Post-lumbar puncture headache (PLPHA) and spontaneous hypoliquorrheic headache are both associated with low spinal fluid pressure. A dull or throbbing occipital ache characteristically worsened by sitting or standing and eased by lying down is peculiar to both. Additional symptoms and signs may accompany the headache. In PLPHA the pain is triggered by leakage of cerebrospinal fluid through the dural rent, but the cause of the pain is probably due to intracranial arterial and venous dilatation. The same mechanism probably applies to spontaneous hypoliquorrheic headache in which the site of leakage is rarely found. The majority of cases subside without treatment over several days. Those that persist may be treated with epidural blood patch or saline infusion with good results. A simple, innocuous, yet underutilized form of treatment is caffeine sodium benzoate. This review will discuss the incidence, pathogenesis, prevention and treatment of these headaches.
Hip MR arthrography with leg traction is a technically feasible and safe procedure that improves visualization of the femoral and acetabular cartilage surfaces.
The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
CT arthrography (CTa) and MR arthrography (MRa) are useful tools for the investigation of intra-articular hip disease. They are minimally invasive techniques with a very low rate of complications and can be performed safely. CTa or MRa can be performed after an intra-articular injection of diluted contrast, but both techniques can also be performed after a single injection. As radiologists we should be able to address the surgeon's questions and work together to standardize terminology and classifications systems for accurate reporting. This update emphasizes radiological findings with a clinical perspective. CTa and MRa allow the precise diagnosis of labral tears, loose bodies, and intra-articular ligaments (capsular and ligamentum teres). The use of careful technique and a tailored protocol has improved our ability to detect and describe cartilage lesions. This is essential because knowledge of the status of the cartilage may dictate a specific surgical approach, and when cartilage lesions are extensive, they are a negative prognostic indicator for arthroscopic treatment.
Laryngeal ultrasound is a nonirradiating, noninvasive method for assessing the upper airway in children. This systematic review and meta-analysis examine available evidence for accuracy of laryngeal ultrasound in diagnosing vocal cord immobility in infants and children after surgery and trauma affecting the vocal cords. DESIGN:Medical subject heading terms were used to search MEDLINE, Embase, Google Scholar, Web of Science, and the Cochrane Library for relevant citations. Publications from January 1, 2000, to June 30, 2020 were included in the search strategy. Study inclusion criteria consisted of randomized control trials and nonrandomized retrospective or prospective observational studies where vocal cord motion was evaluated by laryngeal ultrasound and compared with a reference test. Studies were excluded if there was insufficient data to compute a sensitivity/specificity table. Case reports, case series less than 10, and manuscripts not published in English were also excluded. PATIENTS:Studies which included subjects younger than or equal to 18 years were considered for full article review. SETTINGS:No restrictions on study settings were imposed in this systematic review. MEASUREMENTS AND MAIN RESULTS:The initial search returned 1,357 citations. After de-duplication, abstract, and full review, eight citations were included in the final meta-analysis. A bivariate random-effects meta-analysis was performed, which revealed a pooled sensitivity for laryngeal ultrasound in detecting vocal cord immobility of 91% (95% CI, 83-95%), specificity of 97% (95% CI, 82-100%), diagnostic odds ratio 333.56 (95% CI, 34.00-3,248.71), positive likelihood ratio 31.58 (95% CI, 4.50-222.05), and negative likelihood ratio 0.09 (95% CI, 0.05-0.19). CONCLUSIONS:Laryngeal ultrasound demonstrates high sensitivity and specificity for detecting vocal cord motion in children in a wide range of clinical settings. Laryngeal ultrasound offers a low-risk imaging option for assessing vocal cord function in children compared with the current gold standard of laryngoscopy.KEY WORDS: cardiac surgery; dysphonia; point-of-care ultrasound; vocal cord dysfunction; vocal cord paralysis V ocal cord paralysis is the second most common cause of stridor in children (1). In addition to congenital anomalies which can impact vocal cord function (1), vocal cord paralysis is a well-known complication of cervical and thoracic surgery, trauma, and prolonged intubation (2-4). Current
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