孢子丝菌病超微结构初步观察

对5例孢子兰全菌病患者的皮损标本进行了初步电镜观察.描述了申克氏孢子丝菌在培养基上和病变皮肤组织内的不同超微结构形态特征.并观察了由它所弓I起的肉芽肿性炎症细胞浸润.电镜观察表明在壤养基上生长的真菌结构完好.而皮肤损害内的真菌却呈现许多超微结构改变和变性.后者可能取决于了旨主细咆对真菌的抵抗.我们认为通过电镜观察研究.对于了解真菌细胞的生物学持性以及进行科研工作具有重要意义.     

误诊为扁平苔藓的淋巴管型孢子丝菌病1例

患者男,52岁。右前臂起红色丘疹1年。曾被误诊为"扁平苔藓",治疗效果欠佳。皮损组织病理示:表皮增生,灶状表皮坏死,真皮浅深层血管周围可见不等量淋巴细胞、浆细胞、组织样细胞、嗜中性粒细胞浸润,伴血管增生及较多的血管外红细胞;PAS染色(-),Giemsa染色(-);真菌培养:孢子丝菌。诊断:淋巴管型孢子丝菌病。     

足菌肿1例

患者男,32岁。左底及足背起红斑结节斑块伴溢脓3年。皮损组织病理示:表皮呈假上皮瘤样增生,真皮可见大量混合炎细胞浸润,可见硫磺颗粒,未见菌丝及孢子。脓液及组织块真菌培养示:裴氏着色真菌;细菌培养示:猪红斑丹毒丝菌。诊断为足菌肿,给予克林霉素,伊曲康唑及特比萘芬,治疗好转,目前正在随访中。     

孢子丝菌超微结构观察

我们用透射电镜观察了在真皮和培养的申克氏孢子丝菌,后者见孢子和菌丝,二者都有正常的细胞壁,孢子直径在3.0~5.4μm范围内,菌丝平均直径4.5μm,在孢子胞浆中见糖原颗粒、线粒体、空泡、脂滴、核蛋白体、内浆膜系统、同心膜系统、中心无定形物质及核.前者见直径0.9~4.0μm的缩小孢子,胞浆中可见糖原颗粒、空泡.脂滴、线粒体及核.并讨论了真皮中孢子丝菌与孢子丝菌病的关系.     

泛发性皮肤垢着病样糠秕马拉色菌感染1例

患者男 ,2 3岁。面部灰褐色油腻性鳞屑斑、痂垢 5年 ,手背、躯干鳞屑性红斑 2年。取鳞屑直接镜检可见马拉色菌孢子 ,将鳞屑接种于糠秕马拉色菌培养基 ,3 7℃培养 2周 ,可见酵母样、扁平、微高出斜面的乳白色菌落生长 ,表面有细小突起。皮损组织病理 :表皮角化过度 ,角化不全 ;毛囊角栓 ,棘层灶状海绵水肿 ,基底细胞部分液化变性 ,色素失禁 ;真皮浅层淋巴细胞、组织细胞、噬色素细胞浸润 ,部分炎性细胞侵入表皮。PAS染色 :角质层见大量孢子。给予伊曲康唑 2 0 0mg口服 ,1次 /d ,连续 3周 ,皮损变薄 ,以后失访。     

淋巴管型孢子丝菌病1例

患者男,40岁,农民。右下肢可见线状浸润性斑块、结节、溃疡和结痂4个月。右下肢皮损组织病理示表皮下淋巴细胞、浆细胞、中性粒细胞和组织细胞浸润,可见多核巨细胞,有大量红细胞外溢。真菌培养可见孢子丝菌。     

六例对称性肢端角化病的透射电镜观察

目的 探讨对称性肢端角化病的超微组织病理特点。方法 收集广东医科大学附属医院皮肤科6例对称性肢端角化病皮损及其周围外观正常皮肤、3例正常人皮肤活检标本,做透射电镜观察。结果 皮损中角质层明显增厚,角化细胞形态不规则,角化包膜不连续;表皮各层角蛋白细丝聚集和排列异常;角质层与颗粒层移行区可见较多大小不等的空泡;颗粒层变薄,透明角质颗粒形态及大小异常,被膜颗粒减少;基底层黑素细胞增多,胞质中有大量Ⅳ期黑素小体;真皮浅层中少数淋巴细胞浸润。皮损周围外观正常皮肤亦有类似超微结构变化,但程度较轻。结论 该病皮损中可能存在角蛋白、表皮分化复合体蛋白及脂质代谢异常,从而导致表皮增厚及屏障功能受损。     

儿童足部溃疡——溃疡性扁平苔藓

诊断:儿童足部溃疡性扁平苔藓. 皮损组织病理改变:镜下见一处表皮缺失,未缺失的表皮可见散在角化不全,部分颗粒层增厚,棘层增厚,棘层内可见散在的单一核细胞外溢,基底层液化变性明显,边缘增厚的表皮内部分细胞异形,真皮浅层淋巴细胞略呈带状浸润.并可见血管增生、扩张及充血.组织病理诊断:扁平苔藓;鳞状上皮异形增生.     

发生在家庭成员内的孢子丝菌病

孢子丝菌病是由申克氏孢子丝菌所致的皮肤真菌感染。日本已有2500例的发病报告。其中,有7个家庭内的发病报告。本文作者报告了一家内两例同时发病的患者。病例1,为9岁的日本女孩,于1988年1月10日发现右面颊有一形态不规则的浸润性红斑并有溃疡与结痂拇指尖大小。外搽皮质激素药后扩大、无淋巴系统受累。否认面部外伤史。皮损活检,组织象为炎性肉芽肿,真皮有组织细胞、淋巴细胞、中性粒细胞、浆细胞和巨噬细胞的浸润,其间可见     

大汗腺汗囊瘤一例

12岁男性患儿,头皮孤立性结节12年.皮肤科情况:头顶部可见一直径0.5 cm大小结节,表面光滑,触之有囊性感.皮损组织病理示:表皮轻度角化过度,颗粒层略增厚,棘细胞层增厚;真皮浅层散在以淋巴细胞为主的炎性细胞浸润,真皮中下层可见较多大汗腺腺腔样结构,腔壁由单层立方形细胞组成,见顶浆分泌,腺腔内为嗜碱性无结构物质,囊腔...     

Morphofunctional changes in the skin in foot mycosis

Sixteen specimens of cadaveric intertoe folds of patients who had suffered from intertrichinous mycoses of the soles (miners who died in accidents or because of traumas) were examined by histologic and histochemical methods. For control intertoe fold specimens from 10 suddenly dead workers without mycoses were examined. Examinations of skin specimens from mycosis foci have revealed fungus mycelium in the epidermis and superficial layers of the derma, focal perivascular infiltrates consisting mainly of T-lymphocytes (a positive reaction to alpha-naphthylacetate esterase), macrophages, sensitized lymphocytes (high acid phosphatase activity); this necessitates administration, along with mycocidal agents, of angioprotectors, proteolysis inhibitors, immunostimulants. Histoenzymologic studies have revealed impairments of the principal components of metabolism and activation of glycolysis processes. Less manifest changes were revealed in apparently intact skin, this being an evidence of a systemic involvement of the skin in a prolonged mycotic process.     

Characterization and activity of phospholipase A2 in normal human epidermis and in lesion-free epidermis of patients with psoriasis or eczema

The kinetic properties of phospholipase A2 isolated from single large specimens of normal human epidermis and 'uninvolved' (lesion-free) psoriatic epidermis were determined. The enzymes from the two sources behaved identically with respect to changes in protein concentration, Ca2+ concentration and pH, but the enzymes responded differently to changes in substrate concentration. Furthermore, the specific activity of the enzyme derived from lesion-free psoriatic epidermis was higher than that from normal epidermis under all conditions used. Increased specific activity of the enzyme in the lesion-free epidermis was also found when biopsy specimens taken from thirty-five patients with psoriasis vulgaris at varying severity were compared with biopsies of normal epidermis from thirty-one control volunteers (P less than 0.001). Mixing experiments, in which homogenates of lesion-free psoriatic epidermis and control epidermis were combined, suggested that the relatively low activity of the enzyme in normal epidermis was due to the presence of an inhibitor. As the activity of the enzyme was not elevated in the lesion-free epidermis from twelve cases of eczema, which is also an inflammatory condition of the epidermis and superficial dermis, it is suggested that the raised phospholipase A2 activity demonstrated in the lesion-free epidermis of psoriasis may play an important role in the pathogenesis of the disease.     

Cyclic AMP level in different layers of psoriatic epidermis

In the present study we have determined intracellular levels of cyclic AMP in psoriatic epidermis, which had been microdissected. Involved epidermis had relatively higher cyclic-AMP levels on a tissue weight basis than did uninvolved epidermis, but no significant differences on a DNA basis were obtained. Further microdissection of psoriatic epidermis made it possible to determine cyclic AMP levels in the upper and lower half of the epidermis, respectively. The results clearly demonstrated that the upper epidermis had significantly higher levels of cyclic AMP than the lower epidermis on a DNA basis in individual cases, but no differences between the upper and lower epidermis of involved psoriatic epidermis were obtained on a dry weight basis. It is suggested that the lower levels of cyclic AMP in the lower half of the epidermis may be due to increased activity of cyclic AMP phosphodiesterase as described by Iizuka et al., or to retarded responsiveness of adenylate cyclase to endogenous stimulators in the lower half of the epidermis where the cell surface could be more easily affected by dermal components than the upper half of the epidermis.     

银屑病皮损表皮内Akt的激酶活性增强

目的 探讨Akt在银屑病发病中的意义。方法 免疫组化、免疫印迹法与活性测定的方法对30例寻常型银屑病患者（进行期皮损和非皮损表皮）和20例正常人表皮中Akt的表达与磷酸化水平及Akt的活性分别进行检测,免疫染色的强度进行光密度测定, 免疫印迹和激酶活性测定结果均采用灰度扫描,统计学处理采用方差分析和t检验。结果 免疫组化显示：正常表皮、银屑病皮损和非皮损表皮内Akt蛋白的表达水平差异无统计学意义（Fakt = 0.611,P > 0.05）;正常表皮与银屑病非皮损表皮内,磷酸化Akt的表达差异无统计学意义（Tp-akt = 0.624,P > 0.05）,与二者相比,银屑病皮损表皮内磷酸化Akt的表达明显增强（Fp-akt = 19.081,P < 0.01）。免疫印迹的结果（Takt = 1.378,P > 0.05,Tp-akt = 237.75,P < 0.01）与免疫组化一致。与正常表皮相比,银屑病皮损表皮内Akt的活性增强（Tp-akt = 138.441,P < 0.01）。结论 银屑病角质形成细胞的过速增殖可能与银屑病皮损表皮内Akt的活性增强有关。     

Calmodulin activities are significantly increased in both uninvolved and involved epidermis in psoriasis

In order to elucidate a part of calmodulin actions in the hyperproliferative state in human epidermis, calmodulin activities in the psoriatic and in the normal human epidermis were determined using calmodulin-deficient phosphodiesterase from bovine heart and purified pig skin epidermal calmodulin as a standard. Skin samples were obtained from 11 normal healthy controls and from both the uninvolved and involved regions of 8 nonconsanguineous psoriatic patients. Pure epidermal samples, prepared by the microdissection method, were used for calmodulin assays. Normal human epidermis contained 270 +/- 13 ng/mg dry weight, whereas calmodulin activities were significantly increased in psoriatic epidermis, 412 +/- 29 ng/mg dry weight for the uninvolved epidermis and 747 +/- 46 ng/mg dry weight for the involved epidermis, respectively. These results suggest that calmodulin may play an important role in cell proliferation in human epidermis.     

Localization of anionic sites in normal and psoriatic epidermis: the effect of enzyme digestion on these anionic sites

Cell surface anionic charge is known to be related to various cellular functions. Therefore, we ultrastructurally localized anionic sites in normal and psoriatic human epidermis, using poly-l -lysine-gold complex (cationic gold), to assess their possible participation in the differentiation of keratinocytes and the pathogenesis of psoriasis. In normal and psoriatic epidermis, the cell membrane of keratinocytes showed positive staining at pH 2.0. At pH 7.4 the cytoplasm and nucleus were diffusely stained, in addition to the cell membrane. In normal epidermis, the intensity of labelling on the cell membrane at pH 2.0 was strong in the basal layer and lower stratum spinosum, and decreased in parallel with differentiation of keratinocytes. In psoriatic epidermis, the intensity of labelling on the cell membrane at pH 2.0 was stronger than in normal epidermis. In normal epidermis, heparitinase digested 63% and chondroitinase ABC digested 80% of cationic labelling. This suggests that heparan sulphate and chondroitin sulphate (and/or dermatan sulphate) constitute anionic sites in normal epidermis. In psoriatic epidermis, chondroitinase ABC-sensitive anionic sites were greatly increased, whereas heparitinase-sensitive anionic sites were the same, when compared with normal epidermis. This suggests that chondroitin sulphate and/or dermatan sulphate constitute anionic sites which are increased in psoriatic epidermis.     

Epidermal Langerhans' cells in elderly patients with decubital ulcers

Langerhans' cells in the sacral epidermis 8-10 cm from the lesion of elderly patients (mean age 74 years) with decubital ulcers were studied ultrastructurally and compared with the patients' own normal epidermis from the upper leg, with age-matched normal controls, and with young normal controls (mean age 43 years). High percentages of Langerhans' cells (ranging between 30 and 50%) without dendrites were found in patient epidermis from the sacral region near the lesion and similar percentages in normal skin from the patients' upper leg. In both elderly and young controls, Langerhans' cells without dendrites found in the epidermis of the upper leg were fewer, ranging between 13 and 33%. The density of Langerhans' cells in adjacent sites of the same epidermis was non-homogeneous, being in the range of 0.56-1.19% in patient sacral epidermis, 0.69-1.31% in patient normal leg epidermis, 0.63-4.17% in leg epidermis of the elderly controls, and 0.63-3.94% in leg epidermis of the young controls. The majority of the Langerhans' cells in both patients and controls were located near the basal cell layer and in the mid-epidermis. The percentage of Langerhans' cells found in patient sacral epidermis (0.84 +/- 0.08%) and in their leg epidermis (0.87 +/- 0.15%) was significantly lower than in the elderly controls (1.91 +/- 0.30%) and young controls (1.84 +/- 0.24%). The low percentage of Langerhans' cells in the epidermis of patients with decubital ulcers may affect the healing process of the lesions.     

Incorporation of D-(3H)glucosamine into normal and psoriatic epidermal glycoconjugates

Samples of normal, uninvolved and involved psoriatic skin were maintained for 18 h in organ culture in the presence of D-(6-³H)glucosamine which is a precursor of cell-surface associated carbohydrates in the epidermis. The total incorporation into involved psoriatic epidermis (solubilized with 8 mol/I urea, 5% sodium dodecyl sulphate, 10 mmol 2-mercaptoethanol) was less than into normal or uninvolved epidermis. This decrease was found whether specific radioactivities were expressed in terms of area, wet weight or protein content of the epidermis. Electrophoresis revealed that the major labelled component in normal and uninvolved epidermis had a high molecular weight. The labelling of this material was significantly reduced in involved psoriatic epidermis. Using pig epidermis we have shown previously that this material represents mainly extracellular glycosaminoglycans and proteoglycans. The decreased labelling (and presumably synthesis) of these extracellular carbohydrates may be related to the failure of mechanisms controlling cell proliferation and to the altered cell interactions which are found in psoriatic epidermis. Electrophoresis also showed that a non-glycosylated protein, molecular weight approximately 50,000, which was present as a single band in both normal and uninvolved epidermis was always present as a doublet band in the involved psoriatic epidermis.     

Histopathogenesis of inflammatory linear verrucose epidermal naevus: histochemistry,immunohistochemistry and ultrastructure

Summary Skin lesions of three patients with inflammatory linear verrucose epidermal naevus (ILVEN) were examined. Histologically, orthokeratosis and parakeratosis were alternately seen in the acanthotic epidermis. By N-(7-dimethylamino-4-methyl-3-coumarinyl)maleimide staining, the horny cells in the parakeratotic epidermis showed a cytoplasmic SH pattern and a weak membranous SS pattern. The orthokeratotic epidermis revealed an increased involucrin expression, whereas the parakeratotic epidermis showed almost no involucrin expression. Ultrastructurally, in the parakeratotic epidermis, the living keratinocytes had prominent Golgi apparatuses and vesicles in the cytoplasm. In the intercellular spaces in the upper spinous layer through to the lower horny layer, an electron dense, homogeneous substance was deposited. The cytoplasm of the horny cells was filled with keratin filaments and contained remnants of nucleus and cytoplasmic membrane structures, and some lipid droplets. The marginal band formation was incomplete. Most of these ultrastructural abnormalities were not found in the orthokeratotic epidermis. There are both similarities and differences in histopathogenesis of the parakeratotic epidermis between ILVEN and psoriasis. A unique finding was the lack of involucrin expression in the ILVEN parakeratotic epidermis.     

血管活性肠肽在寻常性银屑病皮损表皮中的免疫组化检测

目的　检测血管活性肠肽(VIP)在寻常性银屑病皮损表皮中的水平,探讨其与银屑病发病的关系。方法　应用免疫组化法检测了VIP在24例寻常性银屑病皮损表皮中的分布。以18例正常表皮为正常对照。结果　寻常性银屑病皮损表皮中VIP的阳性检测结果明显高于对照组(P<0. 05)。结论　VIP阳性的检测结果增高可能与银屑病的发病有关。