[A localized reaction to sublingual immunotherapy]. / Een lokale bijwerking van sublinguale immunotherapie.

An otherwise healthy 31-year-old woman with allergic rhinoconjunctivitis developed considerable swelling of the floor of her mouth after sublingual allergen-specific immunotherapy with the hyposensitization product 'Slit One grass pollen'. After discontinuation, complaints disappeared and she was successfully put on a regimen of subcutaneous immunotherapy. Despite a lack of reports of serious adverse reactions in clinical trials, the Inspectorate of Health Care and The Netherlands Pharmacovigilance Centre Lareb received several reports of sometimes serious localized reactions to oral and sublingual allergen-specific immunotherapy. Under-reporting is likely since local reactions are more or less expected. Caution should be exercised with allergen treatment, even in the case of non-invasive administration.

Meralgia paresthetica is related to degenerative pubic symphysis.

OBJECTIVE: To investigate the relationship between meralgia paresthetica, a mononeuropathy of the lateral femoral cutaneous nerve that often starts in middle age, and radiological degeneration of the pubic symphysis. METHODS: A case-control study of patients aged 40 years and older with meralgia paresthetica who underwent surgical release of the lateral femoral cutaneous nerve; cases were included only when a pelvic radiograph was available. The control group was from a population study including persons aged 55 years and older and was matched to cases (4 controls per case) for sex and age as far as possible. We checked patient records from general practice to ensure control subjects had no symptoms of meralgia paresthetica during the previous 10 years. Radiological degeneration of the pubic symphysis was defined as present when 2 of 3 independent observers noted degeneration on the radiograph. RESULTS: Mantel-Haenszel procedure (stratified for age group and radiological osteoarthritis of the hip) showed a positive relationship (p = 0.004, OR = 4.38) between radiological degenerative pubic symphysis and meralgia paresthetica. In a separate analysis limited to men we also found this positive relationship. CONCLUSION: This study confirmed a positive relationship between radiological degeneration of the pubic symphysis and meralgia paresthetica.

Right temporal lobe glioblastoma presenting in the left orbit. Case report.

Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.

The influence of psychological variables on postoperative anxiety and physical complaints in patients undergoing lumbar surgery.

Previous research has indicated that postoperative distress is influenced by diverse biographic, medical and psychological variables, such as personality, coping behaviours and anxiety. The influence of state variables, apart from anxiety and coping behaviour, has received scant attention. Furthermore, the influence of coping behaviour has remained unclear. The present study investigated coping behaviour and indications of physical distress, i.e., preoperative fatigue, leg pain and back pain, besides preoperative anxiety, as predictors of postoperative anxiety and physical complaints in 126 patients undergoing lumbar surgery. Preoperative anxiety and leg pain independently predicted more postoperative anxiety beyond the influence of age, sex and medical variables. Preoperative anxiety and fatigue independently predicted more postoperative physical complaints. No associations were found between the coping behaviours and the postoperative variables. The implications of these results are discussed in relation to intervention strategies aimed at diminishing the stress of surgery.

Histological preparation of the undecalcified rat otic bulla for mesoscopic observations.

Otic bullas of the rat, obtained by excision and formalin fixed, are successfully embedded in methylmethacrylate by dehydration and subsequent infiltration with plastic under vacuum. Sections 10 microns thick are obtained by cutting the trimmed and sandpapered acrylic blocks on an LKB multirange microtome. The sections are collected on adhesive tape and stained with a Trichrome stain (modified Weigert-van Gieson). Finally, the sections attached to the tape are mounted on microscope slides with glycerin-gelatin and sealed in the same medium. Serial sections are used for three-dimensional graphic reconstruction.

Electrophysiological aspects of the middle ear muscle reflex in the rat: latency, rise time and effect on sound transmission.

The latency, the rise time and the influence of the acoustic reflex on sound transmission were investigated in the adult rat during ketamin anesthesia. This was done by recordings of the cochlear microphonics (CM) and electromyographic (EMG) recordings of the reflex responses of the tensor tympani muscle. The acoustic reflex was elicited by contralateral acoustic stimuli of which the intensity and frequency was varied. Ipsilaterally, the effect on sound transmission was determined by estimating the change in amplitude of the CM's of ipsilateral administered subliminal stimuli. It was shown that both the tensor tympani muscle and the stapedius muscle contribute in the reflex. The latency as well as the rise time of the reflex determined by CM recordings showed to be short (minimal values: 12 and 7 ms respectively). The mean latency of the tensor tympani muscle reflex, measured by EMG, was about 7 ms. The attenuation of 0.25-8 kHz tone bursts upto 115 dB SPL is limited to a mean maximum of 15 dB SPL. The maximal attenuation was shown to occur at 1 kHz. Frequencies above 2 kHz appeared to be the best elicitor of the middle ear muscle reflex.

Three-dimensional graphic reconstruction of the tympanic bulla of the rat with special reference to the middle ear muscles.

On the basis of functional questions, graphic three-dimensional reconstructions of the tympanic bulla of the rat were made to gain insight into the spatial organisation of the contents of the bulla and especially of the tympanic membrane--ossicular chain--middle ear muscle complex. For this purpose drawings of microscopical sections of complete bullae were fed into the computer to make three-dimensional graphic reconstructions with hidden line removal. From these reconstructions plastic representations were made by the medical artist. The topographical anatomy of the tympanic bulla is discussed in detail and compared to the anatomy of the middle ear in man. It is postulated that, despite differences in spatial organisation of the middle ear of the rat compared to that of man, the middle ear muscles influence the ossicular chain in a comparable way. On the basis of the topographical anatomy it is feasible that the muscles in the rat act synergistically in increasing the stiffness of the ossicular chain.

The innervation of the middle ear muscles of the rat.

The innervation of the tensor tympani muscle and the stapedius muscle in the rat was studied. This was done by acetylcholinesterase in toto staining of the tympanic bullae and of muscles dissected separately, acetylcholinesterase staining of serial cross-sections of the muscles, silver impregnation of serial sections of complete tympanic bullae, serial semithin sections stained according to Laczko & Levai and electron microscopy of both muscles. The gross innervation of the muscles and the relation to other nerves in the bulla are described. It is shown that both muscles are innervated by very thin nerve fibres which form a well-organised elaborate network in the muscles, with very short branches that connect with motor endplates. Electron microscopically there are indications that the endplates in the stapedius muscle seem to enable faster activation of the muscle fibres than those of tensor tympani muscle. No morphological evidence for any sensory innervation of the muscles could be detected in the muscles themselves, in the connective tissue related to the muscles, or in the contents of the bulla tympanica. It is postulated that the afferent input of the acoustic middle ear muscle reflex is sound alone and that sensory information from the muscles themselves or from other structures in the tympanic bulla do not contribute to the reflex.

Detailed morphology of the stapedius muscle of the rat. An integrated light microscopical, morphometrical, histochemical, immunohistochemical and electron microscopical study in relation to function.

The stapedius muscle of the rat, a very small muscle, appeared to have several atypical morphological characteristics. The muscle fibres were found to be irregularly shaped and composed of relatively small bundles of myofibrils. Mitochondria were distributed irregularly, i.e. in long strands, between the bundles of myofibrils. Enzyme histochemically, most fibres could be classified as fast oxidative glycolytic fibres (IIA). Only 5% of the fibres appeared to be slow twitch fibres; however, these fibres also had a high glycolytic capacity and therefore could not be classified as the classical slow twitch fibres. The immunohistochemical staining with monoclonal anti-heavy chain myosin isotypes showed discrepancies when compared to the enzyme histochemical results. Moreover, different adult heavy chain myosin isotypes appeared to coexist in one single muscle fibre. The results suggest that the muscle has an isometric contraction pattern and that it can contract rapidly with great endurance. This endows the muscle with properties suitable for a function in the prevention of noise-induced hearing loss and also in impact noise over longer periods of time.

Detailed morphology of the tensor tympani muscle of the rat. An integrated light microscopical, morphometrical, histochemical, immunohistochemical and electron microscopical study in relation to function.

The gross anatomy, microscopical anatomy, morphometry, enzyme histochemistry, immunohistochemistry and electron microscopy of the tensor tympani muscle of the rat was studied. The aim of the study was to create an integrated insight into the morphology of the muscle and to discuss functional implications. The tensor tympani muscle of the rat is an atypical muscle. It is a small muscle composed of very small muscle fibres with a complex microscopical and submicroscopical architecture. Histochemically the muscle consists mainly of fast oxidative glycolytic fibres, but discrepancies are found when anti-heavy chain myosin antibodies are used for fibre typing. Different adult heavy chain myosin isotypes coexist in one single muscle fibre. The electron microscopical study shows that bundles of myofilaments branch and interconnect with other bundles of myofilaments. The findings suggest that the muscle is able to contract fast and is fatigue-resistant. Both features seem to suggest that the muscle has a function in protecting the inner ear against noise damage.