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Background Few studies have evaluated the degree of pain, the amount of retained gas, and the safety of carbon dioxide (CO 2 ) insufflation in patients undergoing double-balloon enteroscopy (DBE). Objective To clarify the usefulness and safety of CO 2 insufflation during DBE. Design Single-center, prospective, randomized, double-blind, controlled trial. Setting University hospital. Patients Forty eligible patients with small-bowel disease for whom DBE was indicated were randomized to a CO 2 insufflation (CO 2 ) group or an air insufflation (air) group by means of sealed envelopes. Intervention DBE with insufflation of CO 2 or air. Main Outcome Measurements Efficacy evaluation was based on the degree of pain as assessed by use of a visual analog scale (VAS) and the amount of residual gas retention within the small and large bowels on radiography. The safety of CO 2 insufflation was evaluated by arterial blood gas analysis. Results Significantly fewer patients in the CO 2 group had severe pain of ≥50 mm on the VAS during DBE than in the air group ( P = .02). Significantly less gas was retained in the small bowel just after and at 3 hours after DBE in the CO 2 group than in the air group ( P = .003, P = .01, respectively). There was significantly less residual gas retention in the large bowel at 3 hours after DBE in the CO 2 group than in the air group ( P = .02). There was no significant difference in pre-DBE and post-DBE partial pressure of oxygen in the blood (PaO 2 ) and partial pressure of carbon dioxide in the blood (PaCO 2 ) between groups. Limitations Small sample size. Conclusion CO 2 insufflation is a safe and useful procedure when performed during DBE.

Background: Endoscopic balloon dilatation (EBD) is a therapeutic option for intestinal strictures of Crohn's disease (CD). Double-balloon endoscopy (DBE) enables EBD to be performed even for deep-situated strictures of the small intestine. The aim of this study was to clarify the efficacy and safety of EBD using DBE for small bowel strictures in patients with CD. Patients and Methods: The subjects comprised 25 patients with CD who underwent EBD using DBE for small intestinal strictures for which a colonoscope or gastrointestinal scope could not be inserted. All subjects had obstructive symptoms due to strictures that were confirmed using small intestinal enteroclysis. They were observed for at least 6 months after the initial EBD. The short-term success rate of EBD using DBE, the complication rate and the long-term outcome were investigated. Results: This procedure was successful with regard to short-term dilatation in 18 of the 25 CD patients (72%). Long strictures measuring more than 3 cm were seen in six out of seven (85.7%) of the unsuccessful EBD cases, compared with two out of 18 (11.1%) of the successful EBD cases (P = 0.001). Complications were encountered in two of the 25 patients (8%). The cumulative surgery-free rate for all the subjects was 83% and 72% at 6 and 12 months, respectively. Conclusion: EBD using DBE is a useful and safe procedure for small intestinal short strictures in CD patients. We conclude that this procedure is a therapeutic option that should be attempted before resorting to surgical therapy.

A 71-year-old male was diagnosed as having pyothorax-associated lymphoma (PAL), a rare hematological malignancy associated with artificial pneumothorax for the treatment of pulmonary tuberculosis. Because of the low incidence, its clinical features have not been fully clarified. The PAL lesion in this patient disappeared after local radiotherapy and corticosteroid treatment. However, 8 months after the initial diagnosis, he developed a variety of neurological disorders and low-grade fever. Neither recurrence of the primary pulmonary lesion nor nodal enlargement was observed. Immediate magnetic resonance imaging of the brain revealed a ring-enhanced mass, suggesting a brain abscess. However, through a stereotactic biopsy of the brain lesion, infiltration of PAL cells was identified. The brain lesion rapidly enlarged despite intensive radiotherapy, and he finally died of lymphoma progression. This case demonstrates that PAL may progress as a type of extranodal lymphoma, and that brain lesions may produce a ring-enhanced pattern on computed tomography.

The targeting of karyophilic proteins to nuclear pores is mediated via the formation of a nuclear pore-targeting complex, through the interaction of nuclear localization signal (NLS) with its NLS receptor. Recently, a novel human protein, Qip1, was identified from a yeast two-hybrid system with DNA helicase Q1. This study demonstrates that Qip1 is a novel third class of NLS receptor that efficiently recognizes the NLS of the helicase Q1. Moreover, the data obtained in this study show that the specific interaction between Qip1 and the NLS of the helicase Q1 requires its upstream sequence of the minimal essential NLS. By using purified recombinant proteins alone in the digitonin-permeabilized cell-free transport system, it was demonstrated that the two known human NLS receptors, Rch1 and NPI-1, are able to transport all the tested NLS substrates into the nucleus, while Qip1 most efficiently transports the helicase Q1-NLS substrates, which contain its upstream sequence in so far as we have examined the system. Furthermore, in HeLa cell crude cytosol, it was found that endogenous Rch1 binds to all the tested NLS substrates, while the binding of endogenous NPI-1 is restricted to only some NLSs, despite the fact that NPI-1 itself shows binding activity to a variety of NLSs. These results indicate that at least three structurally and functionally distinct NLS receptors exist in the human single cell population, and suggest that the nuclear import of karyophilic proteins may be controlled in a complex manner at the NLS recognition step by the existence of a variety of NLS receptors with various specificities to each NLS.

Endoscopic balloon dilatation (EBD) is a therapeutic option for intestinal strictures of Crohn's disease (CD). Double-balloon endoscopy (DBE) enables EBD to be performed even for deep-situated strictures of the small intestine. The aim of this study was to clarify the efficacy and safety of EBD using DBE for small bowel strictures in patients with CD.The subjects comprised 25 patients with CD who underwent EBD using DBE for small intestinal strictures for which a colonoscope or gastrointestinal scope could not be inserted. All subjects had obstructive symptoms due to strictures that were confirmed using small intestinal enteroclysis. They were observed for at least 6 months after the initial EBD. The short-term success rate of EBD using DBE, the complication rate and the long-term outcome were investigated.This procedure was successful with regard to short-term dilatation in 18 of the 25 CD patients (72%). Long strictures measuring more than 3 cm were seen in six out of seven (85.7%) of the unsuccessful EBD cases, compared with two out of 18 (11.1%) of the successful EBD cases (P=0.001). Complications were encountered in two of the 25 patients (8%). The cumulative surgery-free rate for all the subjects was 83% and 72% at 6 and 12 months, respectively.EBD using DBE is a useful and safe procedure for small intestinal short strictures in CD patients. We conclude that this procedure is a therapeutic option that should be attempted before resorting to surgical therapy.