[Tangential skin graft].
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Biomedical subjects
Publications and source records attributed to Rainer Rompel.
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Decorative tattoos have become very popular. As a result, a higher number of hypersensitivity reactions are seen, caused by the mostly undeclared tattoo dyes. If local and intralesional therapy with corticosteroids is not effective, total excision was formerly considered the best approach. Selective laser therapy offers an alternative approach for removing the offending pigment. Case reports are used to illustrate the individual treatment options for removal of tattoos.
Leflunomide is a disease-modifying antirheumatic drug for the treatment of active rheumatoid arthritis and psoriatic arthritis. Skin ulcerations are not listed as a side effect for this drug, and there has been only one case report on leflunomide associated skin ulcerations. We report on two females, 59 and 63 years old respectively, who were treated with leflunomide for rheumatoid arthritis and subsequently developed severe skin ulcerations. After discontinuation of the drug the skin ulcerations healed complete even if very slowly.
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One year after the obligatory implementation of a new hospital funding system based on Diagnosis Related Groups (DRG) the third version of a German DRG-system has been published. It differs significantly from the previous version. Modifications in the classification system and the introduction of further procedure-based payments contribute to a better depiction of specialized clinical services. A number of acknowledged problems which caused great discussion in 2004 have been solved, yielding a more appropriate mapping of clinical services. The algorithms of the major diagnostic categories have been modified and complications, comorbidities and/or multiple procedures will be considered more precisely in selecting a group. However, some inconsistencies concerning highly specialized medical procedures and special features of impatient dermatological care remain. Nevertheless, a great improvement over the previous versions is apparent. The crucial aspects of the G-DRG version 2005 and the accompanying rules and regulations of payment are reviewed in detail with special relevance to dermatology.
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SUMMARY BACKGROUND: The implementation of a DRG system in Germany--voluntarily since January 1st, 2003, and obligatory after January 1 st, 2004--has led to uncertainty, particularly in the hospitals. There are fears that current well-accepted German diagnostic and therapeutic services may not be properly financed by the new system. In response, the German Dermatologic Society (DDG) in cooperation with the DRG Research Group of the University Hospital Muenster and the German Medical Association carried out a DRG evaluation project in order to investigate the medical and economic homogeneity of the case groups. PATIENTS AND METHODS: 19,403 dermatological cases from 19 hospitals--ten university hospitals and nine non-university hospitals-were collected over a period of four months and then evaluated with regard to their performance, length of stay and cost homogeneity. RESULTS: The data provided the background needed to indicate suspected potential deficiencies for mapping dermatology cases within the German DRG system. Based on the data 10 modifications were formulated and submitted to the InEK by the deadline of March 31st, 2003. CONCLUSIONS: The results of the DRG Evaluation Project show that the G-DRG-Variant Version 1.0 does not offer the necessary possibilities of differentiation to map the broad spectrum of various dermatology services in Germany.
In the year 2004 the obligatory introduction of the new hospital funding system based on a Diagnosis Related Groups (DRG) system will become reality for all German hospitals. After all fundamental items of the new G-DRG version were made generally known, the possible consequences had to be considered. The first mandatory German case-based lump sum catalogue differs importantly from the previous payment models and requires intensive study. Economic considerations will increasingly play a role in the daily routine of hospitals and influence treatment patterns. Therefore, comprehensive knowledge of basic principles of G-DRG is essential. In the following aspects of the reimbursement system with special relevance to dermatology are reviewed in detail. Additionally, the revised classification system versions OPS-301 SGB V and ICD-10-GM 2004 and the German coding standards version 2004 must be appropriately applied for dermatologic purposes.
We report on two siblings with aplasia cutis congenita (ACC). This rare congenital malformation is characterized by a local defect of epidermis, dermis, and subcutaneous tissues occurring predominantly on the vertex of the scalp. Patient A (a boy) was born with a parietooccipital 4 x 4 cm scalp defect, that healed under conservative treatment with scar formation within three months. At the age of three years we started with serial excisions of the affected area. In patient B (a girl) two 1.5 x 1.5 cm midline scalp defects were noted at birth. After primary conservative treatment we performed an excision at the age of three years. Both children were born at term following normal pregnancy and delivery. Neither physical nor psychomotor retardation nor any other associated abnormality was found in these cases. Two younger brothers were born without any skin defects or other anomalies. There is no unifying theory on the pathogenesis of ACC. Traumatic, vascular, teratogenic, and genetic factors are discussed as initial steps in etiopathogenesis. In this family the occurrence of ACC in two siblings of either sex, with unaffected parents, may suggest an autosomal recessive mode of transmission. However autosomal dominant inheritance with germline mosaicism in one parent can not be excluded.