[Rhinocerebral Mucormycosis]. / Rhinocerebrale Mucormykose.

Mucormycosis is a rare but serious type of fungal infection, which can progress rapidly especially in immunsupressed patients.We report about a 47 year old female patient with ptosis on the left eye. The ophthalmological report offered no further pathologic findings. Diabetes mellitus was known and the blood sugar value was very high.A computed tomography of the paranasal sinuses showed a shadow in the ethmoid bone and in an additonally performed MRI-scan, an increase of orbital fat and an extension of the ocular muscle were visible.As the patient lost her ability o look above, an operation of the paranasal sinus was done.The microbial results revealed a Mucormycosis (Lichtheimia). As the patient went blind in the further course, indication for orbital exenteration on the left side and revision of the paranasal sinus was given. High doses of Liposomal Ampthotericin B and Posaconazol were given and blood sugar was monitored very strictly. MRI-scans revealed a further progression of the infection and required additional surgeries and a dura resection accompanied by complications like recurrent septical episodes, renal insufficiency, a bifrontal epidural hematoma and multiple cerebral microinfarcts that impeded the recovery of our patient in the further course. After 8 months she was able to leave the hospital, an epithesis was adjusted and she is without a relapse for 24 month since the diagnosis.

[Reduction of post-surgical pain by Manual Medicine following tonsillectomy in adults]. / Reduktion postoperativer Schmerzen durch Manuelle Medizin bei Erwachsenen nach Tonsillektomie.

Objective Postoperative pain after tonsillectomy (TE) can usually be treated sufficiently by non-steroidal anti-inflammatory drugs (NSAIDs). In some patients, however, postoperative pain is more prominent on one side of the neck. Our clinical experience has demonstrated that these patients often show a segmental hypomobility of the upper cervical joints that can be successfully treated by manual medicine (MM). The analgetic effectiveness of this treatment was investigated in a prospective, randomized, placebocontrolled, single-blind study. Material and Methods 52 adults with exceptionally strong (visual analog scale VAS > 4) and/or unilateral pain after TE (between day 1 and 4) were included in this study. Postoperatively (TE) pain scores were immediately evaluated by VAS before (t0) and after (t1) the treatment (MM) as well as 4 hours (t2) and 1 day later (t3). Results Results show a significantly higher reduction in pain in the verum group compared to the placebo group (t1: p = 0.012, t3: p = 0.012, both Bonferroni-adjusted). The difference to t2 was not significant (p = 0.54 Conclusion This study has demonstrated effective pain reduction by manual medicine in adults with exceptionally strong and/or unilateral pain after TE and cervical hypomobolity.