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A caesarean section (CS) is one of the most common surgical procedures performed in the world, for which there are minimal variations in the surgical approach. During the last few years the "skin-to-skin" CS, also coined "natural" or "gentle" CS, is on the rise; parental participation, slow delivery and direct skin-to-skin contact are important aspects. Most Dutch hospitals offer some form of "skin-to-skin" CS but there are local differences in availability and performance of the procedure. Since 2011, the standard procedure in the Martini Hospital in Groningen is the "skin-to-skin" CS (for both elective and emergency CS, 24/7). We describe our method and share our retrospective data, and demonstrate that this procedure does not result in more complications for mother or baby.

A small outbreak of measles occurred after a 33-year-old female aircrew (cabin) member presented at an emergency room with fever. Three members of the hospital staff were infected: a 42-year-old man, a 33-year-old woman, and a 26-year-old woman. The first 2 patients had not been immunised, and the third had received 2 immunisations according to the Dutch National Immunisation Programme. Vaccination of the 2 sero-negative patients within 48 h after exposure with the measles-mumps-rubella vaccine (MMR) did not prevent the development of measles. Vaccination was deemed unnecessary in the third patient. No tertiary cases occurred. The same measles virus (genotype D5) was detected by PCR and sequencing in all 4 patients. Measles remains a risk for hospital staff members who have not acquired natural immunity. The current policy of immunising patients within 72 h after exposure to measles may not be sufficient. It also appears that immunisation through the Dutch National Immunisation Programme does not always protect against nosocomial infection. Providing MMR vaccination or boosters to hospital staff in certain departments might be beneficial.

Objective: In the Netherlands, an increase in prevalence of tuberculin positivity has been noted since the replacement of the Dutch PPD-RIVM preparation by RT23. This investigation was carried out to assess the specificity of RT23 compared with PPD-RIVM., Design: Comparative., Method: In 90 hospital workers simultaneous tuberculin tests were performed in both forearms with RT23 (Statens Serum Institut, Copenhagen, Denmark; lot number 13751; 2 tuberculin units) and PPD-RIVM (Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, the Netherlands; lot number 76B; 1 IU), respectively. Sensitivity to atypical mycobacteria (Mycobacterium scrophulaceum, M. avium and M. kansasii) was assessed where differences were > 3 mm., Results: In two of 73 non-vaccinated subjects, reactions to RT23 were 11 and 15 mm larger than to PPD-RIVM; both showed sensitivity to M. scrophulaceum and M. avium. Five of nine BCG vaccinated subjects showed differences of five to eight mm; in four of these, the reaction to RT23 was larger. Repeat testing in one showed no cross-reactions. The specificity of RT23 compared with PPD-RIVM was 96% (cut-off at 10 mm diameter)., Conclusions: In a low tuberculosis risk population, tuberculin testing with RT23 yields more positive results than PPD-RIVM. This is probably due to stronger cross-reactivity with atypical mycobacteria of RT23. Decisions on isoniazide prophylaxis should take into account an increased false-positivity rate with RT23.

The reconstruction of large skeletal defects presents a challenging problem to the orthopaedic community. Currently bone graft surgery enjoys renewed interest because of the increased demand for bone grafts in limb salvaging bone tumour surgery and reconstructive surgery on failed arthroplasties. Two patients treated with an allograft are presented.