The impact of high level basketball competition, calcium intake, menses, and hormone levels in adolescent bone density: a three-year follow-up.

AIM: The main goal of the present work is to establish the positive influence high-impact physical exercise, specifically high-level basketball, on bone acquisition in adolescent female and verify if the long-term exposure to such programs is the major modifiable factor explaining bone acquisition during adolescence. METHODS: A prospective cohort study comparing the development of bone mass in the lumbar spine, proximal femur and distal radius was carried out over a three-year period in two groups of adolescents: elite basketball players and age-matched controls. Baseline hormone levels and bone remodelling were evaluated. Bone mass, hours of physical exercise, diet, unhealthy habits, anthropometry and menstrual cycle were assessed at baseline and yearly. Differences in acquisition of bone mass were assessed by two-way repeated measures analysis of variance (ANOVA). RESULTS: Elite basketball training and competition appears to increase bone mass in girls aged 14-18 years. The most pronounced benefits were observed in lumbar spine and proximal femur, sites most directly involved in the exercise and subjected to greatest impact. CONCLUSION: The intensive basketball training and competition in adolescent females increases bone mass in the lumbar spine and femur, skeletal sites submitted to high impact in this sport. No significant gain in bone mass was observed in age-matched, normally active, controls.

Oxidised proteins and superoxide anion production in the diaphragm of severe COPD patients.

In the diaphragms of chronic obstructive pulmonary disease (COPD) patients, the nature of oxidatively modified proteins and superoxide anion production were explored. Diaphragm specimens were obtained through thoracotomy because of localised lung lesions in COPD patients (16 severe and eight moderate) and 10 control subjects. Lung and respiratory muscle functions were evaluated. Oxidised proteins were identified using immunoblotting and mass spectrometry. Protein and activity levels of the identified proteins were determined using immunoblotting and activity assays. Lucigenin-derived chemiluminescence signals in a luminometer were used to determine superoxide anion levels in muscle compartments (mitochondria, membrane and cytosol) using selective inhibitors. In severe COPD patients compared with controls, respiratory muscle function was impaired; creatine kinase, carbonic anhydrase III, actin and myosin were oxidised; myosin carbonylation levels were increased five-fold; creatine kinase content and activity and myosin protein were reduced; superoxide anion levels were increased in both mitochondria and membrane compartments; and the percentage of superoxide anion inhibition achieved by rotenone was significantly greater. In severe COPD patients, oxidation of diaphragm proteins involved in energy production and contractile performance is likely to partially contribute to the documented respiratory muscle dysfunction. Furthermore, generation of the superoxide anion was increased in the diaphragms of these patients.

[Guide for the prevention and treatment of glucocorticoid-induced osteoporosis of the Spanish Society of Internal Medicine]. / Guía de prevención y tratamiento de la osteoporosis inducida por glucocorticoides de la Sociedad Española de Medicina Interna.

Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.

Low- vs high-dose almitrine combined with nitric oxide to prevent hypoxia during open-chest one-lung ventilation.

BACKGROUND: Almitrine combined with inhaled nitric oxide (NO) can prevent hypoxia during one-lung ventilation (OLV). The optimal dose of almitrine that would provide therapeutic advantage with few side-effects during open-chest OLV has not been established. METHODS: Forty-two patients undergoing thoracotomy were randomly allocated to three groups: placebo, almitrine 4 microg kg(-1) min(-1) and inhaled NO 10 p.p.m. (ALM4+NO), and almitrine 16 microg kg(-1) min(-1) and inhaled NO 10 p.p.m. (ALM16+NO). Gas exchange, haemodynamic and respiratory variables and plasma concentrations of almitrine and lactate were monitored. Measurements were obtained with the patient awake (baseline), after induction of anaesthesia with two-lung ventilation (control 2LV), 20 min after treatment (2LV+T), and then at 10, 20 and 30 min of OLV (OLV10', OLV20' and OLV30') with FI(O2)1. RESULTS: In the placebo group, OLV impaired Pa(O2) and increased pulmonary shunt [16 (SD 7) kPa and 42 (10)% respectively]. These improved with ALM4+NO [26 (10) kPa and 31 (7)%; P<0.001]. ALM16+NO further improved PaO2) to 36 (13) kPa (P<0.0001) but gave no improvement in the shunt. Mean pulmonary artery pressure was similar in the placebo and ALM4+NO groups [20 (4) vs 23 (5) mm Hg], whereas it was increased in the ALM16+NO group to 28 (8) mm Hg (P<0.01). Plasma concentrations of almitrine and lactate were unaltered by the treatments. CONCLUSIONS: Low-dose almitrine (4 microg kg(-1) min(-1)) together with inhaled NO significantly improves oxygenation during open-chest OLV, without modifying pulmonary haemodynamics. An increased dose of almitrine (16 microg kg(-1) min(-1)) with inhaled NO further improves arterial oxygenation, but also increases mean pulmonary artery pressure.

Sinóstosis congénita del tarso / Congenital tarsal synostosis

Objetivos. Revisión de 86 casos de sinóstosis del tarso (35con sinóstosis astrágalo-calcánea y 52 calcáneo-escafoidea),con el objetivo de constatar algunas características de esta malformación. Material y método. Se estudiaron un total de 121 pies (35casos eran bilaterales: 40,6%). La edad media al diagnóstico fue de 12 años y 2 meses en los varones y 10 años y 8 meses en las niñas. Resultados. El resultado del tratamiento quirúrgico fue malo en 5 pies (de 78 pies observados a largo plazo), con una edad media de 9 años y 8 meses. Distinguiendo el resultado de un grupo diagnosticado antes de los 10 años de edad y otro a más de 10 años, los resultados malos constituyen el25% de los primeros y el 1,6% de los de más de 10 años. Conclusiones. Se sugieren las siguientes conclusiones: a) el diagnóstico se hace a una edad más precoz en las niñas; b)la presencia de un pie plano contracto y signos radiográficos como signo-C o prominencia dorsal en la cabeza del astrágalo permiten sospechar una sinóstosis, pero no hacer el diagnóstico, y c) los malos resultados del tratamiento quirúrgico se dan con mayor frecuencia en los pacientes que al diagnosticarse tenían menos de 10 años

Aim. Review of 86 cases of tarsal synostosis (35 with talocalcaneal synostosis and 52 with calcaneo-navicular synostosis) to identify some of the characteristics of this malformation. Materials and methods. A total of 121 feet were studied(35 bilateral cases, 40.6%). The mean age of boys at diagnosis was 12 years 2 months and of girls, 10 years 8months.Results. The result of surgical treatment was poor in 5 feet(out of 78 feet observed long term) and the patients had a mean age of 9 years 8 months. In a comparison of the results of children diagnosed before the age of 10 years and children diagnosed after the age of 10 years, results were poor in 25% of the early diagnosis group and in 1.6% of the later diagnosis group. Conclusions. The following observations are made: a) diagnosis was earlier in girls; b) the presence of flat foot with contracture and radiographic signs such as the C sign or dorsal prominence of the talar head suggest synostosis but are not diagnostic and c) poor results of surgical treatment are more frequent in patients diagnosed before the age of 10 years

[Analysis of respiratory muscle structure and tumor necrosis and insulin-like growth factor expression in chronic obstructive pulmonary disease: are samples valid if obtained during thoracotomy performed because of localized pulmonary neoplasia?]. / Análisis estructual y expresión de los factores de necrosis tumoral y crecimiento insulina-like en los músculos respiratorios de pacientes con EPOS. Son válidas las muestras obtenidas en el curso de una toracotomía por neoplasia pulmonar localizada?

OBJECTIVE: Various methods have been used to obtain samples to study the structure of human respiratory muscles and the expression of diverse substances in them. Samples are most often obtained from autopsies, from muscle biopsies during thoracotomy performed because of a localized pulmonary lesion (TLL), and from ambulatory thoracoscopic biopsy in patients free of comorbidity (AT). The disadvantage of the first 2 of these methods lies in the possibility of interference from factors related to the patient's death in the first case or from the disease that necessitated surgery in the second. Although AT is free from the disadvantages of the other 2 methods, it is impossible to obtain samples of the diaphragm the principal respiratory muscle with this procedure. The objective of this study was to analyze the fibrous structure of the external intercostal muscle of patients with chronic obstructive pulmonary disease and to quantify the expression of the principal inflammatory cytokine tumor necrosis factor alpha (TNF-alpha)- and of insulin-like growth factor (IGF-1) in the same muscle, comparing the results obtained with TLL and AT samples. METHODS: Prospective and consecutive samples were taken of the external intercostal muscle (fifth space, anterior axillary line) in 15 patients with chronic obstructive pulmonary disease (mean [SD] age 66 [6] years; forced expiratory volume in 1 second 49% [9%] of predicted; PaO2 75 [9] mm Hg). Samples were taken during TLL (8 patients, all with pulmonary neoplasms but carefully selected in order to rule out systemic effects) or TA (7 patients). Patients with serious comorbidity were excluded from the second group. Samples were processed for structural analysis of fibers (immunohistochemical and enzymatic histochemical) and genetic expression of TNF-alpha and IGF-1 (real-time polymerase chain reaction). RESULTS: No differences in the structure of fibers were found between the 2 groups. No differences were observed in the expression of TNF-alpha or IGF-1. CONCLUSIONS: Using rigorous criteria, the TLL method appears to be suitable for studying the structural characteristics and expression of inflammatory cytokines and growth factors in the external intercostal muscle. Moreover, it can also be inferred that TLL is probably also useful for obtaining samples of the diaphragm, a muscle which cannot currently be sampled by any alternative method.

Techniques for small-bone lengthening in congenital anomalies of the hand and foot.

The purpose of this study is to analyse three different lengthening techniques used in 31 small bones for congenital malformations of the hand and foot: 15 metacarpals, 12 metatarsals, 1 foot stump and 3 spaces between a previously transplanted phalanx end of the carpus or the metacarpal. Progressive lengthening with an external fixator device was performed in 23 cases: the callus distraction (callotasis) technique was used in 15 cases, whereas in the other 8 cases the speed of lengthening was faster and the defect bridged with a bone graft as a second stage. In another eight cases, a one-stage lengthening was performed. In the callotasis group, the total length gained ranged from 9 mm to 30 mm and the percentage of lengthening obtained (compared with the initial bone length) averaged 53.4%; in the fast lengthening group, the length gained ranged from 8 mm to 15 mm, and the average percentage of lengthening was 53.1%; and in the one-stage group, the length gained ranged from 7 mm to 15 mm, and the average percentage of lengthening was 43%. The overall complication rate was 22.5%.

Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease.

Injury of the diaphragm may have clinical relevance having been reported in cases of sudden infant death syndrome or fatal asthma. However, examination of diaphragm injury after acute inspiratory loading has not been reported. The purpose of this study was to determine whether an acute inspiratory overload induces injury of the human diaphragm and to determine if diaphragm from chronic obstructive pulmonary disease (COPD) is more susceptible to injury. Eighteen patients with COPD and 11 control patients with normal pulmonary function (62 +/- 10 yr) undergoing thoracotomy or laparotomy were studied. A threshold inspiratory loading test was performed prior to surgery in a subset of seven patients with COPD and five control patients. Samples of the costal diaphragm were obtained during surgery and processed for electron microscopy analysis. Signs of sarcomere disruption were found in all diaphragm samples. The range of values of sarcomere disruption was wide (density: 2-45 abnormal areas/100 microm(2); area fractions: 1.3-17.3%), significantly higher in diaphragm from patients with COPD (p < 0.05) and with the greatest injury after inspiratory loading. We conclude that sarcomere disruption is common in the human diaphragm, is more evident in patients with COPD, and is higher after inspiratory loading, especially in the diaphragm of those with COPD.

Tratamiento quirúrgico de la tuberculosis multirresistente. A propósito de un caso / No disponible

No disponible

[Obtaining samples of the human diaphragm during upper laparotomy. A structural analysis]. / Obtención de muestras del diafragma humano en el curso de laparotomía alta. Análisis estructural.

UNLABELLED: The diaphragm seems to undergo adaptive structural change in chronic obstructive pulmonary disease. The possibility of obtaining muscle specimens is limited, however, particularly when respiratory function is severely affected. OBJECTIVE: To assess the viability of a new technique for obtaining diaphragm muscle samples appropriate for structural assessment even from patients with severe functional change, and to study the size of fibers in relation to severity of disease. METHODS: Fifteen muscle specimens were obtained from patients (aged 57 +/- 15 years) by abdominal laparotomy. All had undergone full lung function testing. Muscle samples were taken during surgery using a new technique involving formation of a tobacco pouch with dome biopsy. The method had been previously validated in animal models. Later, the biopsies were processed to evaluate fiber proportions and sizes (ATPase dyes at different levels of pH). RESULTS: The 15 patients had a wide range of lung function results (FEV1 22-120% ref); 4 were severely affected (FEV1 < or = 50% ref). Nutritional status was normal in all cases; FEV1/FVC was 67 +/- 13%, RV was 134 +/- 55% ref, maximal mouth pressure (PImmax) was -75 +/- 27 cmH2O, transdiaphragmatic pressure (PIdimax) was 96 +/- 26 cmH2O, DLCO was 87 +/- 26% ref and PaO2 was 89 +/- 14 mmHg. We were able to obtain specimens valid for structural analysis from all patients with no complications. Light type I fibers predominated (54 +/- 9%) and size was normal overall (57 +/- 9 microns minimum diameter [Dm] atrophy index 195 +/- 243, and hypertrophy index 66 +/- 78), with no differences between the two fiber subtypes (Dm 58 +/- 8 microns for type I and 61 +/- 8 microns for type II). Overall size correlated inversely with static volumes (e.g. Dm with RV, r = -0.729, p < 0.01). CONCLUSIONS: The laparoscopic technique described is simple and safe for use in humans to obtain diaphragm muscle specimens that are valid for morphometric analysis, allowing us to enlarge the range of subjects that can be enrolled for this type of study. The fiber muscles studied are smaller when functional involvement is greater in chronic obstructive pulmonary disease.

Polidactilia sin pulgar / Thumbless polydactyly

Objetivo: Estudiar seis casos de malformación de la mano (polidactilia y ausencia del pulgar) para buscar otros elementos de coincidencia.Resultados: Dos casos (3 y 6) presentaban cinco dedos trifalángicos, con un primer dedo hipoplásico, siendo unilaterales. Un caso (5) también unilateral, era una típica mano en espejo y presentaba dos cúbitos. Tres casos (1, 2 y 4) eran bilaterales y tenían afectadas las manos y los pies, aunque sus características eran algo diferentes. Tres casos (2, 4 y 6) combinaban la polidactilia con la sindactilia. Si bien dos casos (2 y 4) presentaban sólo anomalías distales, en los demás el antebrazo o la pierna formaban parte de la malformación. El tratamiento fue la pulgarización de un dedo radial y extirpación de los dedos supernumerarios, con resultados globales aceptables, aunque con movilidad activa escasa del pulgar.Conclusiones: 1) la polidactilia sin pulgar tiene diferentes formas de presentación; 2) se hace difícil clasificar los casos, aunque se pueden distinguir las pentadactilias, la mano en espejo típica y formas en que se combinan con malformaciones semejantes en los pies y suelen ser bilaterales, y 3) algunos casos se combinan con anomalías en antebrazo o pierna, afectando al radio o la tibia (AU)

Obtención de muestras del diafragma humano en el curso de laparotomía alta. Análisis estructural / Human diaphragm specimens obtained during high laparotomy. Structural analysis

El diafragma parece presentar fenómenos estructurales adaptativos en la EPOC. Sin embargo, existen limitaciones para la obtención de muestras musculares, sobre todo en enfermos con afectación funcional grave. Objetivo: Valorar la viabilidad de un nuevo modelo de obtención de muestras del diafragma, que permitiría el estudio estructural incluso en los pacientes mencionados, y estudiar si el tamaño de las fibras se relaciona con la gravedad de la enfermedad. Métodos: Se han estudiado 15 enfermos (de 57 ñ 15 años de edad), tributarios de laparotomía por proceso abdominal localizado. En todos ellos se efectuaron pruebas funcionales respiratorias completas. Las muestras musculares fueron obtenidas durante el acto quirúrgico, mediante una nueva técnica, con formación de "bolsa de tabaco" y biopsia en cúpula, validada previamente en modelos animales. Posteriormente, las biopsias fueron procesadas para evaluar las proporciones y tamaños fibrilares (tinción de ATPasa a diferentes pH). Resultados: Los 15 pacientes presentaban un amplio espectro funcional (FEV1 22-120 por ciento ref), que incluía 4 enfermos graves (FEV1 3/4 50 por ciento ref). Todos ellos se hallaban eunutridos y su función respiratoria mostraba un FEV1/FVC del 67 ñ 13 por ciento, RV 134 ñ 55 por ciento ref, y presiones máximas en la boca (PImmáx) de -75 ñ 27 cmH2O y transdiafragmática (PIdimáx) de 96 ñ 26 cmH2O, DLco 87 ñ 26 por ciento ref y PaO2 89 ñ 14 mmHg. En todos los pacientes fue posible la obtención de muestras válidas para el análisis estructural, con total ausencia de complicaciones. Las fibras presentaron un predominio ligero de las tipo I (54 ñ 9 por ciento), que mantenían un tamaño globalmente normal (57 ñ 9 µm de diámetro mínimo o Dm, índice de atrofia de 195 ñ 243 e índice de hipertrofia de 66 ñ 78), sin diferencias entre ambos subtipos fibrilares (Dm de 58 ñ 8 para las I y 61 ñ 8 µm para las II). Se observó una correlación inversa del tamaño global con los volúmenes estáticos (p. ej., Dm con RV, r = -0,729, p < 0,01). Conclusiones: La técnica laparoscópica descrita es sencilla y segura para su utilización en seres humanos, permitiendo obtener muestras del diafragma válidas para el estudio estructural. Esto permite ampliar el espectro de sujetos susceptibles de este tipo de estudios. Por otra parte, las fibras del músculo mencionado presentan un menor tamaño en relación con la gravedad de la afectación funcional asociada a la EPOC. (AU)

Subcellular adaptation of the human diaphragm in chronic obstructive pulmonary disease.

Pulmonary hyperinflation impairs the function of the diaphragm in patients with chronic obstructive pulmonary disease (COPD). However, it has been recently demonstrated that the muscle can counterbalance this deleterious effect, remodelling its structure (i.e. changing the proportion of different types of fibres). The aim of this study was to investigate whether the functional impairment present in COPD patients can be associated with structural subcellular changes of the diaphragm. Twenty individuals (60+/-9 yrs, 11 COPD patients and 9 subjects with normal spirometry) undergoing thoracotomy were included. Nutritional status and respiratory function were evaluated prior to surgery. Then, small samples of the costal diaphragm were obtained and processed for electron microscopy analysis. COPD patients showed a mean forced expiratory volume in one second (FEV1) of 60+/-9% predicted, a higher concentration of mitochondria (n(mit)) in their diaphragm than controls (0.62+/-0.16 versus 0.46+/-0.16 mitochondrial transections (mt) x microm(-2), p<0.05). On the other hand, subjects with air trapping (residual volume (RV)/total lung capacity (TLC) >37%) disclosed not only a higher n(mit) (0.63+/-0.17 versus 0.43+/-0.07 mt x microm(-2), p<0.05) but shorter sarcomeres (L(sar)) than subjects without this functional abnormality (2.08+/-0.16 to 2.27+/-0.15 microm, p<0.05). Glycogen stores were similar in COPD and controls. The severity of airways obstruction (i.e. FEV1) was associated with n(mit) (r=-0.555, p=0.01), while the amount of air trapping (i.e. RV/TLC) was found to correlate with both n(mit) (r=0.631, p=0.005) and L(sar) (r=-0.526, p<0.05). Finally, maximal inspiratory pressure (PI,max) inversely correlated with n(mit) (r=-0.547, p=0.01). In conclusion, impairment in lung function occurring in patients with chronic obstructive pulmonary disease is associated with subcellular changes in their diaphragm, namely a shortening in the length of sarcomeres and an increase in the concentration of mitochondria. These changes form a part of muscle remodelling, probably contributing to a better functional muscle behaviour.

[Capillary density and respiratory function in the external intercostal muscle]. / Densidad capilar y función respiratoria en el músculo intercostal externo.

UNLABELLED: Changes in lung function have been related to adaptive structural modifications in respiratory muscles. OBJECTIVE: To evaluate the capillary density (Dcap) of the external intercostal muscle in patients with chronic obstructive pulmonary disease (COPD), and its possible relation to respiratory function. METHODS: Forty-two individuals (61 +/- 9 years old) underwent conventional lung function testing and evaluation of respiratory muscles (maximum pressures at rest and a tolerance test using Martyn's technique). The sample included 10 subjects with normal lung function and 32 COPD patients (FEV1 between 13 and 78% of reference), in stable phase and with no respiratory insufficiency (PaO2 > 60 mmHg). A local biopsy of the external intercostal muscle was taken from all subjects at the fifth intercostal space (anterior axillary [correction of axile]) on the non-dominant side. The sample was processed for morphometry and fiber typing with ATPase staining and for quantifying capillarity with Gomori's trichrome staining. RESULTS: The mean diameter was 61 +/- 10 micrograms, with type I fibers predominating (56 +/- 11%). Dcap was 2.8 +/- 0.6 capillaries/fiber (equivalent to 1.02 +/- 0.37 capillaries/mm2 of fibrillary surface). The number of capillaries/fiber was significantly higher in patients with severe COPD (FEV1 < 50% ref) than in controls (3.0 +/- 0.6 versus 2.3 +/- 0.5, p < 0.01) and was inversely related to FEV1 (r = -0.395, p < 0.01). Muscle capillarity was unrelated to other function variables, including markers of respiratory muscle function and gas exchange. CONCLUSION: The structural remodelling of external intercostal muscles in COPD patients also includes an increase in density of interfibrillary capillaries. This increase is proportional to the severity of obstruction and probably reflects an adaptive phenomenon.

Structure and function relationships of the respiratory muscles.

Potential relationships between the structure of the diaphragm and external intercostals and several indices of respiratory muscle function, lung function and nutrition in 27 patients (61+/-10 yrs of age) subjected to thoracotomy as a result of a lung neoplasm have been investigated. Prior to surgery the nutritional status of the patients was assessed and lung function (spirometry, lung volumes, transfer factor of the lungs for carbon monoxide, arterial blood gases) and respiratory muscle function (maximal inspiratory pressure (MIP) and diaphragmatic function were measured). Biopsies of the diaphragm (and external intercostals) were obtained during surgery. On average, patients showed mild airflow limitation (forced expiratory volume in one second (FEV1), 70+/-14% of predicted value, FEV1/forced vital capacity (FVC), 70+/-9%) with some air trapping (residual volume (RV), 139+/-50% pred) and normal gas exchange (arterial oxygen tension (Pa,O2), 11.3+/-1.33 kPa (85+/-10 mmHg)) and arterial carbon dioxide tension (Pa,CO2) 5.4+/-0.5 kPa (40.6+/-4 mmHg). MIP was 77+/-25% pred; maximal transdiaphragmatic pressure was 90+/-27 cmH2O. Most morphometric measurements of the diaphragm and external intercostals were within the range of values reported previously in other skeletal muscles. The size of the fibres of these two respiratory muscles was positively related (p<0.05) to MIP (% pred). There were no significant relationships between the structure of both muscles and nutritional status or any index of lung function. In conclusion, in the population studied, the fibre size of the diaphragm and external intercostals appears to relate to their ability to generate force.

Congenital tibial aplasia with preaxial polydactyly. A case report.

An anatomical study of a left lower limb with congenital tibial aplasia and preaxial polydactyly amputated at 10 months of age was carried out. The tibia was replaced by a fibrous band (a band of connective tissue) and there were four cuneiforms, six metatarsal bones and seven toes. The second metatarsal bone showed characteristics of the hallux. An intermuscular septum which showed an orifice for the anterior tibial artery was found on the medial side of the leg and foot. All the muscles of the leg and foot were present except for the tibialis posterior muscle, which was replaced by two atypical muscles. No muscular attachments reached the fibrous band. Several intertendinous connection bands were found. Also, an accessory muscular belly split from the tibialis anterior tendon and attached to the common flexor tendinous sheet of the foot. An unusual motor branch of the deep peroneal nerve ran together with this belly to supply the intrinsic muscles of the hallux. We also observed other minor anomalies of the nerve pattern. The arterial pattern was complete, except for some arteries which showed both an anomalous origin and course. The findings of this study suggest that the development of the skeletal elements plays an important role in the differentiation of the muscles, tendons, arteries and nerves. We postulate that a dysmorphogenic event involving the development of the tibial field of the limb could give rise to both defective histodifferentiation of the tibia and defective programmed cell death in the pre-hallucial anlage. These anomalies would determine secondary adaptations of muscles, tendons, vessels and nerves of the limb.

Structure of the latissimus dorsi muscle and respiratory function.

The aim of this study was to evaluate whether respiratory function influences the structure of the latissimus dorsi muscle (LD). Twelve patients (58 +/- 10 yr) undergoing thoracotomy were studied. Lung and respiratory muscle function were evaluated before surgery. Patients showed a forced expired volume in 1 s (FEV1) of 67 +/- 16% of the reference value, an FEV1-forced vital capacity ratio of 69 +/- 9%, a maximal inspiratory pressure of 101 +/- 21% of the reference value, and a tension-time index of the diaphragm (TTdi) of 0.04 +/- 0.02. When patients were exposed to 8% CO2 breathing, TTdi increased to 0.06 +/- 0.03 (P < 0.05). The structural analysis of LD showed that 51 +/- 5% of the fibers were type I. The diameter was 56 +/- 9 microns for type I fibers and 61 +/- 9 microns for type II fibers, whereas the hypertrophy factor was 87 +/- 94 and 172 +/- 208 for type I and II fibers, respectively. Interestingly, the histogram distribution of the LD fibers was unimodal in two of the three individuals with normal lung function and bimodal (additional mode of hypertrophic fibers) in seven of the nine patients with chronic obstructive pulmonary disease. An inverse relationship was found between the %FEV1-forced vital capacity ratio and both the diameter of the fibers (type I: r = -0.773, P < 0.005; type II: r = -0.590, P < 0.05) and the hypertrophy factors (type I: r = -0.647, P < 0.05; type II: r = -0.575, P = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)