European consensus table 2006 on botulinum toxin for children with cerebral palsy

An interdisciplinary group of experienced botulinum toxin users and experts in the field of movement disorders was assembled, to develop a consensus on best practice for the treatment of cerebral palsy using a problem-orientated approach to integrate theories and methods. The authors tabulated the supporting evidence to produce a condensed but comprehensive information base, pooling data and experience from nine European countries, 13 institutions and more than 5500 patients. The consensus table summarises the current understanding regarding botulinum toxin treatment options in children with CP.     

Adaptation of saccades and fixation to bilateral foveal lesions in adult monkey.

Bilateral foveal lesions were made by laser photocoagulation in adult monkeys. One day post-lesion, animals fixated with a new retinal locus inferior to the fovea (in the visual field) that they used permanently. Fixation stability improved modestly over two days. Initially, saccades maladaptively brought the lesioned foveae to visual targets. Over at least several weeks, saccade trajectories gradually changed bringing targets to intact retina, although some animals never totally adapted. The slow time course of saccadic adaptation to foveal loss suggests a mechanism different from that documented in other studies of saccadic adaptation and from that used by the fixation system.     

Ultrasound examination of the hand

Twenty-five surgically confirmed soft-tissue lesions of the hand were examined prospectively by real-time ultrasound. Use of sonography enabled a reliable diagnosis of the cystic or solid nature of soft-tissue lesions, an accurate estimation of the volume, and precise three-dimensional localization of the abnormality. Sonography also facilitated the location of foreign bodies. Assessment of anatomic relationships of these lesions to tendons and surrounding structures by real-time sonography during palpation, flexion, and/or extension also aided in the surgical approach.     

Gasbrandabsceß des Gehirns nach „Bagatellverletzung“ des Kopfes

Zusammenfassung An Hand eines Falles von Gasbrand-Hirnabsceß nach angenommener Bagatellverletzung der Kopfschwarte werden Schwierigkeiten der gutachtlichen Beurteilung im Strafverfahren aufgezeigt:Unzureichende, verspätete Ermittlungen, unvollständige Befundberichte erschweren in Ermangelung objektiver Feststellungen und Daten eine gutachtliche Stellungnahme, die sich auf den konkreten Fall beziehen muß. Allgemein gehaltene Fragestellungen sind irreführend, es ist Bezug zu nehmen auf strafrechtliche Bestimmungen und Begriffe. Eine Fahrlässigkeit, im Strafverfahren unter Umständen nicht erwiesen oder erweisbar, kann zivilrechtliche Konsequenzen haben.Es bleibt die Tragik des Einzelfalles; muß der u. U. tödliche Ausgang ein unvermeidbares Risiko bleiben? Dies ist kein juristisches, sondern überwiegend ein medizinisches, aber auch sozial- und gesundheitspolitisches Problem; Fragen der ärztlichen Aus- und Weiterbildung, der instrumentellen und personellen Ausrüstung, der organisatorischen Voraussetzungen fordern eine Lösung. Objektive Stellungnahmen im Raum juristischer und medizinischer Vorstellungen und Begriffe abzugeben ist eine Aufgabe; Impulse zu setzen, Prävention, ist gleichfalls Anliegen der gerichtlichen Medizin.

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Summary In discussing the case of a gas-gangrene abscess of the brain with presumed minor injury of the scalp medico-legal problems in criminal trial are discussed:The missing of objective statements and data due to insufficiently made, delayed inquiries or uncomplete medical reports impedes expert's opinion on the actual case. As general formulations are misleading, penal provisions and definitions have to be stressed. Negligence which possibly is not to be proved in the criminal trial may have consequences according to civil law.There is the tragedy of each single case: an accident, possibly turned out fatal, must it remain an unavoidable fact? This is not a juridical but predominantly medical problem and is even of major importance to the social policy and public health administration: Problems of medical primary and continued education, equipment and staff, organizational implications require solution.To submit statements and expertises in the scope of juridical and medical conceptions is one field of forensic medicine; to give impulses, to show preventive feasibilities, is another.

Herrn Professor Dr. G. Dotzauer zum 60. Geburtstag