ULTRASTRUCTURAL STUDIES OF VITILIGO WITH INFLAMMATORY RAISED BORDERS

Ultrastructural studies of vitiligo with inflammatory raised borders were performed. A 41-year-old Japanese female had developed vitiligo on the back and cervical region about six months previously and it gradually increased. Slightly elevated red borders were observed on the periphery of some of the vitiligo lesions. Electron microscopic findings showed a few melanocytes with decreased and irregular melanosomes in the basal layer and dissociation of keratinocytes in the spinous layers. Melanosomes in keratinocytes were markedly decreased. Lymphocytes were frequently observed intraepidermally, and the process by which lymphocytes passed to the basal lamina from the dermis was also observed. Lymphocytes were seen in apposition to some melanocytes in the basal layer. These melanocytes, as a result, may degenerate. The formation of many vacuoles in the cytoplasm was observed. Many typical Langerhans cells with many racket bodies were observed in the upper spinous layers. On the other hand, in the basal layer, Langerhans cells with only a few racket bodies were generally observed. These Langerhans cells were also frequently in contact with lymphocytes. The cause of this inflammatory reaction with a raised border is not known. However, these ultrastructural findings firmly suggested a relationship to some type of immunological mechanism for this occurrence of vitiligo.     

A comparative study of loratadine versus pheniramine maleate in chronic idiopathic urticaria

Fifty cases with chronic idiopathic urticaria of more than 3 months duration were selected and divided into two groups. Group 'A' was given 10 mg loratadine once daily, while group 'B' was given pheniramine maleate 25 mg, twice daily for one month. All patients were followed for one month more. 48% excellent response was observed in group 'A' while 16% excellent response was observed in group 'B'. Good response was observed in 24% of patients in group 'A', while in group 'B' 16% of patients had good response. No side effects were observed in loratadine group, while drowsiness was observed in pheniramine group.     

Effect of topical calcipotriol on congenital ichthyoses

We investigated the clinical efficacy of topically applied calcipotriol in six patients with congenital ichthyosis, using a double-blind, bilaterally paired, comparative approach. Unilateral improvement, in favour of the calcipotriol-treated side, was observed in three patients with lamellar ichthyosis. A beneficial response was also observed in a patient with bullous ichthyotic erythroderma of Brocq. No clinical side-effects or laboratory anomalies were observed. This study indicates that calcipotriol constitutes a new and promising approach in alleviating disorders of keratinization characterized by hyperproliferation, other than psoriasis.     

Dermatoglyphics in Vitiligo

One hundred probands of vitiligo were studied for palmar dermatoglyphics, both qualitatively and quantitatively, and were compared with those of 100 phenotypically normal control subjects. Ulnar loop pattern was the most common digital pattern observed in both probands and controls. An increased incidence of whorls and arches in men and women probands, respectively, was found to be statistically significant when compared with those of controls. Simian crease and Sydney line also have been observed in the present study, which has not been previously reported. A statistically highly significant reduction has been observed in total finger ridge count (TFRC) and a-b ridge count in both sexes of vitiligo cases when compared with those of controls. No significant changes was observed in the values of atd angle and position of axial triradius.     

Autoantibodies to Basement Membrane Collagen: Epidermolysis Bullosa Simplex versus Bullous Pemphigoid

As judged by passive hemagglutination and hemagglutination-inhibition assays, sera from six patients in one family with dominant epidermolysis bullosa contain clearly demonstrable titers of antibodies against the collagen C chain which is derived from basement membrane structures. Moreover, the circulating antibodies observed in these patients are apparently specific for the C chain as no titers were observed when using four additional well-characterized collagen chains in the indicated assays. In contrast to the results with sera from epidermolysis bullosa patients, sera from a series of age- and sex-matched healthy controls, as well as from a group of patients with bullous pemphigoid, did not contain antibodies to any of the test antigens. These results thus clearly differentiate the autoimmune response to basement membranes observed in bullous pemphigoid from that observed in epidermolysis bullosa simplex.     

Micro-island damage with a nonablative 1540-nm Er:Glass fractional laser device in human skin

Background and objectives  Fractional photothermolysis produces micro-islands of thermal injury to the skin while preserving areas among treated tissue sites in order to promote wound healing. Histological changes associated with single and multiple passes of the 1540-nm Er:Glass fractional laser were examined using in vivo human skin.
Methods and materials  Panni of five abdominoplasty patients were treated intraoperatively with a Fractional Lux1540 erbium glass laser system at various laser parameters, with single and multiple passes. Biopsies were removed and examined using standard histological stains.
Results  Deep coagulated columns of collagen separated by regions of unaffected tissue were observed at variable fluence parameters. A direct correlation between the depth of penetration of the coagulated microcolumns and increasing energies was observed. Micro-islands of coagulation were ∼250 μm in diameter and separated by ∼800 μm of unaffected tissue. With multiple passes, significantly more disruption of the dermal–epidermal junction (DEJ) occurred at higher fluences. In contrast to the controlled fractional columns observed with single-pass treatments, nonuniform coagulated columns were distributed randomly throughout the tissue when instituting multiple passes over the same treatment region.
Conclusion  Micro-islands of thermal damage were observed at variable energy parameters. Pathological changes within the skin were clearly dependent on amount of energy and number of passes of the laser treatment. Significantly more superficial damage, accompanied by disruption of the DEJ was observed with multiple passes when compared with single pass at similar fluences. However, with multiple passes, depth of thermal injury did not increase with increasing energies but did disrupt the micro-island array observed with single-pass fractional treatments.     

Pinguecula and Actinic Elastosis

Three cases of pinguecula (conjunctival elastosis) were ultrastructurally investigated. Findings were compared with the features described in cutaneous actinic elastosis. Changes observed were not uniform. In both diseases, numerous elastotoc fibers were present with a finely granular matrix and masses of dense grains. The degenerative changes of the elastotic fibers evolved differently in conjunctival stroma and in dermis. The superficial extracellular concretions observed in pinguecula seemed to be an ultimate stage of elastotic degeneration. Like actinic elastosis and elastosis observed in chronic radiodermatitis, pinguecula is believed to result from a dystrophic increased elastogenesis induced by chronic irradiation, with secondary degenerative changes.     

Glucose tolerance test in leprosy

Glucose tolerance test was carried out in 43 cases of leprosy. They included cases of tuberculoid, borderline, lepromatous leprosy and those with lepra reaction. It was observed that normal curve was common in tuberculoid leprosy. Flat glucose tolerance curve was observed in borderline and lepromatous leprosy. However, the diabetic curve was common in Lepra reaction. Fasting blood sugar was low in lepromatous leprosy and it tended to be marginally high in lepra reaction. Normal GTT response was observed in those with duration of disease between 0-6 months, flat curves in those with duration of disease between 7-12 months while diabetic curve was more common in those with disease duration of more than 2 years.     

The pathogenic mechanisms of blister formation in bullous pemphigoid

Normal human skin was cultured with sera, IgG fractions, and blister fluids (BF) from patients with bullous pemphigoid. Antibody binding (IgG) was observed by immunofluorescence techniques at the dermal-epidermal junction of all skin explants culture with sera, IgG fractions, and BF. Dermal-epidermal separation was observed only in the skin explants cultured with BF. Dermal-epidermal separation was observed in 19 out of 20 explants cultured with BF obtained from fresh bullae. In addition, dermal-epidermal separation can be produced in vivo 6 hr after the injection of BF into the dorsal skin of Hartley guinea pigs. Dermal-epidermal separation was not observed in skin explants cultured with heat-inactivated (56 degrees, C 30 min) BF, although antibody binding was observed. In addition, dermal-epidermal separation did not occur when the BF were preincubated with rabbit antihuman C1, C3, C4, and C5 antibodies. These observations suggested that both antibody and complement were essential for the production of dermal-epidermal separation. Since patient sera failed to produce dermal-epidermal separation, other factor(s) present in BF but absent from serum might be necessary for the production of dermal-epidermal separation. The addition of the proteinase inhibitors, pepstatin, EDTA, and soy bean trypsin inhibitor, did not inhibit the formation of dermal-epidermal separation. In contrast, the presence of alpha 2-macroglobulin inhibited dermal-epidermal separation.     

Leprosy in Portugal 1946-80: epidemiologic patterns observed during declining incidence rates

Compulsory notification of leprosy in Portugal formed the basis for the establishment of a national patient registry used in an epidemiological study. Highest incidence rates were observed in the coastal counties in the middle of Portugal and particularly in the municipalities with a high annual rainfall. Peak incidence rates in males was observed at the age of 25-29 years against 50-59 in females. A continuous and increasing decline in incidence rates was observed throughout the observation period, 1946-80. Towards the end of the period the slopes of the incidence curves seemed to be identical with those observed in other countries where leprosy has previously been eradicated. This is consistent with the notion that towards the end of an endemic situation no new transmission of the disease occurs, and the incidence curve takes the shape of the right part of the distribution of incubation periods which apparently is uniform in leprosy, irrespective of time and place. The pattern observed in other areas during declining incidence rates, of an increase in age at onset by year of onset together with a lack of increase in age at onset by year of birth was confirmed by the Portuguese data, also consistent with a break in the transmission of the disease a long time before the final termination of the endemic situation.     

人表皮黑素细胞与角质形成细胞共培养体外模型中黑素小体转运的观察

目的:建立人表皮黑素细胞与角质形成细胞共培养的体外模型,并且在模型中观察黑素小体的转运。方法:分别培养人表皮黑素细胞和角质形成细胞,用二乙酰羧基荧光素-琥珀酰亚胺酯(CFDA-SE)标记黑素细胞内黑素小体,然后将两种细胞共培养,并在倒置显微镜和共聚焦显微镜下观察共培养模型中黑素小体由黑素细胞向角质形成细胞的转运。结果:培养至第3天和第7天可在倒置显微镜下观察到黑素细胞与角质形成细胞共同存活,并通过树突发生联系,在共聚焦显微镜下可直接观察到黑素小体由黑素细胞向角质形成细胞的转运。结论:成功建立黑素细胞与角质形成细胞共培养的体外模型,并利用CFDA-SE标记,在共聚焦显微镜下直接观察到黑素向角质形成细胞的转运。     

Histopathological changes of primary HIV infection. Description of three cases and review of the literature

The histopathological changes observed in the cutaneous rash of three patients who suffered the acute phase of HFV infection are described. In all three patients a perivascular and interstitial inflammatory infiltrate was present in the upper and mid-reticular dermis. In one biopsy isolated areas of epidermal necrosis were observed and in the two other biopsies a perifollicular inflammatory infiltrate was detected with perforation in one case. Furthermore, a periductal infiltrate was observed in one of these biopsies.     

The differentiation and proliferation of newly formed epidermis on wounds treated with cultured epithelial allografts

Fifteen patients, eight with burn or scald wounds and seven with split-thickness donor sites, were treated with cultured epithelial allografts. Skin was obtained from HIV-negative donors undergoing circumcision and sheets of epithelium were cultured using the 3T3 feeder method. Multiple post-operative biopsies were performed at various time intervals and stained with a panel of monoclonal antibodies against cytokeratins, involucrin, transferrin receptor and epidermal growth factor receptor. Fresh cultured epithelial sheets, normal skin, standard treated donor sites and burns treated with autografts were also studied. Cytokeratin-10 expression was not observed at treated sites until 4 weeks post-grafting, when normal suprabasal levels were observed. Cytokeratins 13 and 16, usually observed in highly proliferative states such as psoriasis, were observed in epithelial-treated sites for up to 6 months. Other proliferation markers such as Ki67 and transferrin receptor were only expressed 2-3 weeks post-operatively. Involucrin, a marker of keratinocyte terminal differentiation, was expressed throughout newly formed epidermis until 15 weeks, when the normal pattern of granular expression was observed. These results indicate that although the cultured 'allograft' does not survive, it may modulate the proliferation and differentiation of spontaneously regenerating epithelium.     

Sclerotic bodies in nephrogenic systemic fibrosis: a new histopathologic finding

Nephrogenic systemic fibrosis (NSF – known previously as nephrogenic fibrosing dermopathy) is a systemic disorder observed exclusively in patients with a history of kidney disease associated with renal failure. Reported histopathologic findings of NSF include spindle-shaped fibroblast-like cells with fibrosis, thickened collagen bundles with surrounding spindled and epithelioid cells, increased number of elastic fibers, sparse inflammatory infiltrate and increased stromal mucin. Two populations of multinucleated giant cells (Factor XIIIa and CD68 positive) have also been observed. We observed the presence of sclerotic bodies with entrapped elastic fibers in two cases of NSF, which we interpreted to be collagenous in nature, a finding not previously reported. These bodies should not be confused with osseous metaplasia previously seen in association with NSF, which show lacunae and cells within the osseous bodies that may or may not be calcified. We did not observe lacunae or cells within the sclerotic bodies in our cases. Furthermore, the sclerotic bodies in our cases stained blue on Masson trichrome, whereas previous investigators observed the osseous metaplasia to be red. We suggest that sclerotic bodies may be an additional clue to the diagnosis of NSF.     

两种类型白癜风患者郎格罕细胞电镜观察

本文对皮节型和泛发型白癜风患者皮肤内郎格罕细胞进行了电镜比较观察。结果表明，两型白癜风患者皮肤内郎格罕细胞均存在着不同程度的形态学改变，以皮节型皮损区更为明显。作者认为白癜风皮肤郎格罕细胞可能受累，但这些改变主要见于皮节型白癜风皮损区。因此目前还难以肯定郎格罕细胞在白癜风发病机制中的作用     

核小体诱导BALB/c小鼠产生狼疮肾的研究

目的 了解核小体在系统性红斑狼疮(SLE)发病中的作用。方法 用蔗糖连续密度梯度离心法从新鲜鸡血红细胞中提取核小体,皮下免疫BALB/c小鼠,采集小鼠血清和肾脏标本。ELISA方法检测其IgG型dsDNA抗体和ANA抗体水平;直接免疫荧光检测小鼠肾脏IgG型免疫复合物的沉积情况;组织病理观察小鼠肾脏损伤情况。结果 核小体免疫后14d,BALB/c小鼠血清中开始出现IgG型dsDNA抗体和ANA抗体,其滴度随时间延长逐渐升高;核小体免疫后35d,小鼠肾脏出现大量IgG型免疫复合物沉积,光镜观察显示有明显肾脏损伤。对照组小鼠无明显自身抗体产生和肾脏病变。结论 核小体可以诱导正常小鼠产生SLE样征候群,提示核小体参与SLE的发病。     

Dermatologic radiotherapy of primary cutaneous follicle center cell lymphoma

A retrospective study was performed to evaluate the results of dermatologic radiotherapy in a large series of patients affected by primary cutaneous B-cell lymphomas. The study included 104 patients with cutaneous follicle center cell lymphoma treated with orthovoltage radiotherapy from 1973 to 2000. The total doses ranged from 14 to 35 Gy (mean 23.55 Gy). Results regarded 102 patients (mean follow-up 65.08 months). Complete remission was observed in all cases; 76 patients experienced a relapse after a mean interval of 22.03 months following radiotherapy, with a relapse-free rate of 22.82 % after 5 years. Extracutaneous progression was observed in 9 cases (8.82 %). An overall actuarial survival rate of 97.36 % was observed after 5 years. A salvage treatment of relapses brought 44 cases to remission. Although we have observed a relapse-free rate lower than that reported by others, dermatologic radiotherapy was "curative" in 25.49 % of cases. Such treatment appears particularly useful in the cases with few lesions and in the management of new cutaneous localizations of follicular center cell lymphoma.     

Prevalence of bacterial vaginosis and vulvovaginal candidiasis mixed infection in a southeastern american STD clinic

Bacterial vaginosis (BV) was diagnosed in 72.5% of female participants. Among women with BV, 33.1% were colonized with yeast. Vulvovaginal candidiasis was observed in 15.7% of participants irrespective of BV status. Overall, the prevalence of BV/vulvovaginal candidiasis mixed infections among young women was observed to be 4.4%.     

Oral photochemotherapy in lichen planus (LP) and mycosis fungoides (MF): ultrastructural modifications of the infiltrating cells.

Six patients (5 with mycosis fungoides and 1 with lichen planus) treated with PUVA, were subjected to biopsy of lesional skin before and during oral photochemotherapy. Ultrastructurally, a reduction in the density of cellular infiltrate was observed in the superficial dermis. In the same areas, necrotic cellular changes were observed. PUVA therapy exercises its beneficial effect by direct destruction of these cells.     

Peripheral T-cell lymphoma with secondary epithelioid granulomatous cutaneous involvement: a clinicopathologic study of four cases

Epithelioid granuloma formation has rarely been observed in specific cutaneous lesions from T-cell lymphomas other than those of mycosis fungoides/Sézary syndrome (MF/SS). Three patients diagnosed with nodal and/or extranodal (tonsillar) non-Hodgkin's peripheral T-cell lymphoma (PTCL) and one patient with angioimmunoblastic T-cell lymphoma (AILD), developed specific cutaneous involvement showing prominent epithelioid cell and/or granulomatous inflammation. The original diagnostic lesions had no granulomatous features. In addition to a specific lymphomatous infiltrate, prominent dermal and/or subcutaneous granulomatous infiltrates were observed. Sarcoid-like granulomas were observed in two patients (one of them presented a granuloma annulare-like pattern in early lesions), granulomatous panniculitis was noted in one patient and in one patient with AILD, masses of epithelioid cells were noted. The clinicopathological features of cutaneous involvement by PTCL showing a florid epithelioid and/or granulomatous cell reaction are reviewed. Various histopathological patterns can be observed. The diagnostic difficulties of these cases are stressed.