We present an outline of the cutaneous wound healing cascade, emphasizing the importance of the interaction between regenerated keratinocytes and fibroblasts via cAMP during the proliferative stage of wound healing. We suggest that this mechanism can be explained by the cycle theory. In addition, we speculate that vasculogenesis might contribute to the vascular development of granulation tissues, as well as to angiogenesis. In clinical practice, we stress that the choice of treatment should be adapted to the wound stage. Finally, it should be kept in mind that contact dermatitis due to disinfectants and ointments used in refractory ulcers is possible.
In order to identify novel target genes for therapeutic agents and diagnostic markers for atopic dermatitis (AD), we utilized the cDNA array to search for genes whose expression is altered in AD skin. We analyzed the gene expression of 548 genes, including inflammatory genes and those that are responsible for the skin barrier, in the skin of AD patients with or without concomitant allergic respiratory diseases and in that of healthy volunteers. We found that, of the 548 probe genes on the membrane, the expression levels of 58 genes differed between AD patients without concomitant allergic respiratory diseases and healthy volunteers. Among these 58 genes, the differential expression of 30 genes had been reported previously, but the differential expression of the other 28 genes were identified in this study for the first time. Moreover, we revealed that these 58 genes could discriminate AD patients from healthy volunteers, regardless of the presence of concomitant allergic respiratory disease. Our results indicate that systematic gene expression analyses are useful tools for detecting the novel target genes for therapeutic agents and diagnostic markers for AD.
In order to establish an assessment tool for estimating the clinical course of decubitis, three widely used tools, Breden scale, DESIGN and PSST, were examined for 4 weeks in 10 cases with 10 medical professionals in our hospital. The results showed these scores did not coincide with the clinical course or agree with each other. The clinical course scale (CC scale) is a newly designed tool that demonstrated a good correlation with clinical course and uniformity among testers. This scale can be considered to be useful for assessing clinical courses of decubitis and judging the validity of the treatment.
Case 1: A 72-year-old woman had multiple pigmentations on the lips and the fingers and longitudinal streaks. The lesions appeared 10 years earlier and increased in number. Histopathologicaly, melanin pigmentation of basal layer was observed, and some melanophages were scattered in the upper dermis. No abnormality was noticed in functional studies of hormones, endoscopical examination of the lower intestine, or patch tests for 24 metals. Case 2: A 27-year-old woman had some pigmented spots localized on the fingers, lips and mucosa of the left cheek. These pigmentations were first noticed 7 years previously. No other internal or functional disorders were found. These two cases were diagnosed as Laugier-Hunziker-Baran syndrome. In Japan, 37 cases of Laugier-Hunziker-Baran syndrome had been reported. We reviewed the complications, and the treatments of Laugier-Hunziker-Baran syndrome from the literature and our two patients.
We reported two overlapping cases of sarcoidosis and Sjögren’s syndrome (SS). Both patients noticed the eruptions on their bodies and came to our hospital. Histological examination of the skin biopsy revealed noncaseating granulomas, and the chest X-ray showed bilateral hilar lymphadenopathy, so we diagnosed them with sarcoidosis. As a result of a careful search for complications, we detected SS. It has been discussed that sarcoidosis and SS are related in terms of pathogenesis because these two diseases share common immunological features. In a survey of 33 reported cases, SS preceded sarcoidosis in most cases. Previous reports disagree about the complication frequency of sarcoidosis and SS. It is necessary to reevaluate the complication frequencies of these two diseases based on histopathological and serological examinations.
We tried to demonstrate Candida albicans by the cotton swab method from the tongues of DM patients less than 60 years old ; they had no lesions. Candida albicans was isolated from 29 out of 81 patients (35.8%), as well as 4 patients (4.7%) positive by the KOH method. The mean serum HbA1c level of patients with Candida albicans was significantly higher than that of patients without it (9.4% versus 8.1%). The number of colonies of Candida albicans was correlated with the HbA1c level of the patients. The complication rate of diabetic retinopathy of patients positive for Candida albicans was 63%，significantly higher than that of patients negative for Candida albicans.
We assessed the usefulness of the Tokyo University Type Egogram (TEG) as an analysis of ego state involvement in the onset of akatsuki disease. The patient was a 75-year-old female who had brownish plaques on the right auriculotemporal area that were easily removed by tweezers. We made a diagnosis of akatsuki disease, in which there is a psychological disorder that prevents patients from washing off everyday dirt. The TEG of this patient showed N-type with a high level of Nurturing Parent (NP) and a low level of Free Child (FC). This pattern is usually observed in patients with anxiety neurosis or depression. The low level of FC is also seen in hypochondriasis. We concluded that this egogram was clinically useful in reflecting the patient’s ego state involvement in akatsuki disease.