Human T-lymphotropic virus 1 (HTLV-1)-associated lichenoid dermatitis induced by CD8+ T cells in HTLV-1 carrier, HTLV-1-associated myelopathy/tropical spastic paraparesis and adult T-cell leukemia/lymphoma.

Human T-lymphotropic virus type 1 (HTLV-1) induces adult T-cell leukemia/lymphoma (ATLL), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and carrier. ATLL is a mature CD4+ CD25+ CCR4+ T-cell neoplasm, and approximately half of patients have direct skin involvement manifesting patch, plaque, tumor, multiple papules, erythroderma and purpura. However, there exist secondary eruptions without tumor cell infiltration in patients with ATLL or HAM/TSP and carriers of HTLV-1. To clarify the presence of reactive skin eruptions in HTLV-1-infected individuals, we reviewed our patients with HTLV-1-associated diseases. In 2002-2012, we saw 50 ATLL or HAM/TSP patients and HTLV-1 carriers presenting with skin lesions. We retrospectively selected cases that histologically showed lichenoid tissue reactions with predominant infiltration of CD8+ T cells, but not CD4+ tumor cells. The cases included erythroderma (HTLV-1 carrier), lichen planus (HTLV-1 carrier), alopecia areata (HAM/TSP), chronic actinic dermatitis (HTLV-1 carrier to acute ATLL conversion) and discoid lupus erythematosus (smoldering ATLL). They were graft-versus-host disease-like, major secondary lesions and seen in HTLV-1 carriers and patients with HAM/TSP and smoldering ATLL. We coin the term HTLV-1-associated lichenoid dermatitis (HALD) to encompass the conditions. HALD may occur in association with the elevated immunity toward HTLV-1-infected CD4+ T cells, thus sharing the pathogenetic role of cytotoxic T cells with HAM/TSP.

Experiences of parents' with children receiving long-term home parenteral nutrition.

BACKGROUND: Home parenteral nutrition (HPN) was introduced in the early 1970s. Parents with children receiving HPN are involved in their children's treatment and strive to resolve difficult problems in adapting to their new lifestyles. This study investigates the positive views acquired by parents' regarding their experiences with their children who are receiving long-term HPN. METHODS: Participants were parents of preschool-aged children who had been receiving total parenteral nutrition for 1-6 years. In-depth interviews were conducted during which parents were questioned about their experiences during the process of providing HPN for their children. Qualitative content analysis was applied to the data. RESULTS: It seemed useful to apply the concept of resilience; therefore, we classified the categories according to factors named in previous research studies on resilience. All parents showed increased resilience in the face of HPN-related demands. CONCLUSIONS: The planning and provision of care could be aided by the conceptualization of subjects' experiences as a process during which they have needs for support and information exchange. To approach this problem appropriately, health-care professionals need to assess both children and parents on a continuous basis. Medical professionals should plan the care of ill children in advance so that appropriate help and support for their families can be provided. Better care for ill children needs to be accompanied by lasting relationships between parents and health-care professionals.

Generalized eruptive xanthoma with prominent deposition of naked chylomicrons: evidence for chylomicrons as the origin of urate-like crystals.

Eruptive xanthoma is defined by the combination of its clinical and histopathological features. While a nodular dermal infiltrate rich in foamy macrophages and associated with extracellular lipid deposition is typical of eruptive xanthoma, some microscopical variability can be seen. Herein, we report an unusual case of eruptive xanthoma exhibiting triglyceride deposition in a peculiar configuration. A biopsy from a papular lesion showed prominent deposition of crystalline material, surrounded by many foamy histiocytes, in the upper and middle dermis. Such material has been previously termed 'urate-like crystals'. An immunohistochemical analysis using antibodies to lipoprotein suggested that the substance is composed of chylomicrons. This observation suggests that naked chylomicrons may be deposited in the dermis of patients with severe hypertriglyceridemia.

Spinal cord compression presumably due to metastasized cutaneous squamous cell carcinoma to the thoracic spine.

Cutaneous squamous cell carcinoma (SCC) frequently metastasizes to lymph nodes, but metastasis to the spine is rare. We report a case of cutaneous SCC with metastasis to a particularly rare region, the thoracic spine, which evolved into a spinal cord compression. In November 2005, a 73-year-old man underwent a resection of a primary tumor and standard inguinal lymphadenectomy for a cutaneous SCC of the right fourth toe, defined as T2N1M1 stage. Over the next 3 years, he was given peplomycin, CAV (cisplatin, adriamycin, and vindesine) therapy and radiotherapy for multiple lymph node metastases. In September 2008, he complained of back pain and urinary retention. Magnetic resonance imaging of the thoracic spine showed the presence of masses in the vertebral body, which compressed the spinal cord. Blood examination revealed an elevated level of serum SCC antigen. After irradiation and chemotherapy, the patient's complaint was relieved and the level of serum SCC antigen concomitantly declined. Spinal metastasis is one of the items to be kept in mind during the follow-up of patients with cutaneous SCC.

[Seborrheic keratosis on the umbilicus: case report and review of Japanese literature].

A 78-year-old man was seen for a tumor on his umbilicus. Clinically, there was a dark brown nodule with thick scales. The excised tumor showed the acanthotic type of seborrheic keratosis. Six cases of seborrheic keratosis arising on the umbilicus have been reported. All of them were of the histologically hyperkeratotic type. Our case is the first report of an acanthotic type of seborrheic keratosis on the umbilicus. Seborrheic keratosis is one of the common skin tumors, but we hesitated in this diagnosis because of its abnormal location.

Aberrant aquaporin 5 expression in the sweat gland in aquagenic wrinkling of the palms.

Aquagenic wrinkling of the palms (AWP) is an uncommon disease characterized by the rapid and transient formation of edematous whitish plaques on the palms on exposure to water. Although this disease is occasionally accompanied by hyperhidrosis, the pathophysiology of AWP remains unknown. Herein we describe a patient with AWP. The location of wrinkling was limited to the areas positive for iodine-starch test after water exposure, which suggests that AWP is etiologically related to hyperhidrosis. Histologic examination revealed hyperplastic and papillated eccrine glandular epithelium with the enlarged diameter of eccrine coils. Immunohistochemically, while aquaporin 5 (AQP5), one of the water channel AQP families, was present exclusively in the dark cells of sweat glands of healthy donors, an aberrant AQP5 staining, extending to the clear cells, was found in the patient with AWP. The hyperplastic glandular epithelium and aberrant AQP5 staining in the patient's sweat glands suggest that AWP stems from dysregulation of sweating.

Copper-catalyzed gamma-selective and stereospecific substitution reaction of allylic carbonates with diboron: efficient route to chiral allylboron compounds.

A copper-catalyzed gamma-selective and stereospecific substitution reaction of allylic carbonates with a diboron reagent affording allylboron compounds is described. Boryl group was selectively introduced at the gamma-position of the leaving carbonate group. Functionalized allylboronates that have an acetal, ester, or isolated alkene were prepared. The reaction of optically active allylic carbonates underwent complete alpha-to-gamma chirality transfer with anti-stereochemistry to produce optically active allylboronates having a boron-substituted stereogenic center.