Central nervous system involvement in adults with epidemic hemolytic uremic syndrome.

Hemolytic uremic syndrome is a multisystem disorder that is caused by infection with Shiga-toxin-producing Escherichia coli. HUS affects mainly children and is rare among adults. This retrospective case series analyzes clinical signs and MR imaging findings of 11 adult patients with HUS associated nervous system involvement during the epidemic EHEC outbreak in northern Europe with its epicenter in Hamburg in May 2011. The most prevalent imaging finding was symmetric pointy vasogenic edema of the brain stem in the acute and subacute phases of the disease (n = 5). One patient exhibited additional symmetric mesiotemporal signal changes mimicking limbic encephalitis. Two patients developed subcortical patchy lesions, and 4 subjects did not present with any signal changes. Remarkably, territorial ischemia, signs of hemorrhage, or blood-brain barrier disruption have not been detected. While brain stem lesions were transient and normalized with clinical recovery, supratentorial lesions did not resolve completely at 2-month follow-up examination.

Long-term treatment risks in multiple sclerosis: risk knowledge and risk perception in a large cohort of mitoxantrone-treated patients.

BACKGROUND: Balancing treatment benefits and risks is part of a shared decision-making process before initiating any treatment in multiple sclerosis (MS). Patients understand, appreciate and profit from evidence-based patient information (EBPI). While these processes are well known, long-term risk awareness and risk processing of patients has not been studied. Mitoxantrone treatment in MS is associated with long-term major potential harms - leukaemia (LK) and cardiotoxicity (CT). The risk knowledge and perception among patients currently or previously treated with mitoxantrone is unknown. OBJECTIVES: The objective of this article is to conduct a retrospective cohort study in greater Hamburg, Germany, to estimate risk awareness and perception in MS patients treated with mitoxantrone. METHODS: MS patients with at least one dose of mitoxantrone between 1991 and 2010 from six major MS centres in greater Hamburg received a questionnaire assessing risk awareness and perception as well as a written EBPI about mitoxantrone-associated LK and CT. RESULTS: Fifty-one per cent in the cohort of n = 575 patients returned the questionnaire. Forty per cent correctly estimated the risk of LK (CT 16%); 56% underestimated the risk (CT 82%). Reading the information increased the accuracy of LK risk estimation, and patients did not report an increase of worries. The EBPI was appreciated and recommended by 85%. CONCLUSION: Risk awareness of mitoxantrone-treated patients is insufficient, but can be increased by EBPI without increasing worries. Continued patient information during and after treatment should be implemented in management algorithms.

[Clinical symptoms, treatment and outcome of EHEC and EHEC-HUS patients treated as in-patients]. / Klinische Symptomatik, Therapie und Verlauf Stationär Behandelter EHEC/EHEC-HUS Patienten.

BACKGROUND AND OBJECTIVE: From May to June 2011 an outbreak of Shiga-toxin-producing Escherichia coli (EHEC) infections occurred in northern Germany leading to a great number of patients with hemolytic-uremic syndrome (HUS). A monocentric case series from Hamburg is described. MATERIAL AND METHODS: All patients at that time presenting with acute diarrhoea at the Asklepios Clinic Barmbek in Hamburg were proved for EHEC infections. Clinical data of EHEC and EHEC-HUS patients treated as in-patients as well as stool analysis and laboratory results were documented. RESULTS: In total, 117 patients suspicious to have EHEC infection were treated as in-patients. In 68 patients an EHEC infection (n = 36) or HUS (n = 32) could be confirmed. Additional infections with other diarrhoea-causative organism could be revealed in 23 of these 68 patients (34 %). The median age of the HUS patients was 44 years being significantly lower compared to the age of EHEC patients without HUS (51 years, p = 0,04). In the group of HUS patients there were significantly more women (26/32 vs. 21/36, p = 0.03). 19 patients with HUS dialysis was necessary. In total, a number of 248 plasma separations were required. 18 patients developed severe neuro-psychiatric symptoms. One patient died. CONCLUSION: This monocentric case series describes one of the so far largest published series of mostly young and female patients with EHEC and EHEC-HUS.

fMRI shows multiple somatotopic digit representations in human primary somatosensory cortex.

Using electrical finger nerve stimulation in normal human subjects, fMRI detected separate representations for all 5 fingers in the primary somatosensory cortex. Responses were located in the posterior wall of the deep central sulcus (most likely corresponding to Brodmann Area (BA) 3b), and the anterior (BA 1) or posterior crown of the postcentral gyrus (BA 2) with rare activations in BA 3a and 4. In BA 3b we found a regular somatotopic mediolateral digit arrangement for fingers 5 to 1 with a mean Euclidean distance of 16 mm between fingers 1 and 5. In contrast BA 1/2 showed a greater number of adjacent activation foci with significantly more overlap and partly even reversed ordering of neighbouring fingers.