Closed-loop clinical trials have resulted in significant advances with continuous glucose monitoring and control systems modulating insulin delivery. Those trials were performed in closely supervised clinical research settings; while adults with Type 1 diabetes were initially targeted, studies in children with Type 1 diabetes have followed in both clinical research units and pediatric diabetes camps. These studies have been conducted as multicenter and multinational efforts. Pediatric studies have since been piloted in home settings overnight for control during sleep. The stage is now set for accelerating efforts, extending the number of patients enrolled, the amount of time during which the system is active daily and the duration of the clinical trials.
Modern air-nailing tools are known to cause penetrating trauma. We report the unusual case of a pneumatically fired carpenter's nail that penetrated the chest of a 30-year-old man and subsequently embolized from the heart to the left femoral artery without clinical evidence of having entered the heart. The nail was surgically removed, and the patient was discharged from hospital without sequelae after 10 days. This case and the relevant literature are discussed from the perspective of the emergency department investigation and care of such patients. RÉSUMÉLes cloueuses pneumatiques modernes peuvent causer des traumatismes pénétrants. Nous présen-tons un cas inhabituel de pénétration d'un clou de charpentier à déclenchement pneumatique dans le thorax d'un homme de 30 ans. Le clou s'est par la suite embolisé à partir du coeur vers l'artère fémorale gauche sans signe clinique de pénétration du coeur. Le clou fut retiré chirurgicalement et le patient reçut son congé de l'hôpital après dix jours, sans séquelle. Le présent cas et la littérature pertinente sont discutés du point de vue de l'investigation au département d'urgence et des soins à donner à un tel patient. CASE REPORT • OBSERVATIONS DE CAS Nail embolization to the femoral artery Case reportA 30-year-old man presented to our emergency department (ED) by private vehicle after being unintentionally shot with a pneumatic nail gun at his workplace. Thirty minutes prior to arrival the patient was standing underneath a wooden board when a colleague, who was sitting above him, fired a nail through the board and into the patient's chest. On arrival the patient was diaphoretic and anxious. His blood pressure was 68/52 mm Hg, heart rate 133 beats/min, respiratory rate 18 breaths/min, room air oxygen saturation 96%, and he had a Glasgow Coma Scale score of 14. There was a round entry wound 5 mm in diameter over the mid-sternum (Fig. 1). No exit wound was identified. Chest auscultation revealed normal air entry and lung sounds bilaterally, and normal heart sounds. There was no jugular venous distension, and the abdomen was soft and non-tender. A detailed examination of the extremities was not initially performed. The patient was immediately placed on 100% oxygen by a non-rebreather mask, and two 16-gauge peripheral intravenous lines were established. After a rapid infusion of 2 L of crystalloid, the patient's blood pressure rose to 151/98 mm Hg with sinus tachycardia at 110 beats/min by cardiac This article has been peer reviewed. Can J Emerg Med 2005;7(4):278-81
BackgroundThe objective of this study was to evaluate the age at onset and frequency of individual pituitary hormone deficiencies (PHDs) in optic nerve hypoplasia (ONH).MethodsWe performed a retrospective chart review of patients ≤21 years of age evaluated between 1996 and 2014. Patients were included if they had: (1) ONH diagnosed by an ophthalmologist and/or magnetic resonance imaging (MRI), (2) documentation of pituitary hormone function on at least two separate occasions and (3) at least one PHD documented or a midline abnormality of the brain on MRI.ResultsThirty-two patients (18 females, 14 males) were included (median age, 8 years [range, 1.1–21.0 years]). All patients had ONH (bilateral, n = 31; unilateral, n = 1) and at least one midline abnormality of the brain. At least one PHD was present in 75% of patients (n = 24). The remaining 25% of patients (n = 8) did not develop any PHD at least until the last follow-up (<2–8.6 years of follow-up), despite the presence of ONH and a midline abnormality of the brain. The median age (years) at diagnosis of antidiuretic hormone (ADH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and growth hormone (GH) deficiencies was 0.5, 0.6, 0.7 and 1.6, respectively. Twenty-three percent of all PHDs were identified during the neonatal period, 56% by 12 months and 72% by 36 months of age. The latest age at diagnosis of GH, ACTH and TSH deficiencies was 9.6, 9.9 and 12.6 years, respectively.ConclusionsThe majority of the PHDs in ONH develop within the first 3 years of life. We propose evaluation for endocrinopathies at the time of diagnosis of ONH, with repeat assessment for new deficiencies every 3–4 months until age 3 years and at least semi-annually until growth and puberty are complete.
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