Optimised surgery (so-called TME surgery) and high-resolution MRI in the planning of treatment of rectal carcinoma.

BACKGROUND: Since November 1998, we have applied the concept of total mesorectal excision (TME) to rectal carcinoma together with a standardised pathological quality assessment. Participation in the European MERCURY study [The MERCURY Study Group Radiology (in press), 2006] required us to establish the indication for neoadjuvant radiochemotherapy on the basis of an magnetic resonance imaging (MRI) scan. The aim of the present retrospective study is to evaluate the quality of the surgery, the efficacy of the MRI and the oncological outcomes achieved. MATERIALS AND METHODS: Between November 2001 and October 2005, 68 out of 109 patients with carcinoma of the rectum were submitted to radical surgery in curative intent and 23/68 (34%) were given neoadjuvant therapy. In an interdisciplinary study group, each patient was evaluated pre-operatively and post-operatively using standardised MRI and histopathological methods. RESULTS: The quality of surgery was established on the basis of the pathological examination of the surgical specimen. The rates of incomplete mesorectal excision, intra-operative tumour cell dissemination and positive circumferential margins were all low at 4%, 7% and 3%, respectively. The effectiveness of MRI proved to be greatest in predicting the tumour status at the circumferential resection margin: in the admittedly limited number of patients it proved possible to correctly predict the tumour status for every patient. The assessment of the anatomic extent of the primary tumour and of the regional lymph node metastasis according to the TNM system, in contrast, was considerably less successful at 73% and 75%, and 37% and 57%, respectively. CONCLUSION: By applying the TME concept and MRI-based therapy planning, excellent results can be achieved and, at the same time, the number of patients requiring neoadjuvant treatment is considerably reduced.

Intensive chemotherapy with idarubicin, ara-C, etoposide, and m-AMSA followed by immunotherapy with interleukin-2 for myelodysplastic syndromes and high-risk Acute Myeloid Leukemia (AML).

Intensive chemotherapy followed by treatment with interleukin-2 (IL-2) was evaluated in a prospective, randomized, multicenter trial including 18 patients with refractory anemia with excess of blasts in transformation (RAEB-T), 86 patients with acute myeloid leukemia (AML) evolving from myelodysplastic syndromes, and six patients with secondary AML after previous chemotherapy. Median age was 58 years (range: 18-76 years). Forty-nine patients (45%) achieved a complete remission (CR) after two induction cycles with idarubicin, ara-C, and etoposide, 52% of them aged 60 years (p=0.06). After two consolidation courses, patients were randomized to four cycles of either high- or low-dose IL-2. Patients aged up to 55 years with an HLA-identical sibling donor were eligible for allogeneic bone marrow transplantation. The median relapse-free survival was 12.5 months, with a probability of ongoing CR at 6.5 years of 19%. Overall survival of all patients was 8 months, and 21 months for the CR patients. Median survival was significantly longer among patients aged

Die Hausarzt/Facharztfrage und die aktuelle Position der Inneren Medizin Die besondere Problematik des Tätigwerdens in zwei gesetzlich definierten Versorgungsbereichen : Die besondere Problematik des Tätigwerdens in zwei gesetzlich definierten Versorgungsbereichen.

SEIT 70 JAHREN DISKUTIERT DIE DEUTSCHE ÄRZTESCHAFT üBER AUFGABENBEREICH UND STELLENWERT DES PRAKTISCHEN ARZTES UND ALS DESSEN NACHFOLGER DES ARZTES FüR ALLGEMEINMEDIZIN, OHNE DIESES PROBLEM DEFINITIV GELöST ZU HABEN. AUCH DIE äRZTLICHEN ORGANISATIONEN IN GESTALT DER ÄRZTEKAMMERN, KASSENäRZTLICHEN VEREINIGUNGEN UND DER BERUFSVERBäNDE HABEN ZUM TäTIGKEITSUMFANG DER ALLGEMEINMEDIZIN ODER DES PRAKTISCHEN ARZTES VöLLIG KONTROVERSE POSITIONEN.: Dies zeigt sich aktuell in einer beim Bundesverfassungsgericht anhängigen Verfassungsbeschwerde, die darauf abzielt, die Erlaubnis zu erhalten, neben der Bezeichnung Arzt für Allgemeinmedizin eine weitere Facharztbezeichnung führen zu dürfen. Das Thema Aufgabengebiet der Allgemeinmedizin hängt untrennbar mit der im Sozialrecht vorgeschriebenen Trennung in einen haus- und fachärztlichen Versorgungsbereich zusammen. Um allen Internistinnen und Internisten die Möglichkeit zu geben, sich mit dieser Problematik systematisch zu beschäftigen, erfolgt nachstehend der Versuch, das Thema umfassend mit allen Facetten darzustellen.

The German Pflegeversicherung (long-term care insurance).

The German Pflegeversicherung, introduced in January 1995, has been very successful. It has been well accepted by persons in need and by their relatives and friends, providing benefits for both parties. The insurance is financially sound and has helped to create new workplaces.

The German health-care system.

The German health-care system is characterized by a statutory health insurance based on the principle of social solidarity. Nonprofit sickness funds and regional associations of physicians are the central components of the German system. The historical development of the system for more than 100 years has been characterized by negotiations, rather than confrontation, among physicians, patients, and insurance carriers. With the increasing sophistication of modern medicine, medical expenditure is rising, and great demands are facing the health-care systems of the industrialized world. The hope is that the German system will be able to preserve the principle of solidarity and remain a one-tier health-care system rather than allow health care to be viewed as essentially a private consumption good, in which case availability and quality are allowed to vary with family income. As a means to achieve this goal, the autonomy of the sickness funds and regional associations of physicians will be increased substantially, and the governmental authority will be decreased. Strengthening of autonomy must be accompanied by incentives for self-responsibility and self-participation of Germany's citizens.

[Emergency service course manual--a contribution to quality assurance in emergency medicine education]. / Das Kursbuch Rettungsdienst--ein Beitrag zur Qualitätssicherung der notfallmedizinischen Fortbildung.

For the purpose of comparison and quality control for the acquisition of the subspeciality in emergency medicine, a committee of experts in the area of emergency medicine developed the first curriculum (course book Emergency medicine) valid in all states of Germany. The requirements for the development of this curriculum were derived from the experts' experiences and from the requirements of the medical society for the quality of medical training.