[Botulinum toxin--the dose controls the poison. A historical sketch]. / Botulinumtoxin--Die Dosis macht das Gift. Ein historischer Abriss.

Botulism, a potentially lethal form of paralytic food poisoning, was described as early as 1793. Basic research, especially in the late nineteenth and early twentieth centuries, revealed that botulism is caused by exotoxins. Further biochemical work around and after the Second World War gave insight into the molecular structure of seven different serotypes of botulinum toxin (BT/A-G) as well as into its acetylcholine blocking mode of action. In 1977, Scott treated patients with strabism by injecting minute amounts of purified BT/A. In short sequence, BT proved effective in blepharospasm, cervical dystonia, and various off-label indications. In the near future, registration of these new indications, marketing of new serotypes (BT/B), and availability of more practical antibody tests can be expected. The first applications of BT were performed by Roggenkaemper, Dressler, and Benecke in Germany and by Poewe and Auff in Austria. According to a worldwide trend, a rapid expansion regarding BT users and indications followed. Formation of BT competence centers in both countries aims at maintaining high standards in BT research and education.

[Functional reduction of vision symptomatic of a conversion reaction in paediatric population]. / Funktionelle Sehstörung als Konversionssymptom im Kindes- und Jugendalter.

BACKGROUND: First case reports of psychogenic visual disorders date back into the 19th century. Nowadays we speak of functional visual disorders of somatoform origin, a conversion reaction in which neurotic conflicts are solved on somatic level. This is the initial kind of reduction of agitation specially in children. In contrary to malingering and aggravation conversion symptoms are unconscious actions. Besides the problems of numerous specific tests for differential diagnosis between organic and functional disturbances strategies for further management are necessary. PATIENTS AND METHODS: 26 patients at the age of 8 - 17 years with isolated reduction of vision due to conversion reaction were analyzed referring to sex, age, wether one or both eyes were affected, the duration of symptoms, the possible reasons for the conversion reaction and the further management. RESULTS: 75 % of our patients were females, the average was 12 years old, in 50 % we found a bilateral involvement. The main reasons for the conversion reaction were in 30 % interfamiliar problems, in 25 % school problems, 2 cases (4 %) occurred after mild head trauma and in 41 % no reason was found. Treatment consisted in discussions and suggestive therapy - "eyeglasses" and/or "eyedrops" parents were not primarily informed the diagnosis. One to three months later the tests were repeated. 90 % were without symptoms, 10 % needed psychotherapy. CONCLUSION: Apart from comprehensive neuroophthalmologic and orthoptic examination it is important to observe the patient for possible doctor shopping, symptom shift and the rare development of depression.

Reinforcing effects of MDMA ("ecstasy") in drug-naive and cocaine-trained rats.

3,4-Methylenedioxymethamphetamine (MDMA; "ecstasy") is one of the most prevalent illegal drugs of abuse among European adolescents, a population not generally experienced with respect to "hard" drugs such as cocaine. We, therefore, determined the reinforcing effect of intravenously self-administered MDMA in a fixed ratio 1 time-out 150 s schedule of reinforcement in rats that were truly drug naive and compared it to cocaine-trained rats. The reinforcing effect of MDMA [0.032-10 mg/(kg.injection)] did not differ between drug-naive rats and cocaine-trained ones. MDMA sensitized the animals to its own rate-increasing effect but not to that of cocaine. When MDMA was tested after cocaine, there was no carryover of cocaine's reinforcing effect to that of MDMA, suggesting that MDMA and cocaine produce distinct interoceptive stimuli in rats.

[Self-injury behavior]. / Zur Problematik selbstverletzenden Verhaltens.

BACKGROUND: Self-damage is defined as intentional injury of the own body. Patients with this disorder often consult and deceive surgeons. In case of factitious disease the diagnosis of self-injurious behavior can be difficult. METHODS: A literature review on self-injuring behavior was done with special emphasis on its clinical presentation in surgical departments, its psychodynamic background and the therapeutic consequences. RESULTS: Self-damaging behavior is most frequent in adolescent females. Both a disturbed relation with the own body and with fellow-beings is the problem of all patients. Deprivation, physical or sexual abuse are common in the biography of these patients. The feelings of internal emptiness and unbearable psychic tension are the immediate psychodynamic causes of the self-damaging act. Psychotherapeutic strategies are aimed at learning to express emotions in a better way, to care for the own body, and to establish confidential and stable relationships. CONCLUSIONS: The knowledge of the psychodynamic background facilitates the therapeutic approach to patients with self-injuring behavior.