[Minimum case volume regulations of the Federal Joint Committee : Mode of function and application in practice]. / Mindestmengenregelungen des Gemeinsamen Bundesausschusses : Funktionsweise und Anwendung in der Praxis.

The minimum case volume regulations of the Federal Joint Committee determine the size of the respective annual minimum number for each site of a hospital, for selected scheduled inpatient services where the quality of the treatment results is dependent on the number of services carried out. In addition, further details on the elucidation of the prognosis are determined in the regulations. Due to the legally defined prognostic procedure as a prerequisite for a prospective justification for service provision, new or altered minimum case volumes come into effect even before the end of the validity period established on the justification for provision of services. The Federal Joint Committee established this basic principle also for the introduction procedure in a resolution from 16 December 2021. This article explains the background and should support the implementation.

[Quality assurance in breast reconstruction - Establishment of a prospective national online registry for microsurgical breast reconstructions]. / Qualitätssicherung in der Brustrekonstruktion ­ Etablierung eines prospektiven nationalen Onlineregisters für mikrochirurgische Brustrekonstruktionen.

BACKGROUND: The loss of a breast, and thus of the female body shape, is often extremely traumatising for women affected. Although free flap grafts have become the gold standard in reconstructive breast surgery, it has not been possible to date to unequivocally document their superiority over conventional alternative techniques. To date, there are no data on the care situation in Germany. Neither the number of reconstructions nor the proportion of the individual techniques is known. A prospective online registry has been set up in order to systematically collect and transparently present the structure and quality of care. The long-term goals are to record the existing quality of care, improve deficits and to certify centres with the appropriate expertise to establish a high level of care nationwide. METHODS: For this purpose, the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) has set up an internet-based database in which treatment data are recorded anonymously. As part of a certification process, auditors checked structure quality, compliance with specifications, and the stringency of the data entered in comparison with the hospital's internal documentation. If the evaluation is positive, the DGPRÄC quality seal is awarded. RESULTS: Since its introduction in 2012, the database has provided validated information. Initially, only a few departments were prepared to present their results transparently. However, the number has grown steadily in recent years. As a result, the quality recording assumed a pioneering function nationwide and can now be used as a reliable source of information by patients and doctors. The DGPRÄC website features a map of the centres, which are colour-coded according to their respective qualifications. It is thus possible to find a qualified plastic surgeon with comprehensive expertise in acceptable proximity to every oncological breast centre. CONCLUSION: The database provides an overview of the quality of the various surgical techniques and thus the possibility of serious self monitoring and scientific analysis. The systematic collection of data has contributed to strengthening the position of plastic surgery in the field of reconstructive breast surgery. However, the financial and personnel resources required to establish the database were clearly underestimated.

Pancreatic cancer in cystic fibrosis after bilateral lung transplantation.

Cystic fibrosis (CF) is the most common lethal genetic disease affecting 1 in 2500 white patients. Chronic obstructive lung disease and pancreatic insufficiency are the main clinical manifestations of CF. Lung transplantation has become a treatment option for advanced pulmonary disease during the last decade. On the other hand, there is evidence from large cohort studies that CF and immunosuppression are risk factors for pancreatic cancer. Here, we report the case of an 18-year-old female patient with CF and bilateral lung transplantation who underwent Whipple procedure for pancreatic adenocarcinoma at the age of 12 years. Because of growth retardation, the patient underwent a 2-year period of growth hormone treatment before the diagnosis of pancreatic cancer. This case should sensitize physicians to be aware of the increased risk for pancreatic cancer in CF patients especially in those after lung transplantation with immunosuppression and prolonged survival.

CT angiography of peripheral arterial bypass grafts: Accuracy and time-effectiveness of quantitative image analysis with an automated software tool.

RATIONALE AND OBJECTIVES: Qualitative analysis of computed tomography (CT) angiography data often is limited by intra- and interobserver variability. The purpose of this study was to evaluate the time-effectiveness and accuracy of a quantitative CT angiography data analysis using automated software in comparison with qualitative axial and coronal CT image reading in patients with peripheral bypass grafts. MATERIALS AND METHODS: Twenty-eight patients with 33 saphenous bypass grafts underwent 4-channel (n = 21) and 16-channel (n = 7) CT angiography. Two readers evaluated in consensus the CT data qualitatively on axial and coronal reconstructions and with the software regarding the presence of graft stenoses, aneurysmal changes, and arteriovenous fistulas. The time for data analysis was taken and the accuracy was compared with the results from digital subtraction angiography (DSA). RESULTS: No significant difference was present between data analysis time using axial and coronal CT images (4.9 +/- 1.5 minutes) and when using the software tool (5.5 +/- 1.4 minutes). Good (kappa = 0.652) to excellent (kappa = 1.000) intermodality agreement was present between qualitative and quantitative CT analysis regarding graft-related abnormalities. Sensitivity and specificity for diagnosing stenoses, aneurysms, and fistula did not differ significantly (P > .025) between qualitative CT image reading and the automated software tool. CONCLUSIONS: CT angiography analysis of peripheral bypass grafts using an automated software tool is similar regarding time-effectiveness and accuracy when compared with qualitative CT data analysis on axial and coronal images. It may assist in determining the significance of an abnormality and can yield objective morphometric data of vessel calibers.