Current status of laser therapy in dermatology]

Indications for dermatological laser therapy have been enlarged during the last few years. In this article the physics and biophysics of laser therapy and the common laser systems in dermatology are described. Modern pulsed laser systems are combined with little side effects. Nevertheless, successfully used alternative methods should not be neglected.     

Surgical treatment of primary neurogenic mediastinal tumors

In the years 1968-1989 out of 300 patients with surgically treated mediastinal tumors in 63 (21%) they were of neurogenic origin. Eighteen of these (29%) proved to be malignant. These tumors occurred in 23 males and 40 females, age range 14 months-67 years (mean 36 years). In all 45 patients with benign tumors and in 12 (66.7%) with malignant tumors the tumors were totally resected. In 4 patients the tumor was only partially resected in further two only a biopsy of the lesion was taken. During postoperative period one patient with a malignant tumor died. Ten (71.4%) patients survived 5 years with malignant lesions, while only 8 (61.5%) survived ten years. All patients that underwent resection of the benign tumor survived 10 years.     

Early and late results of surgical treatment in patients with primary mediastinal germ cell tumors]

A group of 37 patients--20 (54%) men and 17 (46%) women--aged 2-65, mean 31.6 years, was treated between 1978 and 1995 for different kinds of primary mediastinal germ cell tumours. In 14 (37.8%) of them a mature solid teratoma was diagnosed, in 13 (35.1%)--dermoid cyst, in 5 (13.5%)--malignant teratoma, in 1 (2.7%)--immature teratoma, in 4 (10.8%)--seminoma. Mediastinal tumour was removed completely in 30 (81.1%) patients, partially in 7 (18.9%). Out of 37 patients, 3 (8.1%) died during postoperative time. Out of 26 patients discharged after surgical removal of mature teratomas, all are alive and have been followed-up for 10 years (17 patients) or 5 years (6 patients). Out of 8 discharged after surgical removal of malignant neoplasm, 3 are alive and all of them had primary mediastinal seminoma. One of them has survived 17 years after complete resection, and two patients--7.5 years and 2 years after partial resection and radiotherapy. Mean survival time is 4 years and 2 months for all patients with malignant neoplasm.     

Current status of pediatric home mechanical ventilation in Japan]

The first nationwide survey of pediatric home mechanical ventilation (HMV) was conducted. From 35 out of 149 medical centers investigated, 49 cases of HVM were reported. The patients ranged in age from 1 to 20 years, and the causes of respiratory failure were neuromuscular diseases (51%), central hypoventilation (33%), respiratory disorders (10%) and cervical cord injury (6%). Since 1983 when 2 patients were discharged home on mechanical ventilation, more and more ventilator-dependent children have been sent home every year. However, home mechanical ventilation is not yet well recognized in Japan as an option for pediatric patients with chronic respiratory failure, and there are many problems to be solved. Firstly, very few, if any, hospitals have a designated home care team composed of physicians and other specialists. Secondly, the current health insurance system scarcely covers the cost of home ventilation. Thirdly, development of home use equipment, in particular, portable ventilators and monitors is imperative. There are 107 hospitalized patients in 56 institutions who are reportedly able to go home if a support system is established. A program for pediatric home mechanical ventilation should be urgently developed on a national basis.     

Anesthesia for surgery of pituitary tumors

Transsphenoidal operations for pituitary tumors have dramatically decreased the morbidity of pituitary surgery in a group of patients with many potential anesthetic problems. Although a good preoperative endocrine workup and anticipation of problems are the key to ensuring a good outcome, it remains a challenge to the "art" of neuroanesthesia to produce a smooth and safe anesthetic.     

Less invasive surgery for gynecologic tumors

The majority of cancers of the female genital tract are managed primarily by surgery in Western communities. Surgical techniques have developed during the 20th century with a tendency toward increasing radicality in order to deal with those cancers with a propensity for locoregional spread. On occasions during the past 100 years, individual surgeons have made efforts to tailor surgical practice to more appropriately deal with the true risks of spread. In recent times this search for more accurate tailoring has moved on apace and has coincided with the burgeoning interest in minimal access surgical techniques. This review is designed to cover the past year's developments in the quest toward less invasive surgery for gynecologic tumors. A major drawback to tailoring of surgical technique with its inevitable reduction in radicality for some patients is the risk of undertreating the cancer. The temptation for the less experienced or less skilled clinician to reduce radicality because such a move more closely matches his or her level of skill will result in poor results, with the risk that the surgical technique being given a bad name rather than the situation being recognized as a decision to use inappropriate therapy.     

Minimally invasive surgery for solid tumors

The use of minimally invasive surgery in patients with cancer is slowly evolving. There are a number of reports describing laparoscopy in adults for pancreatic, ovarian, gastric, and colon cancers. In addition, thoracoscopy has been described for lung and esophageal cancers. The role of laparoscopy and thoracoscopy in children with cancer is less clear because a number of pediatric neoplasms are sensitive to adjuvant therapy and surgery is often part of a planned multi-dimensional approach. This article describes a previous reported experience with minimally invasive surgery in children with cancer, current indications for this approach, and general principles which are important regarding the operative technique. In addition, future applications for this technology are suggested.     

The status of neurologic intensive care in Germany. Current data]

In 1994 this journal published the results of a survey undertaken on behalf of the Working Association for Neurological Intensive Care Medicine (ANIM) in the winter of 1992/93. In the winter of 1996/97 a continuation of this analysis was performed. With the help of a questionnaire the data of 62 intensive care units with a total of 420 beds were established. This is 11 intensive care units and 83 beds more than 1992/93. The intensive care units were again classified into three groups (ventilation units, monitoring units, interdisciplinary units) relating to their equipment and structure. The questions concerned structural organisation, such as the number of beds, type of clinic, number and training of physicians and nurses, technical equipment and availability of large and high-tech apparatus or access to other facilities, such as neurosurgery. Of great interest were data about whether and to what extent special measures of intensive medicine can be taken on the one hand and performance parameter data e.g. days of ventilation and duration of in-patient treatment on the other hand. Detailed data were provided concerning the frequency of each diagnosis of patients treated in those intensive care units. Evaluating the data a positive development in the last four years of the neurological intensive care can be found in most of the areas investigated. It has also been found that neurological intensive care in the new lander has reached equal standard both in quality and quantity. Now a single physician is responsible for 2,3 beds compared to 3,6. Today 78 per cent of the beds in ventilation units are equipped with a ventilator. The overall time of ventilation increased to 48 per cent. Overall there are, however, considerable differences between individual units as well as regions. The data presented can serve as a means to monitor the quality of neurological intensive care.     

Current status of cataract surgery. Modern methods--internal medicine risk factors and contraindications

Modern cataract surgery is characterized by minimal invasive techniques that have been introduced during the past decade. These include phacoemulsification, capsulorhexis, foldable intraocular lenses and small tunnel incisions. High success rates coupled with low complication rates have resulted in a change in indications--cataract surgery is no longer performed merely to prevent blindness, but also to improve vision in patients whose professional or private visual demands are compromised by the onset of lens opacification. To ensure that their cooperation with the ophthalmic surgeon results in optimal benefit to the patient, it is important for general practitioners and internists to be conversant with the risk factors and contraindications for cataract surgery.