Immunohistochemical and ultrastructural studies of a primary aortic intimal sarcoma.

An intimal sarcoma of the abdominal aorta in a 63-year-old woman is reported. The clinical symptoms consisted of chronic arterial hypertension, vomiting and epigastric pain. Treatment was operative, but the patient died 20 hours after surgery. The studies were performed on a surgical specimen and on autopsy material. The aortic tumour consisted of pleomorphic spindle-shaped and giant cells. In the vertebral metastases a storiform pattern of the tumour cells was found. No specific features characteristic for leiomyogenic, lipogenic or an endothelial nature of the tumour giant cells was disclosed in electron microscopy and the picture rather indicated their histiocytic character. Of the 18 cellular markers studied, the immunostainings for vimentin and alpha-1-antichymotrypsin were evidently positive. The tumour was classified as a pleomorphic intimal aortic sarcoma probably a malignant fibrous histiocytoma (MFH). The literature on 26 previously published aortal tumours is reviewed with emphasis on their topographical distribution and histological classification. In only 4 previous cases was the final diagnosis supported by electron microscopical or immunopathological findings. The role of marker studies in the classification of aortal tumours is discussed.

Effect of dysoxia and moderate air-hyperbarism on red-green color sensitivity.

The effect of acute air-hyperbarism (maximal 520 kPa), normobaric low and high FIO2 levels (minimal 0.1, maximal 1.0) and hyperbaric oxygen (HBO2) on the red-green sensitivity ratio (rgSR) and on color discrimination for foveal vision were studied. Effects were quantified by measuring the red-green flicker (16 Hz) fusion point for normals with the Oscar tester (Am J Optom Physiol Opt 1983; 60:892-901). Color discrimination was examined with the Lanthony's Desaturated 15 Hue test After 15-20 min of exposure rgSR is enhanced 4% (relatively increased red sensitivity) by normobaric acute hypoxia, and reduced 4% by normobaric hyperoxia (FIO2 = 1.0), but HBO2 gives a smaller reduction, and air-hyperbarism (FIO2 = 0.21) has no effect. Hypercapnia (increased FICO2), normobaric hypoxia (reduced FIO2), and HBO2 increase the duration of the Lanthony's test about 20-40%, but the number of errors were practically unchanged. The reduced effect during HBO2 upon rgSR is attributed to an opposing effect of hypercapnia. The absence of an effect during air-hyperbarism is probably due to a suppression by nitrogen of the effect of high PO2. In general, during moderate air-hyperbarism and HBO2 color vision seems to be normal, but evaluation of the colored scene is probably less stable and slightly slower.

[Tissue decompression for the prevention of complications in fractures of the lower leg. A prospective study]. / Weefseldecompressie ter preventie van ischaemische complicaties bij fracturen van het onderbeen. Een prospectief onderzoek.

Short foot syndrome, a form of Volkmann contracture is a not so rare complication after fractures of the lower leg. Retrospectively we found this complication in 5.1% of our patients. This severe complication is prevented by early fasciotomy for decompression of tissues. Prospectively we studied the results of prophylactic fasciotomy of all 4 muscle compartments of the lower leg in patients with tibial or crural fractures at risk. In the three year period from 1981 to 1983 inclusive we treated 145 patients with 147 fractures of the lower leg. Fasciotomy was performed in 32 cases. In this period we saw only one patient with late sequellae of compartment syndrome. The technique of fasciotomy of all 4 compartments by one parafibular incision is described. Morbidity and postoperative complications are minor.

[Replacement of Kathon CG by Euxyl K 400 in cosmetics; from the frying pan into the fire?]. / Vervangen van Kathon CG in cosmetica door Euxyl K 400; van de regen in de drup?

The recent negative publicity on the cosmetics preservative Kathon CG has made many cosmetic manufacturers look for safer alternatives. The most popular substitute appears to be Euxyl K 400, containing phenoxyethanol and methyldibromoglutaronitrile. Unfortunately, this preservative also induces allergic reactions to cosmetics and (at least in the Netherlands) to 'moist toilet paper'. Therefore, in cases of apparent reactions to cosmetics and of eczema ani, allergy to methyldibromoglutaronitrile should be suspected. Testing the finished products often results in false-negative reactions, and consequently the allergen (suggested concentration 0.05% in petrolatum) should preferably be tested separately.

[Behçet's disease in a Dutch boy with painful skin lesions]. / De ziekte van Behçet bij een Nederlandse jongen met pijnlijke huidafwijkingen.

A 14-years-old Dutch boy had pain in both calves, recurrent oral ulcers, fever, hoarseness and erythema nodosum-like skin lesions. Laryngoscopic examination revealed a vocal cord ulcer and leukocytoclastic vasculitis was visible in a skin biopsy. Based on the clinical picture, the diagnosis of 'incomplete juvenile Behçet's disease' was established. During treatment with colchicine, genital ulcers developed. These disappeared after local treatment with corticosteroids. Juvenile Behçet's disease is rare in Western Europe and the diagnosis is often difficult. Diagnostic criteria have been formulated, but in most cases there is a delay before these criteria are fulfilled due to the slow clinical course of the disease. All organ systems may be affected; mucocutaneous and skin lesions are the most frequent manifestations. Therapy depends on the severity and the symptoms of the disease.

Digital photoplethysmography and light reflection rheography. A clinical comparison.

BACKGROUND: Light reflection rheography (LRR) is appropriate for the global assessment of calf-pump insufficiency regardless of whether it is caused by varicosity, the post-phlebitic syndrome, or deep venous thrombosis. The instrument has been increasingly used by many phlebologists. Digital photoplethysmography (D-PPG) is a further development of this well-established LRR. With this D-PPG instrument it is possible, in contrast to LRR, to calibrate the reflected light. OBJECTIVE AND METHODS: To compare the venous refilling times of both the LRR and the D-PPG when measured at the same time on the same leg. We also evaluated the practical use of both instruments. In total we performed 152 simultaneous measurements with both instruments. RESULTS: We found a statistically significant correlation when we compared the venous refilling time of both LRR and D-PPG (r = .664; P < .001). The observed agreement between both instruments for detecting a disturbed venous refilling time (< or = 25 seconds) is 92%. CONCLUSION: Both instruments seems to correlate as has been shown in this and other studies. The D-PPG has the advantage of being more handy. Furthermore the reflected light is calibrated, which enables to compare intra- and interindividual measurements.

Angioplasty after laser perforation.

Perforation is the most important complication of laser angioplasty and leads to a decrease in success because the procedure has to be discontinued. In 3 patients we continued despite perforation and were able to stop extravasation with percutaneous transluminal angioplasty (PTA) and to finish the procedure with a good final result. From our experience we conclude that laser perforation is not an absolute indication to stop the procedure if PTA in the recanalized lumen is possible.

Evaluation of the frequency of contact allergic reactions to Kathon CG in the Maastricht area--1987-1990.

In the period 1987-1990, 999 patients suspected of a contact allergy were patch-tested with Kathon CG 100 ppm active ingredients aq. Of these patients, 84 (8.4%) showed a positive reaction (70% females). In 62% of these cases clinical relevance was established. Most of them suffered from contact dermatitis of the face, the hands or the perianal region.

Muscle oxygen tension, hemodynamics, and oxygen transport after extracorporeal circulation.

In eight patients who underwent elective coronary bypass operation, skeletal muscle PO2 was measured with a polarographic needle electrode as an index of peripheral tissue perfusion to study recovery after extracorporeal circulation. Measurements of skeletal muscle PO2 and O2 supply to the tissues were obtained immediately after ICU admission and after 2, 4, 8, and 16 h. During the first 2 h, mean arterial BP was high, mixed venous PO2 decreased, the arteriovenous O2 difference increased, and skeletal muscle PO2 decreased. The P50 of the O2 dissociation curve on ICU admission was decreased and thereafter increased to a maximal value at 8 h, and normalized again after 16 h. After the initial decrease, the median of the skeletal muscle PO2 returned to normal values, but decreased again after 16 h. The results showed that, during the first 4 h postoperatively, microcirculatory changes occurred despite normal cardiovascular and respiratory variables.

Frequency of false-negative reactions to the fragrance mix.

To estimate the frequency of false-negative reactions to the fragrance mix, the 8 constituents of the mix in concentrations of 5% (2% for cinnamic aldehyde) were added to the European standard series for routine testing. Patients with positive reactions to individual ingredients in the absence of a reaction to the mix were retested with serial dilutions. In a 4-month period, 677 patients were tested. 61 (9%) reacted to the mix and to 1 or more of the ingredients. 4 patients (0.6% of all patients tested and 6.2% of the patients allergic to fragrances) had false-negative reactions to the mix. They were allergic to cinnamic alcohol, geraniol, isoeugenol and oak moss (1 reaction each), in the absence of a reaction to the fragrance mix. It is concluded that the currently used concentration of the mix (8 x 1%) not infrequently results in false-negative reactions, and that further research should be done to overcome this problem.

Methyldibromoglutaronitrile is an important contact allergen in The Netherlands.

From 15 May to 15 December 1994, 2943 patients suspected of having contact dermatitis (1955 women, 988 men) were patch tested with methyldibromoglutaronitrile 0.3%, 0.1% and 0.05% pet. 119 patients (4.0%; women 4.1%, men 3.8%) proved to be allergic. 71% of the reactions were considered to be relevant. In 2/3 of the patients, causative products were cosmetics, in 1/3 moistened toilet tissues. Testing with methyldibromoglutaronitrile at lower concentrations (0.05% and 0.1%) and with commercial allergens (Euxyl K 400 and methyldibromoglutaronitrile, both containing methyldibromoglutaronitrile 0.1%), resulted in a number of false-negative reactions. All preservatives in the European standard series had lower scores than the 4% positive reactions to methyldibromoglutaronitrile (formaldehyde 2.0%, MCI/MI (Kathon CG) 3.2%, parabens 1.0%, quaternium-15 1.3%). It is concluded that methyldibromoglutaronitrile (present in the commercial preservative Euxyl K 400) is an important contact allergen in the Netherlands in cosmetics and moistened toilet tissues. It should be added to cosmetics series and to proctological series. The optimal test concentration is unknow, but may be 0.3% pet. The concentration of 0.1% methyldibromoglutaronitrile in the currently available commercial allergens appears to be too low, resulting in a number of false-negative reactions.