A glucose transport protein expressed predominately in insulin-responsive tissues.

Using low-stringency hybridization to the rat brain glucose transporter (GT), a 2489-base-pair cDNA clone was isolated from a rat soleus lambda gt10 cDNA library. It encodes a 509-amino acid protein whose sequence and predicted membrane structure is very similar to those of the rat brain and liver GTs. The muscle GT-like protein is 65% identical in amino acid sequence to the rat brain GT and 52% identical to the rat liver GT; the major differences are in the NH2- and COOH-terminal hydrophilic segments. This GT-like mRNA is expressed predominately in tissues where glucose transport is sensitive to insulin, including striated muscle, cardiac muscle, and adipose tissue; low-level expression is also detected in smooth muscle and kidney mRNA. This GT-like cDNA is the fourth member of the mammalian GT-related gene family identified to date. We propose that it encodes an insulin-sensitive GT.     

Fatal isoflurane hepatotoxicity without re-exposure.

Isoflurane is less hepatotoxic than its predecessors, halothane and enflurane. We present a 68-year-old man who developed fulminant and fatal hepatic necrosis two days after open cholecystectomy done under isoflurane anesthesia. Laboratory findings included grossly elevated transaminases and bilirubin and prolonged prothrombin time. Serological studies were negative for viral hepatitis. Postmortem examination demonstrated centrilobular necrosis of liver.     

Influence of age and sex on lumbar vertebral morphometry determined using sagittal magnetic resonance imaging.

We evaluated age-related changes in the morphometric features of lumbar vertebrae in both sexes using magnetic resonance imaging (MRI). Midsagittal MRI scans of 366 individuals (156 males, 210 females; 25-82 years old) were evaluated retrospectively. The anterior height (H(a)), central height (H(c)), posterior height (H(p)), and anteroposterior diameter (D) of the body of each lumbar vertebra were measured. These measurements were used to calculate three indices, namely, the anterior wedge index (H(a)/H(p)), the biconcavity index (H(c)/H(p)), and the compression index (H(p)/D). The values of each of the three indices for the upper lumbar vertebrae of females were higher than those of the same vertebrae in males. The values of the compression index for all lumbar vertebrae decreased with age in females, whereas in males the compression index of the L1-L4 vertebrae decreased with age. No significant changes were observed in the value of the anterior wedge index in either sex. The biconcavity indices of the L1 and L5 vertebrae decreased with age in males. These results may be useful for evaluating age-related morphological changes that occur in the lumbar vertebrae.     

Global assessment of the coagulation status in type 2 diabetes mellitus using rotation thromboelastography.

Clinical and epidemiologic observations have led to the concept of a procoagulant state in type 2 diabetes. This study aimed to determine the coagulation status in type 2 diabetic patients using rotation thromboelastography (ROTEM), which measures the interactive dynamic coagulation process. For this purpose, 51 (30 women, 21 men) type 2 diabetic patients (mean age, 56.1 years) and 40 age-matched, sex-matched and body-mass-index-matched healthy individuals were enrolled. Twenty-seven of the diabetic group had diabetic vascular complications. ROTEM using different activators for the intrinsic and extrinsic systems of coagulation cascade (intrinsic TEM-INTEM, extrinsic TEM-EXTEM, FIBTEM) was used to measure the coagulation time (CT), clot formation time (CFT), alpha angle (alpha) and maximum clot firmness (MCF). No significant difference was found in the prothrombin time, partial thromboplastin time, thrombin time, fibrinogen and platelet count between the two groups. INTEM-CT and INTEM-CFT and EXTEM-MCF were significantly higher in the diabetic group compared with controls (P = 0.012, P = 0.007 and P = 0.029, respectively). INTEM alpha in the diabetic group was significantly lower than the controls (P = 0.001). All other parameters, including INTEM-MCF, EXTEM-CT, EXTEM-CFT, EXTEM-alpha, FIBTEM-CT, FIBTEM-CFT, FIBTEM-MCF and FIBTEM-alpha, were similar between the two groups. Taking into account these data, we conclude that there is subtle activation of the extrinsic pathway with a concomitant decrement in the intrinsic pathway of the coagulation cascade in type 2 diabetes. The exact underlying mechanisms leading to these changes, and their consequences with regard to diabetic complications, remain to be determined.     

Preoperative diagnosis of bronchial atresia presenting with recurrent respiratory symptoms in an infant

Bronchial atresia (BA) is a rare respiratory malformation that may be diagnosed from infancy to adulthood. A typical feature of the disease is involvement of the left upper lobe and a mass-like lesion surrounded by a hyperlucent and nondeflating zone. We present a six-month-old male infant who was diagnosed by contrast-enhanced spiral computed tomography (CT) with three-dimensional (3D) technology, and by Tc-99m-macroalbumin aggregate (Tc99m-MAA) radionuclide scintigraphy. We stress that early diagnosis of BA can be made noninvasively using contrast-enhanced spiral CT and radionuclide scintigraphy. 3D computed tomographic reformation allows a more accurate diagnosis as well as a more specific approach to management and follow-up.     

Thrombolytic therapy with tissue plasminogen activator for superior vena cava thrombosis in an infant with sepsis

Superior vena cava syndrome is rare in infants, and rarely responds to conservative treatment. We report a 22-mo-old girl with superior vena cava syndrome due to the use of a central venous line and/or sepsis. Doppler study and computed tomography angiography of the neck showed thrombosis within the superior vena cava and jugular veins. She was admitted to a monitored setting and received recombinant tissue plasminogen activator for 2 d. The clinical features of superior vena cava syndrome disappeared completely 3 d after treatment. No complications were observed and radiological investigations showed blood flow through the thrombus after treatment. Systemic recombinant tissue plasminogen activator may be useful in the treatment of superior vena cava syndrome in children.