It has recently been reported that early postoperative bathing is effective in promoting wound healing. We investigated 275 outpatients who had undergone minor skin surgery at the Niigata Cancer Center Hospital from February to August of 2007 in order to evaluate the factors influencing surgical site infection. The postoperative infection rate of the patients who had bathed and washed their surgical wounds on the day following surgery was significantly lower than the rate in patients who had not bathed (0.7% vs 7.5%, p=0.02);other factors such as sex, age, surgical sites, size of wound, sterilization, and season did not significantly affect the infection rate. Our results showed that early bathing and cleansing after minor skin surgery may be necessary for wound management as well as for improvement of quality of life.
We present a case of generalized pustular psoriasis accompanied by psoriatic arthritis (PsA) which is clinically similar to rheumatoid arthritis. The patient had severe synovitis, and tests for anti-cyclic citrullinated peptide (CCP) antibodies were positive. Anti-CCP antibodies are a highly specific marker of rheumatoid arthritis, and useful in the diagnosis of the early onset of the disease. Severe arthritis with non-reversible joint destruction may develop in progressive PsA. In that case, the same treatment used for rheumatoid arthritis is recommended. We discuss whether anti-CCP antibodies are a useful barometer for treatment of PsA. The rate of positive anti-CCP antibodies in PsA is higher than in normal controls; in severe cases, it is even higher. We suggest that anti-CCP antibodies can be a prognostic factor in progressive PsA.
A 66-year-old woman (Case 1) and a 73-year-old woman (Case 2) were admitted to our hospital because of progressive skin sclerosis. Both cases were diagnosed with diffuse cutaneous systemic sclerosis. Although two easily testable autoantibodies, anti-topoisomerase I antibodies (Abs) and anticentromere Abs, were not found in these patients, anti-polymerases I/III Abs were detected by an immunoprecipitation method. Both patients had interstitial pneumonia and conductive disturbances of the heart. Skin sclerosis was remarkably improved in both cases by oral prednisolone (30mg/day). However, Case 2 died of respiratory failure due to worsening of the interstitial pneumonia, which was resistant to cyclophosphamide pulse therapy. We should test primarily for the presence of anti-RNA polymerases I/III Ab and carefully follow up the clinical symptoms in anti-topoisomerase I Ab-negative SSc patients with rapidly-progressive skin sclerosis.
We report four cases of occupational allergic contact dermatitis due to the polyvinyl chloride gloves. They were 55-, 54-, 57- and 52-year old women who suffered from pruritic eruptions on their hands and forearms. They had used the polyvinyl chloride gloves to protect their hands during farm work, house cleaning, washing-up, weeding, etc. We performed 48-hour closed patch testing. All of them showed positive reactions to their gloves. In response to patch tests using the ingredients in the gloves, two of the four showed positive reactions to poly (adipic acid-co-1, 2-propylene glycol), used as plasticizer, and all of the four showed positive reactions to di-n-octyltin-bis-(2-ethylhexyl) maleate, used as a stabilizer, and mono (2-ethylhexyl) maleate, a component of di-n-octyltin-bis-(2-ethylhexyl) maleate. We conclude that 2-ethylhexyl maleate is the epitope of di-n-octyltin-bis-(2-ethylhexyl) maleate.
In order to reveal the prognosis of patients with pemphigus, we examined the disease course and treatment methods used in patients who have been treated at our outpatient department. The results revealed that 37.7% of the patients (38.5% of pemphigus vulgaris (PV) patients and 35.3% of pemphigus foliaceus (PF) patients) were found to be free from the disease (without symptoms or circulating pemphigus antibody and not requiring any treatment for more than 1 year). Additionally, there were no significant differences in the number of the patients in the remission phase or the disease-free phase between the apheresis-treated group and the non-treated group. Furthermore, the number of PF patients in the remission phase or disease-free phase was not as high as that of PV patients. These results indicate that immediate remission or disease free-condition can be achieved by appropriate treatment in the majority of pemphigus patients.