Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41–61 days), indicative of intestinal toxemia botulism. Patients’ clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient’s feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.

A nulliparous woman presented with menorrhagia, anemia, and an enlarged uterus. A diagnosis of leiomyoma was made. At surgery, hysteroscopic resection was not possible because of the size of the mass. Laparotomy was performed and the uterus was opened through a "classical incision". Hemostasis was secured with an intrauterine balloon. Histology revealed the mass to be an adenomyoma. Resecting an adenomyoma from the uterus can be complicated. Techniques, such as hysteroscopic examination before laparotomy, using a classical uterine scar, intrauterine balloon, and preoperative gonadotropin-releasing hormone analog may help to minimize the risks.

No abstract

No abstract

No abstract