[New assessment recommendations for disability in private accident insurance, part 4 : An interdisciplinary consensus approach-Disability outside the compensation scheme]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 4 : Ein fachübergreifend konsentierter Ansatz ­ Invalidität außerhalb der Gliedertaxe.

The following article is an element of a 4-part series on the presentation and discussion of new design recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the design recommendations for the upper and lower extremities have already been published in Die Unfallchirurgie (formerly Der Unfallchirurg) on 17 February, 18 July and 18 November 2022 [2-4]. The topic of the fourth and final part published here is the assessment recommendations for disability outside the compensation scheme.

[New assessment recommendations for disability in private accident insurance part 3 : An interdisciplinary consensus approach-Lower extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 3 : Ein fachübergreifend konsentierter Ansatz ­ untere Extremitäten.

The following article is an element of a 4-part series on the presentation and discussion of new assessment recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations of the upper extremities have already been published in Die Unfallchirurgie (previously Der Unfallchirurg) on 17 February and 31 August 2022 [2, 3]. The topic of the third part published here is the assessment recommendations for disability in the lower extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 2 : An interdisciplinary consented approach-upper extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 2 : Ein fachübergreifend konsentierter Ansatz ­ Obere Extremitäten.

The following article is one component of a four-part series on the presentation and discussion of new assessment recommendations for disability compensation in private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations have already been published in the Der Unfallchirurg on 17 February 2022. The topic of the second part published here is the assessment recommendations for disability of the upper extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 1 : An interdisciplinary consented approach-Basics]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 1 : Ein fachübergreifend konsentierter Ansatz ­ Grundlagen.

The centerpiece of a private accident insurer is the benefit promise in cases of disability, which must be determined by a doctor in due time. The insurer specifies the rates of the compensation scheme for loss or inability to function and the medical expert must then fall back on generally recognized, revised or updated assessment recommendations in order to be able to apply the given framework to the specific, individual situation of the insured person. In four steps (basics, upper and lower extremities [disability within the compensation scheme] and disability outside the compensation scheme) interdisciplinary consensus benchmarks for disability assessment are presented, which should form the basis of a uniform medical assessment of accident-related functional disorders in private accident insurance compensation.

[Joint arthrodesis in functionally favorable position : Considerations on measurement of disability in private accident insurance]. / Gelenkversteifung in gebrauchsgünstiger Stellung : Überlegungen zur Invaliditätsbemessung in der privaten Unfallversicherung.

If an accident results in a functional disorder that persists and permanently restricts physical and/or mental capacity, this is referred to as a disability. In private accident insurance it is the task of the medical expert to assess this disability by examining the medical findings and produce an assessment taking account of the literature and comparing against generally acknowledged guidance values. The priority dismemberment disability rating schedule initially provides loss values. For the "next lowest" disability levels for arthrodesis of extremity joints, the assessment recommendations are based on a functionally favorable position although this functionally favorable position is not more precisely defined.In this article the authors have defined these functionally favorable positions based on the information available in the literature. In particular, the operatively favorable settings for arthrodesis of the affected joint that are stated in the literature on trauma and orthopedic surgery were consulted. Of course, the functional perspective has been especially emphasized.A difficulty in achieving this was that the literature on arthrodesis is now almost only of historical value due to modern endoprosthetics. The knowledge gained was checked against medical experience and is expounded here.

[What is an accident anyway and what is injury? : Considerations on causality in various legal fields]. / Was ist überhaupt Unfall und was Verletzung? : Kausalitätsüberlegungen in verschiedenen Rechtsgebieten.

It is not infrequent for physicians or lawyers who only occasionally deal with medical expert opinions to have difficulty understanding terms used in a legal context. A question of proof relating to consequences of an accidental injury can refer to the accidental injury itself and it seems relatively unknown that the term accident can apply to both the event and the damage/harm to health. The special situations with mental injuries (psychotrauma) are not dealt with in this article.This article explains the concepts and terms that are frequently used in relation to questions of causality and explains the fundamentals of medical causality assessment, from the viewpoint of both medical expertise and law. The focus is on private and public accident insurance, but the law relating to accidents at work of public officials and liability are also considered.

[Prognostic assessment in private healthcare insurance part 2 : Risk supplement for accidental endoprostheses]. / Prognosebeurteilung in der Privaten Unfallversicherung Teil 2 : "Risikozuschlag" bei unfallbedingten Endoprothesen.

After examining the causes of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed between the parties involved. In addition, this must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability. In contrast to scientifically based findings serving as a prognosis of osteoarthritis, in the case of endoprostheses forecasts can only be based on medical experience, which in this case has to satisfy the standard of proof of a high level of probability, since necessary replacement operations after insertion of a prosthesis are sufficiently probable. The prosthesis supplements that have been applied to date in the context of an assessment of prognosis have their justification. In applying them, however, it must be considered on one hand that this supplement is comprised of an equally weighted proportion for future risk and on the other hand a preventive portion. This increases in significance with different prostheses on one and the same limb.

[Prognostic assessment in private healthcare insurance part 1 : Risk of osteoarthritis]. / Prognosebeurteilung in der Privaten Unfallversicherung Teil 1 : Arthroserisiko.

After examining the cause of an accident the medical expert working in the area of private health care insurance under the general accident insurance (AUB) sample conditions must ascertain incapacity within a period of time that has been contractually agreed upon between the parties involved. In addition, this person must also state their position on the question as to whether there may exist any circumstances up to the latest possible point in time in insurance terms that would comprise an adequate prognosis of a future change in the long-term condition. This requires a high probability.The sole risk of the evolution of the functional deficit arising from a proven or prognosticated post-traumatic osteoarthritis is excluded from this standard of proof which means that flat-rate risk supplements are not suited to this individualized approach and thus do not apply.

[The time-related risk for knee osteoarthritis after ACL injury. Results from a systematic review]. / Das zeitabhängige Arthroserisiko nach vorderer Kreuzbandverletzung. Ergebnisse einer systematischen Literaturrecherche.

AIM: The aim of this review was to evaluate the time-related risk for knee osteoarthritis in patients after ACL injury. MATERIALS AND METHODS: The primary search was carried out in different medical databases with the deadline 12.01.2014. The search strategy for the evaluation was [ACL] AND [osteoarthritis] including "all fields". All 1656 title/abstracts were reviewed by two independent researchers who selected 140 papers for full text review. Finally, a total of 21 relevant publications were identified for inclusion in this current paper. RESULTS: The incidence of knee osteoarthritis rises significantly over time. Two years after injury it was 6.9%, after 5 years 32.2%, after 7 years 36.3%, and after 10 years 79.6%. At the same time, the crude relative risk of OA rises as the time interval since injury increases. The relative risk of OA has already doubled by 2 years after ACL injury). By 7 years it has increased fivefold and compared with OA status at the time of injury it is still increasing significantly after 10 years. CONCLUSIONS: The ACL injury is a significant risk factor for the development of early-onset secondary knee osteoarthritis. Within 5 years of the injury the knee shows clear signs of osteoarthritis on MRI. However, these lesions are often not associated with any clinical signs. Knee osteoarthritis as a severe disease starts 8 years or later after the injury, when it requires treatment.

[Data protection, radiation protection and copyright: Problems of transferring results in assessment practice]. / Datenschutz, Strahlenschutz und Urheberrecht: Probleme der Befundübermittlung in der Begutachtungspraxis.

In Germany, the medical assessor is subject to the law on contracts for work and services ("Werksvertragsrecht"). When a medical expert assesses a subject on behalf of a third party, there is no contractual relationship between them. In the field of private insurance law and in social insurance law, the medical expert is faced with various procedural requirements. Failing to meet these legal requirements often makes the assessment difficult or even impossible. The transfer of radiographs to the medical assessor is dealt with in the German X-ray regulations ("Röntgenverordnung"). The assessor, who is without doubt an examining doctor, has the right to have the radiographs temporarily made available (§ 28 et al.). Passing on the radiographs is all the more appropriate if by doing so additional X-ray examinations can be avoided. The right of access to medical data in the social security law, apart from X-ray regulations, is regulated by German Civil Code (BGB) § 810 and German Basic Law section 1 paragraph 1 in connection with section 2 paragraph 1 ("§ 810 BGB; Art. 1 Abs. 1, Art. 2 Abs. 1 GG"). In the absence of third party interest worthy of protection, the right of access to assessment records has to be granted to the subject, who will then authorize the examining medical expert to exercise this right. In private insurance law, only the private health insurance has its regulation concerning obtaining information about treatment or the access to medical assessments. In other types of insurance the medical assessor's right of access to medical examination data and/or the basis for medical findings can only be derived from secondary obligations as part of the insurance contract or directly from general constitutional personal rights.

[Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation]. / Integration einer präinterventionellen Computertomografie des Herzens in die therapeutische Pulmonalvenenisolation bei Patienten mit paroxysmalem Vorhofflimmern.

PURPOSE: Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. MATERIALS AND METHODS: Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7+/-9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0+/-9.9 years of age). Mann-Whitney tests served for statistical comparison. RESULTS: CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1+/-8.0 vs. 29.1+/-11.9, p=0.030), and a significant reduction of fluoroscopy time was found (41.8+/-12.0 min vs. 51.2+/-16.0 min, p=0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9+/-10.0 mSv vs. 20.0+/-16.0 mSv, p=0.203). The mean additive effective dose of the cardiac CT was 8.5+/-0.3 mSv. CONCLUSION: CT-guided ablation of atrial fibrillation requires less fluoroscopy time than stand-alone PVI. Due to the multi-faceted dependency of individual fluoroscopy doses, a consistent reduction of the effective dose was not observed. Since supplementary CT constitutes an additive dose, optimized CT atriography needs to be designed in order to provide sufficient image quality while reducing X-ray exposure. The reduction in RF pulses implies an increase in the effectiveness and safety of catheter ablation.

[Benign solid and papillary epithelial tumors of the pancreas]. / Benigner solider und papillärer epithelialer Tumor des Pankreas.

A case report of a benign pancreatic tumor and its differential diagnosis is presented. The patient was a 31-year-old woman with a benign solid and papillary epithelial pancreatic tumor. Differentiation from a malignant tumor and from a hormonal active tumor was possible by the smooth boundaries and absence of contrast medium enhancement on CT. Exact diagnosis was found by laparatomy and histology.

[Prognosis of postoperative complications from the chronomedicine viewpoint]. / Prognose postoperativer Komplikationen aus chronomedizinischer Sicht.

In 57 convalescence courses after surgery, temperature, pulse rate and complications recorded daily for 24 days were investigated. Complications were synchronized approximately with temperature. The time structure of the temperature proved to be periodical (reactive periods). The approximately 7-day periods (medium waves) predominated, frequently superimposed by short waves (< or = 4-day periods) and long waves (> or = 14-day periods). There was an intermediate band of approximately 10-day periods. The phases were synchronized with the day of operation, mostly with maxima, otherwise with minima. Periods and phases could jump, the periods preferably in integer ratios, the phases approximately 180 degrees. The long waves yielded a steep drop initially and a reascent of the temperature in the approximately 3rd week. As the number of complications was coincident with the temperature, it also dropped quickly after operation but rose again during the 3rd week. Apart from long waves, temperature and complications descended slowly, synchronizing with the medium waves. The reascent time structure is generally associated with a trophotropic type of patient (late reactive), the gradual descent with an ergotropic type (early reactive). As both of them can be recognized preoperatively, the time structure of the late complications expected can be predicted. Besides the long waves the time structure of the complications is related to the medium waves. Therefore a peak of the complications often occurs at the end of the 1st week.

Alterations of intracranial pressure and cerebral blood flow velocity in healthy neonates and their implication in the origin of perinatal brain damage.

Intracranial pressure and cerebral blood flow velocity were recorded in term healthy neonates during the first 3 days of life using non-invasive methods (LADD-fontanometry and cw-Doppler sonography). Intracranial pressure increased from 4.0 +/- 2.7 cm H2O to 5.8 +/- 2.7 cm H2O and maximal cerebral blood flow velocity in the anterior cerebral artery (ACA) increased from 33 cm/s to 58 cm/s as calculated from a Doppler shift of 0.63 to 1.10 kHz and vascular resistance decreased between the 1st and 3rd day of life. These alterations could not be demonstrated in the femoral artery. This is in accordance with other registrations obtained by different methods and under various conditions. They allow an explanation of some well known physiological phenomena like alterations of cranial volume and the structure of the bony skull in the first days of life. Furthermore, these physiological variations may have implications for the origin of cerebral damage during the perinatal period, especially of hypoxic-ischaemic encephalopathies.

[Serum iron and serum copper in patients with lymphogranulomatosis]. / Serumeisen und Serumkupfer bei Patienten mit Lymphogranulomatose.

The serum iron and serum copper level was determined in fifteen patients with lymphogranulomatosis before and during the course of the therapy. While the serum copper was increased in all stages, for the serum iron only in the stages III and IV a tendency to diminution was found. With obtaining the remission a significant increase of the serum iron and a significant decrease of the serum copper developed. The normalization of serum iron and serum copper suggests a remission, the dissociation of the two parameters an activity of the lymphogranulomatosis.

Dihydroxytryptamines as tools to study the neurobiology of serotonin.

The neurotoxins 5,6- and 5,7-dihydroxytryptamine are accepted tools for "chemical degeneration" of serotonergic (5-HT) axons in the CNS (for reviews, see [11, 12, 15, 20] ). Optimum application of these substances requires knowledge of their chemical properties, disposition in the biophase and mechanism of action. Current knowledge and concepts on this issue are described and results of recent studies utilizing 5,7-DHT uptake as a tool for localizing 5-HT neurons neuroanatomically are reviewed.

Locus coeruleus - cerebellum: interaction during development.

The presentation describes a combined morphological and biochemical analysis of the developmental interaction between the locus coeruleus (LC) and the cerebellum of rats, which receives an afferent innervation from the LC. The LC neurons are among the first CNS neurons to arise during ontogeny. They establish axonal connections to their target areas while migrating into their nuclear area, where they collect around E17. Their perikaryal development proceeds through the well-known stages of neuronal differentiation, Nissl body formation as a sign of synaptic connectivity appearing for the first time on E18. However, changes in the LC-perikarya are taking place in early postnatal stages. Perikaryal volume increases to reach a transitory maximum of 150% of the adult value on P15. Ultrastructurally, a dissolution of Nissl bodies and an increase in the number of polyribosomes are seen during this developmental period, reminiscent of perikaryal changes during the axon reaction. Later, the organization of ribonucleoproteins into Nissl bodies is re-established. NA axons are demonstrable in the cerebellar anlage for the first time on E17. They increase rapidly in number and organization during cerebellar development as shown by catecholamines histofluorescence. Quantitative measurements of cerebellar high-affinity uptake for NA show that a peak of NA innervation is reached on P10, which amounts to about 250% of the adult value. This hyper-innervation is transitory and declines to adult values on P20. The period of cerebellar NA hyperinnervation corresponds to the perikaryal changes in volume and ultrastructure of LC neurons. The phenomenon of transitory hyperinnervation of a target area is discussed with respect to the establishment of axonal connections during normal development and in regeneration.