Tsunao Oh-I

Immunosuppressant pharmacodynamics on lymphocytes from healthy subjects and patients with chronic renal failure, nephrosis, and psoriasis: Possible implications for individual therapeutic efficacy

In organ transplantation, patients with peripheral blood mononuclear cells (PBMCs) that exhibit resistance to cyclosporine (INN, ciclosporin) or glucocorticoids in vitro are refractory to therapy based on these drugs in vivo. However, detection or distribution of the resistant patients with immunologic disorders remains to be documented.

Individual pharmacodynamics assessed by antilymphocyte action predicts clinical cyclosporine efficacy in psoriasis

Cyclosporine (INN, ciclosporin) use for psoriasis has been proposed and clinically examined. However, individual variation in cyclosporine efficacy is currently observed. To evaluate individual therapeutic potency of cyclosporine, pharmacodynamic approaches were performed with use of peripheral blood mononuclear cells (PBMCs) from patients with psoriasis.

Juvenile temporal arteritis is a manifestation of Kimura disease.

An asymptomatic nodule appeared in the right temporal region of an 81-year-old woman. Histopathologic examination confirmed significant thickening of the vascular wall, constriction of the vessel lumen, and infiltration of numerous eosinophils and lymphocytes. Giant cells were not seen. Lymphoid follicles and capillaries surrounded the large vessel. Elastica van Gieson staining revealed a laceration of the internal elastic lamina. Based on these clinical and histologic findings, the patient was diagnosed as having juvenile temporal arteritis (JTA), a disease first proposed by Lie and his colleagues in 1975. Three years later, a new eruption, again asymptomatic, appeared in the posterior region of the patients right ear. Subsequently, she was referred to our department. Histologic examination of the new lesion confirmed the infiltration of lymphocytes and eosinophils, which was accompanied by numerous lymphoid follicles, and the proliferation of endothelial cells and capillaries from the deep dermis to the subcutaneous tissue. The patient was diagnosed as having Kimura disease, which is a persistent and recurrent illness. We hypothesized that JTA was a partial expression of Kimura disease and investigated whether past cases of JTA could be considered Kimura disease. As a result, we found that most cases of JTA could indeed be considered Kimura disease. Furthermore, we examined the vascular changes in the routinely and elastic fiber–stained sections of three cases with Kimura disease and two cases with angiolymphoid hyperplasia with eosinophilia. The results showed occlusive vascular changes in most samples from these cases, supporting the hypothesis that JTA is an accessory lesion of Kimura disease.

Contact Dermatitis Due to Topical Steroids with Conceivable Cross Reactions between Topical Steroid Preparations

Steroids are usually employed to inhibit inflammation. However, allergic contact dermatitis has been reported with topical steroids. We have experienced contact dermatitis due to active ingredients of topical steroids in 11 patients. Therefore, we make it a rule to carry out the patch test with as many topical steroids as possible. Five patients were confirmed to be positive to several corticosteroids in the patch test. Papers on patients allergic to steroids indicate that some patients react to several. It is difficult to evaluate whether the reaction is caused by multisensitivity or by cross reaction. However, even if steroids differ in type, they may often cause cross reactions when they have a common chemical structure. Considering this chemical structure, we tried to classify steroids reported to cause allergy in patients into the following four types:

A Case of Drug Eruption Caused by the Crude Drug Boi® (Sinomenium Stem/Sinomeni Caulis et Rhizoma)

We report a case of drug eruption caused by the crude drug Boi®. A 41‐year‐old female patient had been diagnosed with chronic rheumatoid arthritis in the department of internal medicine. After ingestion of a decoction of the crude drug Boi® for the alleviation of arthralgia, a slight fever developed, which was followed by systemic edematous erythema with itching. HPLC showed that the main components of the crude drug Boi® are sinomenine and magnoflorine. The results of patch tests were negative for all oral drugs that the patient had been taking. Oral ingestion tests showed that the patient showed positive reactions to the as‐is Boi® boiling‐water decoction and 1/10‐volume sinomenine. Based on this, the drug eruption was judged to be caused by sinomenine. It is considered the first time that the causative component of a drug eruption was confirmed by oral ingestion tests with components of a crude drug of Kampo medicine (Sino‐Japanese traditional medicine).

Evaluation of Acceleration Plethysmograms in Dermatology—Efficacy of Lipo PGE1 Preparations against Herpes Zoster and Neuralgia Following Herpes

Reports published in recent years indicate that administration of lipo PGE1 is effective against herpes zoster and neuralgia following herpes. However, there are presently no standards to objectively assess efficacy. We therefore looked into the possibility of achieving this goal by using an acceleration plethysmograph. The results showed a significant difference in the rate of change of pulse waves after initiation of drip infusion as compared to before drip infusion among the effective group, the control group, and the non‐effective group. This method appears to be useful to objectively assess both the analgesic effects of lipo PGE1 and the efficacy of drugs in general, based on data analysis. Our results suggest that investigations using this method may be able to predict the therapeutic effects of vasodilators and analyze hemodynamic disorders of the skin.

A case of giant metastatic malignant melanoma.

We report a rare case of giant metastatic malignant melanoma (GMMM). A 52-year-old man had noticed a small nodule on the top of his head about one year previously. When he visited our hospital on March 18, 1998, the dome-shape nodule measured 30×30mm and was accompanied with satellite lesions. Excisional biopsy of satellite lesion yielded a histopathological diagnosis of malignant melanoma (MM). There were no findings of systemic metastasis. We classified this as MM (pT4bN0M0, Clark level V, Stage III) . After we injected IFN β into the lesion, we perfomed wide local excision. However, in this case, cutaneous metastasis appeared on the left neck 5 months lates MM. He had received DAV-IFN β therapy for the lesion. However, after three courses of adjuvant therapy, the neck metastasis did not decrease. He died of the disease one year and 9 months after the operation. Very few cases of GMMM have been reported to gradually enlarge reaching a size of 330×220×115mm. [Skin Cancer (Japan) 2000; 15: 147-151]