Medicine Hack

Each muscle fibre is closely surrounded by connective tissue. This acts as a support for the muscle fibres and unites them to each other. 1) Each muscle fibres is surrounded by delicate connective tissue that is called the endomysium . 2) Individual fasciculi are enclosed by a stronger sheath of connective tissue called the perimysium . 3) The entire muscle is surrounded by connective tissue called the epimysium . This is illustrated by the schematic diagram below. 1= perimysium, 2= endomysium, 3= fasciculus. At the junction of a muscle with a tendon, the fibres of the endomysium, the perimysium and the epimysium become continuous with the fibres of the tendon. First published on: 27 December 2016

  DEFINITION  Chronic sinusitis refers to inflammation the paranasal sinuses for a period of at least 12 weeks. The most important cause of chronic sinusitis is failure of acute infections to resolve.   PATHOPHYSIOLOGY  Acute infection destroys the normal ciliated epithelium, thus impairing drainage from the sinuses. There is pooling and stagnation of secretions in the sinuses which favours infections. Persistence of infection causes mucosal changes, such as loss of cilia, edema and polyp formation. We eventually have a vicious cycle.   CLINICAL FEATURES  Patients may complain of blocked nose, runny nose, headache and a reduced sense of smell (hyposmia). Foul-smelling discharge suggests anaerobic infection. Some people will also have nasal polyps.   TREATMENT  1) We should always search for underlying aetiological factors which obstruct sinus drainage and ventilation. 2) A work-up for nasal allergy may be required. 3) Culture and sensitivity of sinus discharge helps in t