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Objective: Discrimination of patients with benign prostatic hyperplasia (BPH) from those with cancer of the prostate (CaP) is crucial to the management of these diseases. At present, a number of new treatment modalities for symptomatic BPH, which include various nonsurgical treatment modalities, are being discussed. Prior to treatment, it is important to exclude those patients with CaP. In the present study we examined retrospectively the serum prostat-ic-specific-antigen (PSA) values in both patient groups in order to determine whether serum PSA identifies those patients harboring organ-confined CaP. Patients and Methods: Group 1 consisted of 121 patients with histologically confirmed BPH as determined from pathological analysis of the surgically removed specimens. Group 2 included 69 patients with organ-confined CaP, confirmed pathologically from the analysis of the radical prostatectomy specimens. PSA serum concentration was analyzed in both groups. Results: The median PSA level was 3.96 ng/ml (range: 0.5–31.2 ng/ml) in the BPH group and 7.8 ng/ml (range: 0.7–37.7 ng/ml) in the CaP group. In spite of a statistically significant difference (p = 0.0001), serum PSA values overlapped considerably in both groups. Conclusions: Serum PSA demonstrated only a limited ability to discriminate between BPH and organ-confined CaP. Therefore some patients with symptomatic BPH undergoing nonsurgical treatment may harbor clinically significant CaP despite ‘normal’ serum PSA values. Furthermore, PSA-based screening may overlook a significant percentage of patients in whom a rectal digital examination would detect CaP.

We present epidemiological data of female breast cancer in the region of Aachen (Germany) including incidence and tumour stages for the period 1996-1997. Furthermore, we compare epidemiological data from Aachen with data from the directly neighbouring Dutch region South-Middle Limburg before and after the introduction of a national mammographic screening programme. The field study of breast cancer was undertaken at the Institute of Pathology and Comprehensive Cancer Center at the University of Aachen, supported by the Federal Ministry of Health (Germany), using data files from the Cancer Registry Aachen. The patient's consent to collect all data concerning her epidemiological and social situation as well as information on the outcome of disease was obtained in 83.4% of all cases. The remaining 16.6% of the cases without a patient's consent are based on histopathological reports. Only those patients are included who were documented as residing in the region of Aachen at the time of diagnosis. Tumour cases were counted according to International Agency for Research on Cancer rules and tumour stages are classified according to UICC guidelines. Incidence rates are calculated as crude value, adapted to the European and World Standard population (ESR, WSR), and the age specific incidence is presented in 5-year intervals. The cumulative risk is assessed for a certain life span by summarizing the age-specific incidences. The age-standardized breast cancer incidence rate in Aachen was 94 per 100 000 women in 1996 and 90 cases of invasive breast cancer per 100 000 women in 1997 according to the ESR. The cumulative risk of developing breast cancer in the life span ranging from 0 to 74 years is approximately 8%. The stage distribution of breast cancer reveals only 4% favourable carcinomata in situ, but 12% advanced T4 tumours. T1 and T2 tumour stages count for about 40% and T3 tumour stages about 4%. Incidence rates and the tumour stages of breast cancer in the region of Aachen during 1996 and 1997 are similar to the data obtained from the directly neighbouring Cancer Center of the region South-Middle Limburg, in the Netherlands, in 1989/1990 before the beginning of the national breast cancer screening programme. However, major differences are found in terms of the incidence and the tumour stages between Aachen 1996/1997 and South-Middle Limburg 1995/1996 after the introduction of the mammographic screening. The incidence of female breast cancer in Aachen, Germany, was high and in the range of the data from other cancer registries in Europe without national screening programmes. The tumour stages at diagnosis in Aachen were not very favourable, especially in elderly women. An increase of the cancer incidence and a shift of the tumour stages to more favourable ones were observed in the neighbouring Dutch region of South-Middle Limburg, comparing data from 1989/90 and 1995/96. This is probably as a result of the national mammographic screening programme. As data from Aachen were similar to Limburg's data from 1989/90 before th...

We present epidemiological data of female breast cancer in the region of Aachen (Germany) including incidence and tumour stages for the period 1996-1997. Furthermore, we compare epidemiological data from Aachen with data from the directly neighbouring Dutch region South-Middle Limburg before and after the introduction of a national mammographic screening programme. The field study of breast cancer was undertaken at the Institute of Pathology and Comprehensive Cancer Center at the University of Aachen, supported by the Federal Ministry of Health (Germany), using data files from the Cancer Registry Aachen. The patient's consent to collect all data concerning her epidemiological and social situation as well as information on the outcome of disease was obtained in 83.4% of all cases. The remaining 16.6% of the cases without a patient's consent are based on histopathological reports. Only those patients are included who were documented as residing in the region of Aachen at the time of diagnosis. Tumour cases were counted according to International Agency for Research on Cancer rules and tumour stages are classified according to UICC guidelines. Incidence rates are calculated as crude value, adapted to the European and World Standard population (ESR, WSR), and the age specific incidence is presented in 5-year intervals. The cumulative risk is assessed for a certain life span by summarizing the age-specific incidences. The age-standardized breast cancer incidence rate in Aachen was 94 per 100 000 women in 1996 and 90 cases of invasive breast cancer per 100 000 women in 1997 according to the ESR. The cumulative risk of developing breast cancer in the life span ranging from 0 to 74 years is approximately 8%. The stage distribution of breast cancer reveals only 4% favourable carcinomata in situ, but 12% advanced T4 tumours. T1 and T2 tumour stages count for about 40% and T3 tumour stages about 4%. Incidence rates and the tumour stages of breast cancer in the region of Aachen during 1996 and 1997 are similar to the data obtained from the directly neighbouring Cancer Center of the region South-Middle Limburg, in the Netherlands, in 1989/1990 before the beginning of the national breast cancer screening programme. However, major differences are found in terms of the incidence and the tumour stages between Aachen 1996/1997 and South-Middle Limburg 1995/1996 after the introduction of the mammographic screening. The incidence of female breast cancer in Aachen, Germany, was high and in the range of the data from other cancer registries in Europe without national screening programmes. The tumour stages at diagnosis in Aachen were not very favourable, especially in elderly women. An increase of the cancer incidence and a shift of the tumour stages to more favourable ones were observed in the neighbouring Dutch region of South-Middle Limburg, comparing data from 1989/90 and 1995/96. This is probably as a result of the national mammographic screening programme. As data from Aachen were similar to Limburg's data from 1989/90 before th...

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Der in vielen Fächern etablierte Standard von Qualitätssicherung und Qualitätskontrolle kann auch auf in der Rechtsmedizin ausgeübte Verfahren und Methoden übertragen werden. Es geht um Mindestanforderungen z. B. im Sektionssaal oder Labor und um die Überwachung und Einhaltung solcher Standards. Leitlinien spielen eine wichtige Rolle. Nicht vorhandenes oder schlechtes Qualitätsmanagement in der Rechtsmedizin birgt die Gefahr, dass Untersuchungsergebnisse in foro angezweifelt werden. Riskmanagement bedeutet, mit risikobehafteten Situationen bei Untersuchungsvorgängen umgehen zu können. Bereits im Vorfeld abzusehende oder systemimmanente Fehlerquellen sind zu analysieren und mit dem Ziel der Schadenvermeidung zu eliminieren. Voraussetzung hierfür sind Selbstkritik und Offenheit, die man bei allen Beteiligten motivieren müsste, um Fehler bzw. organisatorische Schwächen aufzudecken. Der Begriff evidence based medicine erscheint für das Fach Rechtsmedizin zunächst nicht einschlägig zu sein. Man versteht hierunter die rationale wissenschaftliche Begründung ärztlichen Handelns durch Gebrauch der besten wissenschaftlichen externen Evidenz aus systematischer Forschung. Die individuelle Behandlung soll sich auf belegbare Forschungsergebnisse stützen, wobei die gefundene Evidenz kritisch auf die Anwendbarkeit zu prüfen ist ("was nützt dies tatsächlich dem Patienten?"). In der Rechtsmedizin würde dies die Einführung von Klassifikationsund Qualitätsrangskalen für Evidenzen bedeuten, also die professionelle Evaluation der Bedeutung eines Untersuchungsergebnisses. Bei der Gutachte -n e r s t e l l u n g wären z.B. die Verwendung eines bestimmten Verfahrens zu begründen, die Möglichkeiten und Grenzen der Methode aufzuzeigen, die eigene Bewertung mit den Ergebnissen systematischer Forschung zu vergleichen. Zwangsläufig würde hieraus auch ein innerfachlicher Diskurs über Ziel und Qualität von rechtsmedizinischen Untersuchungen resultieren. mit strafrechtlichen Ermittlungen bei Fragen ärztlichen Fehlverhaltens sind in der Regel umfangreiche Recherchen notwendigen. Unterschiedliche Sachverhalte sind als mögliche Anknüpfungspunkte zu hinterfragen und für die weitere Verfahrensentwicklung rechtsverwertbar zu dokumentieren. Üblicherweise handelt es sich um die Sicherstellung von Patientenakten und Feststellung von bestimmten Zeitabläufen. Doch von dieser routinemäßigen Bearbeitung gibt es Ausnahmen, insbesondere dann, wenn medizinisch komplexe Sachverhalte zu überprüfen sind und /oder keine hinreichenden Patientendokumentationen vorliegen. Mit Blick auf die rechtsmedizinischen Begutachtungen am hiesigen Institut zur Frage von unerwünschten Nebenwirkungen der als "Diät-Kapseln nach Dr. Coesens" bekannt gewordenen "Arznei" soll diskutiert werden, in wie weit medizinischer Sachverstand bereits während der Ermittlungsarbeit integriert werden kann bzw. muß und welche möglichen praktischen Konsequenzen aus dem konkreten Rechtsfall gezogen werden können. Auf der letzten Jahrestagung haben wir über Ergebnisse eines decubitusbezogenen Routinesc...

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