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Purpose of Review: This study aims to further understand the physiological mechanism of chondroitin sulfate treatment on the urinary bladder in cases of inflammation, by investigating the effect of chondroitin sulfate therapy on recovery of urothelial barrier in an in-vitro chronic injury model., Recent Findings: With inflammatory bladder conditions, the urothelial barrier seems decreased. Glycosaminoglycan (GAG) replacement therapy is supposed to help restore this barrier. Clinical studies on inflammatory bladder conditions are complicated because of the heterogeneous patient population, hence the need for preclinical models., Summary: In a model using porcine urothelial cells, functional barrier (TEER) and barrier markers were assessed. Chronic urothelial damage was simulated through protamine sulfate instillations with and without subsequent chondroitin sulfate instillations during 3 days. Chondroitin sulfate instillations significantly improved TEER compared to protamine sulfate treatment only (TEER difference 310 Ω.cm 2 , P  < 0.001). This consistent effect over 3 days resulted in a significant higher mean TEER value in the chondroitin sulfate treated group (difference 1855 Ω.cm 2 , P  < 0.001). Enhanced recovery of chondroitin sulfate and other barrier markers was observed.Chondroitin sulfate therapy shows promise in facilitating the recovery of the urothelial barrier in cases of chronic damage. This preclinical study lends support to the use of clinical GAG replenishment therapy for patients with a chronically impaired urothelium., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose of Review: This review is timely and relevant because many patients live many years with urinary diversions. Knowledge about the long term outcome with respect to function and complications are important for patient counseling and for the manner to follow-up patients. This study was performed to investigate the functioning of urinary diversions constructed > 25 years earlier., Recent Findings: Most studies have a relatively shorter follow-up, mainly focussing on short term postoperative complications. Focussing on the long term, urinary tract infections (UTI) including pyelonephritis are common. Mild kidney function deterioration is described., Summary: Retrospective study (2018-2019); 43 patients with regular follow-up at the Radboud University Medical Centre Nijmegen the Netherlands. Ileal conduit (n = 19) and ureterosigmoidostomy (n = 11) are the most common diversion types for reasons such as: bladder exstrophy (n = 15), urinary incontinence (n = 9) and malignancy (n = 8). This series with a median follow-up of 40 years, shows it is possible to live and cope with a urinary diversion for a very long time. Ureterosigmoidostomies give relatively good results. Ileal conduits are functioning properly with acceptable complication rates. 95% suffers from chronic UTI's. Kidney function deterioration was mild. Diversions for benign reasons have more complex complications compared to diversion constructed for malignant reasons., Video Abstract: http://links.lww.com/COU/A32., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Cosmetic products contribute considerably to the incidence of contact dermatitis. In response to a resolution of the Council of Europe, the National Institute for Public Health and the Environment (RIVM) in The Netherlands set up a pilot project to report undesirable effects attributed to cosmetic products., Objectives: To provide an overview of undesirable effects attributed to cosmetic products and to identify the ingredients involved. The information could contribute to the assessment of whether current EU legislation on cosmetics provides adequate protection., Patients/methods: General practitioners, dermatologists and consumers in The Netherlands completed questionnaires on reported undesirable effects of cosmetics. Dermatologists also carried out patch tests and, where necessary, tests with specific batch ingredients of the associated cosmetic product. A website and a public awareness campaign were launched to encourage consumers to report undesirable effects., Results: Between July 2009 and May 2011, the RIVM received more than 1600 reports. Severe undesirable effects were claimed in 1-4% of the cases. The most frequently reported cosmetic products were make-up and moisturisers, and the most frequently identified allergens were isothiazolinones and fragrance ingredients. Three patients tested positive for co-polymers/cross-polymers., Conclusions: Further investigations are recommended on the prevalence of isothiazolinone-induced allergic contact dermatitis and the allergenic potential of co-polymers/cross-polymers., (© 2013 John Wiley & Sons A/S.)

A 51-year-old man developed burn wounds on both knees after finishing a cement floor. Cement burns are caused by wet cement, which is highly alkaline Initial treatment consists of lavage. Further management can be conservative but in full thickness injuries excision and grafting should be considered.

Aging may be viewed as a progressive loss of normal biological function. Due to complex genetic and environmental interactions, the sequence of functional impairment shows a high degree of individual variability. In humans life style and health care have an additional influence on the aging process. To study aging and age-related disorders of the human nervous system, brain tissue that has undergone aging and pathological alterations can provide valuable study material. Recently, we have shown that adult human postmortem brain tissue can be cultured and experimentally manipulated. This approach permits the study of cellular aspects of human neuronal aging and neurodegenerative processes and complements those existing research methods such as in vivo imaging (MRI, PET, etc.) and fixed or frozen postmortem brain tissue examination.

A 19-year-old man suffered an anaphylactic reaction after eating 'poffertjes' (small Dutch pancakes). This reaction appeared to be the result of an IgE-mediated allergy to buckwheat, a principal ingredient of 'poffertjes'. It is highly likely that the patient was sensitised by sleeping on a pillow stuffed with buckwheat husk.

Skin reactions due to the use of latex examination gloves occur frequently in dental practice. They consist of immediate type I allergy to natural latex protein, type IV delayed hypersensitivity to rubber additives and irritant dermatitis. Type I allergy to latex protein can cause contact urticaria, angioedema, rhinoconjunctivitis and asthma in the dentist, the dental assistant and also in the patient. Exceptionally, latex allergy can cause a life-threatening anaphylactic reaction. Cross reactions to tropical fruit can occur in the latex allergic patient. Type IV allergy causes allergic contact dermatitis. Rubber additives are also present in synthetic rubber. Glove advice for latex allergic patients are presented.

In six patients (4 women aged 80, 62, 43 and 52 years and 2 men aged 58 and 51 years), who used eyedrops containing beta-blockers for the treatment of glaucoma, allergic contact dermatitis of the eyelids was diagnosed. Three were allergic to metipranolol, 2 to levobunolol and 1 to timolol. In literature, less than 50 cases of hypersensitivity to beta-blockers in eye medication have been reported. There are, however, reasons to assume that sensitization is more frequent: (a) not all patients are referred by the ophthalmologist to the dermatologist; (b) false-negative reactions to patch tests with the commercial preparations and with beta-blockers are not infrequent; (c) they are not routinely tested because beta-blockers are difficult to obtain in pure form; (d) cross-reactions with other beta-blockers are infrequent, and changing to another preparation therefore usually solves the clinical problem. Nevertheless it is advisable to test a battery of beta-blockers (befunolol, levobunolol, metipranolol, timolol) in allergic patients. A test preparation of 2% in water or 3%-10% in petrolatum may be suitable. Control testing in non-exposed individuals is necessary to exclude irritation reactions.

Constitutional eczema (late atopic dermatitis) is a frequent condition: some 30% of the skin diseases seen by the GP involve constitutional eczema. A number of links with (external) factors have meanwhile been established. Patients with constitutional eczema often suffer from food allergy (over 60% of the children with the eczema) and many are allergic to airborne allergens (especially housedust mite allergen). The skin of patients with constitutional eczema has a diminished barrier function against irritants (soaps, acids, bases, water, detergents, biological juices (fruit, meat, fish, vegetables). In 90% of the patients with constitutional eczema the skin contains colonies of Staphylococcus aureus (in 5% of people without eczema). S. aureus can influence the eczema through exoantigens (so-called superantigens) and through conventional antigens that may evoke an IgE-mediated immune response. Emotional stress may influence the eczema. The close anatomical relationship between mast cells and nerve endings and between Langerhans cells and nerve endings suggest that the autonomous nervous system can modulate the immune system of the skin and consequently, the eczema. These factors should be taken into account in the treatment: reduction of exposure to food and airborne allergens and to irritants, treatment and prevention of S. aureus infections and psychological support. New therapies include cyclosporine, autologous IgG antigen complexes and phototherapy.

Since January 1st 1997 there is European legislation labelling that cosmetic products are supplied with a list of their ingredients. The ingredients are given in order of decreasing concentration using the nomenclature 'International nomenclature cosmetic ingredient' (INCI). This enables dermatologists to identify the allergenic components of cosmetic products in patients with allergic contact dermatitis caused by cosmetics, and enables allergic patients to purchase other cosmetic products without risking a recurrence of dermatitis.

Contact allergy to corticosteroids is not rare. In some studies prevalence rates up to 6% have been observed among patients suspected of allergic contact dermatitis. Hypersensitivity occurs especially in individuals who have been suffering for years from atopic dermatitis, contact dermatitis of the hands and feet, or stasis dermatitis caused by chronic venous insufficiency. The clinical picture is rarely that of acute allergic contact dermatitis, because the reaction is mitigated by the anti-inflammatory properties of the corticosteroid itself; the diagnosis must be suspected when eczema does not improve or spreads during topical corticosteroid therapy. Application to the mucous membranes less frequently leads to sensitisation. Most such cases are caused by nasal sprays containing tixocortol pivalate or budesonide. Oral or parenteral administration of corticosteroids to sensitive individuals causes exacerbation of pre-existing contact dermatitis or widespread allergic cutaneous drug reactions. Allergological investigation with corticosteroids presents some specific problems, the most important being occurrence of false-negative reactions. Nevertheless, most sensitive patients can be identified by testing the 'indicator' allergens, budesonide and tixocortol pivalate, which should be added to the routine series of contact allergens. Cross-reactions to other corticosteroids occur frequently. This should be taken into account when prescribing alternative corticosteroid preparations.

In four patients, two women aged 40 and 42 years and two men aged 49 and 37 years, type I allergy to Ficus benjamina was established. Two patients had been sensitized by contact with these pot plants at their homes. The other two patients were plant growers. F. benjamina is a non-flowering, currently very popular pot plant to be found in both private houses and public buildings. The symptoms comprise itching and swelling of the eyelids, tears, running nose, wheezing and dyspnoea. In one plant grower contact urticaria progressing to dermatitis of the hand was the main symptom. Only one patient had a clear-cut atopy. Both plant growers showed a cross-allergy to other Ficus species. Two patients had a cross-allergy to latex and the associated cluster of tropical fruit (banana, kiwi, avocado, and chestnut). Removal of the ficus plants from the homes and change to another crop or to another occupation completely resolved the complaints of these patients.

Euxyl K 400 is a preservative system for cosmetics and toiletries that contains phenoxyethanol and methyldibromoglutaronitrile in a 4:1 ratio. In The Netherlands, Italy, and Germany, the prevalence of allergy to Euxyl K 400 has risen in the past 4 years and is currently 2% to 4% in patients suspected of having contact dermatitis. The allergenic ingredient is nearly always methyldibromoglutaronitrile. Causative products include both stay-on and rinse-off cosmetics and moistened toilet tissue. Because the causative products usually give false-negative reactions, the allergen, methyldibromoglutaronitrile, should be tested in all patients suspected of having cosmetic dermatitis and in those with perianal dermatitis. We suggest a test concentration of 0.3% to 0.5% in petrolatum.

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.

Thirty-four patients suffering from chronic otorrhoea were tested for delayed type contact allergy. Patch testing showed a relevant positive reaction in 19 patients (56%). The most frequent allergens were aminoglycosides with neomycin and framycetin as major offenders. Other antimicrobial agents (clioquinol, polymyxin B), cream bases (lanolin) and corticosteroids (tixocortol) were less common allergens encountered. These results indicate that it is almost obligatory to perform patch testing in any patient with long-standing otitis which does not respond to local therapy. Scoring of the patch tests has to be extended to 7 days, as notably the aminoglycosides and corticosteroids only become positive after such a long interval. Because of the high risk of sensitization, topical preparations containing neomycin and framycetin should not be used routinely. We recommend the use of either a topical antiseptic or a topical antibiotic with low allergenic potential for the initial treatment of otorrhoea.

In 1991, only a low frequency (0.5%) of sensitization by the newly introduced preservative 1,2-dibromo-2,4-dicyanobutane (synonym: methyldibromoglutaronitrile; trade names: Euxyl K400, Merquat 2200, Tektamer 38) was encountered in the Netherlands. It has subsequently been increasingly used in our country as a preservative in moistened toilet tissues, and also in cosmetics such as body milk, lotions and creams. This prompted us to re-evaluate the frequency of sensitization. From January 1993 until July 1994, all consecutive patients attending for routine patch testing were also tested with 1,2-dibromo-2,4-dicyanobutane (0.1% petrolatum): one of 281 (0.3%), nine of 281 (3.2%) and six of 247 (2.4%) were found to be positive in the first and second halves of 1993 and the first half of 1994, respectively. In at least 12 of 16 patients this allergy was responsible for their presenting complaint (perianal and facial dermatitis). As 12 of 16 patients had intensively used moistened toilet tissues containing this preservative, this habit is presumably the cause of sensitization. Our data indicate that the frequency of sensitization is approaching that of allergy to methyl(chloro)isothiazolinone (Kathon CG; 1993: 2.3% in our hospital), a well-known allergen, which seems to have been partially replaced in cosmetics and toiletries by this new preservative.

In spring 1992, several farmers in the western part of The Netherlands developed dermatitis on their hands, forearms and face. In some, the legs, trunk and genitals were also affected. Complaints ranged from a mildly itchy, papular rash to a painful, weeping and blistering dermatitis. Medical aid was needed by 5/9 of them. Some of the farmers grew seed potatoes, the others cultivated lilies. All of them had in common that their complaints emerged after repeated application of a new fungicide over several weeks. The fungicide was Shirlan, with fluazinam as its active ingredient. 9 farmers were patch tested with a concentration range of the whole formulation (aq.) and of the active ingredient (pet.). In 7 of 9 farmers, positive patch tests were scored with both the whole formulation (down to 0.01% aq.) and fluazinam itself (down to 0.1% pet.). Patch tests in consecutive control patients (n = 10) were all negative. As it was impossible to substitute fluazinam as the active ingredient, farmers are now supplied with detailed information as to how to avoid skin contact as much as feasible.

Occupational contact allergy to 1,2-benzisothiazolin-3-one (1,2-BIT, Proxel) is analysed. This compound is widely used in industry as a preservative in water-based solutions such as pastes, paints and cutting oils. The optimal concentration for patch testing proved to be 0.4 g/l (0.04%) in water. In 4 out of 17 patients (23%) at occupational risk (painters, paper-hangers), contact allergy to 1,2-BIT was found. Of 556 consecutive dermatological patients without clear occupational risk, 10 (1.8%) showed positive patch tests to 1,2-BIT; in 3 patients 1,2-BIT contact allergy was related to domestic paper-hanging. Although the chemical structure of 1,2-BIT shows some analogy with the preservative Kathon CG, true cross-sensitivity was found to be unlikely.

4 cases of cosmetic allergy to tocopheryl acetate are reported. The literature on contact allergy to vitamin E and its derivatives is reviewed.

In a retrospective study the data concerning 49 patients with cutaneous leishmaniasis were analysed. The group included 39 patients seen in Amsterdam in the period 1979-1988 in the Royal Institute for the Tropics and the University Medical Centre and 10 patients seen in the University Hospital of Leiden in the period 1970-1982. Mediterranean countries, especially Spain, were important sources of infection. In 26 patients, one skin lesion was found. All but one of the patients had (papulo)nodules, nodules with central scab formation and/or ulcerative skin lesions. In most cases the lesions were localized on the face and extremities, one patient had a mucosal lesion of the nose, three had sporotrichoid extension and six, lymphadenitis. For demonstration of the parasite, aspiration, smear, biopsy and culture were used with varying frequencies. The biopsy and culture methods contributed most to the diagnosis. The treatment in 22 patients consisted in parenteral administration of sodium stibogluconate while 13 received primary cryotherapy. In addition, four patients were subjected to cryotherapy because of a recurrence after, or side effects of the treatment with sodium stibogluconate. In three patients, spontaneous healing was awaited. Owing to incomplete follow-up, the ultimate condition was not known of all patients; the skin lesions treated with cryotherapy all healed. In case of nodular and ulcerative skin lesions in a person who has lived in the (sub)tropics, cutaneous leishmaniasis should be considered; the geographical anamnesis is of great importance in this respect.

Skin equivalents that consisted of a noncontracted collagen gel populated with allogeneic fibroblasts and covered with autologous cultured keratinocytes were used for grafting venous leg ulcers. The results were compared in the same patient with those obtained with a routinely used standard method of grafting with autologous full-thickness punch grafts. The skin equivalents and the punch grafts were grafted successfully in four of five patients. The median healing time of ulcers grafted with skin equivalents was 18 days whereas that of ulcers covered with punch grafts was 15 days. The cosmetic appearance of the skin equivalent-grafted ulcers was better than that of the punch-grafted ulcers.

The human immunodeficiency virus (HIV) exanthem can be the primary manifestation of HIV infection. We report three cases of an exanthematous skin eruption associated with acute HIV infection. HIV antigen (p24 core antigen) was present, whereas results of the HIV antibody test were negative.

The debriding potential of a recently discovered potent enzyme preparation derived from Antarctic krill (Euphausia superba) was compared to a routine non-enzymatic treatment in 31 patients with venous leg ulcers. To assure a reliable interpretation of the cleaning effect, computer image analysis was used to measure wound size and the amount of debris day by day. Krill enzyme treatment was significantly (p less than 0.01) better than the non-enzymatic treatment. The necrotic area diminished by 53%, while in the control group no reduction of the necrotic area was observed in 7 days. The median time required to clean the ulcer was 7 days in the krill group and 10 days in the control group. Afterwards the ulcers were grafted with autologous skin biopsies, which yielded similar results in both groups. No side effects were observed. It was concluded that krill enzymes fulfil criteria for effective debridement of venous leg ulcers.

Immune reactions are often associated with fibrin deposition. The mechanisms that lead to this fibrin formation have not yet been clarified. In this study, we show that mononuclear leukocytes (MNL) from donors with a high proliferative response to protein derivative of tuberculin (PPD) have on average 2.5 to 15-fold more thromboplastin (TP) activity, both exposed and intracellularly, compared with MNL from low responder after 4, 7 and 11 days of culture in the presence of PPD. This difference was not observed between the two groups of donors when PPD was omitted from the culture medium. Further evidence for a specific enhancement of the leukocyte TP activity can be derived from the about 4-fold increase in TP activity of the bilateral mixed leukocyte culture relative to the individually cultured controls after 7 days of incubation. TP activity was associated selectively with the monocytes in a PPD-stimulated culture of MNL. The PPD-specific enhancing effect on the leukocyte TP activity could be transferred by soluble factor(s) from stimulated lymphocytes to purified monocytes, which suggests that the effect is, at least partially, mediated by lymphokine(s).

The deposition of fibrin on infected vegetations and the presence of mononuclear phagocytes that have phagocytized bacteria are remarkabe features in experimental bacterial endocarditis. In a study in vitro, we show that phagocytosis of bacteria by human monocytes enhances thromboplastin generation by these cells. Maximal enhancement of the generation of thromboplastin by monocytes was about six times compared with that in the control experiment without bacteria, and it was obtained by preincubation of the monocytes with 5 to 10 bacteria per monocyte. No quantitative difference was observed between Staphylococcus epidermidis and Streptococcus sanguis as to the enhancement of the monocyte thromboplastin generation. An enhancement of the procoagulant activity generation was also observed after addition of bacteria to human or rabbit whole blood. Probably, this generation was also due to synthesis of thromboplastin by monocytes. It is conceivable that fibrin deposition on infected vegetations during bacterial endocarditis is mediated by thromboplastin synthesis by monocytes.