Mindestmengen

BACKGROUND: Consequences of the volume outcome relationship are controversial. Objectification based on data analysis is strongly needed. The aim of this publication was to analyse the effects of volume outcome reallocations based on German inpatient data. METHOD: The analysis based on inpatient data of the Krankenhauszweckverband Koeln, Bonn und Region (Hospital Association of the Cologne and Bonn Region) of 2002 and 2005. Relevant data sets were identified according to the effects of current German regulations on volume outcome on the special fields liver transplant, kidney transplant, complex pancreatic surgery, and complex oesophageal surgery. RESULTS: The effects of current German regulations on volume outcome results differed greatly between the four surgical specialities. There were fewer effects on kidney transplant, but due to an already very high level of centralisation 34% (oesophagus) and 8% (pancreas) of the hospitals stopped related surgery. This affected 8.9% (oesophagus) and 2.2% (pancreas) of related cases. CONCLUSION: Concentration and the formation of specialised medical centres are results of the implementation of volume outcome relationships. The quality of medical treatment does not automatically improve from this development. It is necessary to analyse any correlation between quality and frequency of treatment or other criteria such as know-how, structure and process management, and multidisciplinarity.     

Die Rolle der Zytokine bei Knorpeldefekten und in der Knorpeltherapie

Cytokines play a pivotal role in the pathogenesis of degenerative joint disease but also in inflammatory conditions as well as osteoarthritis (OA) and rheumatoid arthritis (RA). A key role is attributed to interleukin-1 and tumor necrosis factor-α. Certain cytokines that can inhibit the activity of catabolic cytokines have great therapeutic potential and are currently being investigated in numerous clinical studies. Available scientific findings indicate that proinflammatory cytokines stimulate cartilage breakdown and blockade of these cytokines can protect the cartilage.     

Totale mesometriale Resektion

Abdominal radical hysterectomy (Wertheim operation), currently the standard surgical treatment for cervical carcinoma, is based on historical ideas of the female pelvic anatomy and of locoregional tumor spread. Total mesometrial resection (TMMR) uses new insights derived from developmental biology for a new oncological concept of radicality, i.e. resection of a malignant tumor within the borders of the morphogenetic unit of its origin. The morphogenetic uterovaginal unit that relates to the local spread of cervical carcinoma can be deduced from the embryological and fetal development. Anatomical structures that do not belong to this tissue unit can be left in situ despite close proximity to the tumor. When combined with nerve-sparing therapeutic lymph node dissection, TMMR yields a high locoregional control rate without adjuvant radiotherapy and with relatively little treatment-related morbidity.     

Genotyping of Chlamydia trachomatis in Urine Specimens Will Facilitate Large Epidemiological Studies

The serovars of Chlamydia trachomatis-positive urine specimens (n = 81; as detected by PCR and ligase chain reaction) were successfully analyzed in 94% of cases by omp1 PCR-based RFLP analysis. The use of urine specimens and this simple and sensitive typing method will greatly facilitate epidemiological studies of C. trachomatis serovar distribution in asymptomatic C. trachomatis infections in both females and males.     

Academia Eurasiana Neurochirurgica Brain Death

Conclusions Brain death (or cerebral death) means definitive cessation of all neural functions above the spinal cord, thus implying the irreversible loss of all cerebral and brain stem functions.Spinal cord activity may persist after brain death-priapism, persistence of myotatic reflexes- for a few minutes and this spinal activity may be responsible for coarse limb movements after life-support machines have been turned off.The preservation of these spinal reflexes reinforces the advice to allow only responsible doctors to assist at the declaration of death of the patient.     

The foundation of experimental ophthalmology by Theodor Leber

Theodor Leber grew up in Heidelberg as the son of a professor of Romance languages. Initially he planned to study natural sciences. Bunsen's advice led him to medicine. During his studies he succeeded in solving a competition problem posed by Helmholtz in the medical department. A short period of practical work in the eye hospital of Knapp was unsatisfactory. In Vienna with the physiologist Carl Ludwig, he was able in 1863/64, at the age of only 24 years, to demonstrate the blood circulation of the eye by color injections into the arteries and veins. Since that time the schematic drawings of his results can be found in every textbook of ophthalmology. On the occasion of the congress of the German Ophthalmological Society in Heidelberg in 1864, Theodor Leber reported on these findings and met with immense approval. In 1864–67 he followed an invitation as coworker of Liebreich to Paris; in 1867 he became A.v. Graefe's coworker in Berlin; in 1871 he moved to Göttingen, which became the first eye clinic with a laboratory for experimental investigations.The second epoch-making discovery accomplished by Leber was the detection of the fluid exchange in the eye. These results have also been confirmed by modern methods. Therefore, Theodor Leber can be called the father of experimental ophthalmology.