[Autoimmune hemolytic anemia associated with multicentric Castleman's disease with a 28-year history]

A 49-year-old female admitted because of anemia. had skin rashes since age 20. Generalized lymphadenopathy and fever appeared and the patient was diagnosed as multicentric Castleman's disease (MCD) at 40 years of age. Lymphadenopathy and fever improved with combined chemotherapy. In November, 1992, anemia increased with reticulocytosis (11.8%) and laboratory examination revealed a positive result for Coombs test and increased indirect bilirubin. A diagnosis of autoimmune hemolytic anemia (AIHA) was made. Steroid and plasmapheresis showed temporary effects, but anemia relapsed when steroids were decreased. Immunosuppressive drugs, vincristine and danazole were ineffective. Anemia improved on the second attempt at steroid therapy. The level of Hb rose to 11.2 g/dl after 3 months. The relationship between MCD and AIHA was discussed.

[Pure red cell aplasia with thymoma, myasthenia gravis and normal pressure hydrocephalus]

Cases of pure red cell aplasia with thymoma and myasthenia gravis are rare. We described a patient who had concomitant pure red cell aplasia, thymoma, myasthenia gravis and a normal pressure hydrocephalus. A 63-year-old man with disturbances of gait, left blepharoptosis and anemia was presented to our hospital. Laboratory examination on admission revealed severe anemia. Bone marrow aspirates showed erythroid hypoplasia of marked degree. Chest x-ray and chest CT revealed a tumor to the right of cardiac wall. The tensilon chloride test and antiacetylcholine receptor antibody were positive. A hydrocephalus was demonstrated with brain CT. Cerebrospinal fluid pressure was in the normal range. He was diagnosed as having pure red cell aplasia with thymoma, myasthenia gravis and a normal pressure hydrocephalus. This appears to be a fairly rare case. It seems important to consider that a normal pressure hydrocephalus may have immunological disorders.

Cefadroxil concentrations in human serum, gingiva, and mandibular bone following a single oral administration

Cefadroxil concentrations in human serum, gingiva, and mandibular bone were measured by a paper disk method following a single 500-mg oral dose. The mean peak concentrations in serum, gingiva, and mandibular bone occurred at the identical time, 3 hours, and were 12.92 micrograms/mL, 6.50 micrograms/g, and 2.67 micrograms/g, respectively. Mean cefadroxil concentration ratios of gingiva/serum and mandibular bone/serum at the peak time were 0.54 and 0.21, respectively. Mean concentrations in gingiva and mandibular bone at the peak time exceeded the minimum inhibitory concentrations for 90% of clinically isolated strains of a alpha-hemolytic streptococci.

Immunodeficiency and IL-6 production by peripheral blood monocytes in multicentric Castleman's disease

To study the pathogenesis of multicentric Castleman's disease (MCD), IL-6 producing cells and immune function were investigated in four MCD patients. The expression of IL-6 mRNA in one MCD lymph node was analysed by in situ hybridization. IL-6 mRNA expressing cells were scattered in the interfollicular areas and did not resemble plasma cells. Spontaneous IL-6 production was detected in the culture supernatants of peripheral blood mononuclear cells (PBMNC) from four patients. The IL-6 producing cells among the PBMNC were found to be monocytes by both in situ hybridization and immunohistochemistry. We evaluated immune function in four MCD patients. These studies show: (1) a negative PPD skin test in 3/4 patients, (2) decreased IL-2 production in 3/4 patients, (3) decreased T cell colony formation in 3/4 patients, (4) decreased NK activity and NK cell number in 2/4 patients, (5) increased soluble IL-2 receptor in 4/4 patients, and (6) decreased CD4/CD8 ratio in 3/4 patients. These results show that MCD resembles, in several ways, acquired immunodeficiency syndrome (AIDS).

Effect of calcium-channel blockers on cell proliferation, DNA synthesis and collagen synthesis of cultured gingival fibroblasts derived from human nifedipine responders and non-responders

Human gingival fibroblasts from six patients who developed gingival hyperplasia as a result of nifedipine medication and five who did not were studied for the effects of calcium-channel blockers (nifedipine, diltiazem, verapamil and nicardipine) on cell proliferation, DNA synthesis and collagen synthesis. Phenytoin was used as a positive control. The fibroblasts from reactive patients gave trends toward better cell proliferation rates, DNA synthesis ([3H]-thymidine incorporation), and collagen synthesis ([3H]-proline incorporation) than those from non-reactive patients in the presence of 1 microM of calcium-channel blockers or phenytoin.

Amoxicillin concentration in pus from abscess caused by odontogenic infection

1. Amoxicillin concentration in pus from odontogenic infection was assayed and the concentrations were compared with MIC (minimum inhibitory concentration) of alpha-hemolytic streptococci isolated from odontogenic infection. 2. Measurable amoxicillin concentrations in serum and pus were found in all instances (n = 16). 3. The mean peak concentrations in serum and pus were found at identical times, 1.5 hr after administration, which were 5.92 and 0.90 micrograms/ml, respectively. 4. The mean concentration ratio of pus/serum at the peak time was 0.15. 5. All amoxicillin concentrations in pus at the peak time exceeded the MIC for 90% of alpha-hemolytic streptococci (0.25 micrograms/ml).

Concentrations of lomefloxacin in radicular cyst and oral tissues following single or multiple oral administration

Concentrations of lomefloxacin in serum, the wall and fluid of radicular cyst, gingiva, and jawbone following single or multiple oral administration were measured. The highest concentrations of lomefloxacin in serum, cyst wall, cyst fluid, gingiva, and jawbone occurred at 3 h after multiple administration, and were 2.31 micrograms/ml, 4.06 micrograms/g, 1.54 micrograms/ml, 4.72 micrograms/g and 2.79 micrograms/g, respectively. The mean concentration ratios of wall/serum, fluid/serum, fluid/wall, gingiva/serum, and jawbone/serum at the highest concentrations were 1.74, 0.73, 0.47, 2.52 and 1.20, respectively. Although most lomefloxacin concentrations in cyst and oral tissues following single oral administration did not exceed the MICs for 80% of clinically isolated strains of alpha-hemolytic streptococci, Staphylococcus aureus and Niesseria spp., most of those obtained after multiple oral administration exceeded the MICs except in the case of fluid.

Spontaneous IL-2 production in vitro in two patients with pure red cell aplasia

We investigated spontaneous cytokine production in two patients with pure red cell aplasia (PRCA). The peripheral blood mononuclear cells (PBMNC) from two patients produced IL-2. Cyclosporin A (CyA) suppressed in vitro IL-2 production in one patient, but not in the other. Spontaneous IL-2 production disappeared in one patient 10 months after the start of CyA therapy. The patient for whom CyA therapy was stopped after the disappearance of spontaneous IL-2 production has remained in continuous remission for 1 year. The present case suggests that spontaneous IL-2 production in PBMNC might be an indicator of disease activity.

[Elderly cases of hematological malignancies with second malignancies]

Recently an increase of the elderly patients with hematological malignancies has been pointed out. We analyzed second malignancies in elderly patients with hematological malignancies (95 age 65 or more), and made a comparative study with non-elderly case for the past 5 years. Second malignancies were observed in 26 cases out of the total of 282 hematological malignancies (9.2%). The percentage of patients with second malignancies in the elderly group (19/95; 20%) was significantly higher than that of the non-elderly group (7/187; 3.7%). Among the all kinds of hematological malignancies, the second malignancies were mainly observed in cases with myelodysplastic syndrome and chronic myelo-proliferative disorder. Colon carcinoma, gastric carcinoma and lung carcinoma accounted for nearly half of all the second malignancies. On 11 of the 26 cases with second malignancies, the first malignancies had been treated with some anti-cancer drug such as alkylating agents. Development of a second cancer was greater in cases in which the first hematological malignancy was treated with alkylating agents more than in cases in which the first carcinoma was not treated with alkylating agents.

Ampicillin concentrations in radicular cysts following a single oral administration of bacampicillin

1. Ampicillin concentrations in cyst wall (wall) and cyst fluid (fluid) of radicular cyst and serum following a single oral administration of bacampicillin (equivalent to 500 mg of ampicillin) were measured by a paper disk method. 2. The mean peak concentrations of ampicillin in wall, fluid, and serum occurred at identical times, 1.5 hr, and were 2.39 micrograms/g, 0.77, and 10.24 micrograms/ml, respectively. 3. Mean ampicillin concentration ratios of wall/serum, fluid/serum, and fluid/wall at the peak time were 0.23, 0.07, and 0.40, respectively. 4. Mean ampicillin concentrations in wall and fluid at the peak time exceeded MIC (minimum inhibitory concentration) for 90% (0.5 microgram/ml) for clinically isolated strains of alpha-hemolytic Streptococci.

Circulating abnormal cells detected in a patient with immunoblastic lymphadenopathy

An unusual case of immunoblastic lymphadenopathy (IBL) with circulating CD3-CD4+ cells is reported. A lymph node biopsy specimen showed the characteristic features of IBL. Two-color analyses demonstrated that the circulating abnormal cells were CD3-, CD4+, HLA-DR+, and CD25-. Chromosomal analysis revealed unrelated clones in the lymph node. Though 48% of the peripheral blood lymphocytes were abnormal, no clonal rearrangement of the TcR beta chain gene was detected in the peripheral blood. This case might point out the possibility that some cases of IBL truly had no TcR gene rearrangement and were dysplasias.

Secretion of endogenous 16-kDa beta-galactoside-binding lectin from vitamin A-pretreated chick embryonic cultured skin

Localization of endogenous beta-galactoside-binding 16-kDa lectin and its gene expression pattern were investigated during differentiation of chick embryonic skin in vivo and in vitro and were compared with those of a 14-kDa lectin. By light microscopy, immunostaining of the 16-kDa lectin was weak in the undifferentiated epidermis, while it became intense in the keratinized epidermis, particularly in the intermediate cells. Essentially the same staining pattern was observed both in vivo and in vitro. The gene expression pattern was consistent with these immunohistochemical observations. These results were similar to those of the 14-kDa lectin [1]. On the other hand, in the vitamin A-pretreated cultured skin, mucous metaplasia of the epidermis was induced and marked changes in localization of these two isolectins were observed. The 16-kDa lectin expression was increased in the epidermis, especially in the superficial cells, and the gene expression was detected in all layers of the epidermis. However, 14-kDa lectin expression was markedly reduced in the metaplastic epidermis. In the keratinized epidermis, detailed localization of these lectins under the electron microscope was almost the same. Both of them were located primarily along the plasma membrane, in the intercellular space, and in the desmosomes. In the mucous metaplastic epidermis, however, the localization of the 16-kDa lectin was completely different from that of the 14-kDa lectin; e.g., the former was detected in the mucous granules and on the microvilli of the superficial cells, while the latter was scarcely observed in the epidermis. The present results revealed that (1) the 16-kDa lectin as well as 14-kDa lectin were expressed during the epidermal differentiation and (2) much of the 16-kDa lectin was produced and secreted from the vitamin A-pretreated cultured epidermis, while 14-kDa lectin disappeared. In the view of these facts, it is suggested that (1) both 14- and 16-kDa lectins may play an important role in differentiation of the skin and (2) the gene expression of 14- and 16-kDa lectins is regulated independently.

[Red cell fragmentation syndrome after bone marrow transplantation presumed to be caused by cyclosporin A]

Red cell fragmentation syndrome (RCFS) appeared in a 19-year-old female with acute lymphocytic leukemia 30 days after receiving allogenic bone marrow transplantation (BMT) with a conditioning regimen of a high-dose of cytosine arabinoside, cyclophosphamide and total body irradiation. Thirty days after BMT, severe anemia, reticulocytosis and red cell fragmentation were recognized. As RCFS due to cyclosporin A was suspected, CsA therapy was immediately stopped and methotrexate was substituted for CsA. After the discontinuation of CsA, rapid resolution of the hemolysis was observed. When we resumed treatment with CsA, similar hemolysis developed and disappeared again after discontinuation of CsA. Though we considered that RCFS occurred due to CsA, the participation of GVHD and cytomegalovirus might be undeniable.

[Leukemic B-cell colony formation in patients with B-cell prolymphocytic leukemia]

We performed in vitro B cell colony assay after coculture with phytohemagglutinin-P (PHA-P) and some cytokines (IL-2, IL-4, IL-6 and PHA-MTCM) in B leukemic cells from B-PLL and B-CLL patients. The number of colonies generated with PHA and PHA-MTCM was significantly smaller in patients with B-PLL than B-CLL. The surface markers of colony cells from a PLL patient were similar to those of circulating leukemic cells of the patient. IL-2, IL-4 and IL-6 did not enhance PHA-induced B cell colony formation in B-PLL. The expression of CD23 and CD25 antigens of the PLL cells was not enhanced after coculture with PHA for 72 hours in contrast to the enhancement of these antigens in B-CLL. B-PLL cells might be less responsive to PHA than B-CLL cells.

[Testicular relapse, with Ph-positive chromosome after bone marrow transplantation for acute lymphocytic leukemia]

A 25-year-old man with acute lymphocytic leukemia (ALL) had received bone marrow transplantation (BMT). Testicular relapse occurred 6 months after BMT as the first relapse, and couple of weeks later, bone marrow relapse developed. At that time, karyotypic analysis showed Ph-chromosome which was not observed before the first remission and DNA analysis revealed rearrangements of minor BCR, IgL, IgH, TCR and TCR genes. Testicular relapse often develops in ALL of children after BMT. However, some reports, including this report, indicate that testicular relapse following BMT can also occur in adults, so that the incidence of testicular relapse could be reduced either by total body irradiation (TBI) or testicular irradiation before transplantation. Incidence of Ph-positive chromosome following BMT is a key to illuminate the mechanism of the Philadelphia chromosome. Rearrangements of Ig and TCR gene can be considered as an abnormal gene rearrangement occurring at an early stage of B cell proliferation.

Josamycin concentrations in radicular cysts following a single oral administration

1. Josamycin concentrations in cyst wall (wall) and cyst fluid (fluid) of radicular cyst and serum following a single oral administration of josamycin (600 mg) were assayed by a paper disk method. 2. The mean peak josamycin concentrations in wall, fluid and serum occurred at 1.5, 2 and 1.5 hr, respectively, and were 1.33 micrograms/g, 0.53 and 0.74 micrograms/ml, respectively. 3. The mean concentration ratios of wall/serum, fluid/serum and fluid/wall at the peak times (1.5, 2 and 2 hr) were 1.80, 0.64 and 0.42, respectively. 4. Josamycin concentrations in wall and fluid at the peak time exceeded MIC for 80% for clinically isolated strains of alpha-hemolytic Streptococci.

Immunohistochemical study of basement membrane reconstruction by an epidermis-dermis recombination experiment using cultured chick embryonic skin: induction of tenascin

The production of extracellular matrix components such as laminin, Type IV collagen, fibronectin, and tenascin during the formation of basement membrane in cultured epidermis-dermis recombinant skin of 13-day-old chick embryo was analyzed immunohistochemically. The epidermis and dermis were separated from each other by treatment with EDTA and/or dispase. The basal lamina of the basement membrane was thus removed from both epidermis and dermis. The isolated epidermis was overlaid onto the isolated dermis, i.e., recombined, and then cultured for 1-7 days in a chemically defined medium (BGJb) on a Millipore filter. Immunofluorescence labeling was used for light microscopy and HRP or colloidal gold labeling for electron microscopy. In specimens from 2-day cultures, positive sites of anti-laminin and anti-fibronectin reaction were observed light microscopically as patches which, at the electron microscopic level, corresponded to fragments of the basal lamina located immediately beneath and in the vicinity of the attachment plaques of the hemidesmosomes. The staining pattern became continuous 7 days after recombination. Fluorescence labeling of laminin and fibronectin appeared somewhat earlier than that of Type IV collagen and tenascin. All of the four components were found localized primarily in the basal lamina. Furthermore, fibronectin and tenascin were also distributed in the extracellular matrix of the dermis. The expression of tenascin, which does not exist in the basement membrane of 13-day-old intact embryonic skin, was induced in vitro. These results suggest that hemidesmosomes may play an important role in the reconstruction of the basement membrane and that various components of the basement membrane appeared at different times during the reconstruction.

In vitro proliferative and differentiated responses of lymphoma cells to PHA and IL-4 in a patient with intermediate lymphocytic lymphoma

We carried out in vitro B cell colony assays, with phytohemagglutinin-P (PHA-P) and IL-4, on B cells from one intermediate lymphocytic lymphoma (ILL) patient and four chronic lymphocytic leukemia (CLL) patients. Peripheral blood B cells from the ILL patient responded to PHA and IL-4, they proliferated, and differentiated into cells with plasmacytoid cell morphology. They lost the CD19 surface antigen after 10 day co-culture with PHA and IL-4. The bone marrow of this ILL patient contained atypical plasma cells with multiple nuclei. Peripheral blood B cells from the four CLL patients responded to PHA, but IL-4 did not increase PHA-induced B cell colony formation in these cells. The CLL cells did not differentiate into plasma cells, and they were clearly different from the ILL cells in morphology, as shown by scanning electron microscope examination. Since this study was performed on cells from only one ILL patient, further examination of cells from many patients might be necessary to confirm the difference between ILL and B cell-type CLL.

Cefaclor concentrations in human serum, gingiva, mandibular bone, and dental follicle following a single oral administration

1. Cefaclor concentrations in human serum (n = 59), gingiva (n = 46), mandibular bone (n = 39), and dental follicle (n = 42) following a single oral administration of cefaclor (500 mg) were measured by the paper disk method. 2. The peak times of serum, gingiva, mandibular bone, and dental follicle were 1.5, 2, 2, and 1.5 hr, respectively. 3. The mean peak concentrations of serum, gingiva, mandibular bone, and dental follicle were 7.58 micrograms/ml, 3.71, 1.59 and 2.42 micrograms/g, respectively. 4. The concentration ratios of gingiva/serum, mandibular bone/serum, and dental follicle/serum at peak times of the tissues were 0.49, 0.18, and 0.32, respectively. 5. Mean cefaclor concentrations in gingiva, mandibular bone, and dental follicle at peak times exceeded MIC for 90% for clinically isolated strains of alpha-hemolytic Streptococci.

[Chronic myelomonocytic leukemia associated with translocation 1;7, marked platelet aggregation and cryofibrinogenemia: a case report]

A 64-year-old male was admitted in September 1989 with complaints of fever and muscular weakness in the extremities. A peripheral blood examination on admission revealed WBC 10,300/microliters (monocytes 32%), RBC 195 x 10(4)/microliters, Hb 7.9 g/dl, Plt 12.8 x 10(4)/microliters with trilineage dysplasia. Bone marrow biopsy was normoplastic marrow with 25.7% of monocytes including immature blasts. Cytochemical analysis of the monocytes showed positive for peroxidase and dual esterase staining. Chromosomal analysis of peripheral blood revealed 46, XY, -7, +der(1) t(1;7)(p11;p11). A diagnosis of chronic myelomonocytic leukemia was made. Hemostatic studies revealed cryofibrinogenemia, marked platelet aggregation on blood smear, hyperfibrinogenemia and a marked increase in maximal amplitude of thrombelastogram. Treatment with prednisolone and VP16, resulted in a reduction of peripheral monocytes and a disappearance of cryofibrinogen, marked platelet aggregation and a decrease in muscular weakness. Nine months after diagnosis he died of DIC, pneumonia, lung abscess and sepsis.

[Essential thrombocythemia that transformed to myelofibrosis after three years]

A 66-year-old man was presented with thrombocytosis in February, 1988. Laboratory examinations on admission revealed a white blood cell count of 17,700/microliters and a platelet count of 274.4 x 10(4)/microliters. Bone marrow aspirates showed an increase of megakaryocytes (1,294/microliters). There was no fibrosis or Ph1 chromosome. He was diagnosed as having essential thrombocythemia and was treated with thrombopheresis, carboquone and ranimustine (MCNU). Subsequently his platelet count was well controlled approximately for three years. He was readmitted because of pyrexia and left hypochondralgia in February 1991. Physical examination revealed hepatosplenomegaly. Peripheral blood revealed leukoerythroblastosis associated with the occurrence of tear drop cells. Bone marrow aspiration resulted in a dry tap and the biopsy specimen showed reticulin fibrosis. This is a fairly rare case of essential thrombocythemia that transformed to myelofibrosis.

Changes in expression of the endogenous beta-galactoside-binding 14-kDa lectin of chick embryonic skin during epidermal differentiation

Changes in the expression pattern of the gene for the endogenous beta-galactoside-binding 14-kDa lectin of chick embryo were examined immunohistochemically during epidermal differentiation in vivo and in vitro with special reference to detailed localization of the 14-kDa lectin. The gene expression was visualized by the HRP-staining method following in situ hybridization, in which sulfonated cDNA was employed as a probe. The 14-kDa lectin gene expression (mRNA) was detected mainly in the intermediate layer of the epidermis: it was faint in 13-day-old embryos, gradually increased in intensity during epidermal differentiation, and became intensely positive in 17-day-old embryo. The expression of the gene in skin explants was suppressed by vitamin A, which induces mucous metaplasia of the epidermis in vitro. The anti-14-kDa lectin reaction was positive mainly in the intermediate layer of the differentiating epidermis, coinciding chronologically with expression of the gene at the light microscopic level. Immunoelectron microscopy revealed that the positive reaction was primarily localized in desmosomes, in tonofilament bundles anchored to the desmosomes, along the outer surface of the plasma membrane, and in the intercellular space. Essentially the same staining pattern was observed in differentiating epidermis in vitro. The positive reaction was markedly reduced in the epidermis in which differentiation had been suppressed in vitro by the addition of vitamin A.

Nifedipine-resistant Ca(++)-induced contraction in tail artery of spontaneously hypertensive rats

Nifedipine-resistant Ca(++)-induced contractions (NR-Ca(++)-contraction) were compared in the tail arteries from SHRs and WKYs (5 and 13 week old). NR-Ca(++)-contraction of tail artery was defined as follows: Ca(++)-induced contraction in the presence of norepinephrine (NE) (10(-5) M) or 5-hydroxytryptamine (5-HT) (10(-5) M) in Ca(++)-free medium containing EGTA (0.1 mM) and nifedipine (10(-6) M). NR-Ca(++)-contractions in arteries from 5 week old SHRs and WKYs were not different. In contrast, NR-Ca(++)-contractions in arteries from 13 week old SHRs were about 2-fold greater than in arteries from 13 week old WKYs. In arteries from 13 week old WKYs and SHRs, nitroglycerin (10(-5) M) significantly reduced the NR-Ca(++)-contraction in the presence of 5-HT but not in the presence of NE. The reduction was inhibited by the presence of methylene blue (3 x 10(-6) M). 8-Bromo-cGMP (10(-4) M) reduced significantly the NR-Ca(++)-contraction in the presence of 5-HT in arteries from 13 week old SHRs and WKYs. The present experiments clearly demonstrated that the NR-Ca(++)-contractions (both in the presence of NE and 5-HT) in 13 week old SHRs were significantly greater than those in arteries from 13 week old WKYs. These results suggest that in addition to an increase in voltage-operated Ca++ mobilization reported by others, an increase in NR-Ca++ mobilization may contribute to the development of hypertension in SHR.

Ampicillin concentrations in human radicular granuloma following a single oral dose of bacampicillin

Ampicillin concentrations in human serum and radicular granulomas of 42 patients were determined after a single oral dose of bacampicillin (equivalent to 500 mg of ampicillin). Although wide variations were found among both serum and radicular granuloma ampicillin concentrations, measurable concentrations were found in all cases. The mean peak ampicillin concentrations in serum and radicular granulomas occurred at identical times, 1.5 hours, and were 11.19 micrograms/mL (range, 1.30 to 21.00 micrograms/mL) and 5.12 micrograms/g (range, 0.50 to 10.50 micrograms/g), respectively. The mean radicular granuloma/serum ampicillin concentration ratio at the peak time was 0.42. Ampicillin concentrations in radicular granulomas exceeded most of the minimum inhibitory concentrations for bacteria commonly isolated from odontogenic infections.

Reconstruction of basement membrane in recombinants of epidermis and dermis of chick embryonic skin in vitro: an electron microscopic study

The tarsometatarsal skin from 13-day-old chick embryos was treated with EDTA and/or Dispase to separate it into epidermis and dermis, and the basal lamina was removed. The isolated epidermis and dermis were then recombined and cultured on Millipore filters in a chemically defined medium (BGJb). Beginning at 3-4 days after recombination, short fragments of new basal lamina and subbasal dense plaque were formed along the epidermal basal cell outer surface immediately subjacent to hemidesmosomes. After 6-8 days of culture, fragments of the basal lamina started to fuse together and the lamina became progressively continuous. At the same time, anchoring fibrils were formed to attach to the basal lamina. The hemidesmosome formation preceded the basement membrane formation. When normal embryonic epidermis was recombined with retinol-pretreated dermis and cultured for 7 days in BGJb, short fragments of the basal lamina, the subbasal dense plaque, and anchoring fibrils were formed, but the basement membrane remained discontinuous with many interruptions in the interspace between hemidesmosomes. These results demonstrate that pretreatment of dermis with retinol causes the changes noted in the basement membrane.