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Yoshiyuki MURAKAMI
1996 Volume 58 Issue 2 Pages
197-199
Published: April 01, 1996
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We report a case of contact dermatitis due to both
Alstromeria and
Chrysanthemum in a 36-year-old woman. She had been suffering from pruritic skin eruptions on her face, forearms and hands for approximately the previous 10-month-period after working at her husband’s flower shop. Patch testing resulted in positive reactions for the flower, the leaf and the stem of both
Alstroemeria and the
Chrysanthemum plants.
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Report of Two Cases
Jun TSUJITA, Kyoko NAKAMURA, Shinichiro YASUMOTO, Yasutaka UENO
1996 Volume 58 Issue 2 Pages
200-202
Published: April 01, 1996
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We report two cases of pacemaker dermatitis at the site of cardiac pacemaker inplantation. Both of these patients developed the dermatitis five and ten years, respectively, after the initial insertion of the pacemaker. By patch tests, one of the patients revealed a positive reaction to tiuram mix. Wrapping of the pacemaker with a polytetrafluoroethylene (PETE) sheet proved to be an effective treatment for both patients.
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Yoko HIROTA, Masahiko MUTO, Yoshiaki HAMAMOTO, Toru HIROTA, Chidori AS ...
1996 Volume 58 Issue 2 Pages
203-206
Published: April 01, 1996
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We present a very rare case of cutaneous allergic vasculitis associated with hyper
α-feto proteinemia (AFP) and an ovarian immature teratoma. A 34-year-old female visited our clinic with multiple half rice corn-sized, infiltrative erythema on both her legs. At the time of her visit she could not walk by herself because of general fatigue and severe arthralgia in her ankles. She had no past history of medication nor any infectious focus which could have induced a bacterial allergy. Further examination showed the patient to have a left ovarian tumor. After resection of this tumor no eruptions have since developed after more than one year. Histopathological studies revealed leukocytoclastic vasculitis with small vessels in the dermis and the subcutaneous tissue. Immunohistochemical studies indicated that AFP was expressed in the cytoplasm of the ovarian immature teratomae cells. The increased serum level of AFP (184.7ng/ml) before the resection became normal (23.3ng/ml) and has since remained stable after the resection.
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Shiro NIIYAMA, Hiromi TSUBOI, Akihiko HASHIMOTO, Toshiya ASAI, Kensei ...
1996 Volume 58 Issue 2 Pages
207-211
Published: April 01, 1996
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The case of a 30-year-old man with eosinophilic pustular folliculitis (EPF) is reported. The patient first noticed erythema and pustules on his palms and soles, and was initially diagnosed as either dyshidorotic eczema or pustulosis palmo-plantaris. On admission, pustules on erythematous scaly macules were seen not only on his palms and soles but also on his trunk and extremities. Histo pathologically, intra-epidermal pustules containing many eosinophils were observed. The combined oral administration of indomethacin and minocyclin proved to be effective. We also summarized the 22 cases with EPF treated at our hospital. One of these cases showed a high serum level of androgen. The oral administration of indomethacin proved to be effective in most cases. Indomethacin began to show its efficacy within several days, however, skin lesions were found to recur in most cases after discontinuing the indomethacin administration.
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Hiromichi TAKESHITA, Hiromaro KIRYU
1996 Volume 58 Issue 2 Pages
212-214
Published: April 01, 1996
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A 61-year-old male with proliferative fasciitis is presented. The patient had developed a hard nodule in his right lower leg near a site of recent trauma over the past 10 days. Histopathologically, the mass was mainly composed of a proliferation of fibroblastic cells and many giant cells resembling ganglion cells. Immunohistochemically, the fibroblastic cells and a large number of the giant cells showed a positive reaction for vimentin. The patient also had multiple angiolipomas and chronic lymphoid leukemia, although the relationship among them was unclear.
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Yuka OKUDA, Midori ISODA
1996 Volume 58 Issue 2 Pages
215-218
Published: April 01, 1996
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The case of a 40-year-old Japanese woman with systemic lupus erythematosus (SLE) is reported. The patient was referred to our clinic for an evaluation of erythema multiforme-like eruptions on her elbows, back, buttocks and knees after suffering from an upper respiratory infection. The histological evaluation of a biopsy specimen showed a dense infiltration composed of neutrophils around the dermal vessels with swollen endothelial cells, thus suggesting the diagnosis of leukocytoclastic vasculitis. Treatment with systemic corticosteroid was effective on the eruptions, however, recurrent lesions developed after tapering the drug dosage.
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Tatsuya AKAKI, Satoshi DEKIO, Joji JIDOI
1996 Volume 58 Issue 2 Pages
219-222
Published: April 01, 1996
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We described two cases of multiple scrotal atheromatosis. Case 1, a 44-year-old Japanese man developed small subcutaneous nodules in a group on the right side of his scrotum one and a half years before. Case 2, a 59-year-old Japanese man had noticed 4 small subcutaneous nodules on his scrotum for the last 4-5 years. A histopathological examination after a total excision of the nodules revealed them to be epidermoid cysts in both patients. Using von Kossa staining on specimens of the excised cysts, case 1 showed a negative result, while case 2 showed positive. For alcian blue and colloidal iron staining, case 1 was negative, while case 2 was positive. In case 2, toluidine blue staining was also performed under various pH conditions; the cyst contained metachromatically positive substances at pH 7.0, but not at pH 2.5. These results suggested that the cyst of case 1 contained neither calcium nor acid mucopolysaccharide. However, the cyst of the case 2 contained both calcium and acid mucopolysaccharide with sulfuric bases. We thus concluded that in the calcification of the multiple scrotal atheromatosis, acid mucopolysaccharide with sulfaric bases might thus play an important role.
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Wakatoshi MATSUNAGA
1996 Volume 58 Issue 2 Pages
223-226
Published: April 01, 1996
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A 47-year-old male first presented at our hospital on January 26, 1994. He had congenital portwine stain on the left side of the face, head, ear and neck. From about twenty years of age, nodular tumors began to grow on the lesions and recently grew into huge masses. He was operated six times to improve his facial appearance. Histopathologically, arteriovenous anastomotic vessels were abundant in the dermis. Moreover many capillaries and venules were also dilatated. It was suggested that the cause of hypertrophic portwine stain might be partially due to the hyperplasia of the arteriovenous anastomosis.
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Keisuke MAEDA
1996 Volume 58 Issue 2 Pages
227-229
Published: April 01, 1996
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The case of a 56-year-old woman with polyneuropathy, organomegaly and edema satisfying the criteria for Crow-Fukase syndrome presented with multiple hemangiomas on her trunk and extremities, skin hyperpigmentation and ichthyosis. A histopathologic exarmination of a hemangioma showed proliferating endothelial cells forming immature vascular structures. Plasma exchange treatment led to an improvement in the neuropathy, and the eruptive hemangiomas gradually decreased in both number and size. After the treatment, a specimen from a hemangioma revealed dilated vascular spaces lined by a single layer of flat endothelial cells.
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Keiko KURATA, Masahiko MUTO, Junji NAKANO, Toru HIROTA, Chidori ASAGAM ...
1996 Volume 58 Issue 2 Pages
230-232
Published: April 01, 1996
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A 77-year-old Japanese woman had noticed multiple brownish pigmented spots with papules on her left upper back since birth. At the same site, she also developed a firm subcutaneous tumor at the age 76. The tumor had rapidly increased in size. Histologically, pigmented spots were naevus spilus, the dermal papule was neurofibroma and the tumor was neurofibrosarcoma. This is the first report of neurofibrosarcoma which derived from segmental neurofibromatosis. No recurrence has since been observed in the 3 years following the operation.
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Mitsuharu KAYABA, Yutaka ISHII, Yumiko GOTOH, Yutaka NARISAWA, Hiromu ...
1996 Volume 58 Issue 2 Pages
233-236
Published: April 01, 1996
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We report a 51-year-old Japanese man with malignant schwannoma associated with von Recklinghausen’s disease. The dome-shaped tumor developed on the right side of his chest and was elastic hard, purplish brown with a diameter of 8 cm. Histopathology showed the nodule composed of strongly deformed cells that were spindle or oval shaped while displaying a storiform pattern. Mitosis and bizarre cells, usually observed in malignant fibrous histiocytomas, were present, but the immunoreactivities of S-100 protein and neuron specific enolase and the presence of basal lamina on an electron microscopic examination led to the diagnosis of malignant schwannoma. The patient was treated by a surgical wide excision and postoperative chemotherapy.
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Masaaki KUBOTA, Kazumori ISHIGURO, Makoto YANAGIHARA, Keiichi UEDA, Fu ...
1996 Volume 58 Issue 2 Pages
237-240
Published: April 01, 1996
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An 80-year-old man noticed a verrucous tumor on his head. The tumor consisted of a black nodule and a light-red nodule. Histopathologically the former was trichilemmoma (Tr), while the latter was proliferating trichilemmal tumor (PTT). It was uncertain whether or not the PTT was malignant, because the tumor cells were composed of atypical cells and mitotic cells, and the atypical cells were stained positive with anti-proliferating cell nuclear antigen (PCNA) antibody. It is well known that sugarchains of glycoproteins and glycolipids on cell membrane show structural alterations during malignant transformation. Therefore, we immunohistochemically investigated Tr, PTT and normal follicles regarding their lectin-binding characteristics. As a result, apparent differences in the staining properties were found between PTT and the normal follicles, but not between PTT and Tr.
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Kana KURITA, Atsuro HIRAIWA, Yasunobu HIBI, Eiichi ISOBE, Shuhei TORII
1996 Volume 58 Issue 2 Pages
241-244
Published: April 01, 1996
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A case of a male patient (64 years of age) with Muir-Torre syndrome was reported. The clinical features of this case included multiple sebaceous adenomas located on his face and scalp, and double cancers of the stomach and colon found in multifold lesions. It was found that two of his family members were also suffered from malignant visceral tumors. This case was further discussed regarding clinico-epidemiological factors and in comparison to the eight cases of Muir-Torre syndrome previously reported in Japan.
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Saburo ANZAI, Tadashige SONODA, Atsuko YAMAMOTO, Kazumoto KATAGIRI, Sa ...
1996 Volume 58 Issue 2 Pages
245-248
Published: April 01, 1996
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We report a case of Sézary syndrome demonstrating cytologic transformation from small convoluted cells to anaplastic large cells. A 43-year-old woman was admitted to our hospital because of erythroderma and a marked generalized lymphoadenopathy. The white blood cell count increased to as high as 133700/mm
3. Most of the white blood cells possesed convoluted cerebriform nuclei characteristic of Sézary cells, and were CD4 positive. After she was treated with low dose methotrexate and prednisolone for one year, the white blood cell count decreased to normal values and the lymphoadenopathy almost disappeared. However, soon after the treatment was discontinued due to pancytopenia, an enlargement of the lymph nodes, hepatosplenomegaly and skin tumors all appeared. She died of cardiac insufficiency associated with pleural effusion 6 years after the onset of the disease. Large anaplastic cells in the skin tumor developed in the late stages of disease which were also CD4 positive, and the similar cells in the pleural effusion obtained at the time of death were positive for CD30 as well.
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Kayo TAIRA, Haruhiko OHTSUBO, Seiji RYU, Yutaka NARISAWA, Hiromu KOHDA ...
1996 Volume 58 Issue 2 Pages
249-251
Published: April 01, 1996
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We report the case of a 71-year-old man who presented with chromoblastomycosis on the left knee. The diagnosis was made based on the detection of
Fonsecaea pedrosoi after a direct examination of the scales and the culture of biopsied materials taken from the lesion of erythematous verrucous plaque.
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Rie SUGIMOTO, Takuroh KATOH, Kiyoshi NISHIOKA
1996 Volume 58 Issue 2 Pages
252-254
Published: April 01, 1996
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We report three cases of dermatophytosis in children that were all proven to have been infected outside the house after isolating the dermatophytes from house dust. Case 1 was an 11-year-old boy suffering from tinea pedis by
Trichophyton mentagrophytes that were isolated from house dust. Case 2 was a 5-year-old boy suffering from tinea corporis by
T. rubrum which was also isolated from house dust. In both cases, no dermatophytes were isolated from the house dust after undergoing therapy and we thus concluded that the dermatophytosis not originated in their houses. Case 3 was an 11-year-old boy suffering from tinea pedis by
T. rubrum whose father was also suffering from tinea pedis by
T. mentagrophytes. Though both dermatophytes were isolated from house dust before therapy,
T. rubrum decreased substantially after 2 months of therapy. The
T. rubrum infections in other family members were also ruled out. In cases 1 and 2, the patients had engaged in such outdoor activities as kendo, karate or swimming lesson. We thus concluded that dermatophyte infections originating outside the house were therefore increasing due to a diversification of the children’s life styles.
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Shinichi OYAKE, Tsunao ÔI, Michiyuki KOGA, Hiromi SERIZAWA
1996 Volume 58 Issue 2 Pages
255-258
Published: April 01, 1996
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A 40-year-old male presented with general fatigue and a 2-month history of eruptions on the trunk and upper limbs. He had widespread erythematous papular eruptions on the trunk and limbs. A skin biopsy from his back showed the presence of elastic fiber damage and phagocytosis of multinucleate giant cells (elastophagocytosis). Blood chemistry revealed increase in GOT, GPT and ALP. The venereal disease research laboratories test for syphilis (VDRL) was 512 dilutions and the
Treponema pallidum hemagglutination assay (TPHA) was 10240 dilutions. Because of the clinical findings and the serological tests for syphilis, we made a diagnosis of secondary syphilis. After the patient was treated with amoxicillin, the rash and clinical symptoms gradually disappeared. The Histofogical features of secondary syphilis tend to vary, but a presence of elastophagocytosis is rare.
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—The Time Course of Mycobacterial-Sepcific and Mycobacterium leprae Specific Antibody Levels During the Chemotherapy—
Masako NAMISATO, Akiko OBARA, Kunio KAWATSU, Shinzo IZUMI, Hideoki OGA ...
1996 Volume 58 Issue 2 Pages
259-263
Published: April 01, 1996
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The case of a 68-year-old male with lepromatous leprosy is reported. After his first relapse, the Mitsuda-reaction changed negatively. Later he experienced a second relapse. At the first visit, he presented widely disseminated active skin lesions, after taking DDS and RFP in a different manner from the standard WHO regimen. A skin biopsy specimen showed many rod-shaped organisms, mostly in large clumps (globi), which are usually seen in untreated lepromatous leprosy. Chemotherapy with OFLX and CLDM was then started, and later CLDM was replaced with MINO. About 1.5 years later, the skin lesions had greatly improved and the morphological index (MI) of skin smear became negative. In the second biopsy specimen taken from the decreasing leproma on his chest, all the bacilli had granulated. During the chemotherapy including OFLX, leprosy reactions were sometimes observed, but were not so severe and they could be well controlled with temporarily administrated thalidomide. We monitored the serum levels of IgG and IgM antibodies to phenolic glycolipid-I (PGL), specific to
Mycobacterium leprae, and lipoarabinomannan-B, specific to Mycobacteria, since his first visit. All these decreased in correlation to the patient’s improved clinical features. Especially, the decrease in PGL-IgM was remarkable. In addition to the bacterial index and MI, the evaluations of these antibodies are considered to be useful in monitoring the effectiveness of chemotherapy for leprosy patients, especially for cases of lepromatous leprosy.
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