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Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far., Objective: The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours., Methods: A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered., Results: No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment., Conclusion: Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The Epworth Sleepiness Scale (ESS) is frequently used to determine daytime sleepiness in patients with sleep-disordered breathing. It is still unclear whether different levels of alertness induced by the circadian rhythm influence ESS score., Objective: The aim of this study is to investigate the influence of circadian rhythm-dependent alertness on ESS performance., Materials and Methods: In a monocentric prospective noninterventional observation study, 97 patients with suspected sleep-disordered breathing were investigated with respect to daytime sleepiness in temporal relationship to polysomnographic examination and treatment. The Karolinska Sleepiness Scale (KSS) and the Stanford Sleepiness Scale (SSS) served as references for the detection of present sleepiness at three different measurement times (morning, noon, evening), prior to and following a diagnostic polysomnography night as well as after a continuous positive airway pressure (CPAP) titration night (9 measurements in total). The KSS, SSS, and ESS were performed at these times in a randomized order., Results: The KSS and SSS scores revealed a circadian rhythm-dependent curve with increased sleepiness at noon and in the evening. Following a diagnostic polysomnography night, the scores were increased compared to the measurements prior to the night. After the CPAP titration night, sleepiness in the morning was reduced. KSS and SSS reflect the changes in alertness induced by the circadian rhythm. The ESS score war neither altered by the intra-daily nor by the inter-daily changes in the level of alertness., Conclusion: According to the present data, the ESS serves as a reliable instrument to detect the level of daytime sleepiness independently of the circadian rhythm-dependent level of alertness.

The physician is consulted because of pains in the testicles or enlarged or empty scrotum, and he is primarily challenged to eliminate a possible testicular tumor. He is also questioned about the possibility of a later impairment of fertility. If severe testicular pains prevail, it usually signifies an acute testicular twist, the appearance of which every physician should be familiar with because immediate action is important--possibly an attempt of manual retorsion should be made, and most often the immediate referral to a specialist is imperative--in order to maintain the functioning of the endangered testicle. The testicular twist causes sudden testicular pains, frequently while sleeping or during sportive activities. The pain spreads into the groin region and can even lead to symptoms of shock. Frequent consequences are the disturbance of spermatogenesis. Less frequent infectious causes for testicular pains may manifest themselves as epididymitis or concomitant orchitis (parotitis epidemica). The assessment of the success of a consequent anti-infectious treatment should consider the genital symptomatology as well. Varicocele occurs almost only in the left side of the scrotum. The spermatogenesis of the left testicle is consequently often disturbed. In infertile men the varicocele is about three times more frequent than in fertile ones. If varicocele is found in adolescents, in which case it is important to compare both sides of the scrotum, the indication for a preventive surgical treatment is always impending. This question, however, is seen controversially (physiological state of transition or disease with remaining defects). We see an indication for surgical treatment also in varicocele of the adolescent boy, and not only in proven infertility of the adult male.

To compare the career profiles of thoroughbred racehorses in Germany in different decades all horses which raced for the last time in the years 1966/67, 1976/77 and 1986/87 were selected from the annual report of the German Thoroughbred Racing Association. The number of racing horses increased within decades while the percentage of the horses which raced for the last time was equal in all years. It amounted yearly to about 30%. Most of the horses finished racing at three and four years of age. In 1966, 1967, 1976 and 1977 more than 50% of the horses began their career at the age of two years, while in 1986 and 1987 the rate was below 50%. The duration of the career depended on the age at the first race and the gender. Colts and geldings raced an average of 3.5 and 4.3 years respectively, fillies 2.7 years. The average of races during the career remained constant during each decade at 27 and 35 for the colts and geldings respectively, while for the fillies it decreased from 24 races in 1966/67 to 20 races in 1986/87.

In three children (2, 4 and 10 years of age) a cervical thymic cyst was removed. We found multilocular cysts with xanthochromic luminal fluid covered with a fibrous capsule. Histological features are lymphatic follicles, partly atrophic, as well as regular thymic tissue with cortex, marrow and Hassall's corpuscles.

The concentrations of fetal hemoglobin (HbF) containing red blood cells in the peripheral blood of the mothers was studied in 113 cases by the method of Kleihauer & Betke prior and following trans-abdominal amniocenteses for genetic reasons between 15 and 18 weeks of pregnancy. Prior to the amniocentesis, 25% of the patients had HbF positive cells. Following the amniocentesis 36% of the patients showed HbF positive cells. In one out of six amniocenteses a measurable increase of the concentration of HbF containing red blood cells by approximately 0.22% was detected. These increases are within the limits found prior to amniocentesis and are not significant. There was no difference in the incidence and level of microtransfusions between paraplacental and transplacental amniocenteses. Because of the possibility of Rh sensitization Rh negative mothers should receive Rh immunoglobulin. None of the 112 patients had an abortion within two weeks following the amniocentesis.

Between 1975 and 1987 30 patients with congenital hydronephrosis and megaureter were treated by Y-cutaneostomy according to Sober. 28 are still under our control. 5 of them showed normalisation of urine drainage. No further operation except the closure of the stoma was necessary.

Upper pole resection and ureterectomy in infants as primary procedure for treatment of ectopic ureterocele is a simple and efficient method. In more than half of the cases further interventions are unnecessary. Secondary operations at the uretero-vesical junction are only necessary in persistent obstruction or reflux into the lower pole; they are easier to perform at a later time.

86 patients aged 9 months to 15 years (means = 4.8) having 102 cryptorchid testes were treated with either LHRH nasal spray or with a combination of LHRH and HCG. The immediate success rate after the termination of treatment was 74%. The follow-up showed that 65% of the testes were still descended after the critical period had elapsed. An open processus vaginalis was found in 74% (20/27) while pathological changes of the epididymis (64%) (7/11) and testis "reflexus" (48%) (13/27) were frequently encountered in unsuccessfully treated patients. Furthermore, the above grouping of patients displayed typical histological changes associated with cryptorchidism, namely an impaired number of germ cells (0.14 S/T median values) and atrophy of the Leydig cells. In almost all of the patients classified as treated unsuccessfully, there was a definite improvement in the position of the gonad, thus facilitating subsequent surgery.

Between 1974 and 1986 96 children underwent the Lich-Grégoir antireflux procedure, in 63 patients on both sides in one session. 17 patients had double ureter. In totally 153 controlled operations we found 4 persistent reflux (2.6%) and 1 stenosis (0.7%). The success ratio is, therefore, 96.7%.

A follow-up study of 149 pediatric fractures of the femoral shaft (146 patients had a radiographic control) demonstrated a significant influence of multiple reductions and residual axial deviations on the incidence and extent of posttraumatic overgrowth. The presented group of patients did not show a positive correlation between therapeutic shortening at the time of the initial reduction and reduced incidence of long term overgrowth. Neither extent nor incidence of overgrowth could be prevented by this method. We therefore recommend to reduce fractures of the femoral shaft without forshortening, because it stimulates repair mechanisms at the growth plate and enhances overgrowth. In contradiction to the current concept of therapeutic recommendations it could be shown that posttraumatic rotational deformities will correct themselves in the course of physiologic detorsion of the femoral neck. In 67% of the studied group of patients initial errors of rotation corrected themselves by this mechanism. According to our results the therapeutic concept of pediatric femoral shaft fractures is revised and a new concept of initial and long term treatment is proposed.

The subject dealt with is the prognosis of residual axis deviations following finger fractures in the growing phase. By means of individual examples it is shown that the axis deviation in the frontal plane does not undergo any correction during further growth, whereas the axis deviation in the movement plane - the sagittal plane - can still be completely corrected even in cases of premature joins. Thus the limits of conservative treatment are shown: fractures with axis derivation in the sagittal pland can in most instances be treated conservatively. Fractures with axis deviation in the frontal plane, on the other hand, are better treated operatively, if up to consolidation there is no certainty of stabilizing the correction of this fault by the conservative method.

New trends in the treatment of hypospadias consist on the one hand in conceptional tactics such as earlier operation, shorter hospitalization, one-stage procedures and meatal advancement in distal forms, and on the other hand in operative techniques such as the island-flap procedure for primary and the bladder-mucosa graft for secondary urethroplasty, artificial erection for chordectomy, as well as xylocaine-adrenaline injection for glanduloplasty.