Rhinocerebral mucormycosis after functional endoscopic sinus surgery: A case report.

RATIONALE: Mucormycosis is a rare fungal infection which mainly develops in compromised hosts and the associated mortality rate is high. PATIENT CONCERNS: We report a case of mucormycosis in a 59-year-old woman following routine endoscopic sinus surgery. The patient had a history of diabetes mellitus (DM) and bronchial asthma. DIAGNOSES: On follow-up 4 weeks after the first functional endoscopic sinus surgery (FESS), she complained of a severe headache and was readmitted for a second period. Endoscopic examination revealed bony erosion and a whitish discharge on the left middle turbinate, which was confirmed as mucormycosis by endoscopic biopsy. INTERVENTIONS: Endoscopic debridement of the necrotic tissue and middle turbinectomy were performed and the patient was treated with intravenous amphotericin B for 3 months (3.5 mg/kg/day). OUTCOMES: About 1 month into the second period of hospitalization, left Bell's palsy had occurred. The facial palsy improved naturally after 2 months of hospitalization. One year after endoscopic debridement, follow-up endoscopy showed that there was no residual lesion. CONCLUSION: This is the first report of mucormycosis after routine endoscopic sinus surgery. We did not miss headache symptom after FESS surgery, and diagnosed mucormycosis through early endoscopic biopsy, which played an important role in curing the patient. In addition to the importance of medical therapy such as DM control for patients, emotional support and psychiatric treatment are also important factors as these patients require hospitalization for a long period, 3 months in the case of this patient.

Medical therapy of maxillary sinus inflammatory myofibroblastic tumors.

Inflammatory myofibroblastic tumor (IMT) in the maxillary sinus is a diagnostic challenge. As IMT has various names, it has various findings in magnetic resonance image. Although destructive pattern in computed tomography and hypermetabolism in PET CT suggest malignancy, it is debatable whether it is a tumor or inflammatory lesion. Treatment of IMT usually includes surgery. However, IMT can be dealt with medical treatment according to histologic type and localization. We report a rare case of IMT in the maxillary sinus which is controlled by medical therapy.

The effect of progressive task-oriented training on a supplementary tilt table on lower extremity muscle strength and gait recovery in patients with hemiplegic stroke.

The purpose of this study was to determine the influence of progressive task-oriented training on a supplementary tilt table on the lower extremity (LE) muscle strength and spatiotemporal parameters of gait in subjects with hemiplegic stroke. Thirty subjects between three and nine months post stroke were included in this study. Thirty subjects were randomly allocated to a control group (CG, n1=10), experimental group I (EG1, n2=10), and experimental group II (EG2, n3=10). All of the subjects received routine therapy for half an hour, five times a week for three weeks and additionally received training on the following three different tilt table applications for 20min a day: (1) both knee belts of the tilt table were fastened (CG), (2) only the affected side knee belt of the tilt table was fastened and one-leg standing training was performed using the less-affected LE (EG1), and (3) only the affected side knee belt of the tilt table was fastened and progressive task-oriented training was performed using the less-affected LE (EG2). The effect of tilt table applications was assessed using a hand-held dynamometer for LE muscle strength and GAITRite for spatiotemporal gait data. Our results showed that there was a significantly greater increase in the strength of all LE muscle groups, gait velocity, cadence, and stride length, a decrease in the double limb support period, and an improvement in gait asymmetry in subjects who underwent progressive task-oriented training on a supplementary tilt table compared to those in the other groups. These findings suggest that progressive task-oriented training on a supplementary tilt table can improve the LE muscle strength and spatiotemporal parameters of gait at an early stage of rehabilitation of subjects with hemiplegic stroke.

Effects of motor imagery training on balance and gait abilities in post-stroke patients: a randomized controlled trial.

OBJECTIVES: To investigate the effects of motor imagery training on the balance and gait abilities of post-stroke patients. DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation centre. SUBJECTS: Twenty-eight individuals with chronic stroke. INTERVENTIONS: The experimental group (n = 15) performed motor imagery training involving imagining normal gait movement for 15 minutes embedded in gait training for 30 minutes (45 minutes/day, 3 times/week); the control group (n = 13) performed gait training only (30 minutes/day, 3 times/week). MAIN MEASURES: Balance and gait abilities were measured by the Functional Reach Test, Timed Up-and-Go Test, 10-m Walk Test and Fugl-Meyer assessment before and after interventions. RESULTS: All measurements improved significantly compared with baseline values in the experimental group. In the control group, there were significant improvements in all parameters except the Fugl-Meyer assessment. All parameters of the experimental group increased significantly compared to those of the control group as follows: Functional Reach Test (control vs. experimental: 28.1 ± 3.1 vs. 37.51 ± 3.0), Timed Up-and-Go Test (20.7 ± 4.0 vs. 13.2 ± 2.2), 10-m Walk Test (17.4 ± 4.6 vs. 16.0 ± 2.7) and Fugl-Meyer assessment (12.0 ± 2.9 vs. 17.6 ± 1.3). CONCLUSIONS: Gait training with motor imagery training improves the balance and gait abilities of chronic stroke patients significantly better than gait training alone.

Ascending pathways for mechanical allodynia in a rat model of neuropathic pain.

To determine what the routes by which mechanical allodynia is transmitted following peripheral nerve injury, we assessed the effects of the dorsal column (DC) lesion performed before and 2 weeks after the partial injury of nerves innervating the tail on mechanical allodynia. Ipsilateral DC lesion 2 weeks after neuropathic surgery significantly, but not completely, attenuated mechanical allodynia. In addition, the DC lesion before peripheral nerve injury did not prevent the generation of mechanical allodynia, which was completely blocked by subsequent contralateral hemisection of the spinal cord. However, unlike mechanical allodynia, DC lesion did not change thermal allodynia. These results suggest that the signals for mechanical allodynia following peripheral nerve injury are transmitted via the ipsilateral DC and the contralateral pathway(s).