The therapeutic strategy of the SIOP-9 study includes pre-operative chemotherapy for all patients with nephroblastoma diagnosed by imaging methods aged between 0.5 and 16 years. By pre-operative chemotherapy the rate of radical resectable tumors should be increased and thereby the intensity of postoperative therapy, in particular of radiotherapy, diminished. Patients with nephroblastoma stage I-III were in case of tumorresponse randomised in either a 4 weeks or 8 weeks arm of pre-operative treatment with ACT D and VCR. The question was, if a prolongation of pre-operative chemotherapy could increase the relative part of stage I. Between 1/1/89 and 6/30/91 from 49 oncologic centres of former western Germany 188 patients were registered in the SIOP-9/GPO. From the stage I-III patients between 0.5 and 16 years 80.1% were pretreated with cytostatic agents. Only 53.9% of the patients with tumorresponse were randomised. The relative frequency of intraoperative ruptures was with 3% lower in the group of pretreated patients than in the primary operated (15.3%). The stage distribution for all Wilms' tumor patients showed a prevalence of stage I with 43.3% (after pre-operative treatment 59%; after primary operation 28%). Abdominal radiotherapy was performed in 22.4%. The event-free survival rate of all nephroblastoma lay at 85% 3 years after diagnosis (stage I standard 96%; unfavorable histology all stages 45%). 7.3% of the patients developed a hepatopathy under treatment and 7.8% even a VOD according to the criteria of McDonald.(ABSTRACT TRUNCATED AT 250 WORDS)

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Ultrasound examination is a routine element of antenatal care, and an accurate and reliable ultrasound service is essential for confident patient management. Qualitative findings, e.g. fetal normality and placental site, may be confirmed at delivery, but this form of audit is not suitable for fetal measurements owing to the variation in gestation at delivery and the complexity of neonatal assessment. Our aim was to develop a simple audit method applied a short time after the ultrasound scan. The method was based on assessment of measured images against measurement criteria which are clearly defined in the literature, results for each criterion being recorded in a spreadsheet. Two main forms of report were generated, the first showing overall achievement of satisfactory measurements for each sonographer, the second providing graphical information to show which criteria required greater attention by individual sonographers. Over several phases of audit problems of quality recognition and technical skill were isolated, graphical reports were used to guide tuition and the levels of performance were improved. The method itself and the results satisfy managers at all levels that standards are in place and are being maintained.

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