bluuebunny/crossref_metadata_2025 huggingface dataset:
Topical 0.25% Methotrexate Gel in a Hydrogel Base for Palmoplantar Psoriasis
Authors: Kumar Bhushan , Sandhu Kamaldeep , Kaur Inderjeet
Published: July 2014

Palmoplantar psoriasis (PPP) is a chronic, disfiguring condition, and its management is difficult. The systemic side effects of methotrexate can be avoided if it is effective topically. We studied the efficacy and safety of a recently marketed topical methotrexate (0.25%) preparation in a hydrogel base in patients with palmoplantar lesions. A total of 14 adult patients diagnosed clinically as plaque type of palmoplantar psoriasis (>30% of the palm and/or sole areas involved) were included in the study. Topical methotrexate 0.25% in a hydroxygel base was applied twice daily to the lesions for twelve weeks. The lesions were assessed for degree of erythema, scaling, induration and fissuring (ESIF) and were scored on a severity score of 0–3 (0‐clear, 1‐mild, 2‐moderate, 3‐severe) every two weeks. The most severe condition was given 12 points; 0 denoted no disease. The response at the end of the study was graded as minimal if there was up to 25% reduction in the EISF score, mild as 26–50% reduction, moderate improvement as 51–75% reduction in score, and marked improvement as >75% reduction in score. The average age of the 11 male and female patients was 41.5 years (18–57 years) with the duration of the disease varying from 2 months to 15 years. Ten patients had both palmar and plantar lesions; two each had only palmar lesions or plantar lesions. The ESI score at baseline was 5.8 ± 0.9 for the palms and 6.8 ± 0.5 for the soles. The scores at the end of the study were 3.5 ± 0.7 for palms and 4.8 ± 0.2 for the soles. The average time taken for improvement was at least six weeks. None of the patients had complete clearance of lesions. The drug was well tolerated by all patients. Methotrexate 0.25% in a hydrophilic gel is well tolerated but is not very effective in controlling the lesions of psoriasis on the palms and soles. A higher concentration in a different base with better penetration could possibly provide better results.
Two Cases of Desmoplastic Trichoepithelioma
Authors: Matsuki Takahiro , Hayashi Nobukazu , Mizushima Junichi , Igarashi Atsuyuki , Kawashima Makoto , Harada Shotaro
Published: July 2014

Desmoplastic trichoepithelioma is a rare tumor that usually exhibits the distinct clinical features of a solitary granuloma annulare‐like growth on the face. We experienced two cases of desmoplastic trichoepithelioma, one of which showed unusual clinical features and the other of which was a typical case. The first case was a 20‐year‐old female who presented with a five year history of a solitary yellowish nodule, 5 mm in diameter, centrally between the eyebrows. There was no central dimple or elevated border. The other case was a 40‐year‐old female who presented with a ten year history of a solitary nodule, 6 mm in diameter on her left cheek. The latter lesion had a typical depressed area in the center of the nodule with elevated borders and could be clinically diagnosed as desmoplastic trichoepithelioma. The histopathological examination revealed that both of them were desmoplastic trichoepithelioma. Histopathological comparison of the two specimens suggested that the clinical dimple in the center of the first tumor might be the result of stromal dystrophic changes induced by the tumor.
Widespread and Invasive Trichophyton rubrum Infection Mimicking Kaposi's Sarcoma in a Patient with AIDS
Authors: Kwon Kyung‐Sool , Jang Ho‐Sun , Son Hyo‐Sung , Oh Chang‐Keun , Kwon Yoo‐Wook , Kim Ki‐Hong , Suh Soon‐Bong
Published: July 2014

Opportunistic fungal infections are commonly encountered in AIDS patients. Candidiasis, tinea pedis, onychomycosis, and deep mycotic infections have been the fungal infections most frequently reported in these patients. Dermatophyte infections can appear to be atypical and aggressive in these patients and may lead to a misdiagnosis. We report a Trichophyton rubrum infection in a 44‐year‐old man with AIDS that presented as a widespread and multiple tumor‐like appearance. After the patient was treated with terbinafine for 21 weeks, the lesions cleared completely. We think that this type of dermatophyte infection is very unusual in patients with AIDS and could lead to inappropriate diagnostic processes and treatments.
Fungal Melanonychia
Authors: Lee Sang Won , Kim You Chan , Kim Dong Kun , Yoon Tae Young , Park Hyang Joon , Cinn Yong Woo
Published: July 2014

Melanonychia is characterized by tan, brown, or black pigmentation within the nail plate. Fungal melanonychia is rare and may simulate longitudinal melanonychia caused by melanocytic lesions. We report six cases of fungal melanonychia which were confirmed histopathologically or mycologically. On culture, Candida and/or Aspergillus species were isolated in four patients. The nail pigmentation improved after treatment with antifungal agents in all cases, but one patient experienced a new lesion on another nail after cessation of treatment. Fungal infection should be considered as a cause of melanonychia, and fungal melanonychia should be differentiated from the melanonychia caused by melanocytic lesions, particularly by subungual melanoma.
Odontogenic Sinus Tract to the Neck Skin: A Case Report
Authors: Susic Mato , Krakar Niko , Borcic Josipa , Macan Darko
Published: July 2014

We describe a 22‐year‐old woman with neck skin sinus tract that developed as a consequence of dental infection. The patient was treated twice in an inappropriate way with recurrence of the sinus tract. We opted for an extraction of the tooth. This case illustrates the need for cooperative diagnostic referrals between physicians and dentists.
Syringocystadenoma Papilliferum: Report of the First Case on the Lower Leg
Authors: Yoshii Noriko , Kanekura Takuro , Setoyama Mitsuru , Kanzaki Tamotsu
Published: July 2014

Syringocystadenoma Papilliferum (SCAP) is a benign adnexal tumor which most frequently arises from an organoid nevus on the head and neck. Although they are rarely found on the trunk and limbs, we treated a case of this disorder on the lower leg. A 26‐year‐old man had an asymptomatic tumor on his lower leg. Histopathological examination showed it to be a typical SCAP on organoid nevus. This is the first report of SCAP on the lower leg.
Angiokeratoma Fordyce of the Glans Penis: Combined Treatment with Erbium: YAG and 532 nm KTP (Frequency Doubled Neodynium: YAG) Laser
Authors: Bechara Falk Georges , Jansen Thomas , Wilmert M. , Altmeyer Peter , Hoffmann Klaus
Published: July 2014

A rare case of angiokeratoma Fordyce localized on the margin of the glans penis in a 52‐year‐old Caucasian patient is reported. Combined treatment with Erbium: YAG and 532 nm KTP (frequency doubled Neodynium: YAG) laser led to excellent cosmetic results.
Bicentre Experience in the Treatment of Severe Generalised Atopic Dermatitis with Extracorporeal Photochemotherapy
Authors: Radenhausen Michael , Michelsen Silke , Plewig Gerd , Bechara Falk G. , Altmeyer Peter , Hoffmann Klaus
Published: July 2014

Pilot studies have shown an improvement of atopic dermatitis in approximately 65% of patients during extracorporeal photopheresis (ExP) therapy. The purpose of the present clinical trial was to investigate the response to ExP by controlling clinical and laboratory parameters during short term ExP therapy in patients with severe generalised atopic dermatitis. Thirty‐five patients with severe, therapy‐resistant atopic dermatitis were treated with ExP in an open clinical trial at two week intervals over a period of 6 to 10 cycles. Disease activity was measured before each cycle by SCORAD index together with a standardized protocol for blood samples. ExP led to a significant decrease (p<0.05) in SCORAD from 74.4 ± 15.5 before to 36.8 ± 16.8 after ExP therapy (mean 10 cycles). Approximately 70% (24/33 patients = responder) of patients had a favourable response to ExP requiring at least 6 cycles. The decrease in SCORAD was accompanied by a significant decrease of eosinophil cationic protein (27%), sE‐selectin (37%) and sIL‐2R (53%) levels in serum (p<0.05). No significant correlation between a decrease in these levels and values of blood eosinophils or lymphocytes was found (p>0.05). In comparison to responders, most nonresponders were characterised by very high levels of total IgE before and during therapy (p<0.05). The present clinical trial confirms that short term ExP is an effective treatment for certain patients with severe atopic dermatitis based on anti‐inflammatory mechanisms. Total IgE could be a predictor of outcome in ExP treatment.
The Treatment of Common Warts with Infrared Coagulation
Authors: Piskin Suleyman , Aksoz Turkan , Gorgulu Adnan
Published: July 2014

Treatment of warts can involve medical and surgical methods. Infrared coagulation is a surgical method very rarely used in the treatment of warts. We planned an open‐labeled prospective study to research the effect of infrared coagulation in the treatment of common warts, comparing it with electrocoagulation, and discussing its applicability as an alternative therapy regimen. Eighteen patients with common warts were included in this study. There were 49 warts of various sizes (1 mm to 1 cm) in these 18 patients. Twenty‐seven warts were treated with infrared coagulation, and 22 warts were treated with electrocoagulation. Sixteen patients were treated with both infrared coagulation and electrocoagulation; two patients were treated with only infrared coagulation. The patients were followed‐up for six months after treatment. Changes in sizes of warts, healing times, and cure rates were compared by Mann‐Whitney U test. The mean healing time was 35.5 ± 5.7 days with infrared coagulation and 32.9 ± 4.0 days with electrocoagulation. There was not any significant difference between healing times (p>0.05). Bacterial infection was seen on seven (31.8%) warts treated with electrocoagulation, but no side effects were seen with infrared coagulation. There was a significant difference between side effect rates in two groups (p<0.01). Nine (33.3%) of the warts treated with infrared coagulation and seven (31.8%) of the warts treated with electrocoagulation recurred in the six‐month follow‐up period. The overall cure rates at the end of the follow‐up period were 66.7% and 68.2% respectively. There was not any significant difference between the cure rates in the two groups (P>0.05). We conclude that infrared coagulation is a safe and cheap method and should be kept in mind as an alternative modality for the treatment of common warts.
In Vivo Function of Desmosomes
Authors: Cheng Xing , Koch Peter J.
Published: July 2014

Desmosomes are morphologically and biochemically defined cell‐cell junctions that are required for maintaining the mechanical integrity of skin and the heart in adult mammals. Furthermore, since mice with null mutations in desmosomal plaque proteins (plakoglobin and desmoplakin) die in utero, it is also evident that desmosomes are indispensable for normal embryonic development. This review focuses on the role of desmosomes in vivo. We will summarize the effects of mutations in desmosomal genes on pre‐ and post‐embryonic development of mouse and man and discuss recent findings relating to the specific role of desmosomal cadherins in skin differentiation and homeostasis.
Role of Contact Allergens in Pompholyx
Authors: Jain Vijay K. , Aggarwal Kamal , Passi Shanta , Gupta Sanjeev
Published: July 2014

Fifty patients of both sexes with clinically suspected pompholyx were patch tested with the Indian Standard Patch Test Battery approved by the Contact & Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20–39 years of age with a mean age of 30 years. The mean duration of symptoms was 4 years. The occupational profile of the patients included students (20%), housewives (16%), housewives engaged in farming (12%), labourers (12%), farmers (12%) and paramedical workers (6%). The miscellaneous group, including salesmen, teachers and photographers, accounted for the remaining 22%. The clinical patterns of presentation of pompholyx included cheiropompholyx (60%), cheiropompholyx and podopompholyx (36%) and podopompholyx alone (4%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 20 (40%) reacted to one or more allergens. Nickel sulphate was the commonest offending allergen (14%) followed by potassium dichromate and phenylene diamine and nitrofurazone (8% each), fragrance mix (6%) and cobalt chloride (4%), in descending order of frequency. Hence, patch testing may be considered for all patients with recurrent episodes of pompholyx as allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to these patients.
Effects of Tacrolimus Ointment on Facial Eruption, Itch, and Scratching in Patients with Atopic Dermatitis
Authors: Katoh Norito , Hirano Shinya , Yasuno Hirokazu , Kishimoto Saburo
Published: July 2014

The action of tacrolimus ointment on pruritus in atopic dermatitis is still unclear. In this open study we investigated both the relationship between the severity of eruptions and the degree of itch and scratching in patients with atopic dermatitis and the effects of topical tacrolimus on these symptoms. Seventy adults with moderate to severe atopic dermatitis with facial eruptions that were recalcitrant to topical steroids applied a 0.1% tacrolimus ointment twice per day after discontinuation of topical steroid. The eruption scores and an assessment of the itch and scratching were recorded for 12 weeks. Oral antihistamine was prescribed at least one month before the study and continued unchanged during the study in each patient. The percentage reduction in the score of itch and scratching after two weeks (n=59) was significantly higher than in the score of eruption. Although there was no significant relationship between the severity of the eruptions and the degree of itch and scratching during steroid application, a relationship became significant after four weeks (n=59) of tacrolimus use by a one‐factor ANOVA analysis. This suggests that tacrolimus ointment is effective for the itch and scratching in cases where degrees might be discrepant from the severity of eruptions in patients with recalcitrant facial eruptions of AD.
Merkel Cells in the Vellus Hair Follicles of Human Facial Skin: A Study Using Confocal Laser Microscopy
Authors: Uchigasaki Shuhko , Suzuki Hiroyuki , Inoue Kinji
Published: July 2014

Many cases of Merkel cell carcinoma have recently been reported, and most of them have been localized on the facial skin. In this study, we investigated Merkel cells in the vellus hair follicles of facial region to characterize these cells in human subjects. Skin specimens doubly stained with cytokeratin (CK) 20 and either protein gene product (PGP) 9.5 or vasoreactive intestinal polypeptide (VIP) were examined by confocal laser microscopy. Many of the Merkel cells in the vellus hair follicles of the facial skin were localized in the bulge area. Some of these cells were attached to nerve terminals, although most of them were not associated with them. Our results suggest that there are two types of Merkel cells in the bulge area of the vellus hair follicles of facial skin: cells wholly unassociated with the nerve terminals and cells associated with thin nerve fibers. We postulate that the former cells may be undifferentiated (immature) and the latter differentiated (mature). If this is so, there is a chance that Merkel cell carcinoma originates from the undifferentiated Merkel cells in the bulge of the vellus hair with the formation of tumor masses in the dermis and no involvement of the epidermis. The Merkel cells connected with nerve fibers may secrete endocrine substances via a regulation of autonomic nerves.
Porokeratosis of Mibelli: Successful Treatment with Cryosurgery
Authors: Dereli Tugrul , Ozyurt Selcuk , Ozturk Gunseli
Published: July 2014

Porokeratosis of Mibelli, a disorder of keratinization, should be treated because of the possibility of development of malignant epithelial tumors on the porokeratotic lesions. Liquid nitrogen cryosurgery is considered to be particularly useful in the treatment of precancerous and benign skin lesions. We aimed to evaluate the efficiency of this method in the treatment of porokeratosis of Mibelli. Eight patients with 20 porokeratotic lesions were treated with spray cryosurgery. Each lesion was frozen for 30 seconds with a spray tip after the keratotic borders were removed conically by sharp dissection. Eighteen of the 20 lesions were healed successfully with slight atrophy in one session. One more session was necessary for the other two lesions. Liquid nitrogen cryosurgery may be considered superior to other destructive methods in the treatment of porokeratosis of Mibelli, with advantages such as simplicity, high cure rates, low cost, short treatment period, and few complications.
Unique Keratinization Process in Psoriasis: Late Differentiation Markers Are Abolished Because of the Premature Cell Death
Authors: Iizuka Hajime , Takahashi Hidetoshi , Honma Masaru , Ishida‐Yamamoto Akemi
Published: July 2014

The keratinization process in psoriasis is a unique phenomenon. We have proposed an organized system for keratinization in psoriasis based on the recognition of early and late differentiation markers combined with premature cell death. The early differentiation markers, such as involucrin, small proline‐rich proteins (SPRR), cystatin A and transglutaminase l, are more conspicuously expressed in psoriasis, while the late differentiation markers, such as profilaggrin and loricrin, are abolished. Keratinization markers that are not observed in the normal epidermis are also detected; these include SKALP/elafin as well as K6 and K16. With a markedly diminished turnover time, the psoriatic epidermis rapidly synthesizes differentiation markers that are mostly under the control of the protein kinase C‐AP1 transcriptional control system. Because of the premature cell death, however, the late differentiation markers are not expressed. During the improvement of the lesion and the therefore longer turnover time, the late differentiation markers rapidly catch up to reveal their expression. This explains the rapid appearance of keratohyalin granules (profilaggrin) in the healing lesion of psoriasis. Thus the keratinization process in psoriasis can be explained by the accelerated keratinization combined with premature cell death. The keratinization process in psoriasis is unique, because both accelerated keratinization and premature cell death co‐exist, resulting in the disappearance of late differentiation markers such as profilaggrin and loricrin. It is interesting to note that the premature cell death is also under the control of protein kinase C signaling.
Treatment of Vitiligo with 308‐nm Xenon‐Chloride Excimer Laser: Therapeutic Efficacy of Different Initial Doses According to Treatment Areas
Authors: Choi Kwang‐Ho , Park Jung‐Hwan , Ro Young‐Suck
Published: July 2014

Many preliminary data suggest that the 308‐nm excimer laser can be a highly effective therapeutic alternative for treating vitiligo, inducing rapid repigmentation with minimal ultraviolet irradiation. We evaluated the clinical efficacy of the 308‐nm excimer laser treatment for various body areas, using different initial UV doses. One hundred forty vitiligo patches from 69 patients were assigned to 4 groups; face and neck, trunk, extremities, and acral and joint areas. They were then treated twice a week, using different initial UV doses. The rate of repigmentation continued to increase with the number of treatments up to 20 sessions, and then showed plateaus between 20 to 30 sessions. On the other hand, the lesions in acral and joint areas showed the worst responses throughout the treatment sessions. Our findings extend previous observations that the 308‐nm excimer laser is an effective treatment option for patients with vitiligo. However, further studies will be needed to determine the optimal dosing and administration method, especially for acral and joint areas.
Therapeutic Evaluation of Intralesional 5% 5‐Fluorouracil in Condyloma Acuminata
Authors: Pall Anuj , Mahajan Bharat Bhushan , Puri Karanjit Pal Singh , Gupta Rajesh Rani
Published: July 2014

Condyloma acumianata is one of the most common virally transmitted diseases. Its prevalence has increased many fold throughout the world. Because all the currently available treatments yield low cure rates with side effects, the search for a new alternative continues. Topically, 5‐fluorouracil (5‐FU) has been in used for many years to treat various skin diseases. When applied topically in condyloma acuminata, 5‐FU results in low cure rates with high recurrences. Therefore, intralesional 5% 5‐FU is being evaluated to determine its therapeutic efficacy in condyloma acuminata.
Multiple NSAID Intolerance in Chronic Idiopathic Urticaria Is Correlated with Delayed, Pronounced and Prolonged Autoreactivity
Authors: Erbagci Zülal
Published: July 2014

Autologous serum skin test (ASST) reactivity is positive in up to 60% of patients with chronic idiopathic urticaria (CIU). About 21 to 30% of patients with CIU have intolerance to acetyl salicylic acid (ASA) and/or other chemically unrelated non‐steroidal anti‐inflammatory drugs (NSAIDs). To investigate the relationship between ASA/NSAID intolerance and ASST reactivity, a case‐control study was performed in 110 patients with CIU and 60 healthy controls. A positive ASST was defined as an erythematous wheal with a diameter of ≥ 5 mm more than the saline‐induced response. Patients were assessed at 10‐minute intervals for a minimum of three hours. ASA/NSAID intolerance was ascertained by a placebo controlled‐provocation test with offending drug (s). Forty‐two patients with CIU (38.2%) had autoreactivity whereas only two of the controls (3.3%) displayed early and weak skin responses (P<.0001). ASA/NSAID intolerance was demonstrated in 30 (27.3%) patients with CIU. The prevalences of autoreactivity were 93.3% (28/30) and 17.5% (14/80) in patients with and without ASA/NSAID intolerance, respectively (P<.001). Thirteen of the 25 ASST‐positive patients (52%) who had single (n: 7) or multiple (n: 6) NSAID intolerance showed early (before or at 30 min) and mild autoreactivity of short duration, whereas 15 of the remaining 17 ASST‐positive patients (88.2%) who all had multiple NSAID intolerance showed delayed (later than 30 min) and prolonged autoreactivity (P<.05). These findings suggest that a common mechanism may be responsible for the pathogeneses of both delayed autoreactivity and multiple NSAID intolerance in CIU. It might be further speculated that delayed, prolonged, and pronounced autoreactivity may be a possible predictor for multiple NSAID sensitivity in CIU.
Monitoring of ELISA for Anti‐BP180 Antibodies: Clinical and Therapeutic Analysis of Steroid‐Treated Patients with Bullous Pemphigoid
Authors: Izumi Tomoko , Ichiki Yoshiro , Esaki Chikako , Kitajima Yasuo
Published: July 2014

We studied the precise correlation between ELISA values for BP180 NC16A and the alternations of disease activity in 5 patients with bullous pemphigoid (BP) during various treatments and tried to answer the question of how we can use ELISA to determine the timing of prednisolone (PSL) tapering. Disease activity in some patients with BP, but not in all, was poorly correlated with ELISA values in short‐term follow‐up. However, all patients showed a good correlation of disease activity with ELISA values as a whole in long‐term follow‐up. Three patients with typical BP showed rapid and good responses to PSL for erosion and blister formation. Their ELISA values gradually decreased to 40% of initial values during PSL therapy after four weeks. Two patients with the vesicular type of BP did not show rapid and good responses to PSL for erosion and blister formation. In the cases with the vesicular type of BP, diaphenylsulfone in addition to PSL dramatically improved the clinical symptoms including erosion and blister formation, even though the ELISA values were as high as those before treatment. Relapses did not occur with the tapering of PSL dosage when the ELISA values decreased to 40% of initial values, although they were still not within the normal range.
High‐Dose Intravenous Immunoglobulins in the Treatment of Toxic Epidermal Necrolysis: An Asian Series
Authors: Tan Audrey W. , Thong Bernard Y. , Yip Leonard W. , Chng Hiok Hee , Ng See Ket
Published: July 2014

Toxic epidermal necrolysis (TEN) is a severe, immune‐mediated, mucocutaneous reaction resulting in extensive keratinocyte apoptosis. High‐dose human intravenous immunoglobulins (IVIG) have been proposed as an effective treatment for TEN. Retrospective data from 8 patients with TEN and 4 patients with Stevens‐Johnson syndrome‐toxic epidermal necrolysis (SJS‐TEN) overlap treated with high‐dose IVIG were analysed. The total dose of IVIG administered was 2 g/kg body weight, with the exception of 2 patients who received a total dose of 1.5 g/kg body weight. Their mean age was 49.9 ± 18.8 years (range, 19 to 70 years). The mean time from the first sign of skin lesion or mucosal or epidermal detachment to commencement of IVIG was 8.7 ± 5.5 days (range, 3 to 22 days). Of the 11 patients who survived, the mean time to objective response was 3.6 ± 1.9 days (range, 2 to 8 days). The length of stay (LOS) in hospital was 20.4 ± 8.0 days (range, 10 to 37 days). The survival rate was 91.6%. One patient developed permanent mucocutaneous sequelae following TEN. There were no adverse reactions to IVIG. We conclude that high‐dose IVIG may be a safe and effective therapy for Asian patients with TEN.
Mucinous Nevus
Authors: Yokogawa Maki , Kamakura Tomoko , Ishiguro Hiroaki , Ikeda Mitsunori , Kodama Hajime
Published: July 2014

A 15‐year‐old boy first noticed multiple firm papules on his right upper chest two years before presenting to our clinic. These papules were densely distributed and showed epidermal nevus‐like linear arrangement at some sites. The number, size, and distribution of these papules remained unchanged for one year of our observation. The papules flattened leaving scars and did not recur within a year after one shaving abrasion using a scalpel. Histopathologically, epidermis of the papule displayed acanthosis with elongated rete ridges. Accumulation of mucin was apparent in the papillary and subpapillary dermis. In mucinous nevus, the origin of cells with nevoid proliferation is obscure. In contrast with common collagenous connective tissue nevus, it is hard to define the localized persistent mucin accumulation as a nevoid manifestation. The present case of mucinous nevus might be caused by significantly stimulated glycosaminoglycan synthesis in a kind of epidermal nevus without extreme hyperkeratosis.
Synchronous Microcystic Adnexal Carcinoma and Gastric Cancer with Review of the Literature
Authors: Ohtsuka Hisashi , Nozawa Ryouta , Kushida Yoshio
Published: July 2014

A microcystic adnexal carcinoma (MAC) on the left lateral chest was synchronously accompanied by both an adenocarcinoma and a granular cell tumor of the stomach in a 70‐year‐old Japanese male. The MAC lesion had first appeared approximately 20 years earlier and had slowly increased without symptoms. After a definitive diagnosis was made by an excisional biopsy, a second operation was performed with wider excision, followed by split thickness skin grafting. Meanwhile, a punch biopsy from an erosive lesion, which was performed three days before the second operation, demonstrated gastric cancer. Consequently, a gastrectomy was undertaken 20 days later. The patient had since been followed for 2 years and 3 months without any sign of recurrence nor metastasis. Subsequently, soft lymph nodes in two regions of the left axilla were noticed. Three lymph nodes were excised for diagnostic purposes and found to be reactive hyperplasia without metastasis of skin tumor cells. To our knowledge, in the literature, 11 patients have been reported with MAC associated with double or multiple cancers which developed syn‐ or meta‐chronously; ours is the 12th patient.
Pericostal Tuberculosis Diagnosed by Fine Needle Aspiration Biopsy: Report of a Case with a Review of the Literature
Authors: Abe Hiroyuki , Kumamoto Kensuke , Hoshino Masami , Utsumi Yasufumi , Takenoshita Seiichi , Kaneko Fumio
Published: July 2014

We present an 81‐year‐old woman with pericostal tuberculosis, a rare disease recently, without a past history of pulmonary tuberculosis or tuberculous pleurisy. She developed a subcutaneous nodule on her right chest. She was suspected of skin tuberculosis after the confirmation of acid‐fast bacilli in a fine needle aspiration material of the nodule. A tuberculin skin test was strongly positive. The nodule was resected, and preclusive antituberculosis chemotherapy with rifampicin and isoniazid was started. The histological findings included granulomatous changes, central necrosis and Langhans' giant cells. Mycobacterium tuberculosis was identified from a culture of the specimen. About six months after the operation, no erythema, nodule or abscess was observed. We first suspected that she had mammary carcinoma and therefore observed the nodules on the thorax; it is important to differentiate tuberculosis from neoplasms. We also reviewed 22 cases of pericostal tuberculosis in Japan reported in the 15 years from 1976 to 2002.
Trichophyton Tonsurans Infection Manifesting as Multiple Concentric Annular Erythemas
Authors: Ouchi Takeshi , Nagao Keisuke , Hata Yasuki , Otuka Tomoko , Inazumi Toyoko
Published: July 2014

We report a case of dermatophytosis in a Judo wrestler caused by Trichophyton tonsurans (T. tonsurans) with clinical features that mimicked the concentric rings of tinea imbricata. Tinea imbricata is a unique dermatophytosis caused by Trichophyton concentricum (T. concentricum), observed endemically in subtropical to torrid zones and characterized by impressive concentric rings. We found three similar cases of the dermatophytosis in the literature that were reported as tinea pseudoimbricata or tinea indecisiva. All of these cases were associated with systemic or local immunosuppression, perhaps simulating the mechanism of tinea imbricata, which is known to involve the lack of delayed type hypersensitivity to T. concentricum. These cases imply that iatrogenic immunosuppression may perhaps play an important role in the development of the unique clinical features mimicking tinea imbricata. Furthermore, three of the four cases, including the presented case, were caused by T. tonsurans. It may be necessary to consider T. tonsurans infection when multiple concentric erythemas are encountered.
Mycophenolate Mofetil as an Adjuvant Therapy for Classic and Endemic Pemphigus Foliaceus
Authors: Kawashita Milka Yuri , Tsai Katia , Aoki Valéria , Santi Claudia Giuli , Maruta Celina Wakisaka , Rivitti Evandro
Published: July 2014

Pemphigus foliaceus is an autoimmune cutaneous disease with subcorneal acantholysis and pathogenic IgG4 autoantibodies directed against desmoglein 1. We present our experience with mycophenolate mofetil (MMF) in the treatment of one case of endemic pemphigus foliaceus (fogo selvagem) and two cases of the classic form. All patients had severe, refractory disease and developed marked adverse effects due to long‐term corticosteroid therapy. MMF proved to be an effective corticosteroid‐sparing agent at doses varying from 35 to 45 mg/kg/d. It was well tolerated, and we found no significant adverse effects from this drug.
Psoriasis Arthropathy and HLA‐B51: Report of 5 Cases
Authors: Yamamoto Toshiyuki , Yokozeki Hiroo , Nishioka Kiyoshi
Published: July 2014

Psoriasis arthropathy (PsA) is a chronic inflammatory arthropathy characterized by the association of arthritis with psoriasis. Although the precise mechanisms of PsA still remain obscure, several genetic and environmental factors have been suggested to play important roles. HLA‐B51 has been strongly associated with Behçet's disease; however, its association with PsA has not been documented. We describe herein five Japanese patients (4 males and 1 female) with PsA and positive for HLA‐B51. The clinical forms defined by Moll and Wright revealed that the polyarticular pattern was noted in two cases, and oligoarticular, distal, and spondyloarthropathy patterns were noted in one case each. Positive rheumatoid factor was detected in one patient, and antinuclear antibody in two patients. The other HLA subclasses were A2 and A31 in 3 cases, respectively. HLA‐B51 was detected in 5 out of 17 patients with PsA examined in our department; in contrast, HLA‐B51 was not detected in 17 patients with psoriasis vulgaris. Our observations suggest that HLA‐B51 may play a role in the pathogenesis of PsA in the Japanese population.
Stereotaxic Mapping of the Monoamine Pathways in the Rat Brain*
Authors: Ungerstedt Urban
Published: July 2014

The ascending monoamine pathways in the rat brain are demonstrated by the pile up of fluorescent material occurring in the axons after various types of lesions. The anatomy of the pathways is outlined in drawings of frontal sections of the brain and the origin and termination of several pathways is determined by studying the anterograde and retrograde degeneration occurring after well localised lesions. It is possible to separate the ascending NA pathways into a dorsal and a ventral bundle of axons. The dorsal bundle innervates the cortex and the hippocampus and the ventral bundle supplies NA nerve terminals to the medulla, the pons, the mesencephalon and the diencephalon. The dorsal bundle is found to originate in the locus coeruleus. Lesions of this nucleus abolish the nerve terminals in all cortical areas and in several other areas of the brain indicating a unique role for the locus coeruleus in influencing the activity of the entire brain. The 5‐HT pathways have a distribution similar to the ventral NA pathyway. The course of the nigro‐striatal and the meso‐limbic DA pathways is presented in detail.
Striatal Dopamine Release after Amphetamine or Nerve Degeneration Revealed by Rotational Behaviour
Authors: Ungerstedt U.
Published: July 2014

Amphetamine induced vigorous rotational behaviour in rats where the nigrostriatal dopamine (DA) system was unilaterally degenerated by an intracerebral injection of 6‐hydroxydopamine (6‐OH‐DA). The rotational behaviour was analysed in a specially designed “rotometer” and found highly reproducable. The intensity of the rotation was proportional to the extent of degeneration in the DA system. The amphetamine site of action was in all probability presynaptic as amphetamine caused a rotation in the opposite direction as compared to the DA receptor stimulating drug apomorphine. Tyrosine hydroxylase inhibition abolished the amphetamine effect, while reserpine potentiated the effect. Evidence was also obtained that the amphetamine induced release of DA was dependent upon nerve impulses. The rotational behaviour reflected the degree of DA receptor stimulation, but changes in the noradrenaline (NA) transmission seemed to modulate the behaviour. Decreased NA transmission after dopamine‐β‐hydroxylase inhibition increased the rotational behaviour. The unilateral degeneration of the DA system was studied by the changes in posture and movements that occurred during the degeneration. After inhibition of the monoamine oxidase the rats showed a strong rotation beginning on the 23d and ending on the 33d hour after the operation. The rotational behaviour was probably due to degeneration release of DA and equivalent to the degeneration contraction of the nictitating membrane in the peripheral nervous system Amphetamine greatly potentiated the spontaneous degeneration release during this period.
Effects of dynamic leg exercise on subcutaneous blood flow rate in the lower limb of man
Authors: NIELSEN H. V. , STABERG B. , NIELSEN K. , SEJRSEN P.
Published: July 2014

Subcutaneous blood flow (SBF) was studied simultaneously in the upper arm at heart level and in the lower limb during positional changes and during leg exercise in seven healthy males. SBF was estimated by local clearance of 133Xenon registered by portable cadmium telluride detectors. Venous pressure was recorded directly on dorsum on the foot. Changing the position from supine to head‐up tilt, SBF decreased by 43% (P < 0.01) at the arm level, 40% at the thigh (P < 0.01), 47% at the calf (P < 0.01) and decreased by 51 % at the ankle level (P < 0.01). Performing 20 heel‐raisings per min in nearly erect posture, SBF increased by 96% at the thigh (P < 0.01), 25% at the calf (P > 0.1) and increased by 18% at the ankle level (P > 0.1). At 40 heel‐raisings per min SBF increased by 99% at the thigh (P < 0.01), 121% at the calf (P < 0.01), but only 44% at the ankle level (P > 0.1). During leg exercise subcutaneous vascular resistance was significantly increased at arm and ankle levels. In contrast, a vasodilatory response was noticed at the thigh and calf levels and seemed associated with a decrease in local venous pressure to below the trigger level of the sympathetic veno‐arteriolar reflex mechanism. In conclusion, SBF in the lower limb of man was increased during exercise. The increase in SBF could only partly be ascribed to the concomitant increase in perfusion pressure. The local blood flow response seemed modified by changes in sympathetic nervous activity and metabolic rate.
Somatostatin in the control of respiration
Authors: YAMAMOTO Y. , RUNOLD M. , PRABHAKAR N. , PANTALEO T. , LAGERCRANTZ H.
Published: July 2014

Somatostatin has been found to induce apnoea when applied into the brain ventricular system (Fuxe et al. 1982, Härfstrand et al. 1985). The site of action of somatostatin was suggested to be in the dorsal respiratory neurons in the medulla oblongata of the rat (Fuxe et al. 1982) where high somatostatin‐like immunoreactivity has been detected (Kalia et al. 1984a). In the present study we wanted to further localize the site(s) of action of somatostatin on respiration by microinjection of somatostatin into the medulla oblongata of the cats. We could not detect any inhibitory effect of somatostatin on respiration after microinjection into the nuclear complex of the solitary tract. On the other hand microinjection of somatostatin into the region of nucleus paragigantocellularis lateralis consistently caused apnoea. This finding further supports the idea that this structure functions as an integrative area of respiratory drive inputs.
Temperature‐dependence of rod photoresponses from the aspartate‐treated retina of the frog (Rana temporaria)
Authors: DONNER K. , HEMILÄ S. , KOSKELAINEN A.
Published: July 2014

The effects of temperature changes on rod photoresponses were studied by recording the aspartate‐isolated mass receptor potential in the dark‐adapted retina of the frog Rana temporaria. The amplitude of saturating responses, indicating the magnitude of the dark current, increased linearly with temperature in the measured range 6–26 °C, extrapolating to zero dark current at 0 °C. Sensitivity was maximal around 18 °C but the decrease towards lower temperatures was shallow. The results show that rod phototransduction in the frog Rana temporaria is adapted to lower temperatures than in the tropical toad Bufo marinus. Responses to dim flashes were, approximately up to peak, well fitted by the same ‘independent activation’ model with four delay stages as have been found to best describe current responses from single toad rods. The kinetics (reciprocal time‐to‐peak) showed Arrhenius‐type temperature‐dependence with apparent activation energy 12.4 kcal mol−1 and Q10 = 2.1.
Past, Present, and Future of Water Data Delivery from the U.S. Geological Survey
Authors: Hirsch Robert M. , Fisher Gary T.
Published: July 2014

We present an overview of national water databases managed by the U.S. Geological Survey, including surface‐water, groundwater, water‐quality, and water‐use data. These are readily accessible to users through web interfaces and data services. Multiple perspectives of data are provided, including search and retrieval of real‐time data and historical data, on‐demand current conditions and alert services, data compilations, spatial representations, analytical products, and availability of data across multiple agencies.
A Vision for Future Observations for Western U.S. Extreme Precipitation and Flooding
Authors: Ralph F.M. , Dettinger M. , White A. , Reynolds D. , Cayan D. , Schneider T. , Cifelli R. , Redmond K. , Anderson M. , Gherke F. , Jones J. , Mahoney K. , Johnson L. , Gutman S. , Chandrasekar V. , Lundquist J. , Molotch N. , Brekke L. , Pulwarty R. , Horel J. , Schick L. , Edman A. , Mote P. , Abatzoglou J. , Pierce R. , Wick G.
Published: July 2014

Recent and historical events illustrate the vulnerabilities of the U.S. west to extremes in precipitation that result from a range of meteorological phenomena. This vision provides an approach to mitigating impacts of such weather and water extremes that is tailored to the unique meteorological conditions and user needs of the Western U.S. in the 21st Century. It includes observations for tracking, predicting, and managing the occurrence and impacts of major storms and is informed by a range of user‐requirements, workshops, scientific advances, and technological demonstrations. The vision recommends innovations and enhancements to existing monitoring networks for rain, snow, snowmelt, flood, and their hydrometeorological precursor conditions, including radars to monitor winds aloft and precipitation, soil moisture sensors, stream gages, and SNOTEL enhancements, as well as entirely new observational tools. Key limitations include monitoring the fuel for heavy precipitation, storms over the eastern Pacific, precipitation distributions, and snow and soil moisture conditions. This article presents motivation and context, and describes key components, an implementation strategy, and expected benefits. This document supports a Resolution of the Western States Water Council for addressing extreme events.
Landsat Thermal Infrared Imagery and Western Water Management
Authors: Willardson Anthony G.
Published: July 2014

The Western States Water Council strongly supported the use of thermal infrared sensor (TIRS) data from Landsat 8 (Western States Water Council ). TIRS is increasingly important in monitoring consumptive water uses, particularly agricultural uses. Landsat is the only operational satellite system with a spatial resolution (30m) fine enough to map water use field‐by‐field. TIRS data applications include:

Administering state water rights

Planning for present and future water needs

Implementing interstate compacts, court decrees, and negotiated tribal settlements

Mapping evapotranspiration and consumptive surface and groundwater use

Protecting endangered species and estimating water use by invasive species

Monitoring food supply security

Forecasting commodity market fluctuations

TIRS is essential to quantify beneficial consumptive use, evaluate water rights transfer requests, monitor interstate water compacts, negotiate tribal water right settlements and interstate agreements, and review water right “calls.” The Landsat data archive tracks temporal changes in water uses over decades. A permanent operational land observation program with TIRS is essential.
A Social‐Ecological Framework to Integrate Multiple Objectives for Environmental Flows Management
Authors: Martin David M. , Harrison‐Atlas Dylan , Sutfin Nicholas A. , Poff N. LeRoy
Published: July 2014

“Environmental flows” is a research discipline that emphasizes freshwater allocation in rivers to sustain desired ecological conditions and human well‐being. The basis for environmental flow requirements has traditionally relied on hydrological and ecological data. Contemporary methods focus on detailed hydro‐ecological relationships within river ecosystems; however, there is currently no structured approach to systematically incorporate socially relevant data into the environmental flows discipline. To address this limitation we developed a flexible framework that applies a social‐ecological systems approach to account for multiple flow‐related objectives that reflect both biophysical sustainability and societal preferences. First, we conceptualize the freshwater social‐ecological system as a hierarchy of human and environmental domains. Then, we recommend stepwise procedures to assess flow‐related vulnerabilities of important system attributes, address their feedbacks, and translate these assessments to a common classification for comparative analyses that guide holistic flow management decisions.
Social Observation for Sustainability Science about Water
Authors: Braden John B.
Published: July 2014

I advance the following argument: (1) Coupled observation of humans and nature at large scale is important to many fundamental questions of sustainability. (2) Current programs observing natural and social systems are inadequate to address fundamental questions of sustainability at coarse scale. (3) Water is an attractive medium around which to design an observation program, and water researchers agree on many characteristics of water‐related data needed to advance sustainability science. (4) A program of coupled observation around water will need to be (a) realistic about attainable scope, (b) design data collection scientifically to be representative at useful scale(s) and of both humans and the hydrosphere, (c) leverage existing data collection programs, (d) explore new ways of protecting privacy while enhancing spatial resolution of data and (e) include data on social institutions as well as individuals.
Reach‐Scale Comparison of Habitat and Mollusk Assemblages for Select Sites in the Clinch River with Regional Context
Authors: Ostby Brett J.K. , Krstolic Jennifer L. , Johnson Gregory C.
Published: July 2014

Several hypotheses, including habitat degradation and variation in fluvial geomorphology, have been posed to explain extreme spatial and temporal variation in Clinch River mollusk assemblages. We examined associations between mollusk assemblage metrics (richness, abundance, recruitment) and physical habitat (geomorphology, streambed composition, fish habitat, and riparian condition) at 10 sites selected to represent the range of current assemblage condition in the Clinch River. We compared similar geomorphological units among reaches, employing semi‐quantitative and quantitative protocols to characterize mollusk assemblages and a mix of visual assessments and empirical measurements to characterize physical habitat. We found little to no evidence that current assemblage condition was associated with 54 analyzed habitat metrics. When compared to other sites in the Upper Tennessee River Basin (UTRB) that once supported or currently support mollusk assemblages, Clinch River sites were more similar to each other, representing a narrower range of conditions than observed across the larger geographic extent of the UTRB. A post‐hoc analysis suggested stream size and average boundary shear stress at bankfull stage may have historically limited species richness in the UTRB (p < 0.001). Associations between mollusk assemblages and physical habitat in the UTRB and Clinch River currently appear obscured by other factors limiting richness, abundance, and recruitment.