Psoriatic arthritis of the hands in seven adults.

Psoriatic arthritis is defined as an association of psoriasis with an arthropathy characterized mainly by osteolytic changes in the X-ray. To assess its frequency among Japanese psoriatic patients and to characterize their signs and symptoms, we examined 51 patients (37 males, 14 females) for arthropathy of the fingers. Seven patients (5 males, 2 females) had abnormal X-ray findings of the hands. They were compared with psoriatic patients without arthritis epidemiologically, clinically, and hematologically. Metacarpal indices were also measured and compared with the results from rheumatic arthritis patients and controls.

[Statistical studies on scabies at Division of Dermatology, Urakawa Red Cross Hospital].

Scabies is a relatively common skin disease caused by the itch mite Sarcoptes scabiei var. hominis. Because of its strong contagious capacity, social problems especially as sexual transmission or massive infection in school children arise quite frequently. Since we have experienced many scabies patients in our outpatient clinic of Urakawa Red Cross Hospital, statistical analysis was attempted on patients from April 1976 to March 1987, in order to contribute to prevention and control of the disease. Results have been obtained as follows: (1) The total number of scabies patients was 496 that is 1.96% of the total number of new outpatients seen in this period. (2) Sex ratio was 1.33 (male): 1 (female), slightly higher in male. (3) As to the age distribution, the highest peak was 3rd decade of life. (4) Compared with previous reports, the ratio of children and elders was remarkably high. (5) Massive infection was observed in one nursing home and one hospital. (6) As to the seasonal distribution, the number of patients was high from October to March, and the highest peak was November. (7) We compared three kinds of scabies and discussed about the useful effect of gamma-BHC in the cure and prevention of the disease, comparing with crotamiton and benzyl benzoate.

[An adult case of mixed connective tissue disease associated with myocardial infarction].

A 36-year-old Japanese woman with mixed connective tissue disease (MCTD) was treated with systemic Vitamin E and developed sudden myocardial infarction. The diagnosis of MCTD was based on clinical and serological findings. Since she developed pericarditis with high fever on the occasion of the attack of myocardial infarction, she was treated with systemic corticosteroid and recovered well. Although MCTD had been recognized as a disease with good response to corticosteroid and good prognosis, some cases suffer from interstitial pneumonia, pulmonary hypertension and myocardial infarction with poor prognosis.

Studies on two siblings with recessive dystrophic epidermolysis bullosa (Hallopeau-Siemens) and the plasminogen activator and its inhibitor in the lesion.

Activities of plasminogen activators (PA) and their inhibitors were studied in the bullous lesions of 2 siblings with recessive dystrophic epidermolysis bullosa (RDEB). The hematological findings of the patients revealed hyperfibrinogenemia, hyper-gamma-globulinemia and marked thrombocytosis. The immunofluorescent studies showed strong deposits of plasminogen, fibrin-degenerative products and alpha 1-antitrypsin around the blister lesions. On the other hand, alpha 2-macroglobulin (alpha 2-M) was sparsely deposited. The levels of alpha 2-M in the blister fluid of the patients were also decreased in comparison with those from patients with other bullous dermatoses. The topical application of antibiotic ointment with strong PA inhibitor was clinically effective when applied to the blister and eroded lesions of the patients. These findings suggest that the increased activity of PA may play an important role in the development of blister formation in patients with RDEB.

[Clinical evaluation of the TMS-19-Q.GC tablet on superficial suppurative disease. A comparative double blind study with midecamycin].

Clinical efficacy and safety of TMS-19-Q.GC tablet (TMS), a new macrolide preparation, were compared with those of midecamycin (MDM) in superficial suppurative skin and soft tissue infections. The study was made by the double-blind controlled trial at the dosage of daily 600 mg in TMS group and 1,200 mg in MDM group. Total 218 cases (106 in TMS, 112 in MDM) were analyzed and the final global improvement rating were 82.1% in TMS and 83.9% in MDM. The clinical effectiveness of TMS was favorable and significantly different from MDM in the aged patients (greater than or equal to 60 years old) and the patients infected with susceptible strains (MIC less than or equal to 3.13) of Staphylococcus aureus. TMS is prepared with a specific formulation to make the absorption easier in the patients with lower acidity of gastric juice, and the favorable effect of TMS is considered to be a contribution of the devise in older patients. Slight adverse reactions were observed at 5.0% (6 cases) in TMS and 2.4% (3 cases) in MDM. In conclusion, TMS at the daily half dose of MDM is as effective as MDM in superficial suppurative skin and soft tissue infections.

[Clinical and bacteriological evaluation of TMS-19-Q in superficial suppurative skin and soft tissue infection].

Clinical effectiveness of TMS-19-Q, a new macrolide antibiotic, was evaluated in superficial infectious diseases classified into 6 groups at 13 departments of dermatology. The results obtained were as follows: Final global improvement rating in 311 cases were excellent in 91, good in 158, fair in 45 and poor in 17 and the effective rate was 80.1%. Effective rates in each group were 71.1% in 1st group (folliculitis and acne pustulosa), 78.6% in 2nd group (furuncle, furunculosis and carbuncle), 100% in 3rd group (impetigo), 76.9% in 4th group (phlegmone, superficial lymphangitis, erysipelas and infectious paronychia), 88.7% in 5th group (inflammatory atheroma, subcutaneous abscess, hidradenitis suppurative and acne conglobata) and 77.3% in 6th group (secondary infection). Dominant strains isolated were S. aureus (40.7%), S. epidermidis (26.9%) and anaerobic bacteria (20.8%). S. aureus was frequently isolated from most of all disease. On the other hand, S. epidermidis and anaerobic bacteria were isolated mainly from 1st and 5th group. Optimum daily doses would be over 600 mg. Slight adverse reactions such as gastrointestinal disorders, eruption and malaise were observed in 12 cases.

A Langerhans' cell in mitosis within the epidermis of a case of lichen amyloidosus.

While studying skin specimens of lichen amyloidosus, we found an epidermal Langerhans' cell in mitosis. Since there are only two previous reports of Langerhans' cells in mitosis in the epidermis, a third instance is reported by us.

Presence of basal lamina-like substance with anchoring fibrils within the amyloid deposits of primary localized cutaneous amyloidosis.

The dermal-epidermal (DE) junction areas of skin specimens obtained from 16 patients with either lichen amyloidosis or macular amyloidosis were studied. In the dermal papillae where amyloid was deposited, elastic fibers frequently were absent, but periodic acid-Schiff reaction after diastase digestion was homogenously positive. Ultrastructural studies revealed that a basal lamina-like substance with anchoring fibrils was present between and within amyloid deposits. By indirect immunofluorescence technique using an anti-basement membrane zone antiserum obtained from a patient with bullous pemphigoid, specific linear fluorescence occurred at the DE junction, and in a reticular pattern in dermal papillae. It seemed that apoptotic keratinocytes of the epidermis brought down basal lamina and fine fibrous components attached to it when these cells dropped down to the papillary dermis and became the source of amyloid. These findings support the hypothesis that epidermal keratinocyte degeneration plays an important role in the histogenesis of cutaneous amyloidoses.

Crystalline lamellae in the endothelial cells of a type of hemangioma characterized by the proliferation of immature endothelial cells and pericytes--angioblastoma (Nakagawa).

Two babies were found to have large hemangiomas. Histologically there were many islands of compactly packed mesenchymal cells in the deep dermis and subcutaneous tissue. Electron microscopically there was proliferation of immature endothelial cells and pericytes. Characteristic crystalline lamellae were in the endothelial cells. Our two cases seemed to be an independent entity from other benign angiomas because of the distinct clinical, histologic, and ultrastructural features. The suggested diagnosis was angioblastoma (Nakagawa; Miki and Matsumoto), hypertrophic hemangioma (Watson and McCarthy), and benign hemangioendothelioma (Stout).