Impact of preoperative CEA levels on the prediction of lymphnode (LN) metastasis

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Background: Although CEA is the most commonly used tumor marker for colorectal carcinoma (CRC) and it may correlate with poorer prognosis, data are insufficient to support its use to determine adjuvant therapy. Monitoring preoperative CEA might be useful if it would assist in staging and treatment planning. Methods: This study was a pooled data analysis of 1791 CRC patients (pts) collected prospectively from 25 hospitals participating in the MCSGO. The purpose of this study was to investigate the impact of preoperative CEA on the prediction of the number of LN metastasis (#LN). Data of 1328 pts were completed with preoperative CEA and clinicopathological (CP) data (number of dissected LN, #LN, tumor size, distant metastasis, macroscopic type, depth of invasion, histological type, and lymphatic and vessel invasion). Data of 582 pts with the number of dissected LN 12 were analyzed in this study. #LN was categorized in 5 levels (0, 1, 2, 3, and ≥4), and relationship between #LN and CEA was first investigated via a multivariate analysis based on adjusting for the other CP factors. Discrete logistic regression analysis was used, in which a random effect was incorporated to adjust some bias between hospitals. The linear effects for the factors were evaluated via the regression model. The multivariate adaptive regression spline (MARS), the most powerful tool in the statistical prediction, was employed for the prediction of #LN. Results: The effect of the CEA adjusted by the other CP factors had a positive trend with two-sided P-value of 0.0394 for #LN. The adjusted R-squared measure (R2*) by the MARS fitting, a prediction performance index of #LN, was 0.369, and that averaged based on Bootstrap sampling (Bagging method) was R2* = 0.405. The relative importance of each factor in the prediction of #LN estimated by the decrease rate of R2* on masking each factor is shown in the Table . The relative importance of CEA in the prediction of LN# was ranked second next to lymphatic invasion. Conclusions: Preoperative CEA has a significant impact on the prediction of #LN.

[Table: see text]

No significant financial relationships to disclose.

Cyclosporin-A suppresses p53-dependent repair DNA synthesis and apoptosis following ultraviolet-B irradiation

BACKGROUND

The combination of cyclosporin-A (CS-A) and ultraviolet-B (UV-B) irradiation is not recommended in the treatment of psoriasis, because risks of UV-B-induced skin cancer are increased. The recommendation, however, has not well been confirmed by basic researches.

PURPOSE

In this study, we investigated the effects of CS-A on UV-B-induced repair DNA synthesis, apoptosis and p53 expression.

METHODS

Following the short-term administration of CS-A (5 and 50 mg/kg/day) or vehicle (V) alone, female BALB/c mice, 8-10 weeks old, were treated with UV-B irradiation (100 and 500 mJ(2) cm) or tape stripping (TS). After the treatment, the effects of CS-A on the increased rate of epidermal DNA synthesis were examined by using 5'-bromodeoxyuridine (BrdU) pulse-labelling techniques. In separate experiments, the effects of CS-A on the number of sunburn cells, nick-end labelling+ cells and p53+ cells were examined 24 h after UV-B irradiation.

RESULTS

Cyclosporin-A significantly suppressed the UV-B-induced increase in BrdU uptake, which occurs to repair DNA damage, while there were no significant effects on the stripping (S)-induced increase or the rate of normal epidermal proliferation, which is not associated with any DNA injuries. The number of sunburn cells, nick-end labelling+ cells and p53+ cells was significantly reduced by pretreatment with CS-A.

CONCLUSION

Cyclosporin-A interferes with the self- protective mechanisms involved in both repair and apoptotic removal of UV-B-induced DNA damage. The loss of p53 expression is responsible for the effects of CS-A.

Essential contribution of germline-encoded lysine residues in Jgamma1.2 segment to the recognition of nonpeptide antigens by human gammadelta T cells

Human gammadelta T cells display unique repertoires of Ag specificities largely imposed by selective usages of distinct Vgamma and Vdelta genes. Among them, Vgamma2/Vdelta2(+) T cells predominate in the circulation of healthy adults and respond to various microbial small molecular mass nonpeptide Ags. The present results indicate that the primary Vgamma2/Vdelta2(+) T cells stimulated with the distinct groups of nonpeptide Ags, including monoethyl pyrophosphate, isobutyl amine, and aminobisphosphonate, invariably exhibit Jgamma1.2 in the Vgamma2(+) TCR-gamma chains. Gene transfer studies revealed that most of the randomly cloned Vgamma2/Jgamma1.2(+) TCR-gamma genes bearing diverse Vgamma/Jgamma junctional sequences could confer the responsiveness to all these nonpeptide Ags, while none of the Vgamma2/Jgamma1.1(+) or Vgamma2/Jgamma1.3(+) TCR-gamma genes could do so. Furthermore, mutation of the lysine residues encoded by the Jgamma1.2 gene, which are unique in human Jgamma1.2 and absent in other human or mouse Jgamma segments, completely abrogated the responsiveness to all the nonpeptide Ags without affecting the response to anti-CD3 mAb. These results strongly suggested that the positively charged lysine residues in the TCR-gamma chain CDR3 region encoded by the germline Jgamma1.2 gene play a key role in the recognition of diverse small molecular mass nonpeptide Ags.

Near-infrared irradiation stimulates cutaneous wound repair: laboratory experiments on possible mechanisms

BACKGROUND/AIMS

Several physical agents such as low-energy lasers have been used in the treatment of chronic skin ulcers. This study was performed to investigate potential effects of a newly-developed, specific near-infrared light source on wound repair.

METHODS

Cultured human keratinocytes, endothelial cells and fibroblasts were exposed to the light, and the production of transforming growth factor (TGF)-beta1 and matrix metalloproteinase (MMP)-2 was examined by enzyme immunoassay, zymography and reverse transcription polymerase chain reaction. Incisional wounds were created in ICR and db/db diabetic mice and the effect of irradiation on wound closure was followed photographically.

RESULTS

The TGF-beta1 and MMP-2 content of the medium of cultured cells was significantly elevated after irradiation. The amount of MMP-2 mRNA extracted from irradiated fibroblasts was also upregulated. Negative results in thermal controls suggested that the action of the light was athermic in nature. In animal models, the rate of wound closure was significantly accelerated by repeated exposures.

CONCLUSION

Near-infrared irradiation potentially enhances the wound healing process, presumably by its biostimulatory effects.

Pemphigus foliaceus with prominent neutrophilic pustules

We describe four patients with generalized scaly and pustular skin lesions showing extensive neutrophilic infiltration in the subcorneal region of the epidermis. Immunofluorescence, immunoblot and enzyme-linked immunosorbent assay analyses detected IgG antibodies reacting exclusively with desmoglein 1, the pemphigus foliaceus antigen. This study indicates that pemphigus foliaceus may show prominent neutrophilic pustular skin lesions.

Solar urticaria: report of two cases with augmentation spectrum

Two adult Japanese patients with severe solar urticaria are reported. In both patients, an action spectrum existed in the visible light range, and an augmentation spectrum was demonstrated in the visible light range longer than the action spectrum. The augmentation phenomenon has rarely been documented, and in the previous reports, it was induced by preirradiation with the augmentation spectrum. In our cases, however, only postirradiation with the augmentation spectrum enhanced urticarial reactions.

Unilateral Schamberg disease in a 14-year-old Japanese boy

We report a 14-year-old Japanese boy who has had asymptomatic, multiple, reddish-brown macules and petechiae distributed segmentally only in the right lower extremity for the last 6 months. Histological examination showed a perivascular lymphohistiocytic infiltrate in the papillary dermis, extravasation of red blood cells, and hemosiderin deposition. Treatment with tranilast and topical corticosteroid was dramatically effective. Although the histological findings were compatible with those of Schamberg disease, this case was unusual because the patient was very young and only one extremity was affected.

PUVA therapy: current concerns in Japan

Photochemotherapy using methoxsalen in combination with long-wave ultraviolet light (PUVA) is an essential modality in the treatment of various skin diseases. Major therapeutic regimens include oral, topical and water-delivery methods. An adequate regimen should be chosen regarding cases of disease, extent of involvement and the age of patients. In Japan, however, treatment techniques and protocols have not yet been standardized. PUVA therapy may be a first choice in the early stages of mycosis fungoides and a second choice or an adjunctive measure in other diseases, such as psoriasis, vitiligo and atopic dermatitis, which have been disabling or resistant to conventional treatments. Japanese guidelines for PUVA therapy of psoriasis are being prepared to be produced. Risks and benefits must be weighed and the patient orientation is necessary to complete the treatment and also to minimize side-effects. Although possible risks for skin cancers in Japanese patients have been reported to be much lower, a careful monitoring of the patient's skin changes is recommended. While action mechanisms are not completely understood, recent investigations suggest that both antiproliferative and immunomodulatory effects are involved. This review article deals with the recent progress in clinical and basic research on PUVA therapy, focusing on our current concerns.

Combination therapy with low-dose etretinate and eicosapentaenoic acid for psoriasis vulgaris

A randomized open study was undertaken to compare the therapeutic effects between low-dose etretinate alone and low-dose etretinate combined with eicosapentaenoic acid in 40 patients with chronic, stable psoriasis vulgaris. Better and more rapid improvement was obtained with the combination therapy for 12 weeks than with low-dose etretinate monotherapy. Eicosapentaenoic acid was safe, and adverse reactions due to low-dose etretinate were mild or tolerable. The combination regimen, therefore, has a satisfactory effect on psoriasis without marked adverse reactions.

Ultraviolet light is an environmental factor aggravating facial lesions of adult atopic dermatitis

An increasing number of adult patients with atopic dermatitis (AD) in Japan are distressed by persistent eczematous lesions of the face (so-called atopic red face). Phototests were carried out in 28 patients with the atopic red face to test a possibility that ultraviolet (UV) light could be an aggravating factor. Contact and photocontact dermatitis had been ruled out by repeated patch and photopatch tests. All of the patients had a normal response to a screening dose of UVA (10 J/sq cm) and a normal minimal erythema dose (MED) of UVB. Ten of these patients, however, showed an abnormal papular response to a single or 3-times consecutive UVB radiation above the MED (90 mJ/sq cm).

Density and fine structure of peripheral nerves in various skin lesions of atopic dermatitis

The density and fine structure of the peripheral nerve system in various skin lesions of 64 patients with atopic dermatitis (AD) was quantitatively analyzed by immunohistochemical staining with antibodies directed against protein gene product (PGP) and substance P (SP). The density of PGP-positive peripheral nerves was 2.5 x 10(3) microns2/delta s (delta s = 0.24 mm2 selected area) in early acute lesions, 3.8 x 10(3) microns2/delta s in subacute lesions, 4.9 x 10(3) microns2/delta s in lichenified lesions and 7.1 x 10(3) microns2/delta s in prurigo lesions of AD. The density of nerve fibers in subacute, lichenified and prurigo lesions was significantly higher than in uninvolved skin of AD patients (2.0 x 10(3) microns2/delta s). Electron microscopically, bulging of axons with many mitochondria and a loss of their surrounding sheath of Schwann cells suggests that the free nerve endings in skin lesions of AD are in an active state of excitation. Many pinocytotic vesicles in the periphery of basal keratinocytes facing nerve endings which contained many neurovesicles suggests reciprocal effects between keratinocytes and nerve endings. The number of SP-positive nerve fibers in AD lesions was far less than one-tenth of the number of PGP-positive nerve fibers.

Effects of near-infrared radiation on the epidermal proliferation and cutaneous immune function in mice

While ultraviolet radiation alters various cutaneous cell functions, little is known about the photobiological effects of infrared radiation (IR) on the skin except its local thermal effect. This study demonstrated that single exposure of mouse skin to near IR (0.7-1.3 microns) reversibly suppressed the proliferating activity of the epidermis, the density of Langerhans cells, and the ability of skin to induce contact hypersensitivity reaction. During the exposure, the ear surface temperature was elevated from a mean of 27 to 31.2 degrees C. The results suggest that near IR can modulate the epidermal proliferation and part of the skin immune system, with a mild thermal effect.

Alterations in ICAM-1 and ELAM-1 expression in psoriatic lesions following various treatments

The expression of endothelial leukocyte adhesion molecule-1 (ELAM-1) and intercellular adhesion molecule-1 (ICAM-1) in psoriatic lesions was immunohistochemically examined before and after various single and combination therapies. The increased staining intensity of both adhesion molecules on the proliferated papillary venules in pretreated lesion was markedly reduced after cyclosporin-A monotherapy and etretinate therapy combined with oral eicosapentaenoic acid (EPA), psoralen plus ultraviolet-A radiation (PUVA) or ultraviolet-B radiation (UVB). Less pronounced alterations were observed with etretinate, EPA, PUVA, UVB, and topical corticosteroid alone. The epidermal expression of ICAM-1, on the other hand, faded out completely following any of the treatment measures. The findings suggest that cyclosporin-A monotherapy and the etretinate combination therapies have greater inhibitory effects on the endothelial expression of the adhesion molecules than the other monotherapies. Loss of the epidermal expression of ICAM-1 may be nonspecific to the treatment.

Increased met-enkephalin plasma levels in hemodialysis patients with or without pruritus

Met-enkephalin plasma levels were measured in 21 hemodialysis patients with or without pruritus. The mean value was significantly increased in the total of the patients compared with that in ten healthy subjects. There was, however no correlation between met-enkephalin levels and the degree of pruritus. The findings suggest that the opioid system may be activated in this condition, although the relevance of this endogenous opioid peptide to pruritus remains to be determined.

Histamine-releasing factor(s) in sera of uraemic pruritus patients in a possible mechanism of UVB therapy

Uraemic pruritus is poorly understood despite the high incidence among chronic renal failure (CRF) patients undergoing haemodialysis. Serum histamine levels have been shown to be elevated in CRF patients with itching, and ultraviolet B (UVB) therapy, even if applied to only part of the body surface, has been reported to be beneficial for the generalized relief of the pruritus. A local mechanism of UVB action is suggested by evidence that UVB radiation is able to suppress histamine release from mast cells. However, detailed systemic mechanism(s) remain obscure. Sera from patients with or without uraemic pruritus were incubated with purified rat peritoneal mast cells and the resulting histamine release was compared. A higher histamine release was obtained with sera from uraemic pruritus patients (44.60 +/- 6.32%, n = 9, P < 0.005) than with sera from patients without itching (19.71 +/- 3.14%, n = 5, P > 0.25) and with normal control sera (23.62 +/- 7.14%, n = 6). This increased histamine release was dose-dependently restored to spontaneous release levels in five of seven patients by pre-exposure of the sera to UVB in vitro. From these results, sera of CRF patients with uraemic pruritus were considered to contain some histamine releasing factor(s) which was depleted or diminished by UVB irradiation, suggesting a possible systemic mechanism of UVB action.

Anti-inflammatory effects of eicosapentaenoic acid on experimental skin inflammation models

Anti-inflammatory effects of eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) were examined on three models of skin inflammation induced in mice by topical application of an arachidonic acid (AA) solution, ultraviolet-B (UVB) irradiation, and contact sensitization with dinitrofluorobenzene. Ear oedema reactions induced by AA and UVB irradiation were significantly suppressed in mice fed a daily dose of 300 mg/kg EPA for 2 weeks. The contact hypersensitivity reaction was not impaired by EPA. None of the skin reactions was significantly inhibited in mice fed DHA or safflower oil. The results suggest that EPA, but not DHA, has anti-inflammatory effects on AA- and UVB-induced acute inflammation reactions.

Lectin staining of the endothelial cell membrane is more sensitive to ultraviolet radiation than the epidermal cell staining in guinea-pig skin

Ultraviolet radiation (UVR)-induced alterations in lectin stainings of both endothelial and epidermal cells were histochemically analysed in guinea-pig skin using Bandeiraea simplicifolia agglutinin-I and Ricinus communis agglutinin-I. The endothelial cell staining with both lectins was more sensitive to a single exposure to middle-wave UVR (UVB) and topical psoralen plus long-wave UVR (UVA) (PUVA) than the epidermal cell staining. More remarkable changes were seen following PUVA radiation than UVB radiation. No significant alterations were induced by UVA radiation alone or psoralen alone. The results suggest that the endothelial cell is a susceptible target for UVB and PUVA radiation.

Ultraviolet radiation abolishes cutaneous nerve stainings with two axon-specific antibodies in guinea-pig skin

Cutaneous nerve fibers in guinea-pig skin were histochemically stained with two specific antibodies against different axonal proteins, a newly available protein gene product 9.5 and neuron-specific enolase. A semi-quantitative analysis revealed that the density of nerve fibers positive for either antibody was reversibly decreased following a single exposure to medium wave length ultraviolet (UVB) radiation and psoralen plus long wave ultraviolet (UVA) radiation (PUVA). UVA radiation alone did not markedly affect nerve fiber staining. The UVB/PUVA-induced nerve changes were augmented and prolonged following multiple exposures to UVB and PUVA. Nerve fiber staining was not altered by topical application of corticosteroids. Our findings suggest that both UVB and PUVA can alter the cutaneous innervation density.

Infrared radiation suppresses ultraviolet B-induced sunburn-cell formation

Sunburn cell (SC) formation, a quantifiable measure of epidermal cell injury induced in mouse ear skin by ultraviolet-B (UVB) radiation (290-320 nm), was significantly decreased by pre-exposure to infrared radiation (IR), which elevated the surface temperature of ear lobes to 37-42 degrees C. An autoradiographic study demonstrated that the basal cell labelling indices were significantly reduced in a surface temperature-dependent manner by pre-exposure to IR. Taken together with our previous findings that SC formation depends upon the ratio of cycling to non-cycling cells, the present findings suggest that IR retards the cell cycle and, as a result, decreases SC formation. SC counts were not altered by post-UVB exposure to IR. The effect of IR or the IR-induced increase in surface temperature should be considered when studying cutaneous damage by UVB and sunlight.

The effects of non-interval PUVA treatment on Langerhans cells and contact hypersensitivity

Although application of topical psoralen followed immediately by ultraviolet-A irradiation (non-interval PUVA) was reported to be effective in the treatment of psoriasis, its precise mechanisms of action have not yet been explored. Since regular topical PUVA therapy, consisting of the topical application of psoralen followed by UVA exposure 1-2 h later, can change the number and morphology of Langerhans cells (LCs) and inhibit contact hypersensitivity (CHS), we investigated whether these same effects may be induced by non-interval PUVA. Our results showed that no differences exist between these two types of PUVA treatment. Non-interval PUVA treatments of 3 J/cm2 produced no erythematous reactions and resulted in changes in the number and morphology of LCs. The non-interval regimen also inhibited CHS to dinitrofluorobenzene applied to the treated skin by inducing the suppressor lymphocytes. These results suggest that there might be a link between the observed changes of the LCs and the effectiveness of non-interval PUVA therapy in the treatment of psoriasis, through a mechanism other than the inhibition of DNA synthesis of psoriatic keratinocytes.

Extensive variant of cutaneous amyloidosis: report of a case with electron-microscopic and immunohistochemical studies of the basement membrane zone at sites of amyloid production

A 60-year-old Japanese female developed widespread lichenoid eruptions with pigmentation, which initially appeared in preceding erythematous skin lesions due to dermatomyositis. Thioflavine T and Dylon stainings, electron microscopy and immunohistochemistry revealed that thick amyloid deposits were present in the papillary dermis particularly beneath the epidermis. Autopsy showed no evidence of systemic amyloidosis. Electron microscopy of the lesional skin disclosed the disturbance of lamina densa formation in the epidermal basement membrane zone (BMZ). There was disruption and dissociation of the lamina densa from the basal cell, and a lamina-densa-like substance was found in the amyloid deposits. Immunofluorescence and immunoelectron microscopy showed that type IV and VII collagens, LDA-1 antigen (a noncollagenous component of the BMZ) and laminin were distributed in irregular thick deposits along the BMZ and were also present within the amyloid itself. These findings indicate that morphological and immunohistochemical abnormalities of the lamina densa may be involved in amyloid production at the interface of the epidermis and dermis, at least in this case.

Two cases of diaper area granuloma of the adult

Two cases of diaper area granuloma are reported. Patient 1, a 34-year-old man, had multiple reddish-purple nodules over the diaper area of the right part of the genitocrural region. Candida albicans was not detected from the lesion. Histological examination of the nodule showed acanthosis and dense infiltrates. The granulomas became smaller and flatter after the control of urination. Patient 2, a 28-year-old man, had two large decubitus lesions and multiple nodules over the diaper area of the gluteal region. The decubitus became smaller and the granulomas disappeared after the lesion was kept clean. Because these granulomas resemble granuloma gluteale infantum, but occurred in adults rather than in the aged or infants, we propose to call this condition "granuloma gluteale adultorum." We suggest that these granulomas may represent an inflammatory reaction to the irritation of urine or feces. It is, therefore, of great importance to treat and prevent this condition by controlling the flow of urine and keeping the region clean.

Successful treatment of adult Henoch-Schönlein purpura with factor XIII concentrate

We report the cases of three adult patients with severe abdominal complications of Henoch-Schönlein purpura who had low activity of factor XIII during the acute phase of the disease. In all three cases, abdominal symptoms and purpura immediately responded to heat-treated, placenta-derived factor XIII concentrate. No adverse effects were experienced. Factor XIII concentrate replacement should be considered as the initial treatment for severe abdominal symptoms in adult Henoch-Schönlein purpura associated with a decreased level of factor XIII activity.

Another mechanism for the defect in type III collagen accumulation in Ehlers-Danlos syndrome type IV: increased intracellular degradation of the procollagen

The nature of type III collagen was examined in the skin and cultured skin fibroblasts from a patient with Ehlers-Danlos syndrome type IV. Although the culture medium contained a much lower amount of Type III collagen than the controls, the cells contained an apparently normal amount of Type III collagen. The patient's Type III procollagen showed no abnormalities in apparent molecular weight, the peptide length as examined by cyanogen bromide cleavage, the genomic DNA size including its C- and N-propeptide portion, mRNA size, or thermal stability; but a pulse-chase study revealed prolonged retention of the type III collagen in the cells. Degradation of Type III procollagen was induced by cell extracts but did not occur in the extracellular space and was inhibited in intact cells by the addition of ammonium chloride or leupeptin to the culture medium. Fluorescent staining showed a characteristic granular deposition of Type III procollagen in the peripheral region of the cytoplasm but no granular deposition of Type I procollagen. These results offer new insight into the mechanism of the decreased amount of Type III collagen in the tissue of patients with Ehlers-Danlos syndrome type IV.

Aleukemic leukemia cutis

A 39-year-old man had multiple nodules on the skin. The appearance of atypical monocytes in a skin biopsy specimen preceded the onset of overt acute monocytic leukemia by 14 months.

Ultraviolet radiation suppresses mouse-ear edema induced by topical application of arachidonic acid

The effect of ultraviolet (UV) radiation on arachidonic acid (AA) cascade was examined using an in vivo model. Mouse ear lobes were painted with 1 mg AA, and the maximum response of ear swelling was measured 1 h after challenge. Arachidonic-acid-induced ear swelling was significantly suppressed by preexposure to topical psoralen plus noninflammatory doses of long-wave UV radiation (PUVA) or middle-wave UV (UVB) radiation. Ultraviolet radiation may interfere with AA pathways to suppress ear swelling since AA-induced ear swelling is considered to be mediated by metabolites derived from exogenous AA. The results may relate to the therapeutic mechanisms of UV radiation in psoriasis in which the eicosanoid cascade is involved.

Erythroderma with generalized lymphadenopathy induced by phenytoin

A 40-year-old man developed a generalized erythematous rash, fever, and systemic lymphadenopathy after treatment for two months with anticonvulsants including phenytoin. Laboratory examinations revealed increased white blood cell counts with eosinophilia, abnormal liver function, and increased gammaglobulin levels. A lymphocyte stimulation test showed a significant stimulation index for phenytoin. Skin biopsy findings were nonspecific cellular infiltrates in the upper dermis whereas in lymph nodes the normal architecture was replaced by massive cellular infiltrates consisting largely of lymphocytes, immunoblasts, and eosinophils suggesting a pattern of phenytoin lymphadenopathy. No malignant changes were noted. Phenytoin was discontinued and after a two-month treatment with oral corticosteroids, all manifestations had nearly subsided. However, the patient should be carefully followed up since phenytoin occasionally induces lymphoproliferative states including malignant lymphoma even after cessation of the medication.

Suppressed histamine release from rat peritoneal mast cells by ultraviolet B irradiation: decreased diacylglycerol formation as a possible mechanism

This study was designed to investigate the effect of ultraviolet B (UVB) irradiation on mast cell functions. Purified mast cells obtained from rat peritoneal cavity were irradiated with UVB and subsequently exposed to a degranulator, compound 48/80, or the calcium ionophore A-23187. The amount of histamine released from mast cells measured by the enzyme isotopic assay was significantly decreased by UVB irradiation (100-400 mJ/cm2). Within this dose range, UVB alone was not cytotoxic to the cells because it did not induce histamine release. The suppression was observed when mast cells were subjected to degranulation without intervals after UVB irradiation, and even after 5 h postirradiation. The wavelength of 300 nm from a monochromatic light source showed the maximum effect. When mast cells prelabeled with [3H]arachidonate were irradiated and challenged by compound 48/80, label accumulation in diacylglycerol produced by the phosphatidylinositol cycle was considerably decreased by UVB irradiation. From these results, we hypothesize that, within an adequate irradiation dose, UVB irradiation suppresses histamine release from mast cells, probably by causing noncytotoxic damage to the membrane phospholipid metabolism, which is tied to the degranulation mechanisms.

Increased serum levels of squamous cell carcinoma-related antigen in pemphigus

Serum levels of squamous cell carcinoma-related antigen (SCC-RAG) were measured in five cases of pemphigus, five cases of bullous pemphigoid and 18 cases of benign and malignant dermatoses other than SCC. The SCC-RAG titres were significantly raised in four of five patients with pemphigus, while they remained within the normal range in the other dermatoses except in one case. In three pemphigus cases in whom serial measurements were made, SCC-RAG levels seemed to be related to disease activity. The SCC-RAG levels in blister fluids were much higher than those in serum, suggesting that the skin is a major source of serum SCC-RAG. These results show that SCC-RAG is increased not only in SCC, but also in some cases of pemphigus, and suggest that pemphigus antibodies may cause the production or release of SCC-RAG.

Epidermolytic hereditary palmoplantar keratoderma. Histologic, ultrastructural, protein-chemical, and DNA analyses in two patients

Two cases of epidermolytic hereditary palmoplantar keratoderma were studied by histologic, ultrastructural, protein-chemical, and genetic methods. Histologically, epidermolytic hyperkeratosis was seen at the spinous and granular layers. Electron microscopy showed the aggregation of tonofibrils and an early appearance of keratohyaline granules as well as vacuolar formation in the epidermal cells. Some of these morphologic abnormalities were detected even in the basal cells. The decrease of 67-kilodalton (kd) keratin and the appearance of 48-kd keratin were noted by using sodium dodecyl sulfate polyacrylamide gel electrophoresis. Genetic analysis of the keratin gene family using 67-kd keratin complementary DNA by Southern blot analysis revealed the conserved gene organization of the 67-kd keratin gene. These findings suggest that undetermined regulatory abnormalities of keratinization, but not the gene structure itself, may be causative factors of this rare disease.

Effects of substance P and substance K on the growth of cultured keratinocytes

The effects of substance P and substance K, which are coexpressed in the same mRNA as a beta-preprotachykinin in peripheral tissues and released in the inflammatory lesion of the skin, were examined on epidermal proliferation using spontaneously transformed mouse epidermal cell line (Pam 212 cells). Substance P stimulated the synthesis of DNA of Pam 212 cells in the medium containing 2%-10% fetal calf serum (FCS). Stimulation of DNA synthesis was dose dependent if the cells were cultured in the medium containing 2% FCS (quiescent condition). This effect was inhibited by spantide. In a serum-free medium, substance P had no effect on keratinocyte proliferation. In contrast, substance K, which shares a common amino acid sequence with substance P on its C-terminal, did not affect DNA synthesis of Pam 212 cells in either medium condition. Substance P released in inflammation may stimulate epidermal proliferation.

Antithrombotic treatment in livedo vasculitis

Two patients with livedo vasculitis were treated successfully with antiplatelet drugs including ticlopidine hydrochloride, dipyridamole, and low-dose aspirin. Increased platelet functions were restored 1 week after the beginning of the treatment, followed by dramatic improvement of painful leg ulcers within 1 month. Livedo status was unchanged. We claim that antiplatelet therapy should be the first choice of treatment in this disease.