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Lysyl oxidase initiates cross-linkage of collagen and elastin by catalysing the formation of a lysine-derived aldehyde. In order to study cross-linking in scleroderma, we used monoclonal antibodies to lysyl oxidase to determine the localization of this enzyme in systemic and localized scleroderma, and compared the distributions obtained with that in normal skin. Using an indirect immunofluorescent antibody method and an avidin-biotinylated enzyme complex method, 11 cases of diffuse type of systemic scleroderma and seven cases of localized scleroderma were studied. In the oedematous stage of systemic scleroderma, intracellular and extracellular lysyl oxidase were remarkably increased in the dermis, particularly in groups around blood vessels. In the sclerotic stage of systemic scleroderma, lysyl oxidase was detected intracellularly in fibroblasts and extracellularly among collagen bundles between the lower dermis and the subcutaneous fat tissue. In localized scleroderma, a marked increase in lysyl oxidase was observed in mononuclear cells and fibroblasts near blood vessels in the lower dermis and in the subcutaneous fat tissue, in addition to the extracellular deposits between collagen bundles. The increase in lysyl oxidase in localized scleroderma was much more common than in the oedematous stage of systemic scleroderma. These findings indicated that intracellular and extracellular expression of lysyl oxidase expression was greater in sclerodermatous skin than in normal skin.

A 64-year-old woman was transferred to the intensive care unit with dyspnea and palpitation on effort. Chest x-ray film showed cardiomegaly and pulmonary congestion. We carefully examined for sarcoidosis as a differential diagnosis of heart failure. Serum lysozyme was mildly high, but human atrial natriuretic peptide (HANP) and brain natriuretic peptide (BNP) were strikingly high. Angiotensin converting enzyme was within normal limit. Chest roentgenogram did not reveal bilateral hilar lymphadenopathy. Atrioventricular conduction block was not observed on electrocardiogram. Echocardiographic examination showed left ventricular global hypokinesis with septal thinning and enlargement. Mitral valve regurgitation was recognized by Doppler evaluation. Coronary arteriography showed normal coronary arteries. Endomyocardial biopsy revealed noncaseous epithelioid granulomas containing, Langhans type giant cell accompanied by fibrosis and lymphocyte infiltration. From these data cardiac sarcoidosis was diagnosed. Gallium scintigraphy showed diffuse uptake only in the heart. Treatment with oral prednisolone 20 mg/day was started. Her symptoms improved by several weeks after the medical treatment. In addition, both the value of HANP and BNP were markedly decreased and echocardiogram showed improvement of cardiac systolic function. In Japan, there is a higher incidence of cardiac sarcoidosis than in the West. The prognosis of this condition associated with cardiac dysfunction is reported to be very poor. When progressive heart failure in older patients is seen, cardiac sarcoidosis should also be kept in mind. Endomyocardial biopsy play an important role as the only accurate technique for the diagnosis of cardiac sarcoidosis.

Sirs, Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to an idiopathic chronic granulomatous inflammation of the cavernous sinus [9]. THS usually improves with corticosteroids, however, in cases showing an insufficient effect of corticosteroid therapy or side effects, alternative therapies such as immunosuppressive agents [3] or focal radiation therapy have been reported [2, 5–7]. We describe a patient with THS who was successfully treated with radiation monotherapy. A 36-year-old man with chronic hepatitis B and impaired glucose tolerance since age 30 developed acute left orbital pain and double vision at the end of July 2006. Neurologic examination on 3 August 2006 demonstrated only mild restriction of abduction of the left eye. Magnetic resonance imaging (MRI) of the brain showed no abnormality including the cavernous sinus region at that time. His illness progressed rapidly and he was admitted to our hospital on 14 August 2006. On admission, body temperature and blood pressure were normal. Neurologic examination demonstrated almost complete ophthalmoplegia in all directions and blepharoptosis without pupil abnormality on the left. Spontaneous left ophthalmic pain was also reported. There were no ophthalmic symptoms on the right and there were no symptoms of lower cranial nerves on both sides. Urinalysis and routine hematological examination were normal. Blood chemistry examination demonstrated mild elevation of aspartate aminotransferase (60 IU/L; normal range 11–34 IU/L), alanine aminotransferase (151 IU/L; normal range 6–39 IU/L) and glycohemoglobin A1c (6.1%; normal range 4.3–5.8%). Surface antigen and core antibody of hepatitis B virus were positive. The following immunological and inflammatory investigations were normal or negative; antinuclear antibody, cytoplasmic and perinuclear antineutrophil cytoplasmic antibody, angiotensin converting enzyme level and b-D-glucan. Chest radiography and Gallium scintigraphy of the whole body showed no abnormality suggestive of systemic inflammatory disease. Cerebrospinal fluid examinations were normal including cytology and culture for bacteria and mycobacteria. Brain MRI showed abnormal soft tissue enhanced with gadolinium within the left cavernous sinus (Fig. 1). Based on a diagnosis of THS, we first considered corticosteroid therapy for THS with simultaneous antiviral therapy for hepatitis; however, the patient refused corticosteroid therapy because of the possible exacerbation of hepatitis. One week after admission, the left pupil was dilated and light response was diminished, indicating progression of THS. Thereafter, the patient received a total of 30 Gy in 15 fractions focused on the left cavernous sinus by three-dimensional conformal radiotherapy (3D-CRT). Left blepharoptosis and ophthalmoplegia gradually improved within 2 weeks after the initiation of radiation therapy; blepharoptosis had almost completely disappeared by the middle of October 2006. Ophthalmoplegia also Y. Furukawa W. Yamaguchi K. Ito T. Hamada H. Miyaji Department of Neurology, Fukui Prefectural Hospital, Fukui, Japan

We diagnosed phakomatosis pigmentovascularis type IIIb in an 11-month-old baby who had a giant nevus spilus, a nevus flammeus, and moyamoya disease. Development of the patient was normal until 6 months of age when he developed a sudden onset of focal seizures and left hemiparesis. This patient represents the sixth case of phakomatosis pigmentovascularis type IIIb, including three cases in the Japanese literature, reported thus far. However, to our knowledge, this is the first case with an association to moyamoya disease.

Langerhans cells (LCs) are activated in the epidermis by external and internal stimuli, such as antigens and cytokines, respectively. To reveal the morphologic and functional properties of in vivo-activated LCs during inflammation, we injected the streptococcal preparation OK-432 intradermally into the earskin of mice and performed time-course analyses by immunofluorescence and electron microscopy. Cellular infiltrate appeared in the dermis at 6 h after OK-432 injection and had progressively extended to the dermoepidermal junction at 12 and 24 h. Immunostaining for class II antigen revealed that LCs were enlarged and extended long dendrites during inflammation. Acidic compartments such as lysosomes and multivesicular bodies also increased in number and Golgi apparatuses developed as demonstrated by electron microscopy and morphometric analysis. Birbeck granules, although not showing numerical changes, were translocated from the Golgi area to the subplasmalemmal area. After epicutaneous application of cationic ferritin, LCs often contained endosomes as the result of engulfment by the cytoplasmic projections. The present results indicate that nonspecifically induced dermal inflammation is capable of inducing activation of LCs in vivo, and that in vivo-activated LCs have the capacity for active endocytosis and intracellular digestion or processing.

We diagnosed a unique case of Merkel cell carcinoma (MCC) coexisting with Bowen's disease on the sole of the foot of a 72-year-old man who had worked for about 4 years in a factory handling inorganic arsenic. He had a past history of arsenical keratosis and multiple Bowen's disease. The tumour first appeared as a reddish macule and then showed marked growth over the next month. The tumour was excised and the specimen was examined histopathologically. The tumour consisted of two components: a group of atypical cells representing Bowen's disease in the epidermis and another group of atypical cells with a trabecular pattern characteristic of MCC in the dermis. Neither group of cells showed transitional findings, and the tumour elements were divided by a clear basement membrane. The tumour cells in the dermis were positive for neurone-specific enolase, and on electron microscopy had dense core granules in the cytoplasm. Inorganic arsenic can cause various cutaneous neoplasms, but to our knowledge, this is the first report of a case of MCC associated with Bowen's disease.

Background: The thymus plays important roles in host defense, which may be impaired after burn injury. The effects of thermal injury on thymocytes were investigated in male Wistar rats. Methods: Changes in thymus weight and content of glutathione and corticosterone were determined after burn injury. Apoptosis of thymocytes was detected by electrophoresis of DNA, and lymphocyte subsets were characterized by flow cytometry. The effects of adrenalectomy and the glucocorticoid receptor antagonist RU486 in burned animals were also studied. Results: The weight of the thymus decreased progressively after burn injury, and this effect was accompanied by increases in the corticosterone concentration in plasma and the thymus and apoptosis of CD4 + CD8 + thymocytes. Administration of RU486 or adrenalectomy inhibited burn-induced thymocyte apoptosis. Conclusion: Thermal injury increases the corticosterone concentration in plasma and the thymus and triggers thymocyte apoptosis.

A 79-year-old Japanese male presented our clinic with a painful eruption on the left edge of the tongue. The lesion was a shallow ulcer surrounded by a elevated indulated border. The size was 40mm in diameter. The histopathological examination of the tumor showed squamous cell carcinoma. He was treated by radiation and resection of the left side of the tongue. One and half year after operation, he is still alive

This paper describes the clinical findings and treatment of the recurrence basal cell carcinoma (BCC).1. The recurrence BCCs were located mostly on periorbital and perialar nasi.2. Histologically, all recurrence BCCs were the morphea-like type.3. As for the treatmen tfor BCC, the first complete surgical removal was essential.4. The authors tried to score the prognosis of recurrence BCC.

Cutaneous metastases from pancreatic carcinoma are uncommon. Eight cases have been described in the literature. The metastases display some common features such as umbilical nodules and the histologic pattern of adenocarcinoma. Our patient had erythematous infiltrated plaques in the left axilla and on the upper portion of the chest. A skin biopsy specimen disclosed many poorly differentiated atypical cells throughout the dermis. The diagnosis was confirmed by positive immunohistochemical staining for carbohydrate antigen 19-9.

A patient with primary anaplastic large-cell lymphoma of the skin with characteristic clinical findings is described. The diagnosis was made on the basis of histologic and immunohis-tochemical findings. Thephenotypeof the tumor cells was not determined, but rearrangement of the T-cell receptor β gene indicated that the tumor was of T-cell lineage. Despite high-grade malignancy of the tumor cells, the patient unexpectedly had a benign clinical course. The findings in this case suggest that regressing atypical histiocytosis and lymphomatoid papulosis type A are subsets of anaplastic large-cell lymphoma.

We report a Japanese patient with congenital hypomelanosis with a segmental pattern on the lett abdomen, whorl-like pattern on the back; mosaic pattern on the chest, right abdomen, and proximal extremitiea; and with yellow hair on a portion of the scalp. Chemical analysis of the yallow hair revealed decreased eumetanin content, whereas the pheometanin content was normal.

Summary The activity and gene expression of ornithine decarboxylase (ODC, an indicator of tumour promotion) were induced by the phorbol ester tumour promoter, 12-O-tetradecanoylphorbol-13-acetate (TPA), in mouse skin. In the present study, the effect of colchicine, a microtu-bule-disrupting agent, on ODC activity and its gene expression were investigated. On administration of colchicine (100 μg) intraperitoneally 1·5 h before TPA treatment, ODC activity and ODC mRNA levels stimulated by TPA were suppressed to about 52 and 64%, respectively. These results suggest the involvement of a microtubule or colchicine-sensitive substrate in the signal transduction system for gene expression.

We report the case of a Japanese female infant with Chédiak-Higashi syndrome born to consanguineous parents. At birth she had fair skin but, when she was three months old, marked hyperpigmentation of the sun-exposed skin areas developed. Microscopic examination of blood and electron microscopic examination confirmed the diagnosis. She enjoyed good health until she was two years old when she had pneumonia with marked hepatosplenomegaly. It is important for dermatologists and pediatricians to be aware of the skin manifestations of this disease because hyperpigmentation after sun exposure may be a characteristic, initial feature of this condition.

Vogt-Koyanagi-Harada disease is a rare disease characterized by uveitis, meningitis, dysacusis, alopecia, poliosis, and vitiligo. We describe a 48-year-old patient with Vogt-Koyanagi-Harada disease associated with thin inflammatory raised erythema and plaque-type inflammatory erythema superimposed on vitiligo. Interestingly, inflammatory raised erythema was separated from the perfect vitiligo, and the incomplete vitiligo lay between them initially. Thereafter, incomplete vitiligo became completely depigmented with diminution of inflammatory raised erythema. This is the second case of vitiligo with inflammatory raised borders associated with Vogt-Koyanagi-Harada disease. Our results of immunohistochemical and electron microscopic studies suggested the involvement of T-cell-mediated cytotoxicity and apoptosis in the development of skin lesions.

Chemotherapy-induced acral erythema (CAE) is an uncommon and distinct reaction seen in patients receiving high-dose chemotherapy. The exact pathogenic mechanisms of this disorder are still unknown. We report a 27-year-old woman who presented with red, swollen and painful macules on both palms, clinically consistent with this disease. Histological examination demonstrated vacuolar degeneration of the basal cell layer and spongiotic blisters in the epidermis, especially in the atrophied eccrine ducts and papillary oedema with mild perivascular infiltration of mononuclear and hypersegmented neutrophils. Immunohistochemistry showed that the infiltrating mononuclear cells were CD3-CD16+CD56+ leucocyte function antigen-1+, possibly natural killer cells. The eccrine ducts expressed HLA-DR and intracellular adhesion molecule-1 (ICAM-1). Our findings suggest that cell-to-cell interaction between NK cells and keratinocytes in the eccrine apparatus may induce CAE and may be involved in the pathogenesis of the skin reaction in our patient and possibly in this disease.

We describe a combined cutaneous hamartoma in a 57-year-old man, which comprised a vellus hair cyst, an epidermoid cyst and an intradermal melanocytic naevus in a single facial tumour. The vellus hair cyst was filled with keratinous material with unusual slit-like lacunae. While numerous cases of epidermoid cyst have been reported in association with an intradermal melanocytic naevus, our case is a rare example of a lesion combining several hamartomatous elements.

Two patients with epidermolysis bullosa dystrophica recessiva who had squamous cell carcinoma are presented. Case 1 is a 40–year-old woman who had ulcers on her left lower leg. Case 2 is a 42–year-old man who had a tumor on his left first toe. Wide surgical excision with skin coverage by autograft was performed in case 1. Amputation of the toe in case 2 was performed. A review of the cases of epidermolysis bullosa dystrophica associated with cancer reported in Japan is also presented.

By using antibodies to type I, III, IV, V, and VI collagens and laminin, we examined the localization of interstitial collagens and basement membrane components with indirect immunofluorescence and immunoelectron microscopy (IEM). Furthermore, the morphological changes of these collagens in malignant transformation were investigated. In neurofibroma, IEM showed type I, III, and V collagens to be present diffusely on cross-striated collagen fibrils, whereas type VI collagen was present between the fibrils. Type IV collagen and laminin were observed to surround tumor cells. In neurofibrosarcoma, tumor collagen bundles that reacted with antibodies to type I, III, V, and VI collagens were irregularly arranged. Immunofluorescent deposits that reacted with anti-type IV collagen and anti-laminin antibodies were decreased in number, showing a thin and sparse arrangement.

糖尿病患者にみられたカポシ肉腫を報告した。患者は69歳男子。1982年頃に右足踵から足底にかけて, 紅色∼暗赤色の丘疹, 小結節が出現し, 徐々に増数増大, 疼痛を伴うようになってきた。組織学的にカポシ肉腫と診断され, 5年後には左足, 両手にも皮疹が出現した。糖尿病に対して, インスリン, 経口血糖降下剤投与を行い, さらにアクチノマイシンD, ビンクリスチンによる化学療法を行ったが, 発病約5年後に消化管出血のために死亡した。剖検では, 消化管, 副腎, 横隔膜, リンパ節など多臓器にカポシ肉腫が認められた。

Recently, we have reported two cases with endothelin (ET)-secreting tumor presenting with hypertension and elevated plasma endothelin-1 (ET-1) levels. The present study examines the histopathology of the ET-secreting tumor in one of these cases. The neoplasm was located in the skin and microscopically characterized as a malignant hemangioendothelioma by remarkable intravascular proliferations of atypical endothelium with the expression of Factor VIII-related antigen in the tumor cells. The tumor enlarged rapidly with rising ET-1 and blood pressure levels. The ET-1 content and its messenger RNA expression in the tumor extract were higher than those from normal parts of skin. ET-1 may play a pathophysiological role in patients with ET-secreting malignant hemangioendothelioma.

A primary adenoid cystic carcinoma of the skin is reported. Light microscopy revealed pseudocysts. PAS-positive basement membrane and true glandular lumen, which in aggregates are specific for adenoid cystic carcinoma. Perineural invasion was also observed. Ultrastructural examinations revealed three types of cystic spaces; pseudocysts, true glandular lumens and intercellular spaces. Enzyme histochemical examinations showed positive reactions for eccrine enzymes, including phosphorylase and succinic dehydrogenase and negative for apocrine enzymes. Immunolocalization of collagens and laminin revealed that basement membranes of the pseudocysts involve Type V collagen as well as Type IV collagen and laminin.

Three patients with subungual exostoses, two involving the great toe and one the fourth toe, are presented. Local excision was performed, and the specimens were processed for light and electron microscopy. Light-microscopic study revealed that the tumours consisted of a proliferative fibrocartilaginous cap that merged into mature trabecular bone at its base. Electron-microscopic examination revealed that the tumour was composed of two types of cells: one was rich in cell organelles including rough endoplasmic reticulum, well-developed Golgi apparatus, and glycogen granules; the other cell had few such cell organelles. The former cells seemed to be osteoblasts actively engaged in bone formation, and the latter to be osteocytes related to those situated deeper in bone matrix in normal bone. However, ossification or calcification in subungual exostosis is rather casual, and osteocytes in this disorder may lack the capacity to elaborate compact bone.

A patient with diabetes mellitus who developed the typical classic lesions of Kaposi's sarcoma is described. Our patient presented with a reddish-purple papulonodular lesion on the right foot of five months' duration. A skin biopsy specimen showed a proliferation of spindle cells forming numerous vascular slits and a diffuse extravasation of erythrocytes. The patient's sera was negative for human immunodeficiency virus (HIV) antibodies and cytomegalovirus (CMV) antibodies. Ultrastructural examination demonstrated fibroblast-like spindle cells phagocytosing and digesting red blood cells to form vascular spaces. The patient died, due to gastrointestinal hemorrhage, and the autopsy revealed an extensive visceral involvement of Kaposi's sarcoma.

The influence of topical PUVA on the activity of ornithine decarboxylase (ODC) and its gene expression was investigated in the skin of hairless mouse. After 1 h of application of 0.3% 8-methoxypsoralen, irradiation of 3 J/cm2 of ultraviolet A (UV-A) was administered. The ODC activity markedly increased and peaked at 24 h following UV-A irradiation. The ODC raRNA level analyzed in dot-blot analysis elevated to about 5 times that of control at 24 h after treatment. These results show that the PUVA-induced ODC activity is due in part to an increase in ODC gene expression.

A 7-year-old girl with alopecia universalis had dystrophy of all 20 nails. A nail biopsy specimen disclosed features of lichen planus. The patient also had ichthyosis vulgaris and hypogammaglobulinemia. We are not aware of any previous reports of these associations, which we believe to be noncoincidental.

A 14-year-old boy with linear localized scleroderma had a dramatic improvement in contractures after treatment with N-(3',4'-dimethoxycinnamoyl) anthranilic acid (tranilast, Rizaben). The observation that this anti-allergic drug was effective in localized scleroderma lends further support to the concept that mast cells play a role in increased collagen synthesis in this disease.

Summary Four cases of solitary glomus tumour are reported, three of the angiomatous type, and one of the epitheliomatous type. In all cases, mucinous degeneration was seen, the extent of which correlated with the number of glomus cells.

Background. Rhinophyma is an end stage of acne rosacea. It results in a large nose due to a proliferation of sebaceous glands and fibrous tissue. Many cases of rhinophyma have been reported in the Western world; however, in Japan, rhinophyma has been an uncommon disease. Methods. We present two patients associated with rhinophyma who were treated by cross-shaped full-thickness excision followed by direct closure and compare the rhinophyma in Japan with that in the West. Results. To date, only 20 rhinophyma cases including our 2 cases have been reported in Japan. Epidemiologic factors of rhinophyma between the West and Japan do not differ except for location, malignancy and surgical treatment. Conclusions. In Japan, almost all cases are located on the lower half of the nose, treated by full-thickness excision followed by application of either skin grafts or direct closure. None have been malignant.

Summary Secondary cutaneous T-cell lymphoma may present with various types of skin lesions, hut rarely produces ulceration in contrast to primary cutaneous T-cell lymphoma. We report a case of malignant lymphoma of the tonsil that recurred as a giant cutaneous ulcer on the back of a 45-year-old man, Biopsy of the ulcer revealed a malignant lymphoma of diffuse, mixed-cell type. Surface marker analysis of the tumour cells showed suppressor/cytotoxic T-cell characteristics. The skin lesions were treated by electron beam therapy.

A 45-year-old woman presented with persistent headache which was of acute onset and occurred daily. Laboratory findings included thrombocytosis, elevated levels of antinuclear antibody, rheumatoid factor, and antibodies to Epstein-Barr virus (EBV). Magnetic resonance image of the head, left selective external carotid angiography, temporal arterial biopsy, and cerebrospinal fluid revealed no abnormal findings that could explain her headache. Her headache was compatible with NDPH, which has been reported by Vanast, and was thought to be related to EBV reactivation.

Summary Articular tissue was obtained at surgery for a femoral neck fracture in a patient with psoriasis without arthritis. The proteoglycan of the cartilage of the sample was analysed biochemically. Normal cartilage is known to produce two types of proteoglycan monomers (fast- and slow-sedimenting groups), which are distinguishable by density-gradient ultracentrifugation. In the psoriatic cartilage analysed in the present study, it was shown that the former group was absent and only the latter group remained.

Summary A case of a solitary pigmented neurofibrosarcoma involving the lateral side of the face in a 19-year-old female is described. Clinically it resembled a haemangioma, and angiography showed hypervascularity of the tumour. Light-microscopic study revealed that the major cellular element of the tumour was composed of bizarre neoplastic cells with large pleomorphic, hyperchromatic nuclei, conspicuous nucleoli and moderate to abundant amounts of conspicuous cytoplasm. Mitotic figures and multi-nucleate cells were present in most fields. Neurofibrosarcoma is one of the most highly malignant tumours; however, in the present case, there was no evidence of recurrence during a follow-up period of 5 years.

A 21-year-old male patient had localized papules on the chest and arms. Biopsy of a lesion showed it to be a malignant lymphoid neoplasm, and immunohistochemical studies confirmed a lymphoblastoma origin. Aberrant lymphoid cells were noted in the cutaneous blood vessels, but simultaneous examination of the peripheral blood showed no evidence of leukemia. One month elapsed before observable leukemic cells were found in the blood and sternal marrow, confirming the diagnosis of acute lymphocytic leukemia. Examination of a cutaneous biopsy specimen led to early diagnosis of the disease.

S-carboxymethylated (SCM) fibrous proteins (FPs) from the scalp hairs of the three different hereditary hair abnormalities (trichorrhexis invaginata in Netherton's syndrome, pili trianguli et canaliculi in uncombable hair syndrome, and fine hair in anhidrotic ectodermal dysplasia) were analyzed by two-dimensional polyacrylamide gel electrophoresis. Comparison of the SCM FP compositions of the three hair abnormalities with that of the normal revealed that the SCM FP compositions of these three abnormal hairs were all electrophoretically different from each other and that of the normal.

We report a 22-year-old man with acquired dermal melanocytosis on the hand which developed without any history of previous inflammation. He had no history of contact with or oral administration of any drugs or metals which might have caused pigmentation. Histopathologically, spindle-shaped dermal melanocytes were observed running parallel to the collagen bundles and scattered in all portions of the dermis. The dopa reaction of these cells was positive. Ultrastructurally, dermal melanocytes containing numerous melanosomes (stages II to IV) which were surrounded by the extracellular sheath were observed. Differential diagnosis of other dermal melanocytosis was discussed.

Seven patients who had surgery for malignant skin tumors of the heel were followed up for several years. The reconstructive procedure performed was repair of the large skin defect after excision of a tumor, by using a flexor digitorum brevis muscle flap and an overlying free graft. Although this procedure is a good method without any serious complications, no long-term follow-up data supporting this opinion have been reported. In this study, plantar flexion of the toes and flattening of the plantar arch appeared 3 months after surgery and developed for 1 year, and the patients complained of easy fatigability in walking and difficulty in going up stairs. These sequelae were probably due to sacrifice of the flexor digitorum brevis muscle. We feel that this procedure should be replaced by another procedure that does not sacrifice any muscle, for example, that using a medial plantar flap.

The patient, a 34-year-old Japanese woman who noticed worsening of her rash after using topical corticosteroid preparations on her neck, was patch tested for both commercial preparations and corticosteroids themselves. The patch lest results revealed that she had a contact allergy to gold, oxytetracycline, and 2 types of corticosteroid (acetonides and esters) in 7 compounds (betamethasone valerate and dipropionate, hydrocortisone butyrate and hydrocortisone butyrate propionate, ameinonide, budesonide, and fluocinonide).

Endothelin-1, a potent vasoconstrictor peptide that has recently been isolated from the supernatant of cultured porcine aortic endothelial cells (1), is involved in some vascular disorders (2). Mal...