Steuerliche Einordnung der wirtschaftlichen Vorteile aus einer Vertragsarztzulassung

Abstrakt  Der wirtschaftliche Vorteil einer Vertragsarztzulassung stellt kein gesondert zu bewertendes Wirtschaftsgut dar, sondern einen wertbildenden Faktor des Wirtschaftsguts “Praxiswert” im Rahmen des Gesamtkaufpreises zum Erwerb der Vertragsarztpraxis.     

Why cancer at the primary site and in the lymph nodes contributes to the risk of cancer death

BACKGROUND:

Cancer at both the primary site and in the lymph nodes is associated with lethality, although the mechanism by which lethality arises from each site has been poorly understood. For breast carcinoma, each positive lymph node contributes an approximately 6% risk of death, and each millimeter of primary tumor greatest dimension contributes approximately 1%; whereas, for melanoma, each positive lymph node contributes an approximately 23% risk, and each millimeter of tumor thickness contributes approximately 8%: This is described by a pair of linked equations, the Size+Nodes method.

METHODS:

A simple expression, the ProbabilityEstimation equation, which was derived from the authors' binary‐biologic model of cancer metastasis, was used to calculate the probabilities of spread of cancer cells from data on tumor size, lymph node status, and death rate.

RESULTS:

In this report, the authors demonstrated, that when similar masses of cancer are compared, the chance of lethal spread of a cancer cell to the periphery is approximately the same whether the spread emerges from a lymph node or from the primary site. The greater the number of cells at the primary site (tumor size) or the greater the number of cells in the lymph nodes (number of positive lymph nodes), the greater is the aggregate chance that 1 or more cells has undergone a lethal event of spread, a process captured by the Size+Nodes equations.

CONCLUSIONS:

The lethal contributions of cancer at the primary site and lymph nodes can be explained by a simple mechanical process of the spread of cancer cells occurring with definable probabilities per cell. The presence of cancer in the lymph nodes does not indicate an intrinsic change in a malignancy but, rather, an increased mass of cancer from which spread can emerge. Cancer 2009. © 2009 American Cancer Society.     

A prognostic model for clinical stage I melanoma of the upper extremity. The importance of anatomic subsites in predicting recurrent disease.

Thirteen variables were studied for their relative usefulness in predicting recurrent disease in 107 patients with clinical Stage I melanoma of the upper extremity. After a mean follow-up period of 54 months, the only patents who have had recurrent disease to date are those who primary lesions were located either on the hand or posterior upper arm. The five-year disease-free survival role for 44 patients with melanoma at these sites was 68%. None of 63 patients with melanoma located on the forearm of anterior upper arm have had recurrent disease (i.e., the five-year, disease-free survival rate was 100% (p = 0.00004), compared with the hand or posterior arm group). A Cox proportional hazards (multivariate) analysis demonstrated that two primary tumor histologic variable, thickness in millimeters and ulceration, interacted to produce the best prognostic model for those 44 patients with melanoma of the hand or posterior upper arm. Twenty-one patients with primary lesions at these sites had primary tumors less than 2.25 mm in thickness and no evidence of ulceration histologically. Their five-year, disease-free survival role was 95%. For the remaining 23 patients with primary tumors on the hand or posterior upper arm who had either histologic evidence of ulceration or primary tumors greater than or equal to 2.25 mm, the five-year disease-free survival rate was 37% (p = 0.002, compared with group nonulcerated, thin lesions). The excellent survival rate for patients with melanomas on the forearm or anterior upper arm was not completely explained by pathologic stage, by primary tumor thickness, or by histologic ulceration of the primary tumor.     

Monitoring end-tidal carbon dioxide tensions with high-frequency jet ventilation in dogs with normal lungs

The end-tidal carbon dioxide tension (PetCO2) measured after a single, large tidal-volume breath (15 ml/kg body weight) was compared to simultaneous measurements of PaCO2 in 6 dogs with normal lungs who were receiving high-frequency jet ventilation (HFJV). There was an excellent linear correlation between PetCO2 and the PaCO2 over the entire range of CO2 tensions commonly encountered in clinical practice (PetCO2 = 0.9 PaCO2 + 2.2 torr; n = 51, r = .98, p less than .001, range of PaCO2 = 12-72 torr). We conclude that when lung function is normal, a simple system of measuring PetCO2 after a large breath is an accurate method of monitoring the effectiveness of CO2 elimination during HFJV.     

Cutaneous malignant mixed tumor

Two cases of cutaneous malignant mixed tumor occurred in a 70-year-old man and a 69-year-old man. Nine previously described patients with cutaneous malignant mixed tumor resembled the two patients in this report, both clinically and histologically. All cases with adequate long-term follow-up evaluations were characterized by recurrence or metastasis. In contrast to benign mixed tumors, these tumors tend to occur on the extremities, are of larger size, and may exhibit rapid growth. Histologically, cellular atypism, increased cellularity, increased mitotic rate, invasion of surrounding tissue, and necrosis may be identified.