Coexistence of psoriasis and an unusual IgG-mediated subepidermal bullous dermatosis: identification of a novel 200-kDa lower lamina lucida target antigen

Bullous pemphigoid (BP) is characterized by autoantibodies against 230- and 180-kDa hemidesmosomal antigens located in the most superficial layers of the basement membrane zone (BMZ). Histologically, there is a predominance of eosinophils in the infiltrate. In a psoriatic patient, we identified an unusual autoimmune subepidermal bullous eruption which clinically resembled BP, but which was characterized by IgG autoantibodies against a novel 200-kDa lower lamina lucida component. Histologically there was a predominance of neutrophils in the infiltrate. Direct immunofluorescence showed linear immunoglobulin (Ig)G and C3 deposition at the BMZ. The patient's IgG autoantibodies bound exclusively to the dermal side of salt-split normal human skin. Indirect immunogold electron microscopy showed a marked deposition of IgG at the lower lamina lucida and minimal deposition at the hemidesmosomes. Immunoblot analysis identified a unique 200-kDa autoantigen in dermal extracts and a faint band of the 230-kDa BP antigen in epidermal extracts. The patient responded dramatically well to cyclosporin A. Although the patient's serum also reacted slightly with the 230-kDa BP antigen, there were significant findings different from the usual immunopathological changes of BP. These included finding a novel 200-kDa lower lamina lucida target antigen, the binding of IgG autoantibodies exclusively to the dermal side of the split skin and a predominance of neutrophils in blister infiltrate. The IgG autoantibodies against the 200-kDa lamina lucida target antigen seemed to play a major role in the pathogenesis of this unique autoimmune subepidermal dermatosis.

Arterial reconstruction of the posterior segment after central bisegmentectomy and caudate lobectomy

A 71 year old woman was admitted with jaundice and found to have a tumor originating from the cystic and common hepatic ducts, which infiltrated the origins of the right bile duct and duct of Spiegel. The tumor was also shown to encase the right hepatic artery. A central bisegmentectomy with concurrent caudate lobectomy was performed using the right gastroepiploic artery for reconstruction of the posterior segmental branch of the right hepatic artery. Celiac angiography conducted 3 weeks postoperatively confirmed the patency of the hepatic segmental arterial anastomosis. The patient had an uneventful recovery with no evidence of liver failure, and was discharged home thirty-two days. Tumors infiltrating the right hepatic artery, which have traditionally been treated with extensive liver resection, can be managed with hepatic segmentectomy and reconstruction of the segmental hepatic artery.

A case of uveitis associated with chronic active Epstein-Barr virus infection

Ocular complications of chronic active Epstein-Barr virus infection (CAEBV) have rarely been reported. We describe a 7-year-old girl with CAEBV with associated uveitis. The patient was first observed to have recurrent fever and hepatosplenomegaly in August 1991. She presented with left facial nerve palsy in June 1993. Ocular examination showed right iridocyclitis. Both optic disks were swollen, and the retinal vessels were dilated. Antibody titers to EBV were markedly elevated. Treatment with topical steroids. systemic interleukin-2 and splenectomy dramatically relieved all her symptoms. including the ocular ones.

Cefotiam-induced contact urticaria syndrome: an occupational condition in Japanese nurses

A case of occupational contact urticaria syndrome caused by cefotiam dihydrochloride (CTM) in a Japanese nurse is reported. The patient had become sensitized to CTM through the process of preparing antibiotics 8 months before she developed symptoms. A review of the literature revealed 13 similar cases, all involving Japanese nurses, reported since CTM became available in Japan.

Unusually located lymphocutaneous nocardiosis caused by Nocardia brasiliensis

We report a patient with primary lymphocutaneous Nocardia brasiliensis infection affecting the face and left arm. The mode of infection was via skin abrasions which occurred 2 weeks prior to the development of the skin lesions. Treatment with intravenous minocycline for 4 weeks resulted in a cure. We also review 12 previously reported Japanese cases of lymphocutaneous nocardiosis.

[Surgical stress induces the secretion of alpha human atrial natriuretic peptide]

The changes in plasma alpha-hANP level and the factors affecting its secretion were studied in 35 patients treated by surgery for gastrointestinal disease (laparotomy group, 17) and (non-laparotomy group, 18). They did not have any particular complication during the study period. alpha-hANP, catecholamine (CA), antidiuretic hormone (ADH), aldosterone and plasma renin activity (PRA) were determined serially before and after the surgery. Plasma alpha-hANP level elevated on the post-operative day 1 and dropped to the upper limit of the normal range by the day 3, then gradually recovered to the level of before surgery. This early elevation of alpha-hANP was more marked in the laparotomy group than in the non-laparotomy group. These change in alpha-hANP level correlated well to those of CA, but not to those of ADH, aldosterone, and PRA. Age, sex, duration of surgery, bleeding and infusion volume during surgery did not affect the difference in alpha-hANP secretion between the two groups. In conclusion, the early elevation of plasma alpha-hANP level was correlated well to the surgical stress, and that this alpha-hANP secretion might be induced by CA secretion.

Athletes as health testing examinees

Health-testing examination data of 91 male and 54 female athletes were studied, together with age-matched controls, on serum biochemistry, ECG findings, hematology, and some data on gynecological physiology. Analysis of serum biochemical values revealed statistically significant differences in 14 of 18 routine test items as compared with the age-matched controls. In ECG findings, the combination of bradycardia and left ventricular hypertrophy was most frequently found in male athletes, whereas that of bradycardia and sinus arrhythmia was observed predominantly in female athletes. The incidence of anemia and menstrual dysfunction was higher in female athletes than in controls, especially in the basketball team. In the same team, a high rate of deviant ECG records and a different distribution of the age at menarche were also observed.

The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers

Microvascular replantation at the distal phalangeal level has recently been reported by several authors, but as yet the rate of success has not been constant owing to the technical difficulties associated with small vessels. To solve this problem, over the last 4 years we have used arteriovenous anastomosis to reestablish either the arterial system or the venous drainage system in the 33 digits of our 23 patients. The results have been excellent, with a 91 percent success rate. Such results for replantation of the distal phalanx may be maintained and improved if a small venous graft with several branches is also utilized.

Effects of amiloride on distal renal tubule sodium and calcium absorption: dependence on luminal pH

The goal of our study was to examine the effects of amiloride on distal renal tubule calcium and sodium absorption at low and high luminal pH. In vivo microperfusion of distal convoluted tubules were performed on rats. Total Ca and Na concentrations in perfusion and collected fluids were measured by atomic absorption spectrometry. When tubules were perfused with low pH perfusate (pH = 5.6), net calcium absorption (JCa) averaged 5.4 pmol/min. With high pH perfusate (pH = 7.1), JCa was significantly higher averaging 8.9 pmol/min. (P less than 0.01). In contrast, net sodium absorption (JNa) was not affected by luminal pH (231 pmol/min. versus 237 pmol/min.). At low luminal pH, 10(-4) M amiloride analogue (5-N-methyl-N-isobutyl amiloride) (MIA) inhibited sodium absorption but stimulated calcium absorption. At high luminal pH MIA still inhibited Na absorption but it had no effect on calcium absorption. Thus, the natriuretic effect of amiloride appears to be independent of luminal pH, while the amiloride-stimulated distal calcium absorption is observed at low but not at high luminal pH.

Trichilemmal tumor arising in a seborrheic keratosis: analysis of cell kinetics by BrdU staining

We report a case of a 74-year-old male with a trichilemmal tumor arising in a seborrheic keratosis on the buttock and the results of a cell kinetic study of this tumor using a BrdU staining method. The incidence of trichilemmal tumor arising in a seborrheic keratosis seems to be extremely rare. The labeling index of this tumor was 12.0%; this was a level intermediate between normal epidermis and a variety of hyperproliferative skin diseases such as squamous cell carcinoma, Bowen's disease, and psoriasis vulgaris. DNA replicating cells were present in the germinative layers in normal epidermis and the benign hyperproliferative skin diseases, psoriasis vulgaris. In contrast, DNA replicating cells were found throughout the entire epidermis in premalignant and malignant tumors such as in Bowen's disease and squamous cell carcinoma. In this case, DNA replicating cells were localized mainly in the basal and parabasal cell layers, but also seen in the upper squamous layers. These findings suggest that this trichilemmal tumor had a malignant tendency, though it was slow-growing and relatively benign in nature.

[The kinetics of interleukin 1 and prostaglandin concentrations in human amniotic fluid]

In order to understand the role of Interleukin 1 (IL-1) in human amniotic fluid (AF), the amount of IL-1 in normal human AF at various gestational ages was measured using ELISA. Materials were divided into three groups based on gestational ages. Group 1, less than 22 weeks (n = 16), consisted of AF samples which were collected by amniocentesis. Group 2, greater than or equal to 36 weeks (n = 54), consisted of AF samples collected transvaginally at delivery. Group 3, greater than or equal to 36 weeks (n = 9), transabdominally collected AF samples from elective cesarean section without labor. IL-1 alpha was present in AF of early gestational age in group 1 and appeared to increase with gestational age in group 3. In contrast, IL-1 beta was not detectable in either group 1 or 3. However, the concentration of IL-1 in group 2 was extremely high (IL-1 alpha 201.0 +/- 299.3 pg/ml, IL-1 beta 1,024.1 +/- 1,321.9 pg/ml) when compared to the other groups. Moreover, the IL-1 alpha and IL-1 beta concentrations correlated with those of Prostaglandin E2 and F2 alpha in AF, measured by RIA. These findings suggest that IL-1 has an important role during pregnancy and during labor in particular.

Moving knee joint: technique for kinematic MR imaging

A system for magnetic resonance imaging of the knee joint during movement was developed by using a gating system and cine acquisition. The technique was used in 10 subjects: five with no history of knee pain or injury and five with tears of the anterior cruciate ligament. The normal ligaments and menisci appeared as low-intensity structures against intermediate-intensity hyaline cartilage. The ligament tears appeared discontinuous and faint against the background of the to-and-fro moving joint fluid.

A case of linear IgA bullous dermatosis of childhood: immunoelectron microscopic and IgA subclass studies

A 2-year-old girl developed small tense bullae on the diaper area, face and extremities. Immunofluorescent studies revealed linear deposits of IgA, IgM and C3 at the basement membrane zone (BMZ). In addition, IgA2 deposits, as well as IgA1, were clearly demonstrated in the lesional skin. However, in circulation, only IgA1 anti-BMZ antibodies were found. Immunoelectron microscopic study showed IgA deposits just underneath the basilar surface of the basal cells, which seemed to be associated with hemidesmosomes. The survey of the literature suggests that the involvement of IgA2 is extremely rare in this disease.

[A case of secretory carcinoma of the breast in a elderly Japanese woman]

We report a case of a secretory carcinoma of the breast in a 72-year-old woman with a long history of a left breast mass. Rapid growth and skin invasion of the tumor was noticed three months before a radical mastectomy was performed and a lung metastasis was found one month after the operation. A metastasis to the axillary nodes was noted in 6 of 9 resected specimens and a receptor assay of the estrogen and progesterone proved to be negative. This patient is the oldest case of a secretory carcinoma of the breast reported in Japan.

[Phenotypic expression and functional manifestation of fetal and maternal natural killer (NK) cells]

The NK cells, considered to play an important role in host defense, are reported to show heterogeneity during the cellular development. To document the heterogeneity, studies were carried out on the phenotypic expressions, the cytolytic activities, the responsiveness to recombinant interleukin 2 (rIL-2) and on the ultrastructure of the NK cells of the blood obtained at the time of delivery from 24 pairs of mothers and umbilical cords. The phenotypic expressions were Leu7+-11-(6.2 +/- 2.1%, SD), Leu7+-11+(5.6 +/- 1.8), and Leu7--11+(5.5 +/- 2.1) in the maternal NK cells, whereas the cord blood NK cells expressed only Leu7--11+(8.2 +/- 2.4). The cytolytic effect of the NK cells on K562 target cells was assayed by a method to determine ATP release. The activity of the maternal blood NK cells was 80.4 +/- 10.5%, SD whereas the cord blood samples showed only 40.5 +/- 8.5, after 4-hour incubation; the difference between the maternal and cord NK cells was statistically significant (p less than 0.01). The NK cells were incubated with rIL-2 (10 units), and the cytolytic activity was determined. The activity of the cord blood NK cells was significantly enhanced already after incubation for 2 hours and it lasted until incubation had continued for 4 hours. However, the rIL-2 effect was not significant after incubation for 5 hours. On the other hand, the activity of the maternal blood NK cells was not influenced significantly by rIL-2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of indium-111-labeled leukocyte imaging in bone infection]

In-111-oxine-labeled leukocyte imaging was performed on twenty-one patients suspected of having bone infection. Nine of eleven cases (82%) were diagnosed as having active infection as demonstrated by abnormal accumulation of In-111-labeled leukocytes at the site of infection. There are two false negative (18%) cases. Two cases without active infection showed abnormal uptake. Four cases revealed cold defects on the scintigraphy. Marked uptake of radiotracer was noted not only in the case of acute osteomyelitis with acute septicaemia but also in the case with persistent chronic active osteomyelitis. It was observed that for precise evaluation of the test results it was equally important to compare the imaging findings with physical signs and laboratory investigations. It is concluded that In-111-oxine-labeled leukocyte imaging is a useful tool for the evaluation of the progression of bone infection.

In vitro cell-free synthesis of bullous pemphigoid polypeptide

We investigated the genetic expression of bullous pemphigoid (BP) antigen (230 kD) synthesized by Pam cells using an in vitro cell-free translation assay followed by immunoprecipitation. Prior to the study, we showed that (1) the 230 kD polypeptide does not undergo further processing after it is produced by cells in the short pulse experiment; (2) the 230 kD polypeptide is not degraded at least within the 18 h of the chase experiment; and (3) with tunicamycin treatment the underglycosylated BP antigen still interacts specifically with BP serum. The polypeptide of molecular size slightly greater than 230 kD was identified in the translated proteins directed by ribonucleic acid (RNA) isolated from Pam cells. The size of the mRNA was estimated to be approximately 34S-40S (7.7-10.9 kilobase) using the fractionation method with sucrose density gradient ultracentrifugation of RNA. These results indicate that bullous pemphigoid antigen (230 kD) is a primarily translated product, genetically expressed by Pam cells.

A large inferior mesenteric-caval shunt via the internal iliac vein

A large portosystemic shunt between the inferior mesenteric vein and the right internal iliac vein in a 28-yr-old non-cirrhotic man is presented. This collateral was discovered by ultrasound done as a screening examination for gastrointestinal bleeding. The direct communication of the inferior mesenteric vein with the internal iliac vein was demonstrated by computed tomography and percutaneous transhepatic portography. Surgical ligation of the collateral, performed to prevent future portosystemic encephalopathy, resulted in reduction of serum ammonia level and cessation of long-standing hemorrhoidal bleeding.