[Clozapine use and abrupt smoking cessation; a potentially life-threatening combination]. / Clozapinegebruik en abrupt stoppen met roken; een potentieel levensbedreigende combinatie.

A 58-year-old man was in a period of 3 weeks twice admitted to a general hospital with symptoms of clozapine intoxication, i.e. loss of consciousness. We are of the opinion that the patient developed clozapine intoxication because he had been prescribed clozapine (300 mg/day) and at the same time had suddenly stopped smoking. The link is confirmed in the literature. We therefore recommend that clozapine-dosage be adjusted to a patient's smoking behaviour.

[A patient with feigned mental incompetence requiring medical treatment]. / Een patiënt die wilsonbekwaamheid simuleert en voor wie somatische behandeling is geïndiceerd.

A woman at the presumed age of 60 years was suspected of malingering cognitive impairment, due to her social circumstances (illegal residency) and was consequently unable to give permission for treatment. She was suffering from locally advanced mammary carcinoma, diagnosed according to the Breast Imaging Reporting and Data System in stage 5. In order to assess mental incompetence, an algorithm from the Royal Dutch Medical Association (KNMG) is a useful tool. The algorithm contains questions for determining whether a patient is able to make choices, if he/she understands medical information and can apply this to his/her own situation and whether he/she is able to logically consider the choice. Mental incompetence is a legally defined status - there is no straightforward relation between mental incompetence and the underlying diagnosis, in this case malingering. Since feigning mental incompetence has its own limitations, the subjective judgment of the physician is important. In the case presented, medical treatment i.e. chemotherapy was started in accordance with the Dutch Medical Treatment Contracts Act (WGBO) for a patient with cognitive impairment. Compulsory treatment was not necessary because the patient did not resist either physically or verbally. If a critical situation is to be prevented or is threatening, then there is no difference between genuine or feigned mental incompetence.

[Acute blindness due to trauma in a Welsh pony-colt]. / Acute blindheid ten gevolge van trauma bij een Welsh ponyveulen.

A healthy, 10-day-old Welsh A pony colt was totally blind 1 day after arrival at a studfarm. Both eyes appeared normal on external inspection. The young animal had been very distressed during the 40-km journey to the studfarm. Intravenous corticosteroids were administered for 2 days, but did not result in any observable improvement. The animal was euthanized at the owner's request. Both eyes with the optic nerves were removed for histological examination. Both optic nerves showed Wallerian degeneration, a well-known response of peripheral nerves to trauma. The foal, which was not tethered during transportation, probably sustained a blunt trauma in the trailer. This case highlights the importance of taking adequate measures to prevent young animals from sustaining blunt trauma during transport.

[Chondroma in a sheep]. / Een chondroom bij een schaap.

A chondroma localized in the last two ribs at one-third of the distance from the spinous process to the sternum, and approximately 35 cm in diameter, is reported. The ewe was about four to five years of age and in fairly good condition. Apparently it was a rare case; a condition of this type was not previously reported in the Netherlands. Only two cases of chondrosarcoma (also in the costal arch) out of 129,981 autopsies are reported (1).