The purpose of this study was to identify melanoma patients with positive sentinel lymph nodes (SLNs) at increased risk for further metastases in this specific lymph node basin. A series of consecutive patients with primary malignant melanoma stage I and II were evaluated retrospectively. The results of SLN biopsy in 26 patients with positive SLNs were compared with those of complete regional lymph node dissection (RLND) using the recently published S-classification of SLNs. The results of S-classification of SLNs were correlated with the outcome of complete RLND. There was a significant correlation between the S stage of positive SLNs and the results of complete RLND (P=0.02). Only patients with SIII stage (n=4) SLNs were found to have further metastases in the residual lymph node basin. The present study indicates that patients with SI stage and SII stage SLNs rarely have further metastases in the specific lymph node basin.

Diabetes mellitus type 2 is a central challenge for health policy and healthcare in all advanced countries. For the affected persons, living with a diagnosis of type 2 diabetes is difficult because the disease and its treatment have a considerable effect on daily life. The aim of this study was to investigate the challenges associated with a diagnosis of type 2 diabetes for those affected and the range, depth and complexities of the subjective perspectives of the patients under the conditions of the German healthcare system. A cross-sectional qualitative study was conducted using a sample of 19 adult patients with type 2 diabetes mellitus. Patients were recruited successively from two specialized diabetological practices, three general practitioner’s offices, and two hospitals. The patients were interviewed once in person using semi-structured interviews. All interviews were recorded, transcribed, and analysed based on grounded theory. Persons affected by diabetes mellitus type 2 seem to feel responsible for managing their disease. Two strategies of action could be identified: 1) patients strictly followed the recommendations of the physicians, or 2) they showed that they are knowledgably managing their diabetes mellitus type 2. The action strategy to address the disease seemed to be influenced by patients’ confidence in themselves, the effectiveness of the interventions, or the patients’ locus of control. Minor differences in educational status could be discovered, and patients who were less educated tended to follow the recommendations of the physicians very strictly and seemed to place more emphasis on being compliant, which goes hand in hand with a life with prohibitions and restrictions. In contrast, being perceived as competent patients who make their own rules to manage the disease in daily life appeared to be more important for people with higher education levels. Patient education and self-management programmes for diabetes mellitus type 2 should take different types of learners into account. Giving less-educated patients specific recommendations for successful diabetes self-management is particularly important. German clinical trial register (DRKS-ID: DRKS00007847 ).

Patients with metastases in the sentinel node (SN) are advised to undergo complete lymph node dissection, although the majority of them will have no further metastatic disease. Some of these patients undergo unnecessary surgery. In this study, we tried to predict the likelihood of further non-SN metastases on the basis of earlier published micromorphometric classifications of SN metastases. Metastases in the SN were re-evaluated on the basis of the microanatomic location of the lesions according to the Dewar's criteria, the S-classification of SN, and tumor burden in accordance with the Rotterdam criteria. The results of these classifications were correlated with the presence of further non-SN metastases. Specimens of 124 positive-SN basins and subsequent complete lymph node dissection were investigated. Further metastases in non-SNs were found in 30 lymph node basins (24.2%). All of the above-mentioned classification systems were significantly correlated with non-SN tumor status. Especially, in patients with SN metastases in subcapsular location, a maximum depth of invasion of less than 0.3 mm (stage I according to the S-classification) or metastases of less than 0.1 mm in diameter had a very low probability of further non-SN metastases (0-5%). The validity of earlier published classifications of SN metastases-based on the micromorphometric criteria in predicting non-SN status was confirmed. Especially, in patients with subcapsular metastases, SI stage metastases or metastases of less than 0.1 mm had a very low risk of further non-SN metastases.

Hintergrund: Die statische retinale Gefäßanalyse bestimmt Gefäßdurchmesserwerte in Fundusbildern. Untersucht wurde die Eignung nonmydriatischer und mydriatischer Aufnahmen für derartige Auswertungen sowie der Einfluss der medikamentösen Mydriasis auf die Messergebnisse. Material und Methoden: In die prospektive Untersuchung wurden 30 Augen von 15 Patienten (10 weiblich, mittleres Alter 51,6 J ± 13,2) einbezogen. Zunächst wurden von jedem Auge 3 Aufnahmen mit der Netzhautkamera Topcon NW 200 (Aufnahmewinkel 1) erstellt. Nach Pupillenerweiterung mit Tropicamid AT wurden dann erneut 3 Bilder mit der Topcon NW 200 und folgend 3 Bilder mit dem System Visualis (IMEDOS Jena, FF 450plus, 535 - 561 nm, Bildwinkel 30°, 1840 × 1360 Pixel) aufgenommen. Die Bestimmung der Gefäßdurchmesser erfolgte mit dem Programm Vesselmap2 (IMEDOS Jena). Dabei werden vom Untersucher die Gefäße Arterien und Venen zugeordnet und die Durchmesser automatisch vom System ermittelt. Bei schlechter Abbildung besteht die Möglichkeit, Gefäßkanten manuell festzulegen. Berechnet wurden nach der Parr-Hubbard-Formel das zentrale retinale arterielle und das venöse Äquivalent (CRAE, CRVE) sowie der arteriovenöse Quotient (AVQ). Für die Bestimmung des Einflusses von Tropicamid auf den Gefäßdurchmesser wurden die nasalen Gefäße > 60 µm separat ausgewertet. Ergebnisse: Aufgrund schlechter Ausleuchtung und Kontrastverhältnisse konnten in 21 % der nonmydriatischen Bilder nicht alle Gefäße automatisch erfasst werden. In weiteren 7 % der nonmydriatischen Bilder war eine geringere Anzahl von Gefäßen messbar als in den mydriatischen Bildern. Der Variationskoeffizient für CRAE und AVQ von jeweils 3 Bildern war im Mittel größer bei den nonmydriatischen Aufnahmen (2,6 %; 3,2 %) im Vergleich zu den mydriatischen Aufnahmen mittels Topcon (1,8 %; 2,3 %) und FF450 (1,7 %; 1,8 % ANOVA p < 0,05). Der Variationskoeffizient des CRVE (1,9 %; 1,8 %; 1,7 %) sowie die Mittelwerte von CRAE, CRVE und AVQ wiesen keine signifikanten Unterschiede zwischen den 3 Aufnahmemethoden auf. Die Messung der in allen Bildern gut abgebildeten nasalen arteriellen und venösen Gefäße > 60 µm ergab ebenfalls keine signifikanten Mittelwertunterschiede zwischen den 3 Aufnahmetechniken. Schlussfolgerungen: Nonmydriatische Bilder weisen häufig eine visuell schlechtere Bildqualität als mydriatische Bilder auf. Dies kann die größere Streuung der Messwerte dieser Bilder erklären. Voraussetzung für die Auswertung eines Bildes ist die messbare Darstellung aller relevanten Gefäßabschnitte. Ein Einfluss der medikamentösen Mydriasis mit Tropicamid auf die retinalen Gefäßdurchmesser > 60 µm konnte nicht nachgewiesen werden. Background: Static vessel analysis is a method to determine the diameter of retinal vessels in images of the ocular fundus. The suitability of non-mydriatic and mydriatic images for that method and the influence of mydriasis on the results were examined. Materials and Methods: In the prospective study, 30 eyes of 15 patients (10 women, mean age 51.6 ± 13.2 years) were examined. At first, 3 images were taken of each eye with the retinal camera Topcon NW 200 (magnification 1). After pupil dilation with tropicamid eye drops, 3 more images were taken using the Topcon and 3 others using the system Visualis (IMEDOS, Jena/Germany, FF450plus, 535 - 561 nm, 30° image, 1840 × 1360 pixel). The vessel diameters were measured with the software Vesselmap2 (IMEDOS). The investigator assigned vessels to arteries or veins and their diameters were calculated automatically by the software. There is the possibility to define the vessel edge manually in cases of a poor image quality. The calculation of the central retinal arterial and venous equivalent (CRAE, CRVE) as well as the arterio-venous ratio (AVR) were made according to the formula of Parr-Hubbard. Furthermore, the nasal retinal vessels > 60 µm were examined to estimate the influence of tropicamid on the vessel diameter. Results: Because of insufficient illumination and poor contrast in 21 % of the non-mydriatic images not all vessels could be detected automatically. Additionally, fewer vessels could be detected in 7 % of the non-mydriatic images compared to the mydriatic images. The average coefficient of variation of CRAE and AVR of each triplet of images was higher in non-mydriatic images (2.6 % and 3.2 %, respectively) than in mydriatic images of the Topcon (1.8 %; 2.3 %) and the FF 450 (1.7 %; 1.8 % ANOVA p < 0.05). No significant differences were found between the various examination methods for both the coefficient of variation of CRVE (1.9 %; 1.8 %; 1.7 %) and the average values of CRAE, CRVE and AVR. With regard to their diameters, the nasal retinal arteries and veins > 60 µm, were depicted sufficiently in all images, and only differed insignificantly between the three methods. Conclusion: The quality of non-mydriatic images is often lower than that of mydriatic images. This fact can account for the high variance of measured parameters in the non-mydriatic images. The depiction of all relevant vessel segments is a precondition for the image-based analysis. An influence of the mydriasis caused by tropicamid on the retinal vessel diameters > 60 µm was not found.