Potassium iodide was discovered as part of a war effort at the beginning of the 19th century in France. For the manufacture of gunpowder, sodium carbonate was extracted from seaweed ash. During this process, Courtois, a French chemist, discovered iodide in 1811. Potassium iodide was first used as a medicament for the therapy of goiter, which had been treated with seaweed ash. The therapeutic effect was excellent and dramatic. Thereafter, potassium iodide has been tried for a variety of diseases. In dermatology, it is now being used for the treatment of cutaneous deep mycosis and erythematous dermatoses including erythema nodosum, subacute nodular migratory panniculitis, erythema induratum, Sweet’s syndrome, and erythema exsudativum multiforme. The present author has found that potassium iodide works well as a first choice of medication for erythematous disorders. The action mechanism of the drug is still not fully understood.
We report two cases of trichoblastoma with significant keratin 20 positive cells. One patient was 21-year-old female who had a pinkish nodule and a subcutaneous nodule on her right neck. It presented a “showman-like” appearance. The other patient was 73-year old male who had a brownish nodule with a small, brown-to-purple papule on its top. It presented a “nipple-like” appearance. Both cases showed the “pop-put” phenomenon when surgical resections were performed. Histologically, both tumors were symmetrical and well circumscribed. There were numerous aggregations of germinative cells in the dermis to the subcutis. Immunohistochemically, these tumors showed large numbers of keratin-20 positive cells in the aggregations. We also examined five cases of nodular basal cell carcinoma. None of these were positive for keratin-20. The significance of keratin 20-positive cells in trichoblastoma and their usefulness for differentiation between trichoblastomas and basal cell carcinomas were discussed.
We performed sentinel node biopsies in nine clinical stage I melanoma patients using 99mTc-labeled colloid. 99mTc Sn or rhenium colloid was injected at the periphery of the primary lesion, and radioactive nodes were identified in the regional lymph node basin by a hand-held gamma probe. Using 99mTc Sn colloid, radioactive nodes were detected in all four patients with melanoma lesions on the extremities (average : 2.6 nodes/patient) ; however, we failed to detect any radioactive nodes in two of three patients with the lesions on the trunk and face. In one of these patients, the radioactive nodes were detected after additional injection of 99mTc rhenium colloid. More than 10 nodes were detected in a patient with a lesion on the leg by 99mTc rhenium colloid. The above findings indicate that 99mTc Sn colloid is useful for sentinel node biopsy with patients melanoma of the extremities, but it is necessary to develop a more suitable colloid other than Sn colloid for melanoma of the trunk and head.
We report a case of angiosarcoma of the breast with skin metastases. In this patient, the primary lesion in the breast was found after tumors that metastasized to the skin. The breast lesion and skin metastases were first treated by surgical resection combined with intravenous and intralesional injection with recombinant interleukin-2. However, cutaneus recurrences and hepatic metastases appeared within a year. We tried combination chemotherapy with ifosfamide, mesna, adriamycin and dacarbazine (MAID). Although the tumor subsided once, the patient died from multiple metastases in the lung.
Systemic lupus erythematosus (SLE) frequently affects renourinary systems. However, involvement of lower urinary tract has been rarely mentioned in the literature. We describe two SLE patients with bladder symptoms with different pathogeneses. One patient who had taken 10 mg/day of prednisolone, presented with gastrointestinal symptoms preceding pollakisuria. Abdominal CT scan and intravenous pyelography revealed the thickening of the intestinal wall, bilateral hydroureters and hydronephrosis. Histological examination of the bladder wall confirmed interstitial cystitis that was consistent with the pathological features of lupus cystitis. Her symptoms and radiographic findings were markedly improved with pulse methylprednisolone therapy followed by oral prednisolone, 30 mg/day. Another patient, who had been medicated with 15 mg /day of prednisolone, presented with high fever and malar rash. Laboratory results suggested elevated activities of SLE. Although the dose of prednisolone was increased to 30 mg/day, dysuria along with neurological manifestations such as cognitive dysfunction, a positive Babinski response, and rectal incontinence developed. Radiography of the brain and spinal cord showed no abnormalities. Since urological examinations indicated motor paralytic bladder, we considered the symptoms to be neurolupus. Treatments with pulse methylprednisolone followed by 60 mg/day of prednisolone promptly alleviated her symptoms. Because delayed treatments often result in irreversible urinary dysfunction, we should not overlook lower urinary symptoms with different pathogeneses in SLE patients.
A 29-year-old woman presented with a four-month history of multiple purple-red plaques on her right side of the body. The diagnosis of unilateral generalized morphea (GM) was established on the basis of the clinical and histological findings. To clarify the clinical patterns of GM, we retrospectively reviewed 45 patients with morphea in our department from January 1989 to October 2000, analyzing the correlation between the numbers of morphea lesion and the serologic abnormalities of antinuclear antibody (ANA) and rheumatoid factor (RF). Patients with over 4 morphea lesions (n=18) had more frequent positive reactions for ANA or RF than those with less than 3 morphea lesions (n=12, 33.3% vs 0%, P<0.05). Although our results may support that GM is a distinct subtype of morphea, further studies are warranted to define the clinical definition of GM.