Eosinophilia after intradermal hepatitis B vaccination.
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Biomedical subjects
Publications and source records attributed to S Imayama.
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We describe three neonates who had large eroded areas of skin on their extremities. The clinical course and ultrastructural findings were consistent with a diagnosis of epidermolysis bullosa herpetiformis (Dowling-Meara type). In each case blisters developed around eroded areas after birth and enlarged centrifugally in a herpetiform fashion. One patient died of sepsis at 8 days of age. In the two survivors blister formation subsided gradually within 1 year. Ultrastructural studies confirmed intraepidermal blister formation associated with spheric aggregates of tonofilaments in the lower epidermis. Spheric aggregates were also found in clinically uninvolved skin.
1. In anesthetized rabbits, topical application of dexamethasone to the ear produced an initial vasodilation followed by a vasoconstriction with long delay (120 min). Diphenhydramine inhibited the former, but not the latter. 2. In isolated rabbit ear arteries, dexamethasone reduced the amplitude of contractions of smooth muscles produced by nerve stimulation, noradrenaline and high-K solution, only at high concentrations (> 10(-5) M). 3. The initial vasodilation induced by topical application of dexamethasone may be related to endogenous histamine, while the delayed constriction response may not be direct actions of steroid to smooth muscles.
In a 21-year-old female with severe atopic dermatitis, the secretion of interleukin-2 (IL-2), interleukin-4 (IL-4), and interferon-gamma (IFN-gamma) by her peripheral blood mononuclear cells (PBMC) was measured after incubation with/without antigens extracted from Dermatophagoides pteronyssinus (Dp), to which the patient had developed a positive patch-test reaction. Incubation with Dp antigen produced marked secretion of IL-2 and IFN-gamma, but not IL-4. This may suggest that Dp-specific T lymphocytes present in the circulating blood cells are capable of producing IL-2 and IFN-gamma, which may be relevant to the delayed-type allergic reaction occurring in the skin lesion.
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A 65-year-old woman underwent right modified radical mastectomy for a malignant lesion which had developed just below the right nipple. Two years after the operation, skin lesions composed of dark brown to black, pigmented, papular lesions developed in the precordia. A biopsy revealed this to be a cutaneous metastasis of the previous breast carcinoma. However numerous pigment blockade melanocytes were also found in the tumor nests, located in and/or beneath the epidermis. Although a black-colored breast carcinoma has been reported, the presence of pigment blockade melanocytes was not determined. Culture of the tumor nest recovered a population of melanocytes as well as the carcinoma cells. Boyden chamber analysis revealed the presence of a chemotactic factor for melanocytes in the culture medium. This seems to be the first documentation of melanocyte incorporation in breast carcinoma tissue.
Immunohistochemical and immunoelectron microscopy studies revealed the presence of alpha-smooth muscle (alpha-SM) actin in fibroblasts located in the connective tissue sheath (CTS) of human anagen hair follicles. Immunostaining was positive from the base of the bulb to the upper part of the lower portion of the mature anagen hair follicles. The late catagen hair follicles did not stain. Ultrastructurally, alpha-SM actin was detected only in the fibroblasts located in the innermost layer of the transverse collagenous fibres. Since alpha-SM actin is located in cells with contractile potential, this newly identified layer may play an important role in the morphological changes of the lower portion of the hair follicle during the hair growth cycle.
The distribution of HSV-1 during the development of zosteriform skin lesions in SCID mice was analyzed by immunofluorescence and electron microscopy. The virus initially appeared within certain keratinocytes, sometimes surrounded by keratinocytes whose surfaces were also positive for the antigens, in the lower epidermal layers including the hair follicles, and then extended upward to the entire epidermis and downward to the sebaceous glands 1-2 days later, when no macroscopic skin lesion was seen. The affected epidermal cells subsequently degenerated and lost their viral antigens within a day, when the zosteriform lesion then became evident. This was followed by a degeneration of the dermis. The sebaceous glands eventually degenerated in 10 days, but some glands in the necrotic skin areas preferentially retained HSV-1. The horizontal spread of the virus in the epidermis beyond the first invaded dermatome occurred much later. In mice passively immunized with specific immune serum, viral antigens were observed even 20 days after the infection in sebaceous glands in necrotized areas. Therefore, HSV-1 appears to spread first via the extracellular fluid among the keratinocytes after being shed from nerve endings, and then produces a successive degeneration of the affected keratinocytes which may prevent any further extension of horizontal viral spread. The pilosebaceous apparatus is possibly acting as a site not only for the replication of HSV-1 with a delayed cytopathic effect, but also as an area that is temporarily sheltered from host defense mechanisms.
Five cases of eccrine porocarcinoma were studied by light and electron microscopy. Histopathologically, these could be classified into two types; the common and the giant cell type. The common type was characterized by almost uniform medium-sized cuboidal tumour cells and a formation of well-developed intracytoplasmic lumina. A broad diversity of histopathological and ultrastructural features was seen in these tumours. The tumours of the giant cell type consisted of mononuclear polygonal cells and bizarre giant cells. This type was considered to be an undifferentiated form of porocarcinoma.
Ten cases of spindle cell haemangioendothelioma (SCH) were analysed clinicopathologically, including an immunohistochemical survey of seven cases and ultrastructural observations on one. There were seven females and three males, ranging from 16 to 76 years of age. All but one lesion developed on the extremities, predominantly on the hands and feet. Six of the ten patients presented multiple nodules or papules which gradually increased in size and number over a long duration. Among them, four patients had undergone operations twice or more, but no metastatic foci were recognized. Histologically, the lesions were composed of dilated vascular spaces and a proliferation of bland-appearing spindle cells and interspersed epithelioid endothelial cells. Ultrastructural and immunohistochemical studies demonstrated that the spindle cells were mainly made up of fibroblastic cells admixed with pericyte-like cells and macrophages. Smooth muscle cells and primitive mesenchymal cells were also present. The clinical and microscopic features suggest that SCH may be a benign vasoformative lesion of a heterochronological multicentric origin.
BACKGROUND: Patients with atopic dermatitis sometimes have positive responses to patch testing (PT) with dust mite antigens, which is believed to correlate with the elevated levels of specific IgE for those antigens. OBJECTIVE: The purpose of this study is to identify the correlation between the PT and serum IgE concerning the mite antigens. METHODS: We studied 130 patients with atopic dermatitis by the PT reaction and the serum level of specific IgE for Dermatophagoides pteronyssinus antigens. RESULTS: Fifty-one of the 130 patients assessed as PT-positive had either high (32 of 130 patients; 24.6%) or low or no (19 of 130 patients; 14.6%) levels of mite-specific IgE; there was a significant difference between the groups with elevated and low IgE. Similarly, a total of 79 PT-negative patients also showed an elevated or low mite-specific IgE (42 of 130 patients [32.3%] or 37 of 130 patients [28.5%], respectively). It was noted that clinical morphologic findings were peculiar to three of the four groups; however, the patients who were PT-negative with a low IgE (37 of 130 patients) showed no particular clinical lesions. CONCLUSION: Comparing the results from our 130 patients, there was no correlation between the serum IgE level and the PT reaction for dust mite antigens. Conversely, the results of PT and mite-specific IgE could be used to divide these patients into four distinct groups, each with its own particular clinical morphology, suggesting the heterogeneity of this disease.
A patient with spindle cell hemangioendotheliomas was followed from 1964 to the present time, allowing the authors the opportunity to examine the lesions in the early, mature, and old phases. Organizing thrombi of different stages associated with slit-like vascular proliferation were always observed, whereas cavernous vascular spaces predominated as the lesions became older. Each spindle cell hemangioendothelioma initially developed relatively rapidly and was sometimes painful but then persisted as a silent nodule for decades. Transmission and scanning electron microscopic studies revealed that endothelial cells tended to digitate into the slit-like proliferating channels, became attached to other cells by means of tight junctions, and thus obstructed the channels at sites where thrombi developed repeatedly. The vascular spaces, ranging in nature from slit-like to cavernous, were outlined further by a relatively sparse mantle of ramified or dendritic interstitial cells that corresponded to spindle cells. Most of the cells appeared simply to be fibroblasts, but they developed the features of pericytes when they were close to the endothelial lining of well-developed vascular lumens. Large vascular spaces and phleboliths were surrounded by smooth muscle cells. Approximately 20% of the interstitial cells were dendritic macrophages characterized by phagocytic activity, presence of many lysosomes, and Factor XIIIa expression. The long and characteristic clinical course, the histologic evidence that thrombosis and its organization was continually occurring within the lesions, and the ultrastructural finding that spindle cell hemangioendotheliomas were composed of different microvascular segments from capillaries to veins, suggest that spindle cell hemangioendotheliomas may develop from a cycle of recanalization after thrombosis that occurs repeatedly because of the unique endothelial growth that was noted. This is in contrast with the previous conception that they were low-grade angiosarcomas.
During a series of studies on the involvement of house dust mite antigens in 183 cases of atopic dermatitis, we observed an improvement in two patients following the removal of mites from their environment by means of a thorough housecleaning and replacement of the mattress. Both patients manifested the typical clinical skin lesions of atopic dermatitis and had similar laboratory findings. Although the serum IgE concentrations and specific IgE to Dermatophagoides pteronyssinus and Dermatophagoides farinae were each relatively low, the results of patch tests with these antigens were positive. Thus, a regimen aimed at reducing the presence of house dust mites can produce clinical improvement in a subset of patients with atopic dermatitis who show contact hypersensitivity to mite antigens on skin testing, but negative results on IgE (RAST; radioallergosorbent technique) testing.
Patients with the acquired immunodeficiency syndrome (AIDS) often develop unusual skin complications. We describe a case of a 58-year-old man with AIDS who had a history of multiple transfusions with anti-hemophilic factor A. He developed papulovesicular and lichenified skin lesions on his head, face, neck and the extensor aspects of his extremities accompanied by severe pruritus. Atopic dermatitis was suspected; however, intensive treatment with a potent topical corticosteroid and a systemic antihistamine failed. In addition to the decreased subset of CD4-positive lymphocytes characteristic of AIDS, this patient showed an elevated level of serum IgE particularly specific for Candida albicans, probably because he had a chronic candidial infection of the digestive tract. Oral administration of anti-fungal agents Diflucan and Fungizone produced almost complete relief from the atopic dermatitis-like skin disease within 2 weeks.
Scanning electron microscopy with immunogold labeling revealed that epidermal keratinocytes expressed ICAM-1 (intercellular adhesion molecule-1) and HLA-DR molecules on their surfaces in patterns that differed in mycosis fungoides (MF) and lichenoid reaction (LR). ICAM-1 molecules, visualized as deposits of gold particle, were visualized as clusters adjacent to the junctions interconnecting the keratinocytes of MF lesions. LFA-1 (leukocyte function-associated antigen-1) molecules were seen as granules on the surfaces of all infiltrates, most of which also expressed ICAM-1. HLA-DR molecules were seen continuously along the borders of the individual keratinocytes, thus producing a cobblestone appearance on the epidermal undersurface. In contrast, ICAM-1 and HLA-DR were found only sparsely on the undersurface of the epidermis from LR. These findings may help to explain the differing histological features of MF and LR: ICAM-1 molecules present on the intercellular junctions of MF epidermis lead the LFA-1-bearing cells to migrate into the interspaces, thus producing epidermotropism. These cells aggregate by means of co-expressed ICAM-1 to thus produce Pautrier's microabscess. In LR, the minimal expression of ICAm-1 on the epidermal undersurface leaves most infiltrates within the dermis, thus producing a band-like infiltrate.
Scanning electron microscopy (SEM) with immunogold labeling was employed to observe the undersurface of the human epidermis after it was split from dermal connective tissue, in an attempt to localize the molecules actually expressed on cell/tissue surfaces. We found that human leukocyte antigen-DR (HLA-DR) molecules were expressed on the surfaces of eccrine duct cells as well as those of epidermal Langerhans cells (LC) in normal skin. HLA-DR molecules, visualized by the deposition of gold particles, were distributed evenly on the LC surface but were present only along the interdigitating borders of the individual duct cells, thus producing a meshwork pattern on the duct surface. Transmission electron microscopy confirmed that the gold particles labeling cell surface HLA-DR molecules were seen only on the portions of duct cell membranes the interdigitated with neighboring duct cells. These findings suggest that the function of HLA-DR molecules may vary with their location and distribution. On the LC surface, the evenly distributed molecules seem to be well suited for promoting "accessory cell" functions. On duct cell surfaces, the HLA-DR molecules present along the intercellular spaces may be involved in trapping various peptide antigens that pass into the sweat gland filtrate and then are reabsorbed by the excretory duct, since these molecules have a highly permissive capacity for binding various peptides.