In order to develop a psoriasis specific, health-related QOL (quality of life) index in Japan, we developed a Japanese version of the Psoriasis Disability Index (Japanese PDI) and examined its reliability and validity by examining its relevance to the comprehensive health-related QOL index, SF-36 (short form-36). In creating the Japanese PDI, we first made a draft which adhered to general methods of QOL questionnaire development and completed it using a feasibility study with 5 psoriasis patients. We conducted a validation study in 200 psoriasis patients to examine its reliability, validity and responsiveness ; they responded to both the Japanese PDI and the SF-36. It took about 2 minutes to complete the Japanese PDI. The missing value (unanswered) rate for each of the 15 question categories of the Japanese PDI questionnaire was below 10%. The questionnaire shows good reliability with Cronbach’s coefficient alpha at 0.910. In factor analysis, eigen values were high (>1.0) for factors explaining“leisure/treatment,” “work/school,” “daily activities,” and “personal relationships.” A sufficient correlation coefficient of –0.547 was shown between the total PDI score and the SF-36. In conclusion, the newly developed Japanese PDI has sufficient reliability and validity to evaluate health-related QOL in Japanese psoriasis patients.
A 54-year-old woman was referred to the Department of Internal Medicine for systemic lupus erythematosus (SLE) since 1976. She had been well-controlled with systemic prednisolone (PSL) 10mg daily for twenty-seven years. Two large indurated reddish nodules on her bilateral legs were noticed in 2002. A biopsy taken from one nodule confirmed the diagnosis of necrotizing vasculitis. Laboratory examinations found a high titer of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) and proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) accompanied by positive anti-nuclear, ds-DNA antibodies. This case was diagnosed as SLE with MPO-ANCA positive arteritis. PSL 30mg daily was administered, and the nodules rapidly disappeared. A case-control study was conducted in a cohort of 90 patients given a diagnosis of SLE in the National Hospital Organization Nagoya Medical Center Department of Dermatology. MPO- and PR3-ANCA were not detected separately in any of 90 SLE patients. Both MPO- and PR3-ANCA together were detected in one patient (our case). We suggest that MPO- and PR3-ANCA should be examined in patients with SLE-related necrotizing vasculitis.
The role of pelvic lymphadenectomy in melanoma metastatics to the superficial inguinal region remains controversial. Some authors advocate aggressive surgical treatment, whereas others state that outcome depends more on extent of disease rather than extent of treatment. We performed a retrospective clinical and pathological review of 14 patients having superficial (SLND) or combined inguinal lymphadenectomy (CLND) for melanoma of the lower extremity. A total of 8 SLNDs and 6 CLNDs were performed between 1990 and 2003. The time between lymphadenectomy and the moment of analysis was between 36 and 71 months. The number of involved superficial lymph nodes, lymph node size, and the presence of extracapsular spread were associated with the pelvic nodal involvement and poorer prognosis. Three of 6 (50%) patients who underwent CLND lived over 3 years, while only 1/9 (11%) patients who underwent SLND survived over 3 years. CLND provides significant prognostic information for stage III patients with inguinal lymph node metastases and may be therapeutic for those with pelvic lymph node metastases. CLND is the operation of choice for lower extremity melanoma patients with regional metastases to the inguinal area.
We reported a case of malignant melanoma that developed in the urethra. The patient was 56-year-old man who noted three black papules surrounded by a black macule and hemorrhage in the urethral meatus a half year before his first visit to our clinic. In February of 2005, penis amputation and urethroplasty were carried out. The tumor thickness was 6mm. Sentinel lymph node biopsy revealed no metastasis in either side of the inguinal lymph nodes. As no metastasis was detected throughout his entire body by computed tomography, the patient’s tumor stage was evaluated as stage IIC of pT4bN0M0. After the operation, he was treated with 3 cycles of multiple combinations of DTIC, ACNU, vincristine, and interferon beta. No reccurrence has been observed. To our knowledge, no more than 17 males with urethra melanoma have been reported since 1924 in Japan, and it is therefore thought that melanoma rarely occurs in the urethra.