A case of a 23 year-old nurse is reported who exhibited eczema on both hands after one year and five months working in the surgical ward. Four months after the first appearance of eczema, urticaria appeared all over the body with an anaphylactic reaction beginning on both hands, six different times in all. It appeared when she was mixing solutions for injections and washing syringes. After tests for 24 kinds of antibiotics, the open patch test for cefotiam and the prick test for cefaman-dole had positive results after 20 minutes and 30 minutes, respectively. In the 48-hour closed patch test, 0.50% chlorhexidine gluconate and 0.05% hibiten^® reacted positively and 96 hours later, hibiten^® also reacted positively, but chorhexidine gluconate reacted nagatively. Therefore, the results show that this is an allergic type contact urticaria caused by cefotiam and cefamondole, followed by a delayed type contact dermatitis caused by pigment, perfume, or surfactant contained in hibiten^®.

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Two cases of postthrombotic syndrome are reported. The first patient is a 37-year-old woman who presented with a chronic, indurated and painful board-like plaque occurring immediately inferior to a superficial thrombophlebitis on her left leg. Laboratory abnormal data included elevated plasma levels of FVIII-RAg, β-TG and PF-4. Bed rest and the use of anticoagulants had lead to the resolution of edema, superficial thrombophlebitis and the abnormal data stated above, however the painful board-like lesion remained unchanged. Ultrasound treatment (0.8 W/sq cm, 5 min., twice a week) was given directly to the remaining board-like lesion, and the patient experienced a rapid relief of pain and tenderness after the first few treatment. After 11 treatments, pain, tenderness and the indurated plaque had resolved completely. The second patient is a 79-year-old woman who presented with a painful indurated plaque and diffuse edema on her left shin. Venography of the left leg revealed an occlusive change of popliteal vein. Ultrasound treatment (1.0 W/sq cm, 5 min., per day) directed to the board-like lesion had lead to the relief of pain after 3 applications of ultrasound treatment. After 6 applications, the pain no longer existed and the lesion was less indurated. In summary, we propose the use of ultrasound treatment on the prolonged painful board-like lesions of postthrombotic syndrome.

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A 84-year-old man with psoriatic arthritis (PA) with a positive test for rheumatoid factor (RF) is reported. He developed psoriatic eruption and nail changes, and arthralgia of the fingers and toes. X-ray examination revealed that the distal interpharyngeal joints (DIPJs) were prominently affected. In 24% of the cases of PA reported in Japan (1914∼1989), RF was present. The association of nail changes and/or DIPJs involvement with RF-positive PAs is less frequent than with RF-negative PAs. The cases with the concurrent presence of psoriasis and rheumatoid arthritis may be included in RF-positive PAs. Therefore, we suggest there should be some mechanisms that increase the percentage of the RF positive results in PA.

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We reported a case of PSS (progressive systemic sclerosis) with acute polyradiculoneuropathy (Guillain-Barré syndrome). A 63 y-old man was hospitalized because of a digital ulcer which appeared in August 1988 at Shiratori. He was diagnosed as having PSS by histological features obtained from abdominal skin, and transferred to our department. At admission he had sclerotic lesions on the trunk with diffuse pigmentation and luster which was accompanied with depigmentation in the center. Telangiectasia was seen on the face and chest. Raynaud’s phenomenon was not noticed. The neurological examination showed no abnormal findings. One week after D-PC administration (p. o.) at a dose of 300 mg daily, muscle weakness of whole body appeared and deep tendon reflex diminished. At the same time, a sweat disorder and CSF protein-cell dissociation, NCV decline and neurologic charge in EMG were seen. There was a slight improvement in the neurological findings after stopping of D-PC administration and the results, strongly positive lymphocyte stimulating test by D-PC led us to suggest the existence of a relationship between D-PC and acute polyradiculoneuropathy. In the later part of 1989, a pleural effusion was found and he was diagnosed as malignant lymphoma by the histopathological features obtained from the supraclavicral lymph node and chemotherapy (cyclophosphamide, vincristine) was administrated, however on Jan. 25th, 1990, the patient died due to the involvement of pneumonia.

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A 44-year-old woman with PSS and complicated with pulmonary fibrosis was treated with 5-FU. Pulmonary abnormalities which had been observed before the treatment, such as dyspnea and decreased % VC and DLCO, improved by the treatment. Although sclerotic changes of the skin did not significantly improve, improvement of the range of neck motion, less difficulty in sitting upright, and more ease in protruding her tongue suggested the effectiveness of 5-FU for cutaneous lesions. No significant side effects were observed. In addition, this patient also suffered from Hashimoto’s disease.

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A case of “so-called” sclerodermatomyositis is reported. A 56-year-old man with extensive diffuse skin sclerosis complained of muscle weakness and pain. Physical examination revealed marked erythematous changes as well as diffuse skin sclerosis and pigmentation. Laboratory examination showed positive antinuclear antibodies (speckled pattern) and elevated myogenic enzyme activities in the serum. Esophageal dysfunction and lung fibrosis were also present. Histopathological examinations of the skin and muscle were consistent with scleroderma and myositis, respectively, the latter being confirmed by electromyography as well. Immunohistochemical staining revealed that most of the infiltrating cells were activated T lymphocytes.

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We reported two cases of tuberous sclerosis in a mother and her son. A 27-year-old woman, who showed typical symptoms of tuberous sclerosis; a history of epilepsy, angiofibroma on the face, white leaf-shaped macules and Koenen’s tumor (case 1). A 4-week-old boy, who is her son, was diagnosed as having a cardiac tumor by echogram when he was a fetus (case 2). In case 2, a skin tumor with flat and smooth surface was noticed in the midline of the lower back at one to two weeks after his birth. Because seizures had developed two weeks after his birth, we used CT scanning in order to examine him when he was one-month-old and discovered a multiple calcification on his brain. The skin tumor showed the typical features of shagreen patch seven months after his examination. These findings in case 2 enabled us to confirm the diagnosis in the early stage. It is conceivable that some other symptoms of tuberous sclerosis may appear as he gets older.

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A case of spindle cell hemangioendothelioma, a recently described vascular neoplasm by Weiss and Enzinger in 1986, is reported. A 52-year-old woman presented multiple nodules on the left hand which had developed for the last 30 years since the age of 22-year-old. Histologically, the nodules, which were located in the dermis and subcutis, were well-circumscribed and characterized by cavernous vascular spaces and interstitial spindle cells. From the clinical and histopathological findings, we consider that the spindle cell hemangioendothelioma is a benign neoplasm.

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The patient, a 13-year-old Japanese girl, noticed a red-bluish macule in the right inguinal area when she was 11 years old. Because of the gradual increase of the lesion both in size and height over the last two years, she visited our clinic in 1984. We clinically diagnosed it as dermatofibrosarcoma protuberans (DFSP) and performed an excision with ample margin. Histologically, the tumor lesion consisted largely of fibrotic plague with uniformed spindle cells arranged in a “storiform pattern”. In addition, fibrosarcoma-like cells were also observed. Three and a half years later, local recurrence developed and thus a wide excision and right inguinal lymph node dissection were performed. Together with the present case, there are increasing data suggesting that, even after wide surgical excision, DFSP may recur, if the lesion histologically exhibits fibrosarcomatous changes in the tumor lesion. Therefore, cases with DFSP without a uniformed storiform pattern may need careful follow up.

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A case with malignant lymphoma (diffuse lymphoma, medium-sized cell, B cell type) manifesting Garcin syndrome was described. Histological examination of the cutaneous lesions enabled us to diagnose the disease, since there were no other specific findings in the physical and laboratory examinations. A 66-year-old man had a 4-month history of progressive cranial nerve hemipalsy and increasing cutaneous nodules. The hemiparesis involved the left IIId, IVth, Vth, VIth, VIIth and VIIIth cranial nerves. He also complained of dysosmia. The cutaneous nodules, 10∼23 mm in diameter and bright red in color, were distributed on the face, the chest wall, the left thigh and the left sole. There were no symptoms of increased intracranial pressure and sensorimotor disturbance of the extremeties. Nor were there any abnormal findings in the skull X-ray, the brain computed tomography and the brain magnetic resonance imaging. After the cutaneous nodules were histologically diagnosed, combination chemotherapy was performed. The chemotherapy resulted in a regression of the skin lesions and a slight improvement in the cranial nerve hemipalsy. Nevertheless, the patient died of cachexia 4 months later.

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We investigated the infiltrating cells to chronic radiodermatitis (RD) and squamous cell carcinoma (SCC) appearing on RD by the Avidin-Biotin-Peroxidase Complex method while using four monoclonal antibodies. About 50% of the infiltrating cells in RD were T-cells and the population of T-cells infiltrated in SCC was smaller than that in RD (in two of three cases). Natural Killer (NK) cells (Leu-7 Positive cells) were found to be infiltrated into the tumor nests of SCC but were not in the radio-damaged epidermis in RD. In the case of RD, frozen sections stained with monoclonal antibodies showed that suppressor/cytotoxic T-cells were more predominant than helper/inducer T-cells in number.

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The ultrastructural sites of FVIII-RAg, VWF and MEC-1 antigen were determined by cultured human microvascular endothelial cells (ECs) obtained from a 5-year-old boy. All the above antigens were detected in Weibel-Palade (W-P) bodies, rough endoplasmic reticulum (RER) and Golgi apparatus. In the Golgi complex, immunolocalization of the antigens could be found only in Golgi sacks and vesicles from which immature W-P bodies appeared to be budding. W-P bodies stained positively in all ECs, but the staining intesity varied according to the W-P bodies ranging from virtually negative to strongly positive. The W-P bodies could thus appear to be heterogenous with respect to individual protein content. The W-P bodies and Golgi complex in most cases were located in the perinuclear cytoplasmic region, whereas RER could be found distributed throughout the cytoplasm. In many ECs, FVIII-RAg and VWF stained strongly positive in RER, and thus could be seen to have the same distribution as the latter. MEC-1 staining was positive in the W-P bodies but not as frequently as in RER, and thus appeared as a perinuclear aggregation. From these results, it would appear that the antigens are concentrated in W-P bodies, RER and at least one part of each Golgi complex, and that ECs have the functions of biosynthesis, storage and degradation of these antigens.

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Skin blood flow was measured quantitatively at 29 different sites of 10 healthy men using a Laser Doppler flowmeter. The skin blood flow values evaluated were found to be the highest on the lips and fingertips (33∼34 ml/min/100 g). Those values were followed in order by the earlobes, palms, cheeks, heels, toetips, back of fingers, the mandibular region and the forehead. On the other hand, on the trunk and the proximal parts of the four extremities, the blood flow was markedly low. Interestingly, the skin blood flow appears to be high on the distal portions of the extremities, such as on the fingertips, palms, and toes, where arteriovenous shunts are thuoght to be rich. These values calculated by the Laser Doppler flowmeter were less than those obtained by other methods. In interpreting these differences, some reasons such as the difference in parameters and measurement depth were considered. The advantages of the Laser Doppler flowmeter for clinical use are also briefly described based on the results of some preliminary experiments.

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The relations of antinuclear antibodies (ANAs) in patients with systemic scleroderma (PSS) to their skin, lung and esophagus lesions were studied in 38 patients (28 PSS, 7 mixed connective tissue disease and 3 PSS—dermatomyositis overlap). Among the PSS patients, anti Scl-70 (topoisomerase I) antibody (ASA) was positive in 15 (60% of them were Barnett’s type III), anticentromere antibody (ACA) was positive in 8 (63% of them were type I), anti RNP antibody (ARA) was positive in 2, and types of ANAs different from those listed above were positive in 3. ARA was positive in all patients with MCTD or overlap syndrome. The number of type I PSS patients was significantly higher in those with ACA than in those with ASA. Anti SS-A, SS-B, Ki and mitochondrial antibodies were positive, always together with one or two other ANAs, in 13, 3, 3 and 2 patients, respectively. Twenty percent of the patients with ASA, 50% of those with ARA and 38% of those with ACA were associated with Sjögren’s syndrome. All of the ASA positive group, 42% of the ARA positive ones and 38% of the ACA positive ones had lung fibrosis, the frequency of which was significantly higher in the ASA positive group compared with those in the ARA or ACA positive ones. Esophageal dysfunction was present in 87% of ASA, 89% of ARA and 63% of ACA positive patients. These results confirm the notion that ANAs serve as a useful tool to predict the extent of skin sclerosis and the involvement of internal organs in PSS.

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A total of 111 cases of PSS (M:F=10:101, 49.5±10.9 year-old) was subjected to a mathematical analysis of ADL, which was carried out by questionare score method (25 items were graded into 5 levels according to severity, 4 points; normal, 3; possible, but it takes time, or is slightly districted, 2; moveable, but it is of no daily use, 1; partially possible, or assistance is needed, 0; impossible) over the 3-year-period (1987-1989). According to the results, 49 of 111 cases (44.1%) showed 100 points in ADL score (completely normal), 33 cases (29.7%); 90’s points, 20 cases (18.0%); 80’s points, 4 cases (3.6%); 70’s & 60’s points and one case; 24, 5 points. ADL scores of PSS patients with PSS score 0-3 (slight or moderate type) (95.9±7.2 points, n=61) were statistically higher (p<0.05) than that of PSS score 4-6 (severe type) (90.3±15.1 points, n=37). ADL scores of the patients followed for 3 years (n=12) showed similar points in each year (1987, 1988 and 1989). Climbing up and down stair cases, squeezing towels and standing up from the sitting position were thought to be difficult from the point of the number of patient complaints of all difficulty and in the ADL score points, while on the other hand, using a western style lavotory and eating by spoon were the easiest functions to perform. The ADL score was thought to be useful for estimating the PSS severity and for use in follow-up studies.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Zinc pyrithione (ZPT) has long been recognized as a therapeutic agent that is safe and effective against dandruff and seborrheic dermatitis at levels of 0.95% to 2% in shampoos and 0.1% to 0.25% in grooming aids. In a recent antidandruff efficacy clinical study conducted in a population of Japanese men and women in the cities of Kuzuha and Neyagawa Japan, Head and Shoulders rinse-in-shampoo (1% ZPT) and Head and Shoulders shampoo (1% ZPT) with Head and Shoulders conditioning rinse (0.3% ZPT) were demonstrated to be significantly more efficacious at reducing dandruff flaking than Merit shampoo with Merit moisture rinse (both products contain ZPT). All Zinc pyrithione-containing products tested were significantly more efficacious at reducing dandruff flaking than the placebo shampoo. Correlating with the antidandruff efficacy ranking, subjects with severe dandruff were able to discern that Head and Shoulders rinse-in-shampoo or Head and Shoulders shampoo with Head and Shoulders conditioning rinse were significantly (p values ≤0.05) more efficacious at reducing dandruff flaking than Merit shampoo with Merit moisture rinse. In addition, subjects on the Head and Shoulders shampoo with Head and Shoulders conditioning rinse treatment perceived that they had significantly (p values ≤0.05) healthier scalp and less severe scalp dryness post-treatment than the subjects on Merit shampoo with Merit moisture rinse treatment. Head and Shoulders shampoo with Head and Shoulders conditioning rinse were rated by the subjects to be significantly (p values ≤0.05) more effective in controlling dandruff flaking, scalp itch and scalp dryness than Merit shampoo with Merit moisture rinse. In this clinical study, we found that 37% of the Japanese population had dandruff significant enough to qualify for entry on study but were not using any antidandruff products. It is obvious that these subjects could benefit from using Head and Shoulders shampoo and Head and Shoulders conditioning rinse. Professional recommendations for the regular use of Head and Shoulders shampoo and Head and Shoulders conditioning rinse may be a key to the treatment and prevention of recurrent dandruff in the Japanese population.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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