The association between anti-inflammatory effects of long-term lithium treatment and illness course in Bipolar Disorder.

INTRODUCTION: Altered levels of acute-phase proteins are often described in different conditions in BD. Nevertheless, data on the association between lithium treatment and inflammatory markers in the long-term course of BD are still missing. The aim of the study was to examine the long-term course of BD concerning long-term lithium treatment, chronic inflammatory processes and symptom progression. Furthermore, the association between duration of lithium treatment and levels of hsCRP was explored. METHODS: 267 individuals (males= 139, females= 128) with BD were included. Duration of lithium treatment as well as symptom progression, defined as the increase in severity of symptoms, number of episodes a year and duration of episodes within a period of 1.5 years in the past and hsCRP were evaluated. RESULTS: Male individuals with symptom progression over time had significantly lower duration of lithium treatment compared to individuals without symptoms progression (U= 47.4, p=.037). There were significantly higher levels of hsCRP in male individuals with symptom progression compared to males without symptom progression (U= 47.5, p=.027). Further, there was a significant negative correlation between the duration of lithium treatment and hsCRP levels in the whole sample (r= -.276, p<.05). CONCLUSION: Our results show that an altered inflammatory state may be associated with a more severe illness course in BD. Further, a longer duration of lithium treatment may be associated with lower symptom progression. The shown association between hsCRP-levels and lithium treatment duration suggests a potential anti-inflammatory effect of lithium as a mediator of its significant positive outcome effect in BD.

"Extraepithelial enterochromaffin cell--nerve-fibre complexes" in the normal human appendix, and in neurogenic appendicopathy.

Extraepithelial, extraglandular endocrine cells of types EC1 and EC2 occur in the lamina propria of the normal appendix. They are more numerous in intramucosal neurogenic appendicopathy. Ultrastructurally there is invariably a close association between the cells and non-myelinated nerve fibres of the mucous plexus. Together they form a complex surrounded by a common basal lamina, and the term enterochromaffin cell-nerve fibre complex (ECC-NF) is suggested for this morphological and functional unit. The derivation of extraepithelial EC cells from the glandular epithelial cells could not be established and the existence of the complexes is held to support an origin from neuroendocrine-programmed ectoblasts.

Substance P in the argentaffin carcinoid of the caecum: biochemical and biological characterization.

An argentaffin carcinoid tumour of the caecum which contained serotonin (167 micrograms/g) and consisted predominantly of EC1-cells, was analysed for the presence of peptides using immunohistochemical, biochemical and pharmacological methods. A very high content of 3.9 micrograms/g of immunoreactive substance P was found. The distribution of cells staining positively for substance P matched that of cells containing serotonin. While some immunoreactive somatostatin (3.2 ng/g) was present in the tumour, neurotensin, glucagon, gastrin, and motilin were not found. Part of the substance P immunoreactivity measured most likely represents authentic substance P: it behaved like substance P in two chromatographic systems and in two bioassays, and its activity on the guinea pig ileum was abolished by specific tachyphylaxis towards substance P.

[Bronchial carcinoma, bronchial microcarcinoidosis (tumorlets), and bronchial carcinoids (author's transl)]. / Bronchiale Carcinome, bronmchiale Mikrocardijoidose (==Tumorlets) und bronchiale Carcinoide. Pathologie.

During the last 22 years in Styria lung cancers, as revealed in autopsies, have increased in men by 9% and in women by 173%. In women undifferentiated carcinomas have been found six times as frequently as previously. The histological findings of mixed types of carcinomas with confusing cytology are presented: metastasizing squamous carcinoma with a survival time of 14 years and lung cancer developing in the upper lobe 35 years after being present in the lower lobe. In oat-cell carcinomas, certain structures suggest they originate from endocrine cells of the bronchial epithelium. This was also proven in bronchial peptide-producing microcarcinoidosis (tumorlets) and in carcinoids. At the same time, there are neuroendocrine contacts between tumors and nerves similar to carcinoids of the appendix and rectum.

[A further case of gastric microcarcinoidosis (author's transl)]. / Ein weitererer Fall von Mikrokarzinoidose des Magens.

A diffuse neoplastic peptide-microcarcinoidosis, concentrated in the oral half of the stomach, with 3 small invasive mucosal carcinoids without metastases, was found in a 55 years old woman with a healed duodenal ulcer, cholelithiasis, and obsolete chronic cholecystitis and gastritis. The findings are to be considered within limits as malignant. The only sure hormonal consequence of the microcarcinoidosis was hyperthrophy of the muscularis propria et mucosae (perhaps a Motilin effect?), which was also seen in a previous case. In the clinical picture the symptoms of a chronic gastritis were obscured by gall-stone attacks. The case is of clinical interest as it shows that a diffuse microcarcinoidosis can occur together with one or serveral small gastric carcinoids which have been detected by biobsy and histology. For clarification new biopsies have to be performed.

The amphicrine (endo-exocrine) cells in the human gut, with a short reference to amphicrine neoplasias.

In the human gastrointestinal tract the amphicrine cells are described as a special form of endocrine cells. Depending on their behaviour under silver impregnation, they are divided into three subgroups: the mucoargentaffine, the mucoargyrophilic and the mucoargyrophobic cells. They were detected electron microscopically in 1969, but they were histologically verified and identified as mucus-excreting endocrine elements only in 1977. Since 1969 such cells have also been observed in normal and regenerating rat and mouse stomachs. Our own human material includes stomach (3 cases), appendix (12 cases), colon (1) and a series of amphicrine proliferations and tumours. Two cases of chronic gastritis and one chronic peptic ulcer with metaplastic and regenerating epithelium contained mucoargyrophilic cells with mucus below the nucleus in the atypical glands. The possibility of endocrine granules being sluiced out in the mucous grains is discussed. Of the appendices only two were normal (ages 6 and 7 years), 10 showed pathological changes: there were seven neurogenic appendicopathies (14-58 years), one lymphatic hyperplasia, and one hyperplasia of mucoargyrophobic cells with mucostasis. Mucoargentaffine cells far outnumbered the mucoargyrophilic and mucoargyrophobic cells. The mucus may have either an apical or basal location; in the latter case, paracrine secretion into the subepithelial lamina propria was seen. As neoplastic cells, the amphicrine cells form the rare amphicrine tumours (goblet-cell and muco-adenoid carcinoids) of the appendix and colon. They are also found in mucinous cystadenomas of the ovary [26], in the enteral type of a nasal carcinoma [27,28], and in a 5-HT-carcinoid of the ovary [15]. They are therefore to be regarded as a differentiation disorder of the endocrine cells under the pathological conditions of appendicopathy, hyperplasia, metaplasia and true neoplasias.

Disseminated endocrine cells of the gastrointestinal tract and their possible influence on gastrointestinal disease.

The role of the disseminated endocrine cells of the gastrointestinal tract is reviewed. Some of these cells are scarce or absent in pernicious anemia, ulcerative colitis and Sheehan's syndrome, but are increased in number in peptic ulceration, chronic gastritis and celiac disease. A subgroup of the diffuse endocrine cells with both endocrine and exocrine functions, the so-called amphicrine cells, suggests that these cells originate from the entoderm. A study of the diffuse endocrine cells in the chronic intestinal diseases of the developing countries is suggested.

[Myxochondrosarcoma of the hand]. / Myxo-Chondrosarkom der Hand.

First description of repeated recurrence of a myxochondrosarcoma of the second metacarpal, most probably beginning as a central chondrosarcoma and within few months, after destroying the cortex, spreading into the soft tissues as a myxosarcoma. As it consisted mainly of chondroid material it is to be classified as a chondrosarcoma while histologically it showed small spindle cell and angiomatous areas. The rarity, pathological anatomy and clinical therapeutic experience with chondrosarcoma oft the hand with its greater tendency to metastasize from there than from other locations are discussed. The morphological differences between the common secondary myxoid degeneration of chondrosarcoma and the rare primary myxosarcoma are accentuated.

[Effects of 4-hydroxypentenal on the noncancerous and the cancerous ectocervix uteri hominis (author's transl)]. / Uber die Wirkung von 4-Hydroxypentenal auf die nicht karzinomatös und die karzinomatös veränderte Portio uteri

PROBLEM: 4-hydroxy-2,3-transpentenal (HPE) represents the 5-C-homologue of a series of hitherto unknown alpha,beta-unsaturated aldehydes. The marked inhibition of DNA-biosynthesis by these chemical compounds, particularly by HPE, suggests blocking of mitosis by HPE due to direct action on the S-phase. It is known that DNA-biosynthesis as well as energy metabolism are generally more disturbed by HPE in animal tumor cells (Ehrlich ascites and solid tumors, NK/Ly sarcoma 37, sarcoma 180, plasmocytoma G, murine Harding-Passey melanoma) than in normal cells (liver, kidney, jejunum, spleen, thymus); for details see BICKIS et al. 1969; RINDLER et al. 1970; KAPFER et al. 1972). After systemic administration of HPE the concentration of the cytotoxic agent in the blood caysed a bituceabke but merely selective inhibition of the metabolism in experimental animal tumors; however, it was not sufficient to produce therapeutic results. The low stability of HPE in the blood and in the peritoneal cavity is to be attributed to its affinity to SH-groups. Therefore the biological tests had to be confined to the local administration of HPE. In this histological study of the action of HPE the substance was administered directly to the human portio vaginalis uteri (ecto- and endocervix) in cases of carcinomatous alterations, in cases of non-carcinomatous affections as well as in normal portions. MATERIAL AND METHODS: In this test 42 women were treated with HPE. 3 patients were observed clinically only, the other 39 cases were investigated also histologically. The histological studies were performed on the extirpated uterus (36 cases), the resected portio (1 case) and only on a conus (2 cases). In 17 of these patients examined histologically the portio was clinically free of pathological symptoms. They suffered from such more or less commonplace gynecological disorders as displacement of the uterus, incontinentia urinae relativa, uterus myomatosus, endometriosis and cystical adnexal tumors. 7 patients suffered from ectopies, 8 from Ca coli uteri, 7 were affected by invasive cancer of the cervix. 8 of the patients were older than 50 years, the others were aged between 25 and 50 years. Mode of HPE administration: 1. Application of a small HPE-soaked linen patch fixed on a Sta Seal impression of the vagina (Sta Seal=dental silicon impression paste). 2. Application by means of a small linen patch in a portio cap. The inner surface of a portio cap corresponding to the vaginal uterus in shape and size was coated with a circular linen patch. The unneeded segment was cut off. After moistening with the aldehyde (HPE) it was fit tightly to the inner surface of the cap and, in situ, to the portio surface as well. In several cases the portio did not fill the cap completely and did not contact the tissue in the region of the os uteri. Consequently, there the aldehyde effect was lower than in the lateral regions of the portio. Therefor 3...