Desipramine-induced blue-gray photosensitive pigmentation

BACKGROUND

Blue-gray pigmentation of the skin can be elicited by several medications. We report the first case (to our knowledge) of desipramine-induced photosensitive blue-gray pigmentation.

OBSERVATIONS

Diffuse blue-gray pigmentation on sun-exposed surfaces was noted in a healthy 48-year-old woman who had been taking desipramine hydrochloride for 8 years. Ultrastructural studies demonstrated the presence of melanin and homogeneous electron-dense material in the dermis.

CONCLUSIONS

We conclude that tricyclic antidepressant agents represent another class of medications responsible for blue-gray cutaneous pigmentation.

[Effect of electrical stimulation of hyperstriatum on nucleus dorsalis intermedius ventralis anterior thalami somatosensory units in pigeon]

Discharges of 88 somatosensory units in the nucleus dorsalis intermedius ventralis anterior thalami (DIVA) in response to afferent impulses of radial nerve on 55 urethane anesthetized pigeons were recorded and analysed. Among the 88 units, part of them also responded to the stimulation of sciatic nerve. Following electrical stimulation of somatic projecting area of hyperstriatum, the spontaneous discharges and the responses of DIVA somatosensory units to radial inputs were obviously inhibited and the degree of inhibition was linearly correlated with the frequency and intensity of stimulation. The inhibitory effect on the responses to radial inputs may cause an increase in latency and a decrease in number of spikes. These results indicate that the DIVA certainly belongs to somatosensory system, and the somatic projecting area of hyperstriatum has a descending inhibitory effect on the DIVA somatosensory units. The hyperstriatum may thus exert feedback control over its sensory inputs through descending inhibition. It appears that the functional connection between the highest region of central nervous system and thalamus in avian is similar to that of mammal.

[Studies on the chemical constituents of Fritillaria taipaiensis L]

A new C-nor-D-homo-steroidal alkaloid named taipaienine, together with five known alkaloids namely chuanbeinone, imperialine, verticinone, perimissine and isoverticine were isolated from the bulbs of Fritillaria taipaiensis L. var. ningxiaensis Y. et W.. The unusual structure of taipaienine was a first sample with a hydroxyl group substituted at C-25 of (22)R-trans quinolizidine moiety with orientation of nitrogen lone pair. Their structures were determined by various spectral analyses.

Disulfide containing proteins denatured in 6 mol/L guanidinium chloride are not completely unfolded

The unfolded states of serum albumin, lysozyme and ribonuclease denatured in GuHCl with their disulfide bridges intact or reduced and carboxyamidomethylated have been compared by their circular dichroism, second-derivative and difference spectra in the ultraviolet region. Results obtained indicate that although the secondary structures of denatured proteins with intact disulfides are largely destroyed, they still have considerable ordered conformation even in 6 mol/L guanidinium chloride as indicated by the differences in the extents of exposure of the aromatic residues compared to the denatured proteins without the native disulfide bonds.

C-terminal truncation of bovine protein disulfide isomerase increases its activity

Protein disulfide isomerase as usually purified by the method of Lambert and Freedman (Biochem. J., 1983, 213, 225-234) although appeared homogeneous by sodium dodecyl sulfate-polyacrylamide gel electrophoresis can be separated into two major components on a size-exclusion high performance liquid chromatography column or by polyacrylamide gel electrophoresis. These two components have the same N-terminal sequences but the C-terminal sequences are different, suggesting that one is the C-terminal slightly truncated protein. The shortened protein is more active in both the isomerase and the thiol-protein oxidoreductase activities.

Symmetrical adenovirus minichromosomes have hairpin replication intermediates

A special class of panhandles (hairpin or foldback structures) arising from the replication of symmetrical adenovirus (Ad) minichromosome dimers and oligomers have been identified by two-dimensional gel electrophoresis. Hairpins provide evidence for replicative intermediates in the pathway for Ad complementary-strand synthesis. Furthermore, larger inverted sequences give Ad minichromosomes a replicative advantage.

Formation of enzyme-substrate disulfide linkage during catalysis by protein disulfide isomerase

During the regeneration of native ribonuclease A (RNase) from the disulfide scrambled molecule by protein disulfide isomerase (PDI), the substrate forms a covalent intermediate with the enzyme through disulfide linkage(s). This has been shown by the appearance of a band at the molecular weight position expected in SDS-PAGE at the same time as the increase in RNase activity. The new band decreased when the regeneration of RNase activity approached completion and disappeared by treatment of the reaction mixture with excess dithiothreitol.

xUBF and Rib 1 are both required for formation of a stable polymerase I promoter complex in X. laevis

We show that three protein fractions are required for accurate transcription initiation at a Xenopus laevis ribosomal gene promoter in vitro: RNA polymerase I, Rib1 and xUBF. The Rib1 and xUBF fractions are both necessary and sufficient for formation of a stable initiation complex. The xUBF fraction can be completely replaced by recombinant xUBF. We also report the sequence of a cDNA clone for xUBF. xUBF is 701 amino acids in length, contains domain which are related to a domain found in chromosomal proteins HMG 1 and 2, and has an acidic carboxy terminus of 87 amino acids. xUBF is closely similar in amino acid sequence to its previously reported human homolog, hUBF, except that xUBF has only three of the HMG-related domains while hUBF has four and therefore is 63 amino acids longer than xUBF.

Sweat-related dermatoses: old concept and new scenario

This review focuses on dermatoses that are caused by the presence of sweat--a previously underemphasized subject. A working classification based on 'internal sweating' (extravasated sweat in the dermis and epidermis) and 'external sweating' (sweat on skin surface) is proposed. Clinical observations suggest that transient acantholytic dermatosis is the consequence of extravasated sweat; we speculate that it is an example of sweat-related, protease-induced epidermal acantholysis. Neutrophilic eccrine hidradenitis may represent a sweat-related drug reaction. We emphasize the well-recognized phenomenon of 'sweat retention syndrome' in a new scenario: hospitalized febrile patients, increasing use of chemotherapy, new life style. The concept of 'sweat-gland-mediated cutaneous inflammation' is proposed.

Cutaneous lymphoid hyperplasia. Immunologic characteristics and assessment of criteria recently proposed as diagnostic of malignant lymphoma

Fifteen cases of cutaneous lymphoid hyperplasia were studied immunohistologically with a large panel of monoclonal antibodies to determine their immunoarchitectural composition and to determine whether immunologic criteria recently proposed to identify lymphoma ever occur in benign skin lesions. All lesions were composed of T cells, polytypic B cells, macrophages, and Langerhans cells. Although only six cases containing lymphoid follicles were recognized in routinely stained sections, an additional five were identified in immunoperoxidase-stained sections. These follicles were of both the primary and secondary types and contained dendritic reticulum cell networks. The immunophenotypic features of these follicles were similar to those of reactive follicles in lymphoid organs and contrasted sharply with those reported previously for follicular lymphomas. Helper T cells were predominant in 11 cases. With regard to proposed criteria for T cell lymphoma, we did not detect loss of pan T cell antigens CD2, CD3, CD5, or BF-1, nor did we find populations of T cells with abnormal co-expression or loss of subset antigens such as CD4-8- or CD4+8+. Two cases in which relatively sparse infiltrates were present, however, were moderately CD7-deficient. This finding suggests that the CD7 criterion for cutaneous T cell neoplasia be modified in this situation. As observed previously, Leu-8 antigen deficiency was a common, nonspecific finding. With regard to proposed criteria for B cell lymphoma, we did not detect populations of B cells that were immunoglobulin-negative, nor did we observe preferential loss of one or more B-lineage antigens, histocompatibility complex-associated antigens, or lymphocyte function-associated antigens. We also did not identify any CD5+ B cells. On the basis of a comparison of our current data with prior studies of cutaneous lymphomas, we conclude that the immunologic findings recently proposed as general criteria for the differentiation of lymphoma from lymphoid hyperplasia are, in fact, applicable to cutaneous lymphoid lesions.

Presence of cytoadhesins (IIb-IIIa-like glycoproteins) on human metastatic melanomas but not on benign melanocytes

Glycoproteins IIb and IIIa, a heterodimer complex, play a vital role in blood platelet aggregation and are members of a wide family of membrane receptors known as integrins or cytoadhesins. Cellular interaction to extracellular matrix (ECM) adhesive proteins is mediated by integrins. Certain tumor cells are known to interact with ECM and blood platelets in the process of metastasis. However, it is not known if tumor cells, compared with their normal counterparts, acquire IIb-IIIa-like receptors to help them in their metastatic spread. In this study, monoclonal antibodies directed against the IIb-IIIa platelet glycoprotein complex were used on frozen biopsies of normal and various tumor tissues to detect the presence of these integrins. These studies demonstrate the presence of IIb-IIIa-like glycoproteins on the cells of metastatic malignant melanoma but not on benign melanocytes and rarely on other tumors. The presence of integrins on melanomas may help explain their propensity for frequent metastasis.

[Projection of afferent impulses from the brachial plexus and sciatic nerve to the corpus striatum in pigeons]

The corpus striatum were systematically explored by recording averaged potentials elicited by stimulation of the brachial plexus and sciatic nerve in 53 pigeons. It was found that the projection areas of brachial afferents were located within the neostriatum, the hyperstriatum and the ectostriatum. The sciatic projection areas overlap with the brachial projection areas in the neostriatum and a part of the hyperstriatum. Moreover, the brachial and sciatic projection are as in the striatum receive the inputs from both sides of the body. We suggest that the somatic projection areas of fore- and hindlimb are distributed diffusely in the striatum of the pigeon. That the projection area of forelimb is relatively larger is probably related with functional differentiation of the forelimb. Furthermore, the convergence of afferent impulses originating in the different regions of the body within the same brain area may be important for the integration of limb activities in pigeon.

[Serum lipids and apolipoproteins AI, B100, CI and CII in patients with apoplexy]

Serum triglycerides, cholesterol, HDL-cholesterol and apolipoproteins (apo) AI, B100. CI and CII were determined and analyzed in 72 apoplectic patients and 64 age-matched normal subjects. Significantly increased triglycerides, low HDL-C and slightly decreased cholesterol levels were found in the apoplectics. Apo AI was slightly decreased and apo B100 slightly increased in the apoplectics compared with normal subjects. Apo CI and CII levels were significantly decreased in the apoplectics. The results are discussed.

PUVA treatment of erythrodermic and plaque-type mycosis fungoides. Ten-year follow-up study

Since our preliminary report of psoralen plus long-wave ultraviolet A (PUVA) therapy in ten patients with erythroderma-type or plaque-type mycosis fungoides (MF), we have treated 38 patients with biopsy-proved MF. Approximately one third, mostly patients with erythroderma, received PUVA as primary therapy; the remainder had recurrent disease following electron beam irradiation or topical mechlorethamine (Mustargen) hydrochloride. Follow-up data are presented in 29 patients who completed an initial course of PUVA given two to three times weekly. A complete clinical response was observed in ten patients with plaque-type MF and seven with erythroderma without Sézary syndrome. The PUVA therapy was palliative for patients with advanced disease, in combination with other therapies. The mean observation period was approximately five years. Despite maintenance PUVA, most patients relapsed between ten and twenty months and were treated with another intensive course. Long-term maintenance therapy with PUVA was necessary to control the disease.

Transient acantholytic dermatosis (Grover's disease). A skin disorder related to heat and sweating

We report seven cases of transient acantholytic dermatosis (Grover's disease) to exemplify a causal association with heat and sweating. The excessive heat and sweating was related to the use of a hot tub, a hot water bottle, a steam bath, an electric blanket, the prolonged wearing of a polyester suit, and postoperative bed confinement.

The indeterminate cell proliferative disorder: report of a case manifesting as an unusual cutaneous histiocytosis

A patient with an unusual, distinctive cutaneous histiocytosis is described. Extensive morphologic, antigenic, and enzymatic studies indicate that this histiocytosis represents a proliferative disorder of cutaneous indeterminate cells. Features that distinguish this disorder from other histiocytoses are discussed.

PUVA-induced melanocytic atypia: is it confined to PUVA lentigines?

Widespread lentigines in fourteen patients following long-term therapy with psoralens and ultraviolet A (PUVA) for psoriasis were documented by biopsy of a representative lesion in a non-sun-exposed site. Chronically PUVA-exposed nonlesional skin was examined in ten of the fourteen patients. Melanocytic atypia consisting of large or angular hyperchromatic nuclei was observed in 57% of PUVA lentigines and 70% of the nonlesional PUVA-exposed skin. Comparison with twenty-four specimens of lentigo simplex or solar lentigines revealed melanocytic nuclear atypia in only two cases. Binucleated melanocytes suggesting disturbed cellular kinetics were seen in all types of lesions examined but most commonly in PUVA lentigines. The presence of giant melanosomes was also a frequent nonspecific finding. Our findings of melanocytic atypia in chronically PUVA-exposed skin, as well as in PUVA lentigines, suggest that both sites are at risk for potential complications of repeated melanocytic stimulation. Whether melanocytic atypia will prove to be a precursor of melanocytic dysplasia or malignancy following PUVA therapy requires long-term evaluation.

Generalized pustular psoriasis provoked by propranolol

An 80-year-old man who had had plaque-type psoriasis for 40 years experienced a rapid onset of generalized pustular psoriasis three days after initiation of propranolol hydrochloride therapy. Trial therapy with propranolol on two occasions resulted in similar episodes. The skin lesions and systemic symptoms resolved after the discontinuation of propranolol therapy and administration of methotrexate sodium. This case study documents propranolol--a beta-blocker--as another causal factor for pustular psoriasis.

Blueberry muffin syndrome: cutaneous erythropoiesis and possible intrauterine viral infection

A newborn baby with generalized "blueberry muffin" eruption and histologic evidence of dermal erythropoiesis is described. This case is unusual in that we could not identify any of the congenital viral infections usually associated with this syndrome. The clinical features of dermal erythropoiesis and dermal hematopoiesis are reviewed briefly.

Response of nodular non-X histiocytosis to vinblastine

Progressive cutaneous papulonodular non-X histiocytosis of the face and proximal parts of the extremities developed in a 28-year-old woman. Histologic study showed masses of benign histiocytes with foci of lymphocytes. Occasional cells contained diastase-resistant cytoplasmic polysaccharide that stained positive with PAS stain. No iron, fat, or Touton or other giant cells were present. Ultrastructural study disclosed laminar bodies but no Langerhans' cells or Langerhans' granules. The process responded to low-dose intravenous vinblastine sulfate treatment.

Lipid synthesis in cutaneous xanthoma

In vitro lipogenesis was studied on the xanthoma tissue from 6 patients with normal plasma lipids and 4 patients with hyperlipidemia. Xanthoma tissue was incubated at 37 degrees C for 6 hr in Krebs-Ringer phosphate buffer containing sodium [14C]acetate. The radioactivity of each lipid class was determined after extraction and separation of lipids. The incorporation of acetate into all major lipid groups was much greater in xanthoma tissue than in control normal-appearing skin. There was no difference in the incorporation pattern of 14C between xanthomas of patients with normal plasma lipids and those of hyperlipidemic patients. The data exemplify considerable in situ lipid synthesis of xanthoma tissue. Although the lipids in xanthomas of hyperlipidemic persons may be derived from plasma, the plasma origin of xanthoma lipids in normolipidemic persons remains to be confirmed, and the contribution of local lipogenesis cannot be ignored. The lipids in cutaneous xanthomas are most likely derived from a multiple input system.

Lennert's lymphoma presenting with clusters of cutaneous infection

We recently diagnosed and studied a case of Lennert's lymphoma in a young black man who presented with a chronic pyoderma and multiple cutaneous infections of viral origin. Lennert's lymphoma, or malignant lymphoma with a high content of epithelioid histiocytes, is an uncommon variant of non-Hodgkin's lymphoma. This report highlights the role of idiopathic immunosuppression in lymphoma patients.

Corticosteroids, aurothioglucose and soybean trypsin inhibitor do not prevent pemphigus antibody-induced acantholysis in vitro

Hydrocortisone, triamcinolone acetonide, aurothioglucose and soybean trypsin inhibitor were added to normal human skin explants cultured with IgG from pemphigus serum to determine if acantholysis could be prevented. At the therapeutic concentrations used none of these compounds prevented binding of the autoantibody to the epidermal target cells, and none prevented acantholysis. These experiments support the concepts that the pemphigus antibody alone is responsible for producing the acantholytic lesions of pemphigus, that the therapeutic effectiveness of steroids and gold salts is probably due to their ability to reduce serum autoantibody titres and that pemphigus acantholysis is probably not caused by a serine proteinase.

Dermal duct tumor: a histochemical and electron microscopic study

The histochemical and electron microscopic findings in seven cases of dermal duct tumor are described. All seven of the patients were elderly, and five were women. The tumors were small flesh-colored or red papules located most often on the head and neck region. Intense phosphorylase and moderate respiratory enzymes characterized the histochemical reaction of the tumors. The following three types of tumor cells were recognized ultrastructurally: clear, dark, and luminal. The tumor was principally composed of clear cell proliferation around a regular ductal lumen. In addition, melanocytes, Langerhans' cells, and lymphocytes were occasionally seen within the tumor masses. An intact basal lamina and few hemidesmosomes with no detectable actin-like microfilaments were the features of the tumor-stroma interface. Our study results showed that the dermal duct tumor is a benign tumor with eccrine dermal ductal differentiation.

Epidermal acantholysis induced in vitro by pemphigus autoantibody. An ultrastructural study

Suprabasilar acantholysis can be produced in organ culture of normal human skin in the presence of pemphigus IgG autoantibody. We have examined this in vitro system by electron microscopy. The earliest ultrastructural changes at 12 hours included widening of the intercellular spaces and disruption of the intercellular cement substance in the nondesmosomal areas. After 24 to 48 hours in culture, the tonofilaments retracted from the cell periphery, desmosomes were lost, and extensive cell surface digitation occurred. By 72 hours, isolated cells without noticeable desmosomes were seen in the suprabasilar areas, whereas basal cells, with intact hemidesmosomes, remained attached to the basal lamina. Control cultures which were grown in the presence of normal IgG or F-10 medium alone did not manifest these changes. The ultrastructural features support the conclusion that the acantholysis produced in this system is similar and probably identical to that of naturally occurring pemphigus.