Military health care in the 21st century.

This paper describes the pressures for health care reform which are impinging on the United States health care system. These are costs, access, allocation of resources, unnecessary care, and administrative costs and confusion. The implications of these pressures for military health care are considered to be the redefinition of the health benefit, restructuring of the military health care system, and questions about the appropriate role for the reserve components. Ten persistent issues are identified which will need to be addressed, regardless of whatever changes are proposed in the immediate future. These are the quality of health care, improved management of the military health care system, costs of care including pharmaceuticals, recruitment and retention of health care professionals, graduate medical education, renewed emphasis on health promotion and disease prevention, discharge planning and patient education, development and diffusion of new technologies, information management, and the management of environmental waste.

Healthcare for a new Germany: the West and East German health systems and their unification process.

One of the new Germany's many challenges will be merging a socialist, centralized healthcare system with a decentralized network much like our own. Both Germanys' health services have clear pluses and minuses, and while preserving the best of each may not be completely possible, it is not as remote a goal as one might think. With a summary of the pre-unification East and West health systems, the authors map out Germany's healthcare options.

International healthcare expenditures: spending totals and public satisfaction among the OECD nations.

As an introduction to this Hospital Topics theme issue on international healthcare systems, our guest editor and one of our authors present aggregate health expenditures and public-satisfaction data from member nations of the Organization for Economic Cooperation and Development. Although healthcare funding is not the explicit focus of this issue, it underlies most of the points raised, and however the health systems examined here may vary in structure or impact, financing remains a shared challenge and one of our best base lines for comparison.

Long-term follow-up records.

Having accumulated a very large series of patients' records over a period of 60 years, some involving three generations of a family, the author has selected cases that illustrate the opportunities to observe the progress of patients from infancy for more than half a century. This unique opportunity has included a variety of clinical conditions such as congenital syphilis, cretinism, acute osteomyelitis, and pink disease and represents a long term follow-up of conditions which reflect both the paediatrics of the past and the changes in the pattern of disease which have occurred in the course of 60 years.

Vascular compression: cause of trigeminal neuralgia.

Fifty patients with trigeminal neuralgia have been operated upon, and the site of origin of the fifth nerve from the pons has been explored. Forty-four of these patients were demonstrated to have vascular compression at this point, and relief of the vascular compression resulted in pain relief in all of these patients, although two patients experienced some recurrence of pain. The maximum follow-up period is now six years. It is considered that the most common cause of trigeminal neuralgia is vascular compression of the fifth nerve at the nerve root entry zone.

Vascular compression of lower cranial nerves: observations using microsurgery, with particular reference to trigeminal neuralgia.

A new finding made possible by the use of the operating microscope in neurosurgery is discussed. Nineteen patients with trigeminal neuralgia have been explored, and in 14 of these vascular compression of the fifth nerve at its entry zone to the pons has been found. Relief of this vascular compression has caused cessation of pain in all these patients. In addition, one patient with hemifacial spasm, and one patient with glosso pharyngeal neuralgia, are reported; each of these also had vascular compression of the appropriate nerve causing the symptoms.