In conclusion, our endoscopic repair rate for sinonasal CSF leaks are good and compare well with the standards in the literature. Raised ICP is the most common reason for recurrent CSF leak after repair. Patients with a spontaneous CSF leak and evidence of raised ICP had a 46% failure rate. When consenting such patients for surgery, they must be informed of the lower success rate and that they may need additional procedures, including shunting.

Objective: To determine whether clinically determined Heberden's nodes (HN) and Bouchard's nodes (BN) are associated with underlying individual radiographic changes of osteoarthritis (OA). Methods: 232 index patients with symptomatic large joint and/or hand OA, and 257 of their first degree relatives were included. HN were graded 0-2; BN were scored as present/ absent. Joint space narrowing (JSN) and osteophyte (OST) were each scored 0-3 using the OARSI atlas. A weighted k test was used to examine intraobserver reproducibility. Odds ratio (OR) was estimated for the relationship between nodes and associated JSN and OST. Results: The adjusted OR of HN for underlying JSN in the same digit was 1.72 (95% CI 1.47 to 2.02), whereas for OST it was higher at 5.15 (95% CI 4.37 to 6.08). A similar trend was seen with BN and underlying OA, with OST having a higher OR (OR = 2.98, 95% CI 2.55 to 3.47) than JSN (OR = 1.62, 95% CI 1.37 to 1.91). Conclusion: There is a positive relationship between HN/BN and underlying radiographic changes of OA, especially OST. Nodes do appear to link pathologically to OA in interphalangeal joints. H eberden's nodes (HN) and Bouchard's nodes (BN) are firm swellings over the superolateral and dorsal aspects of distal and proximal interphalangeal joints respectively.1 2 Despite their prevalence the pathogenesis of nodes remains unclear, although bony outgrowth 3 and endochondral ossification of marginal hypertrophic fibrocartilage 4 5 are implicated in their aetiology. Nevertheless, it is widely held that nodes are associated with hand osteoarthritis (OA), [5][6][7] that they are a marker for systemic predisposition to generalised OA, 6 7 and that they reflect the presence of underlying osteophyte (OST).4 5 However, the link between HN and underlying interphalangeal OA has been questioned in one study of middle-aged female twins, 8 in which a poor correlation was found between HN and underlying radiographic OST, assessed on a 0-3 scale using a radiographic atlas. 9 In contrast, a more recent study 10 of 71 subjects with hand OA showed a reasonable correlation between HN and radiographic OA in the corresponding joint, assessed using the global Kellgren and Lawrence scale.11 Thus the postulated association between nodes and underlying OA is in doubt.We therefore undertook a cross sectional study of women and men with HN to determine whether nodes are associated with radiographic OA of the corresponding joint. Unlike previous studies 8 10 we assessed individual radiographic features of OST and joint space narrowing (JSN) and investigated the influence of sex, age, and body mass index (BMI) on the relationship. METHODS ParticipantsThe study was approved by the local research ethics committee. Participants were patients referred to a hospital rheumatology clinic because of symptomatic large joint and/ or hand OA, together with their first degree relatives, who were identified for a nodal OA genetic study. 12 Cross sectional data on these participants were collected.Clinical and radiographic assessm...

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