A systematic review of the nutritional status of women of a childbearing age with severe mental illness.

Little is known about the nutritional status of pregnant women with severe mental illness. We therefore carried out a systematic review to investigate whether pregnant women and childbearing aged women with severe mental illness have significantly greater nutritional deficiencies compared with pregnant women and childbearing aged women with no mental illness. We carried out a search using MEDLINE, EMBASE and PsycINFO from January 1980 to January 2011 for studies on nutritional status of childbearing aged women with psychotic disorders. Identification of papers and quality rating of papers (using a modified version of the Newcastle-Ottawa scale) was carried out by two reviewers independently. We identified and screened 4,130 potentially relevant studies from the electronic databases. Fifteen studies met the inclusion criteria (n = 587 women). There were no studies of pregnant women. There was some evidence of low serum folate and vitamin B(12) levels and elevated homocysteine levels in childbearing aged women with psychotic disorders. Further research into the nutritional status of childbearing aged women with severe mental illness is needed. Maternal nutrition has a profound impact on foetal outcome, is a modifiable risk factor and therefore needs prioritising in the care of all childbearing aged women with severe mental illness.

Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis.

PURPOSE: The purpose of this study was to investigate and report on a new intraoperative measuring technique to place the anterior cruciate ligament (ACL) femoral tunnel in the center of the native ACL femoral insertion site. METHODS: We investigated a novel measuring technique based on identifying the proximal border of the articular cartilage and using a specific ruler parallel to the femoral axis to locate the origin of the ACL. The accuracy of this technique was validated by measuring tunnel position on postoperative 3-dimensional computed tomography scans. Bony tunnels created by the ruler technique were compared with tunnels drilled by a traditional technique referenced from the back wall of the notch. RESULTS: Fifty ACL reconstructions were performed by the novel measuring technique, with placement of the femoral tunnel at the center of the femoral insertion. The mean position for the center of the femoral tunnel measured by the ruler technique was 0.9 mm from the theoretic optimal center position but was a very distinct 5 mm from the mean position in the traditional tunnels. CONCLUSIONS: The ruler technique produced femoral tunnels comparable to published radiographic criteria used for tunnel placement and is reproducible and accurate. We recommend placement of the femoral tunnel at the midpoint of the lateral femoral condyle when using the anatomic single-bundle technique. LEVEL OF EVIDENCE: Level IV, case series.

Delayed incorporation of a TruFit plug: perseverance is recommended.

TruFit plugs (Smith & Nephew, Andover, MA) are synthetic polymer scaffolds that are inserted into an articular surface to provide a stable scaffold to encourage the regeneration of a full thickness of articular cartilage to repair chondral defects. Our unit has shown promising early results for the repair of small articular cartilage defects within the knee. Other series have reported "failures" in which patients have complained of persistent symptoms and joint effusion at 6 months after plug insertion and arthroplasty has been undertaken. We report a case of delayed incorporation of an articular cartilage defect of the lateral femoral condyle treated with 3 TruFit plugs. The patient eventually reported symptom alleviation and resumption of functional activity after 24 months of continued rehabilitation. We recommend that patients with continued symptoms persevere with rehabilitation and allow the regenerating articular cartilage time to mature fully before considering undertaking irreversible arthroplasty procedures.

High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience.

The purpose of this study is to determine the reliability of high-resolution ultrasound (HRUS) in the diagnosis of upper limb disorders compared with the initial clinical opinion. We prospectively studied 178 patients referred for HRUS examination (47.2% hand, 34.8% wrist, and 18% elbow examinations) by recording the clinical opinion, the specific ultrasound diagnosis, and the final diagnosis, as established by surgery (79.9%) or follow-up (20.1%). HRUS examination was highly reliable in diagnosing cystic lesions, synovial disease, ligament injury and foreign bodies (100%), and slightly less reliable for solid lesions (82.1%) and nerve, bone, and tendon disorders (97%, 91.7%, 86.5%, respectively). HRUS examination resulted in significantly more correct diagnoses (92.1%) than the clinical opinion (70.8%) (McNemar test, P = 0.001). The agreement between the HRUS diagnosis and the clinical opinion was slight (Kappa test, k = 0.16). HRUS examination is more reliable than clinical examination in diagnosing upper limb disorders.