The normal TTTG distance is 10 ± 1 mm with MRI being a reliable method of measurement. Literature supports a high degree of variability in reporting TTTG. This study establishes normal TTTG values, which will help in the assessment and treatment of patellofemoral disorders.
Time to surgery did not significantly affect 1-year mortality within each ASA Class.
Background:There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received. Methods: A 6-month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct-skin doses. Screening times were recorded in a subsequent 6-month post at a tertiary trauma centre. Results: Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with a screening time of 124 min at an average of 0.48 min per procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon's hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17-0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one-third of recommended limits. If a printer was used to record the image, 58% of intra-operative radiographs would have been avoided. Conclusions: Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose-reduction gloves should be considered for high-risk procedures. A printer can reduce the need for intraoperative plain radiographs.
Introduction In sleep clinics, hypersomnia is a frequently encountered condition. While narcolepsy and idiopathic hypersomnia are discrete diagnoses that typically do not have co-existing psychiatric co-morbidities, sleep practitioners often have to address mental illness and/or psychotropic medication needs in these patients with hypersomnia. The reasons for co-occurrence of idiopathic hypersomnia and narcolepsy with psychiatric disorders is not well understood. This study aimed to assess the degree of overlap between psychiatric diagnoses with central hypersomnias and the temporal relationship between the development of hypersomnia and psychiatric conditions. Methods Using the University of Utah EPIC database, patients with diagnoses of idiopathic hypersomnia or narcolepsy encountered over the last decade were identified. Out of the 307 available medical records, only those that met strict criteria for diagnosis of narcolepsy and idiopathic hypersomnia were included. Medical records were reviewed for the presence of psychiatric disorders and psychotropic medication use, and to assess the prevalence of mental illness with central hypersomnia. Results Out of 119 patients that met ICSD-2 criteria for central hypersomnia, 37 were diagnosed with narcolepsy type 1 (T1N), 59 with narcolepsy type 2 (T2N) and 23 with idiopathic hypersomnia (IH). There were 69/119 (58%) patients with central hypersomnia that had psychiatric comorbidities with 23/37 (62%) of T1N, 32/59 (54%) of T2N and 14/23 (60%) of IH experiencing psychiatric problems. Approximately 45% were prescribed antidepressants or a mood stabilizer either before, during or after diagnosis of a central hypersomnia. 46% of patients on stimulants alone vs. 23% of patients on sodium oxybate had a concurrent psychiatric diagnoses or psychotropic medication use. Conclusion Given the degree of overlap between psychiatric disorders and central hypersomnias, further research is necessary to understand whether this overlap is a result of common neurological substrates driving these disorders or whether the hypersomnia is from comorbid psychiatric disorder or psychotropic medication use. The highest prevalence of psychiatric illness was seen with T1N. Patients with hypersomnia on sodium oxybate had lower rates of psychiatric co-morbidities. Whether these findings point to more optimal diagnosis and treatment of underlying hypersomnia with reduced need for psychotropic medication needs to be understood. Support (if any) None
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