Covered expandable metallic stent placement for hemostasis of colonic bleeding caused by invasion of gallbladder carcinoma.

A 72-year-old Japanese man was admitted to our hospital complaining of right upper-quadrant abdominal pain, blood in his stool, and symptoms of anemia. On physical examination a hard mass, about 6 cm in diameter, was palpable in the right upper quadrant of the abdomen. Computed tomography revealed a gallbladder carcinoma which had invaded the transverse colon, with liver metastasis. We diagnosed gallbladder carcinoma, stage IVB. Colonoscopy was performed for persistent blood in the stools. This revealed an elevated lesion which appeared to be an invasion of gallbladder carcinoma, with diffuse bleeding from the right-side of the transverse colon. It proved difficult to stop this bleeding by ordinary therapeutic endoscopy. In order to achieve hemostasis we therefore inserted a covered Ultraflex metallic stent to compress the tumor. After stent placement, blood was no longer seen in the patient's stools, he became able to eat soft food and was discharged. This treatment was uninvasive and effective. Covered stent placement appears to be a new and useful method in the management of bleeding from malignant gastrointestinal tumors.

Secretion of authentic 20-kDa human growth hormone (20K hGH) in Escherichia coli and properties of the purified product.

Using Bacillus amyloliquefaciens neutral protease gene (npr), we have constructed a secretion system of 20-kDA human growth hormone (20K hGH) in E. coli. The secretion-signal region from npr was modified inserting a fragment coding a 2Lys-5Leu cluster. In this system we found that co-expression of glutathione reductase remarkably increased accumulation level of 20K hGH in periplasm and confirmed that secreted 20K hGH was correctly processed. The recombinant 20K hGH was highly purified and subjected to analyses of physicochemical properties and biological activities which are still unclear and controversial due to difficulty in preparing the sample with authentic structure. The secreted recombinant product had authentic disulfide linkages and showed molecular weight of 20,270.5 +/- 3.7 (theoretical value, 20,269.9). The results suggest that the recombinant 20K hGH is a full agonist on rat growth promotion and lipolysis stimulation in isolated rat adipose tissues. In particular, the lipolysis-stimulating activity of 20K hGH was distinct as compared with that of 22K hGH under physiological concentration. Cell proliferation activity via prolactin-receptor in Nb-2 lymphoma was obviously low as compared with that of 22K hGH.

[Clinical significance of urinary N-acetyl-beta-D-glucosaminidase activities in surgery].

Urinary N-acetyl-beta-D-glucosaminidase (U-NAG) activities were measured in 62 patients surgically treated in our clinic. The results obtained were as follows: The preoperative U-NAG activities were 9.53 +/- 8.63 IU/day in patients in elective operations, and 31.39 +/- 23.47 IU/day in cases in emergency surgery or exploratory laparotomies. The U-NAG activities were elevated slightly even in patients with no postoperative complications, suggesting there was significant damage to the renal tubular epithelium. In the patients with postoperative complications, the U-NAG activities were elevated markedly, especially in those with circulatory shock, suggesting severe damage to the renal tubular epithelium. Though the U-NAG showed abnormally high activities, the values of BUN, S-Cr, U-protein, UUN/BUN, FENa, Ccr, CH2O remained within the normal range. On the contrary, when they were abnormal, the U-NAG activities were not elevated. All patients, who showed high U-NAG activities with abnormal values of Ccr and/or CH2O, developed acute renal failure (ARF). In order to detect ARF in an early stage, Ccr and CH2O should be measured when U-NAG activities rose to over 50 IU/day.