Pediatric Posterior Sternoclavicular Dislocation Closed Reduction and Management.

SUMMARY: Posterior sternoclavicular joint (SCJ) dislocations are rare shoulder girdle injuries. Despite the paucity of cases, posterior SCJ dislocations pose an important threat to patient safety because of the proximity of the medial clavicle to the mediastinum, resulting in possible compression and/or injury to these structures. Current guidelines recommend attempting closed reduction in the acute setting followed by open reduction if closed reduction is unsuccessful. This video highlights a case of posterior SCJ dislocation in a pediatric patient who presented with dyspnea after a football injury.

Tissue resonance analysis; a novel method for noninvasive monitoring of intracranial pressure. Technical note.

A number of noninvasive methods used to measure intracranial pressure (ICP) have been proposed in the literature. For a variety of reasons, however, none of these have displayed significant practical applicability. The authors describe their development of a new, computerized, portable device based on tissue resonance analysis (TRA) technology for the noninvasive monitoring and measurement of ICP. In response to the heart beat, the soft tissue and fluid compartments of the brain each exhibit characteristic vibration and mechanical resonant responses that radiate through the organs and tissues of the body. Patterns of vibration and mechanical resonance of various body organs and tissues are different and provide the possibility of extracting new and specific information in a noninvasive fashion. According to the TRA approach, ICP is dependent on the value of the dominant secondary (mechanical) resonance level of brain tissue. By digitally processing a reflected ultrasound signal (by using a concave ultrasonography probe with a carrier frequency of 1 MHz) from the third ventricle, the authors obtained a digital high-resolution echopulsogram, which visually is equivalent to ICP waves that are obtained invasively. The fast Fourier relationship of electrocardiogram and echopulsogram waves allowed the derivation of the secondary mechanical resonance levels. The authors developed a formula for a quantitative, noninvasive measurement of ICP, which uses information regarding multiple components of the intracranial space-both mechanical (secondary resonance) and physiological (time required for transfer of arterial blood to venous blood through brain tissue)-and the relationship between these components. A comparison of invasive and noninvasive ICP measurements was made during blinded trials in 40 patients with various diseases of the central nervous system, and ranges of ICP were measured from I to 66 mm Hg. The ICP values obtained using the two methods were highly correlated (r = 0.99), without a statistically significant difference between simultaneously obtained readings (p = 1). By using an integrative approach that reflects all components of the intracranial compartment, TRA allows for accurate noninvasive recordings of ICP. This method has significant advantages over other noninvasive technologies reported to date.