Metal Allergy and Systemic Contact Dermatitis: An Overview

Contact dermatitis is produced by external skin exposure to an allergen, but sometimes a systemically administered allergen may reach the skin and remain concentrated there with the aid of the circulatory system, leading to the production of systemic contact dermatitis (SCD). Metals such as nickel, cobalt, chromium, and zinc are ubiquitous in our environment. Metal allergy may result in allergic contact dermatitis and also SCD. Systemic reactions, such as hand dermatitis or generalized eczematous reactions, can occur due to dietary nickel or cobalt ingestion. Zinc-containing dental fillings can induce oral lichen planus, palmoplantar pustulosis, and maculopapular rash. A diagnosis of sensitivity to metal is established by epicutaneous patch testing and oral metal challenge with metals such as nickel, cobalt, chromium, and zinc. In vitro tests, such as the lymphocyte stimulating test (LST), have some advantages over patch testing to diagnose allergic contact dermatitis. Additionally, the determination of the production of several cytokines by primary peripheral blood mononuclear cell cultures is a potentially promising in vitro method for the discrimination of metal allergies, including SCD, as compared with the LST

Development of the Career Decision Inventory: (1) Exploratory Factor Analysis for University Students

Controversy arose around the issue of the dimensionality of the Career Decision Scale (CDS: Osipow, Carney & Barak, 1976). Related discussions and research are reported, and scales developed recently for measuring the multi-dimensions of career indecision are reviewed. To measure the career indecision of Japanese university students, forty two items were constructed for seven dimensions. The participants were 467 undergraduate students enrolled in the psychology program at Kansai University. Exploratory factor analysis of these items revealed the following six factors ; choice anxiety and feeling awkward, conflict, moratorium, seeking counsel, evasion, and a sense of "barriers". To search the sub-dimensions of the first factor, exploratory factor analysis was used. These ten items were separated into two factors ; choice anxiety and indecision. The high reliability of seven scales constructed form the results of these two factor analyses, is reported, and the methodological issues of the measurement of career indecision were discussed.　CDS (Osipow,Carney & Barak,1976)の次元性について論争が起きた。これについての議論や実証研究に言及し、キャリア不決断の複数次元を測定するために最近開発された尺度をレビューした。日本の大学生のキャリア不決断を測定するために7つの次元について42項目が作成された。調査対象者は、関西大学の心理学専攻の 467名である。これらの項目の探索的因子分析から次の6因子が得られた。すなわち、決定不安と自信不足、葛藤、モラトリアム、相談希求、逃避、そして、障害である。第1因子の下位次元を求めて、探索的因子分析が使われた。これらの10個の項目が2つの因子に分かれた。すなわち、選択不安と不決断である。 2つの因子分析結果から構成された7つの尺度信頼性が高いことを報告し、キャリア不決断の測定の方法論的問題を議論した

Newly developed data-matching methodology for oral implant surgery allowing the automatic deletion of metal artifacts in 3D-CT images using new reference markers: A case report

Patients: The patient was a 55-year-old woman with left upper molar free-end edentulism and 9 full cast metal crowns in her mouth. Three three-dimensional (3D) images were superimposed: a computed tomography (CT) image with the patient wearing the CT-matching template (CTMT) with six glass ceramic markers, which hardly generate any artifacts, on the template surface, and oral plaster model surfaces with and without CTMTs. Metal artifacts were automatically removed by a Boolean operation identifying unrealistic images outside the oral plaster model surface. After the preoperative simulation, fully guided oral implant surgery was performed. Two implant bodies were placed in the left upper edentulism. The placement errors calculated by comparing the preoperative simulation and actual implant placement were then assessed by a software program using the 3D-CT bone morphology as a reference. The 3D deviations between the preoperative simulation and actual placement at the entry of the implant body were a maximum 0.48 mm and minimum 0.26 mm. Those at the tip of the implant body were a maximum 0.56 mm and a minimum 0.25 mm. Discussion: In this case, the maximum 3D deviations at the entry and tip section were less than in previous studies using double CT. Conclusions: Accurate image fusion utilizing CTMT with new reference markers was possible for a patient with many metal restorations. Using a surgical guide manufactured by the new matching methodology (modified single CT scan method), implant placement deviation can be minimized in patients with many metal restorations

Ocular infestation by a juvenile leech, Myxobdella sinanensis in Japan

[Purpose] The case of ocular infestation by a leech is rare. We reported that Myxobdella sinanensis infests conjunctiva. [Observations] A 5-year-old girl presented with blood clots in the inner corner of the left eye, and a history bloody eye discharge and bloody tears for 5 days. She was prescribed 0.5% levofloxacin ophthalmic drops for conjunctival damage. However, her parent watched a worm moving in her conjunctiva while taking a bath. She presented again the same day, and a worm was found in the left eye of the lower conjunctival fornix and was adsorbed to the inner corner. We removed a worm under eye drop anesthesia, the next day the patient had no symptoms. We captured the worm, and it was identified morphologically and genetically as Myxobdella sinanensis. This was the first case reported of Myxobdella sinanensis be infestation in a human. [Conclusions and Importance] The ecological trait of Myxobdella sinanensis still did not remain clear, so this case report was helpful to find out a life cycle of Myxobdella sinanensis. As the outdoor population continues to increase, the cases of human parasites such as leech are expected to increase. When a patient with bloody eye discharge and bloody tears presents, we should carefully examine the conjunctiva and ocular surfaces, and interview recent history of exposure to stream water

Significance of MDR1-Gene and P-Glycoprotein (P-gp) Expressions in the Lesional Skin of Psoriasis Vulgaris

We have examined P-gp (P-glycoprotein) and multi-drug resistance 1 (MDR1) gene expressions in the lesional skin of psoriasis vulgaris and atopic dermatitis some of those showed a decreased clinical response to topical corticosteroid ointment during the clinical course. The patients were subdivided into four groups; S (-): responder to topical steroid without steroid ointment for one month at the time of biopsy, S (+): responder to topical steroid and under steroid therapy at the time of biopsy, R (-): low or non- responder to topical steroid without steroid therapy for one month at the time of biopsy, R (+): low-or non-responder to topical steroid and under steroid therapy at the time of biopsy. P-gp was mainly expressed in the cytoplasm of some epidermal keratinocytes and most of infiltrating cells in the dermis of the lesional skin of psoriasis or atopic dermatitis. Scores of P-gp protein-expression was significantly higher in the patients under steroid ointment both in psoriasis vulgaris and atopic dermatitis. While R (+) group showed much more intense expression of P-gp than S (+) group in psoriasis vulgaris but this was not the case for atopic dermatitis. MDR1 gene was expressed in the lesional skin of R (+) psoriasis but not in S (+) psoriasis or normal skin. These results suggest that steroid-resistance occasionally experienced in psoriasis vulgaris might be related to the overexpression of P-gp which is possibly induced after topical steroid ointment. This might provide a new insight for the mechanism of steroid -insensitivity in inflammatory skin disorders especially in psoriasis vulgaris