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The management of recurrent furunculosis is difficult, and often disappointing. We present the case of a 23-year-old female patient suffering from recurrent furunculosis. The furunculosis persisted after treatment with mupirocin nasal ointment, chlorhexidine soap and instructions for washing clothes, towels and bed sheets for a period of 7 days. Treatment with low-dose clindamycin for three months ultimately proved successful. We propose a structural approach for recurrent furunculosis in which extensive history-taking is followed by appropriate tests. Before prescribing an oral antibiotic (preferably low-dose clindamycin or a macrolide for 3 months), the patient should use an antimicrobial nasal ointment and soap and follow hygienic instructions as mentioned above. Members of the household who also have signs of the infection should be treated. Hygienic education is an essential component of treatment. We believe that this approach will lead to a treatment that is more effective and efficient.

The robot-assisted transaxillary (hemi)thyroidectomy (RATT) is a new surgical technique using the da Vinci S surgery robot. This technique has recently been successfully introduced in the Netherlands. In a RATT a subcutaneous tunnel from the axilla is created to gain access to the thyroid gland. The operation is then carried out with the robot much like an open procedure. Using a RATT, a total thyroidectomy can be performed. However, surgeons at the beginning of the learning curve are advised to start with hemithyroidectomies only. The indication area consists of nodules up to three centimeters and most probably being benign. The major advantage of this technique is the prevention of a potentially disfiguring scar. The most important disadvantage of this technique is its high cost compared with the conventional procedure. In order to successfully introduce the RATT procedure, thorough preparation by both surgeons and operating room personnel is required. A proctoring program is also necessary.

A 24-year-old man presented with a solid swelling of the right hemi scrotum at the urological out-patient unit. Ultrasound and CT-scan showed a herniation in the scrotum in which a solid mass was visible. After surgical resection and pathological examination it was determined to be a desmoid tumor, either of intra-abdominal origin having herniated through the inguinal annulus, or originating from a previously herniated omentum in the scrotum. Adjuvant chemotherapy, due to the limited added value and the possible consequences for fertility.

Background: Following the introduction of a heptavalent pneumococcal conjugate vaccine (PCV7) in the Netherlands in 2006, the incidence of invasive pneumococcal disease (IPD) declined significantly. Since then a shift towards non-vaccine serotype IPD has been noted., Case Description: We present the case of multidrug resistant non-vaccine serotype 19A pneumococcal meningitis in a 5-month-old boy. He was admitted to our Paediatric Intensive Care Unit (PICU) with seizures and septic shock. A barbiturate-induced coma was eventually required to control the seizures; shock was combated with intravenous fluids and inotropes. He received a 6-week course of ceftriaxone and vancomycin. At follow-up, one year after discharge, he had unilateral deafness and minor developmental delay., Conclusion: Worldwide, pneumococcal serotype 19A is now the most common cause of IPD in children, with an increasing incidence of multidrug resistant strains. This trend has not yet been observed in the Netherlands. This case demonstrates that even following the introduction of PCV7 pneumococcal meningitis can still occur. Prompt recognition of the symptoms is still essential.