A rare disorder or not? How a child with jaundice changed a nationwide regimen in the Netherlands.

Due to global migration, there is an increased frequency of diseases, which used to be rare in Western countries. Here, we describe a striking case in order to create awareness for diseases that are known for decades but sometimes "forgotten" in Western countries, including glucose-6-phosphate dehydrogenase deficiency. We will discuss how everyday practice can lead to serious medical problems and present general recommendations to support.

[Two patients with Hantavirus infection in The Netherlands; substantial increase in incidence in neighbouring countries]. / Twee patiënten met een Hantavirus-infectie in Nederland; sterke toename van de incidentie in de ons omringende landen.

A 12-year-old girl and a 57-year-old woman were admitted with fever, general malaise, abdominal pain, nausea and vomiting. Both patients had acute renal insufficiency based on tubulointerstitial nephritis caused by the genus Hantavirus, which was confirmed by blood tests. Both patients recovered spontaneously. The neighbouring countries of France, Germany and Belgium have recently reported 2- to 7-fold increases in the number of Hantavirus infections. Hantavirus is a zoonotic viral disease that is transmitted by mice and is found in humans worldwide. Infection with Hantavirus is associated with severe renal impairment and thrombocytopenia, which usually resolves spontaneously. Recognition of the clinical signs and targeted serological testing can lead to adequate management of the disease. Diagnosing patients with Hantavirus infections will also help to prevent infections in The Netherlands and track epidemiological changes.

[Results of extracorporeal membrane oxygenation following cardiac surgery in 16 children in the St Radboud University Medical Centre, 1996-2004]. / Resultaten van extracorporele membraanoxygenatie na een hartoperatie bij 16 kinderen in het Universitair Medisch Centrum St Radboud, 1996-2004.

OBJECTIVE: Description of the results with extracorporeal membrane oxygenation (ECMO) in infants with cardiorespiratory failure after open-heart surgery. DESIGN: Prospective observational study. METHOD: Data on the indications, survival, and complications were collected from all infants treated with ECMO for cardiorespiratory failure after open-heart surgery in the period 1996-2004 in the St Radboud University Medical Centre in Nijmegen, the Netherlands. RESULTS: 17 ECMO treatments were carried out in 16 paediatric patients: 7 girls and 9 boys. All patients had severe circulatory failure, sometimes combined with respiratory insufficiency. The patients' average age was 8 months (range: 1 day-3 years and 10 months). The average duration of treatment was 137 hours (range: 8-433). In 12 of the 17 ECMO treatments, the patient was successfully weaned from ECMO and 7 patients were discharged home. 5 patients died in hospital after successful ECMO treatment. 10 of the 16 patients died. A functional univentricular heart was associated with a high mortality. Haemorrhage, renal insufficiency and; sepsis were the most frequent complications. Major causes of death were sepsis, multi-organ failure and pulmonary hypertension.