[Indications for antibiotic prophylaxis in patients with a prosthetic joint]. / Indicaties voor antibiotische profylaxe bij patiënten met een gewrichtsprothese.

Under certain circumstances, patients with a prosthetic joint and a focal infection elsewhere in the body may be at risk of developing bacterial infection of the prosthesis. Patients and physicians should actively prevent infections that can spread systemically. Routine antibiotic prophylaxis is not recommended for all patients with a prosthetic joint and suspected bacteraemia. Antibiotic prophylaxis is warranted in three groups of patients with a prosthetic joint who must undergo an invasive procedure that could cause bacteraemia: patients with a predisposing immunocompromising systemic condition or those receiving immunosuppressive therapy, patients with a dermatological infection, and patients with an obvious focal infection, e.g., urosepsis. If the patient is already receiving antibiotics for the infection, additional prophylaxis is usually unnecessary. For patients undergoing dental procedures who require antibiotic prophylaxis, amoxicillin-clavulanic acid or clindamycin are preferred.

[Complications within two years after revision of total hip prostheses]. / Complicaties tijdens en 2 jaar na revisie van een totaleheupprothese.

OBJECTIVE: To describe the complications within 2 years after revision of failed total hip prostheses. DESIGN: Descriptive. METHOD: Using prospective registration, data were collected on the complications that had occurred in patients who had undergone hip revision in 2002 and 2003 on the orthopaedic department at the University Medical Centre St. Radboud in Nijmegen, The Netherlands. RESULTS: The study group consisted of 67 patients, 47 women and 20 men, with an average age at time of revision of 62 (SD: 15.3). 67 revisions of total hip prostheses were performed: 64% underwent first revision and 36% re-revision. In 40% a cup revision only was performed, in 15% a femoral revision and 45% underwent total revision. The most frequent indications for revision were aseptic loosening (76%) and recurrent dislocation (13%). In 19% of the procedures a peroperative complication occurred, 2 patients died during follow up although not from operation-related causes, and in 51% of remaining patients a complication occurred within 2 years after surgery. The most frequently seen complications were dislocation (8%) and deep infection (5%). 2 of 3 deep infections were re-infections of earlier septic revisions. The most frequent complication was luxation. Together with recurrent dislocation, deep infection was the most frequent indication for a re-operation. The re-operation percentage was 12. 3 out of the 5 luxations that occurred were re-revised due to recurrent dislocation. CONCLUSION: Hip revision procedures are associated with a high rate of complications within 2 years of implantation. The data are comparable with the limited amount of published data.

[A colo-colic invagination on the basis of MutYH-associated polyposis in a boy aged 14]. / Een colocolische invaginatie op basis van MutYH-geassocieerde polyposis coli bij een jongen van 14 jaar.

A 14-year-old boy presented with acute abdominal pain, vomiting and diarrhoea. Colo-colic intussusception was diagnosed by means of a colonic contrast X-ray. The intussusception was successfully reduced during this procedure. Hundreds of polyps were seen throughout the entire colon. Genetic research showed a mutation of the MutYH gene. Proctocolectomy with ileoanal pouch anastomosis was carried out. The pathology specimen showed an intramucosal carcinoma and multiple adenomas. MutYH-associated polyposis coli is an autosomal recessive disease that occurs as a result of a mutation in the MutYH gene. This will lead to polyposis coli. An intussusception is a rarely seen symptom. Patients need preventive surgical treatment because of the high risk developing a colorectal carcinoma.