Yoshio Tsujino

Fluorescence navigation with indocyanine green for detecting sentinel nodes in extramammary Paget's disease and squamous cell carcinoma.

The radioisotope navigation method, which has usually been used for identification of sentinel nodes, is less useful in locating sentinel nodes close to primary lesions in cases of extramammary Pagets disease because of overlapping radioactivity from the primary site. We applied fluorescence navigation with indocyanine green (ICG) in two patients with skin cancer to cover this defect. The use of a charge‐coupled device camera enabled real‐time visualization of dynamic lymph flow without skin incision. The inguinal skin over the identified sentinel node with a handheld gamma probe was in accordance with the point detected by ICG fluorescence in a patient with squamous cell carcinoma of the foot. Sentinel node biopsy using fluorescence navigation with ICG proved to be easy and reliable.

Skin analysis following dermal exposure to kerosene in rats: the effects of postmortem exposure and fire

To evaluate the usefulness of skin analysis for the forensic examination of cases involving postmortem dermal exposure to kerosene and/or fire, an experimental study using rats was performed. Rats received dermal exposure to kerosene before or after death, and the effect of fire was determined by burning an area of exposed skin after death. Kerosene concentrations in skin and blood were determined by gas chromatography-mass spectrometry and microscopic observation was performed for skin samples. No differences were observed in skin kerosene levels between antemortem and postmortem exposure. Kerosene concentrations in mildly burned skin where the stratum corneum (SC) was retained were approximately 84% compared to those in non-burned exposed skin, whereas concentrations in severely burned skin where the SC was almost completely burned off were 28% of non-burned skin. Even in non-exposed control skin 14% of the original kerosene concentrations could be detected, which was considered to be caused by contamination during the experimental protocol combined with kerosene’s property of a high affinity for the SC. These results suggest that (1) skin analysis is useful in estimating the type of petroleum product involved in crimes or accidents even for postmortem exposure, (2) whether the SC is retained or not primarily determined the kerosene levels in burned skin, and (3) attention must be paid to evaluate the results obtained from skin samples in the light of the circumstances surrounding the case.

Distribution of kerosene components in rats following dermal exposure

The systemic distribution of kerosene components in blood and tissues was analysed in rats following dermal exposure. Four types of trimethylbenzenes (TMBs) and aliphatic hydrocarbons (AHCs) with carbon numbers 9–16 (C9–C16) were analysed as major kerosene components by capillary gas chromatography/mass spectrometry (GC/MS). The kerosene components were detected in blood and all tissues after a small piece of cotton soaked with kerosene was applied to the abdominal skin. The amounts of TMBs detected were higher than those of AHCs. Greater increases in TMB levels were found in adipose tissue in an exposure duration-dependent manner. The amounts of TMBs detected were only at trace levels following post-mortem dermal exposure to kerosene. These findings suggest that kerosene components were absorbed percutaneously and distributed to various organs via the blood circulation. Post-mortem or ante-mortem exposure to kerosene could be distinguished when the exposure duration was relatively long. Adipose tissue would seem to be the most useful for estimating the degree of kerosene exposure.

Dermal absorption of kerosene components in rats and the influence of its amount and area of exposure

The influences of amount and area of dermal exposure to kerosene upon the levels of kerosene components in biological samples were examined in vivo and in vitro. Thirty-two rats were randomly divided into four groups and exposed to kerosene through the abdominal skin for 2h. The amounts (soaked in cotton) and area of kerosene exposed were 1 ml/4 cm(2) in Group I, 4 ml/4 cm(2) in Group II, 4 ml/16 cm(2) in Group III and 16 ml/64 cm(2) in Group IV. Before, then 5, 10, 20, 30, 45, 60, 90 and 120 min after exposure, 0.5 ml of blood was collected. Solid tissue samples, including the exposed skin area, were harvested at 120 min. Kerosene components were analyzed by gas chromatography/mass spectrometry. Trimethylbenzens (TMBs) that are easily absorbed kerosene components, appeared at 5-20 min. The time course changes in TMB levels in blood were significantly different between Groups I and II or Groups I and III, and almost identical between Groups II and III. Similar trends were observed in tissue samples at 120 min. High concentrations of aliphatic hydrocarbons (AHCs) were detected in the exposed skin and the AHC levels were dependent on the amount of kerosene exposed per unit area. These results suggest that (1) dermal absorption of kerosene occurs soon after dermal exposure started, (2) absorption of TMBs is influenced by the total amount of kerosene rather than area of exposure, and (3) AHCs remaining in the skin at significant levels are influenced by the amount of kerosene per unit area exposed.

Fusion of single-photon emission computed tomography and computed tomography images of sentinel lymph nodes in extramammary Paget's disease of the scrotum.

We describe a new method for the fusion of single‐photon emission computed tomography (SPECT) and multidetector computed tomography (MDCT) images using an acrylic resin marker containing 99 m‐Tc phytate and viewing software (Fusion Viewer Version 1.0 for Windows). This method provided the fusion of SPECT and CT images in a short time and made it easy to identify the sentinel lymph nodes in the patient with extramammary Pagets disease of the scrotum.

Acetaminophen-induced urticaria without aspirin intolerance.

Dear Editor, Acetaminophen is an analgesic-antipyretic drug, used world-wide, having a weak inhibitory effect on cyclooxygenase (COX). Hypersensitivity to acetaminophen is seen mostly in patients with aspirin intolerance, and acetaminophen-specific hypersensitivity is rare. We describe a case of acetaminophen-induced urticaria without aspirin intolerance confirmed by oral challenge test. A 31-year-old woman had several prior episodes of acute urticaria. The first episode occurred approximately 5 months before the evaluation. She complained of itching, and several hives were present on her abdomen approximately 1 h after ingesting 1 g PL (150 mg acetaminophen) for a cold. The next episode occurred approximately 1 month before the evaluation. She was given one tablet of Cocarl (200 mg acetaminophen) for a treatment of toothache. Approximately 20 min later, she noticed itching on her eyes and ear canals. Approximately 30 min later, urticaria developed on her chest and arms, and she complained of dyspnea. She was taken to the emergency room of Shimane Prefectural Central Hospital, and treated with 20 ml Stronger Neo-Minophagen-C (glycyrrhizinate, glycine, and L-cystein hydrochloride) and 5 mg Polaramine (d-chlorpheniramine maleate) i.v. After several hours, she recovered from the symptoms. She had a history of acute urticaria after ingesting an analgesicantipyretic drug when she was a child. She had no history of atopic diseases. Aspirin intolerance was suspected and then she was referred to our hospital. Serum antigen-specific immunoglobulin (Ig)E were negative to foods or environmental allergens. Skin prick tests with 200 mg/ml solution (99.5% ethanol) of acetaminophen and of aspirin were negative (Fig. 1). An oral challenge test with 200 mg pure acetaminophen elicited uriticarial lesions developed on her abdomen and left thigh (Fig. 2). Oral challenge tests with 100, 300, 500 mg of

Intravascular Papillary Endothelial Hyperplasia on the Penis: Report of a Case

An 82‐year‐old Japanese man with intravascular papillary endothelial hyperplasia on the penis is described. To the best of our knowledge, this is the first report of a patient who developed this tumor on his penis.

Cutaneous lymphoid hyperplasia: report of a case in which oral administration of minocycline was effective.

To the Editor: Cutaneous lymphoid hyperplasia (CLH) , which is also called SpieglerFendt sarcoid, lymphocytoma cutis, lymphadenosis benigna cutis, and cutaneous lymphoplasia, is characterized histopathologically by a relatively dense, B-cell rich, lymphoid infiltrate with germinal centers in the dermis (1). Minocycline, as well as glucocorticoids, crytotherapy, antimalarials, and radiation therapy, has been used with variable success to treat CLH. To our best knowledge, however, there has not been any report that minocycline therapy has been effective for CLH in japan. We thus describe herein a recently encountered male japanese patient with a CLH nodule on his right ala nasi. Oral administration of minocycline was very effective for him. The 74-year-old, healthy looking man visited our clinic on October 20, 1998. Approximately three weeks previously, a small red papule appeared on his right ala nasi. This papule had gradually enlarged. He went to a nearby doctor and was treated with topical administration of a steroid ointment containing an antibiotic. This therapy, however, was not effective. When he presented, a red, smooth surfaced, elastic-hard nodule 1.6 em in diameter was seen on the right ala nasi (Fig. 1). The regional lymph nodes were not palpated. A biopsy specimen was taken from the nodule. Its histopathology was a dense infiltration of lymphocytes with germinal centers in the dermis (Fig. 2a). Under higher magnification, it was found that the infiltrate was mainly composed of small mature lymphocytes. Large lymphoid cells containing large, pale, vesicular nuclei with small nucleolei were also seen (Fig. Letters to the Editor