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Hidezo FUKUDA, Shuhei IMAYAMA
1995 Volume 57 Issue 5 Pages
929-933
Published: October 01, 1995
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After analyzing 132 cases of allergic contact dermatitis due to topical corticosteroids application reported in Japan, including our two cases, we found that 1) 95 of the 132 patients (72%) developed a positive reaction of patch testing for the applied corticosteroids, 2) there was a relative predominance of females (83) over males (49), 3) atopic dermatitis was one of the frequent (21%) existing skin lesions to which the corticosteroid ointments were often applied, and 4) some patients were sensitized to several corticosteroids that shared certain chemical structures. Therefore, in order to avoid any possible cross-reaction of the alternative corticosteroids to the sensitized ones, we analyzed the most common corticosteroid ointments (available in Japan) according not only based on the potency of the ointments but also based on the chemical structure of the corticosteroids.
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Tomiko YAMAGUCHI, Yoshiko KUDO, Osamu OKAMOTO, Sakuhei FUJIWARA, Susum ...
1995 Volume 57 Issue 5 Pages
934-938
Published: October 01, 1995
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A 50-year-old man presented with dark red macules on the face, upper chest and forearms after several hours of sun exposure. He subsequently noticed general fatigue, ragged cuticles and keratotic erythematous macules on the dorsal surface of digits. A biopsy specimen obtained from the deltoid muscle showed vacuolization and fragmentation of the muscle fibers. A laboratory examination revealed either a marked or moderate increase of the following values; serum GOT, GPT, CPK, LDH, aldolase and myoglobin. The patient’s condition moderately improved after the systemic administration of prednisolone. However, shortly thereafter both high fever and muscle weakness developed. His general condition rapidly deteriorated in spite of pulse therapy of corticosteroids. CT scans revealed numerous low density areas in the liver. He died 8 months after the onset of the disease. Autopsy revealed carcinoma of the liver and metastatic lesions in stomach, bone marrow, capsule of the pancreas, heart and para-aortic lymph nodes. HCV mRNA was detected by RT-PCR in the serum and liver, although a routine examination of HCV in the serum was negative. This is a rare case of dermatomyositis complicated with liver carcinoma. A flare-up of dermatomyositis with a rapid progression of liver carcinoma thus suggests that an HCV infection and/or tumor antigens might have induced the dermatomyositis.
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Eishin MORITA, Mitsuru MOTIZUKI, Susumu SHINODA, Shoso YAMAMOTO
1995 Volume 57 Issue 5 Pages
939-942
Published: October 01, 1995
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From 1989 to 1994, 28 patients (12 male cases, 16 female cases) were diagnosed as having Behçet’s disease in our department. They consisted of 6 patients with a complete form and 22 patients with an incomplete form. The major histocompatibility antigens were analysed in 23 patients, and it was found that 3 out of 5 complete form patients and 8 out of 18 incomplete form patients were HLA-B 51 positive. The patients with uveitis also showed high incidence of HLA-B51 (66%), which thus indicated that HLA-B51 is a risk factor for uveitis.
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Kazufumi GOTO, Shin KOSEKI, Shigeo KONDO
1995 Volume 57 Issue 5 Pages
943-947
Published: October 01, 1995
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A case of coma blister with compartment syndrome was reported. A 35-year-old Japanese man developed a coma after taking an overdose of major and minor tranquilizers with beer. He demonstrated indurated erythematous plaques and tense bullaes on his extremities, ulcers on his face and left gluteal region, and swelling of his left leg. After regaining consciousness he complained of paralysis and pain of the left leg. A laboratory examination revealed an increased white blood cell count and an elevation of both the serum CPK and the myoglobin levels. A histopathologic examination revealed subepidermal blisters and necrosis of the epidermis and eccrine sweat glands. The findings of CT and MRI corresponded to rhabdomyolysis. We thus diagnosed this to be a case of coma blisters accompanied with left sciatic nerve palsy and rhabdomyolysis due to compartment syndrome.
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Yasuhiko MAEYAMA, Shingo TSUDA, Minoru MIYASATO, Yoichiro SASAI
1995 Volume 57 Issue 5 Pages
948-952
Published: October 01, 1995
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The authors report five cases of lichen planus-like keratosis (LPLK). Four of the five cases had solitary lichenoid lesions with pruritus in the sun-exposed areas of the face, forearm or dorsum of the hand. These eruptions occurred on preexisting pigmented macules. The histopathologic findings showed parakeratosis, liquefaction degeneration of the basal cells, the appearance of Civatte bodies, and as a consequence, the incontinence of pigment. Dense, patchy or band-like T lymphocytes infiltrated in the upper dermis and dermo-epidermal interface. Based on an immunohistochemical analysis in one biopsy, CD 4
+ and CD 8
+ cells were equally distributed in these infiltrates, and revealed that epidermal keratinocytes in the lesion were strongly immunoreactive for HLA-DR and ICAM-1. These histologic and immunohistochemical findings, in addition to the subsequent regression of the eruptions, may thus suggest that some cell-mediated host defense mechanism plays an important role in the occurrence and rejection reaction of LPLK.
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Tetsuo SHUKUWA, Koji SHIMAZAKI
1995 Volume 57 Issue 5 Pages
953-957
Published: October 01, 1995
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A five-year-old boy developed exfoliative erythema and hyperkeratotic papules on his extremities after suffering foom high fever and throat pain. There was no personal or familiar history of any such similar diseases. Hematological investigations showed no noticeable changes except for an elevated ASO. Since there was no clinicalresponses to the topical application of vitamin A and corticosteroid, 1
α, 24-dihydroxyvitamin D
3 (an active form of vitamin D
3) was topically applied twice daily. An improvement of these eruptions began one week later. All hyperkeratotic lesions were completely cleared after an application of three months without any side effects. The topical application of 1
α, 24-dihydroxyvitamin D
3 is thus considered to be a safe and effective therapy for pityriasis rubra pilaris in childhood.
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Satoko HIHARA, Eishin MORITA, Susumu SHINODA, Shoso YAMAMOTO
1995 Volume 57 Issue 5 Pages
958-961
Published: October 01, 1995
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We present two familiar cases of psoriasis vulgaris. In one family the patients were a father and son, while in another family the patients included a father and daughter. To determine the association of HLA with psoriasis vulgaris, HLA typing was performed. The existence of aspargic acid at position 9 of HLA-C molecules, which is common to Cw6 and Cw7, was recognized in these patients. The HLA type shared in these patients were A2, B70, Cw7 in the first family, and A2, B35 in the other family. Aspargic acid at position 9 was also demonstrated in 3 out of 4 patients.
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Naoki OTAKE, Akito TANAKA, Takashi SUGA, Hiroshi HAMADA, Hayao MIYOSHI ...
1995 Volume 57 Issue 5 Pages
962-967
Published: October 01, 1995
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Three cases of epidermodysplasia verruciformis (E.V.) are reported. All caces showed typical of E.V. with disseminated, flat wart-like lesions and/or tinea versicolor-like lesions. In addition, skin cancer also developed in all cases at a young age. Two cases demonstrated an immunosuppressitive state. One case has already died due to a cerebral hemorrhage, while the other two cases require a close and careful follow-up in the future.
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Mayo YASUNAGA, Shonosuke NAGAE, Nobuyuki SHIMIZU, Hiromaro KIRYU, Yosh ...
1995 Volume 57 Issue 5 Pages
968-972
Published: October 01, 1995
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We report an 18-year-old woman with Poland’s syndrome. The patient showed the asymmetry of the breasts, accesory mammas, a deformity of the nail on the right second finger, an absence of the nail on the right third finger, finger deformities on the right hand, and a deficiency of the left thumb since birth. Scoliosis and spina bifida were also observed. A right mammopexy was performed to improve the asymmetry of the breasts and prosthetic nails were attached. We discuss the clinical symptoms of Poland’s syndrome, focusing on our case, and are also reviewing several previous reports concerning the pathogenesis.
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Keiko KATO, Shingo TSUDA, Katsumi TANAKA, Masahiro KUSUHARA, Yoichiro ...
1995 Volume 57 Issue 5 Pages
973-977
Published: October 01, 1995
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Extraocular sebaceous carcinoma of the skin is an uncommon neoplasm. A case is reported in which a 62-year-old Japanese man had a tumor measuriug 12×8×3mm in size on his right nose wing and nostril. The histopathological appearance of the tumor showed a mixture of lobules of cells with an abundant foamy cytoplasm and atypical basaloid cells. An electron micrograph of the neoplastic cells exibited atypical nuclei with nucleolies, intracytoplasmic lipid droplets, lipid vacuoles, well-formed desmosomes, and clustered mitchondria and lysosomes. The necessity to ensure a complete tumor excision is stressed, since extraocular sebaseous carcionoma may behave in a biologically aggressive manner.
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Koji MURATA, Naotaka ISHIKURA, Sadao TSUKADA
1995 Volume 57 Issue 5 Pages
978-982
Published: October 01, 1995
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Two cases of plantar fibromatosis in 58-year-old and 53-year-old women, are reported. Histologically, a proliferation of fibroblast-like cells containing long fusiform nuculei formed small nodules in the fibrous tissue of the foot. These cells showed a positive reaction for human anti-
α smooth muscle actin antibody, and also shared certain morphological characteristics of myofibroblasts in an electron-microscopic study. The existence of myofibroblasts in both cases of plantar fibromatosis was confirmed.
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Tsuneaki NAKAGOMI, Hiroko NANKO, Akira MIZOO, Yasushi INOUE, Yoyun PAR ...
1995 Volume 57 Issue 5 Pages
983-989
Published: October 01, 1995
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Primitive neuroectodermal tumor (PNET) is very rare and is classified as a type of small cell sarcoma, which includes Ewing’s sarcoma, neuroblastoma, etc.. Recently we experienced a case of PNET which was detected after a sudden appearance of subepidermal nodules. This is the second case of PNET reported by dermatologists in Japan. In our case, the tumor originally occurred in the intrapelvic space, and then invaded the soft tissue of the thigh and thereafter moved to the subepidermal tissue of the abdomen, the mesothelium of chest as well as the paraaortic and superficial lymph nodes. Unfortunately the name “PNET” is not so well known among dermatologists. But in accordance with advances in histopathological research, we expect that the reported cases of this sarcoma may increase in number in the future. We discuss this entity in general and also comment on the differential diagnosis.
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Niro HANADA, Miho YAMAMOTO, Hiroaki EGUCHI, Takashi HORIKOSHI, Michio ...
1995 Volume 57 Issue 5 Pages
990-992
Published: October 01, 1995
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This paper reports one case with verruciform xanthoma of a 70-year-old Japanese man who complained of a thumb tip sized, yellow-red and verrucous nodule on the right side of the scrotum. By the histological examination, an elongation of the rete ridges and numerous foamy cells with a large cytoplasm in the papillary and upper dermis were identified. The foamy cells were stained positively for Suden III. We performed in situ hybridization to investigate the presence of human papilloma virus (type 16, 18, and 33 DNAs) on the paraffin embedded sections. However, no HPV DNA was found.
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—An Assesment of the Management for Aged Patients with Paget’s Carcinoma—
Atsushi NAKAMURA, Yoshihiro MAEKAWA, Kayoko YASUNO, Reiko NOGAMI
1995 Volume 57 Issue 5 Pages
993-998
Published: October 01, 1995
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Two cases of genital Paget’s carcinoma are reported. Case 1: an 82-year-old male who developed a tumor on his penis, and showed nult: ple metastatic lesions including the muscle, bone, liver and lymph nodes. He was treated only for the local skin lesion. Case 2: A 93-year-old male who had a wide pigmentated and erosive lesion on his penis and lower abdomen. Since he demonstrated no metastasis, a wide excision of the carcinoma was performed. We also reviewed the previous reports of genital Paget’s carcinoma and discussed the management for aged patients.
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Takahiro GYOTOKU, Hiromaro KIRYU, Masahiro USHIJIMA, Yoshiaki HORI
1995 Volume 57 Issue 5 Pages
999-1002
Published: October 01, 1995
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A 15-year-old boy had a soft mass in his left thigh since ten years of age. The resected mass was macroscopically huge and dumbbell-shaped, and histopathologically composed mainly of a proliferation of mature lipocytes and scattered lipoblasts with cytoplasmic vacuoles. Although ordinary lipomas generally show a slow growth and no recurrence, some cases associated with histopathological features similar to those seen in our case have a tendency toward rapid expansion and local recurrence. Such similar tumors have been named “lipoma-like well differentiated liposarcoma” or “atypical lipoma”. However, these terms do not seem to be appropriate because they evoke fears of malignancy against their clinical benignity. Regardless of the terminology, since our case is different from ordinary lipoma based on its location, gross appearance and histopathological features, a careful follow-up of this case will be necessary.
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Yukari BABA, Yasushi INOUE, Kimiko TAJIMA, Ryoichi FUKUSHIRO, Shigeo I ...
1995 Volume 57 Issue 5 Pages
1003-1008
Published: October 01, 1995
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A 71-year-old Japanese man who had been treated with oral corticosteroid administration for relapsing polychondritis for three years, developed a large subcutaneous abscess on the right thigh. Delicate, branching, gram-positive hyphae were found in pus and abscess. A chest X-ray P and CT scan revealed abnomal shadows in the right lung.
Nocardia brasiliensis was isolated from the pus of abscess and repeatedly from sputum. The abscess was excised and several chemotherapeutic agents, includings fluconazole and sulfonamides were given with partial success. The patient eventually died of hepatic failure and DIC. An autopsy revealed some abscesses in the right lung. Eight cases of systemic nocardiosis accompanied with metastatic subcutaneous abscesses reported in Japan are also briefly reviewed.
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Toshiki SATO, Shinya TAKAHASHI, Yasushi TOMITA
1995 Volume 57 Issue 5 Pages
1009-1013
Published: October 01, 1995
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A case of primary cutaneous aspergillosis, which developed in an 11-year-old girl with acute myelomonocytic leukemia, is reported. In addition, 22 cases previously reported in Japan since 1986 to 1994 were also reviewed. The patient had undergone bone marrow transplantation but experienced a relapse. While she had been treated with anticancer drugs, a bean-sized ulcer was found on her right palm where there had been contact with a splint used to immobilize her intravenous infusion line. A KOH examination of the scales around the ulcer demonstrated a dichotomous branching hyphae.
Aspergillus flavus was isolated from tbe scales and the ulcer. The ulcer disappeared after a week of treatment with topical povidone-iodine and bifonazole. Electron microscopic examination showed the hyphae to penetrate the corneocytes, with little space between the cytoplasm and the hyphae. These findings suggest that the hyphae of
A. flavus thus produce keratinase.
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Masanori BAN, Manabu MAEDA, Machiko FUJIHIRO
1995 Volume 57 Issue 5 Pages
1014-1017
Published: October 01, 1995
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A 79-year-old female with an erythematous lesion on her left forearm came to our hospital. A month before admission, she wore a new watch and developed itching on her wrist. We diagnosed the eruption as a kind of metal allergy, and treated her with corticosteroid ointment. When she visited us again ten days later, several nodules had further appeared on the lesion. A histopathological examination revealed a granuloma including a hair follicle in the dermis. The specimens stained by PAS showed a few spores in the granuloma, and many demonstrated invading hair shafts. A culture from biopsy tissue grew
Trichophyton rubrum. The distribution of the spores suggested that her lesion was trichophytia profunda acuta of the glabrous skin, and not granuloma trichophyticum. However, the clinical appearance made us suspect the latter, because it had very weak inflammatory reaction and had no pustules. These features might have then become modified by the application of corticosteroid ointment.
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Yuji YAMAGISHI, Norio OHTSUKI
1995 Volume 57 Issue 5 Pages
1018-1021
Published: October 01, 1995
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The appearance of a discoid lupus erythematosus-like eruption induced by camostat mesylate is reported. A 41-year-old man developed infiltrated erythema on the scalp, face, upper back, and the dorsal aspect of the hands. He had been treated for chronic pancreatitis with camostat mysylate for one year and two months. The eruption first appeared four months after the drug was first administered. The laboratory examinations were all within normal ranges without an elevated peripheral WBC count. A histological examination showed hyperkeratosis, follicular plugging, acanthosis, vacuolar degeneration of some parts of basal layer, and an infiltrate composed mainly of lympocytes and some eosinophils around the vessels and follicles of the upper dermis. A direct immunofluorescence test revealed a fine granular deposit of C 3 along the basement membrane zone of the follicle. A patch test by camostat mesylate was negative, but a scratch patch test was positive. In addition, the lymphocyte stimulation test was also positive. After termination of the drug, he was treated with ointment containing corticosteroid and the symptoms healed within about two months.
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Takehito ISHIKAWA, Masako MURATA, Kazue NISHIOKA
1995 Volume 57 Issue 5 Pages
1022-1027
Published: October 01, 1995
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A 72-year-old man developed similar eruptions after taking three drugs, hydroxyzine hydrochloride, oxamide, and tiaramide hydrochloride. The eruptions consisted of scattered millet-sized erythema almost over the entire body which then coalesced into diffuse erythema on the trunk and extremities, and millet-sized purpura on the thighs and the abdomen. Patch tests with 5%. 10%, and 20% hydroxyzine hydrochloride and 10% tiaramide hydrochloride were all positive. Provocation tests with hydroxyzine hydrochloride, oxatomide and tiaramide hydrochloride were also positive. Since these three drugs have a common structure composed of a piperazine ring, we inferred that the piperazine ring should have been antigenic. In patch tests with 3 other kinds of drugs and a reagent that contained a piperazine ring, 5% and 10% perazine dimaleate were also positive. We thus concluded that the piperazine ring was causative for the cross-reaction among these three drugs.
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