Ganglión oculto: comparación de dos técnicas quirúrgicas

Identificar y evaluar la existencia de posibles diferencias entre los resultados de dos técnicas quirúrgicas para resección de ganglión oculto usadas en el Institut Kaplan en Barcelona. Material y método: Se diseñó un estudio de casos y controles. Se intervinieron ochenta y dos muñecas que se dividieron en dos grupos. En el grupo I, se incluyeron por cincuenta y una muñecas en las que se les realizó la resección del ganglión oculto junto con todo el grosor del ligamento escafo-semilunar dorsal. En el grupo II se incluyeron treinta y una muñecas en las que se les resecó el ganglión sin resecar el ligamento escafo-semilunar. Se tomó la información de registros consignados entre 1994 hasta octubre de 2010 y se realizó un seguimiento clínico y telefónico en ambos grupos para valorar el estado actual. Dentro de los resultados postoperatorios se evaluó la reaparición del dolor, la presencia de inestabilidad postoperatoria y la fuerza con respecto al preoperatorio y la disminución de la movilidad articular. Resultados: No encontramos diferencias estadísticamente significativas entre los resultados postoperatorios de ambos grupos y ninguno de los pacientes presentó recidiva del ganglión. Conclusión: Consideramos que se requiere un estudio con mayor tamaño de muestra que pueda evidenciar las diferencias posiblemente existentes que no fueron detectadas en este estudio. Con la integridad de los otros elementos estabilizadores, la sección del ligamento escafosemilunar no hace aparecer signos clínicos de inestabilidad escafolunar.

Evolution of clinical and functional results after arthroscopic treatment of Discoid Meniscus. A case series study of 31 cases.

Purpose: To evaluate the evolution of clinical and functional outcomes of symptomatic discoid lateral meniscus treated arthroscopically over time and to investigate the relationship between associated intra-articular findings and outcomes. Methods: Of all patients treated arthroscopically between 1995 and 2010, patients treated for symptomatic discoid meniscus were identified in the hospital charts. Baseline data (demographics, previous trauma of ipsilateral knee, and associated intra-articular findings) and medium term outcome data from clinical follow-up examinations (pain, locking, snapping and instability of the operated knee) were extracted from clinical records. Telephone interviews were conducted at long term in 28 patients (31 knees). Interviews comprised clinical outcomes as well as functional outcomes as assessed by the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC). Results: All patients underwent arthroscopic partial meniscectomy. The mean follow-up time for data extracted from clinical records was 11 months (SD ± 12). A significant improvement was found for pain in 77% (p<0.001), locking in 13%, (p=0.045) and snapping in 39 % (p<0.005). The mean follow-up time of the telephone interview was 60 months (SD ± 43). Improvement from baseline was generally less after five years than after one year and functional outcomes of the IKDC indicated an abnormal function after surgery (IKDC mean= 84.5, SD ± 20). In some patients, 5 year-outcomes were even worse than their preoperative condition. Nonetheless, 74% of patients perceived their knee function as improved. Furthermore, better results were seen in patients without any associated intra-articular findings. Conclusions: Arthroscopical partial meniscectomy is an effective intervention to relieve symptoms in patients with discoid meniscus in the medium-term; however, results trend to deteriorate over time. A trend towards better outcome for patients with no associated intra-articular findings was observed.

La formación del profesorado en didáctica de la geografía, ¿cómo articular investigación y formación? : el contexto francés.

Resumen de la autora

Proporción de pacientes que presentan hipotermia peri operatoria durante un reemplazo articular de cadera, rodilla u hombro

Introducción: La hipotermia perioperatoria se ha documentado como factor de riesgo para el aumento de la morbimortalidad de los pacientes aumentando morbilidad miocárdica, riesgo de infección, pérdidas sanguíneas y tiempo de hospitalización. La aplicación de anestésicos toma relevancia ya que causa la pérdida de control central de la temperatura. Nuestro objetivo con este estudio fue describir la proporción de casos de hipotermia en la población sometida a un reemplazo articular durante un periodo de cuatro meses. Materiales y métodos: Se realizó un estudio de cohorte prospectivo. La población a estudio fueron los pacientes que fueron sometidos a un reemplazo total de cadera, rodilla u hombro. Se registró la temperatura central en el momento previo a la inducción anestésica, 30, 60 y 90 minutos después, al finalizar el procedimiento y al ingresar a recuperación. Se reportó el porcentaje de pacientes con hipotermia en cada tiempo. Resultados: Se analizaron en total 88 pacientes, el 55,7% fue llevado a cirugía de cadera, 39,7% de rodilla y 4,5% de hombro. El tipo de anestesia más utilizado fue general y la duración promedio de anestesia fue 164 minutos. La medición de la temperatura central se realizó en nasofaringe, esófago o tímpano. La proporción de pacientes que presentaron hipotermia en la inducción fue 21,6%, a 30 minutos 83%, a 60 minutos 73,9%, a 90 minutos 68,2%, al finalizar 59,1% y en recuperación 58%. Se realizó una prueba Chi cuadrado comparando las proporciones entre la inducción y los cinco periodos posteriores, se encontró que la proporción de pacientes con hipotermia en los cinco tiempos posteriores tuvo una diferencia estadísticamente significativa (p=0,00) comparada con la proporción de pacientes con hipotermia durante la inducción. Conclusión: En los pacientes sometidos a un reemplazo articular la hipotermia fue una condición prevalente posterior a la aplicación de los anestésicos sistémicos. Los dispositivos de calentamiento intraoperatorio usados actualmente son insuficientes para evitar la hipotermia, lo que indica concordancia con la literatura en cuanto a las recomendaciones de calentamiento perioperatorio, con énfasis en el precalentamiento, para prevenir la caída significativa de la temperatura y la morbimortalidad asociada.

Relación entre flexibilidad músculo-articular global, fuerza muscular y componentes cineantropométricos en estudiantes de enseñanzas medias.

Expone la evolución y relación de la flexibilidad global, fuerza muscular y componentes cineantropométricos en adolescentes. 859 sujetos, 426 mujeres y 433 varones de 14 a 18 años, pertenecientes a ESO, BUP y FP, clasificados en sedentarios, activos y deportistas. La muestra se considera representativa de los adolescentes valencianos por pertenecer, sin ningún sesgo o característica diferente, a la población adolescente general de la provincia de Valencia, siendo la procedencia del conjunto de la muestra de muy diversas localidades, barrios y estatus sociales. Han sido elegidos aleatoriamente según las circunstancias del posible horario de aplicación de las mediciones y test condicionales. Los pasos llevados acabo para la temporalización de la aplicación práctica fueron: 1) Contactos informales de constitución del equipo investigador, participantes y colaboradores. 2) Formación del equipo investigador, concertación con profesores y alumnos de los I.E.S., confección del horario y protocolos de mediciones y prácticas internas de medición. 3) Aplicación de cuestionarios, test de fuerza y flexibilidad y mediciones antropométricas a todos los sujetos de la muestra. 4) Análisis de los datos obtenidos e introducción en el ordenador para su tratamiento estadístico. Cuestinarios, test de flexibilidad músculo-arterial y test de fuerza muscular, mediciones antropométricas (balanza, tallímetro, cinta métrica, paquímetro). La metodología para la valoración condicional, basadas en tests de campo validos, ha sido por medición directa para la fuerza muscular isométrica, propuesta por Litwin y Fernández (1982), para la elástica-explosiva, propuesta por Bosco(1985), para la flexibilidad global anterior, propuesta por Porta (1987); González Millán y Benavent (1999) y para posterior, propuesta por González-Millán(1997). Para los componentes cineantropométricos, basados en el Grupo Español de Cineantropometría, ha sido por medición directa para el tamaño corporal y doblemente indirecta por ecuaciones de regresión para los cuatro componentes corporales de Matiegka(1921), desarrollado por Rocha (1975), Faulkner y Cols (1980) y De Rose y Guimaraes(1980), y para los tres componentes del somatotipo de Heath-Carter (1967). Se ha realizado un tratamientos estadísticos de las variables por grupos de edad, sexo y actividad física, con el programa SPSS (v8) para Windows y Excel (Offiss 2000), calculándose las medias y desviaciones típicas de las variables, posteriormente la Normalidad paramétrica con la prueba de Kolmogorov-Smirnov, y por ausencia de Normalidad se ha aplicado para la diferencia entre grupos la prueba de Krustal-Wallis, entre sexos la prueba U de Mann-Whitney, y para las correlaciones la prueba de Pearson, siendo el nivel de significación mínimo en todas las pruebas de (p0,05). La flexibilidad global, la fuerza muscular y los componentes cineantropométricos aumentan con la edad en la adolescencia, la práctica de actividad física influye positivamente en sus evoluciones, el test Tot-Flex Mejorado es más discriminativo que el Indice de Puente Dorsal, y el somatotipo de los varones es Endo-Mesomorfo y el de las mujeres Meso-Endomorfo. La fuerza muscular y la flexibilidad músculo-articular tienen una correlación directa poco considerable, los tests de fuerza isométrica correlacionan mejor con el Tot-Flex Mejorado y los de fuerza elástica-explosiva con el Indice de Puente Dorsal. Las variables cineantropométricas de Peso, Masa Osea y Masa Muscular correlacionan directamente con los tests de fuerza isométrica, y la Talla y Masa Osea, directa y Endomorfo, indirectamente, con los de fuerza elástica-explosiva. Las variables cineantropometricas no se correlacionan con los test de flexibilidad global. En definitiva, lo que se ha pretendido es conocer y cuantificar la fuerza muscular y la flexibilidad músculo-arterial global, a través de mediciones con test de campo válidos y fiables.

The counter-propagating Rossby-wave perspective on baroclinic instability. I: Mathematical basis

It is shown that Bretherton's view of baroclinic instability as the interaction of two counter-propagating Rossby waves (CRWs) can be extended to a general zonal flow and to a general dynamical system based on material conservation of potential vorticity (PV). The two CRWs have zero tilt with both altitude and latitude and are constructed from a pair of growing and decaying normal modes. One CRW has generally large amplitude in regions of positive meridional PV gradient and propagates westwards relative to the flow in such regions. Conversely, the other CRW has large amplitude in regions of negative PV gradient and propagates eastward relative to the zonal flow there. Two methods of construction are described. In the first, more heuristic, method a ‘home-base’ is chosen for each CRW and the other CRW is defined to have zero PV there. Consideration of the PV equation at the two home-bases gives ‘CRW equations’ quantifying the evolution of the amplitudes and phases of both CRWs. They involve only three coefficients describing the mutual interaction of the waves and their self-propagation speeds. These coefficients relate to PV anomalies formed by meridional fluid displacements and the wind induced by these anomalies at the home-bases. In the second method, the CRWs are defined by orthogonality constraints with respect to wave activity and energy growth, avoiding the subjective choice of home-bases. Using these constraints, the same form of CRW equations are obtained from global integrals of the PV equation, but the three coefficients are global integrals that are not so readily described by ‘PV-thinking’ arguments. Each CRW could not continue to exist alone, but together they can describe the time development of any flow whose initial conditions can be described by the pair of growing and decaying normal modes, including the possibility of a super-modal growth rate for a short period. A phase-locking configuration (and normal-mode growth) is possible only if the PV gradient takes opposite signs and the mean zonal wind and the PV gradient are positively correlated in the two distinct regions where the wave activity of each CRW is concentrated. These are easily interpreted local versions of the integral conditions for instability given by Charney and Stern and by Fjørtoft.

The counter-propagating Rossby-wave perspective on baroclinic instability. II: Application to the Charney model

The constant-density Charney model describes the simplest unstable basic state with a planetary-vorticity gradient, which is uniform and positive, and baroclinicity that is manifest as a negative contribution to the potential-vorticity (PV) gradient at the ground and positive vertical wind shear. Together, these ingredients satisfy the necessary conditions for baroclinic instability. In Part I it was shown how baroclinic growth on a general zonal basic state can be viewed as the interaction of pairs of ‘counter-propagating Rossby waves’ (CRWs) that can be constructed from a growing normal mode and its decaying complex conjugate. In this paper the normal-mode solutions for the Charney model are studied from the CRW perspective. Clear parallels can be drawn between the most unstable modes of the Charney model and the Eady model, in which the CRWs can be derived independently of the normal modes. However, the dispersion curves for the two models are very different; the Eady model has a short-wave cut-off, while the Charney model is unstable at short wavelengths. Beyond its maximum growth rate the Charney model has a neutral point at finite wavelength (r=1). Thereafter follows a succession of unstable branches, each with weaker growth than the last, separated by neutral points at integer r—the so-called ‘Green branches’. A separate branch of westward-propagating neutral modes also originates from each neutral point. By approximating the lower CRW as a Rossby edge wave and the upper CRW structure as a single PV peak with a spread proportional to the Rossby scale height, the main features of the ‘Charney branch’ (0

The counterpropagating Rossby wave perspective on Kelvin Helmholtz instability as a limiting case of a Rayleigh shear layer with zero width

The Kelvin Helmholtz (KH) problem, with zero stratification, is examined as a limiting case of the Rayleigh model of a single shear layer whose width tends to zero. The transition of the Rayleigh modal dispersion relation to the KH one, as well as the disappearance of the supermodal transient growth in the KH limit, are both rationalized from the counterpropagating Rossby wave perspective.

The counter-propagating Rossby-wave perspective on baroclinic instability. Part III: Primitive-equation disturbances on the sphere

Baroclinic instability of perturbations described by the linearized primitive quations, growing on steady zonal jets on the sphere, can be understood in terms of the interaction of pairs of counter-propagating Rossby waves (CRWs). The CRWs can be viewed as the basic components of the dynamical system where the Hamiltonian is the pseudoenergy and each CRW has a zonal coordinate and pseudomomentum. The theory holds for adiabatic frictionless flow to the extent that truncated forms of pseudomomentum and pseudoenergy are globally conserved. These forms focus attention on Rossby wave activity. Normal mode (NM) dispersion relations for realistic jets are explained in terms of the two CRWs associated with each unstable NM pair. Although derived from the NMs, CRWs have the conceptual advantage that their structure is zonally untilted, and can be anticipated given only the basic state. Moreover, their zonal propagation, phase-locking and mutual interaction can all be understood by ‘PV-thinking’ applied at only two ‘home-bases’—potential vorticity (PV) anomalies at one home-base induce circulation anomalies, both locally and at the other home-base, which in turn can advect the PV gradient and modify PV anomalies there. At short wavelengths the upper CRW is focused in the mid-troposphere just above the steering level of the NM, but at longer wavelengths the upper CRW has a second wave-activity maximum at the tropopause. In the absence of meridional shear, CRW behaviour is very similar to that of Charney modes, while shear results in a meridional slant with height of the air-parcel displacement-structures of CRWs in sympathy with basic-state zonal angular-velocity surfaces. A consequence of this slant is that baroclinically growing eddies (on jets broader than the Rossby radius) must tilt downshear in the horizontal, giving rise to up-gradient momentum fluxes that tend to accelerate the barotropic component of the jet.

The counter-propagating Rossby-wave perspective on baroclinic instability. Part IV: Nonlinear life cycles

Pairs of counter-propagating Rossby waves (CRWs) can be used to describe baroclinic instability in linearized primitive-equation dynamics, employing simple propagation and interaction mechanisms at only two locations in the meridional plane—the CRW ‘home-bases’. Here, it is shown how some CRW properties are remarkably robust as a growing baroclinic wave develops nonlinearly. For example, the phase difference between upper-level and lower-level waves in potential-vorticity contours, defined initially at the home-bases of the CRWs, remains almost constant throughout baroclinic wave life cycles, despite the occurrence of frontogenesis and Rossby-wave breaking. As the lower wave saturates nonlinearly the whole baroclinic wave changes phase speed from that of the normal mode to that of the self-induced phase speed of the upper CRW. On zonal jets without surface meridional shear, this must always act to slow the baroclinic wave. The direction of wave breaking when a basic state has surface meridional shear can be anticipated because the displacement structures of CRWs tend to be coherent along surfaces of constant basic-state angular velocity, U. This results in up-gradient horizontal momentum fluxes for baroclinically growing disturbances. The momentum flux acts to shift the jet meridionally in the direction of the increasing surface U, so that the upper CRW breaks in the same direction as occurred at low levels

Undulation instability in block-copolymer lamellae subjected to a perpendicular electric field

We examine the stability of lamellar stacks in the presence of an electric field, E-0, applied normal to the lamellae. Calculations are performed with self-consistent field theory (SCFT) supplemented by an exact treatment of the electrostatic energy for linear dielectric materials. The calculations identify a critical electric field, E-0*, beyond which the lamellar stack becomes unstable with respect to undulations. This E-0* rapidly decreases towards zero as the number of lamellae in the stack diverges. Our quantitative predictions for E-0* are consistent with previous experimental measurements by Xu and co-workers.

Flow structure and variability in the subtropical Indian Ocean: Instability of the South Indian Ocean Countercurrent

The origin of the eddy variability around the 25°S band in the Indian Ocean is investigated. We have found that the surface circulation east of Madagascar shows an anticyclonic subgyre bounded to the south by eastward flow from southwest Madagascar, and to the north by the westward flowing South Equatorial Current (SEC) between 15° and 20°S. The shallow, eastward flowing South Indian Ocean Countercurrent (SICC) extends above the deep reaching, westward flowing SEC to 95°E around the latitude of the high variability band. Applying a two-layer model reveals that regions of large vertical shear along the SICC-SEC system are baroclinically unstable. Estimates of the frequencies (3.5–6 times/year) and wavelengths (290–470 km) of the unstable modes are close to observations of the mesoscale variability derived from altimetry data. It is likely then that Rossby wave variability locally generated in the subtropical South Indian Ocean by baroclinic instability is the origin of the eddy variability around 25°S as seen, for example, in satellite altimetry.

Instability of surface-temperature filaments in strain and shear

The effects of uniform straining and shearing on the stability of a surface quasi-geostrophic temperature filament are investigated. Straining is shown to stabilize perturbations for wide filaments but only for a finite time until the filament thins to a critical width, after which some perturbations can grow. No filament can be stabilized in practice, since there are perturbations that can grow large for any strain rate. The optimally growing perturbations, defined as solutions that reach a certain threshold amplitude first, are found numerically for a wide range of parameter values. The radii of the vortices formed through nonlinear roll-up are found to be proportional to θ/s, where θ is the temperature anomaly of the filament and s the strain rate, and are not dependent on the initial size of the filament. Shearing is shown to reduce the normal-mode growth rates, but it cannot stabilize them completely when there are temperature discontinuities in the basic state; smooth filaments can be stabilized completely by shearing and a simple scaling argument provides the shear rate required. Copyright © 2010 Royal Meteorological Society