ULTRASONOGRAPHIC EVALUATION OF THE RUPTURED MEDIAL HEAD OF GASTROCNEMIUS MUSCLE / AVALIAÇÃO ULTRASSONOGRÁFICA DA RUPTURA DA CABEÇA MEDIAL DO MÚSCULO GASTROCNÊMIO / EVALUACIÓN ULTRASONOGRÁFICA DE LA RUPTURA DE LA CABEZA MEDIAL DEL MÚSCULO GASTROCNEMIO

ABSTRACT Introduction: Tennis leg, a common injury of the medial head of gastrocnemius muscle in the muscle-tendon junction, is usually reported in men during recreational sports. Sudden pain is the main symptom accompanied by the feeling of rupture in the calf. Clinical examination followed by ultrasound is the standard diagnostic procedure. Objective: The main objectives of this study are to compare clinical and ultrasonographic findings in cases of tennis leg, evaluate the location and type of lesion in the medial head of gastrocnemius muscle, and evaluate the edema volume and the presence of deep vein thrombosis (DVT). Second, the healing process was monitored with ultrasound to distinguish the level of recovery and to record the presence of chronic sequelae. Methods: Eighty-one subjects with clinical symptoms of rupture of the medial head of gastrocnemius muscle participated in the study. A linear probe (7-12 MHz) was used for ultrasonographic (US) and a Doppler was used to verify the presence of DVT. Results: In 78 of 81 subjects examined, we found obvious US changes (96.3%) and three of them had no positive findings. In 67 of them, we diagnosed rupture of the medial head of the gastrocnemius muscle. Most of them had partial rupture (73.13%) and the remaining had total rupture (26.87%). The edema (30.84%) was found in the space between the aponeurosis of the gastrocnemius and soleus muscles. DVT with the clinical signs of tennis leg was observed in 5 of 81 patients (6.17%). Conclusion: Our findings indicate that ultrasound is very important for early diagnosis of muscle-tendon injuries in the leg. In addition, monitoring the healing process and assessing the chosen treatment showed a high efficiency. Ultrasonography is an effective method to identify and differentiate the sequelae of the injured muscles and vascular complications.

RESUMO Introdução: A "perna do tenista", lesão comum da cabeça medial do músculo gastrocnêmio na junção músculo-tendínea, em geral, é relatada em homens, durante a prática de esportes recreativos. A dor repentina é o principal sintoma, sendo acompanhada pela sensação de ruptura na panturrilha. O exame clínico seguido pelo exame de ultrassom é o procedimento diagnóstico padrão. Objetivo: Este estudo tem como principais objetivos comparar os achados clínicos e ultrassonográficos em casos de perna do tenista, avaliar a localização e o tipo da lesão na cabeça medial do gastrocnêmio e avaliar o volume do edema e a presença de trombose venosa profunda (TVP). Em segundo lugar, o processo de cicatrização foi monitorado com ultrassom para se distinguir o nível de recuperação e registrar a presença de sequelas crônicas. Métodos: Oitenta e um indivíduos com sintomas clínicos de ruptura da cabeça medial do gastrocnêmio participaram do estudo. Empregou-se uma sonda linear (7 a 12 MHz) para a avaliação ultrassonográfica (US) e Doppler para verificar a presença de TVP. Resultados: Em 78 dos 81 indivíduos examinados, foram encontradas alterações US evidentes (96,3%) e três deles não tiveram achados positivos. Em 67 pacientes, diagnosticamos ruptura da cabeça medial do músculo gastrocnêmio. A maioria deles apresentou ruptura parcial (73,13%) e os restantes tiveram ruptura total (26,87%). O edema (30,84%) foi encontrado no espaço entre a aponeurose dos músculos gastrocnêmio e sóleo. A TVP com sinais clínicos de perna do tenista foi verificada em 5 dos 81 pacientes (6,17%). Conclusão: Nossos achados indicam que o exame de ultrassom é muito importante para o diagnóstico precoce de lesões músculo-tendíneas no membro inferior. Além disso, constatou-se grande eficiência na monitoração do processo de cicatrização e na avaliação do tratamento aplicado. A ultrassonografia é um método efetivo para identificar e diferenciar as sequelas nos músculos lesionados e as complicações vasculares.

RESUMEN Introducción: La "pierna de tenista", lesión común de la cabeza medial del músculo gastrocnemio en la unión músculo-tendinosa, en general, es relatada en los hombres durante la práctica de deportes recreativos. El dolor repentino es el síntoma principal, acompañado de la sensación de ruptura en la pantorrilla. El examen clínico seguido de un examen de ultrasonido es el procedimiento de diagnóstico estándar. Objetivo: Los principales objetivos de este estudio son comparar los hallazgos clínicos y ultrasonográficos en los casos de pierna de tenista, evaluar la ubicación y el tipo de lesión en la cabeza medial del músculo gastrocnemio y evaluar el volumen del edema y la presencia de trombosis venosa profunda (TVP). En segundo lugar, el proceso de la curación se monitorizó con ultrasonido para diferenciar el nivel de reparación y registrar la presencia de secuelas crónicas. Métodos: Ochenta y un sujetos con síntomas clínicos de ruptura de la cabeza medial del gastrocnemio participaron en el estudio. Se empleó una sonda lineal (7-12 MHz) para ultrasonografía (US) y Doppler para verificar la presencia de TVP. Resultados: En 78 de los 81 sujetos examinados, fueron encontrados cambios obvios en el US (96,3%) y tres de ellos no presentaran casos positivos. En 67 pacientes hemos diagnosticado ruptura de la cabeza medial del músculo gastrocnemio. La mayoría de ellos presentó ruptura parcial (73,13%) y los restantes tuvieron ruptura total (26,87%). El edema (30,84%) se encontró en el espacio entre la aponeurosis de los músculos gastrocnemio y sóleo. Se observó TVP con los signos clínicos de la pierna de tenista en 5 de 81 pacientes (6,17%). Conclusión: Nuestros hallazgos indican que la ultrasonografía es muy importante para el diagnóstico precoz de las lesiones músculo-tendinosas de la pierna. Además, hubo gran eficiencia en el monitoreo de la curación y la evaluación del tratamiento aplicado. La ultrasonografía es un método efectivo para identificar y diferenciar las secuelas en los músculos lesionados y complicaciones vasculares.

ANTHROPOMETRIC CHARACTERISTICS AND FUNCTIONAL CAPACITY OF ELITE ROWERS AND HANDBALL PLAYERS.

INTRODUCTION: Anthropometric and anaerobic profile of elite athletes are fundamental for the assessment of their respective performance. The present study was designed to evaluate the anthro- pornetric parameters, body composition and anaerobic characteristics of elite male handball players and rowers, and to compare them in relation to specific sport demands. MATERIAL AND METHODS: The study group consisted of 41 elite national level athletes: 20 handball players (aged 23.7±3.72) and 21 rowers (aged 19.7±2.84). Anthropometric characteristics (body mass, body height, skinfold thickness, body circumferences), and body fat mass were evaluated, and Wingate anaerobic test for anaerobic power assessment Iwas applied. RESULTS: The significant differences were noted in chest-upper arm, waist and hip circumferences, and supraspinal and calf skinfolds between the two investigated groups. Rowers showed higher values of fat body mass (13.2±3.76 vs. 10.7±3.76%), but lower body mass index (22.0±1,92 vs. 25.7?2.31 kg/in12) compared to handball players. When analyzing the Wingate test parameters, significantly higher values of absolute anaerobic power (786±127 vs. 691±140 W), absolute explosive power in the handball players compared to the rowers were recorded ( 18±26.3 vs. 105±27.8 W/s), whi le rowers achieved higher relative anaerobic capacity (192±3 1.2 vs. 177±E20.8 J/ kg). CONCLUSION: Specific body composition and anthropometri- cal assessment as a part of morphological analysis should complement physiological profile of elite athletes. The analysis of the anaerobic performance shows that the handball players have greater alactic anaerobic and explosive power component, compared to the rowers in whom the anaerobic endurance and specific training have the greatest effect on the consumption of dominant metabolic substrate during the race.

[Parameters of Anaerobic Physiological Profile of Elite Athletes].

INTRODUCTION: Anaerobic capacity is much less evaluated in literature compared to aerobic component. Anaerobic performance of athletes can be measured using different motoric tests, lasting 20 to 30 seconds, one of them being the Wingate anaerobic test (WAnT). OBJECTIVE: The aim of this study was to determine the work performed and power generated by athletes and non-athletes during a 30-second high intensity exercise, as well as to compare explosive characteristics of subjects using a new parameter of WAnT, named explosive power, or slope of power. METHODS: All parameters of anaerobic power were investigated in 152 subjects classed into different groups depending on their physical fitness and sport specialties as follows: non-athletes (n=31), rowers (n=26), volleyball players (n=37), handball players (n=34) and judo players (n=24). The WAnT, as well as basic anthropometric measurements, was administrated to all participants. RESULTS: Values of anaerobic parameters were higher in the group of athletes compared to physically inactive subjects.The highest values of the WAnT parameters were registered in the group of volleyball players (AP=1 006 W; relative AP=11.4 W/ kg, AC=19.8 kJ), compared to athletes of other sport disciplines (volleyball, rowing and judo). The new parameter of the WAnT, explosive power, also showed highest values in volleyball players (EP=1 54 W/s; relative EP=1.74 W/s/kg). These differences were statistically significant (p<0.05). CONCLUSION: The results of laboratory tests can provide useful information on improvements in training processes. The new parameter of the WAnT could be implemented in further analyses of explosive characteristics of muscle contraction.

Ultrasonographic diagnostics and evaluation of calcaneal fracture: case report.

INTRODUCTION: Radiography is the standard tool in the diagnostics of bone fractures. This paper presents a case of calcaneal fracture diagnosed by ultrasonography that was also used in the follow-up of recovery progress. CASE OUTLINE: A 68-year-old male patient was diagnosed avulsion fracture of the calcaneus by ultrasonography (US) examination using a multi-frequency linear probe (7-15 MHz) and confirmed by X-ray findings; US also provided insight into the dynamics of the reparatory processes. Control examinations were performed on day 14, 21, 30, 60 and 300 (10 months) after the occurrence of the fracture. During this time rehabilitation process was carried out. The diameters of the wedge defect of the calcaneus were measured by US for the follow-up of the healing process of the injured bone. Postero-anterior (PA) or longitudinal diameter and latero-medial or medio-lateral or transverse diameter were measured. CONCLUSION: Study results indicate a possible use of US in the diagnostics of fractures and monitoring of calcaneal healing.

Cardiac power output and its response to exercise in athletes and non-athletes.

Cardiac power output (CPO) is an integrative measure of overall cardiac function as it accounts for both, flow- and pressure-generating capacities of the heart. The purpose of the present study was twofold: (i) to assess cardiac power output and its response to exercise in athletes and non-athletes and (ii) to determine the relationship between cardiac power output and reserve and selected measures of cardiac function and structure. Twenty male athletes and 32 age- and gender-matched healthy sedentary controls participated in this study. CPO was calculated as the product of cardiac output and mean arterial pressure, expressed in watts. Measures of hemodynamic status, cardiac structure and pumping capability were assessed by echocardiography. CPO was assessed at rest and after peak bicycle exercise. At rest, the two groups had similar values of cardiac power output (1·08 ± 0·2 W versus 1·1 ± 0·24 W, P>0·05), but the athletes demonstrated lower systolic blood pressure (109·5 ± 6·2 mmHg versus 117·2 ± 8·2 mmHg, P<0·05) and thicker posterior wall of the left ventricle (9·8 ± 1 mm versus 9 ± 1·1 mm, P<0·05). Peak CPO was higher in athletes (5·87 ± 0·75 W versus 5·4 ± 0·69 W, P<0·05) as was cardiac reserve (4·92 ± 0·66 W versus 4·26 ± 0·61 W, P<0·05), respectively. Peak exercise CPO and reserve were only moderately correlated with end-diastolic volume (r = 0·54; r = 0·46, P<0·05) and end-diastolic left ventricular internal diameter (r = 0·48; r = 0·42, P<0·05), respectively. Athletes demonstrated greater maximal cardiac pumping capability and reserve than non-athletes. The study provides new evidence that resting measures of cardiac structure and function need to be considered with caution in interpretation of maximal cardiac performance.

Comparative analysis of two different methods of anaerobic capacity assessment in sedentary young men.

BACKGROUND/AIM: The Wingate anaerobic test is a valid and reliable method of measuring anaerobic capacity. The aim of this study was to determine whether other modified test can be used instead of the Wingate test. METHODS: A group of 30 sedentary young men were first tested with a cycle ergometer (classic Wingate test), and then with a dynamometer during 30 s of "all out" leg extension exercise (modified Wingate test; WAnTe) in order to test anaerobic capacity. Subsequent correlations between these tests were made. RESULTS: Peak power, mean power on cycling ergometer in absolute and relative values were 463 +/- 105 W, 316.7 +/- 63.8 W, 5.68 +/- 1.17 W/kg, 3.68 +/- 0.78 W/kg, respectively. On a dynamometer absolute and relative values of maximal and mean load in kg and power in Watts were 136.54 +/- 21.3 kg, 1.67 +/- 0.26; 128.65 +/- 19.93 kg, 1.57 +/- 0.24 kg, 657 +/- 125.87 W, and 8 +/- 1.54 W/kg, respectively. There was no correlation between 5 s intervals of the classic Wingate test and WAnTe during the first, fourth and fifth intervals, but in the second (r = 0.49, p < 0.05), third (r = 0.38, p < 0.05) and last 5 s intervals (r = 0.39, p < 0.05), and also in peak power and mean power (r = 0.42, p < 0.05 and r = 0.45, p < 0.05 respectively), a significant positive correlation was detected. CONCLUSION: A modified Wingate test of leg extension on a dynamometer in sedentary young men shows a correlation with the classic Wingate test only in parameters of peak power, and mean power and the second, the third and the last 5 s intervals. Because of that it should only be used for orientation, whereas for precise measurements of anaerobic capacity the classic Wingate test should be used.

[Exercise induced rhabdomyolysis]. / Rabdomioliza nakon ekstermnog fizickog napora.

INTRODUCTION: Rhabdomyolysis is a potentially life-threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. CASE REPORT: A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. CONCLUSION: Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis.

The righting reflex from a supine to a prone position in the guinea pig fetus.

The aim of this study was to examine the righting reflex from a supine to a prone position in the albino guinea pig fetus. Ultrasound examinations of one-fetus gestations were performed in the period from the 31st to the 66th day of gestation. The experimental and control group each encompassed 6 fetuses. Fetuses were brought into supine positions relative to the gravity vector by manipulating the pregnant females into the appropriate positions. The control group received 15 mg/kg of diazepam intraperitoneally before the examination to show whether changes in fetal position occurred as the result of passive rotation. In the experimental group, each fetus was examined every other day (summary results: absent 69 times, prone position 10 times, lateral position 29 times). In the control group, each fetus was examined every five days (summary results: absent 42 times). The absence of the righting reflex in the control group was statistically significant (chi(2) = 18.66, df = 1, p = 0.000, p < 0.05). The experimental group fetuses assumed a prone position more frequently in the period from the 51st to the 66th day of gestation than in the period from the 31st to the 50th day of gestation (chi(2) = 4.17, df = 1, p = 0.0412, p < 0.05), suggesting maturation of the righting reflex.

[Event-related potentials following exercise bouts of different intensity].

INTRODUCTION: A number of articles on physical activity analyze the effects of acute bouts of physical exercise on the whole body. These experiments mainly include questionnaires and measurements of reaction time. The use of event-related potentials in laboratories for functional diagnostics is only of recent date. The aim of this experiment was to give insights into the impact of physical activity of different intensity on the amplitude and latency of P300 cognitive potentials. MATERIAL AND METHODS: After recording cognitive event-related potentials in 17 young (21.6+/-1.07 yrs) healthy adults (at Fz and Cz), the participants underwent a controlled bicycle ergometer exercise. Each exercise lasted 10 minutes, with successive increase in the intensity to 60%, 75% and 90% of the maximum pulse rate and maintaining this level of intensity for six minutes. Immediately after each bout of exercise, event-related potentials were recorded. RESULTS: The amplitude of the P300 wave, following exercise intensity at 75% of the maximum pulse (Pmax) (Fz 15.00+/-4.57, Cz 18.63+/-8.83 mV ) was statistically higher (p<0.05) than the amplitude of the P300 at rest (Fz 11.21+/-4.15 mV; (Cz 13.40+/-8.04 mV), at 60% (Fz 11.86+/-5.11 mV; Cz 14.54+/-8.06 mV) and at 90% of maximum pulse (Fz 13.26+/-4.73 mV; Cz 14.91+/-8.91 mV). There were no statistically significant differences (p>0.05) between amplitudes at 60% of Pmax and values obtained at rest and at 90% of Pmax. Also, no statistically significant differences were recorded (p>0.05) among the latencies of P300 recorded at rest (Fz 323.57+/-3.24 ms; Cz 323.57+/-13.24 ms) and at 60% of Pmax (Fz 321.14+/-22.38 ms; Cz 321.86+/-22.88 ms), at 75% of Pmax (Fz 321.50+/-16.67 ms; Cz 322.50+/-14.60 ms) and at 90% of Pmax (Fz 326.29+/-7.85 ms; Cz 325.43+/-7.63 ms). DISCUSSSION AND CONCLUSION: Physical activity has a positive impact on cognitive functions. At intermediate intensities, the amplitude of P300 increases, but at submaximal intensities it decreases to values obtained at rest. However, the latency of P300 did not show a statistically significant change after different intensities of exercise.

The fetus cannot exercise like an astronaut: gravity loading is necessary for the physiological development during second half of pregnancy.

On the basis of published Magnetic Resonance Images and the values of the specific fetal and amniotic fluid weights, apparent weight of the fetus from the 18th week of gestation until term was determined. Up to the 21-22nd gestation week the fetus is in conditions similar to neutral floating, while after the 26th gestation week the apparent weight of the fetus is 60-80% of the actual weight. Decreased effect of the buoyant forces that affect the fetus in human species during the last trimester has a number of implications for the colonization of the solar system. During space flight it is impossible to apply the existing countermeasures against microgravity deconditioning of the muscular and cardiovascular systems to the fetus. Absence of gravitational loading during the last trimester of gestation would cause hypotrophy of the spinal extensors and lower extremities muscles, reduction in the amount of myosin heavy chain type I in the extensor muscles of the trunk and legs, hypoplasy and osteopeny of the vertebras and lower extremities long bones, and hypotrophy of the left ventricle of the heart muscle. Because of decreased capacity of postural and locomotor stability, acquisition of the gross developmental milestones such as sitting, standing and walking could be delayed. In the authors' opinion, only artificial gravity (rotating platform) during space flight will allow physiological development of the human fetus. Independency of offspring's of the guinea pig as regards locomotion and nursing increases probability of successful breeding in microgravity compared with rat offspring's, and make this species a candidate for future experiments under conditions of microgravity and hypergravity. Examining the gestation of this species in different gravities requires first the experimental determination of the amount of buoyant force to which the fetus is exposed in physiological conditions.