Enhancement patterns of pancreatic adenocarcinoma on conventional dynamic multi-detector row CT:Correlation with angiogenesis and fibrosis

AIM:To evaluate retrospectively the correlation between enhancement patterns on dynamic computed tomography (CT) and angiogenesis and fibrosis in pancreatic adenocarcinoma.METHODS: Twenty-three patients with pancreatic adenocarcinoma underwent dynamic CT and tumor resection. In addition to the absolute and relative enhanced value that was calculated by subtracting the attenuation value on pre-contrast from those on contrast-enhanced CT in each phase, we defined one parameter, "tumor-aorta enhancement ratio", which was calculated by dividing enhancement of pancreatic cancer by enhancement of abdominal aorta in each phase. These enhancement patterns were correlated with the level of vascular endothelial growth factor (VEGF), microvessel density (MVD), and extent of fibrosis.RESULTS: The absolute enhanced value in the arterial phase correlated with the level of VEGF and MVD (P=0.047, P=0.001). The relative enhanced value in arterial phase and tumor-aorta enhancement ratio (arterial) correlated with MVD (P=0.003, P=0.022). Tumor-aorta enhancement ratio (arterial) correlated negatively with the extent of fibrosis (P=0.004). The tumors with greater MVD and higher expression of VEGF tended to show high enhancement in the arterial dominant phase. On the other hand, the tumors with a larger amount of fibrosis showed a negative correlation with the grade of enhancement during the arterial phase.CONCLUSION: Enhancement patterns on dynamic CT correlated with angiogenesis and may be modified by the extent of fibrosis.

Pseudolymphoma of the liver associated with primary biliary cirrhosis:A case report and review of literature

We report a case of two pseudolymphomas of the liver in a 63-year-old Japanese woman with primary biliary cirrhosis.One of the lesions was found incidentally during a medical examination,presenting as a 10 mm hypodense nodule that revealed hyperdensity in the early phase and hypodensity in the late phase in computed tomography(CT)after injection of contrast medium.Retrospectively,the 10 mm nodule had first been discovered as a 4 mm nodule during CT 4 years previously.Superparamagnetic iron oxide-enhanced MRI revealed another 4 mm hyperintense nodule in segment 6 in addition to the 10 mm hyperintense nodule in segment 7.CT during arterial portography revealed two hypointense nodules.Findings with other imaging modalities such as ultrasonography,magnetic resonance imaging,and hepatic angiography were consistent with hepatocellular carcinoma.A right posterior segmentectomy was performed,and the lesions were microscopically diagnosed as pseudolymphoma.To the best of our knowledge,only 31 other cases of this disease have ever been reported,with a highly asymmetrical male:female ratio of 1:9.7.Although we could find only one case of transformation of hepaticpseudolymphoma into lymphoma in the liver,the exact nature of development from benign pseudolymphoma to malignant lymphoma is still not fully understood and cases of hepatic lymphoma need to be followed carefully.

Aberrant methylation of the TDMR of the GTF2AIL promoter does not affect fertilisation rates via TESE in patients with hypospermatogenesis

Increasing evidence shows a relationship between epigenetic regulation and male infertility. The GTF2A1L gene promoter contains the DNA methylation site of a tissue-specific differentially methylated region （TDMR）. Eighty-six patients with non-obstructive azoospermia were assessed for the DNA methylation state of CpG islands in the GTF2AIL promoter using testicular genomic DNA. Based on histological criteria, 26 of the 86 patients had normal spermatogenesis （controls）, 17 had hypospermatogenesis and 26 had a Sertoli cell-only phenotype or tubular sclerosis. GTF2AIL TDMR methylation was significantly lower in testes DNA from control samples than from hypospermatogenic samples （P=0.029）. Patients with hypospermatogenesis were divided into two subgroups： high DNA methylation （HM, n=5） and low DNA methylation （LM, n= 12）. The GTF2AIL TDMR methylation rate differed significantly between the HM and LM groups （P=0.0019）, and GTF2A 1L expression was significantly higher among the LM than in the HM patients （P=0.023）. High TDMR methylation was correlated with low GTF2AIL gene expression levels. Both groups demonstrated relatively good outcomes with respect to sperm retrieval, fertilisation, pregnancy and childbirth rates. We observed that aberrant GTF2AIL gene expression was not correlated with fertilisation rates. The testicular sperm extraction （TESE） technique may be used to overcome male infertility due to aberrant TDMR methvlation.

Effects of mineralocorticoid receptor antagonists on responses to hemorrhagic shock in rats

AIM To evaluate the effects of mineralocorticoid receptor(MR) antagonists on mortality and inflammatory responses after hemorrhagic shock(HS) in rats.METHODS One hundred and two male Sprague–Dawley rats were randomly assigned to one of the following three groups: Control, spironolactone (SPL), and eplerenone(EP) groups. HS was induced by the removal of blood. One half of rats were evaluated to determine mortality, hemodynamics, plasma tumor necrosis factor-alpha(TNF-α) concentrations, and arterial blood gas at 8 h afterHS recovery. In the remainder of rats, the expression levels of genes encoding cytokines were evaluated in liver tissue samples at 1 h after HS recovery. RESULTS The survival rates 8 h after HS recovery were 71%, 94%, and 82% in the control, SPL, and EP groups, respectively. There were no significant differences in survival rates among the three groups (P = 0.219). Furthermore, there were no significant differences in gene expression levels in the liver or plasma TNF-α concentrations among the three groups(P = 0.888).CONCLUSION Pretreatment with MR antagonists did not improve mortality or cytokine responses in the liver after HS recovery in rats.

Effectiveness and adverse effects of hormonal therapy for prostate cancer： Japanese experience and perspective

Recently, novel anti-androgens and inhibitors of androgen biosynthesis have been developed through the elucidation of mechanisms of castration resistance of prostate cancer. We believe that these new developments will improve hormonal therapy. On the other hand, there has been an increase in criticism of hormonal therapy, because hormonal therapy is supposed to induce adverse effects such as cardiovascular disease. In this review, we have introduced the Japanese experience of hormonal therapy, because we believe that there may be ethnic differences between Caucasians and Asian people in the efficacy and adverse effects of hormonal therapy. First, we showed that primary hormonal therapy can achieve long-term control of localized prostate cancer in some cases and that quality of life of patients receiving hormonal therapy is rather better than previously thought. Neoadjuvant and adjuvant hormonal therapy in cases undergoing radical prostatectomy or radiotherapy are very useful for high-risk or locally advanced prostate cancer. Further clinical trials are required to confirm the efficacy of neoadjuvant or adjuvant hormonal therapy. We showed that the death from cardiovascular dis- eases in Japanese patients receiving hormonal therapy was not higher than that in the general population. However; efforts should be made to decrease the adverse effects of hormonal therapy, because life-style change may increase the susceptibility to adverse effects by hormonal therapy even in Japan. Managements of endocrine and metabolic dysfunction, such as diabetes mellitus, are essential. New hormonal compounds such as selective androgen receptor modulators capable of specifically targeting prostate cancer are expected to be developed.

Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases

BACKGROUND Although contrast-enhanced magnetic resonance imaging(MRI)using gadoxetic acid has been shown to have higher accuracy,sensitivity,and specificity for the detection and characterization of hepatic metastases compared with other modalities,the long examination time would limit the broad indication.Several abbreviated enhanced MRI(Ab-MRI)protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases.However,an optimal protocol has not been established,and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography(CE-CT),which is the preoperative imaging of colorectal cancer staging in clinical settings,to determine the best therapeutic strategy.AIM To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.METHODS Study participants comprised 87 patients(51 males,36 females;mean age,67.2±10.8 years)who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021.Each exam was independently reviewed by two readers in three reading sessions:(1)Only single-shot fast spin echo(FSE)T2-weighted or fat-suppressed-FSE-T2-weighted,diffusion-weighted,and hepatobiliary-phase images(Ab-MRI protocol 1 or 2);(2)all acquired MRI sequences(standard protocol);and(3)a combination of an Ab-MRI protocol(1 or 2)and CE-CT.Diagnostic performance was then statistically analyzed.RESULTS A total of 380 Lesions were analyzed,including 195 metastases(51.4%).Results from the two Ab-MRI protocols were similar.The sensitivity,specificity,and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI(P>0.05),while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone,although the difference was not significant(P>0.05),and were quite similar to those from standard MRI(P>0.05).CONCLUSION The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol.Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.

Attenuation of nicotine-evoked Ca²⁺influx by antibody to the nicotinic acetylcholine receptor <i>α</i>3 subunits in human embryonic kidney cells

Autoantibody against neuronal nicotinic acetylcholine receptor (nAChR) α3 subunit is implicated in severe autonomic dysfunction in the patients with autoimmune autonomic ganglionopathy (AAG). Although this autoantibody has been revealed to impair fast excitatory synaptic transmission in autonomic ganglia, its precise mechanism remains unknown. Here, we show that antibody-induced reduction of cell-surface α3 subunits result in impairment of nicotine-evoked Ca2+ influx in stably transfected human embryonic kidney cells. These effects of the antibody were remarkably inhibited by interfering with the endocytic machinery at low-temperature. We conclude that reduction of nAChR in autonomic ganglia can be mediated by the endocytosis of α3 subunits, and resulted in autonomic failure in AAG patients.

Overall Estimation of Anti-Oxidant Activity by Mammal Macrophage

Super oxide anion had been known as a critical role in a phagocytic cell when microorganisms invade inside. However, this radical seldom need for a clean environment such in a developed country. Moreover, this agent sometimes triggered as serious factor in the site of inflammation. There are many papers which concerned newly found anti-oxidative substances. However, many reports only focused on the molecular basis in vitro, how oxidative stress damaged the human tissue. The key factor for oxidative stress needs to be discussed first for immunological standpoint, such as armed reduction treaty. In other words, minimum armed force is necessary for an invasion by outer or inner irregular cells. On the basis of phagocytic function of the cell in vivo, we tried to access anti-oxidative activity by employing peritoneal murine macrophage and human monocyte. So, the purpose of this study is to establish a conventional but tailor made system for which is useful for evaluating the anti-oxidative activity to different constition. Especially in human peripheral monocyte, the sample was tested each constitution such in granulocyte rich type and lymphocyte rich typ. In order to establish the direct estimation by phagocytic cell, a murine peritoneal exudates cell suspension was obtained after one week of oral administration with anti-oxidative sample. The samples we selected were traditional Chinese medicine, Shi-Quan-Da-Bu-Tang (SDT), Bu-Zong-Ye-Qi-Tang (BYT) and Shao-Chin-Rong-Tang sCRT), Agaricus, Chlorella, and Propolis. The amount of generated super oxide anion was calculated through measuring the optical density change of this supernatant using cytochrome-C which was reduced by generated super oxide anion in the phagocytic cell. The generated super oxide anion after administration of Agaricus, Chlorella, SDT, BYT, sCRT and Propolis were 2.64, 1.95, 1.24, 1.25, 2.88, 2.55 × 10﹣5 mmol/ml, respectively, whereas 2.85 × 10﹣5 mmol/ml in control group. The fermented sample from SDT, BYT, sCRT and microfied Propolis were also tested and the value of super oxide anion were 0.62, 0.84, 1.50 and 2.55 × 10﹣5 mmol/ml, respectively. In this report, we discussed the direct method for measuring the generated super oxide anion of macrophages, especially from different constitution.

A comparison of the efficacy of dutasteride on reducing lower urinary tract symptoms among patients with small versus large benign prostatic hyperplasia

Background Only a few reports have currently studied the efficacy of dutasteride in patients with small benign prostatic hyperplasia(BPH).We investigated the efficacy of dutasteride on reducing lower urinary tract symptoms among them.Materials and methods A total of 81 patients with BPH who completed 52weeks of 0.5?mg dutasteride treatment were enrolled.Each patient filled out the International Prostatic Symptom Score(IPSS)and overactive bladder symptom score(OABSS)at baseline and at the 6-and 12-month follow-up visits.Total testosterone,prostate-specific antigen,adenoma/prostate volume(PV),uroflowmetry analysis,and postvoid residual volume were evaluated at baseline and at the 12-month follow-up visit.The enrolled patients were divided into 2 groups according to PV at baseline.The groups were as follows:Group A(PV≥30 mL)and Group B(PV<30 mL).Results Groups A and B had mean PVs of 52.1 and 23.6 mL and mean IPSS scores of 16.7 and 14.4,respectively.Group A had significantly higher OABSS and prostate-specific antigen levels at baseline than Group B,while no significant differences in any other baseline characteristics was observed.After dutasteride treatment,adenoma volume and PV decreased significantly,while testosterone level showed a significant increase in both groups.Group A showed significant improvements in the total IPSS,voiding and storage subscore of the IPSS,OABSS,maximum flow rate,and postvoid residual volume.Group B,on the other hand,also showed significant improvements only in the total IPSS,voiding subscore of the IPSS,and maximum flow rate.Conclusions The present study suggests a possible beneficial effect of dutasteride treatment on the reduction of lower urinary tract symptoms in patients with small and large BPH.However,the effectiveness of dutasteride was limited compared to patients with large BPH(PV≥30 mL).

Hepatitis B virus X protein induces hepatic stem cell-like features in hepatocellular carcinoma by activating KDM5B

To determine the role of hepatitis B virus X protein (HBx), HBx in regulating hepatic progenitor cell (HPC)-like features in hepatocellular carcinoma (HCC) and the underlying molecular mechanisms.METHODSWe used a retrovirus vector to introduce wild type HBx or empty vector into HepG2 cells. We then used these cells to analyze cell proliferation, senescence, transformation, and stem-like features. Gene expression profiling was carried out on Affymetrix GeneChip Human U133A2.0 ver.2 arrays according to the manufacturer’s protocol. Unsupervised hierarchical clustering analysis and Class Comparison analysis were performed by BRB-Array Tools software Version 4.2.2. A total of 238 hepatitis B virus (HBV)-related HCC patients’ array data were used for analyzing clinical features.RESULTSThe histone demethylase KDM5B was significantly highly expressed in HBV-related HCC cases (P < 0.01). In HBV proteins, only HBx up-regulated KDM5B by activating c-myc. Hepatic stem cell (HpSC) markers (EpCAM, AFP, PROM1, and NANOG) were significantly highly expressed in KDM5B-high HCC cases (P < 0.01). KDM5B played an important role in maintaining HpSC-like features and was associated with a poor prognosis. Moreover, inhibition of KDM5B suppressed spheroid formation and cell invasion in vitro.CONCLUSIONHBx activates the histone demethylase KDM5B and induces HPC-like features in HCC. Histone demethylases KDM5B may be an important therapeutic target against HBV-related HCC cases.

CT经动脉门静脉成像与肝动脉成像显示肝癌发生时引流血管多步改变的影像与病理相关性研究

目的利用CT经动脉门静脉成像（CTPA）与CT肝动脉成像（CTHA），以组织学表现为参考标准，明确肝癌生成中发育不良结节与肝细胞癌（HCC）引流血管发生的变化。材料与方法研究由学院伦理委员会批准并获得知情同意书。按CTAP与CTHA的表现，将46个手术切除的肝细胞结节分为3型：A型18个，与肝脏相比。

Combined choriocarcinoma, neuroendocrine cell carcinoma and tubular adenocarcinoma in the stomach

We described a patient with adenocarcinoma of the stomach combined with choriocarcinoma and neuroendocrine cell carcinoma. An 85-year-old man visited our hospital because of appetite loss. Gastric fiberscopy revealed a large tumor occupying the cardial region and anterior wall of the gastric body. The patient underwent total gastrectomy with lymphnode dissection and partial resection of the liver. Choriocarcinoma, small cell carcinoma and tubular adenocarcinoma existed in the gastric tumor. The choriocarcinomatous foci contained cells positive for beta-subunit of human chorionic gonadotropin （B-hCG） and human placental lactogen mainly in syncytiotrophoblastic cells. The small cell carcinomatous loci contained cells positive for synaptophysin, neuron-specific enolase （NSE）, and chromogranin A. The prognosis for gastric adenocarcinoma with choriocarcinoma and neuroendocrine cell carcinoma is exceedingly poor. This patient died about 2 mo after the first complaint from hepatic failure. This is the first reported case of gastric cancer with these three pathological features.

Hepatic pseudolesions caused by alterations in intrahepatic hemodynamics

Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver.The concept of hepatic arterial buffer response(HABR)has become mainstream for the understanding of the mechanism of the reciprocal effect between hepatic arterial and portal venous flow.And HABR is thought to be significantly related to the occurrence of the abnormal imaging findings on arterial phase of contrast enhanced images,such as hepatic arterial-portal vein shunt and transient hepatic attenuation difference,which mimic hypervascular tumor and may cause clinical problems.Third inflow to the liver also cause hepatic pseudolesion,and some of the cases may show histopathologic change such as focal hyperplasia,focal fatty liver,and focal sparing of fatty liver,and called pseudotumor.To understand these phenomena might be valuable for interpreting the liver imaging findings.

Single-nucleotide polymorphisms in HORMAD1 may be a risk factor for azoospermia caused by meiotic arrest in Japanese patients

Genetic mechanisms are implicated as a cause of some male infertility, yet are poorly understood. Meiosis is unique to germ cells and essential for reproduction. The synaptonemal complex is a critical component for chromosome pairing, segregation and recombination. Hormadl is essential for mammalian gametogenesis as knockout male mice are infertile. Hormadl-deficient testes exhibit meiotic arrest in the early pachytene stage and synaptonema! complexes cannot be visualized. To analyze the hypothesis that the human HORMAD1 gene defects are associated with human azoospermia caused by meiotic arrest, mutational analysis was performed in all coding regions by direct sequence analysis of 30 Japanese men diagnosed with azoospermia resulting from meiotic arrest. By the sequence analysis, three polymorphism sites, Single Nucleotide Polymorphism 1 （c. 163A〉G）, SNP2 （c. 501T〉G） and SNP3 （c. 918C〉T）, were found in exons 3, 8 and 10. The 30 patients with azoospermia and 80 normal pregnancy-proven, fertile men were analyzed for HORMAD1 polymorphisms. Both SNP1 and SNP2 were associated with human azoospermia caused by complete early meiotic arrest （P〈0.0S）. We suggest that the HORMAD1 has an essential meiotic function in human spermatogenesis.

Decreasing trend in prostate cancer with high serum prostate-specific antigen levels detected at first prostate-specific antigen-based population screening in Japan

To clarify the recent trends in prostate-specific antigen （PSA） distribution in men in Japan, we analyzed the PSA distributions of men undergoing PSA-based population screening. We summarized the annual individual data of PSA-based population screening in Kanazawa, Japan, from 2000 to 2011, and analyzed baseline serum PSA values of the participants at the first population screening. Serum PSA distributions were estimated in all participants and those excluding prostate cancer patients according to age. From 2000 to 2011, 19 620 men participated aged 54-69 years old in this screening program. Mean baseline serum PSA level of all participants at the first screening was 2.64 ng m1-1 in 2000, and gradually decreased to approximately 1.30 ng ml-I in 2006. That of participants excluding prostate cancer patients was 1.46 ng m1-1 in 2000, and there was no remarkable change during the study period. The 95t＂ percentiles in the participants excluding prostate cancer patients detected at the first population screening of men aged 54-59, 60-64, and 65-69 years old were 2.90, 3.60, and 4.50 ng m1-1, respectively. After the commencement of population screening, the proportion of prostate cancer patients with high serum PSA levels decreased. However, there were no changes in serum PSA levels in men without prostate cancer. Age-specific PSA reference level of men without prostate cancer in Japan was similar to that in China and Korea.

A single nucleotide polymorphism in SPA TA17 may be a genetic risk factor for Japanese patients with meiotic arrest

Genetic mechanisms have been implicated as a cause of some cases of male infertility. Recently, 10 novel genes involved in human spermatogenesis were identified by microarray analysis of human testicular tissue. One of these is spermatogenesis-associated 17 （SPATA17）. To investigate whether defects in the SPATA17 gene are associated with azoospermia due to meiotic arrest, a mutational analysis was conducted, in which the SPATA17 coding regions of 18 Japanese patients with this condition were sequenced. A statistical analysis was carried out that included 18 patients with meiotic arrest, 20 patients with Sertoli-cell-only syndrome （SCOS） and 96 healthy control men. No mutations were found in SPA TA17. However, three coding single nucleotide polymorphisms （cSNPs： SNP 1-SNP3） were detected in the patients with meiotic arrest. No significant differences in the genotype or allele frequencies of SNP1 and SNP2 were found between patients with meiotic arrest and the others. However, the frequency of the SNP3 allele was significantly elevated in the meiotic arrest group （P 〈 0.05）. This study suggests that SPATA17 may play a critical role in human spermatogenesis, especially in meiosis.

Androgen-independent growth in LNCaP cell lines and steroid uridine diphosphate-glucuronosyltransferase expression

Aim: To investigate the mechanism of androgen-independent growth of prostate cancer after androgen ablation in LNCaP cells and the effect of glucuronidation activity. Methods: To establish androgen-independent growth in prostate cancer LNCaP-SF, continuous passage was performed in androgen-stripped medium and the cells were evaluated for glucuronidation activity. The expression vector of antisense uridine diphosphate glucuronosyltransferase (UGT) 2B15 cDNA was also constructed and evaluated. Results: LNCaP-SF lead to a higher expression in UGT2B15 and their glucuronidation activity is 2.5 times higher than that of LNCaP cells. Significantly fewer LNCaP and LNCaP-SF than control were transfected with the antisense UGT2B15 cDNA, suggesting that UGT2B15 plays an important part in the glucuronidation activity of androgens in both cells. Conclusion: The alteration of UGT2B15 expression in LNCaP-SF cells is proposed as a biological characteristic involved in the growth of hormonerefractory prostate cancer.

Intestinal histoplasmosis in immunocompetent adults

AIM: To present a retrospective analysis of clinical and endoscopic features of 4 cases of immunocompetent hosts with intestinal histoplasmosis(IH).METHODS: Four immunocompetent adults were diagnosed with IH between October 2005 and March 2015 at West China Hospital of Sichuan University. Clinical and endoscopic characteristics were summarized and analyzed retrospectively. GMS(Gomori methenamine silver), PAS(periodic acid-Schiff) and Giemsa staining technique were used to confirm Histoplasma capsulatum(H. capsulatum). The symptoms, signs, endoscopic presentations, radiographic imaging, pathological stain results and follow-up are presented as tables and illustrations.RESULTS: The cases were male patients, ranging from 33 to 61 years old, and primarily presented with nonspecific symptoms such as irregular fever, weight loss, abdominal pain and distention. Hepatosplenomegaly and lymphadenopathy were the most common signs. Endoscopic manifestations were localized or diffuse congestion, edema, ulcers, and polypoid nodules with central erosion involving the terminal ileum, ascendingcolon, transverse colon, descending colon, sigmoid colon and rectum, similar to intestinal tuberculosis, tumor, and inflammatory bowel disease. Numerous yeast-like pathogens testing positive for PAS and GMS stains but negative for Giemsa were detected in the cytoplasm of the histiocytes, which were highly suggestive of H. capsulatum.CONCLUSION: Immunocompetent individuals suffering from histoplasmosis are rarely reported. It is necessary that gastroenterologists and endoscopists consider histoplasmosis as a differential diagnosis, even in immunocompetent patients.

Targeting CC Chemokine Ligand 2 (CCL2) for Cancer Skeletal Metastasis

Prostate, breast, and lung cancer preferentially metastasize to bone resulting in bone lesions and thus high mortality. However, the

羊膜移植在有严重角膜受累的毒性表皮坏死综合征急性期中的作用

Objective: To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. Design: Interventional case report. Method/Intervention: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40%of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins. Results: Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye. Conclusions: Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.