Three patients were followed up under the tentative diagnosis of auto-immune annular erythema or atypical SLE. These patients had an edematous annular erythema over the entire body, conspicuously edematous, macular erythema on the face, chilblain-like cyanosis on the foot-pads, or crusted erosive erythematous lesions on the lower lip, respectively. Laboratory results revealed negative LE cells, negative anti-DNA antibody, negative deposits of immunoglobulins with complements at the dermo-epidermal junction. Serum complement level was also within normal range. In every case, anti-SS-A and anti-SS-B antibody was positive while sicca syndrome was not clearly observed. Sjögen syndrome was discussed with a special reference to cutaneous manifestations.

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Two cases of human infestation with the ixodid ticks are reported. The patients in either case got bitten by ixodid ticks in Mts. Tachibana and Mikazuki located in the north-eastern part of Fukuoka City. The first patient, a 49-year-old man, complained of the formation of a small painful tumor under the left arm. The tick found there was broken on extirpation and could not be identified. The second patient, an 8-year-old girl with a tick on her parietal region, had no subjective symptoms of the enlarged tumor with the swelling of nearby lymph nodes. The tick identified as an adult female of Haemaphysalis flava Neumann is commonly seen in various wild and domestic animals. Six cases have been reported with only one occurring in Kyushu. Our two patients were cured in 1-2 weeks after treatment, and each had a favorable prognosis. The detailed surface structure of the tick was examined under a scanning electron microscope.

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A 74-year-old woman received 600mg of a compound containing gold. Pruritic eruptions occurred just before the end of chrysotherapy and then became exfoliative. We measured periodically the concentration of gold in the serum. After systemic administration of corticosteroids, the concentration of gold in the serum was increased although there was a decrease in the extent of the eruptions.

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A 57-year-old man with no history of alcohol intake and drug inducing porphyria developed fragility, blistering, small scarring and hyperpigmentation on the skin of the face and backs of the hands. He had no episode of acute photosensitivity. He had a chronic, active hepatitis. There was an abnormal increase in 24hr urinary porphyrin excretion, therefore cutaneous lesions suggested hepatic cutaneous porphyria. In the histopathological examinations, deposition of PAS-positive materials was observed in the dermoepidermal basement membrane zone and small dermal blood vessel-wall of the scar-like eruption on the back of the hand. Direct immunofluorescence showed marked deposition of IgG and fibrinogen and mild deposition of IgA in the regions in which the PAS-positive materials were deposited. Similar findings were observed in the clinically normal skin not exposed to sunlight, but the magnitude of the deposition of IgG, IgA and fibrinogen was much less marked than that occurring in the cutaneous lesions exposed to sunlight.

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A 32-year-old Japanese man with eruption on the upper and lower lips as the result of T. rubrum infection, had an accompanying superficial tinea of the face and extremities. Intradermal trichophytin tests provoked strongly positive immediate and delayed reactions. Laboratory studies showed a leucocytosis with eosinophilia, an IgE level as high as 1,500U/ml and a strongly positive Mantoux reaction. The oral 50g glucose tolerance test revealed an oxyhyperglycemia. The serum zinc level was only 56μg/dl, and a normal value (131μg/dl) was reverted to after oral administration of zinc sulfate 200mg/day. The eruption disappeared four weeks later following treatment with griseofulvin and zinc sulfate. We consider that this patient was susceptible to infection of sycosis trichophytica as there was a zinc deficiency.

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We treated a patient with heterotopic lingual tonsil on the foliate region of the tongue. Histopathology showed that this condition is a lymphoid hyperplasia and that it functions as a tonsil.

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A 76-year-old man had a thumb-sized, plateau-like elevated tumor which was black in color and with a granulomatous appearance in the center. Histologic examination revealed different portions, the larger was tumor islands composed of diastase-labile PAS-positive clear cells and trichilemmal keratinization and squamous eddies in some areas. The smaller portion was tumor islands composed of PAS-negative basophilic cells and cyst.

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A 84-year-old man noticed a papular lesion on his left temple two months ago and was admitted for evaluation as it gradually increased in size. During one month between his first visit and the admission, the tumor tended to shrink and histologically showed a large amount of degenerative tissue. On admission, the size of the tumor was 30×35×20mm and a total resection was done under the diagnosis of fibrohistiocytic tumor. The histological findings led to a diagnosis of atypical fibroxanthoma of the skin.

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Pigmented lesions in a 21-day-old boy with congenital giant pigmented nevus were studied light and electron microscopically. There were nests of nevus cells in the upper, and neurofibromatous structure in the middle and lower portions of the dermis. One of specimens, obtained from a pigmented nodule with a central keratotic mass, showed hyaline cartilage and bundles of smooth muscle cells in addition to nevus cells and neurofibromatous tissue. One of the chondrocytes was found to have a melanosome complex. In general, it is considered that the neural crest contributes to the formation of a pigmentary system, nervous system as well as skeletal and connective tissue. Cells of the neural crest which form bone, cartilage, connective tissue and smooth muscle in the cephalic region have been called “mesectoderm”. Thus, it is speculated that the cells which composed giant pigmented nevus in our patient, are all derived from the neural crest and/or mesectoderm. Neural crest underdevelopment seems to account for the giant pigmented nevus.

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We treated an eight-year-old girl with peculiar eccrine angiomatous hamartoma on the left thigh. This tumor clinically resembled lipoma at onset and gradually changed to an angiokeratoma-like lesion. Histological examination revealed that the eccrine glands increased in number and size and there were numerous, dilated thin walled blood vessels resembling angiokeratoma. Lipomatous changes were also evident in the subcutaneous region.

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We studied the surface topography of dermal blood vessels following removal of the surrounding tissues. Arterioles were characterized by a layer of densely packed, uniform and thick muscle cells with longitudinally running parallel creases and small pits on the surface. There were interconnections by means of a number of thin lateral projections. In contrast to arteries, venules were characterized by a discontinuous muscle cell layer and width of the cells varied. The cells seemed to be superimposed on the underlining endothelial cells due to lack of intercalating elastic lamina. Here too there were interconnections by means of thin lateral projections, but the number was smaller than that of arterioles.

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Circulating immune complexes (CIC) were measured in sera from 97 patients with lupus erythematosus, including 66 with systemic lupus erythematosus (SLE), 12 with widespread discoid lupus erythematosus (W-DLE), 5 with subacute LE and 14 with localized DLE. We used a Clq enzyme immunoassay (Clq EIA) and an a-C3 enzyme immunoassay (a-C3 EIA). Elevated CIC levels were most frequently noted in cases of SLE, in both assays. However, we found no significant correlation between the results of Clq EIA and that of a-C3 EIA. In SLE patients, disease activity correlated with the results of Clq EIA but not with that of a-C3 EIA. CIC positive sera with both assays were detected only in cases of SLE and W-DLE and not in other types of LE. By gel filtration with Sephacryl S 300 superfine, it was possible to estimate the molecular size distribution of CIC. Several peaks of CIC varying from large (over the M.W. of IgM) to small size (near the M.W. of IgG) were found in each assay. Therefore, about one half of the peaks detected by Clq EIA showed different distributions of molecular size from that of a-C3 EIA. There was no significant differentiation of size distribution patterns among SLE, W-DLE, subacute LE and L-DLE. Distribution pattern of the molecular size was studied in sequential sera from two patients with active SLE before and after oral steroid therapy. The disappearance of large size CIC and decrease of total CIC levels were seen with this therapy.

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The administration of a 0.1% concentration of griseofulvin (GF) to D-D strain mice induced an abnormality of porphyrin metabolism only in a small number mice in contrast to findings in most mice administered over 0.5% concentration of GF. To determine the cause of abnormality in porphyrin metabolism, the mice were fed with a diet containing GF, ethanol plus iron, estrogen and polychlorinated biphenyls (PCB), individually or in combinations. The following eight groups were prepared; 1. normal diet, 2. 0.1% GF, 3. ethanol-iron, 4. 0.1% GF+ethanol-iron, 5. estrogen, 6. 0.1% GF+estrogen, 7. PCB, and 8. 0.1% GF+PCB. The results were as follows:
1) The high incidence of elevation of liver protoporphyrin level was observed in group 4, as compared to groups 2 and 3. A slight elevation of liver protoporphyrin levels was evident only in one mouse in group 3. This suggested that the combined administration of alcohol and iron may raise the porphyrinogenecity of a 0.1% GF.
2) Elevation in the levels of liver coproporphyrin and protoporphyrin was observed in group 6 as compared to groups 2 and 5. The levels of liver porphyrins were fairly normal in group 5, except for one mouse.
3) The elevation of the levels of liver coproporphyrin and protoporphyrin was observed in 8/12 in group 8, as compared to group 7.
Thus, the mechanism of the involvement of porphyrin metabolism in the mouse liver related to the combination of either 0.1% GF and estrogen (group 6) or 0.1% GF and PCB (group 8) seems to be different from that related to 0.1% GF itself (group 2). It seems that the porphyrinogenic action of 0.1% GF (group 2) is enhanced by the addition of other chemicals (groups 4, 6, 8).

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Light microscopic observations of semithin sections were prepared to evaluate lymphoma cells in three patients with malignant lymphoma. From plastic embedding for electron microscopy, semithin sections were prepared and stained by methylene blue-fuchsin. The thickness of these semithin sections was about 0.5-1.0μ and this thickness was intermediate between routine paraffin sections for conventional light microscopy and ultrathin sections for electron microscopy. The findings of semithin sections were compared to those of paraffin and ultrathin sections. In semithin sections, the cytological details were superior to paraffin sections and the cytological contours were almost equal to those seen with ultrathin sections. Semithin sections for light microscopy can bridge the gap between conventional light microscopy and electron microscopy and may be useful diagnostic aids.

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Bacteria, especially staphylococcus, isolated from pyodermia and their antibiotic susceptibilities in San’in district were studied in 1982. Among the isolated bacteria, Staphylococcus occupied 83.3% (Staphylococcus aureus: 66.9%, Staphylococcus epidermidis: 16.4%). Although the antibiotic susceptibilities of the isolated staphylococcus strains were high to CEX, MINO, CP, CLDM, GM, FOM, they were low to ABPC, EM. These results are in good agreement with recent reports in Japan. However, the antibiotic susceptibilities of staphylococcus in San’in district were generally higher than in other areas in Japan.

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We studied the clinical course and prognosis on sixty-eight cases of anaphylactoid purpura. Age distribution, clinical symptoms and laboratory findings were analyzed.
1) In most cases skin eruptions regressed within three months.
2) Forty to sixty percent had renal involvement and in some patients, chronic glomerulonephritis or renal failure occurred.
3) Abdominal involvement and arthropathy were transient.
4) Slight inflammatory reactions and increased serum IgA levels were evident in many patients.

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The incidence of trauma in kindergarten children was investigated three times from November, 1982 to April, 1983. Sixty-four percent of the trauma was on the face, 15% on the lower extremities, 12% on the upper extremities and 9% on the trunk. Thus, the predilection site of sporotrichosis in young children seems to be restricted to the face.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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