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Volume 66 (2004)
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Volume 66, Issue 6
Displaying 1-18 of 18 articles from this issue
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Color Atlas
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Miwa Kobayashi, Yoshiki Tokura, Kanichiro Nakayama2004 Volume 66 Issue 6 Pages 551-552
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSDownload PDF (790K)
Clinical Case Reports
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Koji MAKINO, Shunji HIRAI, Yasushi KANEKO2004 Volume 66 Issue 6 Pages 553-558
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe report a 51-year-old male with refractory leg ulcers complicating Klinefelter's syndrome. Recurrent leg ulcers had occurred for 16 years. Although valvoplasties of both femoral veins were performed in 1999, the condition was not relieved. Therefore, the patient were referred to our department on April 15, 2003. Ulcers were noted on both ankles. Both eyes were separated. Gynecomastia, thin hirci and pubic hair, and atrophic testis and penis were noted. Chromosome karyotypes were mos 47 XXY/46 XY and he demonstrated elevated serum LH and FSH and decreased serum testosterone. After hospitalization, he was diagnosed as having Klinefelter's syndrome. Split-thickness graft was performed, and oral administration of fluoxymesterone 4 mg/day prescribed. The ulcers initially recovered and he was discharged on June 20. However, ulcers recurred when the patient neglected to take fluoxymesterone in mid-July. When compliance was restored, the ulcers neither expanded nor reduced.View full abstractDownload PDF (5458K) -
Yutaka ASATO, Shigeo NONAKA, Takeo AOKI2004 Volume 66 Issue 6 Pages 559-563
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 46-year-old male had suffered from varix and chronic eczema with occasional pain on his both legs since he was 27 years old. When he was 30 years old, he was treated with stripping surgery at his nearby hospital, but symptoms still persisted after surgery. In April, 2003, he visited our hospital with complaint of severe pain over left ankle joint. We diagnosed this case as stasis dermatitis, based on his clinical history and presentation. But, from his appearance, we suspected that any other primary diseases might have been related with it. We performed clinical investigations and relevant laboratory examinations, which confirmed diagnosis of Klinefelter's syndrome. He had been treated with monthly testosterone injection since he was 30 years old. Klinefelter's syndrome, which is one of the abnormal sex chromosome disorder, is caused by an X-chromosome aberrations, in general, 47XXY karyotype. The patients are usually presented with tall stature, small testis, long extremities and gynecomastia. But reports of varix and leg ulcer are relatively rare. We review the other case reports that suggested varix and stasis dermatitis associated with Klinefelter's syndrome. In Japan, a total of 21 cases of patients accompanied with leg ulcer was reported, 5 cases with varix, and 5 cases with stasis dermatitis. In our patient, treatment with oral prednisolone resulted in the improvement of his dermatitis.View full abstractDownload PDF (2117K) -
Kyoko WATANABE, Chiaki OGINO, Mieko OOI2004 Volume 66 Issue 6 Pages 564-566
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe report a 67-year-old man with an ulcer on the right foot due to acute right tibial arterial occlusion. He had had hypertension and angina for several years. Just after examination for neoplasm of the colon, he complained of pain, pallor, and paralysis of the right foot. On the first visit, his right foot was cyanotic and had no palpable pulse, and digiti were becoming gangrenous. Histopathologically, necrosis of the entire epidermis and thrombi in the deep dermal artery was found. MR angiography showed occlusion of the right tibial artery. Results of treatment with intravenous prostaglandin were disappointing. However, the severe pain disappeared after only a few sessions of hyperbaric oxygen therapy. After six such treatments, the foot ulcer had healed.View full abstractDownload PDF (2414K) -
Makoto INAOKI, Chiaki MARUOKA, Maiko SASAE, Yuko MIYASHITA, Wataru FUJ ...2004 Volume 66 Issue 6 Pages 567-571
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 46-year-old Japanese woman had presented with a 2-month history of painful swollen fingers. Examination showed swelling, skin sclerosis, and flexion contractures of the fingers. The feet and toes were cyanotic, and varices were seen on the left lower extremity. A skin biopsy specimen from the forearm revealed closely packed, thick collagen bundles in the reticular dermis. Results of serological examination were positive for anticentromere antibodies, anti-SS-A antibodies, and lupus anticoagulant. Angiography revealed thrombus in the aorta and left common iliac vein. Dry eyes and positive Schilmer's test were noted upon an ophthalmic examination. From these findings, a diagnosis of systemic sclerosis associated with antiphospholipid syndrome and Sjögren's syndrome was made. The patient received aortoiliac bypass surgery. Antithrombotic treatment with warfarin was begun. Twelve years after the presenting symptoms, her platelet count fell (1.1 × 104/mm3). Administration of oral prednisolone (35 mg daily) resulted in an increase in platelet count to 10 × 104/mm3.View full abstractDownload PDF (3395K) -
Hiroaki TATENO, Mitsutaka NAKAMURA2004 Volume 66 Issue 6 Pages 572-574
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSAn 85-year-old woman who was regularly treated at a nearby internal medicine clinic developed skin ulcer on the left middle finger. Since her condition remained unchanged despite about one week of treatment there, she was reffered to our department. During her first examination at our department, a skin ulcer with clear borders was noted over the entire circumference of the DIP joint of the left middle finger. When the tissue inside of the ulcer was examined with ophthalmologic forceps, a buried rubber band was discovered, which was removed immediately. Her ulcer cured about 3 weeks after the operation.View full abstractDownload PDF (3458K) -
Yoko YAGI, Yoshinori UMEZAWA, Akira OZAWA, Eiren TOH, Joji MOCHIDA, Ma ...2004 Volume 66 Issue 6 Pages 575-577
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 54-year-old female noticed a sweating dysfunction on her left thigh during summer over a period of 5 years. She experienced no other symptoms, neurological disturbances, or any cutaneous disease. Sweat test (Minor) revealed that the left trunk and left leg did not sweat while the right side sweat normally. MRI of the head revealed no evidence of lesions or neurological disorders. Laboratory data or physical findings were not significant. Skin biopsies were obtained from both sweating and non-sweating areas, with no pathological findings from either area. Thoracic MRI revealed a tumor approximately 1.2 cm × 1.8 cm at the 6th and the 7th thoracic level. CT subsequent to the MRI showed that the tumor was an osteochondroma, a benign bone tumor, compressing the spinal cord from the left dorsal side where the left sympathetic ganglia were located. The sweating dysfunction in this patient is considered to be a sympathetic disorder due to the presence of the spinal osteochondroma.View full abstractDownload PDF (2402K) -
Emiko AKASAKA, Yukinori OHTA, Yoko YAGI, Yoshinori UMEZAWA, Mariko IIZ ...2004 Volume 66 Issue 6 Pages 578-581
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 34-year-old male with Down syndrome had a one-year history of lesions on both thighs. Skin lesions consisted of different types of papules, with either a keratotic plug or umbilicated center, arranged in a serpiginous pattern. The biopsied specimen revealed basophilic debris surrounded by epidermal hyperplasia that appeared to be a transepithelial perforating channel. These findings were compatible with the diagnosis of elastosis perforans serpiginosa (EPS). The patient was treated successfully with topical application of vitamin D3 analog ointment. Here, we report a case of EPS with Down syndrome, which seems to be relatively rare, and present a literature review of the subject.View full abstractDownload PDF (3644K) -
Tetsuya YAMAMOTO, Reiko OFUJI, Takashi OONO, Keiji IWATSUKI2004 Volume 66 Issue 6 Pages 582-584
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe report a 62-year-old man with puffy eyelids caused by amiodarone-induced hypothyroidism and elevated levels of serum muscle enzymes. He had been diagnosed as having spontaneous dilated cardiomyopathy in July 1990 and had received amiodarone hydrochloride (Ancaron®) since May 10, 2001. In January 2002, erythematous puffy edema appeared in the periocular regions without subjective symptoms and gradually expanded around the eyelids. Tentative clinical diagnoses included dermatomyositis or photosensitivity due to amiodarone hydrochloride. Despite the elevated levels of serum myoglobin and aldolase, histopathologic features showed no liquefactive degeneration suggestive of dermatomyositis. The eyelid lesion was weakly positive for mucin. Neither muscle weakness nor abnormal findings of electromyogram were observed. Phototests using UVA and UVB were normal. Hypothyroidism due to amiodarone hydrochloride was diagnosed because of increased levels of TSH with decreased freeT4 levels. Administration of levothyroxine sodium (Tyradin S®) improved the hypothyroidism and skin lesions.View full abstractDownload PDF (2906K) -
Makiko KIDO, Shuhei IMAYAMA, Miki URYU, Reiko KAWASAKI, Morishige TAKE ...2004 Volume 66 Issue 6 Pages 585-589
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe studied a case of epithelioid sarcoma that had developed on the right sole of a 27-year-old Japanese man. The lesion, which had a history of 6 months, presented as indurated erythematous plaque of 4×7 cm scattered with several irregular scars. Microscopically, the majority of the proliferated tumor cells were large, plump epithelioid-like cells with eosinophilic cytoplasm and an oval nucleus. The remainder were fibroblast-like, bearing spindle-shaped cell bodies. Immunohistochemistry indicated that the epithelioid-like cells were positive for Vimentin and AE1/AE3, but that the fibroblast-like cells were negative. Electron microscopy revealed that the former cells were characterized by an abundant and monotonous cytoplasm being filled with intermediate filaments densely arranged throughout the cell bodies. Small mitochondria were the only organelles around the nucleus. On the other hand, the fibroblast-like cells were characterized by prominent cytoplasmic organelles, including mitochondria, rough endoplasmic reticulum, Golgi apparatus and free ribosomes, and by abundant glycogen within the cytoplasm. Regardless of such different features, both cells were partially surrounded by basal lamina and exhibited close contact with juxta cells with gap junctions. These findings support the belief that the tumor was related etiologically to synovial sarcoma.View full abstractDownload PDF (5102K) -
Sho TOKUMARU, Keisuke SUGIURA, Yumiko MATSUMOTO, Masana HARADA, Tomoko ...2004 Volume 66 Issue 6 Pages 590-593
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 79-year-old Japanese man visited our hospital on October 1, 2002, because of a right axillar ulcer. In 1989 he had noticed a small nodule on the right axillar region. Cryosurgery with liquid nitrogen had been performed several times for the nodule, resulting in the formation of an ulcer. Three months prior to this visit, the growth rate of the lesion had increased. The ulcer was 6×5 cm in size and biopsy revealed basal cell carcinoma (BBC). There were regional lymph node metastasis and skin metastasis in his axilla. The primary tumor and metastasis were excised and covered with a split-thickness skin graft. The histological appearance of both the lymph nodes and cutaneous metastasis was the same as that of the primary tumor. Based on pathological examination, a diagnosis of metastasizing BCC was made. Four months after treatment, local recurrence was observed. However, 14 months after re-excision, there has been no recurrence.View full abstractDownload PDF (4297K) -
Sayaka HAYASHIDA, Shiori SAIGO, Manabu HAMADA, Yoichi MOROI, Kazunori ...2004 Volume 66 Issue 6 Pages 594-598
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA 37-year-old male was admitted to our hospital in May 2002 because of severe pain in both lower extremities and the back accompanied by a 4-day history of high fever. He had undergone total aortic arch replacement for acute aortic dissection on 1994 and 2001. On admission, he had shock, disseminated intravascular coagulation and acute renal failure. Furthermore, he developed erythema on the left thigh and both feet and purpura on his right fingers. A histopathologic examination of the erythema revealed the presence of many neutrophils and gram-positive bacterial colonies in the subcutaneous tissues. β-hemolytic group C streptococcus (Streptococcus dysgalactiae subsp. equimilis) was detected from skin and blood cultures. The diagnosis of septicemide was confirmed. Imaging tests failed to detect the primary focus of the infection, and the patient died on the 18th day of hospitalization in spite of intensive care. Autopsy revealed the presence of abscesses at the patient's artificial vessel graft.View full abstractDownload PDF (2892K) -
Hiromi SUZUKI, Atsushi HATAMOCHI, Michio HASIKABE, Soji YAMAZAKI, Moto ...2004 Volume 66 Issue 6 Pages 599-601
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSGefitinib (Iressa®) is a new anticancer agent against lung cancer that acts by inhibiting signal transduction of the growth factor receptor. We describe six patients receiving gefitinib (250mg/day) who developed an acne-like eruption consisting of follicular papules and pustules on their faces, chests and/or backs. A histopathological examination of one patient revealed an inflammatory cell infiltration around the hair follicles.View full abstractDownload PDF (2154K) -
Miho UCHIHIRA, Takahiro EJIMA, Takao UCHIHIRA, Jun ARAKI, Toshiaki KAM ...2004 Volume 66 Issue 6 Pages 602-607
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe investigated 24 patients with non-small cell lung cancer who were treated with Gefitinib (IressaTM) from October 2003 to February 2004 in Yamaguchi Prefectural Center Hospital. A variety of cutaneous manifestations were seen in 19 of 24 (79.2%) patients, and 15 patients were referred to the dermatological division for skin treatment. We had to discontinue Gefitinib therapy in 4, 3, and 3 patients due to pulmonary dysfunction which included definitive or suspected interstitial pneumonitis, liver dysfunction, and cutaneous side effects, respectively. The most common cutaneous reaction to Gefitinib therapy was the development of an acneiform follicular eruption (57.9%). Additional dermatological side effects included xerosis (42.1%), seborrheic dermatitis (31.6%), and paronychia (26.3%). It is now generally accepted that Gefitinib is one of the most effective agents for advanced lung cancer. To continue treatment with this agent, therefore, might improve the prognosis. In maintaining this treatment, it is important to successfully control the cutaneous side effects that are the most common adverse effects of this drug. To achieve this aim, a lower dose or a modification of the dosage, such as intermittent administration, should be considered to lessen these side effects.View full abstractDownload PDF (3819K)
Statistics
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Emi YOKOYAMA, Yumie OGASAWARA, Yoshiaki HAMAMOTO, Masahiko MUTO, Masak ...2004 Volume 66 Issue 6 Pages 608-611
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSA women's outpatient clinic run by women for women was started at Yamaguchi University Hospital in March 2003. Thirty-five female patients with dermatological diseases visited our Dermatology Division by the end of September 2003. Patients with dermatological diseases in the women's clinic amounted to 12% of 302 outpatients, ranging in age from 16 to 76-years. Twenty of the 35 patients had more than 2 dermatological diseases. There were total 62 diseases. Their chief complaints were dermatitis (37%), neoplasm (16%), alopecia (10%), acne, fungal infection (each 8%), viral infection, collagen disease, pigmented disease (each 3%), and others (11%). With respect to the affected sites, 38% were on the scalp and/or face, and 31% were on the inguinal, genital bottom and/or breast region. There were no malignant diseases and very few acute diseases. Many diseases had appearance problem and women's specific lesions. These results suggest that dermatologists play an important role in the women's clinic.View full abstractDownload PDF (1896K)
Therapy
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Yukiko TERAMOTO, Makoto ICHIMIYA, Yuko TAKITA, Yoshiaki YOSHIKAWA, Mas ...2004 Volume 66 Issue 6 Pages 612-614
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSThe thigh is a common donor site for split skin grafts. We experienced regional blockade of the lateral femoral cutaneous nerve for harvesting split skin grafts from thighs in 6 patients. We blocked the lateral femoral cutaneous nerve by injecting 10 ml of 1% lidocaine with or without 1 : 100,000 epinephrine. Sufficient anesthesia was achieved in 5 patients. The remaining patient obtained partial anesthesia of local infiltration into the thigh. We suggest that the lateral femoral cutaneous nerve block is very useful for harvesting split-thickness skin grafts from the thigh.View full abstractDownload PDF (580K) -
Tetsuya KOGA, Takeshi NAKAHARA, Masutaka FURUE, Yoshiko ABE, Hiroshi M ...2004 Volume 66 Issue 6 Pages 615-620
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSWe investigated the efficacy and safety of a cosmetic detergent and moisturizer in patients with dry skin, having such problems as atopic dermatitis and xeroderma. The detergent is a liquid soap consisting of two kinds of fatty acids with L-arginine for a protective effect on the skin. It was applied to 39 cases. The moisturizer is a lotion emulsified from white petrolatum that contains trimethylglycine for the moisturizing effect. It was applied to 43 cases. After 4 weeks of application, the former was observed to be safe in 37 cases and the latter in 41 cases, with efficacy in 40 cases. These results indicate that the two skin care products in this study are highly safe for dry skin diseases, and that the moisturizer can improve dryness and itching of the skin.View full abstractDownload PDF (883K) -
Kikyo GO, Shouei FUJISHIGE, Yuhei ICHIMARU2004 Volume 66 Issue 6 Pages 621-624
Published: 2004
Released on J-STAGE: October 21, 2005
JOURNAL RESTRICTED ACCESSThe moisturizing effect on the skin of horse oil that resembles the fatty acid composition of human sebum and contains a large amount of linolic acid was investigated. Horse oil applied to seven healthy females was shown to increase water and oil content in the horny layer. Examination of the fatty acid composition of the oil remaining on the surface of the skin two hours after application revealed a clear decrease in linolic acid content. The increase in water and oil content in the skin due to local application of horse oil was an important contribution to the structure of the skin to maintain its function as a barrier, mainly as a result of absorption of linolic acid by the skin. These findings indicate that horse oil as a preparation for external use is suitable for maintaining the health and moisture of skin through percutaneous administration.View full abstractDownload PDF (601K)
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