[Travelling to High Altitude Destinations after Recovery from COVID-19-infection: New Aspects of Medical Advice in Altitude Medicine]. / Aufenthalte in großen Höhen nach COVID-19-Infektion − neue Aspekte der höhenmedizinischen Beratung.

After loosening of travel restrictions due to the COVID-19 pandemic, tourism to high-altitude destinations over 2500 metres is expected to increase again.In line with this trend, it can be expected that patients after recovery from COVID-19 infection will seek advice from specialists on altitude or travel medicine before travelling to high altitudes.Here, the physician on altitude medicine is faced with major challenges, as such a question has not been raised so far.In addition to the basics of altitude sickness and high altitude pulmonary edema, this article deals with the current studies on pulmonological pathologies and disease course of COVID-19 infections and, in accordance with the current state of knowledge, provides recommendations for advice in altitude medicine for patients after COVID-19 infection.

Bone-anchored hearing aids and chronic pain: a long-term complication and a cause for elective implant removal.

OBJECTIVES: To report a case series of elective removal of bone-anchored hearing aid implants, and reasons for removal. DESIGN: Retrospective review of a prospectively collected database. SETTING: Two tertiary referral centres in the Manchester area: Manchester Royal Infirmary and Salford Royal University Hospital. PARTICIPANTS: A series of 499 adults and children who had undergone a total of 602 implant insertions (1984-2008). MAIN OUTCOME MEASURES: Implant removal rates, and reasons. RESULTS: Twenty-seven of the 602 implants (4.5 per cent) required removal. Of these, 12 were due to pain (2.0 per cent), seven to persistent infection (1.2 per cent), three to failure of osseointegration (0.5 per cent), three to trauma (0.5 per cent) and two to other reasons (0.4 per cent). CONCLUSION: Chronic implant site pain represents the main reason why implants are removed electively, and affects 2 per cent of all implants. This complication has important medico-legal implications and should be discussed when obtaining informed consent for implantation.

Coblation of rhinophyma.

INTRODUCTION: Rhinophyma is a disfiguring hypertrophy of the skin of the tip of the nose. OBJECTIVE: To assess the new technique of coblation of rhinophyma. STUDY DESIGN: Case series of six patients. RESULTS: All patients had a good cosmetic result. Comparison with existing techniques showed advantages due to the lower tissue temperature involved. CONCLUSION: Coblation of rhinophyma is an effective treatment with few side effects.

Complications of bone-anchored hearing aid implantation.

INTRODUCTION: Bone-anchored hearing aid implantations have been performed in Manchester for over 20 years. This study examined a range of variables that can occur during the implantation process, and the effect they may have on successful outcome. METHOD: Retrospective study and literature review. LOCATION: Tertiary referral centre in central Manchester. RESULTS: Details of 602 bone-anchored hearing aid implantation procedures were retrieved from the departmental database. The overall complication rate was 23.9 per cent. The rate of revision surgery was 12.1 per cent. CONCLUSION: This study involved a significantly larger number of patients than any previously reported, similar study. Possible reasons for differences in outcomes, and recommendations for best practice, are discussed.

Angioedema of the airway: an unusual case.

We report a case of angioedema caused by angiotensin-converting enzyme inhibitor and topical lignocaine spray, administered during nasendoscopy. Angioedema induced by angiotensin-converting enzyme inhibitors is a rare but well known entity. Allergy to topical lignocaine has been acknowledged as a rare phenomenon when used for dental surgery and for skin anaesthesia, but it has not previously been reported after topical administration prior to nasendoscopy. In the reported case, our patient was unfortunate enough to be allergic to both lisinopril and lignocaine. The result was life-threatening airway obstruction, and the continued use of lignocaine spray sustained the laryngeal oedema. We advise that patients are asked about any and every allergy--specifically, any previous problems with dental procedures--before administration of local anaesthetic spray to the upper aerodigestive tract.

Osteocartilaginous choristoma: a case report.

A choristoma is a benign tumour-like mass consisting of mature tissue derived from one or more germ cell layers that are foreign to the site at which they are located. Choristomas of the pharynx are rare with few cases being reported in the English literature. Management of these lesions is usually complete surgical excision. We report a case of osteocartilaginous choristoma arising from the pharynx.

Evaluation of the dissemination of active support training in staffed community residences.

Our aim was to replicate Active Support, a staff training intervention designed to increase the assistance given to adults with severe mental retardation living in community residences in order to increase their participation in activities. Training was conducted in 38 residences, involving 303 staff members and 106 persons with mental retardation. Active Support resulted in significant increases in assistance and engagement in activity. Significant correlations between participant abilities, receipt of assistance, and levels of engagement were found. Active Support was found to be of greater benefit to people with lower adaptive behavior and to have a diminishing value for people with higher adaptive behavior, implying that its implementation should be matched to the support needs of residents.

Development of a relocatable frame technique for gamma knife radiosurgery. Technical note.

OBJECT: One of the limiting factors in gamma knife radiosurgery is the restriction to one treatment imposed by the fixed stereotactic frame. The ability, in selected cases, to remove the frame and replace it on a subsequent occasion in the same location would facilitate fractionated treatments and provide flexibility in the timing of treatment delivery. It is the purpose of this work to investigate techniques for frame fixation and for essential verification of frame position once it has been reapplied. METHODS: A technique is proposed that requires four surgical self-tapping screws to be inserted into the skull. Aluminum pins are inserted through the frame pillars and are tightened against the head of the screws, providing a firm fixation of the frame. Pin lengths are recorded on gauges to ensure reproducibility of the position. In phantom tests, test objects were localized (using the angiographic localizer) before and after each of five frame removal/reapplications to test the reproducibility of frame position. The mean error in the observed target coordinates was 0.3 mm and the maximum error observed was 0.7 mm, indicating that the frame can be reapplied with some confidence. Repetition of bubble skull measurements has been investigated as a means of verifying that the frame was repositioned correctly; however, reproducibility of patient measurements was found to be poor even when no frame movement had occurred. In contrast, the use of a radiotherapy simulator to obtain repeated lateral and anteroposterior projections of the head was shown to be capable of detecting frame movements of as little as 1 mm. CONCLUSIONS: Using this technique of frame application facilitates the reapplication of the frame with an accuracy of plus or minus 0.7 mm. Bubble measurements are inadequate for the detection of frame movement. Simple techniques in which a radiotherapy simulator is used can verify correct frame placement and indicate frame movements of less than 1 mm.

[Pharmacokinetics in newborns and infants]. / Pharmakokinetik bei Neugeborenen und Säuglingen.

Physiologic changes influence the pharmacokinetics of drugs relevant to anesthesia in neonates and infants. The neonatal phase is the phase of life with the most rapid and dramatic changes of organ-functions responsible for pharmacokinetics of most anesthetics. Changes in body composition and the content of plasma proteins influence volume of distribution, the drug distribution to different compartments and the amount of free fraction in plasma. Due to the immaturity of hepatic microsomal enzyme systems there is a decreased metabolism particular of agents which undergo low hepatic extraction like Diazepam, Morphine or some local anesthetics. In the first year of life capacity of the enzymatic systems increases and also clearance increases. Until puberty the clearance of some drugs is greater than the adult level. There are also pharmacodynamic changes like modified sensitivity to some drugs like volatile anesthetics or neuromuscular blocking agents. In summary neonates and infants are a highly heterogenous group with large interindividual differences. Therefore the dosage of anesthetic agents must be individualized to achieve optimal pharmacodynamic effects without toxicity in this age group.

[Pharmacokinetics from the viewpoint of the clinical anesthetist]. / Pharmakokinetik aus der Sicht des klinisch tätigen Anästhesisten.

Pharmacokinetics describes the time-depend course of plasma concentration of a drug. Pharmacodynamics describes the pharmacological effect of the substance. Both together form the pharmacological model used in clinical practice. The global descriptors total clearance Cltot, volume of distribution Vd, and half-life t1/2 allow for a first good approximation of drug delivery and a characterisation of drugs. Unwanted side-effects such as inadequate anaesthesia or prolonged recovery periods may be explained. The main clinical use of pharmacokinetics is to sustain dosing schemes based on scientific data. It also may be helpful in creating new administration schemes especially for continuous infusion of intravenous hypnotics or analgetics. New developments such as Target-Controlled Infusion (TCI) are based on pharmacokinetic data and computations and may be an improvement for the clinically working anaesthetist.

Rotavirus-induced fusion from without in tissue culture cells.

We present the first evidence of fusion from without induced in tissue culture cells by a nonenveloped virus. Electron micrographs of two strains of rotavirus, bovine rotavirus C486 and rhesus rotavirus, show that virally mediated cell-cell fusion occurs within 1 h postinfection. Trypsin activation is necessary for rotavirus to mediate cell-cell fusion. The extent of fusion is relative to the amount of virus used, and maximum fusion occurs between pHs 6.5 and 7.5. Fusion does not require virus-induced protein synthesis, as virus from both an empty capsid preparation and from an EDTA-treated preparation, which is noninfectious, can induce fusion. Incubation of rotavirus with neutralizing and nonneutralizing monoclonal antibodies before addition to cells indicates that viral protein 4 (VP4; in the form of VP5* and VP8*) and VP7 are involved in fusion. Light and electron micrographs document this fusion, including the formation of pores or channels between adjacent fused cells. These data support direct membrane penetration as a possible route of infection. Moreover, the assay should be useful in determining the mechanisms of cell entry by rotavirus.

A longitudinal psychopathological schedule.

A schedule is described for rating the symptoms of mental illness over a period of time which includes several episodes. The reliability was measured in a study involving six raters. The sources of information required were studied, in 20 patients, by comparing an interview with the patient, a similar interview with an informant and an analysis of the case records. A synopsis of interview and record data are necessary to obtain adequate information about longitudinal psychopathology and 'lifetime' diagnosis.

Schizophrenia, bipolar disorder and depression. A discriminant analysis, using 'lifetime' psychopathology ratings.

Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness has been made. DSM-III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a 'schizodepressive continuum', but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.

Changing face of treatment of peritonsillar abscess.

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches. The patients ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow-up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis. The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.