[Discussing a "two-tiered medical system": a statement]. / "Zwei-klassen-Medizin"--ein Beitrag zur Versachlichung der Diskussion.

The criticism of a "two-tiered medical system" is a political slogan, which is also not exactly defined. However, for the public discussion this is not of further importance because talking about a "two-tiered medical system" has a priori a negative impact; in particular in times when people's fears surrounding medical care in Germany are great. Especially in a public health insurance system, insured people worry that in the future they will only receive the most essential medical services, rather than all services that are deemed reasonable and medically appropriate. One of the central themes in the discussion of a "two-tiered medical system" that causes disputes (or animosity) between privately and publicly insured persons arises when comparing differences in waiting periods to see a doctor and additional medical treatments made available to the privately insured. Critics of the "two-tiered medical system" envision a "one-tiered medical system"; one in which every person receives uniform healthcare, and in which the "purchase" of additional medical treatments is not permitted. However, the "one-tiered medical system" remains a theoretical construct. Service differences based on price differences are the reality. So the problem of the "two-tiered medical system" manifests itself only when those services that go beyond the basic care (privately offered services) negatively impact basic care, and/or displace basic care offerings. An example of this would be when a publicly insured patient has to wait longer to see a doctor because preference is given to privately insured patients. Economically speaking, negative external effects come into play. This causality has not been found or proven to be present in the German healthcare system. It exists neither in the inpatient nor in the outpatient healthcare sector. There is no basis to the claim that there is a difference in treatment favouring private patients with detrimental effects to non-privately insured patients. Therefore the claim that a "two tiered medical system" exists is negated. On the contrary: In the German health care system treatment differences above and beyond the basic services lead to an advantage for publicly insured patients. There are no negative, but rather positive external effects. This is mainly attributed to the increased doctors' revenue in the outpatient sector which amounted to Euro 4.4 billion in 2006 alone. Therefore, private patients subsidise the public insurance by funding a disproportionately high share of doctors' budgets.

[Habent sua fata libelli]. / Habent sua fata libelli.

Books sometimes out-live their authors even before they have been completed, in which case they often contain material other than that compiled by the original writer. Taking the desktop volume by Baerensprung and Hebra as an example, we are shown how such works can tell us more about medical history than is apparent at first glance.

[The first tuberculosis cure with chemotherapy: a lupus patient in Hornheide]. / Die erste Tuberkuloseheilung mit Chemotherapie: Eine Lupuskranke in Hornheide.

Karl Wilhelm Kalkoff (1909-1981) describes in his unpublished memoirs the first cure of a female patient suffering from a severe form of tuberculosis cutis of the lupus vulgaris type. The drug used in this case was TBI/698 developed by Bayer Leverkusen, which was later named Conteben. This was the first chemotherapeutic cure of tuberculosis.

[Regression of over 150 skin metastases of malignant melanoma with complex homeopathic therapy]. / Regression von über 150 Hautmetastasen eines malignen Melanoms bei homöopathischer Komplextherapie.

Within a period of 7 years, a female patient with malignant melanoma on the calf developed over 150 cutaneous metastases in the vicinity of the primary tumour. During the course of the following 8 years all but one of these disappeared again. One year later the patient died of metastases in the lungs and brain. The author discusses this unusual history and examines the significance of a course of homeopathic "complex therapy" administered during the decisive period.

[Wigs as medical aids. Selection, care and cost regulation]. / Perücken als medizinisches Hilfsmittel. Auswahl, Pflege, Kostenregelung.

In a discreet way, wigs not only cover up a disfiguring loss of hair but also chronic and suppurative diseases of the scalp. We especially deal with the problems regarding the choice of such wigs, how they are--if necessary--disinfected, cleaned, and tended, and how the expenses may be settled.

[Dermatologic radiotherapy--today, yesterday, tomorrow]. / Dermatologische Strahlentherapie--Heute, gestern, morgen.

Dermatologic therapy with ionising radiation has changed in the last 30 years. Adapted to the limitations of the area of indication, the improved radiotechnique, as well as the stricter working conditions, it is still today an important therapeutic method. As there are to be expected increased numbers of malignant diseases of the skin, radiotherapy will be an essential part of dermatologic tumor therapy in the near future.

Effect of calcium mineral solutions on the histamine release from human peripheral leukocytes.

Histamine release from human peripheral leukocytes was studied in patients with urticaria, pollinosis, and psoriasis and compared with the release in normal healthy donors using anti-IgE or the calcium-ionophore A 23187 as stimuli in the presence of three calcium mineral solutions (Frubiase Calcium). It was observed that among 35 donors 29 revealed a calcium dependent inhibition of histamine release. The inhibition was also evident when calcium mineral solution was added to an ongoing histamine release. The membrane biochemical effects of calcium mediated inhibition are currently under investigation.

[Omphalolith]. / Der Nabelstein.

In rare instances a hard, smooth, almost black bolus, "omphalolith" is found in the umbilicus, resembling a malignant melanoma. After removal by a pincette it reveals on its backside a colourless lamellar epithelium. At microscopic examination it also constists of stratified corneocytes. Differential diagnosis of the omphalic stone includes the so called umbilical cholesteatoma, an accumulation of crumbling, fetid masses in the umbilicus, often times accompanied by seborrhea which may lead to abscess formation. The term omphalic stone could not be found in the medical literature. However, it has been used to name a jewel which is worn in the umbilicus or a huge stone in Delphi which was believed by our ancestors to be the center of the world.

[Tuberculosis of the peripheral lymph nodes]. / Tuberkulose der peripheren lymphknoten.

In Germans as well as in "foreign workers" acute tuberculous lymphnode disease is most often seen in the drainage areas of old sometimes even calcified tuberculous processes. The infective agent is almost always mycobacterium tuberculosis. Resistant strains are rarely found even in recurrent disease. Differential diagnosis includes tulareaemia, cat scratch syndrome, lues, and foreign body reaction. In those cases in which the histopathologic findings are similar to productive tuberculosis, sarcoidosis and epitheloid cell reaction in the drainage area of malignant tumors have to be taken into account. Knowing the usual good-response to tuberculostatic drugs there is no need to perform risky operations or to utilize rather dangerous agents such as streptomycine.

[Clinial picture and localization of skin metastasis of visceral carcinomas]. / Klinisches Bild und Lokalisation der Hauntmetastasen viszeraler Karzinome.

Seven cases with secondary skin carcinomas are described. The primary tumor was located at the tongue, the larynx, the thyroid, the abdomen, the ovaries, the collum uteri and the rectum. From the literature 60 other patients with secundary skin carcinomas and 100 primary carcinomas were evaluated. Clinical evidences for a secundary skin carcinoma are: unusual localization, multiple occurrence and an even surface. It was examined whether the localization of the secundary skin tumor refers to the localization of the primary tumor.

[Treatment of malignant melanoma with dinitrochlorobenzene ointment]. / Die Behandlung des malignen Melanoms mit Dinitrochlorbenzol-Salbe.

35 patients with malignant melanomas in different stages were treated with dinitrochlorobenzene according to Malek-Mansour in the last three years. Nine typical cases are demonstrated. The treatment is more effective when the tumor lies close to skin surface and has not yet spread. Distant metastases may react--but normally these metastases cannot be removed. Regarding effects and side effects of DNCB, the methods of treatment and the range of indications are described.