Twenty-seven cases with verruca vulgaris were examined in which the treatment consisted of oral administration of biscoclaurin alkaloids and Kampo medicine (Jumi-haidoku-to) with Siun-ko ointment. Seven of these cases were cured within one month-12 cases were cured within three months; and 8 cases required more than 3 months for a cure to be effected. However, there were no regressions or ineffective cases. Histopathological features of 5 cases examined after two or four weeks usage of Siun-ko ointment showed swelling of keratinocytes with formation of lacunae or fissures. This combination is thought to be an effective and useful treatment.

Although the patent ductus venosus is congenital, the symptoms due to hyperammonemia vary, possibly depending on the shunt ratio and individual tolerance to ammonia. We have experienced two adult patients with large caliber patent ductus venosus and compensated liver cirrhosis. In one case, the ductus venosus simply communicated to the portal vein, but in the other case there were multiple short communicating vessels between the ductus venosus and left portal vein. Both cases were successfully treated by the transvenous embolization with steel coils and ethanolamine oleate, which has an expansive nature.
Adult ; Cases ; Transvenous approach ; Two ; Open

A 65-year-old man visited our department because of 3 nodules that had appeared 6 months earlier in the lower jaw and left lower leg. One month before presentation, papules appeared and spread across his body. Palpation revealed a soft nodule in the lower jaw and relatively hard nodules in the left lower leg. Biopsy of the nodules showed moderate-sized cell infiltration in the middle to lower dermis and mononuclear cells (mainly lymphocytes) with many eosinophils in the adipose tissue. Histochemistry confirmed CD4-positive and CD8-positive cells, but not CD30-positive larger lymphocytes. Accordingly, psuedolymphoma was diagnosed. Two months later, prurigo pigmentosa appeared on the trunk, and minocycline (200 mg/day; p.o.) was effective to some degree. Both eruptions were thought to be induced by land leech bites.

Statistical analysis of bee stings was carried out for patients who visited Hachiman Hospital during the 7-year period from April, 2015 to October, 2021. Of 234 total cases, 223 were analyzed (105 men, 118 women;age 44.6±21.8 years; range 7-97 years). The mean number of cases per year was 30, although there were twice as many in 2016 when the rainfall was low. August was the month with the most cases, and most bee stings occurred in the morning. Most patients were stung only once, and the most common sites were the hands, followed by the upper extremities, head, face, lower extremities, trunk, feet, and neck. Erythema and swelling were the most common clinical manifestations, followed by petechiae, purpura, and vesicles (erosion). Systemic symptoms were observed in 19 cases (8.1%), including pharyngeal swelling, pruritis, urticaria, and fatigue. Swelling was the most common clinical manifestation in patients stung by paper wasps, but a wide range of symptoms were observed in patients stung by hornets. Effective treatment were corticosteroids (p.o. and ointment), anti-allergic medicines (p.o), biscoclaulin alkaloid (cepharanthine;20-30 mg injection), and kampo medicine (Saireito 7.5 g/day).

Skin damage caused by stink bugs was categorized into three types: I) pigmentation, II) bites, and III) ulcer/erosion due to accidental ingestion. Dermoscopic examination of type I damage revealed two types: amorphous and homogenous/diffuse pigmentation. The amorphous type was seen in 4 cases and involved the fingers, arm, and back, as well as the foot of an infant. The homogenous/diffuse type was seen in 6 cases, which all involved the foot except for 1 case involving a finger. These different types were thought to arise from different degrees and durations of crushing stink bugs. The diffuse type was attributed to high pressure between the foot and stink bug. Eruptions had characteristic colors of yellow, orange, or brown. The pigmented skin was exfoliated after several days in 2 cases. A crushing experiment using a stink bug revealed pigmentation on the foot, which disappeared naturally within 1 week. Examination of the pigmentation by the tape stripping method showed that pigmentation affected several layers of the stratum corneum.

This study analyzed patients with metal allergy who underwent patch test (Sato Pharmaceutical Co., Ltd.) in the past 5 years. Seventy-five patients (male 27, female 48, mean age 55.7 ± 18.7 years) were divided into three groups: metal allergy only (metal only group; n = 22), metal allergy complicated by pustolosis palmaris et plantaris (PPP group; n = 13), and metal allergy complicated by lichen planus or other conditions such as prurigo and hand dermatitis (LP group; n = 7). The result showed that patch tests were most frequently positive for gold thiosulfate, nickel, cobalt, para-phenylenediamine, and carba mix, in that order. The most common positive allergen was gold, at more than 70% in all three groups, followed by cobalt in the metal only group, nickel & carba mix in the PPP group, and carba mix and paraphenylenediamine in the LP group. Gold allergy increased markedly over the 5-year study period.

An 87-year-old woman visited our hospital because of severe widespread purpura with swelling on the right arm. Two days earlier, she had used an electric vacuum cleaner for several hours in order to remove an insect infestation (march flies) in her house. The next day, the purpura expanded to the right chest. Internal medical examination revealed no abnormality except for high levels of myogenic enzymes (lactate dehydrogenase, 326U/L; creatine kinase, 401 IU/L). The electric vacuum cleaner was made in Japan and showed a vibration level of 60dB, which is half that of a chainsaw or lawnmower (120dB). The purpura may have been caused by long-term use of the vacuum cleaner given that the effective value of equivalent vibration acceleration exceeded the European guideline (2.5m/s2 for 8 hours per day).

Transmucosal Immediate-Release Fentanyl（TIRF）can be a key-drug for breakthrough cancer pain. Prescription audit is needed because there are concerns about tolerance or serious adverse events including respiratory suppression and addiction due to inappropriate use of these drugs. The aim of this audit study is to evaluate appropriateness of TIRF prescriptions, reasons of violation, and adverse events in the real-world setting. A retrospective chart review was conducted in 31 patients who had breakthrough cancer pain and were treated with TIRF. A 2-step algorithm was generated：baseline pain and administration situation of other opioid rescues. TIRF was prescribed appropriately in six patients（19.4％）. Reasons of violation were as follows：prescriptions only for using same drug with around-the-clock opioids（fentanyl transdermal patches, n＝19）, and patients could take oral medicines and use of morphine or oxycodone rescues would be preferable（n＝12）. TIRF was initiated with a minimum dose in all patients and no serious adverse events were observed. Although TIRF was used widely for breakthrough cancer pain, prescription was not necessarily done appropriately. Detailed assessment of breakthrough cancer pain and consideration of the use the other rescue medication would be required.