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Three patients with signs of temporal arteritis are presented. In two patients a normal ESR resulted in the diagnosis 'temporal arteritis' being discarded, prompting clinicians to consider meningitis, sinusitis, and blindness due to atherosclerosis. In the third case, the ESR measured with the Alifax Test-1TH apparatus was 17 mm/h, whereas the Westergren method used on the same sample resulted in an ESR of 83 mm/h. In all three cases CRP was elevated. On the basis of literature on the sensitivity of ESR and CRP it is advisable to use both measures when temporal arteritis is being considered. It is noted that in one hospital using the Alifax Test-1TH, only 52% of 25 patients with biopsy-proven temporal arteritis had an ESR over 40 mm/h, while 96% had elevated CRP. This observation requires further evaluation. The significance of signs, symptoms and new imaging techniques for recognising cranial giant cell arteritis is summarised.

Every year about 800 chronic hepatitis B infections are identified in the Netherlands as result of the nationwide pregnancy screening. About one-third of these are newly discovered infections. In recent years there has been a marked increase in treatment options for chronic hepatitis B infection using antiviral drugs. Pregnant women can now be treated as well. A pregnant woman with a low viral load does not require immediate treatment, as due to the passive immunisation and active vaccination of the newborn the chances of infection due to perinatal transmission are negligible. Treatment of the mother can therefore be postponed until after the birth. However, when the pregnant woman has a high viral load (>10(9) copies/ml in serum), perinatal transmission can still occur despite vaccination of the newborn. In these women, antiviral treatment in the last trimester of the pregnancy should be considered. At present, experience of treating HBV-infected pregnant women has only been gained with lamivudine. It appears that the quantity of circulating virus decreases due to the treatment. Treatment should always be supervised by a gastroenterologist or an infectiologist. Detection, referral and treatment of the mother and child are described in several guidelines that have recently been updated and harmonized with each other. These include a practice guideline from the Dutch College of General Practitioners, a guideline from the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment, and a guideline from the Netherlands Society of Gastroenterology.