Effects of flurbiprofen and suprofen on the miotic activity of 1% acetylcholine and 0.01% carbachol

The nonsteroidal antiinflammatory agents (NSAIAs) flurbiprofen and suprofen applied topically to reduce miosis may counteract the desired effects of miotics used during ocular surgery. In a pigmented rabbit model, 1% acetylcholine was shown to cause a greater, significant initial (for the first 30 minutes) constriction (P less than .05) than 0.01% carbachol in eyes pretreated with flurbiprofen and suprofen. From 2 to 8 hours, NSAIA pretreatment had a greater miotic effect with carbachol than with acetylcholine. There were no significant differences between flurbiprofen and suprofen on the miotic effect of carbachol or acetylcholine.

Comparison of the effect of 8-methoxypsoralen (8-MOP) plus UVA (PUVA) on human melanocytes in vitiligo vulgaris and in vitro

In this study, we examined the various effects of PUVA treatment on cultured human melanocytes, and it revealed that 1) the higher the dose of PUVA treatment, the more significant the inhibition of cell DNA and protein synthesis; 2) the higher the dose of PUVA treatment, the more significant the depletion of epidermal growth factor receptor (EGFR) expression; 3) PUVA treatment at 124 mJoule/cm2 depleted the vitiligo-associated melanocyte antigens (VAMA) immediately after irradiation, and both the VAMA and EGFR expression progressively recovered at 24 or 72 h after PUVA; 4) PUVA treatment stimulated tyrosinase activity, but not in a dose-dependent fashion. In vitiligo vulgaris, PUVA treatment may stimulate the regrowth of melanocytes from hair follicles, but deplete the epidermal Langerhans cells in depigmented lesion of patients with stable vitiligo. Comparing the above results obtained from in vivo and in vitro studies, it reveals significantly different biologic responses. Although the precise therapeutic mechanism of PUVA treatment in vitiligo is still not well known, it is proposed that 1) PUVA treatment may stimulate the other components of skin, such as keratinocytes, to release inflammatory mediators and some of them may act as melanocyte growth-stimulatory factors (MGSF), which further enhance the proliferation of remaining melanocytes in hair follicle; and 2) PUVA treatment may deplete the VAMA expression on cell membrane of melanocytes and also deplete epidermal Langerhans cells, which may result in blocking the progressing of antibody-dependent cell-mediated cytotoxicity to melanocytes in vitiligo.

Alterations of skin-associated lymphoid tissue in the carcinogenesis of arsenical skin cancer

We investigated the skin-associated lymphoid tissue in arsenical skin cancers, including 14 Bowen's disease, 6 basal cell carcinoma and 6 squamous cell carcinoma patients from an endemic area by immunohistochemical and morphometric methods. There was a progressive decrease of Langerhans cells in the order of normal skin, normal appearing edge and arsenical cancers. A disruption of the uniform Langerhans cell dendrites was also noticed. The Langerhans cell density in arsenical tumors did not correlate with the peritumoral infiltrates. The prominent infiltrated cells in the peritumoral area had T cell markers. The number of peritumoral T lymphocytes in squamous cell carcinoma was significantly less than that of Bowen's disease and basal cell carcinoma. Peritumoral mononuclear infiltrates in Bowen's disease and squamous cell carcinoma showed a higher helper/suppressor T cell ratio than that in basal cell carcinoma. This may be accounted for by a selective increased recruitment of helper T cells to the tumor infiltrates in Bowen's disease and squamous cell carcinoma.

Characterization of an immortalized human cell line derived from neonatal foreskin diploid fibroblasts

A new human skin cell line, designated as CCFS-1/KMC, immortalized from human neonatal foreskin diploid fibroblast cells, has been subcultured successfully in vitro for more than 500 passages. This anchorage-dependent cell line possesses many common features of transformation such as morphological and cytoskeletal changes, hypotriploidy, infinite lifespan, increasing plating efficiency and saturation density, and decreasing serum requirement and population doubling time. Human papillomavirus (HPV) type 18 DNA was detected in the cell line before and after immortalization by the polymerase chain reaction (PCR) method. Tumorigenicity, however, was not demonstrated in vivo. The isoenzyme activity of the cell line shows activation of a placental form of alkaline phosphatase and a changing lactate dehydrogenase isoenzyme pattern that is different from transformation by carcinogens. Class I HLA and class II HLA antigens are constitutively expressed on this skin cell line. Here we report that these immortalized human fibroblasts derived from neonatal HPV-18-DNA-contained diploid fibroblasts possess double minute chromosomes (DMs), a karyotypic aberration usually found in cancer cells.

[Expression of keratin 16 in normal and lesional skin of solitary and multiple Bowen's disease using monoclonal antibody Ks 8.12 staining]

Bowen's disease is an intraepidermal squamous cell carcinoma usually consisting of a solitary lesion. However, multiple Bowen's lesions are one of the characteristics of arsenicalism in endemic areas where people drink deep well water containing high concentrations of arsenic along the southwest coast of Taiwan. This work seeks to clarify the differences between multiple Bowen's disease in the blackfoot disease endemic area, and solitary Bowen's disease in a non-endemic area by means of Ks 8.12 monoclonal cytokeratin antibody staining. Ks 8.12 may be regarded as a specific antibody for Keratin 16 in the skin and is used as a marker for hyperproliferation. Our results show that Ks 8.12 staining of normal skin in patients with a solitary Bowen's lesion is patchy and always restricted to the basal cell layer. By contrast, the normal skin of patients with multiple Bowen's lesions shows diffuse Ks 8.12 staining of the basal cell layer and various degrees of staining of the suprabasal layers. Similar results were observed in both solitary and multiple Bowen's lesions showing diffuse Ks 8.12 staining of the epidermis. Our results revealed clear differences in keratin expression between the clinically normal skin of patients with solitary Bowen's disease and that of patients with chronic arsenicalism. Finally the clinically normal skin of patients with multipole Bowen's disease showed characteristic changes in the expression of Keratin 16 in the suprabasal layers.

Mast cell degranulation and elastolysis in the early stage of striae distensae

The lesions of nine patients with early striae distensae (SD) during puberty were examined by light and electron microscopy. Specific changes were seen in very early stage SD, and in clinically uninvolved skin 0.5 to 3 cm remote from the edge of the long axis of the SD lesions. Sequential changes of elastolysis accompanied by mast cell degranulation appeared first, followed by an influx of activated macrophages that enveloped fragmented elastic fibers. The relationships among elastic fibers, mast cells, and macrophages seen in the present work suggest their critical roles in the process of SD formation, especially in the early stage. Our results also indicate that the elastic fiber is the primary target of the pathological process, and the abnormalities extend as far as 3 cm beyond the lesion into normal skin.

[Necrolytic migratory erythema as the first manifestation of glucagonoma]

A 49-year-old woman suffered from recurrent episodes of necrolytic migratory erythema over the lower legs, lower abdomen, and buttocks for more than two years. Stomatitis, glossitis and vaginitis were the accompanying symptoms and signs during each episode. The result of skin biopsy revealed superficial necrosis in the upper half of the epidermis. Laboratory examinations revealed mild glucose intolerance and hypoaminoacidemia. Fasting plasma glucagon level measured by radioimmunoassay was 890 pg/mL. Oral glucose loading test showed a paradoxical increase in plasma glucagon level up to 1,500 pg/mL. Abdominal echo, computerized axial tomography, and celiac angiography demonstrated a hypervascular tumor, 4 cm in diameters, located at the pancreatic head. Glucagonoma syndrome was confirmed and diagnosed. The patient underwent surgical resection of the tumor mass. Necrolytic migratory erythema disappeared thereafter, and the plasma glucagon level declined to 120 pg/mL. Histologically, the tumor revealed an islet cell carcinoma composed of moderately uniform cells with a few mitosis, arranged in cords and nests. Abundant characteristic secretory granules of the pancreatic A cell were found within the tumor cells by electron microscopic examination.

Dyschromatosis universalis hereditaria: report of a case

The case of a 43-old-year woman who had a generalized asymptomatic pigmentary disorder with onset at about age 20 is presented. Tracing back her family history, we found that her father and six of her siblings had also suffered a similar skin pigmentary defect with onset at the same approximate age. In depigmented lesions, three distinct histopathological features were observed: (1) decreased epidermal melanin content and lower density of melanocytes in the upper dermis; and (3) ultrastructural vacuolar degeneration in the focal melanocytes and in the keratinocytes immediately nearby. No deposit of amyloid was observed in the biopsied skin specimens. In hyperpigmented lesions, the histopathological features included: (1) increased melanin content and high density of melanocytes; (2) few melanophages in the papillary dermis of focal areas, but no vacuolar degeneration of the epidermal cells; and (3) an increased number of melanosomes in the basal and suprabasal keratinocytes. Direct immunofluorescence examination revealed no deposit of immunoglobulins in either the hyperpigmented or depigmented lesions. By indirect immunofluorescence examination, the serum of the patient was found to contain antinuclear antibodies (ANA, IgG, class, homogeneous pattern); however, the maximal positive dilution titer of sera against cultured human cells was much higher in melanocytes (1:500 dilution) than in keratinocytes (1:50 dilution) or fibroblasts (1:10 dilution). The pathogenesis of dyschormatosis universalis hereditaria remains unclear; however, hereditary genetic defects may play an important role in alternating regular melanogenesis, which results in a pigmentary anomaly.

Modulation of epidermal terminal differentiation in patients after long-term topical corticosteroids

The expression of the various markers for terminal epidermal differentiation in atrophic skin of patients after long-term topical corticosteroids (TCS) was studied by electron microscopy, immunofluorescence using antibody to profilaggrin/filaggrin (PF/FG), immunoperoxidase staining using antibody to involucrin, and oil red O stain for neural lipids of the stratum corneum. Thirty-nine patients were subdivided into two groups: (A) 19 patients suffering from rebound phenomenon after stopping TCS and (B) 20 patients without rebound phenomenon. Biopsy specimens were taken before ending the use of TCS in both groups. In group A, both the morphological markers (including the different epidermal strata, keratohyalin granules, lamellar granules, and cornified cell envelopes) and the molecular markers (including involucrin, PF/FG, and neutral lipids) of terminal epidermal differentiation were significantly suppressed. On the other hand, the differentiational markers in the atrophic skin of patients without rebound phenomena were only slightly altered. These results suggest that potent TCS not only has antiproliferative actions but also inhibits the differentiation of epidermis, resulting in structural defects in the epidermis, especially the stratum corneum.

Effects of temperature on cutaneous microcirculation in vibration syndrome

In order to clarify the role of cold on the cutaneous microcirculation in vibration syndrome, groups of rabbits vibrated at 4 degrees and room temperature served as the subjects of this study. A cold provocation test, capillary microscopy, and laser-Doppler flowmetry were used to evaluate the microcirculations of the test rabbits. The results indicated that vibration-induced impairment of the microcirculation was more prominent in the 4 degrees vibration group than in the room temperature group. The severities of the microcirculatory disturbances were dose-effect correlated. Vibration induced not only functional disturbances but also structural destruction of the capillaries. Furthermore cold temperatures enhanced these abnormalities of the blood vessels.

A survival study of surgically treated lung cancer in Korea. Lung Cancer Surgical Study Group

Survival rate over a 5-year period were studied in a series of 658 proven primary lung cancer patients treated by thoracic surgeons at 8 institutes during the period from 1976 to 1987 in Korea. The study was designed as a multi-center cooperative work for the statistical analysis of the followup result. Clinical data of age, sex, morbidity, and staging of the tumor were assessed in 540 patients to evaluate their 5-year survival rates. Eventually, 405 resectable patients were analyzed by stage, cell type, surgical procedure, and TNM status. The 5-year actuarial survival rates by stage in the resectable group were: stage I 39.7%, II 30.6% III A 16.3%, III B 6.7%, and IV 0%. The 5-year survival rates by cell type were: squamous cell 31.9%, adenocarcinoma 21.2%, large cell 11%, and small cell 6%. The survival rates by surgical procedures were: lobectomy 30.7% and pneumonectomy 25.7%. The survival rates by TNM status in the operable group were: T1 34.7%, T2 26.8%, T3 7.5%, T4 5%; N1 23%, N2 10%, N3 3%; MO 21%, and M1 0%, respectively. The overall actuarial 5-year survival rate in the group of 405 resectable patients was 25.9%.

Cutaneous neonatal neuroblastoma: report of a case

We herein report a case of neonatal neuroblastoma with cutaneous metastasis. This newborn male was a full-term infant of a G3P3 mother. Asphyxia occurred immediately after birth, though he was revived after intensive medical treatment. Physical examination revealed multiple firm cutaneous nodules distributed over his body. In addition, congenital glaucoma, hepatomegaly, and a soft tissue mass along the right temporal bone were also observed. Laboratory data revealed markedly elevated urinary vanilmandelic acid excretion, leukopenia, thrombocytopenia and an increased level of SGOT and SGPT. A skin biopsy was performed on a cutaneous nodule on the right hip, and the histopathological picture confirmed the diagnosis of neuroblastoma. The patient expired 12 days after birth due to complications caused by his condition.

Diurnal rhythms of immunoreactive melatonin in the aqueous humor and serum of male pigmented rabbits

Using specific radioimmunoassays, melatonin was quantified in the aqueous humor and serum of male pigmented rabbits adapted to 12L:12D with lights on at 06.00 h. Melatonin concentrations in the aqueous humor at 08.00 and 16.00 h were similar (mean: 5.23 pg/ml) and significantly lower than those at 22.00 and 01.00 h (mean: 22.06 pg/ml). A parallel rhythm was also demonstrated in the serum with higher melatonin concentrations (daytime mean: 75.26 pg/ml; nighttime mean: 168.94 pg/ml). We propose that the aqueous melatonin rhythm is associated with the rhythmic change in aqueous flow.

[A study of changes in the ratio of collagen types in skin after long-term treatment with topical glucocorticoids]

The topical glucocorticoids, widely used in the treatment of a variety of skin disorders, usually induce skin atrophy after long-term administration. In this study, the skin from a 30-year-old female patient was used, and the changes in the ratio of collagen types in atrophic skin derived from the treatment with glucocorticoid were investigated in comparison with that of normal human skin. By transmission electron microscopy, the collagen fibrils in the papillary dermis of normal skin were loose and fine, their diameters ranging from 30 to 40 nm; while those in the atrophic skin appeared tightly compact, their diameters increasing to 50-60 nm. The collagen chains, alpha 1 (I), alpha 2 and alpha 2 (III), from peptic digest of skin were separated by interrupted gel electrophoresis. The ratios of collagen type III to type I as calculated from the normal skins of a 21- and a 39-week fetus and a 36-year-old human were 49.45, 45.51 and 43.65%, respectively, while that of the atrophic skin was 12.89%. Therefore, the persistent treatment of skin with topical glucocorticoids results in a decrease in the ratio of collagen type III to type I.

Depletion and repopulation of Langerhans cells in nonsegmental type vitiligo

The role of Langerhans cells in the pathogenesis of nonsegmental type vitiligo is still unknown. In this study, biopsies were taken from 26 patients at various stages of nonsegmental type vitiligo and morphometrically observed to investigate the kinetics of Langerhans cells in patients at various stages of the disease. A marked depletion of OKT6-positive and ATPase-positive epidermal dendritic cells was noted in patients with active nonsegmental type vitiligo. A repopulation of both OKT6-positive and ATPase-positive epidermal dendritic cells was noted in patients with stable nonsegmental type vitiligo. Profound depletion of epidermal OKT6-positive and ATPase-positive dendritic cells was noted in patients with repigmenting nonsegmental type vitiligo receiving treatments involving topical use of 0.05% Fluocinonide cream or PUVA photochemotherapy. Transmission electron microscopy confirmed the absence of epidermal dendritic cells (Langerhans cells and intermediate cells) in patients with active and repigmenting nonsegmental type vitiligo. In active nonsegmental type vitiligo, two possible explanations are proposed for the depletion of OKT6-positive and ATPase-positive epidermal dendritic cells (presumptive Langerhans cells): 1) the cells are destroyed by cytotoxic factors released during the course of destruction of melanocytes in active vitiligo, and/or 2) they leave the epidermis and migrate to regional lymph nodes to present certain antigens which are released from certain destroyed epidermal cells (keratinocytes or melanocytes) during the course of active vitiligo. The repopulated epidermal Langerhans cells may result from phenotypically transformed dermal dendritic cells in the depigmented lesions of patients with stable vitiligo. Since various therapies which result in repigmentation deplete the density of epidermal Langerhans cells markedly, it is suggested that depletion of epidermal Langerhans cells in stable vitiligo may aid in repigmentation. It is also proposed that the repopulated epidermal Langerhans cells may play a role in inhibiting the proliferation of epidermal melanocytes in depigmented lesions of stable vitiligo, thus various methods of treatment which deplete the Langerhans cells may eventually aid in the repigmentation of nonsegmental type vitiligo.

The occurrence of carpal tunnel syndrome in frozen food factory employees

Two hundred and seven (207) active workers from two frozen food plants were classified according to their daily tasks and placed into three groups. Each classification was evaluated for risk factors which could lead to Carpal Tunnel Syndrome (CTS). The workers were thoroughly studied by structured interviews, neurological screening, and electrophysiological studies. Those workers who experienced little hands' local exposure to cold and low repetitive movements of the wrist (group I) served as the internal standard. In groups II (no local exposure to cold, but a high degree of repetitiveness) and III (a combination of local exposure to cold and a high degree of repetitiveness) 40.54% and 37.19%, of the workers respectively were diagnosed to have CTS by neurological studies. The risk of CTS for group II + III was 14.39 times higher than that of group I, when group I was compared with group II + III (high repetitiveness). After adjusted for sex, age, and/or the length of employment, group III still had a higher risk of CTS than group II. Repetitiveness as well as hands' local exposure to cold were found to be contributing factors in leading to CTS. Recognition, evaluation, and management of CTS in the related industries in Taiwan should be initiated to assure early diagnosis and prevention of this occupationally related syndrome.

Ascorbate-enhanced copper toxicity on bovine corneal endothelial cells in vitro

The present results indicate that 30 micrograms/ml copper was toxic to bovine corneal endothelial cells (BCEC) cultured in a serum-free medium (SFM) when the duration of treatment was 72 hours or more. Copper at 10 micrograms/ml, if mixed with 50 micrograms/ml ascorbate 2 to 3 hours before treatment, caused a transient decrease in the number of nuclei/mm2 at 72 hour, whereas 10 micrograms/ml copper alone was apparently non-toxic. When 10 micrograms/ml copper was added to 50 micrograms/ml ascorbate at the time of treatment, the toxicity was increased. All the treated cells failed to survive beyond 24 hours, and copper at a lower concentration of 1 microgram/ml could inhibit the proliferation of BCEC. We propose that copper toxicity on BCEC is augmented by ascorbate possibly through the increased replenishment of Cu+ and the subsequent enhanced production of free radicals by copper auto-oxidation.

Ultrastructural changes of the peripheral nerve induced by vibration: an experimental study

To investigate the effects of vibration on the peripheral nerves, rabbits were exposed to vibration of 60 cycles/s frequency with 0.35 mm amplitude (acceleration: 51 m/s2) for two hours daily. After 150, 250, 450, and 600 hours vibration, thin sections of the saphenous and median nerves were examined under the electron microscope. Vibration was found to induce the following changes: (1) disruption of the myelin sheath and constriction of the axon, (2) accumulation of vacuoles in the nodal gap and paranodal region, (3) disorganisation of the paranodal end loops and detachment of the paranodal end loops from the axolemma, (4) dilatation of the Schmidt-Lanterman incisures (SLI) and increased density of SLI, and (5) disappearance of neurotubules and neurofilaments in axons. The diameters of myelin sheaths disrupted by vibration varied from 2 to 12 microns. The extent of the myelin disruption is proportional to the vibration dose.

Isolation of Cryptococcus albidus var. albidus in patient with pemphigus foliaceus

Cryptococcus albidus var. albidus was isolated from the blood of a patient with pemphigus foliaceus after steroid therapy. This organism was found in triple extract peptone medium which is used in our laboratory for blood culture to detect aerobic and anaerobic bacteria. Identification of Cryptococcus was made by the API 20C yeast carbohydrate assimilation test, together with conventional procedures. These include the demonstration of chlamydospore production, germ tube test, urease test, nitrate assimilation test and colony morphology. The patient infected with Cryptococcus albidus var albidus had a good response to oral ketoconazole therapy, then the recovered and was discharged. The isolate obtained from this case may be regarded as an etiologic agent in fungemia.

[Skin eruption and histopathological changes in dengue fever]

Evaluation of histopathological and ultrastructural changes in skin eruptions of three dengue fever patients was performed. The main pathological findings in skin lesions were swelling of the endothelial cells in small vessels of papillary dermis, diapedesis of neutrophils, extravasation of erythrocytes and perivascular mononuclear cells infiltration. Ultrastructural observation revealed degeneration of endothelial cells and neutrophils. The relationships among endothelial cell damage, cell infiltration and hemorrhage were discussed.

Syndrome of deltoid and/or gluteal fibrotic contracture: an injection myopathy

One hundred and fifteen cases of injection myopathy with deltoid and/or gluteal fibrotic contracture were studied, almost all of whom had definite histories of repeated intra-gluteal or intra-deltoid injections. One third had siblings affected by the same fibro-muscular disorders manifested by focal muscle atrophy and limitation of adduction and flexion of the shoulder or hip. Electromyography disclosed myopathic changes of the fibrotic muscles. Muscle biopsy showed marked perimysial and endomysial fibrosis with non-specific degeneration, regenerative changes and, in some cases, partial denervation signs. Under the electron microscope, endomysial and perimysial collagen fibrils lost their normal unimodal diameter distribution and showed a rather broad spectral distribution of diameters suggesting a defective control of collagen formation in this disease entity. Repeated injection injuries and myotoxicity resulting in multifocal myositis are the first trigger of this fibrotic syndrome, and abnormal control of collagen formation could be another important pathogenic factor.