Genital melanoma: prognosis factors and treatment modality.

PURPOSE: Genital melanoma is a rare pathology. We present the experience of two comprehensive cancer centers in Lyon (France) in the management of genital melanoma in order to identify prognostic factors and optimal treatments. METHODS: Between April 1992 and Mars 2014, 16 patients with a primary genital melanoma were referred to our department. Nine patients presented a vaginal melanoma, six vulvar melanomas and only one cervical melanoma. The median dimension of the lesion was 33.7 mm (5-100 mm). The AJCC stage ranged from IB to IIIC. 12 cases were the classic dark-blue flat melanoma and the other 4 cases were an atypical amelanotic tumor. Wide local surgery was performed in nine patients. A radical surgery was performed in six patients. In the large cervical melanoma, radiotherapy was performed as first-line treatment. In all the patients regional lymph node staging was performed. Adjuvant treatment was realized in nine patients. RESULTS: Two patients are alive without recurrence. Only one patient was lost to the first follow-up. The other 13 patients experienced a rapid recurrence. The median disease-free survival and the median overall survival were 11.8 months (2-49 m) and of 30.4 m (11-144 m), respectively. The disease-free survival and overall survival could be linked to a clinical presentation (Breslow thickness and morphology of lesion) associated to the early diagnosis. CONCLUSIONS: In our small series, the most important prognosis factor remains the tumor thickness. These rare lesions should be treated in experienced centers in order to improve their prognostic.

What about ST waveform analysis signal quality in the second stage of labor? A case-control study.

AIM: This study aimed to investigate ST waveform analysis (STAN) signal quality during the second stage of labor by comparing signal quality in the first and second stages of labor. METHODS: Fifty women who delivered vaginally were randomly selected in a large prospective database including all women with STAN monitoring during labor. Quality signal was analyzed during the second stage of labor (Period B) and during the same period of the first stage of labor (Period A), just preceding active pushing. STAN signal quality was evaluated using seven variables. Main outcome was the presence of at least one signal loss >4 min. RESULTS: At least one signal loss >4 min was present for, respectively, 4% (95% confidence interval [CI] 0-9.43) of patients in Period A and 28% (95% CI 15.5-40.5) of patients in Period B (P<0.05). A significant difference was detected for all variables analyzed between the two periods (P<0.05). CONCLUSION: STAN quality signal deteriorates in the second stage of labor compared to that in the first stage. As guidelines clearly indicate that signal quality influences the decision process, it should be carefully and systematically checked before including STAN analysis in the decision-making.

Management and outcome challenges in newborns with gastroschisis: A 6-year retrospective French study.

OBJECTIVE: To identify the gestational age (GA) at which risk of mortality and severe outcome was minimized comparing preterm delivery and expectant management. METHODS: Retrospective study performed between 2009 and 2014 of newborns with gastroschisis in three large French level III neonatal intensive care units. Each department followed two distinct strategies: elective delivery at 35 weeks' GA and a delayed approach. RESULTS: We included 69 gastroschisis cases. The lengths of stay lasting more than 60 days were significantly greater in the planned delivery group than in the expectant approach group (18/30 (60%) vs. 8/39 (20.5%), p = 0.001). Gastroschisis cases receiving antenatal corticoids during the last two weeks of gestation required significantly less surgeries during their initial stay (p = 0.003) as well as shorter parenteral feedings (p = 0.002). A multivariate logistic regression showed that a GA of less than 36 weeks' GA was is a pejorative factor for a stay above 60 days, regardless of whether it was a simple or complex gastroschisis, (OR= 3.8; p = 0.021). A complex gastroschisis was a risk factor for significantly longer parenteral feedings, regardless of the center where patient is treated (Beta = -0.3, p = 0.035). CONCLUSIONS: Future research should focus on decisions about delivery timing by incorporating risk of neonatal morbidity.