Thirty patients with stasis ulcer who visited our department from January of 2006 to December of 2008 were analyzed. They included 19 males and 11 females between 32 and 90 years of age (average: 62.4 years old). The D-dimer value was elevated in 21 patients out of the 27 who were analyzed. Two cases were complicated by deep vein thrombosis. Ten cases were treated surgically for varicose veins by stripping and/or ligation. One or more risk factors were found in 21 patients, when obesity, prolonged standing, and musculoskeletal disease were considered as the risk factors for stasis ulcer. Five patients were engaged in business that required prolonged standing. Fourteen were obese (BMI≧25 kg/m2). Six suffered from musculoskeletal disease. Among the 9 patients who did not have any risk factors, 8 had ulcer (s) smaller than 4 cm2, and 7 have an ulcer only on one leg.
A case of actinic keratosis in a 78-year-old woman is reported. Erythema on her middle finger showed atypical cells along the basal layer histologically. The application of imiquimod cream, which has not been approved in Japan, was her choice among the therapeutic options. According to the successful clinical case report, imiquimod was applied three times a week for 12 weeks, and the atypical cells disappeared completely without any recurrences to date. The cosmetic outcome was excellent. During the therapy, a dense lymphocytic infiltration was observed, and some of the cell showed exocytosis. Using immunohistochemical staining, it became apparent that these cells were CD1a, Granzyme B, and CD20 positive. We concluded that imiquimod can be a good treatment option for actinic keratosis, because it stimulate an immune response.
(BACKGROUND) Cutaneous angiosarcoma (AS) is a rare malignant tumor with a poor prognosis. No prognostic factors or standardized treatment policies have been established. (PATIENTS AND METHODS) We reviewed 37 cases of AS seen between 1982 and 2007 at the National Cancer Center Hospital, Tokyo, Japan. Statistical analysis was performed in terms of overall, local recurrence free, and distant metastasis-free survival rates. (RESULTS) The five year overall survival of the 37 cases was 13.8%. Multivariate analysis suggested that the patient’s age (P=0.029) and the presence of distant metastasis (P=0.012) were the statistically significant prognostic factors. Twenty-five cases were treated with radical operations. Neither the presence of tumor cells at the margin nor the addition of adjuvant radiotherapy affected the local recurrence-free survival. The width of surgical margin was not related to local recurrence rate, either (P=0.073). Distant metastasis-free survival was significantly shortened with local recurrence (P=0.038). Three cases of AS with relatively good clinical courses were also described. (CONCLUSION) Because the prognosis of cutaneous angiosarcoma is poor, a multimodality treatment strategy following the surgical removal is essential. Neoadjuvant chemotherapy would be appropriate for the expanded tumor. Elective lymph node dissection might be required because lymph node metastasis is not unusual. Clinical information with prognostic variables should be shared by therapeutic centers for establishing a treatment policy for this rare tumor with a very poor prognosis.
We have evaluated the correlation between PASI, Self-PASI (Self-administered Psoriasis Area and Sevirity Index), and the extent of QOL impairment using the psoriasis-specific QOL related index (the Psoriasis Disability Index, PDI). Fifty Japanese psoriasis patients were examined at the outpatient clinic of the Osaka City General Hospital for two months from November 1, 2007 to December 30, 2007. The correlation coefficient of the PASI and Self-PASI was high at 0.61, that of PASI and PDI was 0.34, and that of Self-PASI and of PDI was 0.21. The PDI scores had a higher association with Self-PASI than did the PASI scores. These results show that the Self-PASI would be a valid and useful index for choosing treatment. Furthermore, the PDI was higher in the groups of women complaining of pruritus and severe eruptions involving the scalp. Therefore, the QOL of these groups might be worse than expected from the PASI score or BSA, and they might require intense treatments. These results suggested that the Self-PASI and PDI might be good tools when considering patient-oriented treatments.
We investigated the expression of C5a receptor (C5aR) and the subfamily receptor, C5L2, in human in flammatory skin diseases. C5L2 is known to be the decoy protein for C5aR. Neutrophils and monocytes infiltrating the inflammatory skin lesions were positively stained with anti-C5aR and anti-C5L2 anti bodies. In particular, the infiltration of myeloperoxidase (MPO)-positive neutrophils around the small vessels of the dermis or subcutis of either anaphylactoid purpura or erythema nodosum was remarkable. In psoriasis vulgaris, both MPO-positive and CD68-positive cells were detected around Munro’s microabscess, but were only sparsely positive in the papillary layer of the dermis similarly, in atopic dermatitis, the positivity with the antibodies in the dermis was not remarkable. Both C5aR and C5L2 co-expressed on MPO- and/or CD68-positive cells, as detected by the immunofluorescent multiple staining. Although many of the MPO- and CD68-positive cells had not infiltrated into the upper dermis of either psoriasis vulgaris or atopic dermatitis, expression of the mRNAs of C5aR, C5L2 and C3aR, both in the granulocyte fractions and the monocyte fractions of the whole peripheral blood of these skin diseases, was increased with statistical significance as compared to that in the fractions of normal volunteers. Thus, it is concluded that an increase in the expression of C5aR on the surface of MPO-positive and CD68-positive cells also induces the concomitant expression of C5L2, and that activated granular leucocytes and monocytes in the peripheral blood extravasate and migrate into the target lesions locally in re sponse to the concentrations of C5a and/or C5a-des-Arg in the skin. The mechanism and significance of the expression of C5L2 in neutrophilic inflammatory skin diseases should be further investigated.