Don't Assume the Control Group Is Normal-People with Asymptomatic Tendon Pathology Have Higher Pressure Pain Thresholds.

Objective: Pain pressure thresholds (PPT) are used to study peripheral and central pain processing. In the tendon, pathological changes may exist without pain. This pilot study aimed to compare PPT between individuals with normal tendons and asymptomatic tendon pathology, and between individuals with and without a history of tendon pain. Methods: The patellar, Achilles, and supraspinatus tendons of 128 asymptomatic participants were examined with ultrasound. Global PPT average was determined using a digital algometer at the patellar tendon, quadriceps muscle, L3 spinous process, and deltoid muscle insertion. Participants were separated into three groups: (1) healthy control group (no pathology, no history of pain), (2) tendon pathology at any site without a history of pain, (3) history of tendon pain anywhere. Results: There were 92 controls, seven with asymptomatic pathology and 29 with a history of tendon pain. Asymptomatic tendon pathology at any site (without a history of pain) was associated with globally increased PPTs compared with controls (P < 0.001, pathology N = 7, N = 92 controls). Matched pair analysis remained significant (P < 0.004). A history of tendon pain was associated with globally increased PPTs compared with the control group (P = 0.026). Matched pair analysis was not significant (P = 0.122). Conclusions: Asymptomatic tendon pathology is associated with higher PPTs. These findings point toward central nervous system adaptations but in a novel way-central desensitization. This challenges the validity of conclusions drawn from PPT studies that do not verify normal structure in the control group; artificial inflation of control group data may incorrectly indicate decreased PPTs in the comparison group.

[A case of neurofibromatosis with occlusion of multiple cerebral artery, moyamoya phenomenon and scoliosis].

Cases of cerebrovascular occlusive lesion with neurofibromatosis have rarely been reported. We report here, the case of a 57-year-old woman who twice had sudden onset of brain hemorrhage. She had a family history of neurofibromatosis. Her elder daughter and her niece had a diagnosis of neurofibromatosis and examination showed café au lait spots and neurofibroma over the body, accompanied with scoliosis. CT scans revealed subependymal hemorrhage at the first onset of cerebral bleeding and secondly showed a high-density mass at the left basal ganglia. SPECT(99mTC-HMPAO) showed decreased activity in the left frontal and temporal lobe. Angiogram revealed multiple occlusive lesions of the cerebral arteries, including occlusions of the bilateral anterior cerebral artery and the right middle cerebral artery at the proximal portion and stenosis of the left posterior artery at the proximal portion. Abnormal vascular networks (so called Moyamoya phenomenon) at the base of the brain were also seen bilaterally. Seizinger and others have found a genetic locus of this disease in the use of genetic engineering, and Riccardi showed that mast cell is related to the tumorous growth of neurofibroma and suggested a possibility of medical treatment for growing neurofibroma by stabilizing mast cell function with ketotifen. We anticipate the treatment for this disease will be established in recent years.

Treatment of Adult T Cell Leukaemia by Extracorporeal Photochemotherapy.

Four patients with chronic or smouldering type adult T cell leukaemia (ATL) were treated by extracorporeal photochemotherapy (photopheresis). From 4 to 8 months after starting photo-pheresis, skin lesions with ATL cell infiltration began to disappear. Cell surface markers in three patients showed improvement. In one patient, a serial decrease of soluble interleukin-2 receptor levels (950 U/ml to 620) in the serum was observed after 4 months. This pilot study suggests that photopheresis may be successfully applied in ATL. It is still necessary to continue follow-up observations in these patients and to treat a larger number of cases, before definite conclusions can be drawn in the future.

A proposal for smoldering adult T-cell leukemia: a clinicopathologic study of five cases.

We have observed five patients with smoldering adult T-cell leukemia (ATL) who had skin lesions as premonitory symptoms. The illness developed slowly, but flared up after several years. Skin lesions appeared in the form of erythema, papules, or nodules. Infiltration of the skin by ATL cells was slight, and the proportion of ATL cells in the peripheral blood was 0%-2%. The serum lactate dehydrogenase (LDH) value was within normal range and was not associated with hypercalcemia; lymphadenopathy, hepatosplenomegaly, and bone marrow infiltration were very slight. In most cases, hypergammaglobulinemia was seen, and in one case, monoclonal hypergammaglobulinemia was observed. All five patients had lived in an area in which ATL was endemic, and their anti-ATLA antibodies were positive; none had ever received a blood transfusion. One patient developed typical ATL after more than 13 yr of illness and died of renal insufficiency. Another patient developed typical ATL after 5 yr of illness and died of cryptococcus meningitis. Based on clinical and pathologic differences, we believe that these cases should be distinguished from typical ATL cases for the purposes of prognosis and treatment.

A proposal for smoldering adult T-cell leukemia--diversity in clinical pictures of adult T-cell leukemia--.

We have observed five patients with smoldering adult T-cell leukemia (ATL) who had skin lesions as premonitory symptoms. The illness developed slowly but flared up after several years. Skin lesions appeared in the form of erythema, papules or nodules. Infiltration of the skin by ATL cells was slight, and the proportion of ATL cells in the peripheral blood was from 0% to 2%. The serum lactic dehydrogenase value was within normal range, and was not associated with hypercalcemia, lymphadenopathy, or hepatosplenomegaly, and bone marrow infiltration was very slight. In most cases, hypergammaglobulinemia was seen, and in one case monoclonal hypergammaglobulinemia was observed. All five patients had lived in an area in which ATL was endemic, and their sera were positive for anti-ATL-associated antigen antibodies. None of them had ever received a blood transfusion. One patient developed typical ATL after more than 13 yr of illness, and died of renal insufficiency. Another patient developed typical ATL after 5 yr of illness, and died or cryptococcus meningitis. These cases were clinically and pathologically different from typical ATL cases already reported, and we feel it necessary to make distinctions from the viewpoints of prognosis and treatment. In discussing these cases, we compared smoldering ATL with typical ATL, and deliberated upon the causes of both.

Evaluation of tonsillectomy as a treatment for pustulosis palmaris et plantaris.

One hundred and twenty-four cases of pustulosis palmaris et plantaris (PPP) were studied by questionnaire survey to evaluate the effectiveness of tonsillectomy as treatment. We found that tonsillectomy as a method of treatment for PPP showed a significantly high rate of cure, against which other methods of treatment, e.g. corticosteroid therapy, PUVA therapy and so on, were compared. The examination, by means of Kaplan-Meier's method, showed a 59.2% cure rate for patients one year after tonsillectomy and 71.8% 2 years after the operation. When patients are older than 60 years, the prognosis is good, regardless of the method of treatment.

Morphological and immunological studies on pustulosis palmaris et plantaris, especially on its focal infection theory.

The deposition of immunoglobulins and complement was examined in skin lesions of pustulosis palmaris et plantaris by applying a direct-immunofluorescence technique. Linear deposition of IgG and C3 was demonstrated in the horny layer in 5 cases out of 10. The antikeratinlayer antibody was measured using the sera of patients with PPP, and elevated levels were recorded in patients with a maximum ratio of 1:80. Light and electron-microscopical examinations revealed a structure similar to the epidermal keratin layer of the tonsillar epidermis and phagocytosis of the structure by macrophages. This is an interesting finding in view of the antigen of the epidermal keratin layer.

Banded structure in solitary trichoepithelioma.

Electron microscopical observations were made in a case of solitary trichoepithelioma. Enlarged ERs were found in the tumor cells, showing a peculiar structure with fine granules and an electron-dense banded structure, about 50 nm wide respectively, lying at intervals of 250 nm. In addition to this structure, dense ovoid bodies, about 500 to 600 nm in diameter, were also observed.