Manifestation of migraine in adolescents: Does it change in puberty?

PURPOSE: To analyze the association between pubertal stage, menstrual cycle and migraine attacks in girls with migraine. In addition, headache frequency, accompanying symptoms, duration and onset in relation to the specific phase of the cycle were investigated. METHODS: Girls between 7 and 18 years old, diagnosed with headaches that met "International Classification of Headache Disorders II" diagnostic criteria for migraine without aura, kept a daily headache and menstrual cycle diary over 8 weeks. Ovulatory cycles were identified by weekly progesterone saliva tests. RESULTS: 47 girls participated in the study and were divided into three groups according to Tanner stage and onset of regular menstruation: pre- (n = 16), peri- (n = 19) and post-pubertal (n = 12). A significant difference in migraine frequency was found between pre- and post-pubertal girls (p = 0.005). No significant differences with regard to headache characteristics were detected. Interestingly, a higher frequency of attacks in follicular phase occurred compared to luteal phase in peri- and post-pubertal girls (p = 0.030). CONCLUSION: During puberty, migraine patterns in girls change to a typical adult pattern of migraine in a stepwise manner not clearly related to menarche. The first sign of this transition phase could be the higher frequency of migraine attacks in post-pubertal girls.

Transesophageal echocardiography and clinical features of fat embolism during cemented total hip arthroplasty. A randomized study in patients with a femoral neck fracture.

Forty patients suffering from a medial femoral neck fracture participated in a prospective, randomized study. In 20 patients, the femoral component was cemented using a contemporary technique. In the patient group operated on with the bone vacuum technique, the medullary cavity was drained during the insertion of the stem. The proximal draining hole was placed in the intertrochanteric region, along the prolongation of the linea aspera. The distal hole was placed 2 cm below the tip of the femoral component. Embolic phenomena were documented intraoperatively by continuous transesophageal echocardiographic imaging of the right atrium and ventricle. The clinical relevance of the emboli was noted simultaneously by recording hemodynamic and blood gas parameters. Patients of the control group showed severer and longer-lasting episodes of embolism than patients of the bone vacuum group. Ongoing emboli were first seen during the injection of the cement, and continued during stem insertion. Massive emboli of small particles could be verified in 19 patients (95%) of the control group and in 1 patient (5%) of the bone vacuum group (P < 0.05). During massive emboli, a distinct decrease in the arterial oxygen saturation and the end-expiratory carbon dioxide level was observed. The calculated average pulmonary shunt volume showed an increase after the insertion of the stem using the contemporary technique (36.5%; P < 0.05). These distinct hemodynamic changes were not observed in the bone vacuum group. This study was able to show a clearly reduced risk of pulmonary emboli using the bone vacuum cementing technique. The presence of pre-existing disease greatly magnified the clinical relevance of fat embolism.

Relevance of the drainage along the linea aspera for the reduction of fat embolism during cemented total hip arthroplasty. A prospective, randomized clinical trial.

The aim of this study was to assess the relevance of drainage placed along the linea aspera for the prevention of fat embolism and cardiopulmonary impairment during the insertion of a cemented stem. We studied 40 patients with coxarthrosis randomly allocated to total hip arthroplasty with proximal drainage or without it. The venting hole for the drainage of the medullary cavity was placed posteriorly, between the greater and the smaller trochanter, in the prolongation of the linea aspera. The heart was monitored intraoperatively by a echocardiography probe positioned in the patient's oesophagus. During the operation we monitored the hemodynamics and blood gas values. Severe embolic events were observed in 85% of the control group and in 20% of the drainage group (P = 0.01). Embolism occurred during the insertion of the femoral component and continued after reduction of the hip joint. After major embolism, the pulmonary shunt values increased significantly in the control group (+22.7%), but there were no marked changes in the drainage group (+7.1%). The logical therapeutic measure to avoid intravasation of bone marrow, fat, and bone debris during the insertion of the femoral component is to prevent the rise of intraosseous pressure. The drainage of the venous system located along the linea aspera significantly reduces the risk of intraoperative embolism and cardiopulmonary impairment.