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Background: Programmed death-1 (PD-1) antibodies and BRAF + MEK inhibitors are widely used for adjuvant therapy of fully resected high-risk melanoma. Little is known about treatment efficacy outside of phase III trials. This real-world study reports on clinical outcomes of modern adjuvant melanoma treatment in specialized skin cancer centers in Germany, Austria and Switzerland., Methods: Multicenter, retrospective study investigating stage III-IV melanoma patients receiving adjuvant nivolumab (NIV), pembrolizumab (PEM) or dabrafenib + trametinib (D + T) between 1/2017 and 10/2021. The primary endpoint was 12-month recurrence-free survival (RFS). Further analyses included descriptive and correlative statistics, and a multivariate linear-regression machine learning model to assess the risk of early melanoma recurrence., Results: In total, 1198 patients from 39 skin cancer centers from Germany, Austria and Switzerland were analysed. The vast majority received anti PD-1 therapies (n = 1003). Twelve-month RFS for anti PD-1 and BRAF + MEK inhibitor-treated patients were 78.1% and 86.5%, respectively (hazard ratio [HR] 1.998 [95% CI 1.335-2.991]; p = 0.001). There was no statistically significant difference in overall survival (OS) in anti PD-1 (95.8%) and BRAF + MEK inhibitor (96.9%) treated patients (p > 0.05) during the median follow-up of 17 months. Data indicates that anti PD-1 treated patients who develop immune-related adverse events (irAEs) have lower recurrence rates compared to patients with no irAEs (HR 0.578 [95% CI 0.443-0.754], p = 0.001). BRAF mutation status did not affect overall efficacy of anti PD-1 treatment (p > 0.05). In both, anti PD-1 and BRAF + MEK inhibitor treated cohorts, data did not show any difference in 12-month RFS and 12-month OS comparing patients receiving total lymph node dissection (TLND) versus sentinel lymph node biopsy only (p > 0.05). The recurrence prediction model reached high specificity but only low sensitivity with an AUC = 0.65. No new safety signals were detected. Overall, recorded numbers and severity of adverse events were lower than reported in pivotal phase III trials., Conclusions: Despite recent advances in adjuvant melanoma treatment, early recurrence remains a significant clinical challenge. This study shows that TLND does not reduce the risk of early melanoma recurrence and should only be considered in selected patients. Data further highlight that variables collected during clinical routine are unlikely to allow for a clinically relevant prediction of individual recurrence risk., (© 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

We report a fetal bilateral renal agenesis in a woman suffering from insulin-dependent diabetes mellitus. Early diagnosis of this lethal congenital anomaly allows well-timed termination of pregnancy. Transvaginal sonography in combination with color flow mapping render possible an accurate diagnosis of bilateral renal agenesis. Sonographic and color flow mapping features of the above described malformation as well as invasive diagnostic possibilities and causes of renal agenesis in maternal IDDM are discussed.

This paper presents results of a retrospective study covering 506 older women (age range: 60 years and older), who were treated by major gynecologic operations in a twenty-years-period between 1962 and 1981 at the Department of Gynecology and Obstetrics at the District Hospital of Stralsund. The total number of patients operated on during these twenty years was 6,246, the frequency of the operated older women 10.11 per cent. In two control periods (1967-1971 and 1977-1981) there was a slight increased of these patients in the last period from 8.22 per cent to 13.29 per cent. Comparing postoperative outcome and complication rate of the geriatric patients group there is no statistically significant difference to another group of patients (age range: 30-40 years) undergoing gynecologic surgery in 1981. Indications for gynecologic surgery showed age-dependent differences in the two groups. Our conclusions are that retrospective studies concerning clinical assuring of professional quality of medical care are not sufficient enough. As a result of this study we present our concept for medical data processing (documentation) regarding quality-assessment of gynecologic surgical care.

Recommendation of a telemetric system for the direct fetal monitoring using the monitor BMT 914-1 (Zwönitz). The free movement of parturients during labor is more comfortable and involves an increasing uterine activity, a labor progress and a decrease of oxytocic infusion rate.

Report about 156 intrapartum ambulations who failed progress of labor. Internal fetal monitoring was used in all patients. Labor progress with cervical dilatation was stated in 92,1% in first stage and in 68,7% in second stage of labor. An average increase of 10 mmHg in baseline tonus and an increase in amplitude and contraction frequency were found. No significant changes in either FHR baseline, variability or floating line were observed during ambulation. The lack of any demonstrable ill effects with ambulation in labor and the improved tolerance to pain and comfort are remarkable. Intrapartum ambulation with internal fetal monitoring has a great efficacy for progress of labor and is safe for both mother and fetus.

Based on 6,490 cardiotocographic examinations and numerous following diagnostic investigations a combined cardiotocographic and sonographic management during pregnancy care is recommended. The management starts with a non-stress-test (NST). Two acceleration (greater than 15 seconds, greater than 15 bpm) recorded within 10 or more minutes are a sign of fetal well-being. In order to differentiate between physiological- and pathologically suspicious heart frequency patterns a mechanical or acoustic provocation test is recommended. The dorsal transcutaneous electrical nerve stimulation (20 mA) is an effective continuous stimulus to wake up the fetus. The nipple stimulation test is the best physiological contraction stress test. The oxytocin challenge test may be replaced by the nipple stimulation. The following sonographic parameters of fetal condition are summarized to the fetal biophysical profile (FBP): body movements, breath movements, tonus and amniotic fluid volume. All these, together with the result of non-stress-testing, give the FBP-score. The predictive value of combined cardiotocographic and sonographic examination is much higher than the NST alone. An FBP-score less than or equal to 6 is an indication for the hospitalization. A score less than 4 with verified signs of maturity is an indication for the induction of labor.