Association Between #Migraine and Cervical Artery #Dissection
The Italian Project on #Stroke in Young Adults

http://jamanetwork.com/journals/jamaneurology/fullarticle/2606444

In this cohort study of 2485 patients aged 18 to 45 years with first-ever acute ischemic stroke, a history of migraine, especially the subtype without aura, was independently associated with cervical artery dissection. The strength of this association was higher in men and in younger individuals.

Meaning In young patients with ischemic stroke, migraine is consistently associated with cervical artery dissection. This finding implicates possible common biologic mechanisms underlying the 2 disorders

Completion #Dissection or Observation for Sentinel-Node Metastasis in #Melanoma
http://www.nejm.org/doi/full/10.1056/NEJMoa1613210

Background
Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear.

The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group.

Conclusions
Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases