Neuroendocrine skin carcinoma coexpressing cytokeratin and neurofilament proteins

Neuroendocrine (Merkel cell) carcinomas of the skin have been recognized as such for several years. Given the reported wide variability in the morphology and clinical evolution of these tumors, the notion that may they comprise several variants rather than a single type has been advocated. Electron microscopy has played a key role in the early recognition of these tumors while immunohistochemical studies for various neuroendocrine markers have facilitated their subsequent diagnosis and improved our understanding as to their complexity by the demonstration of immunoreactivity for NSE (neuron specific enolase) and a number of neuropeptides. There has also been considerable interest in the study of the cytoskeletal intermediate filament complement of neuroendocrine neoplasms in general and of those of the skin in particular. Early reports indicated that neuroendocrine skin carcinomas had neurofilaments while subsequent investigations determined that they had cytokeratin. However, more recent studies have indicated that at least some neuroendocrine skin carcinomas could in fact coexpress both aforementioned classes of intermediate filament proteins. This brief report is presented to confirm the latter investigations.

Bombesin in human neuroendocrine (NE) neoplasms

Bombesin is a 14 amino acid peptide isolated from amphibian skin which was found to have stimulatory effects upon gastric and pancreatic secretions, release of gastrointestinal hormones, gallbladder contraction and bronchoconstriction. It is present in amphibian gastric endocrine cells, avian proventriculus endocrine cells and avian brain. In mammals it is present mainly in nerve cells and fibers. The only mammalian endocrine cell shown to date to have bombesin is the P-cell in fetal lung. Bombesin is also found in mammalian brain, with its highest concentration in the hypothalamus. We examined several groups of human neuroendocrine neoplasms for the presence of bombesin by immunohistochemistry. Our findings indicate that bombesin is present 68% of bronchial carcinoids, 65% of pulmonary neuroendocrine carcinomas, 62% of neuroendocrine carcinomas of the skin, 5-10% of pheochromocytomas and extraadrenal paragangliomas and 35% of gastrointestinal carcinoids and neuroendocrine carcinomas. Parallel studies in a wide variety of non neuroendocrine neoplasms failed to reveal the presence of bombesin. We conclude that bombesin is a highly specific marker of neuroendocrine differentiation and thus a valuable tumor marker. Furthermore, its specificity compares favorably with another neuroendocrine marker, neuron specific enolase, an enzyme thought to be present only in neural tissues and neuroendocrine cells but recently found in non neural human tissues and non neuroendocrine neoplasms.

Paragangliomas of the head and neck: ultrastructural and immunohistochemical analysis

Eighteen head and neck paragangliomas were studied by light microscopy and light microscopic immunohistochemistry by the peroxidase technique for the presence of NSE (neuron-specific enolase), serotonin, and a battery of neuropeptides. Seven of these tumors were also studied by electron microscopy. All 18 cases demonstrated immunostaining for NSE; 10 of the 11 carotid body tumors had immunostaining for multiple hormones. Considering all 18 cases, the most frequently demonstrated hormonal substances were in order: serotonin, leu-enkephalin, gastrin, substance P, vasoactive intestinal polypeptide (VIP), somatostatin, bombesin, calcitonin, and alpha MSH. In several tumors, adjacent-step sections stained for different hormonal substances strongly suggested reactivity for more than one hormone in given tumor cells. By electron microscopy, all 7 cases studied displayed considerable heterogeneity of the neurosecretory granules with respect to size, shape, and electron density. This demonstrated that branchiomeric paragangliomas are capable of producing a spectrum of neuropeptides in addition to their known amine content. The presence of immunoreactive serotonin in most of these neoplasms was confirmed. In addition to these findings, neurofibrils within the substance of carotid body paragangliomas demonstrated immunoreactivity for somatostatin and a gastrinlike neuropeptide. The significance of the neuropeptides in these neoplasms and their possible presence and role in normal and hyperplastic paraganglia remain to be defined.

A comparison of subliminal, supraliminal and faded phobic cine-films in the treatment of agoraphobia

Thirty-two agoraphobic patients were randomly allocated to four groups and treated by repeated exposure to cine-films at twice weekly intervals for three weeks. Three of the groups saw the same cine-film, comprising a range of agoraphobic scenes, and a control group saw a potter working on his wheel. The three groups seeing the phobic cine-film included one who viewed it at an illumination level below the visual threshold (subliminal group), one seeing it under normal conditions (supraliminal group) and one which underwent graduated exposure from subliminal to supraliminal viewing levels as the study proceeded (faded group). The faded group showed significantly greater improvement than the control and supraliminal groups and this improvement was maintained over twelve weeks.

Blastogenic responsiveness of spleen cells from guinea pigs sensitized to Legionella pneumophila antigens

An in vitro leukocyte blastogenic assay was utilized to establish an in vitro correlate of cell-mediated immunity to Legionella pneumophila antigen with spleen cells from sensitized guinea pigs. Incubation of spleen cells from sensitized but not normal guinea pigs with graded amounts of killed whole cell Legionella bacteria or sonicate derived from the bacteria resulted in an antigen-induced blast cell proliferation as evidenced by an increased uptake of [3H]-thymidine into spleen cell cultures. Peak responses occurred approximately 4-6 days after incubation of the spleen cells with antigen. Sensitivity of spleen cells from animals immunized with Legionella vaccine in adjuvant persisted for at least 150 days, while responses after infection of guinea pigs with viable bacteria persisted about 4-6 weeks. The blastogenic responses of the spleen cells to Legionella antigen appeared to be a correlate of cell-mediated immunity.

Analgesic properties of meperidine, amitriptyline and phenelzine in mice

Sixty-three white Swiss Webster mice were divided into seven equal groups. Their tolerance to pain (heat applied to the tail by a test tube containing hot water at a temperature measured by telethermometry) was assessed before and after intraperitoneal injection of (1) physiologic saline; (2) meperidine 14 micrograms X g-1; (3) amitriptyline 6 micrograms X g-1 (4) amitriptyline 12 micrograms X g-1; (5) phenelzine 1.5 micrograms X g-1; (6) phenelzine 3 micrograms X g-1; and (7) amitriptyline 6 micrograms X g-1 plus phenelzine 1.5 micrograms X g-1. All post-injection tests were conducted 45 and 90 minutes after administration, and repeated 24 hours later. No significant difference in pain threshold was noted in any pre-injection test or in any test conducted with physiologic saline. By 90 minutes post-injection, all groups receiving drugs developed increased tolerance to pain. Mice which had received phenelzine plus amitriptyline, or either dose of phenelzine were more tolerant to pain for up to 24 hours than mice which had received physiologic saline. The most marked increases in tolerance to pain were seen with 1.5 micrograms X g-1 and 3 micrograms X g-1 of phenelzine and phenelzine plus amitriptyline. However, phenelzine was more effective and had a longer-lasting effect than either dose of amitriptyline, or meperidine. The combination of phenelzine plus amitriptyline was no more effective than phenelzine alone.

Cellular immunity to Legionella pneumophila in guinea pigs assessed by direct and indirect migration inhibition reactions in vitro

Spleen cell cultures from guinea pigs given legionella pneumophila vaccine in complete Freund adjuvant or as a sublethal infection were inhibited in their migration activity in vitro when incubated with specific antigen. Both direct and indirect migration inhibition assays revealed sensitization of the guinea pigs to the bacterium, with demonstrable reactivity 25 to 40 days or more after sensitization. No consistent reactions occurred when the guinea pigs were given the killed Legionella vaccine in incomplete Freund adjuvant in saline. However, spleen cells from guinea pigs injected with sublethal doses of the Legionella vaccine 3 to 4 weeks earlier showed positive migration inhibition factor reactivity. Cutaneous hypersensitivity and lymphocyte blastogenic responsiveness in vitro also developed in guinea pigs sensitized with killed Legionella vaccine in complete adjuvant or given a sublethal infection with the bacterium. These results indicate that in vitro assays for migration inhibitory activity may be utilized to monitor the development of the sensitization of guinea pigs to L. pneumophila, and such reactions correlate with skin reactivity and in vitro lymphocyte blastogenic responses.

Agar microdroplet assay for delayed hypersensitivity to Legionella pneumophila serogroup 1

An agarose microdroplet technique was utilized to assess the cellular immunity of guinea pig lymphoid cells to Legionella pneumophila antigen in vitro. Both direct and indirect migration inhibition procedures were shown to be capable of detecting sensitization of guinea pigs to L. pneumophila antigens. Animals injected with adjuvant alone or unrelated antigens did not yield spleen cells responsive to L. pneumophila, indicating the specificity of the response. Migration inhibition factor induction by Legionella antigen in vitro correlated well with skin test responses in vivo. The positive reaction detected by migration inhibition occurred at times similar to that of skin reactivity but later than that of the earliest serum antibody titers. The assay appears to be useful for monitoring sensitization to Legionella and may be applicable to the study of cell-mediated immunity to this bacterium in infected individuals.

Physiological characteristics of tremor after chronic lithium therapy

Twenty-three patients taking lithium carbonate alone in therapeutic dosage for a mean period of 43 months (range 6--108 months) and 23 control subjects matched for age and sex had the frequency and amplitude of postural tremor measured and extrapyramidal symptoms assessed by standard techniques. Patients on lithium had a significantly lower peak frequency of tremor than control subjects (P less than 0.05) and significantly greater extrapyramidal symptoms (P less than 0.01), indicating that tremor appearing after chronic lithium therapy is likely to be an extrapyramidal symptom. Such symptoms are common long-term adverse effects of lithium carbonate.

Self-report and physiological responses to subliminal and supraliminal motion pictures

Six groups of volunteer students were shown a series of four 90-second pictures: and anxiety inducing, one neutral, and two control sequences with no information content, under both subliminal and supraliminal conditions. Self-report and physiological responses to each picture were recorded. Each group was shown the same set of eight motion pictures, in counterbalanced order, but the level of subliminal presentation was varied from completely subliminal in group 1 to a level at which all the subjects could recognize the material in group 6. The results showed that although the anxiety-provoking motion pictures produced significantly greater anxiety responses under supraliminal conditions, there were no significant differences between responses to the pictures at any level of subliminal exposure.

Prognostic factors determining response to antidepressant drugs in psychiatric out-patients and general practice

The outcome of antidepressant drug treatment was measured in 200 patients, 145 seen in psychiatric out-patient clinics and 55 in general practice, after 4 weeks of therapy. The results of the 200 patients taken together suggested that prognosis was largely determined by factors dependent on the natural history of the disorder and that clinical symptoms were unimportant, but when the results for patients in each drug group were analysed separately symptoms were more important than natural history factors. We conclude that clinical symptoms are only important predictors of response to antidepressant drugs when the patients studied are homogeneous with regard to natural history factors, particularly duration of illness.

An extrapyramidal syndrome after lithium therapy

Two patients developed an extrapyramidal syndrome after therapy with lithium carbonate. Although the clinical features of this syndrome were indistinguishable from those of drug-induced parkinsonism, it was made worse by the anti-parkinsonian drug, orphenadrine. These findings were reproduced later under laboratory conditions when extrapyramidal symptoms and physiological tremor were recorded before and after challenge doses of orphenadrine. This unwanted effect of lithium carbonate may be explained by selective blockade of dopamine receptors.

Awareness of cardiac function in anxious, phobic and hypochondriacal patients

Awareness of pulse rate was tested in 60 psychiatric out-patients with anxiety, phobic or hypochondriacal neuroses by asking them to record how fast their hearts were beating during exposure to short film sequences. Correlations between subjective and objective heart rate (ECG) were significantly higher in anxious and hypochondriacal patients than in phobic ones. The results suggest that somatic symptoms in hypochondriacal and anxiety neurosis reflect increased awareness of bodily function.

Responses of chronic agoraphobics to subliminal and supraliminal phobic motion pictures

Fifteen agoraphobics took part in a study to investigate their responses to repeated presentations of a phobic motion pciture. Five patients were shown the film supraliminally, five were shown it subliminally, and the remaining five formed a control group. Subjective feelings were assessed with visual analogue scales, and three physiological measures, heart rate, skin conductance, and respiratory rate, were recorded. An earlier report showed that both subliminal and supraliminal presentation produced significant improvements in phobic fear and avoidance, and the present results show that the subliminal group found the procedure much less stressful than the supraliminal group. The physiological changes during treatment showed no consistent pattern and appeared to be independent of clinical response. The results show that repeated exposure to subliminal phobic motion pictures is not anxiety provoking to agoraphobic patients and so may be appropriate therapy for those unable to tolerate other forms of treatment.

Finger tremor and extrapyramidal side effects of neuroleptic drugs

Finger tremor and extrapyramidal side-effects (EPSEs) were measured in seven patients before and during neuroleptic drug treatment to assess the relationship between the onset of EPSEs and changes in finger tremor spectra. Tremor and EPSEs were also measured in twelve patients stabilized on neuroleptic drugs to determine whether tremor could provide a reliable index of the presence and severity of extrapyramidal system disturbance. A downward shift in peak tremor frequently was noted within 48 hours of starting neuroleptic drug therapy, usually before the onset of EPSEs, and a significant negative relationship between the severity of EPSEs and tremor frequency (but not tremor amplitude). The peak frequency of finger tremor is thus a sensitive index of extrapyramidal disturbance and might be of value in predicting which patients taking neuroleptic drugs need anti-parkinsonian therapy.

Inhibition of elastolysis by proteinase inhibitors from chick plasma and aorta

Chick plasma contains inhibitor(s) against trypsin and elastase which also appear to retard the degradation of tropoelastin by arterial tissue extracts. Chick aorta extracts also contain similar inhibitors against elastase and trypsin. Both levels of the plasma inhibitor(s) and inhibitor(s) extracted from thoracic aorta increase during early stages of growth and maturation. There is a three- to four-fold increase in the levels of the inhibitor(s) in chick plasma and aorta between one to four weeks after hatching. Of particular interest are the observations that the presence of the inhibitor(s) retards the conversion of soluble elastin (tropoelastin) to smaller elastin peptides. Subsequently, it is speculated that in addition to other vital roles, such proteinase inhibitors may also act in regulating elastogenesis and elastin fiber formation.

Treatment of agoraphobia by subliminal and supraliminal exposure to phobic cine film

Three groups of 5 chronically agoraphobic patients were treated by repeated exposure to cine film at weekly intervals for six weeks. A supraliminal group saw an agoraphobic film specially made for the study illustrating a range of phobic situations. A subliminal group viewed the same film at a level of illumination below the threshold of awareness. A control group saw a blank screen with no filmed material for the same length of time. The films were screened five times at each treatment and were alternated with neutral film shown under normal viewing conditions. Ratings of phobic and other symptoms were made by a separate assessor who was unaware of the patient's treatment. The supraliminal and subliminal groups improved significantly more than the control group with regard to phobic fears, avoidance, and overall assessment.

Effects of subliminal and supraliminal stress on symptoms of anxiety

Two experiments were carried out with volunteer subjects to test whether the subliminal viewing of emotive material induced anxiety and its associated bodily symptoms. In one experiment 24 subjects looked at anxiety-inducing words presented singly through a tachistoscope under supraliminal or subliminal conditions, and in the other study 50 subjects looked at a neutral and an emotive movie film under similar conditions. Subliminality was insured in the first experiment by reducing the duration of exposure and in the second by reducing the level of illumination. The results showed that ratings of anxiety were significantly increased under subliminal emotive conditions, and reduced following subliminal neutral exposure. Correlations between psychic and somatic symptoms of anxiety were significantly higher under supraliminal conditions compared with subliminal ones. The possible role of subliminal stimulation in investigating the psychic and somatic components of anxiety is discussed.

Arterial elastin synthesis in the young chick

In the growing chick a marked stimulation in soluble and mature arterial elastin synthesis occurs 2 and 5 weeks after hatching. Measurement of [3H]valine and [3H]proline incorporation into arterial soluble protein during this period indicated that most of the label is found in a 70 000 dalton protein subunit. The labeled soluble subunit had the characteristics of native soluble elastin or tropoelastin. During the period in which the greatest percentage increase in mature elastin occurs, the highest specific activities of soluble [3H]valine-labeled protein were observed. These changes were striking and suggest a developmental period for the growing chick in which factors related to elastin metabolism may be more easily studied.