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Although rare, tuberculosis has been reported with biologic treatment against psoriasis in Japan, a tuberculosis medium-burden country. Mycobacterial infection often develops after a long incubation period and might not have been adequately identified in clinical trials or post-marketing surveillance. To determine the real-world incidence of tuberculosis in psoriatic patients treated with biologics, we conducted a retrospective, multicenter, observational study in 18 facilities in Western Japan. Psoriatic patients who visited a participating facility between 2010 and March 2017 and received biologic reagents were enrolled. Information on sex, age at first biologic treatment, results of interferon-γ release assay (IGRA) for Mycobacterium tuberculosis, treatment history with isoniazid, and onset of active and/or latent tuberculosis was collected. A total of 1117 patients (830 men and 287 women) were enrolled. The mean duration of biologic treatment was 3.54 years. Sixty-five patients (5.8%) showed positive IGRA results at screening. Active tuberculosis developed in two patients after the administration of tumor necrosis factor inhibitors (both involved miliary tuberculosis). Latent tuberculosis was observed in two patients treated with anti-interleukin-12/23p40 antibody. The incidence rate of tuberculosis, including latent tuberculosis, in this survey was 0.36%. Although the incidence rate of tuberculosis was low considering the observation period of biologic treatment, active tuberculosis was found in both the screening-negative group and a screening-positive subject after isoniazid prophylaxis (both miliary tuberculosis), concluding that negative screening or isoniazid treatment does not always assure that an individual has no tuberculosis. Hence, dermatologists still need to pay careful attention to tuberculosis at every patient visit.

Eosinophilic pancreatitis (EP) is a rare disease characterized by eosinophilic infiltration of pancreatic parenchyma. Although the etiology of EP is not fully understood, there may be some allergic mechanisms related to the disease. Here we report on an EP patient with psoriasis vulgaris. A 47-year-old man was admitted with cardiac space pain and a feeling of abdominal compression. He had a history of psoriasis vulgaris treated with steroid ointment for the past 30 years. Laboratory findings revealed elevated serum titers amylase. An abdominopelvic computed tomography scan showed a cystic lesion 45 mm in diameter localized in the pancreatic tail. He was diagnosed with pancreatic pseudocyst and conservative medical treatment was initiated with antimicrobial drugs and gabexate mesilate. Whenever meals were taken, pancreatitis aggravation returned. Eosinophilic leukocytosis occurred during steroid administration. Pseudoaneurysm in the splenic artery solution part occurred and a splenic artery embolism was performed in interventinal radiology. The patient underwent distal pancreatectomy. The operation specimen revealed eosinophilic infiltration. Despite the unusual occurrence of EP, it should be considered in the differential diagnosis of patients with allergic disease or with an eosinophillia group presenting pancreatitis. In such cases, EUS-FNA or laparoscopic biopsy should be mandatory to avoid unnecessary surgical operation.

84歳, 男性。陰嚢悪性黒色腫, 左鼠径リンパ節転移に対して, 拡大切除, 右鼠径センチネルリンパ節生検および左鼠径骨盤リンパ節郭清を施行した。皮膚切開はLazy S in cisionに準じ, 腹壁は外腹斜筋腱膜の走行に沿って開き, 内腹斜筋・腹横筋を縦切開し, 腹膜外経路で後腹膜腔に到達した。鼠径靭帯を切除することなく鼠径・骨盤リンパ節を一塊に摘出した。骨盤リンパ節郭清は施設により様々な手術手技で行われているが, 手術法の統一がみられていない。手術方法および手技につき, 若干の文献的考察を加えて報告する。

The radioisotope navigation method, which has usually been used for identification of sentinel nodes, is less useful in locating sentinel nodes close to primary lesions in cases of extramammary Paget's disease because of overlapping radioactivity from the primary site. We applied fluorescence navigation with indocyanine green (ICG) in two patients with skin cancer to cover this defect. The use of a charge-coupled device camera enabled real-time visualization of dynamic lymph flow without skin incision. The inguinal skin over the identified sentinel node with a handheld gamma probe was in accordance with the point detected by ICG fluorescence in a patient with squamous cell carcinoma of the foot. Sentinel node biopsy using fluorescence navigation with ICG proved to be easy and reliable.

We used to believe that medial rectus surgery was more effective on near deviation than on distant deviation, and conversely lateral rectus surgery was more effective on distant deviation. Therefore, an unequal amount of unilateral recession and resection, bimedial rectus recession or bilateral rectus resection has often been per formed on non-basic type horizontal strabismus (Awaya, 1985; von Noorden et al, 1986). However, no statistical study has ever clearly demonstrated the propriety of these relationships. Our purpose is to clarify how each recession and resection of rectus muscle influences the surgical result.