Disappearance of serum HCV-RNA after short-term prednisolone therapy in a patient with chronic hepatitis C associated with autoimmune hepatitis-like serological manifestations

We report a 70-year-old woman with chronic hepatitis C associated with autoimmune hepatitis (AIH)-like serological manifestations, in whom elimination of hepatitis C virus (HCV) was observed after corticosteroid treatment. The patient was infected with HCV, genotype Ib, but had several laboratory findings, such as markedly elevated serum gamma-globulin and IgG, characteristic of AIH, as well as a high titer of an anti-nuclear antibody. An ultrasound (US)-guided liver biopsy disclosed chronic active hepatitis F3. Corticosteroid worsened her liver function test results and raised amounts of HCV-RNA in the serum. Withdrawal of the corticosteroid led to prompt normalization of transaminase levels and the disappearance of serum HCV-RNA, determined by reverse transcription-polymerase chain reaction (RT-PCR). For 4 years, up to the time of this study, her transaminase values have been normal and HCV viremia was not detected by repeated RT-PCR. We believe this to be the first reported case in which eradication of HCV was achieved by corticosteroid therapy alone, without the introduction of interferon.

Electron-microscopic study of the bactericidal effect of OPB-2045, a new mono-biguanide disinfectant produced from biguanide group compounds, against Pseudomonas aeruginosa

The bactericidal activity of OPB-2045 (1-(3,4-dichlorobenzyl)-5-octylbiguanide monohydrochloride hemihydrate) at several concentrations against Pseudomonas aeruginosa IFO 13275 was investigated morphologically by transmission and scanning electron microscopy. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of OPB-2045 against P. aeruginosa were the same, at 12.5 microg mL(-1), suggesting that it may be a suitable disinfectant for use in the medical field. Test bacteria were treated at concentrations of one half the MIC value (6.25 microg mL(-1)), the MIC value (12.5 microg mL(-1)), twice the MIC value (25 microg mL(-1)) or ten times the MIC value (125 microg mL(-1)) at 37 degrees C for 30 min or 6 h and the cells were then examined by transmission and scanning electron microscopy. The cell damage evident after 6h incubation was greater than observed after 30 min incubation. Especially, at one half the MIC, no cell damage was evident after 30 min incubation, but damaged cells were observed after 6 h incubation. The proportion of empty cells of P. aeruginosa increased as the concentration of added disinfectant was increased, and the release of intracellular components was also recognized. These results suggest that OPB-2045 acts on the cell membrane and cell wall of P. aeruginosa, and destroys their integrity at the level of the MIC (MBC). With the increase in OPB-2045 concentration and the increase in reaction time, the bactericidal effect increased markedly. Agglutination of the cells was observed at high concentrations of OPB-2045. This indicates that the bactericidal effect at high concentrations of OPB-2045 differs from that at low concentrations. A clear cell-damaging effect against the test strain was recognized which was dependent on the OPB-2045 concentration and the incubation time. From experiments concerning the relationship between the number of surviving bacteria and MIC values in soybean casein digest broth, the decrease in bacterial numbers was found to be dependent on the OPB-2045 concentration. We conclude that it would be a useful contribution to the medical field to supply a new disinfectant to be employed in preventive countermeasures against infection caused by pathogenic bacteria.

Prospective and retrospective studies of recovery in aphasia. Changes in cerebral blood flow and language functions

Prospective and retrospective language evaluations and single photon emission computed tomography (SPECT) scans were performed in order to study the relationship between post-stroke recovery from aphasia and changes in cerebral blood flow (CBF) in groups of patients who had made a good recovery and those who had not. For the prospective study, 20 right-handed patients with aphasia secondary to an acute cerebrovascular accident (CVA) in the left middle cerebral artery territory received language evaluations with a Japanese Standard Language Test of Aphasia (SLTA), and SPECT scans performed twice, at a mean of 3.2 and a mean of 9.2 months post-onset. Only one slice of SPECT data was analysed. A significant correlation was observed between the severity of the initial language deficit and initial CBF on the left side, but not the right. Initial CBF was not a predictor for future language recovery in either hemisphere. There was a correlation between the change in the left mean hemispheric CBF (but not the right) and the change in the overall SLTA severity rating from 3 to 9 months post-stroke. In the retrospective study, 16 right-handed patients with residual aphasia secondary to CVA in the left middle cerebral artery territory received SLTA and SPECT at a mean of 82.8 months post-onset. The patients had also received initial language evaluation with SLTA at a mean of 6.5 months post-onset. In contrast to the prospective study, the results demonstrated that the mean left hemispheric CBF at approximately 7 years post-onset did not differ between good and poor recovery groups. However, the mean right hemispheric CBF of the good recovery group was higher than that of the poor recovery group in the frontal and the thalamic regions, and also in the left frontal region. The results of these complementary studies suggest that the initial language recovery within the first year post-onset may be linked primarily to functional recovery in the dominant hemisphere, where an increase in CBF was observed at 9 months post-onset. The increased perfusion adjacent to the lesion may be crucial for early recovery in aphasia. Subsequent language recovery and the long-term recovery in aphasia may be related to slow and gradual compensatory functions in the contralateral hemisphere, specifically in the homotopic frontal and thalamic areas.

[Regional cerebral blood flow and oxygenation following cervicothoracic sympathetic block]

Stellate ganglion block (SGB) is considered to increase blood flow to the governing area, but recent studies have shown the decrease of common carotid arterial blood flow in the unblocked side following SGB. We investigated the influence of SGB on bilateral cerebral blood flow and oxygenation using a regional oxygen saturation (rSO2) monitor, TOS-96 (TOSTEC, Japan). The changes of blood volume (hemoglobin index: Hb I) and rSO2 were measured in twenty adult patients who underwent SGB at the transverse process of the C 6 vertebra. Prior to the investigation, two sensors were calibrated and placed on either side of each patient's forehead in order to see the difference. There were significant increases in rSO2 and Hb I in the blocked side and decreases in rSO2 and Hb I in the contralateral side. These results suggest that blood flow in the blocked side following SGB increases with decreased blood flow in the unblocked side. Patients with cerebral vascular disease undergoing SGB might be at risk of a decrease in cerebral blood flow in the unblocked area.

A missense mutation in the CD38 gene, a novel factor for insulin secretion: association with Type II diabetes mellitus in Japanese subjects and evidence of abnormal function when expressed in vitro

Cyclic adenosine 5'diphosphate-ribose (cADPR) is thought to have a second messenger role in insulin secretion through mobilisation of Ca2+. As human lymphocyte antigen CD38 has both ADP-ribosyl cyclase and cADPR hydrolase activity, it may be important in glucose-induced insulin secretion in islets. Thirty one randomly selected Japanese patients with Type II diabetes mellitus who had first-degree and/or second-degree relative(s) with Type II diabetes mellitus were screened for mutations of this gene using single-stranded conformation polymorphism. Two variant patterns in exon 3 and exon 4 of the CD38 gene were identified. The variant in exon 3 resulted in an amino acid substitution from Arg140 (CGG) to Trp (TGG). The Arg140Trp mutation was observed in 4 of 31 patients, and allele frequencies were significantly different in patients and the control subjects (p = 0.004). One patient with this mutation has two missense mutations on beta cell/liver glucose transporter (GLUT2) gene; her mother, who has impaired glucose tolerance, also has this mutation on the CD38 gene and one missense mutation on the GLUT2 gene. Enzyme activity studies using COS-7 cells expressing the Arg140Trp mutation showed a reduction in ADP-ribosyl cyclase and cADPR hydrolase activity of around 50%. The Arg140Trp mutation on CD38 thus appears to contribute to the development of Type II diabetes mellitus via the impairment of glucose-induced insulin secretion in the presence of other genetic defects.

Anti-MRSA activity of sophoraflavanone G and synergism with other antibacterial agents

Anti-MRSA activity of sophoraflavanone G (SFG) and synergism between SFG and antibacterial agents against MRSA (methicillin-resistant Staphylococcus aureus) were evaluated by means of Minimal Inhibitory Concentrations (MIC). The MICs of SFG against 27 strains of MRSA ranged from 3.13 to 6.25 micrograms ml-1. Synergism between SFG and vancomycin hydrochloride (VCM) or fosfomycin (FOM) was observed (the fraction inhibitory concentration (FIC) indices were 0.16 and 0.48), while partial synergism was admitted between SFG and other antibacterial agents such as methicillin (DMPPC), cefzonam (CZON), gentamicin (GM), minocycline (MINO) and levofloxacin (LVFX) (the FIC indices were 0.71, 0.73, 0.69, 0.65 and 0.58, respectively). These findings suggest that SFG in combination with VCM or FOM may be useful in controlling MRSA infections.

Memory for subject performed tasks in patients with Korsakoff syndrome

We examined the ability of alcoholic Korsakoff patients to remember verbal and action-related information. Eight Korsakoff patients and eight alcoholic control subjects learned action phrases in either subject-performed tasks (SPTs) or verbal tasks (VTs). Free recall and recognition tests were then administered. Despite the severe anterograde amnesia observed in Korsakoff patients for VTs, their memory performance for SPTs was similarly facilitated over VTs as was the case with alcoholic controls. Domains preserved in this amnesic syndrome may account for the benefit seen when using SPTs in Korsakoff patients. The therapeutic utilization of action events for memory rehabilitation is discussed.

[Positive end-expiratory pressure facilitates washout of nitrous oxide in patients with obstructive pulmonary disease]

This study was designed to investigate the relationship between nitrous oxide elimination and each value of pulmonary function tests: percent vital capacity, air way resistance and percent of forced expiratory pressure (FEV1.0%) in patients undergoing general anesthesia. Furthermore, the effect of positive end-expiratory pressure (PEEP) on nitrous oxide elimination was studied. Thirty nine patients, anesthetized by oxygen, nitrous oxide and sevoflurane, were allocated randomly to one of two groups; one, with PEEP 10 cmH2O during nitrous oxide elimination and the other, without. After discontinuation of nitrous oxide, the concentration of nitrous oxide was measured at 15 sec intervals under controlled ventilation with 100% oxygen-sevoflurane. There was a significant correlation between nitrous oxide washout time and FEV1.0% (P < 0.05). Patients were further divided into two subgroups: FEV1.0% of over 70% (normal FEV) and that of less than 70% (low FEV). In the normal FEV group, the washout time was unaffected by PEEP. In the low FEV group, the washout times, with and without PEEP, were 7.07 +/- 0.93 min and 9.13 +/- 2.32 min, respectively. The difference was significant (P < 0.05). These results suggest that patients with chronic obstructive lung disease are at risk of delay in nitrous oxide elimination. This delay was found to be preventable with PEEP.

Visible changes in lesion borders on CT scan after five years poststroke, and long-term recovery in aphasia

This study examined 12 aphasia patients at approximately 1 year poststroke (Time 1) and again at 5-12 years poststroke (Time 2) with language testing and CT scan. Significant increases in naming scores, and phrase length in nonfluent speech were observed after 5 years poststroke. Significant expansion in visible lesion borders (lesion size) was observed after 5 years poststroke; an increase in lesion size of > 1% was present in 9/12 cases (75%). Not one case had a second stroke. Thus, it appears that even though lesion expansion may occur after 5 years poststroke, as long as this expansion is unilateral and gradual, it has no adverse effect on language, and in fact, continued recovery in naming and nonfluent speech may also occur. Long-term recovery patterns in aphasia which may be associated with brain reorganization deserve further study, especially with functional brain imaging techniques.

[Postoperative hypoxia and hyperfibrinolysis in patients after total knee replacement]

It was revealed that postoperative hypoxia had occurred frequently in patients after total knee replacement (TKR) in our preliminary study. Since we speculated that pulmonary embolism was the cause of the hypoxia, we investigated the relationship between PaO2 and D-dimer in patients after TKR and high tibial osteotomy (HTO). A total of 13 patients with the diagnosis of osteoarthritis were studied. Ten patients underwent TKR and three received HTO under subarachnoid block. Arterial oxygen tension and D-dimer were unchanged in patients who had undergone HTO. Even on the 5th postoperative day, five of the ten patients after TKR revealed a decrease in oxygen tension by more than 10% compared with the preoperative control (hypoxia group). In the other patients after TKR, a decrease of oxygen tension on the 5th postoperative day was under 10% (non-hypoxia group). There was a positive correlation between a decrease of PaO2 and a value of D-dimer in all of the patients who had undergone TKR and HTO. Although no patient developed dyspnea clinically, one patient in hypoxia group was diagnosed as pulmonary embolism in the scintigram. It is likely that pulmonary embolism is the cause of postoperative hypoxia in patients after TKR.

Polysaccharide of Astragali radix enhances IgM antibody production in aged mice

The effect of Astragali Radix (AR) on IgM antibody production in mice of various ages (10 weeks, 36 weeks and 60 weeks) was examined. The antibody production levels in the 36- and 60-week-old mice were significantly decreased to about 70 and 60% of that in the 10-week-old mice. The enhancement effect of a crude polysaccharide AR fraction on the antibody production was nil in the 10-week-old mice, but significant enhancement effects were observed in the 36- and 60-week-old mice, compared to the age-matched control. Two polysaccharides active in the enhancement of the IgM antibody production in the aged mice were isolated from the high molecular weight fraction of AR by cetavlon precipitation, ion-exchange and gel permeation chromatography. The molecular masses of these polysaccharides were calculated by HPLC in salt solution. Only one major peak was observed for each, and their molecular masses were estimated to be 1.2 x 10(4) and 2.2 x 10(4). The major components of these polysaccharides were neutral carbohydrates (89.3 and 95.5%), followed by uronic acid and protein; glucose was the predominant sugar component.

Repetition priming in an auditory lexical decision task: effects of lexical status

The effect of lexical status on the time course of repetition priming was examined in an auditory lexical decision task. Words and nonwords were repeated at lags of 0, 1, 4, and 8 items (Experiment 1A) and 0, 2, 4, and 8 items (Experiment 1B). The pattern of repetition effects differed for words and nonwords in that repetition priming for nonwords at lag 0 was significantly greater than for words. The magnitude of this effect decreased when one or more items intervened. A second experiment, replicating Experiment 1A with visual presentation, clarified that the greater magnitude of repetition priming for nonwords at lag 0 is unique to the auditory modality. This finding suggests that in the course of forming a stable perceptual representation, the details of the acoustic/phonological information of an auditory stimulus are more readily available for nonwords than for words. The capacity to carry this phonological information is limited, however, and can only be maintained until another stimulus is encountered.

[Autobiographical memory loss following herpes encephalitis]

We report a patient with prominent autobiographical memory (ABM) impairment, and discussed possible mechanisms of her deficits. The patient was a 36-year-old woman who suffered from herpes simplex encephalitis in November 1994. Four months after the onset, the neuropsychological examination disclosed that her intelligence, attention, language and frontal lobe functions were normal. Moderate anterograde amnesia was evident for visual materials, and she showed difficulties in retrieving visual images. Deficits in verbal learning were minimal. In contrast, her retrograde amnesia (RA) was severe. Further analyses clarified that memory for public events and personal semantic memory were relatively well preserved whereas ABM was severely impaired with no evidence of temporal gradient. Her performance on the ABM questionnaire was even worse than that of alcoholic Korsakoff patients. Interestingly, however, deficits in memory for public events also emerged when questions were presented with pictures instead of ordinary verbal questionnaires. The results suggest that her principle deficits consisted in utilizing visual information of the past events. Her access to and manipulation of the past visual representation/images were impaired. Consequently, her deficits were almost exclusive to ABM because visual information is most crucial for ABM. This material specific ABM impairment demonstrated in the present patient could be differentiated from nonspecific retrograde amnesia observed in typical focal RA patients. MRI, SPECT and PET demonstrated that the present patient had lesions basically in the right hemisphere, specifically in the medical temporal area including the hippocampus.

[A semantic-pragmatic learning disabled child who showed a discrepancy between the abilities of verbal and non-verbal comprehension]

A learning disabled (LD) child with disorder of verbal semantic comprehension was reported. This case showed normal ability of non-verbal semantic comprehension. He was not able to understand the meaning of what he read aloud and/or repeated, which he did well. The focus of his brain dysfunction in the left temporal lobe was revealed by SPECT in spite of MRI findings of no particular lesions. Neuropsychological and cognitive-psychological findings were similar to those reported of adult sensory aphasias with localized lesions.

Dry eye and Meige's syndrome

AIMS

To determine the relation between dry eye and Meige's syndrome.

METHODS

325 patients with dry eye were divided into those responsive to topical and other forms of treatment (n = 276) and those who were not (n = 49). A neuropsychiatric examination was performed to check for Meige's syndrome in the latter group.

RESULTS

Twenty eight (57%) of the treatment unresponsive patients were diagnosed with Meige's syndrome.

CONCLUSIONS

There is a subgroup of patients with dry eye who do not respond to simple therapy. More than half of these patients have Meige's syndrome and need psychiatric, as well as ophthalmic, care.

Efficient callus initiation from leaf of mangrove plant,Bruguiera sexangula in amino acid medium: Effect of NaCl on callus initiation

Experimental conditions for efficient callus initiation from mangrove plants were investigated. As a source explant, leaf ofBruguiera sexangula was used. Mangrove plant is one of the most famous woody plants which can grow at the salty area. The initiated callus can be a suitable material for the investigation of salt tolerant mechanisms of mangrove plants.Leaf pieces cultured in an Amino Acid medium supplemented with 2 μM 2,4-dichlorophenoxyacetic acid and 2 μMN-(2-chloro-4-pyridyl)-N'-phenylurea at 30 C developed calluses. Microscopic observation suggested that the callus was initiated from the tissue in the vascular bundles in the leaf.We also examined the effect of NaCl on callus initiation and short-term culture of the calluses on the leaves. Callus initiation rate decreased with increasing NaCl concentration higher than 100 mM in the culture media. The medium containing 100 mM NaCl produced the largest callus on the leaf, compared with higher or lower concentrations of NaCl.

NaCl-Dependent growth, ion content and regeneration of calluses initiated from the mangrove plant,Bruguiera sexangula

Calluses initiated from leaves and seedlings of the mangrove,Bruguiera sexangula, were isolated from the original tissues and subcultured. Effects of NaCl on growth and ion content of each callus were measured. The growth rate of calluses derived from leaves (leaf callus) gradually decreased as the NaCl concentration in the medium increased, while that of calluses derived from seedlings (seedling callus) was highest in the medium containing 100 mM NaCl. Concentrations of Na and Cl in both calluses increased with increasing the NaCl concentration in the culture medium. The concentration of K of leaf calluses greatly decreased at 300 mM NaCl, while the K concentration of seedling calluses decreased only slightly and remained relatively high even in the presence of 300 mM NaCl.Transient treatment of leaf calluses with media containing high concentrations of NaCl frequently induced regeneration of adventitious tissues.

Corticobasal degeneration: neuropsychological and clinical correlates

A comprehensive neuropsychological test battery was administered to 3 patients who met the clinical criteria of corticobasal degeneration (CBD). The pattern of neuropsychological deficits in CBD appears to be a distinctive mixture of posterior cortical dysfunction and frontal-subcortical system impairment.

Cytochrome P450-dependent drug oxidation activities in liver microsomes of various animal species including rats, guinea pigs, dogs, monkeys, and humans

Levels of cytochrome P450 (P450 or CYP) proteins immunoreactive to antibodies raised against human CYP1A2, 2A6, 2C9, 2E1, and 3A4, monkey CYP2B17, and rat CYP2D1 were determined in liver microsomes of rats, guinea pigs, dogs, monkeys, and humans. We also examined several drug oxidation activities catalyzed by liver microsomes of these animal species using eleven P450 substrates such as phenacetin, coumarin, pentoxyresorufin, phenytoin, S-mephenytoin, bufuralol, aniline, benzphetamine, ethylmorphine, erythromycin, and nifedipine; the activities were compared with the levels of individual P450 enzymes. Monkey liver P450 proteins were found to have relatively similar immunochemical properties by immunoblotting analysis to the human enzymes, which belong to the same P450 gene families. Mean catalytic activities (on basis of mg microsomal protein) of P450-dependent drug oxidations with eleven substrates were higher in liver microsomes of monkeys than of humans, except that humans showed much higher activities for aniline p-hydroxylation than those catalyzed by monkeys. However, when the catalytic activities of liver microsomes of monkeys and humans were compared on the basis of nmol of P450, both species gave relatively similar rates towards the oxidation of phenacetin, coumarin, pentoxyresorufin, phenytoin, mephenytoin, benzphetamine, ethylmorphine, erythromycin, and nifedipine, while the aniline p-hydroxylation was higher and bufuralol 1'-hydroxylation was lower in humans than monkeys. On the other hand, the immunochemical properties of P450 proteins and the activities of P450-dependent drug oxidation reactions in dogs, guinea pigs, and rats were somewhat different from those of monkeys and humans; the differences in these animal species varied with the P450 enzymes examined and the substrates used. The results presented in this study provide useful information towards species-related differences in susceptibilities of various animal species regarding actions and toxicities of drugs and xenobiotic chemicals.

In vivo and in vitro characterization of CYP2E1 activity in Japanese and Caucasians

Chlorzoxazone's disposition after oral administration was determined in 20 young healthy Caucasian men and a similar group of Japanese men. The drug's plasma concentrations were significantly higher and its rate of elimination slower in Japanese compared to Caucasian men. Accordingly, chlorzoxazone's oral clearance was smaller (40%) in Japanese men and a similar difference (30%) was still apparent after normalizing for body weight (3.74 +/- 1.23 versus 5.05 +/- 1.41 ml.min-1.kg-1, P < .05). This slower elimination was associated with a reduced (fractional) clearance by 6-hydroxylation (2.34 +/- 1.04 ml.min-1.kg-1 versus 3.23 +/- 1.10, P < .05). Because such metabolism is mediated by cytochrome P4502E1 (CYP2E1), these findings suggest a lower level of the enzyme's catalytic activity in Japanese men. This was confirmed by in vitro studies with microsomes prepared from livers of individuals representative of the two racial groups. CYP2E1 levels were lower (61% P < .002) and CYP2E1-mediated chlorzoxazone 6-hydroxylase (22%, P < .001) and aniline 4-hydroylase (35%, P < .0001) activities were reduced in Japanese preparations compared to those from Caucasians. No relationships were found between measures of CYP2E1 activity, both in vivo and in vitro, and genomic polymorphisms in the CYP2E1 gene identified by Rsal/Pstl and Dral restriction fragment length polymorphisms. Collectively, these data show an interracial difference in CYP2E1 activity. Because this enzyme is importantly involved in the activation of environmental procarcinogens, such a difference may account, in part, for the lower rate of some cancers, e.g., lung cancer, in Japanese compared to Caucasians men.

Preserved semantic priming effect in alexia

BH, a left-handed patient with alexia and nonfluent aphasia, was presented with a lexical-decision task in which words and pronounceable pseudowords were preceded by semantically related or unrelated picture primes (Experiment 1). In Experiment 2, BH was given an explicit reading task using the word lists from Experiment 1. Performance on Experiment 2 disclosed severe reading deficits in both oral reading and semantic matching of the words to pictures. However, in Experiment 1, BH demonstrated a significant semantic priming effect, responding more accurately and more quickly to words preceded by related primes than by unrelated primes. The present results suggest that even in a patient with severe alexia, implicit access to semantic information can be preserved in the absence of explicit identification. The possibility of categorical gradient in implicit activation (living vs. nonliving) in BH was also discussed, which, however, needs to be clarified in the further investigation.

Conformation of cyclic and linear (1 --> 2)-beta-D-glucans in aqueous solution

The conformations of cyclic (1 --> 2)-beta-D-glucan chains having degree of polymerization (dp) 17 to 24 were characterized by means of small-angle X-ray scattering and Monte Carlo simulation. The results indicate that cyclic (1 --> 2)-beta-D-glucan chains adopt the shape of a doughnut-like ring with a thickness of about 10 A for all the samples. The diameter of the annulus for the cyclic glucan having dp 21 is estimated to be only about 4-5 A. Two linear (1 --> 2)-beta-D-glucans possessing dp 19 and 21 prepared by acid hydrolysis of a cyclic glucan and subsequent fractionation showed different scattering profiles from those obtained for cyclic glucans having the corresponding dp. Although the Monte Carlo simulation does not completely reproduce the scattering profiles observed by small-angle X-ray scattering, linear (1 --> 2)-beta-D-glucans seem to possess a characteristic cylindrical shape with cross-sectional diameters of 11.8 and 13.2 A for linear glucans of dp 19 and 21, respectively.

Histopathology of cutaneous changes in non-drug-induced coma

To compare the histological features of non-drug-induced and drug-induced coma blister, we performed histopathological and immunopathological studies of four biopsy specimens from three patients with non-drug-induced coma. These results were compared with the previously well-documented histology of drug-induced coma. The findings of the present study of non-drug-induced coma included (a) a variable degree of epidermal cell degeneration, including vacuolation of basal cells, intraepidermal blister formation with pale cytoplasm, and extensive coagulation necrosis with pale nuclei; (b) alteration of the outer root sheath of telogen follicles, ranging from focal necrosis to total coagulation necrosis, and degeneration of sebaceous gland with disappearance of the germinative cell layer; (c) secretory eccrine cells with pyknotic nuclei, vacuolation of the cytoplasm, and intercellular edema, resulting in poorly defined cytoplasm, although the nuclei of the outer basal layer were partially preserved; (d) from slight edema of the vessel wall of the venules to fibrinoid, thrombosis and/or fibrinoid necrotic degeneration of arterioles and venules; and (e) deposits of immunoglobulins or complement as detected by direct immunofluorescent technique in all the three cases. One significant difference between non-drug-induced and drug-induced coma blister was the presence of fibrinoid thrombi in the lumina of non-drug-induced coma blisters. Since one of the three cases of non-drug-induced coma studied in the present report did not show thrombi in the lumina, this feature may not always be available for the differential diagnosis of these two conditions. However, fibrinoid thrombi may be a good marker for the differentiation of these two conditions, when the depth and duration of non-drug-induced coma are severe enough to induce these lesions.