[in Japanese]

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We encountered 3 patients with symptoms of oral allergy syndrome (OAS) and anaphylactic reactions to soymilk. CAP-RAST analysis showed negative findings for soybean but was positive for Glym4. These patients also had past history of birch pollen allergy and/or OAS in response to certain fruits. These cases all seemed to have class 2 food allergies based on the cross-reactivity between pollen allergens and antigens in soymilk. Prick test for soymilk and detection of IgE antibodies to Glym4 were considered useful for diagnosis of soymilk allergy. All previously reported cases were female. Thus, one of the present cases is the first male patient reported in Japan.

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Between October 2008 and March 2009, 202 patients with varicose veins consulted the Division of Dermatology, Fukui Red Cross Hospital. In these cases, we performed high ligation surgeries for 53 legs of 46 patients with saphenous type of varicose veins. Surgery was performed during a one- or two-day admission using a clinical path. Preoperative examination included color Doppler echogram of deep veins in addition to routine blood test, chest X-ray, and electrocardiogram. The average number of ligation sites of a saphenous veins was 3.2. Color Doppler echogram in a surgical position just before surgery facilitated detection of the saphenous vein. Using a curved forceps made it possible to hold the vein in an area of less detachment than ordinary forceps. Sclerotherapy was only applied to postoperative varicose veins. There were no severe complications such as pulmonary embolism or deep vein thrombosis in our series.

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A thirty-one-year-old man consulted our clinic with widespread erythema, blisters and erosions on his body surface. These skin lesions rapidly deteriorated until they extended over 70% of his skin surface area and the patient showed a high serum level of anti-desmoglein 1 antibody (880 index). Based on the diagnosis of severe pemphigus foliaceus, we started rapid treatment with combination therapy consisting of oral prednisolone (70mg/day at first dosage), double-filtration plasmapheresis (DFPP) and high-dose intravenous immunoglobulin (IVIG), which successfully achieved remission. Therefore, this combination therapy is considered useful in the treatment of severe pemphigus foliaceus in order to reduce corticosteroid dosage smoothly without disease relapse and to shorten the duration of admission.

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A 72-year-old woman developed redness and swelling of the right arm, and high fever. Her illness was diagnosed as erysipelas. She was admitted to our hospital and therapy with piperacillin sodium 2g daily was commenced. She was also prescribed loxoprofen sodium for high fever. Several days later, she developed diffuse erythematous lesions with many small pustules. Skin biopsy of the abdomen demonstrated subcorneal pustules and perivascular infiltration of eosinophils. Acute generalized exanthematous pustulosis (AGEP) was suspected, and these drugs were discontinued. Her skin lesions resolved within 2 weeks. Drug-induced lymphocyte stimulation test (DLST) for piperacillin sodium and loxoprofen sodium were both positive.

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A 79-year-old Japanese male presented at our hospital with hyperkeratotic skin eruptions on his body trunk and both lower legs. These lesions developed around the age of thirty, and had increased gradually. He had a history of skin excision for Bowen's disease on the right dorsal foot at the age of 71. On physical examination, thousands of small, hyperkeratotic, pigmented oval to polygonal macules with narrow and elevated rim were disseminated across his body including sun-unexposed areas. Histopathological findings demonstrated a coronoid lamella at the rim. Therefore, we diagnosed these skin lesions as disseminated superficial porokeratosis. We review the Japanese literature and discuss the development of cutaneous malignancies in patients with disseminated superficial porokeratosis.

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A 65-year-old woman who underwent Appleby procedure for carcinoma of the pancreatic body (T4, N1, M0, Stage IVa) presented with a slowly growing nodule on her left abdomen, where the drain had been placed. On physical examination, we found a light red nodule measuring 18mm covered by a crust on her left abdomen. A diagnosis of metastasis of pancreatic carcinoma was made based on biopsy findings. Since there were no other distant metastases or signs of recurrence, the nodule was resected and there has not been recurrence during the 2-year follow up to date.

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A 91-year-old male consulted our hospital with tumors on the right leg and left dorsum of hand. Both lesions were squamous cell carcinoma (SCC). Because CT-scanning from neck to leg did not detect any evidence of metastasis, both tumors were speculated to be primary SCC. The tumor of the leg and left dorsal of hand were treated successfully by electron beam and surgical excision, respectively. The patient also had basal cell carcinoma (BCC) on his back and this was also excised. Furthermore, he had many lesions suggesting lentigo and actinic keratosis. The patient's lifestyle, working as a carpenter exposed to sunlight for many years, was considered an important factor contributing to the pathogenesis of multiple tumors because these tumors were coincident with the areas exposed to sunlight while he was working.

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