of type 1 diabetic girls is reduced and adolescent diabetic girls have a tendency to be overweight. Metabolic control (for the range observed in these patients) or insulin dosage does not seem to affect the growth of diabetic girls.

Anthropometry↗
PubMed1992

[Differentiated thyroid carcinoma in childhood].

We report the cases of 6 patients, all younger than 14 years of age, with differentiated thyroid carcinoma. None of the patients had a previous history of radiation exposure. All patients presented with an enlarged thyroid gland as a solitary nodule, with or without cervical nodes. The fine-needle aspiration cytological examination was found to be the most sensitive and specific, evidencing 5 pure papillary adenocarcinoma and 1 follicular. Our standard preoperative evaluation included thyroid scintiscan and ultrasound examination, laboratory studies of thyroid function and serum calcitonin, chest x-ray, fine needle aspiration and vocal cord examination. The treatment was total thyroidectomy and bilateral modified neck dissection. A whole body scan (WBS) with 131I was performed 6 weeks after surgery, followed by radioiodine therapy for ablation of thyroid remnants and treatment of metastases when present. Patients then began thyroid replacement treatment. The follow-up of the patients consisted of thyroglobulin and WBS. The microscopic carcinoma was found in the contralateral lobe in 100%. Lung metastases were detected in 2 patients. All of the patients have survived during a follow-up period ranging from 6 to 108 months.

Adenocarcinoma↗
PubMed1988

[Graves' disease in childhood].

Authors describe clinic and therapeutic results in seven hyperthyroid Graves' disease patients between ages of three and a half an 15 and a half (x: 11.2) years relating their results with those of literature. Most peculiar aspects of these cases were pretibial myxedema in two patients and lack of goiter in one of them. Results include T4 greater than 18.5 mcg/100 ml in five, T3 greater than 645 ng/100 in three and a relationship between T3/T4 greater than or equal to 20 in five. These results have been evaluated as signs of a bad prediction. After a two years treatment with antithyroid drugs remission was obtained in five cases, two of which relapsed again (40%). Authors recommend as initial treatment anti-thyroids drugs in high dosages with an individual lasting period of treatment using specific markers of remission (antibodies directed the receptor for TSH, triiodothyronine suppression test, relationship okt4/okt8).

Adolescent↗
PubMed1988

[Recurrence of Cushing's disease in a child after transsphenoidal excision of a pituitary adenoma: hypothalamic change?].

A case of Cushing disease in a 5 4/12 year-old boy is reported. After adenomectomy was performed, he was considered as "cured" but he relapsed after nineteen months. In a second transsphenoidal surgery a 2 X 3 mm piece of pituitary tissue with adenomatous aspect, was removed. It was histologically constituted by normal pituitary cells and Crooke cells. As the patient was in a cortisol-deficient state a remission was established. Nowadays, since the cortisol response to hypoglycemia was positive, we are paying attention to the risk of relapse. We discuss the possibility of a hypothalamic lesion as the cause and different therapeutic strategies in order to be more selective.

Adenoma↗