[Networking physicians' practices: teleconsultation/teleconferencing]. / Vernetzung von Arztpraxen: Telekonsil/Telekonferenz.

Tele-medicine offers clear possibilities to improve the work of the doctor, in order to ensure the optimal treatment of the patient. In particular, cooperation between outpatient and inpatient doctors can be organised more efficiently using new forms of communication and information via the electronic network and EDP-based information processing. Problems with the utilisation of tele-medicine lie in both the design of the fundamentals and standards with regard to legal unity as well as in a lack of knowledge of many doctors in the utilisation of these new techniques.

[Health care contract, economic options and budgeting in ambulatory care]. / Versorgungsauftrag, Wirtschaftlichkeitsgebot und Budgetierung im ambulanten Bereich.

At the beginning the principle of profitability (sufficient, suitable, economical, necessary) and its effects on medical action are analysed. An explanation is given why the appointed doctors cannot provide medical care satisfactorily in a budgeted system under mere economical criteria. The budget leads to rationing and quality reduction and leaves no scope for medical progress. The instruments for the observance of profitability (profitability examination and guidelines) are dealt with critically. Another instrument, the department budgets, which were introduced by the Social Democrat--Green government, is rejected as a mere economically calculated control mechanism with regard to health care. As a further budget the restrictive medication and curative budgets are presented. They involve the danger of payment exclusions, whereby the high quality care is called into question, if the doctor does not want to suffer a loss of fees. Alternatively, standard values with individual examination are suggested instead of the budgets with collective regress.

[Medical discretion towards relatives, colleagues and the media from the physician's point of view]. / Arztliche Schweigepflicht gegenüber Angehörigen, Kollegen und Medien aus ärztlicher Sicht.

Three aspects are examined more closely: discretion towards relatives, medical colleagues and the media. Medical discretion has a long tradition and forms an indispensable part of the medical ethos. Physicians, however, often find it difficult to cope with the diversity of legal regulations. Legal regulations manifest themselves in the Social Code with its different books of legislation; in the Federal Data Protection Law; in the Federal Epidemics Law; in the Criminal Code; in the Code of Criminal Procedure. Physician's discretion is an indispensable prerequisite for the confidential relationship between doctor and patient, thus enhancing the success of medical treatment. Consequently, this discretion must never be jeopardized. First of all, it protects the patient's privacy and personal rights. The discretion towards relatives bears different facets which are considered more closely: these include the patient's declaration to unconscious patients, therapeutical decisions. Medical discretion must also be observed among fellow doctors. This is unproblematic if the patient remains informed in the case of joint/further treatment. The following cases are problematic: consulting in additional physicians without the patient's knowledge; joint practices and practice networks. As far as the media are concerned, there is no case whatsoever that would justify a patient being presented in the media without his or her consent.

[Billing fraud from the viewpoint of the federal health insurance society]. / Abrechnungsbetrug aus Sicht der Kassenärztlichen Vereinigung.

During the past ten years, there has been a controversy among the German registered physician about settlement fraud-then outraged, now calling for criminal proceedings and an investigation by the public prosecutor. This is due to the fierce competition in a system of dense medical representation. Economically, any settlement fraud in the compulsory health insurance damages the colleagues, not the health insurance. An assessment of remuneration settlements under criminal law reveals the following: there is only one premeditated, punishable settlement fraud. Before demanding criminal proceedings which result in investigations by the public prosecutor, the society of panel doctors has to decide whether there is a case of premeditation or negligence. The society must be aware of the consequences for the physician. Types of deficit settlement: (1) settlement of services not rendered; (2) settlement of services not rendered personally; (3) false settlement of services rendered; (4) uneconomical settlement of services. Whether the latter can lead to criminal investigation, is still controversial. Within the medical profession, however, disciplinary action as well as proceedings for the cancellation of the licence can be requested.

[Experience with a one-stage hypospadias repair (author's transl)]. / Erfahrungen mit einer einzeitigen Harnröhrenplastik

33 single-stage hypospadias repairs are reported, which were performed within 2 years. The operative technique is described. In two cases, fistulas developed and required operative treatment. The average follow-up was 13.5 months. 28 cases showed good functional and cosmetical results. Three cases required additional surgery to improve the cosmetical result. The Allen-Spence-Hoffman-Hall one-stage technique has proved to be suitable to correct a distal hypospadias without chordee.

[Comparative investigations in closing nephrotomies with conventional suturing technique and dura ribbons (author's transl)]. / Vergleichende Untersuchungen zur Versorgung von Sektionsschnittnephrotomien mit konventioneller Nahttechnik und mit Duragurtung

On 13 rabbits total longitudinal nephrotomies were performed on both kidneys. On the right side the margins of the parenchyma were sutured together with figure eight sutures. On the left, the nephrotomies were closed by tying ribbons of human dura around the kidney. Excretory urograms after 4-8 months showed no differences on both sides. On histological examination there was no difference of the scars. After roentgenological and histological criteria there are no advantages by closing kidney wounds with dura ribbons versus conventional suturing technique.

[Varicocele as a cause of disorder in fertility (author's transl)]. / Die Varicocele als Ursache von Fertilitätsstörungen

In this study the pathophysiological connections in varicocele genesis are discussed, as well as its effect upon spermiogenesis and the causal factors. In 73 patients the high retroperitoneal ligature of the testicular vein was performed. Indication was given either on the basis of subjective complaints or on the proof of subfertility. In 79% of the cases a good anatomic result was obtained after operation. Of the spermiograms established prior to operation 56% showed postoperatively a distinct improvement in quality. In 52% of the sterile marriages conception occurred following operative intervention. In our clinic the operative method according to Bernardi is preferred, since it meets best the criteria of an ideal varicocelectomy. Operative intervention should take place early for possible preventing of spermiogenetic lesion.

Replacement of tunica albuginea of corpus cavernosum penis using human dura. Experimental study on dogs.

The tunica albuginea of corpus cavernosum penis was excised and replaced with human dura in experiments on 11 dogs. The surface of the implant epithelialized within three weeks, and later the implant was replaced by autologous tissue with no scarring and shrinkage. After resection of placques in Peyronie's disease the tunica albuginea can be replaced with specially treated human dura.