Background/Aims: The exact mechanism that links insulin resistance and vascular disease remains unknown. A significantly increased Na+-H+ exchanger (NHE 1) activity and a different effect of insulin on obese individuals erythrocyte NHE 1 has been suggested. These observetions may provide a link between obesity, hyperinsulinemia and vascular disease. Methods: The intracellular pH and sodium influx were measured before and after addition of insulin in erythrocyte suspensions from normal and obese individuals. Amiloride, a specific NHE 1 inhibitor, and staurosporine a protein kinase C inhibitor were used to inhibit erythrocyte NHE Results: Erythrocytes from normal individuals showed increased pH and increased sodium influx after insulin stimulation. This effect of insulin was inhibited by amiloride and by staurosporine as well. In contrast insulin had no effect on NHE 1 activity of erythrocytes from obese individuals. Conclusion: These ex vivo data indicate that erythrocyte NHE 1 activity in obese individuals is "insulin resistant". Erythrocytes may provide a simple system for the study of insulin resistance pathways in obesity..
Swine flu is a multisystemic disease and can affect the gastrointestinal system. There are only three published reports of swine flu cases with acute appendicitis; two of them in children under 16 years of age. We present an unusual case of acute appendicitis in a child already diagnosed with swine flu infection. A 9½-year-old girl presented with febrile illness and mild abdominal pain. PCR (+) was positive for H1N1. 3 days after hospital admission she developed acute appendicitis and was operated on. On the fourth postoperative day she developed right upper lobe atelectasis; she was started on antiviral treatment to which she responded very well. She was discharged on day 7 without further consequences in her postoperative course. Children with swine flu may be susceptible to rapidly deteriorating and complicated acute appendicitis. This calls for more caution especially in periods of epidemics.
We describe an asymptomatic case of PJS in a six-year-old boy with café au lait spots in several parts of his body, a large gastroduodenal polyp, two polyps near the ampulla of Vater, and another in the jejunum. This patient shows some unique aspects of PJS. No other such large gastric polyp in a Peutz-Jeghers child is reported in the literature. The large size of the gastric polyp with lack of symptoms is unusual and poses a unique challenge in terms of management and surgical resection.
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