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Individuals with the genetic disorder neurofibromatosis type 1 (NF1) are typically diagnosed in a medical hospital setting strongly relying on the presence of well-defined physical symptoms such as neurofibromas or pigmentary spots (known as café-au-lait spots). In mental health care settings, however, aside from a few highly specialized centres, the diagnosis and treatment of individuals with NF1 receives little attention, while the need for psychological treatment is increasingly identified, both in clinical practice and in the scientific literature. Occasional referrals of individuals with NF1 to the mental health services are often only targeted at psychological assessment. Subsequent treatment, however, is usually lacking. We describe two individuals with NF1 for whom by means of specialized clinical neuropsychological assessment, participation in a tailored dialectical behavior therapy (DBT) skills training was indicated. We exposit how they were able to develop their skills and how they themselves and their significant others experienced the treatment.

Background: Malignant mesothelioma is an aggressive neoplasm, which arises from serous membranes, such as the pleura and the peritoneum. Malignant peritoneal mesothelioma is relatively rare, but the incidence is increasing worldwide because of intensive asbestos use during the 20th century., Case Description: A 60-year-old man complained of malaise, night sweating and weight loss and was seen by a specialist in internal medicine. Additional investigation included a CT scan, 2 PET-CT scans, 2 diagnostic laparoscopies and histological examination of peritoneum biopsies. After 7 months the diagnosis of malignant peritoneal mesothelioma was made., Conclusion: Histological investigation is of great importance when there is indication of malignant peritoneal mesothelioma. There is not yet a consensus concerning the optimal treatment, but a small increase in survival can be achieved by systemic chemotherapy or intraperitoneal therapy consisting of hyperthermic intraperitoneal chemotherapy after cytoreductive surgery.

Objective: To gain an insight into perinatal mortality and morbidity in full-term infants without congenital abnormalities admitted to a neonatal intensive care unit (NICU)., Design: Retrospective analysis., Method: In this study, all full-term infants, who were born in the period 1997-2003 without congenital disorders and admitted to the NICU at the Wilhelmina Children's Hospital in Utrecht, the Netherlands were included. Information about the delivery, NICU-admission and follow-up until the age of 18 months was obtained from the hospital charts., Results: In total 597 full-term neonates were admitted to the NICU during the study period; this is equivalent to 3-4 per 1,000 full-term neonates in the Utrecht region. Of these, 47% were admitted on account of asphyxia, 17% with respiratory problems and 12% with infections. In 79% of all NICU admissions the delivery had taken place under secondary care; in 29% labour had started under exclusive care of a primary level midwife, because the pregnancy had been defined as low-risk. 21% of the neonates were admitted to the NICU following delivery under exclusive primary care. Almost 15% of the infants died in the NICU, in 89% due to asphyxia. Of the surviving infants following perinatal asphyxia, 15% had a permanent disability at the age of 18 months., Conclusion: Post-partum admission of a fundamentally healthy full-term neonate to the NICU is a serious adverse perinatal outcome, and warrants further investigation. The various factors that influence these admissions should be analysed in more detail, for instance by means of perinatal audits.

Recently, the Dutch Health Council published a report on the risks of the use of alcohol during conception, pregnancy and lactation. Because the medical literature does not prove the safety of the use of small amounts of alcohol, the Health Council recommends using no alcohol whatsoever. One may wonder whether the advice of the Health Council is not too rigid. Since Karl Popper, it is evident that the truth of the hypothesis that the consumption of small amounts of alcohol is safe will never be verified. Because the medical literature also does not prove the harmfulness of the irregular use of small amounts of alcohol, it is not necessary to upset pregnant women who occasionally take an alcoholic beverage. It is preferable to use no alcohol; however, the rare consumption of a single glass does not seem to be harmful.

In a 56-year-old woman, 'drug rash with eosinophilia and systemic symptoms' (DRESS) was diagnosed. She had been admitted to hospital twice in two months because of fever and skin rash. Further studies revealed that in addition to the skin rash, the woman also suffered from eosinophilia, lymphadenopathy and a temporary liver-function disorder. After infectious and malignant causes had been excluded, the DRESS syndrome was diagnosed. The syndrome was attributed to the oral skin-care supplement Imedeen. She had stopped using this preparation previously, after which the symptoms decreased markedly. Now she was treated with corticosteroids and methotrexate and recovered completely after almost four months. The DRESS syndrome is characterised by skin rash, fever, lymphadenopathy and haematological abnormalities, especially eosinophilia and/or atypical lymphocytosis. Single or multiple organ involvement, especially of the liver, kidney, lungs and/or heart, is also common. The syndrome is associated with a number of different drugs.

A swollen ear canal: not to be underestimated. The role of radiology in three patients with problems due to unaccomplished otitis externa is discussed. The choice between CT scanning and MRI in selected cases is balanced.

From twenty-eight balance trials and supplementary findings on the state of health, milk production, body weight and composition of the bone, blood, saliva, milk, urine and faeces it is concluded that four cows of the Dutch-Friesian breed can conveniently live and produce for seven and, including the preliminary period, for sixteen months on a ration consisting of straw, potatoes and concentrates having an average calcium content (including calcium in drinking water) of 0.22 per cent (varying from 0.17 to 0.25 per cent) in the dry matter. There was found to be an inverse relationship between the calcium content of the ration and the absorption coefficient. The absorption coefficient of calcium ranged from 28.7 to 83.8 per cent when the calcium content of the ration varied from 0.44 to 0.17 per cent. For sixteen months, the calcium-phosphorus ratio of the ration varied from 0.4 to 0.8. Bone biopsy was successfully performed using a universal drill.

The intensification of pig husbandry has important consequences for pig health care. More attention must not only be paid to clinical outbreaks of disease but also to subclinical problems and disturbances of production. More research must be done to improve the efficiency of disease control and beyond this to the optimalization of prevention. The roles of etiology, biotechnology, the research on pathogenesis, epidemiology and immunology in meeting these goals are roughly outlined and illustrated with concrete examples derived from the program of the C.V.I. (Central Veterinary Institute) in the Netherlands. How this research will affect research immediately connected with health care is explored at the end of this article.

The registration, licensing and investigation of veterinary vaccines are discussed with reference to the producer, the user and the authorities. The significance of basic research by the producer, of testing by the authorities, of quality control and of evaluation (laboratory and field studies) in the control of animal diseases are examined more closely. The fact is stressed, that legislation concerning veterinary medicines in general and vaccines in particular should be well defined. All this is regarded as an integral part of recent developments in animal farming in the Netherlands.