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Because of the new hospital finance law a DRG (Diagnosis Related Groups) controlled discount liquidation under consideration of the medical impairment becomes necessary. In this paper the importance of a correct and complete description of the psychic comorbidity for the development of German-Refined-DRGs (GR-DRGs) in the orthopedic field is described. Therefore we analysed data of orthopedic in-patients, who are diagnosed by consultation of the clinic for psychosomatics and psychotherapy. A psychic comorbidity (ICD-10 Chapter F (V)) was diagnosed by 95% of the consulted patient. 30% of the patients showed difficulties in coping with their disease. 40% suffered from chronical psychoneurotic patterns and conflicts, which can be explained (a) as consequence of a difficult psychosocial adaptation by chronic disease or after an amputation (b) as basic mental disorders (c) as cause of the orthopaedic complications. Therefore the number of indications for a psychotherapeutic or psychiatric treatment is very high. The knowledge about a psychic comorbidity can--beside financial aspects--help the team on the orthopaedic station in the treatment of difficult patient.

Every medical treatment which involves risk to the patient requires the informed consent of the patient. Taking into account the fundamental right of the patient to remain physically unscathed and the right of self-determination, proper information must be given to the patient regarding typical risks. This is a prerequisite to patient consent. In this regard, the law makes strong demands. Even in cases where medical treatment is unsuccessful due to complications beyond the physician's control, the physician is still held liable (even if there was no fault found in his medical treatment) if he had not properly informed his patient of the risk involved in the procedure or he cannot prove that he had informed the patient. The following paper explains the legal demands of the duty to inform patients along with examples of precedents.

In Europe, several studies are currently underway to investigate the cancer risk of pilots and cabin crew exposed to low-level ionizing radiation of cosmic origin. Although no individualized exposure measurements of airline personnel are available, exposure assessment based on job history data is feasible. However, there is a marked variability in the level of detail of these data between studies in different countries and between subcohorts in national studies raising the issue of comparability of exposure estimation. In this paper we investigate the comparability of several methods of exposure assessment in a large German cohort of pilots and cabin crew. We found that the correlation between the estimates obtained by the four approaches analysed, is relatively high, ranging from 0.85 to 0.97. The precision attainable in the exposure assessment is higher than in many other epidemiological studies but can be refined further with simulation studies and comparison with ongoing and future on-board measurement programmes.

The paper focuses on the cultural history of brain death in Germany in the second half of the 20th century. It analyzes scientific and public discourses on the relevance of brain death and the importance of medical innovations in intensive care medicine. The paper examines how the public reacted when heart transplantation led to an urgent need for a new definition of death. It will be shown how the concept of brain death was accepted by the public, introduced into clinical routine, and implemented through medical and legal policies. Finally, it will be analyzed why the public consensus on brain death was definitely questioned in the last ten years. An understanding of the use of the concept of brain death by scientists, lawyers, theologians, and the public during the last three decades may help to shed light on the social role of science in modern and late-modern societies.

Background: Follow-up programs in colorectal cancer have been under question recently due to their low efficacy. Some meta-analyses found a survival benefit and four randomized studies suggested the opposite. Therefore, this paper analyzes existing and proposed follow-up programs for costs and efficacy., Methods: One thousand and fifty-four colorectal cancer patients intensively followed-up in Ulm (endoscopy, chest radiography, abdominal ultrasound, computed tomography (CT) pelvis) were prospectively evaluated for recurrence, salvage surgery rate, survival and costs. Costs were compared among existing and proposed international follow-up programs retrieved by a MedLine search., Results: A total of 350/1,054 colorectal cancer patients (33.2%) relapsed asymptomatically, as detected by follow-up. 56/350 (local 47%, distant 53%) recurrences were resectable (16%), 21/350 patients survived (6%). The efficacy of follow-up was 21/1,054 patients (2%). Costs were, per patient, 2,220 euros (colon) or 4,851 euros (rectum). Costs in five randomized studies varied between 616 euros for minimal and 5,049 euros for intensive follow-up. Four proposed follow-up concepts include risk-adaption, which claim to reduce costs by 50-60% and range between 889 (colorectal) and 5,910 (high-risk, rectum) euros. The recommended German follow-up guideline costs 610 euros (low-risk, colorectal), 1,120 euros (high-risk, colon) or 2,252 euros (high-risk, rectum)., Conclusion: Follow-up concepts for colorectal cancer should aim at the identification of curable patients with recurrence. Evidence-based concepts, including life quality tests, remain to be defined, but currently abdominal ultrasound, endoscopy and carcino-embryonic antigen (CEA) determination at 6-month intervals for 2 years and annual intervals for 3 years seem to identify this patient sub-group.

This paper describes preprosthetic surgery from its historical beginnings to its present state-of-the-art status. Future perspectives of preprosthetic surgery are also outlined, excluding implants. In an enquiry of 250 German-speaking maxillofacial departments, 160 responded. Results showed that a surprising 30-50% of the institutions are still following guidelines for procedures which have been proven by scientific follow-up studies to be almost 100% unsuccessful.

In this paper an attempt is made to survey the surgical treatment of cleft lip and palate regarding all classifications and all parts of the cleft. The most important developments up to 30 years ago to have been summarized in Millard's three-volume "Cleft Craft". Therefore, the author tries to analyze the present state-of-the-art cleft surgery. This part is certainly of a subjective nature due to the high rate of complexity in cleft malformations.

Background: To evaluate the publication rate of abstracts presented during the German Anaesthesia Congress (DAK) in MEDLINE-listed journals in comparison to the publication rate of abstracts presented during the meeting of the European Society of Anaesthesiologists (ESA)., Methods: All abstracts of free papers (FP, orals) and posters of the 1994 DAK and the 1994 ESA meeting were included. Over a period of approximately 7 years (1993 to May 1999) the appearance of authors and abstracts topics in the literature were searched with the help of MEDLINE. Only original papers were included in the analysis., Results: All 322 abstracts (268 FPs and 54 posters) of the DAK and all 244 abstracts (81 FP and 163 posters) of the ESA were analyzed. A total 122 of the DAK abstracts (37.9% of all abstracts) and 111 of the ESA abstracts (45.5% of all abstracts) were published in MEDLINE-listed journals. Posters presented at the DAK were as published often (37%) as were oral presentations (38%). Of the 122 abstracts of the DAK that were published 71 (58.2%) were published in English (in 38 different journals) and 51 (41.8%) were published in German (in 8 different journals), whereas 102 (92%) of the ESA abstracts were published in english (in 42 different journals)., Conclusion: The overall portion of abstracts of the DAK published in MEDLINE indexed journals within 7 years was disappointing. The reasons for this may include deliberate avoidance of a publication (e.g. due to lack of interest to publish, no time) or low quality of the abstract that hinders publication in a MEDLINE indexed journal.

Objective: In 1994 the Department of Anaesthesiology and Intensive Care Medicine of the Justus Liebig University of Giessen decided to implement an Anaesthesia Information Management System (AIMS) to replace the previous hand-written documentation on paper. From 1997 until the end of 1998 the data sets of 41,393 anaesthesia procedures were recorded with the help of computers and imported into a data bank. Individual aspects and results of this data pool are presented under the aspect of how the system in its present form is able to guarantee documentation of quality according to the requirements of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI)., Methods: Since 1997 information on all anaesthesia procedures has been documented "online" with the anaesthesia documentation software NarkoData 4 (ProLogic GmbH, Erkrath). The data sets have been stored in a relational data bank (Oracle Corporation) and statistically processed with the help of the SQL-based program Voyant (Brossco Systems, Espoo, Finland). As an example of two adverse perioperative events (AVB) we compared incidences of "hypotension" and "nausea/vomiting", recorded by staff members into the AIMS, with the incidence of comparable events that were recorded with the help of online data during anaesthesia procedures, such as blood pressure and drug application. Since 1998 data recording has been revised constantly in department meetings; advanced training has been given. The results have been analysed critically., Results: In 1997 the incidence of adverse perioperative events entered manually into the system was 3.6% (grade III and higher 0.9%) and increased during 1998 to 22.2% (grade III and higher 1.9%). The frequency of anaesthesia procedures with manually documented AVBs was significantly below the incidence (determined with the help of online data) of comparable events: "hypotension" (1.8% vs. 8.5%) and "nausea/vomiting" (4.9% vs. 8.3%)., Conclusion: The current documentation of AVBs in almost any hospital is incomplete. In contrast to the hand-written procedure, the AIMS provides recorded data for evaluation and guarantees more detailed and complete quality documentation. In addition, the effort needed for documentation is reduced. Whether these data sets really describe and measure quality or not has to be evaluated. In addition it has to be considered whether different requirements (such as automatic AVB recognition for an AIMS) are advantageous for quality documentation regarding the data raster and the AVB recognition, with respect to different documentation procedures.

It has been observed an increasing discrepancy between the supply and demand of cadaveric organs for transplantation for a few years, particularly in renal transplantation. For this living organ donation will occupy an lasting place also in Germany. The new regulation organ donation and transplantation in Germany provides a legal protection and prohibits all forms of organ trading. First of all the transplant team have to take into consideration medical and psychological aspects of donor and recipient but a detailed enlightenment of the pair concerning risks, complications and long term outcome is important as well. In this paper is introduced the enlightenment procedure and the common declaration of donor and recipient of the transplant center Jena. The authors conclude, that living organ donation is not a problem after intensive preparation and enlightenment of donor and recipient with the new Transplant Law in the background.

Recent developments in intravital microscopy make this technique an attractive approach to studying microvascular, cellular, and molecular mechanisms of distinct surgical diseases. We investigated the value of this technique in surgical research laboratories by analyzing the studies presented during the past 26 years (1972-1997) at the Surgical Forum of the Annual Congress of the German Society of Surgery. From a total of 2279 papers 188 contributions (8.3%) presented data which derived from the analysis of the microcirculation using techniques, such as H2 and 133Xe clearance, autoradiography, thermodiffusion, laser Doppler fluxmetry, laser speckle, radioactive and fluorescent microspheres, polarographic oximetry, and intravital microscopy. There were 72 presentations (3.2% of all contributions) reporting the use of intravital microscopy, thus reflecting 38.3% of all microcirculatory analyses. Although these numbers may be considered quite small, analysis over time revealed a significant (P<0.05) increase in the number of microcirculatory studies (11.4%) and in particular of those using intravital microscopy (6.3%) in the 1990s when compared to the 1970s (5.3%; 0.1%) and 80th (7.1 %; 1.3%). In 1997, 27 of 165 contributions (16.4%) included microcirculatory analyses, and 18 of the 165 contributions (10.9%) reported results analyzed by intravital microscopy. Thus our analysis reflects an increasing interest of surgical researchers to study in vivo the microcirculation, and by doing so to use intravital microscopy for the elucidation of mechanisms of surgical disease.

Telepathology, defined as the practice of pathology over a distance by viewing images transmitted from a remote site, was previously analyzed mainly with respect to technical equipment and diagnostic accuracy compared with conventional histological diagnosis. In this paper, telepathology is analyzed with regard to economic points of view, demonstrating the background for the cost-saving analysis of telepathology. The acquisition cost and the operating costs of a telepathology system are compared with potential cost-saving and other benefits from telepathology. This analysis may help to decide whether or not telepathology should be established in a hospital.

Alois Alzheimer published two papers on the disease which was named after him by Emil Kraepelin in 1910. Each of these papers contains clinical and pathological data on a patient Alzheimer had seen at the hospital. We have previously reported on the rediscovery of tissue sections from Alzheimer's second published case of Alzheimer disease, Johann F., which probably gave the disease its name (Neurogenetics 1997; 1:73-80). Here, we describe the histopathology and APOE genotype of Alois Alzheimer's first patient, Auguste D. As in the case of Johann F., a large number of tissue sections belonging to Alzheimer's laboratory, which was later headed by Spielmeyer, were found among material kept at the Institute of Neuropathology of the University of Munich. As described by Alzheimer in his original report (Allg Zeitschr Psychiatr 1907; 64:146-148), there were numerous neurofibrillary tangles and many amyloid plaques, especially in the upper cortical layers of this patient. Yet, there was no microscopic evidence for vascular, i.e., arteriosclerotic, lesions. Interestingly, Alzheimer's histological preparations did not include the hippocampus or entorhinal region. The APOE genotype of this patient was shown to be epsilon3/epsilon3 by PCR-based restriction enzyme analysis, indicating that mutational screening of the tissue is feasible. The historical importance of the case of Auguste D. lies in the fact that it marks the beginning of research into Alzheimer disease. In addition, neurofibrillary tangles were first described in this brain.

DER CHIRURG is the most successful German surgical journal and, reaches with a circulation of more than 8400 copies approx. 60% (including secondary readers approx. 80%) of active surgeons in Germany. DER CHIRURG covers scientific information by highly qualified reviews (30%-35% of the content) as well as peer-reviewed original papers (60%). The rejection rate of original papers is currently 55%. Topics of the reviews are as follows: oncology (20%), benign gastrointestinal surgery (20%), traumatology (15%) and general topics (20%). The thematic spectrum of the original papers is similar. The current problems for this journal are quality control, the issue of double publication, the assurance of an adequate impact factor, and the recruitment of local and international experts for highly qualified reviews.

As has been shown by the authors of a paper recently published in this journal, a deviation from a long-term trend in perinatal mortality within the former Federal Republic of Germany occurred in 1987, i.e. 1 year following the Chernobyl disaster. It is the aim of this study to make a comparison between the areas of the state Bavaria. Germany, with different fallout levels as well as between the observed and expected numbers of perinatal deaths relating to these areas. The expected numbers of perinatal deaths, defined as external standard, were derived from the remainder of the former FRG. Testing an a priori formulated hypothesis revealed no differences in the temporal development of perinatal mortality between the areas with different fallout levels and subsequent exposure. Including May 1986 into the analysis revealed a significant increase during the first 3 months after the accident, which is due to an excess in May alone. Since no elevated radiation risks for the last days in utero are known, the additional Chernobyl radiation exposure is not plausible as a causative agent. Further analyses on stillbirths showed an increase in Southern Bavaria during the first 2 years following the accident. Later on, the rates were comparable to the expected values again.

The German Society of Pathology emerged from the Society of German Scientists and Physicians. Founded in Braunschweig in 1897, the first scientific meeting was held in Düsseldorf in 1898. Rudolf Virchow was the first chairman up to this death in 1902. From the beginning the Society with its former name of German Pathological Society till the 2nd world war, was an association of German-speaking countries including Austrian and Swiss pathologists who also regularly presided at the meetings. Alternately the meetings were held in Germany, Austria, or Switzerland. The 100-year-history of the Society has been documented in 80 volumes of the meetings so far. Since 1903 these are published by Gustav Fischer, Jena-Stuttgart. The scientific results of the annual meetings show not only the growth and development of Pathology, but also the lectures and papers to the main subjects contribute considerably to the history of medical basic research in the 20th century. The chairmen's speeches combine to a history of problems in the subject of Pathology. Rudolf Virchow began it with his opening address in 1898. A special chapter covers the period of national socialism and German partition after the 2nd world war. The German Pathological Society suffered great losses by dismissal and emigration after 1933. Institutes rich in tradition got lost in East Germany. The partition of Germany, especially after construction of the wall, excluded the East German colleagues for Society life. An attempt has been made to record the losses in numbers by evaluation of the member lists of the meeting volumes. At the end of the century and after overcoming of the German partition, the German Society of Pathology has got a chance for revival.

This paper tries to approach a difficult problem, namely how to deal with a resident who has failed to meet the internal standards of a residency training program. First the problems of the definition of a standard and the associated problems of its reproducibility, documentation, teaching, update, and internal variability inside the same teaching program are dealt with. Consequently the question needs to be answered that constitutes a failure to meet the standard. The results of a survey of residents' attitudes are quoted as are some responses to a survey among the chiefs of teaching programs. Considering the attitudes of residents on how to handle breaches of standard the basic message was that residents want to be told that they do not function. Both parties want the collaboration of senior staff members on this topic. Whereas residents want to re-train, exercise and talk they do not want sanctions. Chiefs, however, want much less re-training, exercising and talking but earlier sanction. The difficult point of dealing with a true failure is discussed in the light of the German legal situation and the actual possibilities of how to handle the case. Before it comes to the point of discontinuing the training of a resident, it needs to be agreed upon what would be a classical situation of failure in which both the chiefs responsible for training and the residents agree that training is better discontinued. The author describes his experience with the real course of events in 7 cases he witnessed in 22 years.

The present study analyses a selection of German and American surgical and cancer research journals from the years 1984 and 1994. The aim of the study was to evaluate the amount of publications by German surgeons in these journals. Furthermore, any influence of the impact factor on the publication criteria was analyzed. German surgical journals showed a high percentage increase in the impact factor but are, in absolute numbers, still significantly behind the American journals. In parallel, German surgeons are still the major contributors to German language journals, but increasingly publish in the American ones as well. The impact factor is one of the major selection criteria on to which journal a paper shall be submitted.

The actual situation regarding the education für MIS requires the optimisation and standardisation of the training system. This paper presents the results of an inquiry about the evaluation of the course of operative laparoscopy. 80-90% of those interviewed made the comments "very good" and "good", with regard to the imparting of the theoretic foundation of the technique of endoscopic operations, for sufficient possibility of manual training and for the realistic setting of the animal organ model compared with the clinical operation. Because of our experience, we recommend attending such training courses before starting laparoscopic operations.

With a system of modeling, simulation, animation of information, communication in medicine (mosaic-m) the structures of organisation and information in a level 1 trauma center were analysed and animated as a virtual environment on screen in a first step. One result: in existing paper orientated documentation 50% of documentation was redundant. In a second step the requirements of the future information system were described systematically, user- and organisation-oriented. All components (hard- and software) were simulated an screen that the user could work virtually in the future working place. With mosaic-m the user is fully integrated in analysing and developing a new information system in the clinic.

In this paper the planning of research in a neurosurgical training program is discussed. There are good arguments to organize research rotation after one or two years of clinical exposure rather than at the beginning or the end of the program. Teacher as well as resident can prepare the rotation more carefully selecting the topic according to abilities and interests, selecting a suitable research institution, and prepare funding if necessary. The goals of a research rotation, the various categories of basic and applied research, and the length of the research period are being treated.

An optimal treatment of soft tissue sarcomas is influenced by multiple factors. The high local recurrence rate is often based on inadequate surgical primary therapy. An improvement of prognosis which is still unfavourable in some patients can be achieved only if guidelines described in this paper gain increasing influence in practice. A treatment concept for soft tissue sarcomas must be worked out interdisciplinary within the knowledge of all relevant data. Surgery is just one but an essential component of therapy to be placed at the right time. To achieve a R0-resection is an important requirement for survival free of recurrence. However, the influence of a local recurrence on overall survival remains controversial. Amputations should be taken into consideration only after exhaustion of all reconstructive procedures available.

Unlabelled: In a large, multicenter survey in 1994, the prevalence of nosocomial infections in German hospitals was examined, predominant pathogens were identified, and possible risk factors evaluated. In this paper the results from the intensive care units (ICUs) are presented., Methods: Seventy-two representative hospitals in Germany were selected by randomisation and divided into four different groups according to their size (< 200 beds; 200-400 beds; 400-600 beds; > 600 beds). During 10 months four especially trained doctors documented the patients clinical and laboratory data and possible endogenous and exogenous risk factors for nosocomial infections. For better evaluation, they discussed the cases with the responsible senior officers and health care workers and visited the patients. Diagnosis of nosocomial infection was based on CDC criteria., Results: In 515 patients in 89 ICUs, 78 hospital-acquired infections were documented (15.3%). The most common were pneumonia (5.9%), bronchitis (2.7%), urinary tract infections (2.4%), and septicaemia (2.2%). Possible exogenous risk factors included: peripheral venous catheters (65.6%); catheterisation of the urinary tract (64.5%); central venous catheters (60.4%); gastric tubes (38.0%); wound drainage (28.6%) and artificial ventilation (27.6%). The most frequent concomitant diseases were cardiovascular (61.9%), diabetes (20.2%), malignancies (18.8%), pre-existing infections (15.3%), and chronic respiratory disease (14.0%). The prevalence of nosocomial infections was higher in hospitals with more than 600 beds than in smaller ones (28.3% versus 12.9%, P < 0.001). Predominant pathogens were Pseudomonas aeruginosa, enterococci, Staphylococcus aureus, Candida spp., Escherichia coli, and Klebsiella spp.. Fifty per cent of the ICUs changed ventilation tubes and 66.3% changed infusion sets daily; 34.8% of patients received drugs for the prevention of stress ulcers that neutralise or decrease production of gastric acid; only 7.6% received sucralfate. Routine microbiological surveillance of tracheal aspirates and urine was done by 25.9% and 24.6% of the ICUs, respectively., Discussion: Nosocomial infections are seen far more often in ICUs than on normal wards due to the immuno-suppressed state of many ICU patients and the continuous use of invasive diagnostic and therapeutic procedures. Most of these infections are of endogenous origin. Other prevalence surveys have shown results comparable to ours. Daily changing of ventilation tubes is no longer necessary, but is still routine in many hospitals. Infusion sets were also changed more often than required. The use of selective decontamination of the digestive tract for the prevention of pneumonia is still controversial; in our study it was practised in only 1.5% of the cases. The most commonly used drugs for the prevention of stress ulcers were H2-receptor blocking agents, although it has been shown that sucralfate is the better choice, as it can help prevent nosocomial pneumonia. Routine microbiological surveillance of tracheal aspirates and urine was done in 25.9% and 24.6% of the ICUs. No study so far has shown that routine cultures of tracheal secretions and urine have a preventive effect regarding infection.

Every action taken by a physician comes under the jurisdiction of the courts. The physician is sentenced when he offends against the duties of care, set down by the respective standard, or when he carries out treatment without having first obtained the patient's consent. Using the examples of many decisions made by the chief justice and the supreme court relating to the field of anaesthesia, this paper sets out to indicate which rules on diligence apply in this area. In the second part, 14 guiding principles on the physician's obligation to obtain informed consent are set out. The burden of proof for fulfillment of this obligation lies with the physician. The final part of the paper is a discussion of the documentational obligations, which are important for litigation on the physician's liability. A description of a variety of topics from a physician's everyday work is also given.

The legal "contract for patient care" issued by the Federal Government for all hospitals interferes with graduate medical education (approbation order), postgraduate surgical training, the KMK paper for new structures and financing of university medicine, health politics of the Physicians Parliament and the Legal Health System, guidelines for surgical practice, internal and external quality measurement, and, last but not least, with clinical research in surgery. The different effects are outlined in detail.

In this paper my experience with a databank for cases with bone diseases is reported. All cases which had been diagnosed in the newly formed Department of Bone Pathology of the University of Hamburg since 1970 were registered in uniform fashion. Adapting the system to state-of-the-art network structures required a lot of personal and financial investment. This could not be accomplished by university resources alone, but only in cooperation with other research funds. Now 76,000 cases can be routinely accessed and scientifically analysed.

Since 1980 the German Children's Cancer Registry has documented all childhood malignancies in the Federal Republic of Germany. Various statistical procedures have been proposed to identify municipalities or other geographic units with increased numbers of malignancies. Usually the Poisson distribution, which requires the malignancies to be distributed homogeneously and uncorrelated, is applied. Other discrete statistical distributions (so-called cluster distributions) like the generalized or compound Poisson distributions are applicable more generally. In this paper we present a first explorative approach to the question of whether it is necessary to use one of these cluster distributions to model the data of the German Children's Cancer Registry. In conclusion, we find no indication that the Poisson approach is insufficient.

The FRG has no transplantation law as most other European countries do. A model of agreement is practised which is derived from fundamental principles, i.e., a personal right outlasting death and the agreement of the next of kin for organ removal. The paper favours a legal regulation that resolves the difference between a model of presumed consent on the hand and a model of agreement on the other hand, and advocates informing the next of kin, who can then object as representatives of the deceased.

A standardized treatment protocol is essential for scientific evaluation of parameters influencing the outcome and survival of patients who have suffered cardiac arrest in a non-hospital situation. In addition, a standardized therapy algorithm permits effective, time-saving interaction of all members of the emergency team who work together to perform cardiopulmonary resuscitation (CPR) in any emergency outside the hospital. This paper gives the results obtained in 50 patients in whom on-the-spot resuscitation was performed by a specially trained team [emergency medical team (EMT) + on-scene physician] using an ACLS (advanced cardiac life support) protocol modified from the AHA (American Heart Association) standard. Two different algorithms were used one for ventricular fibrillation (VF) and pulseless ventricular tachycardia and one for asystole and pulseless bradycardia. When indicated, countershocks were first administered at a continuous energy level of 360 J, up to three times one after the other. All patients then received epinephrine intratracheally, 2 mg, immediately after intubation. In the case or persisting asystole a further 2-mg dose of epinephrine and then one 5-mg dose were given i.v. in keeping with the ACLS protocol. In the case of persisting VF or pulseless tachycardia we gave one 100-mg dose of lidocaine i.v. and then performed the next countershock at the same energy level. The time the team members actually needed for the single steps of the ACLS protocol was meticulously documented with the aid of a stop watch.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper is a survey of the literature in an attempt to provide the basis for our current understanding of the disciform process. Particular emphasis is placed on its pathogenesis and the role of subretinal neovascularization. No two lesions appear exactly alike because of the many stages and combinations possible. Gass (1967) has delineated the broad spectrum with the many different clinical manifestations of this disease process. Verhoeff and Grossman (1937) provided the histopathologic basis for our understanding of the disciform process. The histologic correlation of the clinical "predisciform" state would seem to offer the most promising information for understanding the pathogenesis of the disciform process (Frank et al. 1973; Green and Key 1977; Kornweig 1967; Sarks 1973 and 1976; Small et al. 1976; Zauberman 1970). It is hoped that this literature review has sufficiently emphasized the inherent deficiencies of strictly clinical studies and the need for an appropriate experimental animal model (Ryan 1979).

Tracheotomy is one of the oldest operations. Indications for and methods of the operative technique are reported already from the ancient times. The following outline - subdivided in three parts - tries to give a comprehensive survey of the development of tracheotomy throughout the centuries. The first part is concerned with the role of tracheotomy in antiquity, in Greek and Roman medicine and in the medicine of the Arabians at the turn of the millennium according to our time. The first tracheotomy is said to have been performed by Asklepiades of Bythinien, who lived in Rome during the last century before the Christian era. The question whether tracheotomy would be of use or not was highly controversal in the following centuries. There were advocates of the operation (for example Antyllus, Paulus von Aegina), but there were strict antagonists, too (for example Aretaeus). In Arabian medicine finally, tracheotomy had an important rank in theory, but probably it had never been performed in humans. The second part of this paper is occupied with the establishment of tracheotomy in the medicine of the European middle ages. Despite many ethical reservations, it became generally accepted as the last live-saving method in certain syndromes. Protagonists of the method included Ambroise Paré, Thomas Fienus, Hieronymus Fabricius ab Aquapendente, Julius Casserius, and Johannes Scultetus. A new method of performing tracheotomy, the opening of the trachea with the use of a trocar, was first described by Sanctorius Sanctorius (1561-1636). The third part of this outline describes the development of the method of tracheotomy in the last 400 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Max Wertheimer, the chief founder of an experimentally based Gestalt psychology, conducted his pioneering studies in motion perception on new theoretical grounds. Since the influence of this approach may be greater in today's cognitive psychology than it has ever been during the half-century of introspectionism and radical behaviorism, it is appropriate to review the actual roots of Wertheimer's (1912) seminal publication and his continuing research on apparent and real motion perception in the light of past and recent work. Illustrative examples, especially of Wertheimer's early research, are provided in this paper. The implications of his experimentation and biopsychological theorizing are still of major interest for present psychological inquiry. Nevertheless, the need for more future systematic comparative research on motion perception must be emphasized. The Epilogue of this paper examines why important parts of Wertheimer's experimental contributions to psychology may have been underrated or neglected by many contemporary psychologists.