Sphenoid sinus fungall ball: a retrospective study over a 10- year period.

A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease.

[Physiotherapy for the recreational athlete]. / Physiotherapie beim Freizeitsportler.

Physiotherapy plays a significant role in the treatment of sport injuries and can be especially adapted for this purpose. The physiotherapist has two tasks: 1. As a therapist treating a well defined pathologic entity or functional deficit. 2. Instructing the patient in further self-treatment and appropriate measures, behavioral changes and preventive approaches. The therapeutic emphasis is presented in seven interdependent groups: pain/swelling, flexibility, strength, coordination, endurance, psychological measures, preventive measures. The aim of treatment is to resume training activities. For each group there is a description of clinical symptoms, diagnosis according to functional tests and recommended treatment measures. The therapy group(s) and their priorities should be listed when making an individual therapeutic decision.

[How much strength is needed for fitness?]. / Wieviel Kraft braucht die Fitness?

In order to tolerate the exertion in fitness exercise in the long term a sufficiently strong trunk musculature should be aimed at. In order to stabilize and balance the trunk and the pelvis there should be an optimal interaction of the muscles of the abdomen, the lateral trunk, the back and the flexors and extensors of the hip. If that balance is disrupted, muscular imbalance and a weakening or shortening of the muscles involved can occur. That imbalance leads to inadequate and excessive strain of the functional system of spine and pelvis. The functional anatomy of the trunk is described with clinical references in order to elucidate this context. A program of strength and stretching exercises for the trunk is presented suited to the needs of those practicing fitness exercise.

[General muscle rehabilitation practice]. / Praxis der muskulären Rehabilitation.

This article presents a five-step approach to the rehabilitation of sports injuries. (1) pain management; (2) specific exercise instruction for treatment of localized functional disturbances/motion restrictions; (3) training therapy to increase localized and general physical performance; (4) patient education and instruction of an individualized home/gym program and for precautions and injury prevention; and (5) enhancement of psychological performance. Described are the negative sequelae of a sports-related injury or immobilization after surgery on joints, bones and circulatory system, with particular emphasis of the effects on the involved musculature. The negative impact of an injury on generalized physical performance is presented (deconditioning syndrome). The course of rehabilitation requires a specific functional diagnosis, so as to implement an individualized treatment plan. Regular and objective follow-up/monitoring is suggested within the context of projected goals. The specific steps are described. Pain and discomfort can impede the restoration process and must be addressed effectively. Even though many questions remain to be answered in the field of muscular rehabilitation, the present day knowledge coupled with successful empirical interventions allow the introduction of effective and efficient rehabilitation concepts.