RESUMEN
Intermittent change in ventricular size in patients with ventriculo-peritoneal shunts is a recognised complication but definitive imaging evidence is rare. We report a 3 years old boy with a medullary astrocytoma and ventriculo-peritoneal shunt placement who demonstrated intermittent ventriculomegaly during a single MRI scan.
Asunto(s)
Ventrículos Cerebrales/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Derivación Ventriculoperitoneal/efectos adversos , Astrocitoma/complicaciones , Astrocitoma/diagnóstico por imagen , Neoplasias del Tronco Encefálico/complicaciones , Neoplasias del Tronco Encefálico/diagnóstico por imagen , Preescolar , Falla de Equipo , Humanos , Hidrocefalia/cirugía , Masculino , Resultado del TratamientoRESUMEN
Magnetic resonance imaging using T2* (MRI T2*) is a highly sensitive and non-invasive technique for the detection of tissue iron load. Although the single breath-hold multi-echo T2* technique has been available at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, since 2006, it could not be performed on younger patients due to their inability to hold their breath after expiration. This study was carried out between May 2007 and May 2015 and assessed 50 SQUH thalassaemic patients aged 7-17 years old. Seven of these patients underwent baseline and one-year follow-up MRI T2* scans before receiving physiotherapy training. Subsequently, all patients were trained by a physiotherapist to hold their breath for approximately 15-20 seconds at the end of expiration before undergoing baseline and one-year follow-up MRI T2* scans. Failure rates for the pre- and post-training groups were 6.0% and 42.8%, respectively. These results indicate that the training of thalassaemic patients in breath-hold techniques is beneficial and increases rates of compliance for MRI T2* scans.
RESUMEN
Optimum glycemic control is extremely important in patients with diabetes mellitus to avoid long-term complications. Glycemic control relies mainly on the use of hemoglobin A1c, which unfortunately showed inaccurate results in patients with hemoglinopathies. The authors describe a case of beta-thalassemia with poorly controlled diabetes mellitus that has misleading low levels of HbA1c. The use of a continuous glucose monitoring system was useful in documenting her poor glycemic control, with prolonged periods of hyper- and hypoglycemia. Based on these results, her insulin regimen was adjusted and the blood glucose levels were greatly improved throughout and the patient was able to meet her target blood glucose range (72-140 mg/dL [4-7.8 mmol/L]) in 70% of the time.