The most common perceived benefits of RT-CGMS are prevention of hypoglycemia and decrease in hypoglycemia-related anxiety. Negative effects are uncommon and seem to be unlikely to affect the decision to use RT-CGMS for a LT. A ST trial seems to be a valuable tool for the patient/caregiver in determining whether to purchase the device and in setting realistic expectations of its potential benefits.

Black youths with type I diabetes mellitus are in poorer metabolic control than white youths.

We present two patients with subcutaneous fat necroses (SCFN) in whom endocrinologic studies revealed an association with elevated prostaglandin E (PGE) levels. A boy born after prolonged labor complicated by meconium aspiration developed erythematous, indurated plaques over the back, arms, buttocks, and cheeks at 4 days of age. A biopsy specimen of involved skin showed panniculitis with foci of necrotic adipocytes containing radially arranged, needle-shaped clefts and a granulomatous infiltrate in the septae. Laboratory studies revealed hypercalcemia of 13.6 mg/dl (normal 8.8-10.1 mg/dl), elevated 1.25-1.25(OH)2D3, and increased urinary excretion of PGE2. The child was hospitalized and treated with systemic steroids and diuretics, with resolution of SCFN and hypercalcemia. The second patient was a girl born with cyanotic heart disease. A diagnosis of Ebstein anomaly was made, and intravenous PGE1 was started to keep patent the ductus arteriosus. Four days later erythematous, indurated plaques were noted on the knee, back, and anterior chest. A skin biopsy specimen revealed SCFN. There was no associated laboratory abnormality. On discontinuing PGE1, no new lesions formed and the existing panniculitis resolved. These two cases demonstrate the association between SCFN and elevated PGE levels (endogenous in patient 1, exogenous in patient 2). No previous reports of SCFN after the administration of PGE1 have appeared in the literature.

Continous subcutaneous insulin infusion therapy in young children with type 1 diabetes is a safe, effective and superior alternative to a twice-a-day insulin regimen.

An infant was evaluated for a low thyroxine value, detected on routine neonatal screening for congenital hypothyroidism. She was found to have the congenital nephrotic syndrome, and to be euthyroid with low thyroid binding globulin. Congenital nephrosis can be detected by neonatal screening programs which use thyroxine as the primary screening test, but not by those which use TSH. This may be important in those countries in which the incidence of congenital nephrosis approaches that of congenital hypothyroidism.

No abstract

LD cosyntropin stimulation testing results should be interpreted cautiously when used alone to prevent unnecessary long-term treatment. Using a lower cut-off for LD (≥14 µg/dL) seems to avoid false positive results and still detects most cases of impaired HPAA.

SIR-In their Letter 'Global trends in emerging infectious diseases' (Nature 451, 990-993; 2008), Kate Jones and colleagues reveal that emerging human infectious diseases are becoming globally more prevalent, particularly those originating from wildlife. Even when cases of all other transmission types started to decrease during 1990-2000 compared with previous decades, cases of wildlife-associated human diseases continued their upward trend. The authors highlight the implications for conservation, advocating more monitoring and preservation of areas rich in biodiversity to counter it. They do not mention the social and psychological effect this proliferation of wildlife-associated zoonoses could have. Such diseases are widely perceived as a threat to humans (see, for example, W. D. Newmark et al. Biol. Conserv. 63, 177-183; 1993). Negative interactions with wildlife tend to stifle support for conservation policies and initiatives. The increasing prevalence of such diseases could stand in the way of the very conservation initiatives that Jones and colleagues are recommending to protect human health. Widespread disease in wildlife populations could encourage humans to view wild animals as pests, instead of as resources to be protected and enjoyed. Risk-perception research on wildlife-associated zoonoses would confirm the extent to which this shift has occurred. Such research would also identify gaps between the public's attitudes and epidemiological assessments, and would help to gauge the extent of public support for different proactive management plans. This would enable wildlife managers to decide which plans would be the most politically and socially viable, as well as the best ways to inform the public about them.