Search

Background: Genetic, biologic and clinical data suggest that Parkinson's disease (PD) is an umbrella for multiple disorders with clinical and pathological overlap, yet with different underlying mechanisms. To better understand these and to move towards neuroprotective treatment, we have established the Quebec Parkinson Network (QPN), an open-access patient registry, and data and bio-samples repository., Objective: To present the QPN and to perform preliminary analysis of the QPN data., Methods: A total of 1,070 consecutively recruited PD patients were included in the analysis. Demographic and clinical data were analyzed, including comparisons between males and females, PD patients with and without RBD, and stratified analyses comparing early and late-onset PD and different age groups., Results: QPN patients exhibit a male:female ratio of 1.8:1, an average age-at-onset of 58.6 years, an age-at-diagnosis of 60.4 years, and average disease duration of 8.9 years. REM-sleep behavior disorder (RBD) was more common among men, and RBD was associated with other motor and non-motor symptoms including dyskinesia, fluctuations, postural hypotension and hallucinations. Older patients had significantly higher rates of constipation and cognitive impairment, and longer disease duration was associated with higher rates of dyskinesia, fluctuations, freezing of gait, falls, hallucinations and cognitive impairment. Since QPN's creation, over 60 studies and 30 publications have included patients and data from the QPN., Conclusions: The QPN cohort displays typical PD demographics and clinical features. These data are open-access upon application (http://rpq-qpn.ca/en/), and will soon include genetic, imaging and bio-samples. We encourage clinicians and researchers to perform studies using these resources.

The phenomenon of bacterial growth in water softeners is well known since years. To upgrade the hygienic safety of water softeners, the German DIN Standard 19636 was developed, to assure that the distribution system could not be contaminated by these devices and that the drinking water to be used in the household still meets the microbiological standards according to the German drinking water guidelines, i.e. among others heterotrophic plate count (HPC) below 100 CFU/ml. Moreover, the standard for the water softeners includes a test for contamination with Pseudomonas aeruginosa which has to be disinfected during the regeneration phase. This is possible by sanitizing the resin bed during regeneration by producing chlorine. The results of the last 10 years of tests of water softeners according to DIN 19636 showed that it is possible to produce water softeners that comply with that standard. Approximately 60% of the tested models were accepted. P. aeruginosa is used as an indicator for potentially pathogenic bacteria being able to grow also in low nutrient conditions which normally prevail in drinking water. Like other heterotrophs, the numbers of P. aeruginosa increase rapidly as stagnation occurs. Normally P. aeruginosa is not present in the distributed drinking water. However, under certain conditions, P. aeruginosa can be introduced into the drinking water distribution system, for instance, during construction work. The occurrence of P. aeruginosa is shown in different cases in treatment plants, public drinking water systems and in-house installations. The compliance with DIN 19636 provides assurance that a water softener will not be a constant source of contamination, even if it is once inoculated with a potentially pathogenic bacterium like P. aeruginosa., (Copyright 2003 Elsevier B.V.)

Background: Analysis of surveys concerning current practice in pacemaker implantation has shown a difference between the United States and Canada: almost 70% of pacemakers are implanted in the operating room (OR) by surgeons in Canada, while in the United States, 70% of the implantations are done in a catheterization laboratory., Objective: To analyze the impact (in terms of complications, time on the waiting list, length of hospitalization and costs) of moving surgery from the OR to the electrophysiology laboratory (EPL) in a 450-bed Canadian teaching hospital. Data were collected on 100 consecutive implantations in the OR and, subsequently, on 100 procedures in the EPL., Results: The populations were identical in age (68+/-18 and 69+/-18 years, respectively) and sex ratio (both groups were 58% male). The implantation technique differed: the subclavian approach was used in 73% of patients in the OR group and in 99% of those in the EPL group. Antibiotic prophylaxis was given to all patients. The dual chamber rate was 22% in the OR group and 28% in the EPL group. Complication rates were similar in the two groups. Eleven per cent of procedures in the OR group and 46% in the EPL group were elective. For patients who underwent nonelective surgery, the time from indication to implantation was reduced from 3.3+/-2.6 days in the OR group to 1. 9+/-1.8 days in the EPL group (P=0.0005), and the total stay in hospital was 10.2+/-7.4 days and 6.9+/-7.8 days, respectively (P=0. 01). For both elective and nonelective surgery, the total stay in hospital was 9.2+/-7.4 days in the OR group and 4.2+/-6.4 days in the EPL group (P<0.00001). The overall cost reduction, taking into account an arbitrary earlier discharge in the EPL group, was almost 50%., Conclusions: In this general teaching hospital, moving pacemaker implantation surgery from the OR to the EPL was safe and reduced by almost 50% the hospitalization stay by reducing the delay before implantation and by allowing elective surgery.

Objective: To determine whether the success and complication rates of oral anticoagulation obtained in large, well controlled trials, upon which recommendations are based, are comparable with routine cardiology practice., Design: An observational, prospective cohort study collected data on all patients followed at an anticoagulant clinic over one calendar year., Patients: One thousand and seventy-eight patients anticoagulated for cardiovascular indications, mainly atrial fibrillation, prosthetic valves and ventricular dysfunction, were followed for 804 patient-years of treatment. No patient was lost to follow-up., Interventions: Telephone conversations and regular verification of medical files were used to record and classify all bleeding and thromboembolic events according to severity. International normalized ratios (INR) were compared with target ranges., Results: One hundred and twelve bleeding events, ie, 13.9/100 patient-years (% p-y), were recorded, of which 61 required medical attention. Major hemorrhages, defined as those requiring treatment or hospital observation for more than 24 h, occurred in 15 instances (1.9% p-y). Among these, 9 (1.1% p-y) were classified as life threatening, with four being fatal (0,5% p-y). Twenty-two thromboembolic events (2.7% p-y) occurred, of which 10 were major (1.2% p-y), leaving three patients (0.4% p-y) with long term sequelae and causing two deaths (0.25% p-y). INRs were within target range 62.3% of the time, with 2.2% of values recorded above 5 and 0.3% above 10., Conclusion: The low failure and complication rates obtained in large, controlled trials are similar to those observed in actual cardiology practice.

Objectives: To investigate a noninvasive technique to localize the atrial insertion site of concealed accessory pathways based on the analysis of body surface potential maps (BSPMs) of retrograde P waves in dogs with simulated retrograde pathways., Animals and Methods: Orthodromic tachycardias were simulated by atrial stimulations at eight different sites around the atrioventricular ring with long (250 ms and 300 ms) and short (100 ms and 130 ms) coupling times in 14 anesthetized dogs to have P waves well separated from the T wave or occurring during the T wave, respectively. The distance between pacing sites was 15 to 40 mm in group 1 (eight dogs) and 2 mm (in the right atrial free wall region) in group 2 (six dogs). Beats were signal-averaged during 30 s and BSPMs were constructed from 63 unipolar leads., Results: The P wave BSPM pattern for any specific stimulation site was stable and reproducible (correlation coefficient greater than 0.98), and similar in different dogs at long coupling interval stimulations. The thoracic distribution of negative potentials and position of the potential minimum clearly identified the stimulation site when long coupling time stimulations were used. The spatial resolution of the technique as determined by comparison of correlation coefficients in group 2 was 6 mm (P<0.05). When short coupling time stimulations were used (fast tachycardia simulation), the T wave masked the P wave potential distribution in four of eight dogs, but the retrograde P wave map could still be accurately extracted by subtracting a straight line joining the onset and offset of the P wave in 24 of 28 (86%) of the tachycardia simulation sites in these four dogs., Conclusions: The BSPM patterns of simulated retrograde P waves are specifically related to the site of atrial stimulation. Although the T wave altered these BSPM patterns, a subtraction technique recovered the pattern of the retrograde P wave in 93% of all simulated orthodromic tachycardias. The spatial resolution of the retrograde P wave BSPM method was 6 mm.

Comments are given on the present status of regulations concerning water in swimming pools and baths--1991--(in connection with the KOK regulations--1972--and the Federal German standard [DIN] No. 19643-1984-). Reference is made to microbiologic limits of Legionella pneumophila among others.

The problems of hygiene to be tackled in spas are governed by Federal German legislation such as the Federal Communicable Diseases Act, the Federal German DIN standard regulation No. 19643, the guidelines for the construction of medical baths and the legal definition of a spa. The article describes the problems of hygiene encountered in respect of the water in swimming pools and in physical exercise basins in spas, as well as the problems of hygiene in other fields with particular reference to microorganisms that are of special importance as far as hygienic aspects are concerned. Reference is made to the trihalogen methanes and to the problems in connection with the employed materials.

Because of their increased environmental resistance faecal streptococci are a good indicator of a contamination dating back a long time. Under the new Federal German Drinking Water Regulations, examination of faecal streptococci is not mandatory. On the basis of 190 samples of water from natural springs it was shown that, if the water was examined only in respect of E. coli and coliform bacteria there were no objections in 22% of water that was faecally contaminated, so that such water escaped detection. Hence, it is advisable to perform the faecal streptococci test in water that is frequently or potentially infected with bacteria.

This is a survey of textile-technical requirements, of quality controls, of the hygiene certificate as well as of the relevant valid legal provisions, regulations and directions. The test-list for works inspection is quoted. The hygienic-bacteriological control methods as well as the checking methods are described by means of selected examples.

The rules of the European Economic Community to harmonize the hygienic quality of drinking water write out the faecal streptococci as indicator organisms. This operating definition of the faecal streptococci prohibits its taxonomic limitation to enterococci or group D streptococci. Therefore, we have undertaken studies concerning the methods for routine examinations. Comparative investigations of selective enrichment broths showed no significant differences of the end concentration of glucose in the range of 0.5-1.0% and of sodium azide in the range of 0.02-0.05%. 36 degrees C was a better incubation temperature than 44 degrees C and the results were better after 24 h than after 48 h. Comparative investigations of selective plating media showed less selectivity of the bile-aesculin agar and gentamicinthallous-carbonate agar than that on the one hand of citrate-azide-tween-carbonate agar, KF streptococcal agar or Slanetz-Bartley enterococcal agar, and on the other hand of kanamycin-aesculin-azide agar. All together the kanamycin-aesculin-azide agar seems to be a little better than the other media (Table 2) 356 strains of faecal streptococci were isolated from the studied media. More than 20 characteristics were investigated and, there upon, the strains were differentiated (Table 3). S. faecalis predominates in human materials, i.e. urine, S. faecium and S. durans were isolated specially from sewage and waste water (Table 4). The single species of faecal streptococci grow specificly on the different selective media, and therefore, each agar specimen prefers the one or other species more or less selectively (Table 5).