The eczema area and severity index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group.

OBJECTIVE: To test the reliability of the eczema area and severity index (EASI) scoring system by assessing inter- and intra-observer consistency. DESIGN: Training of evaluators, application, and assessment over 2 consecutive days. SETTING: An academic center. PATIENTS: Twenty adults and children with atopic dermatitis (AD); cohort 1 (10 patients > or = 8 years) and cohort 2 (10 patients < 8 years). INTERVENTIONS: None. MAIN OUTCOME MEASURE: The EASI was used by 15 dermatologist evaluators to assess atopic dermatitis in cohort 1 and cohort 2 on 2 consecutive days. Inter- and intraobserver reliability were analyzed. RESULTS: Overall intra-evaluator reliability of the EASI was in the fair-to-good range. Inter-evaluator reliability analyses indicated that the evaluators assessed the patients consistently across both study days. CONCLUSIONS: This study demonstrated that the EASI can be learned quickly and utilized reliably in the assessment of severity and extent of AD. There was consistency among the evaluators between consecutive days of evaluation. These results support the use of the EASI in clinical trials of therapeutic agents for AD.

[A case presenting with Raeder's syndrome-like symptoms due to vertebral artery aneurysm].

A 50-year-old man complained of headache around his left orbit, left frontal pain and paresthesia associated with left incomplete Horner syndrome. MRI demonstrated a mass at the level of medulla oblongata. Left vertebral angiogram revealed an aneurysm of left vertebral artery. Following the removal of the aneurysm, these Raeder's syndrome-like symptoms improved. Therefore, they were probably caused by a compression of the spinal tract of the trigeminal nerve and the central sympathetic tract by the aneurysm. This is the first report of Reader's syndrome-like symptoms caused by vertebral artery aneurysm, thus indicating that MRI and cerebral angiogram are necessary for differential diagnosis of this syndrome.

Heterogeneity of dermal deposition of eosinophil granule major basic protein in acute lesions of atopic dermatitis.

Deposition of eosinophil granule major basic protein (MBP) often occurs in acute and chronic lesions of atopic dermatitis, but it is not clear what the factors may be that are related to the MBP deposition in some skin lesions of the disease. The purpose of this study was to determine whether a personal or family history of respiratory atopy is related to the intensity of MBP deposition in acute lesions. We immunohistochemically stained biopsy specimens from acute, non-oozing indurated erythematous lesions of atopic dermatitis with BMK-13, a monoclonal antibody which recognizes MBP. The subjects were 40 adult patients with atopic dermatitis. Of the 40 patients, 22 had a personal history of respiratory atopy, 8 had a family history of respiratory atopy, and 10 had neither a personal nor a family history of respiratory atopy. Deposition of MBP was observed in the specimens from 24 (60%) of the 40 patients examined. Furthermore, there were great individual differences in the intensity of MBP deposition. A strong MBP deposition was often seen in specimens from patients with atopic dermatitis who had a personal or family history of respiratory atopy, but was absent in specimens from those patients with atopic dermatitis who had neither a personal nor a family history of respiratory atopy. We conclude that a strong MBP deposition seems to occur in acute lesions of those patients with atopic dermatitis who have a predisposition to respiratory atopy.

[Effects of long-term ethanol intake on the bone mass on femoral bone of mice: a microdensitometrical study].

This report on the effects of ethanol intake on bone tissue in ICR strain mice. The authors let male and female ICR mice take 16% ethanol solution (Sake) ad lib for 472 days beginning at the age of 38 days. Observations were using radiograph on bone density of hind legs, we were measured at the middle of the femur densitometer. The effects of indices. Observations were carried out on bone density were analyzed using six indices: the maximum density of the middle of the bone cortex (h1, h2) (the maximum density of the bone cortex (h1 + h2)/2 [hmax]); the minimum density of the middle of the bone marrow (h3) (minimum density of the bone marrow [hmin]); the bone cortical width (d1 + d2); the bone marrow width (d); the cortical bone index (the ratio of cortical bone width to bone width [CBI]); and the radial trabecular index (the ratio of bone width to hmin [RTI]). The results were as follows: In male mice, hmax, hmin, d1 + d2, CBI and RTI were significantly lower than controls (p < 0.01, p < 0.01, p < 0.01, p < 0.01, p < 0.05). In females, hmax, hmin, d1 + d2 and CBI were significantly lower than controls (p < 0.01, p < 0.01, p < 0.01, p < 0.05). The number of osteocytes in the femur diaphysis did not significantly differ between groups. These findings suggest that ethanol intake affects kidney tissues, and decreased reabsorption of calcium were caused by damaging the kidneys, thereby increasing excretion of Ca to the urine. Bone resorption occurred in order to homeostasis of Ca concentration in blood.

Prevalence of childhood and adolescent atopic dermatitis in a Japanese population: comparison with the disease frequency examined 20 years ago.

To ascertain the prevalence of childhood and adolescent atopic dermatitis in a Japanese population, we clinically observed the total body of 5 to 6-year-old children (994 cases), 7 to 9-year-old children (1,240 cases), 10 to 12-year-old children (1,152 cases), 13 to 15-year-old children (1,670 cases), and 16 to 18-year-old adolescents (2,159 cases). The examination was performed in the spring of 1994-96, when exacerbation of childhood and adolescent atopic dermatitis most frequently occurs in Japan. Atopic dermatitis was observed in 24% of the 5 to 6-year group, in 19% of the 7 to 9-year group, in 15% of the 10 to 12-year group, in 14% of the 13 to 15-year group, and in 11% of the 16 to 18-year group. The prevalence of atopic dermatitis in 9 to 12-year-old children was two times and in 18-year-old adolescents five times as high as in similar age groups examined 20 years ago.

Density and fine structure of peripheral nerves in various skin lesions of atopic dermatitis.

The density and fine structure of the peripheral nerve system in various skin lesions of 64 patients with atopic dermatitis (AD) was quantitatively analyzed by immunohistochemical staining with antibodies directed against protein gene product (PGP) and substance P (SP). The density of PGP-positive peripheral nerves was 2.5 x 10(3) microns2/delta s (delta s = 0.24 mm2 selected area) in early acute lesions, 3.8 x 10(3) microns2/delta s in subacute lesions, 4.9 x 10(3) microns2/delta s in lichenified lesions and 7.1 x 10(3) microns2/delta s in prurigo lesions of AD. The density of nerve fibers in subacute, lichenified and prurigo lesions was significantly higher than in uninvolved skin of AD patients (2.0 x 10(3) microns2/delta s). Electron microscopically, bulging of axons with many mitochondria and a loss of their surrounding sheath of Schwann cells suggests that the free nerve endings in skin lesions of AD are in an active state of excitation. Many pinocytotic vesicles in the periphery of basal keratinocytes facing nerve endings which contained many neurovesicles suggests reciprocal effects between keratinocytes and nerve endings. The number of SP-positive nerve fibers in AD lesions was far less than one-tenth of the number of PGP-positive nerve fibers.

[Effects of long-term ethanol administration (1). Effects of long-term ethanol administration on kidney studied at several periods of time during the administration].

The kidney is an important organ having not only excreting function but also other functions such as production of the substances that activates a living body, enzymatic reaction, immunization etc. For several years we have carried out experiments of ethanol administration to rats and involved observations of various organs including the kidney. Thus we have recognized no small effect of ethanol on the kidney. After ethanol administration, the ethanol and its metabolites go through kidneys and are excreted into urine, and their content of the urine is higher than that of the blood. Their content of the kidney is higher than that of the liver. In view of all these facts, the ethanol effect on kidney is easily assumed. In this study a comparison between effect of ethanol on kidney and that of the liver was made at several periods of time during the administration. Under short, a week ethanol administration, the direct action that exerts on cells is as follows: in the kidney swelling of glomerula and tubules, proliferation of mesangial cells, and hyaline drop in tubular epithelial cells are seen; in the liver storing of small fat drops and enlargement of Kupffer cells are observed. Under long, two month administration, products like ethanol metabolites-protein adducts and hyaline in tubular epithelial cells as their removal reaction are observed in the kidney; in the liver, enlargement of Kupffer cells in shown. Under long administration of six and eleven months, kidney shows atrophy of tubular epithelial cells, urinary casts, and cell infiltration to interstitial tissue; liver shows fat storing and bile duct proliferation. These changes found through the effects of age appear in the experimented rats earlier than the control. In addition thickening of basement membrane of glomerulus, PAS positive deposits in glomerulus, and proliferation of mesangial cell are observed in the kidney. It was apparently observed that effects of ethanol on the kidney appeared earlier than those on the liver.

[Effect of long-term ethanol administration (2). Free type and bound type ethanol and related substances contents of the urine from ethanol administrated rats, indices in the serum, and renal tissues].

Histological effects of ethanol on the kidney were published in our previous report. In the present paper, results of the following measurement will be reported: contents of ethanol and related substances in the urine, both free and bound types, collected during the periods from 30 minutes to 11 hours after ethanol administration to rats, and ACE, alpha-GST, LPO, 25(OH)-D3, 1 alpha-25(OH)2-D3, 24, 25(OH)2-D3 in the serum of rats which had ethanol every day for a month. These will be reported together with histological observation of the kidney excised immediately after the blood sample was collected. The measurement of free and bound types ethanol, acetaldehyde, acetone and methanol in the urine was made up to 11 hours after administration of 4 g/kg b.w./day, p.o. and its results showed the highest contents at 9 hours after the administration. Bound type acetic acid showed the high contents at both 90 minutes and 9 hours after the administration. In 11 hours free type ethanol and acetaldehyde recovered their pre-administration value but as to the bound type only acetic acid recovered it. In the serum of the rats which were ethanol 4 g/kg b.w./day, oral administrated for a mouth, ACE showed significantly high value and 1 alpha, 25(OH)2-D3 and 24, 25(OH)2-D3 showed significantly low value relative to the control. Also alpha-GST showed a low value. In the kidney of the same rats the following changes were observed: swelling of glomerulus, thickening of basement membrane of glomerulus, PAS positive deposits in glomerulus, proliferation of mesangial cell, proliferation of juxtaglomenular cell, dilation of tubular lumen, swelling of tubular epithelial cell, its falling, hyaline droplet in tubular epithelial cell, cell infiltration to interstitial tissue, and basophilic tubule. There was not only difference between findings in the control and those in the liver and the brain of the rats which showed changes above-mentioned. As described above, changes were seen in the renal tissue caused by ethanol administration and in this connection changes in indices related to renal function were observed, too. Furthermore, urinary ethanol and related substances, not only free type but also bound type, that went through the kidney were observed for a long period time. The bound type, in particular, was observed for longer duration and hence effects of ethanol on the kidney were surely assumed. Presently longer term experiments are proceeding and other indices connected with renal functions are being studied.

Prevalence of infantile and early childhood eczema in a Japanese population: comparison with the disease frequency examined 20 years ago.

To investigate the prevalence of infantile and early childhood eczema in a Japanese population, we clinically inspected the entire bodies of 4-month-old infants (341 cases), 10-month-old infants (339 cases) and 3-year-old children (341 cases). The examination was performed in spring, when exacerbations of infantile and childhood eczema most frequently occur in Japan. Eczema was observed in 30-31% of the infants, and in 20% of the 3-year-old children. The prevalence was almost the same as in similar age groups that we examined 20 years ago.

The effect on the bones of condensed phosphate when used as food additives: Its Importance in Relation to Preventive Medicine.

Based on the fact that chemical products such as binding agents are produced by mixing three kinds of phosphates with different ratios, we mixed metaphosphate, polyphosphate and pyrophosphate. Each was made to Na-phosphate, K-phosphate, and Ca-phosphate and each was mixed with commercial feeds so that the content of P would be approximately 0.1, 0.15, 0.3, 0.4, 0.6 and 1.0%. The prepared pellets were given to ICR, CF # 1 and AKR strains of mice at 29 days of age for 680 days and observations were made through this experimental period at different stages. The observations were also carried out on the mice administered with the experimental feeds for 1.5 months from 9 to 10.5 months of age. The observations were compared with those of the control group at all times. As a result, plasma 1 α, 25 (OH)(2) D(3) and P levels were always significantly higher in the phosphate administered groups relative to the control. Urine P and Fe increased while urine Ca decreased in the phosphate-treated groups.The effect of phosphates on the bones was studied taking soft X-ray pictures of hind legs and applying microdensitometry to them. Through these observations we recognized thinning of the cortex of bones, reduction of marrow trabecules and development of osteophyte. Histological observations disclosed that changes in knee joint tissues were apparent; that is, a decrease in or an irregular loss of the number of cells in superficial, intermediate, and radial strata of the joint cartilage, proliferation of subchondral bone, and the development of osteophytes were noted. As for muscles, diameters of musclar fibers became smaller; in particular, type II fibers showed greater shrinkage. Regarding kidneys, swelling and atrophy of glomerular capillaries, proliferation of mesangial cells, nephroselerosis, swelling, thinning, and loss of tubular epithelium, interstitial tissue inflammation, development of cylindruria, and deposition of calcium were observed. All these changes seem to be a particularly advanced aspect of the changes which are more pronounced with increasing dose and age.These changes were found even in the group administered with the feed containing 0.1% phosphorus, and, these changes were dependent on the concentration level of P. It was observed that administration to older subjects for a short term (1.5 months) produced effects stronger than those to younger subjects administered for a long term (10.5 months).The effects of condensed Ca-phosphate on bones were similar to those of condensed Na- and K-phosphates, and, hence, it was supposed that these effects were caused by phosphate radicals.

[The effects of long-term intake of restricted calcium, vitamin D, and vitamin E and cadmium-added diets on various organs and bones of mice: a histological and the roentgenological study].

The toxic effects of long-term administration of cadmium (Cd) on the kidneys, liver, and hind leg bones were studied histologically and roentgenologically in 29-day-old female ICR-strain mice separated into groups variously fed 1) a commercial (calcium [1.17%], vitamin D [220IU/100g], vitamin E [10mg/100g]) diet, 2) a low Ca (0.18% diet, 3) a low Ca and low D (50IU/100g) diet, and 4) a low Ca, low D and low E (5mg/100g) diet. Though the levels of vitamin D and vitamin E were designed to be low in each diet, their amounts fulfilled the nutritional requirements. Three subgroups in each category were fed Cd at dietary concentrations of 0, 20 or 40 ppm. After 12, 18 or 24 months on these diets the mice were sacrificed. 1) In the groups fed the commercial diet containing Cd, prominent swelling of the glomerulus and thickening of the basement membrane of glomerulus were observed. This did not occur in the groups fed the commercial diet without Cd. 2) In the groups fed the Cd-added low-Ca diet the following findings were more prominent compared with the low-Ca diet group. In the kidneys, swelling of the glomerulus, hyaline casts in tubular lumina and cellular infiltration of the interstitial tissue were present. In the liver, cellular infiltration on the interstitial tissue were present. In the liver, cellular infiltration of the interstitial tissue occurred. In the hind leg bones, thinning of trabeculae and ossification of the Achilles's tendon were seen. 3) In the Cd-added low-Ca, D diet groups, there was atrophy of glomerulus, thickening of basement membrane of glomerulus, and atrophy of tubular epithelial cells in the kidneys, while in the liver, binuclate cells, anisonucleosis and enlargement of Kupffer cells were seen. In the hind leg bones, thinning of the cortex and trabeculae were present. All of these findings were more prominent in this group than in the low-Ca, group. 4) In the Cd-added low-Ca, D, E, diet groups subjects the following findings were more prominent than in the low-Ca, D, E, diet group. In the kidneys, there was swelling of glomerulus and in the liver, there were binuclate cells, anisonucleosis, and cellular infiltration into interstitial tissue. In the hind leg bones, thinning of the cortex and trabeculae, a decrease of cartilage cells and a decrease of osteocytes were seen. These histological and roentgenological changes were seen to increase in a dose-dependent manner with the amount of dietary Cd.(ABSTRACT TRUNCATED AT 400 WORDS)

Histopathological features of recalcitrant erythema of the face in adult patients with atopic dermatitis.

Recalcitrant erythema on the face of 21 adult patients with atopic dermatitis was histologically examined. All patients had been applying topical corticosteroids to the facial erythema for three years or more. The histopathology of the recalcitrant facial erythema was not homogeneous. Thus, the facial erythema was roughly classified into three categories: 1) erythema which mainly showed eczematous changes, 2) erythema which mainly showed steroid-induced rosacea-like changes, and 3) erythema which showed both eczematous changes and steroid-induced rosacea-like changes. The majority (75%) of recalcitrant facial erythema belonged to the third category.