Long-term follow-up of patients with migrainous infarction.

Among patients with migrainous infarction, the long-term prognosis is unclear. This study aims to estimate the long-term risk of stroke recurrence and functional outcome in patients with migrainous infarction. In our study, 15 patients with migrainous infarction were followed for up to 7.5 years (12-240 months). For each patient, clinical and imaging data were reviewed. Disability after migrainous Infarction was assessed with modified Rankin Score. Mean age was 34.8 (±â€¯11.1) years. At the end of the follow-up 80% of the patients had favorable prognosis, 47% recovered completely and no patient died or had stroke recurrence. Our series also confirmed a low frequency of the traditional risk factors and the reduction of migraine frequency after migrainous infarction. This study has clinical implications and public health relevance, since our case series confirms a low frequency, low recurrence rate, and good functional outcome for patients with migrainous infarction.

[Ecological studies in environmental health: Beyond epidemiology]. / Estudios ecológicos en salud ambiental: más allá de la epidemiología.

Ecological studies provide important and frequent sources of evidence of environmental health, since their unit of analysis is populations. This review summarizes the foundations of ecological studies with the premise that they can be performed using quantitative, qualitative or mixed methods. It presents the logic behind their design, their role in exploring causality, the variables and categories of analysis and the design principles and techniques used to collect data. Examples of ecological studies performed in Latin America are then presented, as well as some common methodological problems and options to address them. Lastly, the relevance of quantitative and qualitative ecological studies to environmental health as a way to overcome the dominance of conceptual and methodological individualism is highlighted, though ecological studies alone do not suffice for studying population health.

Estudios ecológicos en salud ambiental: más allá de la epidemiología / Ecological studies in environmental health: Beyond epidemiology

Los estudios ecológicos se caracterizan por tener como unidad de análisis a las poblaciones, y constituyen una fuente importante y frecuente de información comprobada en salud ambiental. En esta revisión se resumen los fundamentos de los estudios ecológicos, partiendo de la premisa de que es posible hacerlos con métodos cuantitativos, cualitativos o mixtos. Se presenta la lógica que subyace a su diseño, y su papel en la exploración de la causalidad, las variables y las categorías de análisis, los principales diseños y las técnicas de recolección de datos. Igualmente, se dan ejemplos de estudios ecológicos llevados a cabo en América Latina, y se discuten algunos de los problemas metodológicos frecuentes y las posibles vías para abordarlos. Por último, se resalta la relevancia de los estudios ecológicos cuantitativos y cualitativos en salud ambiental como una forma de superar el individualismo conceptual y metodológico hegemónico, que resulta insuficiente para el estudio de la salud en las poblaciones .

Ecological studies provide important and frequent sources of evidence of environmental health, since their unit of analysis is populations. This review summarizes the foundations of ecological studies with the premise that they can be performed using quantitative, qualitative or mixed methods. It presents the logic behind their design, their role in exploring causality, the variables and categories of analysis and the design principles and techniques used to collect data. Examples of ecological studies performed in Latin America are then presented, as well as some common methodological problems and options to address them. Lastly, the relevance of quantitative and qualitative ecological studies to environmental health as a way to overcome the dominance of conceptual and methodological individualism is highlighted, though ecological studies alone do not suffice for studying population health.

Limb length discrepancy and congenital limb anomalies in fibular hemimelia.

The aim of this study was to determine the prevalence of ipsilateral congenital musculoskeletal anomalies associated with fibular hemimelia. We also attempted to determine the corelation between the eventual limb length discrepancy at maturity and these associated anomalies, as well as the Achterman-Kalamchi class of these patients. The records and roentgenograms of 45 patients with fibular hemimelia were reviewed retrospectively. All patients were classified into three groups (types I-A, I-B, and II) according to the Achterman-Kalamchi system. The prevalence of congenital limb anomalies, lower extremity discrepancy percentage, and ultimate limb length discrepancy at skeletal maturity were evaluated. There was no significant statistical association between the number of congenital limb anomalies and severity of the limb length discrepancy, but patients included in the mildly affected group (type I-A) had a higher average prevalence of congenital limb anomalies than those classified as types I-B and II. There was a substantial correlation between congenital short femur as well as the Achterman-Kalamchi classification system and the predicted limb length discrepancy. A similar percentage of limb length discrepancy in types I-B and II was seen. In conclusion, the numbers of associated congenital limb anomalies are not predictive of the eventual limb length discrepancy. Presence of a congenital short femur and ball and socket ankle are predictive of a higher limb length discrepancy. Achterman-Kalamchi types I-B and II show a similar percentage of limb length discrepancy and this is significantly higher than that seen in type I-A.

Descenso de patela: resistencia inicial de dos procedimientos en cadáveres y escripción de una técnica quirúrgica / Decrease in patella: initial resistance of two procedures on cadavers and description of a surgical technique

La disfunción del mecanismo extensor de las rodillas en parálisis cerebral espástica ocasiona marcha agazapada y es causada por el ascenso de la patela. Para restaurar la fuerza muscular extensora de la rodilla se recomienda el descenso de la patela. Hay algunas técnicas quirúrgicas para el avance del tendón patelar en parálisis cerebral descritas en la literatura, y en los diferentes centros hospitalarios se utilizan técnicas variadas. Presentamos la técnica que hemos diseñado y estudiamos experimentalmente en cadáveres comparándola con la técnica de cerclaje con alambre. Realizamos pruebas en quince rodillas de cadáveres frescos, cuatro con cerclaje con alambre, y diez con la técnica descrita en este trabajo. Encontramos una resistencia inicial de 222 Newton para la técnica con Vicryl ® y 366 Newton para el cerclaje en alambre pero con pérdida de elongación hasta de 10 mm durante el pretensado. Se encontró mejor memoria con la técnica con sutura sin pérdida de corrección comparada con la técnica con alambre.