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Purpose Pyrotechnics are a long-standing tradition at the turn of the year. There are little data available on New Year's Eve-associated ORL injuries. Due to restrictions during the Corona pandemic, the handling of fireworks and meetings on New Year's Eve 2020–2022 had been significantly changed. Our aim was to analyze first data about New Year's Eve-associated ORL injuries. Methods A retrospective analysis of 16 turns of the year (2006–2022) at a University ORL department was performed. The 2 recent years were influenced by the changes and restrictions of the COVID-19 pandemic. Results Of 343 emergency presentations, 69 presented with New Year's Eve-associated reasons (20%). 72% were male, 15.9% were underage. 74% presented for fireworks-related injuries, 19% due to violent altercations. Noise trauma was present in 71%. The average number of New Year's Eve-associated emergency patients per year and the average total number of patients were reduced by more than half under COVID-19 pandemic conditions. Conclusions New Year's Eve-associated ORL injuries range from inner ear trauma to midface fractures. Long-term damage may include hearing loss and tinnitus. These results shall support the responsible use of fireworks even after the end of the special regulations of the COVID-19 pandemic.

OBJECTIVES There are three surgical treatment options for patients with peritonsillar abscess (PTA): needle aspiration, incision and drainage (ID), and abscess tonsillectomy (ATE). The updated German national guideline (2015) included changes in the treatment of PTA. The indication for tonsillectomy (TE) in patients became more stringent and preference was given to ID in certain cases. STUDY DESIGN Retrospective analysis. METHODS We performed a retrospective systematic analysis of patient data using the in-house electronic patient records and considered a 4-year period from 2014 to 2017. About 584 patients were identified. Our aim was to analyze the influence of the updated guideline on clinical practice. RESULTS 236 of 584 patients (40.4%) underwent ATE with contralateral TE. In 225 patients (38.5%), unilateral ATE was performed. Mean surgery time was significantly shortened when only unilateral ATE was performed. Concerning postoperative bleeding, we noted a tendency toward a lower incidence after ATE in comparison to ATE with contralateral TE. Less than 1% of patients who underwent ATE had to be revised surgically due to postoperative hemorrhage. After the revision of the guideline, unilateral ATE and ID were conducted more frequently. CONCLUSION These results support that ATE in an inpatient setting is a considerably safe and effective primary therapeutic option. ID represents a favorable treatment option for patients with PTA and comorbidities, nevertheless, patient compliance is required and insufficient drainage or recurrence of PTA may occur. The revision of the guideline had a significant impact on the choice of interventions (P

One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate.Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19.Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital.Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation.Clinical and ventilation data were obtained from medical records in a retrospective manner.A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42-87 years. All patients received open tracheostomy between 2-16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR).Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.HINTERGRUND: Ein Hauptsymptom der schweren Infektion mit dem neuen Coronavirus‑2 (SARS-CoV-2) ist das hypoxämische Atemversagen aufgrund einer Viruspneumonie, welches eine mechanische Beatmung erfordert. Eine längere mechanische Beatmung erfordert ggf. eine Tracheostomie, welche aufgrund des erhöhten Kontaminationsrisikos jedoch umstritten ist. ZIEL: Bewertung von Sicherheit und Auswirkungen der chirurgischen Tracheostomie auf Beatmungsparameter und Überleben bei Patienten mit COVID-19.Retrospektive Beobachtungsstudie zwischen 27. März und 18. Mai 2020 auf einer COVID-Intensivstation in einem Krankenhaus der Tertiärversorgung.Patienten mit COVID-19 wurden wegen schweren hypoxämischen Atemversagens mit offener chirurgischer Tracheostomie behandelt.Klinische Daten und Beatmungsparameter wurden retrospektiv aus medizinischen Unterlagen entnommen.Analysiert wurden die Daten von 18 Patienten mit chirurgischer Tracheostomie bei bestätigter SARS-CoV-2-Infektion. Die Altersspanne betrug 42–87 Jahre. Bei allen Patienten erfolgte zwischen 2 und 16 Tage nach der Aufnahme eine offene Tracheostomie. Anschließend war die Beatmung weniger invasiv, die Lungen-Compliance nahm zu und die Sedierung konnte reduziert werden. Es starben 6 von 18 Patienten. Alle chirurgischen Mitarbeiter waren mit FFP3-Masken oder mit motorbetriebenen luftreinigenden Atemschutzmasken ausgestattet.Die vorliegenden Daten legen nahe, dass eine offene chirurgische Tracheostomie ohne schwerwiegende Komplikationen durchgeführt werden kann. Diese kann die Invasivität der mechanischen Beatmung sowie den Bedarf an Beruhigungsmitteln und Katecholaminen verringern. Falls verfügbar, sollten Empfehlungen für die persönliche Schutzausrüstung befolgt werden.

Dimension, position and stability of the cartilaginous nasal septum are crucial for successful surgery of the nasal septum. The objective of septoplasty is to create sufficient space in the anterior parts of the nose, particularly in the region of the nasal valves. Therefore, the cartilaginous nasal septum should obtain a state of "balanced tension". Essential steps of septoplasty include the hemitransfixion incision, the dissection of subperichondrial/subperiosteal tunnels, the mobilization via chondrotomy/osteotomy, the resection of cartilage/bone, the replantation of extracorporeally straightened material/reconstruction of the caudal nasal septum, closure by suture and fixation with nasal splints. Firmness of the caudal nasal septum is essential for sustainable septal surgery. It ensures the stability of the entire cartilaginous nose over decades.

Radikale Kieferhohlenoperationen galten bis in die 1990er-Jahre als Standardeingriff bei Erkrankungen der Kieferhohle, werden aber aufgrund der hohen Morbiditat nicht mehr favorisiert. Die „functional endoscopic sinus surgery“ (FESS) gilt heute als Goldstandard der Nebenhohlenchirurgie. Modifikationen der Zugangswege ermoglichen heute auch Zugange zu bisher schwierig erreichbaren Regionen der Kieferhohle. Je nach Anatomie und pathologischer Veranderung konnen unterschiedliche Arten der Erweiterung des Kieferhohlenostiums gewahlt werden. Bei der Sinusotomie Typ I wird das naturliche Ostium um maximal 1 cm nach dorsal erweitert. Die Sinusotomie Typ II beinhaltet eine Erweiterung des naturlichen Ostiums bis zu einem maximalen Durchmesser von 2 cm. Bei der Sinusotomie Typ III erfolgt eine Erweiterung des Ostiums nach dorsal bis zur Hinterwand des Sinus maxillaris und nach kaudal bis zum Ansatz der unteren Muschel. Als invasivere Zugange stehen neben dem pralakrimalen Zugang die mediale Maxillektomie, bei der die mediale Wand der Kieferhohle reseziert wird, und deren Modifikationen „mega antrostomy“ und „extended maxillary antrostomy“ zur Verfugung. Die richtige Wahl der Grose des Kieferhohlenfensters ist die Grundvoraussetzung fur eine erfolgreiche Therapie und fur den langfristigen postoperativen Erfolg. Isolierte purulente sinusitische Beschwerden der Kieferhohle konnen i. d. R. durch defensive Erweiterungen des Ostiums (Typ I) therapiert werden. Die Sinusotomie Typ II wird bei Polyposis nasi mit Beteiligung der Mukosa des Ostiums, rezidivierender Stenose nach Voroperation, chronischer Sinusitis maxillaris aufgrund zystischer Fibrose, eitriger Sinusitis maxillaris mit Beteiligung benachbarter Nebenhohlen eingesetzt. Eine Sinusotomie Typ III ist erforderlich bei Choanalpolypen mit Ansatz am Boden der Kieferhohle, ausgedehnter Polyposis und Pilzsinusitis sowie bei invertiertem Papillom. Vor allem bei (Rezidiv‑)Erkrankungen und ausgedehnten Interventionen in der Kieferhohle konnen die mediale Maxillektomie und deren Modifikationen erforderlich werden.

Introduction Nonsteroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (NERD) is defined by intolerance to cyclooxygenase 1 inhibitors, chronic rhinosinusitis with recurrent nasal polyps, and/or intrinsic bronchial asthma. Long-term administration of acetylsalicylic acid (ASA) after desensitization has been used to mitigate these sequelae, but the optimal dose and balancing symptom relief and side effects remain unsettled. Methods Retrospective data analysis of 85 patients with NERD receiving maintenance therapy of 300 mg ASA was followed by questionnaires (our own, not validated and the Sino-Nasal Outcome Test-20). We received responses from 55 patients and examined 30 of them clinically. Results Patients with no ASA-associated side effects were 56.4% (56 of 85 patients) of the cohort. In this study, 60% (33 of 55 patients) continued prophylaxis of 300 mg ASA daily for an average of 34.7 months. Elective surgery was the most frequent cause of discontinuation of ASA (21.8%; 12 of 55 patients). Rhinomanometry values were significantly improved with ASA ( P Conclusions Minor clinical improvements were identified. Side effects were well tolerated by most patients, and no serious sequelae occurred. The indications for long-term ASA therapy in NERD patients remain unsettled.

Aims: Angioedema is a rare side effect of angiotensin-converting enzyme (ACE) inhibitors. It remains unclear why it is only induced in a few patients taking ACE inhibitors, often after a long period of uneventful treatment. The aim of this study was to analyze the influence of ACE inhibitor treatment on C1-inhibitor (C1-INH) levels. Methods: Captopril (5 mg/25 mg) was added to blood samples of 5 healthy subjects. C1-INH levels were measured before and after incubation for 180 min. The second section of the study was done with 17 patients who received therapy with an ACE inhibitor for the first time. C1-INH levels were measured before ACE inhibitor treatment, 24 h after first drug administration, and 4 weeks later. Results: After incubation of blood samples with 5 mg captopril, there was no detectable change in C1-INH levels. After incubation with 25 mg, C1-INH activity was decreased by an average of 29% and the C1-INH concentration was decreased by an average of 0.06 g/L. In the second study section, inconsistent effects on C1-INH levels were detected. In the majority of patients, 24 h after the first ACE inhibitor administration C1-INH activity was tending to be increased. Conclusions: A dose-dependent effect on C1-INH levels in captopril-incubated blood samples of healthy test persons was shown. In patients with new ACE inhibitor treatment, heterogeneous reactions of C1-INH values were detected. Larger studies are needed over a longer period of time to find correlations between the effect of ACE inhibitor therapy on C1-INH levels and the clinical course/development of side effects.

Background Hereditary angioedema (HAE) is a rare genetic disorder that leads to recurrent development of mucosal and dermal swelling. It is mediated by bradykinin, and can affect virtually any part of the human body, including the gastrointestinal tract, the extremities, and the laryngeal and pharyngeal regions. Safe and potent drugs are available for acute and prophylactic treatment of HAE. Owing to its unspecific symptoms and unique manifestations, HAE is often misdiagnosed and treated incorrectly. Abdominal edema in particular can resemble appendicitis or cholecystitis, and is therefore often treated with unnecessary surgical procedures. We performed a questionnaire study to quantify this issue. Patients and methods We designed questionnaires for HAE patients and probands without HAE. The patient-control ratio was chosen at 1 : 2. Results Compared with the general population, HAE patients are subject to a significantly greater number of invasive diagnostic and therapeutic interventions. Our study showed that the HAE patients were 2.5 times more likely to undergo abdominal surgery (including gynecological and urological procedures) than the individuals without HAE (p = 0.007). The number of operations per patient correlated with the period (number of years) between the onset of symptoms and diagnosis (correlation coefficient 0.511; Spearman). Furthermore, twice as many appendectomies were performed on HAE patients (18.9 % vs. 37.7 %). Our results also showed that the HAE patients were 2.3 times more likely to undergo a gastroscopy than the control group without HAE (p = 0.003). Conclusions Patients with rare diseases such as HAE not only suffer from the effects of the disease itself. The conditions are often misdiagnosed for years owing to the general lack of knowledge about such diseases and unspecific manifestations. This leads not only to erroneous and ineffective treatment, but also to needless invasive diagnostic and therapeutic medical procedures. It is therefore important to increase the general knowledge and awareness of orphan diseases such as HAE with a view to improving diagnosis and treatment, minimizing the patients' suffering and enhancing their quality of life.

Tailor-made poly(α-methylstyrene)- and poly(4-methylstyrene)-block-poly(4-vinylpyridine) diblock copolymers with poly(4-vinylpyridine) as the minority component were synthesised via living anionic polymerisation. In bulk they show spherical or cylindrical microphases. From these block copolymers highly-ordered isoporous block copolymer membranes were prepared by combining block copolymer selfassembly and the nonsolvent induced phase separation process (SNIPS). The membrane properties were analysed by water flux and retention measurements. Due to the high glass transition temperatures of the major blocks these block copolymer membranes show a thermal stability up to 150 °C.

This performance study deals with isoporous ultrafiltration membranes made through a combination of self-assembly of amphiphilic block copolymers and the non-solvent induced phase separation process (SNIPS). Ten different polystyrene-b-poly(4-vinylpyridine) (PS-b-P4VP) diblock copolymers were used to prepare membranes with pore sizes increasing with the molecular weight of the polymers. The pore diameters of the membranes vary from 17 to 86 nm. Pure water permeances were studied with respect to pore sizes, P4VP content, thickness of the membranes and flux recovery after protein adsorption. Suitable working conditions were identified and rejection of poly(ethylene glycol) (PEG) molecules with molecular weights between 100 and 1000 kDa were carried out. The characteristics of PS-b-P4VP diblock copolymer membranes were compared with a commercially available polyethersulfone ultrafiltration membrane.

Membrane formation via the combination of self-assembly and the non-solvent induced phase separation (NIPS) process of diblock copolymers is investigated. Several polystyrene- block -poly(4-vinylpyridine) (PS- b -P4VP) diblock copolymers with different molecular weights and weight percentages of both blocks are tested under different parameters, leading to membrane surfaces with uniform pores of approximately 20–70 nm diameter. The average pore diameter is proved to be adjustable by changing the total molar mass of the block copolymer. The solution composition is an additional parameter controlling the structure formation. The purpose was to explore the upper and lower limits of the membrane structure formation by varying the molecular weight and the composition of the block copolymer. Scanning electron microscopy (SEM) is used to image the surface morphology and the homogeneity of the pore sizes. Primary results of water flux and retention are presented.

The formation of integral asymmetric membranes from ABC triblock terpolymers by non-solvent-induced phase separation is shown. They are compared with the AB diblock copolymer precursors. Triblock terpolymers of polystyrene-block-poly(2-vinylpyridine)-block-poly(ethylene oxide) (PS-b-P2VP-b-PEO) with two compositions are investigated. The third block supports the formation of a membrane in a case, where the corresponding diblock copolymer does not form a good membrane. In addition, the hydrophilicity is increased by the third block and due to the hydroxyl group the possibility of post-functionalization is given. The morphologies are imaged by scanning electron microscopy. The influence of the PEO on the membrane properties is analyzed by water flux, retention, and dynamic contact angle measurements.

Photoisomerization of a protein bound chromophore is the basis of the light sensing and signaling responses of many photoreceptors. Z-to-E photoisomerization of the Pr Cph1Δ2 phytochrome has been investigated by polarization resolved femtosecond visible pump-infrared probe spectroscopy, which yields structural information on the Pr excited (Pr*), Pr ground, and lumi-R product states. By exhaustive search analysis, two photoreaction time constants of (4.7 ± 1.4) and (30 ± 5) ps were found. Ring D orientational change in the electronic excited state to the transition state (90° twist) has been followed in real-time. Rotation of ring D takes place in the electronically excited state with a time constant of 30 ± 5 ps. The photoisomerization is best explained by a single rotation around C(15)═C(16) methine bridge in the Pr* state and a diffusive interaction with its protein surrounding.

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Double stimuli-responsive membranes are prepared by modification of pH-sensitive integral asymmetric polystyrene-b-poly(4-vinylpyridine) (PS-b-P4VP) diblock copolymer membranes with temperature-responsive poly(N-isopropylacrylamide) (pNIPAM) by a surface linking reaction. PS-b-P4VP membranes are first functionalized with a mild mussel-inspired polydopamine coating and then reacted via Michael addition with an amine-terminated pNIPAM-NH2 under slightly basic conditions. The membranes are thoroughly characterized by nuclear magnetic resonance (1H-NMR), Fourier transform infrared spectroscopy and X-ray-induced photoelectron spectroscopy. Additionally dynamic contact angle measurements are performed comparing the sinking rate of water droplets at different temperatures. The pH- and thermo-double sensitivities of the modified membranes are proven by determining the water flux under different temperature and pH conditions.

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