[Solid pediatric tumors : A brief survey of the rarity cabinet]. / Solide Kindertumoren : Ein Streifzug durch das Raritätenkabinett.

Solid tumors in childhood are extremely rare entities, which are usually treated in specialized centers. Diagnosis and therapy are carried out according to a joint European protocol, whereby the pathological evaluation and therapy are carried out according to international guidelines. For the correct diagnosis and/or therapy of most tumors, analysis of specific genetic changes is mandatory; therefore, tumors have to be adequately sampled for parallel genetic analysis during the pathological work-up. A second opinion reference of the histopathological assessment is part of the international guidelines. Neuroblastomas, congenital mesoblastic nephromas and rhabdoid tumors are examples of solid tumors in childhood that are not restricted to one organ and occur exclusively during childhood.

[Economic aspects of surgical wound therapies]. / Okonomische Aspekte in der chirurgischen Wundbehandlung.

INTRODUCTION: Health care insurers in Germany pay 5 billion Euros annually in materials alone for pressure ulcers, diabetic foot ulcers, and ulcus cruris. With such figures it is necessary to consider, economic aspects of treatment. METHODS: Due to the lack of evidence-based data on wound treatment costs, we investigated available studies for an effect on treatment costs when standard moist wound therapy was compared with alternative methods. Suited medical parameters are calculated and compared. Daily costs and length of treatment are correlated and compared. RESULTS: Published data show that alternative wound therapies may lead to an earlier wound closure, fewer complications, and reduction in hospital admissions and length of stay. Despite higher daily costs, some alternative wound therapies turn out to be more cost effective, when all economical factors are considered. In this respect a move towards alternative wound therapies could possibly lead to major savings. DISCUSSION: At present there is insufficient evidence to prove the efficacy of various treatment modalities for chronic wounds. This is due to numerous factors such as comorbidities and frequent multimorbidity. Nevertheless critical evaluation of one innovative treatment alone already uncovered an enormous potential for savings in a wider economic context, despite the comparatively higher cost of a single treatment. It is of utmost importance that conservative wound care become firmly embedded in surgical concepts.

[Cost-effectiveness in wound care]. / Kosteneffektivität in der Wundbehandlung.

INTRODUCTION: In Germany, treatment costs for pressure ulcer, diabetic foot ulcer and ulcus cruris sum up to Euro 5 billion p. a. (cost of materials only). The question is to be answered how much money could be saved to sick funds, if the treatment is switched from traditional wound care, e. g. hydro-colloids to Vacuum Assisted Closure (V.A.C.). METHODS: Clinical studies are analysed with regard to complication rates and speed of wound healing V.A.C. vs. traditional. Daily costs and the length of treatment are then correlated and compared. RESULTS: V.A.C. therapy significantly reduces the time for the wound closing process, hospital admissions and complication rates. Despite higher daily treatment costs (cost of material, only), the V.A.C. therapy turns out to be the superior cost-effective method by far. Assumed V.A.C. therapy substitutes other methods by 50 %, sick funds could have saved Euro 0.7 billion p. a. DISCUSSION: The V.A.C. related saving potential is not available to sick funds because the approval process for home care use is still (Jan 2006) ongoing since 1999. The improvement of the relevant decision making process is strongly required to faster provide better care and savings at the same time.

[Indications and safety aspects of vacuum-assisted wound closure]. / Indikationen und Sicherheitsaspekte der Vakuumtherapie.

Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.

Threats to identity in survivors of multiple AIDS-related losses.

Survivors of multiple AIDS-related losses face threat to their identity because of the extreme disruption to their personal, assumptive, and interpersonal worlds. This article briefly explains the experience of multiple-loss survivors and includes a case history of a survivor. An individual's sense of self is transformed through identification with the disease. In the gay community, a particularly strong identification with AIDS arose. One outcome of the meshing of an AIDS and homosexual identity is the tendency for gays to assume an identity in relation to HIV ("I am HIV positive/negative.") Personality alteration is not uncommon and may include an inability to trust, labile emotionality, and diffuse anger. Erik Erikson's developmental stage model is used to clarify the confusion survivors face in maintaining and forming identity. Many survivors are catapulted into an integrity versus despair task, reporting many similarities with the situation of their grandparents. The survivor's interpersonal connection to the world, especially their connection to a community, is severely shaken. The article does not ignore the potential for positive identity growth arising from this tragedy. Conclusions from this experience may have applicability in other areas of multiple, ongoing losses.

Issues and implications in the counseling of survivors of multiple AIDS-related loss.

Survivors of multiple AIDS-related loss face a unique phenomenon for which existing theories and diagnostic criteria regarding grief and trauma are inadequate. Unresolved grief and complicated bereavement are normal responses to multiple loss. This distinctive experience and the resulting symptoms have implications for counselors. Suggestions are offered for counselors to help clients process the aggregate and individual losses arising from this experience. AIDS provides a rare opportunity to analyze concurrent traumatization and complicated bereavement occurring on an ongoing basis. This analysis and its implications may therefore be useful in the future in regard to tragedies that share these characteristics.

Depression and anxiety in pediatric inflammatory bowel disease and cystic fibrosis.

The lifetime and current prevalence of depression and anxiety disorders was determined in 41 children with Crohn's disease, 12 children with ulcerative colitis, and 52 children with cystic fibrosis, using the Kiddie-Schedule for Affective Disorders and Schizophrenia interview. The lifetime prevalence of depression was 29% in Crohn's disease, 21% in ulcerative colitis, and 11.5% in cystic fibrosis. The difference in the prevalence of depression between Crohn's disease and cystic fibrosis was significant (p less than 0.05). The lifetime and current prevalence of dysthymia was significantly greater in ulcerative colitis than Crohn's disease (p less than 0.01) or cystic fibrosis (p less than 0.01). The lifetime prevalence of atypical depression was significantly greater in Crohn's disease than cystic fibrosis (22% versus 5.8%, p less than 0.05) and was also greater in ulcerative colitis than cystic fibrosis (21% versus 5.8%, p = 0.1). There was no difference between the groups in the current prevalence of major depression or atypical depression, or in the lifetime or current prevalence of anxiety disorders.

Medullary osteogenesis with platinum cathodes.

Studies of electrical stimulation of osteogenesis with stainless steel electrodes have previously established a dose-response relationship between current and bone growth. Examination of the effect of differing geometric current densities resulted in the conclusion that very little electrode surface area was involved in stimulation and led to the design of a multiport "distributive" cathode. A series of experiments were performed to extend these results to wire and multiport platinum electrodes. As before, a current-bone growth dose-response relationship was found. Peak bone growth was greater than for stainless steel. However, peak bone growth occurred at 2.0 microA (versus 20 microA for stainless steel). Correlation studies suggest that small changes in cathodic potential affect bone growth more than similar size changes in current. Finally, the generally benign local host response to platinum suggests that platinum may be a suitable material for chronic indwelling anodes for stimulation of osteogenesis.

[The structure of drug costs. A criticism of monocausal explanation (author's transl)]. / Die Struktur der Arzneimittelkosten. Zur Kritik einer monokausalen Erklärung.

Proceeding from the arguments of a recent publication, an attempt is made to establish whether a monocausal assessment is fruitful in the explanation of the development of drug costs in the statutory health insurance. The question is raised whether the price increase for drugs is in fact the decisive variable determining the costs. This is denied on the grounds of a differential analysis of the causative variables involved and it is shown what role, besides price and quantity components, the innovation or structure effect plays in the development of drug costs.