[A contractor with damaged knees]. / Een aannemer met kapotte knieën.

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.

Post-mortem brain tissue cultures from elderly control subjects and patients with a neurodegenerative disease.

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.

[Sensitisation to 'poffertjes' as a result of sleeping on a pillow containing buckwheat]. / Slapend allergisch geworden voor poffertjes door boekweit in het hoofdkussen.

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.

[Latex glove allergy in dental practice]. / Allergie voor latexhandschoenen in de tandartspraktijk.

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.

[Contact allergy to eyedrops containing beta-blockers]. / Contactallergie voor oogdruppels met beta-blokkers.

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.

[Contact allergy for corticosteroids]. / Contactallergie voor corticosteroïden.

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.