Regulation of translocation of the desmoyokin/AHNAK protein to the plasma membrane in keratinocytes by protein kinase C

Desmoyokin was identified as a desmosomal plaque protein. We previously demonstrated that desmoyokin is identical to a protein encoded by a human gene, AHNAK, whose expression is suppressed in neuroblastoma cells. Although this protein is distributed in the cytoplasm and the nucleus in various cells, it is associated closely with the plasma membrane in keratinocytes. In keratinocytes, desmoplakin translocates from the cytoplasm to the plasma membrane following both high calcium switch and protein kinase C (PKC) activation by 12-O-tetradecanoylphorbol-13-acetate (TPA). In the low calcium medium, the desmoyokin/AHNAK protein resides diffusely in the cytoplasm and the nucleus. However, 2 h after shift to the high calcium medium, the desmoyokin/AHNAK protein localized to the cell boundary in all cells in a pattern similar to that of desmoplakin. Selective PKC inhibitors completely inhibited the calcium-induced translocation of the desmoyokin/AHNAK protein, but the inhibition of desmoplakin translocation by these inhibitors was only partial. TPA also induced translocation of both the desmoyokin/AHNAK protein and desmoplakin, which was completely inhibited by PKC inhibitors. The calcium-induced phosphorylation of the desmoyokin/AHNAK protein was confirmed by immunoprecipitation using [32P]orthophosphate-labeled keratinocytes. Furthermore, the study of extractability with non-ionic detergent indicated that desmoplakin, but not the desmoyokin/AHNAK protein, is associated with the cytoskeleton. These results suggested an involvement of PKC in the translocation of the desmoyokin/AHNAK protein in keratinocytes. It was, however, also suggested that different mechanisms are likely involved in the translocation of the desmoyokin/AHNAK protein and desmoplakin.

Effects of naloxone on regional norepinephrine content of the rabbit urinary bladder after electrical pelvic floor stimulation

OBJECTIVES

Effect of opioid blockade on regional norepinephrine content of the rabbit urinary bladder was investigated under electrical pelvic floor stimulation.

METHODS

Norepinephrine content of the bladder body and base of the rabbit was estimated by high-performance liquid chromatography in the following four subgroups: control group; group 1, treated by electrical stimulation; group 2, treated by naloxone alone; and group 3, treated by electrical stimulation and naloxone.

RESULTS

Intravenous administration of naloxone (group 2) caused depletion of norepinephrine content in the bladder body (P < 0.001). Norepinephrine content in the bladder base was also reduced, although this difference was not statistically significant. Electrical stimulation to the pelvic floor musculature (group 1) increased norepinephrine content both in the bladder base and the body (P < 0.01). Such a norepinephrine elevation disappeared in the rabbit treated by electrical stimulation plus naloxone (group 3). Norepinephrine content of this group was almost the same as those treated by naloxone alone.

CONCLUSIONS

Opioid blockade appeared to block the hypogastric nerve activation induced by electrical pelvic floor stimulation.

Epidural anaesthesia blocks changes in peripheral lymphocytes subpopulation during gastrectomy for stomach cancer

To examine the effects of surgery and anaesthesia on cell-mediated and humoral immunity, we investigated changes in subpopulations of peripheral T cells and B cells during gastrectomy. Twenty-one patients with gastric cancers who underwent total or subtotal gastrectomy were randomly assigned to receive thiopental/N2O general anaesthesia supplemented with either epidural (epidural group, n = 12) or enflurane(enflurane group, n = 9). The changes in peripheral lymphocyte subpopulations were detected and quantified using single and double label analysis of monoclonal antibodies against lymphocyte membrane surface markers (Leu series). Subpopulations were measured before induction, and 1 and 2 hours after skin incision. In the enflurane group, B cells (Leu12+), total T cells (Leu4+), inducer T cells (CD4+, Leu8+) and the CD4/CD8 ratio decreased and suppressor T cells (CD8+, Leu15+) increased significantly after skin incision. Whereas, the epidural group showed no change in the number of B cells and each T cell subpopulation during the study. These data suggest that epidural anaesthesia blocks the effect of stress induced by major surgery on fluctuation of peripheral lymphocyte subpopulations which may be associated with suppression of immunity.

A case of pemphigus vulgaris showing reactivity with pemphigus antigens (Dsg1 and Dsg3) and desmocollins

Both pemphigus vulgaris antigen (PVA; Dsg3) and pemphigus foliaceus antigen (PFA; Dsg1) are members of the desmoglein subfamily of the cadherin supergene family. Another desmosomal cadherin, desmocollin, is occasionally recognized by certain pemphigus sera. We present a 38-year-old Japanese male who showed clinically and histopathologically typical features of pemphigus vulgaris, whose sera reacted with all PVA, PFA, and desmocollins using immunoblotting of both human epidermis and bovine snout epidermis. Studies using domain-specific fusion proteins of PFA and PVA suggested that this patient's serum reacted with the intracellular domain of PFA and the extracellular domain of PVA, the latter of which seems to be responsible for initiating the skin lesion. The patient's serum showed reactivity with human desmocollin and was shown to react with bovine Dsc2 fusion protein, further suggesting the significance of anti-desmocollin autoantibodies in pemphigus. These results indicate that certain pemphigus cases may produce antibodies against multiple antigen molecules, although the complex mechanism of the production of autoantibodies remains to be elucidated.

A simple epithelial cell line (MDCK) shows heterogeneity of desmoglein isoforms, one resembling pemphigus vulgaris antigen

The epidermal blistering disease, pemphigus vulgaris (PV), is caused by circulating autoantibodies that react with a desmosomal glycoprotein desmoglein (Dsg3). This antigen is expressed only in stratified epithelial tissues. Here we show that the simple epithelial canine kidney cell line, MDCK, expresses at least two desmoglein isoforms recognised by different monoclonal antibodies. One of these isoforms is a 130 × 10(3) M(r) polypeptide that is recognised by both PV autoantisera and a monoclonal antibody reactive with a cytoplasmic domain of human Dsg3. Antibodies in PV sera bind to the surface of MDCK cells but not cause loss of intercellular adhesion. This is the first demonstration of the expression of a polypeptide related to human PV antigen by a simple epithelial cell type.

Significance of superoxide dismutase (SOD) in human colorectal cancer tissue: correlation with malignant intensity

The significance of superoxide dismutase (SOD) activity in colorectal cancer tissue was determined from the aspect of the antioxidant defense system. SOD activity and thiobarbituric acid reactive substance were measured in the tumor, in tissues adjacent to the tumor, and in regions that appeared normal, and the results were analyzed in terms of various histopathological factors (stage of disease, depth of invasion, venous invasion, etc.). DNA ploidy pattern and cell proliferation in cancer tissue were also measured, and the results analyzed in relation to SOD activity. SOD activity in cancer tissue was higher than in the other two regions. SOD activity in cancer tissue increased with the progression of stage, and changed with the depth of invasion. There was a significant difference in SOD activity between patients with venous invasion and those in whom this was absent. Stepwise regression analysis suggested that venous invasion was the most significant factor influencing SOD activity. The proliferation index was high in cancer tissue with low SOD activity. The incidence of aneuploidy was high in cancer with high SOD activity, whereas the incidence of diploidy was high in cancer with low SOD activity. These results suggest that elucidation of the antioxidant system in cancer tissue can provide us with a better strategy for cancer treatment.

Detection of autoantibodies against bullous pemphigoid and pemphigus antigens by an enzyme-linked immunosorbent assay using the bacterial recombinant proteins

To develop a new method to evaluate autoantibodies in various autoimmune bullous skin diseases, we examined reactivity of bullous pemphigoid (BP) and pemphigus vulgaris (PV) patients' sera with partial bacterial fusion proteins of the 230 kD BP antigen (BPAG1) and PV antigen, respectively, by an enzyme-linked immunosorbent assay (ELISA), and compared the results with those of immunoblotting. We used two fusion proteins derived from the mouse BPAG1 and a fusion protein derived from the amino-terminus (EC1-2) of PV antigen. For both BP and PV sera, the ELISA scores were well correlated with the reactivities on immunoblot assays. The present study indicates that ELISA using recombinant antigen proteins in various autoimmune bullous skin diseases will be a new useful technique to detect the autoantibodies. However, development of recombinant proteins with the entire molecule and correct conformation will be necessary to establish a perfect ELISA system in the future.

[Mediastinal abscess diagnosed after its rupture into the trachea in a patient after esophagectomy]

A 52-yr-old man with esophageal cancer underwent esophagectomy and retrosternal reconstruction using stomach under general anesthesia. In the postoperative period, the patient developed mediastinal abscess which failed to be diagnosed by daily routine chest X-rays, because of surgical alterations of mediastinal anatomy. On the 11th postoperative day, the abscess ruptured into the trachea and severe hypoxemia (PaO2 73 mmHg, FIO2 1.0) developed while the patient was still on mechanical ventilation. A chest X-ray on that day showed a radiolucent cavity with defined margins in the right superior mediastinum. Thoracic CT scanning on the 15th postoperative day disclosed a capsulated cavity which indicated abscess formation in the posterior mediastinum. Although surgical drainage was not undertaken, the patient's severe hypoxemia was resolved within 4 days by the supportive therapies including chest physiotherapy, postural drainage and administration of antibiotics and corticosteroids. Although mediastinal abscess after esophagectomy is a rare complication, it may rupture into the trachea and lead to severe hypoxemia. In this case thoracic CT scanning was useful to detect the mediastinal abscess which had not been diagnosed by routine chest X-rays.

Autoantibodies from patients with cicatricial pemphigoid target different sites in epidermal basement membrane

Indirect immunogold electron microscopy studies of cryofixed, freeze-substituted, and post-embedded normal human skin were performed to localize precisely the ultrastructural binding site of circulating autoantibodies from two groups of patients with cicatricial pemphigoid. One group of patients had circulating IgG autoantibodies that bound the dermal side of 1 M NaCl-split skin and immunoprecipitated epiligrin. The other group of patients had circulating IgG autoantibodies directed against the epidermal side of 1 M NaCl-split skin and showed no specific reactivity to any keratinocyte polypeptide by immunoprecipitation. IgG autoantibodies from all patients with anti-epiligrin cicatricial pemphigoid bound the lowermost aspect of the lamina lucida at its interface with the lamina densa; the greatest staining was seen beneath and beside hemidesmosomes. In contrast, IgG from cicatricial pemphigoid patients whose autoantibodies bound the epidermal side of 1 M NaCl-split skin localized to hemidesmosomes and the junction between hemidesmosomes and the plasma membranes of basal keratinocytes. Although the latter staining pattern is similar to that observed with anti-BPAG2 autoantibodies, sera from our patients with cicatricial pemphigoid did not bind BPAG2 in immunoprecipitation studies of radiolabeled human keratinocyte extracts or show immunoblot reactivity to a fusion protein corresponding to the immunodominant epitope of this polypeptide. These studies demonstrate the following: 1) Autoantibodies from patients with anti-epiligrin cicatricial pemphigoid consistently bind the lower lamina lucida at its interface with the lamina densa; and 2) other patients with the same phenotype may have IgG autoantibodies against yet-unknown epitopes in basal keratinocytes.

Hepatocellular carcinoma: efficacy of transcatheter oily chemoembolization in relation to macroscopic and microscopic patterns of tumor growth among 100 patients with partial hepatectomy

PURPOSE

To evaluate the efficacy of transcatheter oily chemoembolization (TOCE) for hepatocellular carcinoma (HCC) on the basis of microscopic and macroscopic findings postembolization.

METHODS

HCCs ranging in size from 0.5 to 13 cm (mean 3.6 cm) were obtained from partial hepatectomies of 100 consecutive patients who had undergone TOCE between 20 and 246 days (mean 59.5 days) prior to surgery. The efficacy of TOCE was assessed on the basis of the necrotic to live cell ratio of the tumors. The microscopic pattern of tumor growth was grouped into expanding type (complete capsule formation) and replacing type (incomplete or no capsule). There were five types of macroscopic groupings: single nodule, single nodule with extranodular growth (SNE), contiguous and noncontiguous multinodular, and massive growth type.

RESULTS

Among 79 cases with the expanding type, 29 (37%) had 100% HCC necrosis, but none with 100% necrosis were in the replacing type. By macroscopic grouping, the efficacy of TOCE decreased from the single nodule type (50% of patients had 100% necrosis) to the SNE type (21%), and the other types (9%).

CONCLUSION

TOCE appears to be most efficacious for HCC with the expanding growth pattern and HCC forming single nodules. Poor results are to be expected in HCC of replacing growth type and multinodular or massive growth types.

Cytoplasmic body myopathy with hypertrophic cardiomyopathy

A patient with cytoplasmic body myopathy presented muscle hypotonia from birth and developed progressive muscular atrophy and weakness, scoliosis, contracture of joints and cardiorespiratory failure. At the age of 17, he died of heart failure. Post mortem examination revealed severe hypertrophy of cardiac walls and generalized muscular atrophy. Microscopic examination showed many cytoplasmic bodies in skeletal muscle fibers and myofiber disarray in myocardium. No cases of cytoplasmic body myopathy with hypertrophic cardiomyopathy have been reported previously. It is suggested that the Z-line component is related to the formation of the cytoplasmic body in skeletal muscle and disarray in the cardiac muscle.

[Herpes gestationis. Clinical spectrum and diagnostic possibilities]

Herpes gestationis (HG) is a rare autoimmune disease of pregnancy. We report on five patients in whom the clinical diagnosis was confirmed by histology, immunofluorescence and immunoblot studies. The time of onset ranged from the 8th week of pregnancy to the 1st day post partum. In one patient erosions and ulcerations of the oral cavity predominated while the remainder of the skin was nearly unaffected. One patient had intense pruritus without any skin eruptions during the final 8 weeks of her pregnancy, developing bullous lesions on the 1st day post partum. The other patients initially suffered from pruritic polymorphic skin lesions, followed by vesiculae and bullae. In the serum of all patients, the complement-fixing HG factor was found. Immunoblot studies with epidermal and dermal extracts demonstrated the binding of the antibodies to a 180-kD protein of the epidermis. All patients improved markedly with medium dosages of systemic corticosteroids. In four cases the newborns were healthy and mature, and in one case, the infant met all criteria for a "small-for-dates" baby. We discuss both clinical spectrum and diagnostic options of HG and review new aspects related to the pathogenesis of this disease.

Nucleotide sequence of the SrRNA gene of Entamoeba gingivalis: applications for construction of a species-specific DNA probe and phylogenetic analysis

The small subunit ribosomal RNA (SrRNA) gene of Entamoeba gingivalis was amplified by PCR and the product of 1.9-kbp sequence was cloned into a plasmid vector pUC18. Four clones were isolated and sequenced. The insert DNAs were 1918- to 1921-bp long and A+T rich (65.5%). The four SrRNA sequences of E. gingivalis were found to be aligned with those of nine related protozoans while searching for E. gingivalis-specific sequences. A sequence of 28 oligonucleotides was chosen, chemically synthesized, and labeled with digoxigenin for use as a DNA probe. The probe thus constructed was shown to hybridize only with either the SrRNA-coding DNAs or the cells of the two E. gingivalis strains and not with those of other protozons or oral fungi tested. A representative SrRNA-sequence was analyzed and a phylogenetic tree was constructed by the neighbor-joining (NJ) method. Among the protists examined, E. gingivalis was placed next to Entamoeba histolytica as expected from the traditional taxonomy.

[Hyperviscosity syndrome]

Common clinical manifestations of the hyperviscosity syndrome are bleeding from mucosal membrane, retinopathy, visual disturbance and neurological disorders. These changes can be lethal, and early recognition is important for the proper therapy. Five to 10 percent of patients with multiple myeloma are suffered from the hyperviscosity syndrome because of increased serum viscosity due to the presence of myeloma protein. These patients were currently treated with the combination of plasmapheresis and cytotoxic drugs. Plasmapheresis is known as an efficient method for rapid improvement of the hyperviscosity syndrome, and double filtration plasmapheresis is most commonly used for plasma exchange of multiple myeloma patients in our country. Recent studies have revealed plasmapheresis make blood flow smooth from the standpoint of blood flow dynamics.

Cleavage of bovine mitochondrial ATPase inhibitor with endopeptidases, and binding of the resulting peptides to the interface between the alpha- and beta-subunits of F1ATPase

Mitochondrial ATPase inhibitor binds to F1ATPase, forming an equimolar complex with the enzyme, and the binding site has been reported to be located in the beta-subunit [Klein, G. et al. (1980) Biochemistry 19, 2919-2925] or at the interface between the alpha- and beta-subunits of the enzyme [Mimura, H. et al. (1993) J. Biochem. 113, 350-354]. In the present study, bovine ATPase inhibitor as well as three peptide fragments of the inhibitor, Gly1-Asn51, Glu52-Asp84, and Lys46-Asp84, were used to examine the features of the binding of the inhibitor and F1ATPase. Only the amino terminal fragment, Gly1-Asn51, exhibited a similar level of inhibitory activity to that of the native ATPase inhibitor. Although the other two carboxyl terminal side fragments did not exhibit any inhibitory activity, they interfered with the action of the intact ATPase inhibitor when they were pre-loaded to F1ATPase. Since the two carboxyl fragments did not interfere with the inhibitory action of the amino fragment, it is inferred that the inhibitor interacts with F1ATPase at its carboxyl terminal region prior to binding at the amino terminal region of the enzyme. Cross-linking experiments revealed that ATPase inhibitor bound to the alpha- and beta-subunits of F1ATPase, and that the amino terminal peptide preferentially bound to the alpha-subunit and the carboxyl terminal peptides to the beta-subunit.

[Analysis of gait disturbance in a patient with corticobasal degeneration]

A 64-year-old right-handed man was admitted because of increasing clumsiness of the right hand and difficulty in walking since 8 months earlier. The WAIS revealed verbal IQ 124, performance IQ 104 and full scale IQ 115. Neurological examination revealed slight dysarthria and normal eye movements. The right upper extremity showed Gegenhalten, tremor, dystonic elbow flexion, marked grasp reflex, grasping and groping behavior. Voluntary movements were slow and clumsy on the right side. However, neither ideational nor ideomotor apraxia was observed. Tendon reflexes were slightly exaggerated on the right side. Plantar responses were normal. The patient had difficulty in initiating forward walking and turning movements. Once started, he walked dragging his right foot ahead of the left with short steps. A line on the floor was of no benefit. He could not stride across the line on the floor in front of him. Analysis of gait with floor reaction force revealed that the single step rhythm of his frozen gait was about 1.5 Hz, which contrasted with the high frequency seen in Parkinson's disease. MRI demonstrated atrophy of the frontal and parietal lobes on both sides. 123I-IMP single-photon emission CT demonstrated severe hypoperfusion of the left frontal and parietal lobes. Frozen or shuffling gait is a popular symptom as well as unsteady gait and tendency to fall in corticobasal degeneration. It may result from the frontal lobe dysfunction. Lack of improvement in freezing by the visual input contrasts with Parkinson's disease and may be related to dysfunction of the mesial part of the frontal lobe or the parietal lobe involved in corticobasal degeneration.

[Sex differences in EEG background activity: a study with quantitative analysis in normal adults]

The present study performed quantitative EEG analysis in normal 20 males and 20 females, aged 18-26 years, in order to examine the sex differences in EEG activity at rest. The females had more absolute EEG power than the males, with significant differences observed for delta, theta and beta bands. In contrast, no significant difference was found in peak alpha frequency or relative EEG power for any frequency band. The present findings provide further evidence that females have more absolute power in resting EEG, and emphasize the importance of matching patients and control populations for sex in future investigations dealing with the relationship between resting EEG and various pathological conditions.

Cholesterol emboli following percutaneous transluminal coronary angioplasty as speculated by toe skin biopsy

A 55-year-old man required hemodialysis for acute renal failure 3 days after repeat percutaneous transluminal coronary angioplasty (PTCA). Bilateral acrocyanosis and necrotic lesions of the toes occurred 10 days after PTCA. Skin biopsy samples revealed needle-shaped cholesterol crystals of the intraluminal clefts in his small arteries. He was diagnosed with cholesterol emboli presenting as blue toe syndrome. The conditions improved with anticoagulation and vasodilation, but improvement in renal function was temporary. He later required maintenance hemodialysis. Cholesterol emboli following PTCA are life threatening because they are difficult to diagnose and can cause severe complications.

Development of the brainstem and cerebellum in autistic patients

Studies of magnetic resonance images have revealed morphological disorders of the brainstem and cerebellum in autistic children and adults. When we studied development of the brainstem and cerebellum in autistic patients, we found that although the brainstem and cerebellum significantly increased in size with age in both autistic patients and controls, these structures were significantly smaller in autistic patients than in controls. The speed of development of the pons, the cerebellar vermis I-V and the cerebellar vermis VI-VII was significantly more rapid in autistic patients than in the controls. However, the speed of development of the other brain structures in the posterior fossa did not differ between autistic patients and controls. The regression intercepts of the brainstem and cerebellum as well as those of their components were significantly smaller in autistic patients than in controls. Results suggest that brainstem and vermian abnormalities in autism were due to an early insult and hypoplasia rather than to a progressive degenerative process.

[Intra-and extracranial chondrosarcoma]

A 17-year-old female, who had diplopia and progressive gait disturbance, had been diagnosed as having a right parasellar mass lesion in 1986. Initial CT scan failed to show a parasellar space occupying lesion, although it was well demonstrated on MRI. No surgery was carried out at that time. Seven years later, she was hospitalized because of progressive gait disturbance, lower cranial nerves palsy, and cerebellar sign as well as the known right abducence palsy. At this time, CT scan exhibited a huge low density area with a marginal high density area suggesting calcification, which extended from the right parasellar area to the ventral portion of the midbrain. She underwent surgery under the diagnosis of cartilaginous tumor or chordoma. The intracranial lesion was removed via combined translabyrinthine approach and epidural subtemporal approach. The tumor was hitologically diagnosed as well-differentiated chondrosarcoma. Electron-microscopy demonstrated tumor cells with features of chondrocytes. Since the original site of the tumor, strategies for treatment and prognosis are different from each other, distinction between chondrosarcoma and chordoma is important. MRI seemed very useful for making this distinction as a first step.

Atypical pemphigus associated with monoclonal IgA gammopathy

We describe a 60-year-old woman with atypical pemphigus and IgA-lambda monoclonal gammopathy. Histopathologic study of vesiculopustular lesions showed intraepidermal acantholytic and neutrophilic blisters. Direct immunofluorescence revealed intercellular IgG deposition with concurrent deposits of IgA and C3. Indirect immunofluorescence and immunoblotting studies revealed that the patient had circulating IgG anti-intercellular antibodies that recognized the 150 kd desmoglein (pemphigus foliaceus antigen) in bovine desmosome preparation. Immunoblot studies with human epidermal extract showed that the IgG of this patient exclusively reacted with the 140 kd protein (between the 150 kd human desmoglein and the 130 kd human pemphigus vulgaris antigen), the nature of which is currently unknown. The patient also had IgA anti-intercellular autoantibodies, which reacted with the desmoglein in the bovine desmosome sample but did not show any reactivity in human epidermal extract.

Prognostic significance of nucleolar organizer regions in hepatocellular carcinoma

It has been suggested that the number of argyrophilic nucleolar organizer regions (AgNORs) correlates with cellular activity and the aggressiveness of malignancy. The mean number of AgNORs per nucleus may, therefore, be a prognostic factor for hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the prognostic significance of the number of AgNORs in HCC. The silver-staining technique was applied to surgically resected specimens to indicate AgNORs. Eighty-nine of the specimens were of HCC, 23 were of normal liver adjacent to HCC, and 32 were of cirrhotic liver adjacent to HCC. The number of AgNORs of HCC (mean +/- SD, 3.26 +/- 1.23) was significantly higher than those of normal liver (1.37 +/- 0.13) and cirrhotic liver (1.49 +/- 0.14). The number of AgNORs was significantly correlated with serum alpha-fetoprotein level, tumor size, portal vein invasion, and Edmondson-Steiner histological grade. In patients undergoing curative resection, the survival rate of those with a high number (> 3.04) of AgNORs was significantly worse than that of those with a low number (< or = 3.04) of AgNORs. Multivariate analysis showed that the number of AgNORs was a significant prognostic indicator in patients without portal vein invasion, and portal vein invasion was the only significant variable when all patients undergoing curative resection were assessed together. The results of this study suggest that the number of AgNORs is useful as an indicator of the grade of malignancy and as a predictor of the prognosis of patients with HCC who do not have portal vein involvement.

[A case of Behçet's disease with severe esophageal stenosis treated with esophageal bujie]

A 50-year-old woman who had been suffering from Behçet's disease came to our clinic. The patient developed recurrent oral aphthae, genital ulcers, and folliculitis when she was 25-year-old. In 1971 the diagnosis is of Behçet's disease was made and oral prednisolone was started. In 1976 oral and labial aphthae became worse, and after healing of these aphthae, adhesion of oral angle developed. At that time plastic surgery for adhesion was made. In 1990 the patient felt difficulty in opening the mouth again and operation for mouth was performed. In 1991 the patient was admitted to our hospital for the third time because of recurrent oral aphthae, vomitting, and dysphagia. Upper gastrointestinal series and endoscopic examination revealed that there was severe stenosis in the middle portion of esophagus. Above that lesion, dilatation of esophagus with retention of barium was observed. Forty mg/day of prednisolone with liquid meal was started, and operation for stenosis of the esophagus using bujie was performed twice. After that operation, the patient was able to take solid meals. Esophageal ulceration with Behçet's disease treated with prednisolone was reported and discussed with the review of the literture.