[A recrute with blisters on the cheek].

A 37-year-old recrute in the Royal Dutch Army developed blisters on the right cheek approximately 30 minutes after a boot camp exercise in the mangroves of the island of Curaçao. This bullous dermatitis was caused by direct contact with sap from the bark of the manzanilla tree (Hippomane mancinella). As a member of the family Euphorbiaceae, all parts of this tree are highly toxic.

Anatomical Variations of the Lateral Femoral Cutaneous Nerve and Iatrogenic Injury After Autologous Bone Grafting From the Iliac Crest.

Objective: We describe 2 patients with surgical injury to the lateral femoral cutaneous nerve (LFCN) after bone harvesting from the iliac crest for autologous bone grafting.

Design: A case-series of 2 patients and literature study of all anatomical variants of the LFCN in relation to the anterior superior iliac spine and inguinal ligament.

Setting: A teaching hospital in The Hague, the Netherlands.

Effects of Sequence Variations in Innate Immune Response Genes on Infectious Outcome in Trauma Patients: A Comprehensive Review.

Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. Increasing evidence suggests that genetic variants, particularly single nucleotide polymorphisms (SNPs), are critical determinants for interindividual differences in both inflammatory responses and clinical outcome in sepsis patients. Although the effect of SNPs on sepsis and MODS has been studied in many populations and diseases, this review aimed to summarize the current knowledge on the effect of SNPs on infectious complication specifically in trauma patients.

Multiple Infectious Complications in a Severely Injured Patient with Single Nucleotide Polymorphisms in Important Innate Immune Response Genes.

Trauma is a major public health problem worldwide. Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. There is increasing evidence for the role of genetic variation in the innate immune system on infectious complications in severe trauma patients.

Perforation of the gallbladder: a rare cause of acute abdominal pain.

An 82-year-old woman without any previous medical history arrived in the emergency department with severe pain in the entire abdomen since 5 h. Blood tests showed, apart from a CRP of 28 mg/l, no abnormalities. We decided to perform an abdominal ultrasound, which showed an easily compressible gallbladder, containing a small, mobile gallstone and free fluid in the abdomen.

Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial.

Background: Fractures of the distal radius are common and account for an estimated 17% of all fractures diagnosed. Two-thirds of these fractures are displaced and require reduction. Although distal radius fractures, especially extra-articular fractures, are considered to be relatively harmless, inadequate treatment may result in impaired function of the wrist.

Phyllomedusa bicolor skin secretion and the Kambô ritual.

The ritual of Kambô or Sapo is a type of voluntary envenomation. During this purification ritual a shaman healer, from various South American countries, deliberately burns the right shoulder with a glowing stick from a fireplace. Excretions of Phyllomedusa bicolor (or Giant Leaf Frog, Kambô or Sapo) are then applied to these fresh wounds.

Single-nucleotide polymorphisms in the Toll-like receptor pathway increase susceptibility to infections in severely injured trauma patients.

Background: Sepsis and subsequent multiple-organ failure are the predominant causes of late mortality in trauma patients. Susceptibility and response to infection is, in part, heritable. Single-nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) and cluster of differentiation 14 (CD14) genes of innate immunity may play a key role.

[A man with a painful knee].

A 53-year-old patient presented with a rupture of the left patellar tendon. The tendon was reconstructed using Krackow whipstitch sutures through drill holes in the patella.

[A woman with a painful ankle].

A 17-year-old woman was hit on the left ankle during hockey. There was pain over the dorsal fibula, though no swelling. During dorsiflexion the tendon of the M.

Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial.

Background: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified speciic limitations of the shoulder function in subgroups of patients with these injuries.

Aim: A prospective, multicentre randomised controlled trial (RCT) will be conducted in 21 hospitals in the Netherlands, comparing fracture consolidation and shoulder function after either non-operative treatment with a sling or a plate fixation.

A hinged external fixator for complex elbow dislocations: a multicenter prospective cohort study.

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture.

Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial.

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a static plaster for different periods of time or so-called functional treatment.

Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): a multicenter randomized controlled trial.

Background: Fractures of the proximal humerus are associated with a profound temporary and sometimes permanent, impairment of function and quality of life. The treatment of comminuted fractures of the proximal humerus like selected three-or four-part fractures and split fractures of the humeral head is a demanding and unresolved problem, especially in the elderly. Locking plates appear to offer improved fixation; however, screw cut-out rates ranges due to fracture collapse are high.

Leiomyosarcoma of the great saphenous vein: a case report and review of the literature.

Introduction: Leiomyosarcoma of the venous system is rare, even more so in the greater saphenous vein. In the 85 years since van Ree described the first case in 1919 only 25 cases have been reported in the world.

Methods: We describe a case of an 85-year-old woman who was successfully treated by excision of the tumour.