Background Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta‐analysis has investigated the effectiveness of SMT exclusively for CGHA. Objective To evaluate the effectiveness of SMT for CGHA. Databases and Data Treatment Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk‐of‐bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow‐up periods. GRADE described the quality of evidence. Results Seven trials were eligible. At short‐term follow‐up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] −10.88 [95% CI, −17.94, −3.82]) and small effects for pain frequency (standardized mean difference [SMD] −0.35 [95% CI, −0.66, −0.04]). There was no effect for pain duration (SMD − 0.08 [95% CI, −0.47, 0.32]). There was a significant, small effect favouring SMT for disability (MD − 13.31 [95% CI, −18.07, −8.56]). At intermediate follow‐up, there was no significant effects for pain intensity (MD − 9.77 [−24.21 to 4.68]) and a significant, small effect favouring SMT for pain frequency (SMD − 0.32 [−0.63 to − 0.00]). At long‐term follow‐up, there was no significant effects for pain intensity (MD − 0.76 [−5.89 to 4.37]) and for pain frequency (SMD − 0.37 [−0.84 to 0.10]). Conclusion For CGHA, SMT provides small, superior short‐term benefits for pain intensity, frequency and disability, but not pain duration, however, high‐quality evidence in this field is lacking. The long‐term impact is not significant. Significance CGHA are a common headache disorder. SMT can be considered an effective treatment modality, with this review suggesting it providing superior, small, short‐term effects for pain intensity, frequency and disability when compared with other manual therapies. These findings may help clinicians in practice better understand the treatment effects of SMT alone for CGHA.

Mixed adenoneuroendocrine carcinomas, spindle cell carcinomas, and clear cell carcinomas are all rare tumors in the biliary tract. We present the first case, to our knowledge, of an extrahepatic bile duct carcinoma composed of all three types. A 65-year-old man with prior cholecystectomy presented with painless jaundice, vomiting, and weight loss. CA19-9 and alpha-fetoprotein (AFP) were elevated. Cholangioscopy revealed a friable mass extending from the middle of the common bile duct to the common hepatic duct. A bile duct excision was performed. Gross examination revealed a 3.6 cm intraluminal polypoid tumor. Microscopically, the tumor had foci of conventional adenocarcinoma (CK7-positive and CA19-9-postive) surrounded by malignant-appearing spindle cells that were positive for cytokeratins and vimentin. Additionally, there were separate areas of large cell neuroendocrine carcinoma (LCNEC). Foci of clear cell carcinoma merged into both the LCNEC and the adenocarcinoma. Tumor invaded through the bile duct wall with extensive perineural and vascular invasion. Circumferential margins were positive. The patient's poor performance status precluded adjuvant therapy and he died with recurrent and metastatic disease 5 months after surgery. This is consistent with the reported poor survival rates of biliary mixed adenoneuroendocrine carcinomas.

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Intracranial abscesses are life-threatening medical emergencies with pyogenic debris accumulating in the brain. Delay in the diagnosis can result in significant morbidity and mortality. Computed tomography and magnetic resonance imaging play an important role in the diagnosis of brain abscesses. However, the classic ring-enhancing appearance of an intracranial abscess can be mimicked by several other entities, most notably a necrotic tumor. This paper reviews new advances in CT and MR for imaging patients with suspected brain abscess. The role of computed tomography (CT) perfusion and new magnetic resonance sequences including DWI sequences, ADC map, MR spectroscopy, FLAIR and post-contrast enhanced T1 weighted images will also be discussed.