[Defects in accuracy of the singing voice: tonal competences and deficits]. / Les défauts de justesse de la voix chantée: compétences et déficits tonaux.

Whereas the general population usually sings accurately (Dalla Bella 2007), certain individuals display a real deficit in pitch matching whilst singing. The description of this deficit in adults is in its infancy. This is an acoustic study of 15 adults judged socially as poor singers. The accuracy is tested by three elementary tests of song: A reproduction of isolated notes, a reproduction of sequences of notes, a song "a capella". A test of microphone-tonal discrimination was added and the fundamental frequency of the productions was analyzed. We showed that the deficits are heterogeneous: The control of pitch can be insufficient on the level of the tonal centre, the intervals between notes, and sometimes on the level of the note itself with regard to the target being aimed at. The error tends to be an undervaluation. The capacity for fine discrimination is however preserved for part of our study population. Broader studies of deviating productions should be undertaken looking at the diversity of deterioration and the specificity of the tasks as they could shed a new light on the cognitive processes which control the installation of the vocal control.

Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients.

The Dialysis Outcomes Quality Initiative emphasizes increasing arteriovenous fistula prevalence, by promoting referral for fistula creation in patients with stage 4 chronic kidney disease (CKD). The aim is to provide an optimal access for initiation of dialysis, thus avoiding central venous catheter use. The endovascular management of nonmaturing fistulas is more complicated in these patients, where the expected benefit of catheter avoidance must be weighed against the risk of contrast induced nephropathy (CIN). This study reports on the safety of a low-dose radiocontrast regimen, used in performing endovascular fistula salvage procedures in patients with stage 4 CKD. All consecutive endovascular procedures performed over a 2-year period in patients with stage 4 CKD and nonmaturing access were identified. Data collected included the type of procedure, contrast volume per procedure, pre, 2- and 7-day creatinine, need for acute dialysis, and the type of access used to initiate dialysis. Total of 65 procedures were performed in 34 patients. The mean contrast volume was 7.8 ml per procedure. The incidence of CIN (25% increase in serum creatinine) was 4% at 2 days and 4.6% at 1 week. All values returned to baseline within 2 weeks, and no patient required acute dialysis. Among the 33 patients with nonmaturing fistulas, 20 initiated dialysis during the follow-up period, 15 (75%) using their fistula, and five (25%) using a catheter. This study demonstrates that in patients with advanced CKD, fistulas can be successfully salvaged using small contrast volumes with a low incidence of CIN.

Dedicated outpatient vascular access center decreases hospitalization and missed outpatient dialysis treatments.

Dedicated outpatient vascular access centers (VAC) specializing in percutaneous interventions (angiography, thrombectomy, angioplasty and catheter placement) provide outpatient therapy that can obviate the need for hospitalization. This paper reports the impact of one VAC staffed by interventional nephrologists on vascular access-related hospitalization and missed outpatient dialysis treatments. We performed a retrospective analysis of vascular access-related hospitalized days and missed vascular access-related outpatient dialysis treatments from 1995 to 2002 in 21 Phoenix Arizona Facilities (5928 cumulative patients) and 1275 cumulative Fresenius Medical Care North America (FMCNA) facilities (289,454 cumulative patients) to evaluate the impact of the introduction of a VAC in Phoenix. Vascular access-related hospitalized days/patient year and missed dialysis treatments/patient year declined from 1997 to 2002 across all access types. The decline was greater in Phoenix and coincided with the creation of a VAC in 1998. By 2002, there were 0.57 fewer hospitalized days/patient year and 0.29 fewer missed treatments/patient year than in the national sample (P<0.01). In 2002, the relative risk for vascular access hospitalized days was 0.38 (95% confidence interval (CI) 0.27-0.5) (P<0.01) and for vascular access-related missed outpatient dialysis treatments was 0.34 (95% CI 0.24-0.49) (P<0.01) in Phoenix vs FMCNA after adjustment for age, gender, diabetic status duration of dialysis and access type. VAC development was associated with a significant decrease in vascular access-related hospitalization and missed outpatient dialysis treatments. Further studies are necessary to demonstrate this effect in other communities.

[Federal Cancer Reporting Unit. Surveillance program for cancer registration in Germany]. / Die Dachdokumentation Krebs. Eine Surveillance-Einrichtung der Krebsregistrierung in Deutschland.

For 20 years the Federal Cancer Reporting Unit has been processing and analyzing the comprehensive data of the population-based cancer registries in the Federal Republic of Germany. For this purpose the registries transfer their epidemiological records that have been made anonymous to the Federal Cancer Reporting Unit in the Robert Koch Institute once a year. An essential task of the Federal Cancer Reporting Unit is to check the data coherence and especially the completeness of cancer registration. The completeness of registration is estimated by site- and register-specific log-linear models. Based on data from sufficiently complete registries, national incidence rates and their time trends are estimated. Cancer survival rates, lifetime, and age-conditional probability of developing cancer and risk of dying from cancer are calculated and interpreted. The results are published regularly. With increasing completeness of registration, multiple notification of cases in different registries and their exclusion by matching procedures becomes more important. With increasing completeness of registration, further problems can be addressed such as the incidence of rare cancer sites or the analysis of regional patterns of cancer incidence and their underlying causes. Given the different legal requirements of cancer registration in the federal states of Germany, a national institution such as the Federal Cancer Reporting Unit in the Robert Koch Institute, which is not directly involved in cancer registration, can perform these activities best.

[Cancer incidence estimates for Germany via log-linear models]. / Krebsinzidenzschätzungen für Deutschland mittels log-linearer Modelle.

In Germany presently no nationwide cancer registration exists. To estimate national cancer incidence, Poisson regression models were fitted to incidence/mortality ratios using age and sex specific data of the cancer registry of Saarland, Germany and were then applied to national mortality. The models estimate the absolute number of incident cases at a given point in time and moreover allow the assessment of time trends. Applied to nationwide mortality the models imply a total of 347,000 new cancer cases in Germany for 1998 with 179,000 females and 168,000 males. During the nineties the age-standardised rate (European standard) has slightly decreased for males and slightly increased for females.

Naming of musical notes: a selective deficit in one musical clef.

We investigated the ability to perform solfeggio, i.e. oral reading of musical notes in MP, a 65 year-old female professional musician, who, following a left temporoparietal ischemia, showed a complex pattern of amusia. The deficit on which we focused was her inability to read orally the bass (F) clef, often substituting it with the violin (G) clef. This problem could not be attributed to a lack of comprehension. The patient could in fact correctly perform on the piano the same sequences she erroneously read aloud; she was also able to correctly judge whether two strings, one in bass clef and the other in violin clef, represented the same sequence of notes. The problem seems to lie in the inability to retrieve note names keeping into account the clef-rule. It is hypothesized that, in the production of note names, this function requires the identification and application of syntactic-like information, in analogy with what is thought to happen in the retrieval of other words.

Comparison between language and music.

Similarities and differences between language and music processing are examined from an evolutionary and a cognitive perspective. Language and music cannot be considered single entities; they need to be decomposed into different component operations or levels of processing. The central question concerns one of the most important claims of the generative grammar theory, that is, the specificity of language processing: do the computations performed to process language rely on specific linguistic processes or do they rely on general cognitive principles? Evidence from brain imaging results is reviewed, noting that this field is currently in need of metanalysis of the available results to precisely evaluate this claim. A series of experiments, mainly using the event-related brain potentials method, were conducted to compare different levels of processing in language and music. Overall, results favor language specificity when certain aspects of semantic processing in language are compared with certain aspects of melodic and harmonic processing in music. By contrast, results support the view that general cognitive principles are involved when aspects of syntactic processing in language are compared with aspects of harmonic processing in music. Moreover, analysis of the temporal structure led to similar effects in language and music. These tentative conclusions must be supported by other brain imaging results to shed further light on the spatiotemporal dynamics of the brain structure-function relationship.

[Family information days. Attitudes and needs of family of schizophrenic patients]. / Angehörigen-Informationstage. Einstellungen und Bedürfnisse von Angehörigen schizophrener Patienten.

OBJECTIVE: This study aimed to examine attitudes, knowledge about disease and needs of relatives of schizophrenic patients. METHOD: Questions concerning needs and wishes addressed to professionals were added to the "Questionnaire of attitudes concerning disease for relatives". The questionnaire was distributed to relatives participating in the workshop at Bezirksklinikum Regensburg and sent by post to non-participating relatives. RESULTS: The relatives of both groups were predominantly comparable regarding attitudes, knowledge and needs. Mainly they wished more dialogue with therapists. Information about schizophrenia was assessed as very important. Relatives participating in the workshop reported significantly more frequently that the atmosphere in the family is strained and that they understand the nature of the illness less than non-participating relatives. They reproached themselves more frequently, but felt less depressive than non-participating relatives. 95% of the participating relatives were satisfied or very satisfied with the workshop. They assessed self-help groups for relatives of schizophrenics as more important than non-participating relatives. CONCLUSION: Workshops for relatives of schizophrenic patients have proved to be economic and well accepted to contact many relatives and to give attention to their problems.

Salvage of occluded autologous arteriovenous fistulae.

Well-functioning vascular access is essential to optimizing outcomes in hemodialysis patients. Initial placement of greater numbers of autologous arteriovenous fistulae (AVFs) is needed, as is more attention to salvage of such accesses when they become occluded. In this study, thrombolysis with small doses of thrombolytic agents in combination with balloon angioplasty was attempted in 15 patients with 16 autologous AVFs (7 forearm AVFs, 8 upper-arm AVFs). Either urokinase (UK; mean dose, 109,375 U) or tissue plasminogen activator (tPA; mean dose, 7.1 mg) was used for thrombolysis. The technical success rate was 94%, whereas long-term patency was achieved in 81% of the accesses. Failure to achieve long-term patency was caused by the inability to achieve adequate drainage in 2 patients. In 1 patient, technical inability to cannulate the access and penetrate the venous end of a basilic vein transposed fistula occurred. One patient was successfully declotted and angioplastied twice. Successful salvage of thrombosed AVFs can be safely performed with much lower doses of thrombolytic agents than previously reported. In addition, tPA is effective in this setting, in addition to UK. Salvage of occluded autologous AVFs should be attempted more frequently than is currently practiced and would result in improved hemodialysis patient outcomes.

Cancer registration in Germany: current status, perspectives and trends in cancer incidence 1973-93.

BACKGROUND: A federal law effective in 1995 makes it mandatory for all German States to build up population-based cancer registries. Although the law provides a model of cancer registration, each State may modify this by State-specific regulations, as long as they ensure data exchange between the registries and between registries and scientific institutions. The 'Network of German Population-Based Cancer Registries' constitutes the basis for cooperation among the German cancer registries. In order to improve the cooperation between physicians and epidemiologists, and to demonstrate the benefits of cancer registration, the network published a booklet containing facts on time-trends in cancer incidence during the last two decades. METHODS: Information on cancer incidence and mortality was derived from the population-based cancer registries of Saarland, the former German Democratic Republic (until 1989), the City of Hamburg and the region of Münster. Altogether these registries cover a population of about 23 million. Sixteen types of cancer were selected for the analyses. RESULTS: Major increases in cancer incidence were observed for female lung cancer, testicular cancer, cancer of the oral cavity, malignant melanoma of the skin and non-Hodgkin's lymphoma. Incidence rates also increased for cancer of the female breast, prostate cancer and colorectal cancer. A decrease was observed for stomach and cervical cancer. DISCUSSION: In 1998, only a small fraction of all German adults were monitored by a population-based cancer registry, making it impossible to work out accurate incidence rates for the whole of Germany. Several new cancer registries have been built up recently. Data summaries of existing German population-based cancer registries assist in enhancing the completeness of new cancer registries.

[Expectations and satisfaction of social-psychiatric services regarding their collaboraton with the psychiatric hospital] . / Erwartungen und Zufriedenheit sozialpsychiatrischer Dienste im Rahmen ihrer Zusammenarbeit mit der psychiatrischen Klinik.

OBJECTIVE: Collaboration with the psychiatric hospital should be investigated from the viewpoint of social-psychiatric services (SpDi). METHODS: Based upon a content analysis of interviews with staff members of all social-psychiatric services working in the catchment area of a psychiatric hospital, a questionnaire was developed which consists 32 Items assessing expectations and satisfaction in 6-step Likert-type scales. RESULTS: Response rate was 80% (n = 40). SpDi's staff express high expectations to psychiatric hospital. They assess good inpatient treatment, patient's information about treatment, SpDi's involvement in discharge planning, patient's attendance at SpDi's consulting in the hospital, and networking of psychiatric institutions to be very important. Differences between expectation and satisfaction especially refer to information of SpDi about client's admission, SpDi's involvement in discharge planning, and knowledge of hospital staff about social-psychiatric services. CONCLUSIONS: Evaluation of expectations and satisfaction of SpDi as an important partner of the psychiatric hospital allows conclusions for quality assurance of psychiatric care and offers concrete clues for a better collaboration at the interface of out-patient and in-patient care being advantageous for patients.

[Cooperation between social-psychiatric services and psychiatric hospital--expectations and chances of improvement]. / Zusammenarbeit sozialpsychiatrischer Dienste mit der psychiatrischen Klinik- Erwartungen und Verbesserungsmöglichkeiten.

OBJECTIVE: Expectations of social-psychiatric services regarding their cooperation with psychiatric hospitals should be examined by qualitative research. METHODS: Based upon a content analysis of interviews with nine social-psychiatric services working in the catchment area of a psychiatric hospital, the statements were analysed quantitatively to assess their relative importance. RESULTS: Expectations on patient related communication between SpDi and hospital staff were expressed most frequently. Further aspects of an "ideal" cooperation from the SpDi's point of view are sympathy for each other, information of patients, community based psychiatric care, and quality of inpatient care. CONCLUSIONS: Social-psychiatric services' expectations represent important clues to improve the cooperation at the interface between outpatient and inpatient care and should be taken into consideration with respect to continuity of treatment of the chronically mentally ill.

Legislation to protect individual confidentiality: the case of cancer registration in Germany.

Until 1994, cancer registration in Germany was characterized by non-uniformity. This was caused by different legal requirements for population-based cancer registries in the individual states (or Länder), resulting in either incomplete registration on the one hand, or the impossibility of using the data at the individual level for epidemiologic studies on the other hand. These existing disadvantages can be overcome with the new Act on Cancer Registration that came into effect in 1995. The new Act on Cancer Registration in Germany is discussed as a compromise between the interests of data protection and those of epidemiologic research.

[Churg-Strauss syndrome]. / Churg-Strauss-Syndrom.

A 41-year-old woman was hospitalized because of dyspnoea, myalgia-like aches in the shoulders and back, recurrent fever up to 38 degrees C and a feeling of being in poor health for some 6 weeks. She had allergic rhinitis and, for the past 3 years, bronchial asthma. One year ago maxillary sinusitis had been diagnosed. The blood sedimentation rate was increased and there was marked eosinophilia (74% eosinophils in the differential blood count). The titres of antibodies against cytoplasmatic components of neutrophil granulocytes (pANCA and cANCA) were negative. The chest radiograph showed marked pleuropulmonary shadows. Pulmonary aspergillosis, Wegener granulomatosis, panarteritis nodosa and hypereosinophilic leukaemia were excluded on clinical and biochemical grounds, as well as by bone-marrow biopsy. Transbronchially obtained lung tissue histologically demonstrated interstitial and intra-alveolar infiltration with eosinophilic granulocytes and confirmed the clinically suspected diagnosis of Churg-Strauss syndrome. Under treatment with prednisone, 100 mg daily, the symptoms improved within a few days and the chest radiograph became normal within 14 days. 15 months later the patient, now on prednisone by mouth, 5 mg daily, was free of symptoms.

Total nutritional support through the peritoneal cavity.

We prepared ten dogs with intraperitoneal catheters to allow total nutritional support for 30 days by constant infusion of a solution containing 1.5% amino acid, 10% glucose, and 1% lipids at a rate of 4 ml/kg/hr. Seven dogs survived in apparent good health but with a 13.9 +/- 1.3% weight loss. There was no correlation between actual caloric input and percentage of weight loss. Serum albumin concentration fell to 2.6 +/- 0.3 gm/dl but other chemistries remained near normal. The peritoneum showed significant inflammatory reaction but this resolved by 30 days. Three dogs died in the first week from what appeared to be circulatory collapse from rapid fluid shifts. We conclude that a significant amount of nutrients can be delivered through the peritoneal cavity but whether total nutritional support is feasible remains to be proven.

Role of the medullary collecting duct in potassium excretion in potassium-adapted animals.

Previous studies have demonstrated that the rate of urinary potassium excretion is markedly greater in animals fed a high potassium diet than in animals on a control diet before and during the acute infusion of potassium salts. Because the contribution of the medullary collecting duct to urinary potassium under these conditions has not been determined, microcatheterization studies were performed to elucidate the role of that nephron segment in regulating potassium excretion in controls and in animals on a potassium-enriched diet. Although there was no evidence of net transport of potassium by the medullary collecting duct in control animals under basal conditions, net secretion of potassium by that nephron segment accounted for nearly one half of the increased rate of urinary excretion in animals fed a high potassium diet. During acute infusion of potassium salts, potassium secretion by the medullary portion of the collecting duct contributed approximately one half of the potassium in the final urine samples in both controls and animals fed a high potassium diet. Because the rate of urinary excretion was twofold greater in experimental animals during acute potassium loading, absolute potassium secretion in medullary collecting duct was twice the control rate in animals adapted to a high potassium dietary intake. These data demonstrate, therefore, that the medullary collecting duct plays an important role in regulating the excretion of potassium when the excretory load is either acutely or chronically increased.