[A case of Borrmann type 4 gastric cancer responding to sequential methotrexate and 5-fluorouracil combined with CDDP]

A case of Borrmann type 4 gastric cancer responding to sequential methotrexate and 5-fluorouracil combined with cis-diamminedichloroplatinum (CDDP) is reported. A 57-year-old woman was admitted to our hospital complaining of abdominal fullness. Upper gastrointestinal series and gastrofiberscopy revealed almost the entire stomach was involved with Borrmann type 4 cancer. Gastrectomy could not be performed because of peritoneal dissemination. However, the patient responded to sequential methotrexate and 5-fluorouracil therapy and CDDP administration. She enjoyed more than one year of hospital-free survival period and survived for almost two years.

The effect of ultraviolet (UVB and PUVA) radiation on the expression of epidermal keratins

Using a panel of monoclonal antibodies directed against keratins (PKK2, CK8.12 and KL1), the effects of ultraviolet B (UVB) and psoralen plus ultraviolet A (PUVA) irradiation on keratin expression in guinea-pig skin were examined immunohistochemically. Following irradiation, whether by UVB or PUVA, rapid alterations in the distribution pattern of keratins were observed in the epidermis. The alterations included the induction of basal cell-type keratins (PKK2 and CK8.12 staining) in the suprabasal layers, with concomitant reduction of the suprabasal-type keratins (KL1 staining). These alterations in keratin expression were observed during the period when DNA synthesis appears to be accelerated by ultraviolet light exposure (5 h-5 days after UVB, and 2-10 days after PUVA irradiation). Therefore, these changes are probably reflections of a proliferative or regenerative state of keratinocytes. This explanation was supported by the result of an experiment involving tape stripping of the epidermal horny layers, which also accelerates DNA synthesis by keratinocytes. Immunohistochemistry appears to be a useful and sensitive method of detecting the effect of ultraviolet light on keratinization.

Noonan phenotype associated with intracerebral hemorrhage and cerebral vascular anomalies: case report

A case of a 19-year-old man with multiple characteristics of the Noonan phenotype and a massive intracerebral hemorrhage in the left putaminal region is presented. The hemorrhage was removed surgically, and the patient made a good recovery and was finally able to walk unassisted. Postoperative cerebral angiograms revealed various vascular anomalies, including a small aneurysm. To the best of our knowledge, this is the second detailed case report of an association of the Noonan phenotype with cerebral vascular anomalies presenting intracerebral hemorrhage. The etiology of this syndrome remains unknown but the possible causes of this rare association are discussed.

A new animal model for contact dermatitis: the hairless guinea pig

Allergic and irritant contact reactions were evaluated in the recently identified hairless guinea pig, Crl:IAF(HA)BR, a mutant from the Hartley strain. The cutaneous changes were observed macro- and microscopically. The irritant contact dermatitis was induced by croton oil, 2,4-dinitrochlorobenzene (DNCB), or anthralin. Both hairless and hairy guinea pigs developed similar reactions to these chemicals. The density of the epidermal Langerhans cells (LC) of hairless guinea pigs was significantly higher than that in the hairy strain. Allergic contact sensitization was easily induced with DNCB. Photoallergic contact sensitization was also induced with tetrachlorosalicylanilide (TCSA) but not with tribromosalicylanilide (TBS). However, by administration of cyclophosphamide before sensitization, positive photocontact responses were seen with TBS. These results indicate that hairless guinea pigs can be used as animal models for investigation of immunologic and nonimmunologic contact reactions.

[Immunohistochemical study for the localization of apolipoprotein AI, B100, and E in normal and psoriatic skin]

Recently many new knowledge about the LDL receptors and LDL-receptor mediated endocytosis of cholesterol have been reported (Goldstein et al. 1979). This phenomenon is also observed in keratinocyte. The use of low density lipoprotein-gold (LDL-gold) technique in electron microscopy demonstrated a reciprocal correlation between cell differentiation and LDL-receptor expression in normal and psoriatic skin which is characterized by keratotic disorder and epidermal hyperproliferation. (Mommaas-Kienhuis et al. 1987). In order to study the interaction between normal skin and lipid, and the affect of lipid to psoriatic skin, we investigated the localization of apolipoprotein AI, B100 and E in epidermis. Six normal skins, ten psoriatic skins and three skins of seborrheic dermatitis were obtained. In normal epidermis, apolipoprotein B100 was markedly detected intercellularly, and apolipoprotein E was observed intracellularly. In contrast, apolipoprotein AI was not detected in epidermis. This result showed that keratinocytes expressed B and E receptors on their surface membrane, connecting with apolipoprotein B100 and apolipoprotein E respectively. But this finding that positive reaction sites were found in all layer of epidermis also suggested that anti-apolipoprotein B100 antibody reacted extracellular cholesterol excreted outside from keratinocytes. In psoriatic skin, the basement membrane of dermo-epidermal junction, the vascular walls and perivascular regions in papillary dermis were stained positively by anti-apolipoprotein AI antibody. But the localization of apolipoprotein B100 and E were similar to normal skin, and they were also detected in the parakeratotic regions in horny layer. These results did not show the relationship between cell differentiation and B, E receptor expression on keratinocyte. And it is suggested that cholesterol metabolism in keratinocyte affected the pathogenesis of psoriasis.

The distribution of IgG subclass autoantibodies in bullous pemphigoid analysed by immunofluorescence and immunoblotting

The distribution of IgG subclasses in bullous pemphigoid (BP) autoantibodies in 14 BP sera and four biopsies was analysed by immunofluorescence (IF) and immunoblotting (IB). Three clones of monoclonal antibodies (MoAbs) to each IgG subclass were used. All 14 sera showed linear fluorescence in the basement membrane zone with IF, and 240 kDa and/or 180 kDa protein bands in human epidermal extract were detected by IB using a polyclonal antibody to total IgG. BP antibody in IgG4 subclass was found to be predominant, as it was detected most frequently and intensively in all positive sera and lesions studied by both techniques. In the IgG1 to IgG3 subclasses, a range of proportions of positive sera was obtained among MoAbs to the same IgG subclass in both techniques. However, one MoAb could detect IgG1 subclass BP antibody with a high frequency in both techniques. No difference in IgG subclass distribution of BP antibodies was observed during the course of the disease. In each serum, any IgG subclass of BP antibody recognized the identical BP antigen(s). These results suggest the predominance of IgG4 subclass and the possible presence of IgG1 subclass in BP antibodies.

Localized pemphigoid shares the same target antigen as bullous pemphigoid

A case of localized pemphigoid is described in which the lesions were only on the lower legs. Immunoblotting of the patients' serum reacted with a 240-kDa polypeptide identical to one of the bullous pemphigoid antigens. IgG1 was detected in the lesional skin and IgG1 and IgG4 in the patient's serum. These observations suggest that the immunopathological mechanisms in the blister formation in localized pemphigoid are similar to those found in more widespread bullous pemphigoid.

The ATPase-staining of Langerhans cells in previously stored skin tissues

The ATPase-staining of Langerhans cells is usually done on fresh, unfixed biopsy specimens. In the present study, we attempted to stain these cells in previously stored tissues of guinea pig skin. The ATPase activity disappeared after freezing or preservation in formalin or ethanol. In contrast, tissue specimens which had been stored in physiological saline at 4 degrees C stained as well as fresh cells even after 14 days.

T-cell subsets in drug-induced toxic epidermal necrolysis. Possible pathogenic mechanism induced by CD8-positive T cells

A patient with bromisovalum-induced toxic epidermal necrolysis showed pronounced delayed hypersensitivity to bromisovalum by patch testing. Biopsy specimens from the cutaneous lesion and the site of the positive patch test reaction were analyzed and compared immunohistologically. The findings were similar: most of the mononuclear cells disposed along the dermoepidermal junction and migrating into the epidermis were CD8-positive lymphocytes, whereas the dermal inflammatory infiltrates were composed predominantly of CD4-positive lymphocytes. This case showed the potential usefulness of patch testing in evaluating cases of toxic epidermal necrolysis. We believe that delayed hypersensitivity plays a crucial role in the development of drug-induced toxic epidermal necrolysis. Furthermore, potential effector cells with phenotypic characteristics of CD8-positive lymphocytes (suppressor/cytotoxic T cells) seem to represent important mediators of the epidermal damage of the cutaneous lesion in our case.

Simultaneous determination of bromvalerylurea, bromodiethylacetylurea, and allylisopropylacetylurea in serum and urine by high-performance liquid chromatography with a multiwavelength UV detector and thin-layer chromatography

A method for rapid detection and identification of bromvalerylurea (BVU), bromodiethylacetylurea (BDU), and allylisopropylacetylurea (AIU) in serum and urine by high-performance liquid chromatography (HPLC) with a multiwavelength UV detector after Sep-Pak C18 cartridge extraction is reported. A Jasco Finepak C18 reversed-phase column was used for the separation. Acetonitrile-distilled water (1:1, v/v) was used as a mobile phase. There was no significant absorption of the three hypnotics in the UV spectra (210-350 nm). However, the absorption of each was higher at the shorter wavelengths. The quantifications for the three hypnotics detected at 210 nm by the chromatogram were linear over the range 0.2-4 micrograms/mL and the detection limits of BVU, BDU, and AIU were 5, 10, and 10 ng as absolute amounts, respectively. The mean recovery yields of BVU, BDU, and AIU by Sep-Pak C18 cartridge extraction were 85.7 +/- 4.1, 98.6 +/- 2.2, and 95.1 +/- 3.5% (n = 5) in serum and 79.5 +/- 3.8, 95.7 +/- 1.8, and 93.0 +/- 4.2% (n = 5) in urine, respectively. An optimal system of thin-layer chromatography for the identification of the hypnotics is also discussed.

Chronic actinic dermatitis: a time course study of histopathological changes

We report herein a case of chronic actinic dermatitis in which histopathological changes were observed on several occasions during the course of 2 years. The findings were quite different among stages of the eruption. At a half year after the appearance of the lesion, histological findings revealed eczematous changes. However, gradually a granulomatous change appeared with histiocytes and giant cells. Although the mechanism of histogenesis is not clear, the appearance of histiocytic giant cells seems to be unusual in chronic actinic dermatitis.

The hairless guinea pig as an experimental animal for photodermatology

Photobiologic reactions to various modalities of ultraviolet light (UVL) irradiation were evaluated in the recently identified hairless guinea pig, Crl: IAF(HA)BR, a mutant from the Hartley strain. The cutaneous changes were observed macro- and microscopically. The animal developed similar but somewhat stronger reactions than the Hartley guinea pig to the UVB irradiation and topical and systemic PUVA treatments. The density of the epidermal Langerhans cell of the hairless guinea pig was significantly higher than that of the hairy strain. The photoallergic contact sensitization was easily induced by tetrachlorosalicylanilide. These results indicate that the hairless guinea pig can be used as an animal model for photobiologic and photoimmunologic investigations.

[A case of Pickwickian syndrome with improvement of obesity-related sleep apnea following vertical banded gastroplasty]

The patient was 22-year-old male who had suffered from hypermotility during sleep and excessive daytime sleepiness, and 270% in excess body weight. Values of arterial blood gas analysis during sleep were 65mmHg in PaCO2 and 19mmHg in PaO2. He was diagnosed as morbid obesity with Pickwickian syndrome and underwent vertical banded gastroplasty. His body weight decreased from 170kg to 113kg four months after surgery and 107kg one year after surgery. The whole-night polyhypnographic sleep study was performed before and after operation and showed dramatic improvement of apnea index which was calculated by dividing the number of apneas by the total sleep time. We analyzed 199 case reports which had noted symptoms of Pickwickian syndrome between 1963 and 1989 in Japan. In many reported cases, body weight decreased transiently but returned to the level before medical treatment. Under these considerations, gastroplasty is a beneficial surgical treatment for the morbid obesity with Pickwickian syndrome.

Successful treatment of disseminated cutaneous cytomegalic inclusion disease associated with Hodgkin's disease

A case of disseminated cutaneous cytomegalic inclusion disease associated with Hodgkin's disease is described. The patient had a diffuse eruption of pruritic, erosive erythematous nodules. Histologically, many inclusion bodies were observed in perivascular areas of the skin lesions. Immunohistologically, the inclusion bodies positively stained with both anticytomegalovirus antibody and anti-factor VIII-related antibody. On electron microscopy many virus particles and dense bodies were found in the area where inclusion bodies were observed. Treatment with high-dose intravenous acyclovir and a large amount of immunoglobulin resulted in prompt healing of the skin lesions. Subsequently, the patient's Hodgkin's disease was well controlled on chemotherapy. The patient steadily improved without relapse of skin lesions 1 year after antiviral therapy was administered.

Evolutionary changes of immunohistological characteristics of secondary lesions in pityriasis rosea

In 15 patients with pityriasis rosea, we studied the evolutionary changes of the immunohistological characteristics of the secondary lesions. Many CD1a+ cells were seen in the epidermis and dermis of early lesions. In the well-developed lesions, the number of CD1a+ cells greatly increased in the dermis. In the late lesions, CD1a+ cells in the dermis significantly decreased as compared with the well-developed lesions. Early lesions showed a moderate T-cell infiltrate. In the well-developed lesions, the dermal T-cell infiltrate was dense, and the CD4 CD8 ratio was 2.9. The late lesions had a moderate T-cell infiltrate, in which the CD4 CD8 ratio significantly decreased as compared with the well-developed lesions. Thus, the relative decrease in CD4+ helper inducer cells during lesion regression, concomitant with a decrease in number of CD1a+ Langerhans cells, is in accordance with a broader concept of increased suppressor mechanisms during healing.

Follicular occurrence of prurigo nodularis

Thirty-eight biopsies of prurigo lesions (22 large, mature nodules and 16 smaller, intermediately developed nodules) were obtained from 17 patients with idiopathic prurigo nodularis Hyde who had not been bitten by insects, nor had other underlying diseases. Each biopsy was serially sectioned to reveal its histological structure. In 88% (14/16) of the smaller nodules and in 55% (12/22) of the large ones, a hair follicle was observed in the center of the prurigo lesion. The follicular epidermis and the adjacent surface epidermis showed various degrees of acanthosis and spongiosis. The dermal infiltrates extended from the superficial dermis into the middle dermis in a triangular fashion around the involved hair follicle. It is suggested that idiopathic prurigo nodularis most frequently occurs in connection with a hair follicle.

Evaluation of carcinoembryonic antigen in extramammary Paget's disease

An autopsied case of extramammary Paget's disease associated with the elevation of serum CEA level is reported. An abnormally high level of serum CEA was found in 46% of patients with this disease.

The morphologic characteristics of dry skin in atopic dermatitis

Uninvolved skin sites in 436 consecutive patients, 6 to 25 years old, with atopic dermatitis were observed during the winter months (from November to February). Ichthyosis vulgaris occurred in 133 patients. Of the 303 remaining patients, only 11 (4%) had generalized dry skin; 191 (63%) exhibited focal areas of dry skin; and 95 (33%) showed only normal-appearing skin. Microscopically, in 41 patients, dry skin associated with atopic dermatitis showed mild eczematous changes. Dry skin coexistent with ichthyosis in patients with atopic dermatitis revealed ichthyotic changes frequently superimposed on eczematous changes. We suggest that in patients with atopic dermatitis the presence of dry skin may reflect mild eczematous changes, a manifestation of concomitant ichthyosis, or a complex of both of these changes.

Diminished contact sensitivity response in vitiliginous skin

Thirty patients with vitiligo (ten of the segmental type and 20 of the generalized type) were sensitized with dinitrochlorobenzene (DNCB) in a normal skin site on the upper medial aspect of the arm. Challenge tests with dinitrochlorobenzene were performed in vitiliginous patches and in normal skin sites. In vitiliginous patches diminished contact sensitivity reactions to dinitrochlorobenzene were noted in both patient groups, while in normal skin sites a normal delayed hypersensitivity response to the same antigen developed in the same patients. Tuberculin reactivity was not suppressed in vitiliginous lesions. We suggest that diminished contact reactivity in vitiliginous skin might be due to functional changes in Langerhans' cells, or to an alteration of carrier (skin) proteins in the lesions.

Bullous pemphigoid and antinuclear antibodies. Unmasking of basement membrane fluorescence in sodium chloride-treated substrates

Immunoflourescent (IF) microscopic studies were done on a patient with bullous pemphigoid who had a high titer of antinuclear antibodies (ANAs). Direct IF microscopy showed deposition of lgG and C3 at the basement membrane zone (BMZ), while, by indirect IF microscopy, ANAs (but not circulating pemphigoid antibodies) were detected. The 2M sodium chloride (NaCl) solution-treated substrates, in which nuclear antigens were eluted, uncovered pemphigoid antibodies. Treatment of the substrates with NaCl solution unmasked BMZ fluorescence in another set of experiments in which a large amount of serum samples containing ANAs was added to serum samples containing only pemphigoid antibodies. These results suggest that pemphigoid antibodies are able to react to the BMZ in the presence of concomitant ANAs unless bind to the nuclear antigens.