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Yoshihito Sasaki, Atsuko Adachi, Shinichi Shimoura, Akihisa Yao, Takaf ...
2007 Volume 6 Issue 6 Pages
567-571
Published: 2007
Released on J-STAGE: December 06, 2010
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A twenty four-old man, who suffered from acute epididymitis for two weeks, came to the dermatology department of our hospital on November, 2005, because of his oral ulceration and painful erythema of bilateral lower legs. The histopathological finding of biopsy specimen from the erythematous lesion showed septal panniculitis and vasculitis, which is compatible with Behçet’s disease. At first, treatment with potassium iodide and colchicines relieved him from acute epididymitis and erythema nodosum, but he suffered from diarrohea two weeks after. Endoscopic findings of the terminal ileum showed multiple deep ulcers, indicating that he developed intestinal Behçet’s disease. He had recovered completely by the treatment with oral predonisolone 30mg/day since then.
We think that acute epididymitis is a rare initial symptom of Behçet’s disease as well as the sign which should suggest the severe form of Behçet’s disease. Since intestinal Behçet’s disease often recurs, the patients is now under the intensive observation.
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Yuika Uno, Yukiko Endo, Shinichi Moriwaki, Kimihiro Kiyokane, Eijiro M ...
2007 Volume 6 Issue 6 Pages
572-576
Published: 2007
Released on J-STAGE: December 06, 2010
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We report a case of Henoch-Schönlein purpura (HSP) with severe abdominal symptoms and purpura, resistant to systemic steroid therapy. A 17-year-old woman who had noticed purpura on her foot with no precedent episode, and the skin lesions exacerbated gradually. She came to our hospital because of abdominal pain and arthralgia. A diagnosis of HSP was made based on the clinical symptoms as well as histopathological examination showing leukocytoclastic vasculitis. The patient’s serum level of factor XIII activity dropped to 32% of normal value. Systemic prednisolone treatment was commenced, however, there was no improvement of abdominal pain, proteinuria and purpura. Additional treatment with intravenous factor XIII and steroid pulse therapy were effective to these symptoms.
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Yuki Yoshida, Naoki Maekawa, Kazuhoshi Yamanaka, Shuichi Kuniyuki
2007 Volume 6 Issue 6 Pages
577-581
Published: 2007
Released on J-STAGE: December 06, 2010
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We describe two cases that were successfully treated by this method. One is skin ulcers with pocket-formation, and the other is fixation of skin graft dressings for exudative skin ulcers. This method has the advantage of providing a good dranaige and keeping wound bed preparation for skin ulcers. In addition, it provides a good fixative and well-balanced pressure dressing on the skin grafts.
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Yuki Shimizu, Shigefumi Morimoto, Hiroshi Kosaka
2007 Volume 6 Issue 6 Pages
582-586
Published: 2007
Released on J-STAGE: December 06, 2010
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Oxaliplatin has become a pivotal drug as a part of FOLFOX4 chemotherapy against the colon cancer. Here we show two cases of colon-cancer-bearing females, both stricken by hypersensitive reaction just in a few-minute infusion of oxaliplatin. Case 1 : a 52 year-old female, having been attacked by dyspnea and itchiness in the hands at the seventh term of FOLFOX4, was proven clearly positive to oxaliplatin in intracutaneous test. Although a combination of dexamethasone, cetirizine and hydroxyzine were previously taken before the next term to prevent hypersensitivity, the crucial reaction was hardly circumvented. Case 2 : a 46-year old female, having been suffered from general urticaria at the ninth term, showed weakly but significantly positive in intracutaneous test. Rechallenge to her was canceled based on the experience of the previous case.
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Mayuko Yamamoto, Kimiko Nakajima, Hajime Kodama, Shigetoshi Sano
2007 Volume 6 Issue 6 Pages
587-589
Published: 2007
Released on J-STAGE: December 06, 2010
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A 82-year-old male presented with violaceous papules on the trunk and extremities that had appeared 4 months after the oral administration with methyldigoxin for angina and arhythmia. A biopsy specimen obtained from a papule revealed vacuolar alteration of the basal layer of the epidermis, the presence of colloid bodies, and dense band-like infiltration of lymphocytes in the superficial dermis, all of which are characteristic of lichen planus. The lesions disappeared after discontinuation of the medication. Oral provocation test with methyldigoxin showed positive reaction.
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Yui Hirata, Yukiko Endo, Shinichi Moriwaki, Kenzo Takahashi, Kimihiro ...
2007 Volume 6 Issue 6 Pages
590-594
Published: 2007
Released on J-STAGE: December 06, 2010
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A 42-year-old woman noticed a 6 months history of asymptomatic erythema on the back of head. The patient had been diagnosed as impetigo contaginosa, and had been treated by oral and topical antibiotic without effectiveness. The patient consulted our hospital complaining of the refractory, partially crusted erythema on the head and newly-appeared multiple erythema on the back. Histological examination of erythema on the head revealed acantholytic cells in the suprabasal cleft. Direct immunofluorescence result was negative. We diagnosed this patient as having transient acantholytic dermatosis (pemphigus vulgaris type, persistent type). Skin lesions were treated effectively by oral steroids.
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Tomoo Matsuo, Takeshi Horio, Yuuji Horiguchi
2007 Volume 6 Issue 6 Pages
595-599
Published: 2007
Released on J-STAGE: December 06, 2010
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A 67-year-old man had been suffering from pruritic eruption on the legs from May, 2001. Skin changes gradually worsened even though the patient had been treated with topical and systemic corticosteroids, and developed into erythroderma. Clinical findings were characterized by papules and plaques with cobblestone appearance on the body and limbs sparing large folds on the chest and abdominal regions. Broadband-UVB phototherapy was not effective and systemic corticosteroid had been continuously administered. Oral PUVA therapy was started with 30mg of 8 methoxypsoralen and 3~4J/cm
2 of UVA. Pruritus was sufficiently decreased after 2~3 treatments, and the eruptions disappeared almost completely after 10 exposures, then systemic corticosteroid was discontinued. After 20 treatments, PUVA therapy was switched to narrowband-UVB phototherapy to prevent the reccurence with beneficial effects.
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Yoshiyuki Nakamura, Junichi Furuta, Shusaku Ito, Yasuhiro Kawachi, Fuj ...
2007 Volume 6 Issue 6 Pages
600-604
Published: 2007
Released on J-STAGE: December 06, 2010
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We report a 77-year-old female with pellagra. Two months before her initial visit, infiltrative erythema appeared on dorsum of her hands and feet. The erythema was well-demarcated, symmetric and asymptomatic. Topical corticosteroid was not effective. Dementia, appetite loss and numbness of her extremities were apparent. She was admitted to our hospital for further treatment. Routine biochemical and hematological studies revealed anemia and hypoproteinemia. Subsequent blood tests confirmed deficiencies in nicotinamide, tryptophan, several vitamins and minerals. Vitamin supplements and diet adjustment quickly controlled her symptoms. She was diagnosed with pellagra due to inadequate diet. Social isolation seemed to be the underlying cause of this case.
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Asuka Wakuda, Makiko Sasahashi, Soukou Sugi, Ken-Ichi Toda
2007 Volume 6 Issue 6 Pages
605-609
Published: 2007
Released on J-STAGE: December 06, 2010
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A case of the cutaneous ganulomatous lesions and refractory gastric ulcer was reported. A 63-year-old woman was suffering from uncurable gastric ulcers although she had been treated with various kinds of anti-gastric ulcer drugs for more than 9 years. The Helicobacter Pylori infection in the ulcer lesions was negative. The patient also noticed the skin lesions on the front side of her lower legs about 1 year before the ulcer treatment was initiated. The skin lesions showed marginally elevated asymptomatic annular erythemas on the legs with the sized of 5cm meter on her left leg and to 15cm diameters on the right. The histology of the biopsied skin specimen revealed noncaseous granuloma formation in the dermis with many Langhans type giant cells infiltrations and asteroid body existence inside the some giant cells. Both the clinical and histological findings strongly suggest necrobiosis lipoidica as the diagnosis of the skin lesions.
Since topical steroid applications to the skin lesions were not successful and she did not have diabets, the systemic treatment with predonisolone was started and proved remarkably effective with a complete lesional remission. In addition, the gastric ulcers were also completely cured in conjunction with the improvement of the skin lesions, although the histology of the gastric ulcer specimens did not note the granuloma formation. From the standpoints of the remarkable steriod efficacy, it should be further disscused whether or not the systemic sarcoidosis would be a possible differential diagnosis for the both skin and gastric lesions.
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Hideyuki Iida, Nobuhiko Kobayashi, Satoshi Yurugi, Hideo Asada, Sachik ...
2007 Volume 6 Issue 6 Pages
610-613
Published: 2007
Released on J-STAGE: December 06, 2010
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A 74-year-old man was admitted to our hospital for the treatment of a tumor above his sternum. The tumor had been slowly enlarging for about 20 years and was a red-brown hyperkeratotic plaque, measuring 12×10cm at admission. By incisional biopsy, it was diagnosed as the clonal type of seborrheic keratosis. Later the tumor was excised and the defect was repaired with a split-thickness skin graft. Although cases of giant seborrheic keratoses larger than 3cm in diameter have rarely been reported, it should be noted that some authors have suggested the risk of malignant change.
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Masahiro Kira, Yoko Nishida, Chiho Matsumoto
2007 Volume 6 Issue 6 Pages
614-617
Published: 2007
Released on J-STAGE: December 06, 2010
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Cesarean section scar endometriosis is a rare condition.
We report a case of ectopic endometriosis in surgical scar after cesarean section scar.
A 42-year old woman complained of painful abdominal mass at the site of an old cesarean section scar. Physical examination revealed a slightly tender subcutaneous nodule at the left edge of the scar. The CT examination showed a high-density mass in the abdomen. Ultrasonographic imaging showed hypoechoic subcutaneous mass lesion. The subcutaneous mass was excised under local anesthesia. Histopathological examination of the specimen confirmed the diagnosis of ectopic endometriosis.
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Sonoko Miyamoto, Masaru Natsuaki, Yumi Nakayama, Shoichiro Minami, Nob ...
2007 Volume 6 Issue 6 Pages
618-622
Published: 2007
Released on J-STAGE: December 06, 2010
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A 10-year-old boy felt discomfort on the coccygeal region from his age of 6 and had noted a tumor on the region for one year. He saw us because the tumor was enlarging late. The subcutaneous tumor 4×2cm in size was not connected with spinal cord on computed tomography images and was totally resectable. Pseudorosettes were formed by tumor cells, which were strongly positive for glial fibrillary acidic protein (GFAP) and vimentin, and focally positive for S-100 protein. Myxopapillary ependymoma was diagnosed according to those features. No recurrence was evident one year after the resection.
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Atsuko Uchida, Aiko Watanabe, Tomoe Tsugawa, Toshiaki Doi, Naohisa Kaw ...
2007 Volume 6 Issue 6 Pages
623-627
Published: 2007
Released on J-STAGE: December 06, 2010
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We report on a 1-year-old boy who was referred to our hospital at the age of 3 months due to his proliferating firm nodules. A biopsy was performed and the diagnosis of IM was established by histological examination. CT scan revealed some nodules in his lung and kidney. As both the solitary and the multicentric variety without visceral involvement carry a good prognosis with spontaneous regression of the lesions, whereas patients with involvement of vital viscera have a high mortality, we took some treatment with chemotherapy into consideration. However, he had no clinical symptom and had a normal physical and laboratory examination, so we follow him without antitumour therapy.
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Hiroshi Hosokawa, Kayo Hosokawa
2007 Volume 6 Issue 6 Pages
628-631
Published: 2007
Released on J-STAGE: December 06, 2010
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A 65-year-old man presented with an asymptomatic, dark-red, firm plaque with well-defined borders in the right cheek. He stated that the lesion had been there more than 30 years and had enlarged very slowly. Histopathological examination of the lesion showed coalescing tuberculoid granulomas with a few Langhans-type giant cells just beneath the epidermis and in the papillary and mid-dermis. Caseation necrosis was absent. Culture of biopsied tissue on Ogawa egg medium was negative. A polymerase chain reaction(PCR) assay did not reveal the presence of mycobacteria in a lesional biopsy sample. Although the tuberculosis culture and PCR did not confirm tuberculosis, a diagnosis of lupus vulgaris was made considering the clinical and histopathological findings. After a 6-month antituberculous therapy, the lesion disappeared. We believe that a diagnosis of lupus vulgaris still depends more on clinical and histopathological findings than on tuberculosis culture or PCR.
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