No abstract

Botulism is a rare, life-threatening, time-critical neuroparalytic disease that is frequently a subject of differential diagnostic considerations. But there is much uncertainty regarding diagnosis and therapy. Rapid diagnosis, early antitoxin dose, consistent food hygiene and the sensitization of the population can help to reduce incidence, morbidity and mortality. This overview is based on an epidemiological data inquiry (RKI, ECDC, CDC, WHO) and a selective literature research (pubmed till March 2017). Additionally, the German botulism guideline (2012) and own diagnostical experiences were taken into account. The incidence of botulinum toxin intoxication induced by ubiquitous spore-forming (main representative) is< 0.01/100 000 EU citizens. Foodborne botulism is a pure intoxication syndrome (most common form) due to improperly prepared or incorrectly stored food. Wound and infant botulism are kinds of "toxico-infections". A "bulbar" neuroparalysis is a main symptom progressing to a flaccid tetraparesis up to respiratory paralysis. Infant botulism is presented non-specific and is treated only symptomatically; but a special human-derived antitoxin is available at international pharmacies. In case of suspected foodborne or wound botulism antitoxin must be administered as soon as possible, which may also be effective 24 hours after symptoms onset. There is no evidence for adjuvant treatment except of intensive care unit (ICU) therapy. Despite typical symptomatology botulism is often diagnosed too late. Early antitoxin administration and ICU therapy are crucial for survival. A consultant laboratory should be contacted for advice.

No abstract

Here, we combined magnetic resonance imaging with lesion-symptom mapping in patients with chronic brain lesions to investigate brain representations of sugar and fat perception. Patients and healthy controls rated chocolate milkshakes that only differed in sugar or fat content. As compared to controls, patients showed an impaired fat, but not sugar perception. Impairments in fat perception overlapped with the anterior insula and frontal operculum, together assumed to underpin gustatory processing. We also identified the mid-dorsal insula as well as the primary and secondary somatosensory cortex - regions previously assumed to integrate oral-sensory inputs. These findings suggest that fat perception involves a specific set of brain regions that were previously reported to underpin gustatory processing and oral-sensory integration processes.

Parts of the study were selected as one of the 120 best poster presentations at the Annual Meeting of the AUA 2000, Atlanta Accepted for publication 2 June 2003 comprised men with bladder outlet obstruction in accordance with the AbramsGriffiths nomogram; group 2 (four men and four women, 56, SD 7.2 years) had detrusor instability; and group 3 (54, SD 9.6 years) had normal bladder emptying. BWT, as the detrusor force per cross-sectional area of bladder tissue (in N/cm 2 ), was calculated after a urodynamic evaluation and ultrasonographic estimate of bladder wall thickness. RESULTSIn all patients it was possible to measure BWT; the mean ( SD ) maximum BWT in group 1 was 9.8 (3.9) N/cm 2 , in group 2 during bladder instability was 11.7 (2.6) N/cm 2 and in group 3 was 2.8 (0.5) N/cm 2 . CONCLUSIONSEstimating BWT in humans is possible by combining a urodynamic evaluation with an ultrasonographic estimate of bladder wall thickness. Further clinical research should elucidate the clinical relevance of BWT under comparable conditions.