[Telemedicine for heart failure, diabetes and chronic obstructive pulmonary disease]. / Telemedizin bei Herzinsuffizienz, Diabetes mellitus und chronischen Lungenerkrankungen.

It is generally believed that telemedicine has a tremendous potential to improve health care. This publication reviews the current knowledge available on telemedical concepts for heart failure, diabetes and chronic pulmonary diseases, discusses existing difficulties, and suggests how such concepts could best be used in the near future.

[Ambient assisted living - an overview]. / Ambient Assisted Living - ein Überblick.

Ambient assisted living (AAL) technologies are mainly developed to support elderly people in their own homes and facilitate a longer, self-determined life. In addition to providing a demographic prognosis for Germany, the present publication includes the definition, classification and current market situation of AAL. Lastly, the benefit of AAL technologies to the insurance industry and the subsequent steps to be taken are addressed.

[Telemedicine - an overview]. / Telemedizin - ein Überblick.

Currently, there is considerable interest in telemedicine for two reasons: Firstly, it is expected to bring improvements in health care. Secondly, it is assumed that telemedicine reduces health care costs. The latter is of particular importance because health care costs are expected to rise considerably in the future. The present article describes the current situation of telemedicine in Germany.

[Cost effectiveness of telemedicine]. / Ist die Telemedizin kosteneffektiv?

Demographic development in Germany will lead to increasing health care costs. Telemedicine is believed to have the potential to generate cost savings and therefore to reduce the expected increase in health care costs. This publication reviews the relevant literature, presenting the results of available studies, describing the problems involved in performing appropriate studies, and examining solutions.

[Transurethral laser ablation of the prostate in high risk patients with obstructive benign prostatic hyperplasia. Perioperative morbidity and 6 month outcome in 72 patients]. / Transurethrale Laserablation der Prostata (TULAP) bei Hochrisikopatienten mit obstruktiver BPH. Perioperative Morbidität und 6-Monats-Ergebnisse bei 72 Patienten.

Between November 1993 and September 1995, we carried out visual laser ablation of the prostate (VLAP) in 72 high-risk patients (ASA 3-4; severe cardiovascular and/or pulmonary diseases) aged 60-88 years (mean 76.7 years); the prostate volume was 22-136 ml (mean 56 ml). The urinary peak flow rates (Qmax.) ranged from 2 to 15 ml/s (mean 4.4 ml/s) preoperatively; 42 patients (58.3%) suffered from acute urinary retention for up to 2 weeks and had an indwelling catheter. The residual urinary volume (RUV) was 0-320 ml (mean 142.3 ml) in those 30 patients with spontaneous micturition. The International Prostate Symptom Score (IPSS) ranged from 10 to 33 (mean 21.8). In the first 37 patients, pressure-flow studies were carried out only in cases of doubt to verify obstruction. In the last 35 patients, pressure-flow studies were carried out in every case. Perioperatively, there was no appearance of blood loss of absorption of irrigation fluid. None of our patients needed transfusions or intensive care perioperatively. Further complications were not severe and could be handled without problems. In two patients with large benign prostate hypertrophy (BPH) a second operation (VLAP, no conventional transurethral prostatectomy) was necessary. After 6 weeks, 29.4% of the patients suffered from symptomatic urinary tract infections (UTI). After 6 months, only 7.1% of the patients had symptomatic UTI. After 6 weeks (n = 61), Qmax. was 6-34 ml/s (mean 15.3 ml/s), RUV was 0-230 ml (mean 51.5 ml), and the IPSS was 12.3 (8-28). After 3 months (n = 54), Qmax. was 9-45 ml/s (mean 19.8 ml/s), RUV was 0-96 ml (mean 31.6 ml), and the IPSS was 1-23 (mean 7.4). After 6 months (n = 52) Qmax. was 12-33 ml/s (mean 20.4 ml), RUV was 0-53 ml (mean 26.4 ml), and the IPSS was 1-12 (mean 4.1). VLAP provided no further risks for our high-risk patients, while Qmax., RUV, and IPSS were improved noticeably (improvement of more than 75%). It represents a step forward in the treatment of obstructive BPH in high-risk patients. Particularly in high-risk patients with cardiac diseases, this procedure lessens the perioperative risk. Despite the minimal appearance of UTI after 6 months, UTI seemed to be the most important complication during the first few weeks after VLAP by virtue of the bothersome symptoms.