对超声凝胶中丙二醇发生过敏接触性皮炎1例(发生在肝细胞癌动脉导管栓塞治疗皮肤损伤泄露处)

A 63-year-old man with hepatocellular carcinoma consequent to chronic viral hepatitis C presented with severe dermatitis on the lower right side of the back after transcatheter arterial chemoembolization (TACE) via the 10th intercostal artery, because his hepatic artery had already collapsed due to repeated usage for TACE. The regional skin showed redness and hardness with pustules. Histologically, there was epidermal and appendage necrosis, as well as exocytosis of red blood cells. With a diagnosis of skin injury due to leakage of lipiodol ultrafluid, mitomycin, and epirubicin, administered via the 10th intercostal artery, onto the skin tissue, topical application of 0.06%fluocinonide-containing cream was prescribed. After several weeks of conservative local treatment, the leakage skin injury improved significantly, leaving pigmentation, hardness, and a small necrotic mass, as reported elsewhere (Honda T, Matsushima S, Fujii S, et al. A case of skin injury following transcatheter arterial chemotherapy through intercostal artery for hepatocellular carcinoma. Skin Res 2003; 2: 18-22)-. Subsequently, the patient again consulted the Dermatology Department with further dermatitis in an almost identical skin region on the right side of the abdomen (irregularly spreading erythematous and edematous eruptions with itching; Fig. 1). As he had undergone an ultrasonic examination 2 days earlier, allergic contact dermatitis from the ultrasonic gel was suspected. The contact dermatitis was treated with a topical corticosteroid hormone-containing ointment. Patch testing was performed with Ultra Phonic Conductivity Gel (Pharmaceutical Innovations Inc., Newark, NJ, USA), with which the patient had undergone a series of ultrasonic examinations, and Sono Jelly (Toshiba Medical Supply Co., Ltd., Tokyo, Japan) as a reference, as well as white petroleum as a negative control. A positive result was obtained for Ultra Phonic Conductivity Gel, whereas Sono Jelly was negative (Fig. 2a). Pharmaceutical Innovations Inc. kindly supplied the ingredients of the gel: propylene glycol (PG), preservative in PG, color in PG, thickener 1, and thickener 2. The company gave no further details about the preservative, color, and thickeners. Patch testing was performed using these five materials, resulting in a positive reaction for PG, preservative in PG, and color in PG. Thickeners 1 and 2 and lipiodol ultrafluid were negative (Fig. 2b). On the assumption that the causative chemical was PG, commercially obtained PG, free of preservative and color, was then patch tested (original, 10%aqueous, 1%aqueous, and 0.1%aqueous solutions), resulting in original strongly positive, 10%positive, and 1%and 0.1%weakly positive (Fig. 2c). The medical records showed that the patient had received 16 ultrasonic examinations with the same ultrasonic gel before the leakage skin injury. The 17th examination was performed 2 days after leakage dermatitis, and the 18th 3 months after the injury,when contact dermatitis occurred. The 19th examination was performed using Sono Jelly, which contains no PG, and no skin problems were observed.

复发性水痘引起的寻常型天疱疮皮损由口腔黏膜向体表发展1例

A 60- year- old female with pemphigus vulgaris limited to the oral mucosa being treated with prednisolone showed a widespread extension of lesions to the body and extremities over a short period. The eruptions on the body began as small vesicles that looked unlike the blisters of pemphigus vulgaris, and increased to large blisters and erosions compatible with pemphigus. A smear test of the vesicles in the early stage demonstrated multinucleated acantholytic keratinocytes, which were positively stained with an antivaricella zoster virus (VZV) antibody by the immunoperoxidase method. The widespread eruptions improved immediately after 5 days’ administration of valaciclovir hydrochloride tablets and increased dosage of prednisolone, leaving tiny shallow scars and pigmentation. The anti- VZV antibody in the serum was not elevated, and there were no zosteriform eruptions noted during the course. We thought that widespread extension of the pemphigus vulgaris in this case was provoked by recurrent varicella, in a similar fashion to Koebner phenomenon.

光学相干断层扫描研究特发性黄斑裂孔的裂孔形状对术后视力结果的预测

Purpose To evaluate whether an index based on hole configuration can be used t o predict visual outcome in eyes with idiopathic macular holes. Design Prospecti ve interventional case series. Methods Thirty five eyes of 32 patients with idi opathic stage 2 or 3 macular hole were enrolled in this study. The best correct ed visual acuity (BCVA), cross sectional image of the macular hole by optical c oherence tomography (OCT), and retinal thickness in the central ( < 1000 μm), i nner (1000 to 2220 μm), and outer ring areas (2220 to 3450 μm) as defined by t he OCT retinal mapping program were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively. The change in retinal thickness of the inner ring ar ea at the 6month postoperative period was used to evaluate the degree of preoper ative retinal deformation. The macular hole index (MHI) (ratio of hole height to base diameter of hole) was calculated and correlated with minimum diameter of h ole, base diameter of hole, the postoperative decrease in macular thickness, and the postoperative BCVA. The postoperative BCVA was further evaluated in two pat ient matched groups. Results Retinal thickness values in the inner ring area we re decreased at the 1 month postoperative period. MHI significantly correlated with the postoperative decrease in macular thickness in the inner ring area at 6 months (correlation coefficient=-0.632, P=.030, Spearman analysis) and with th e postoperative BCVA (P=.013, multiple regression analysis). Postoperative BCVA in the MHI ≥0.5 group was better than that in the MHI < 0.5 group (P= .032, Man n Whitney test). Conclusions The MHI is a ratio easily calculated from OCT tran sverse images of the macular area. The MHI represents the preoperative configura tion of a macular hole and is a prognostic factor for visual outcome.

长期重度溃疡性结肠炎患者肠道非肿瘤上皮的雌激素受体基因甲基化可预示结肠直肠癌肿瘤的发生

Background: Surveillance colonoscopy is widely recommended in patients with longstanding and extensive ulcerative colitis (UC) in order to detect colorectalneoplasia at an early stage. However, it still remains questionable whether surveillance colonoscopy effectively enables early detection of UC associated neoplasia. There is a great need for sensitive markers to identify individuals at increased risk of neoplasia. The oestrogen receptor (OR) gene shows age related methylation in the colorectal epithelium and is methylated frequently in sporadic colorectal neoplasia, suggesting that OR methylation may predispose to colorectal neoplasia. Aim: To clarify whether analysis of methylation of the OR gene in non-neoplastic epithelium can contribute to prediction of increased neoplasia risk in UC patients. Materials and methods: Atotal of 165 non-neoplastic colorectal epithelia from 30 patients with longstanding and extensive UC, including 13 UC patients with neoplasia and 17 patients without, were evaluated. Methylation specific polymerase chain reaction was performed to determine the methylation status of the OR gene. Results: Methylation of the OR gene was detected in 54 of 70 (77.1% ) non-neoplastic colorectal epithelia in UC with neoplasia but in only 23 of 95 (24.2% ) without neoplasia. Methylation of the OR gene was significantly more frequent in non-neoplastic epithelium from UC with neoplasia than in chronic colitic epithelium from UC without neoplasia. Furthermore, in UC with neoplasia, the OR gene was extensively methylated in non-neoplastic epithelia throughout the colorectum compared with those in UC without neoplasia. Conclusion: These results suggest that analysis of OR gene methylation may have potential as a useful marker for identifying individuals at increased risk of neoplasia among those with longstanding and extensive UC.