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Eight university medical centres in the Netherlands have established clinical genetic services. Patients receive intensive, and therefore costly, genetic counselling before genetic testing takes place. In recent years the number of patients referred to clinical genetic services has risen dramatically, creating waiting-list backlogs. Knowing your carrier status in hereditary cancers, for instance for a BRCA1/2 mutation, can have consequences for surveillance, treatment, and prevention; however, 90% of patients with breast cancer do not have a mutation. We, therefore, argue that the pathway to genetic testing should be reconstructed in order to safeguard timely and adequate genetic testing for an increasing number of patients. The treating physician should be able to request a DNA test in carefully-selected patient-populations, and only refer patients for genetic counselling after a positive finding. Prerequisites for this 'mainstream pathway' are adequate training for medical specialists, good communication with genetics' departments, and guaranteed referral in uncertain or complex cases.

Since the only registrated anti-ectoparasiticum for horses (foxim) is no longer available in The Netherlands, some cases of amitraz intoxication of the horse have occurred. In this article the literature concerning amitraz intoxications and experiments will be discussed and some cases will be described.

Two female patients, aged 48 and 52 years, developed severe bone marrow suppression and (gastrointestinal) mucositis following administration of capecitabine. Analysis of the dihydropyrimidine dehydrogenase (DPD) activity in peripheral blood mononuclear cells revealed the presence of DPD deficiency. Both patients recovered in 3-4 weeks, and both had a (partial) remission of their tumours. Capecitabine is metabolised to 5-fluorouracil (5-FU) in the body. DPD-deficiency leads to impaired breakdown of 5-FU and hence to severe cytotoxicity following treatment with capecitabine or 5-FU. The most common mutation, IVS14 + 1GA, is found in approximately 2% of the Dutch population. In case of unexpected severe toxicity during 5-FU or capecitabine treatment, DPD deficiency should be considered. Screening could be considered in view of the widespread use of capecitabine and 5-FU, the severe toxicity that may develop in patients with low DPD activity and the prevalence of the mutation.

Mares regularly have an enlarged ovary. The main causes are haematomas, anovulatory follicles, abscesses, and neoplasia. The granulosa-theca-cell tumour is by far the most common neoplasia of the ovary (about 97%) and accounts for 2.5% of all equine tumours. In this article the differential diagnosis of an enlarged ovary and the background of granulosa-theca cell tumours are reviewed. A case is described of a mare with a very large granulosa-theca cell tumour in the left ovary, which was discovered 1 month after delivery of a healthy foal. This case is special not only because the tumour was enormous (diameter 60 cm) but also because the contralateral ovary was functional and there were no behavioural changes. The fact that a haematoma had been found 2 years earlier made the diagnosis even more difficult.