Physiological responses in handcycling. Preliminary study.

INTRODUCTION: In the field of sports for the disabled, this last decade has been marked by the development of handcycling. Although assessment of maximal capacity during arm exercises in cases of spinal cord injury (SCI) has been widely investigated, investigations of maximal capacity in handcyclists remain less frequent. OBJECTIVE: The aim of this study was to investigate the physiological parameters of an incomplete quadriplegic athlete (cervical lesion C5-C6; ASIA-D) during an adapted incremental handcycling test and to judge the appropriateness of the test. Using such a test, it will then be possible to determine the individualized training program intensity needed to improve the athlete's aerobic capacity. METHODS: The athlete completed an incremental hand cycling test (i.e., an adapted Léger-Boucher test), with the handbike mounted on an ergotrainer. The athlete's physiological parameters were recorded during the test, and the pedalling rate and the perceived exertion rate were estimated. Given the athlete's pathology, ergonomic adaptations were necessary in order to improve comfort and propulsion quality. RESULTS: The maximum values recorded (VO2peak = 1.16l/min; [La]=7.7 mmol/l; heart rate peak=133 beats/min; maximum respiratory frequency=85 cycles/min and averaged pedaling rate=95 tours/min) indicate that the incremental test, adapted for handcycling, is maximal, and consequently, it should be possible to individualize the training intensity. CONCLUSION: This test is innovative and potentially applicable in a booming discipline garnering more and more interest. However, first it is necessary to extend this test to a larger population and to test the extended application in field.

[Fortuitously discovered lung nodules]. / Nodules pulmonaires de découverte fortuite.

Pulmonary nodular amyloidosis is a rare entity. We report a new case where multiple nodules suggested, first, a neoplastic process. Clinical and radiological findings were non specific. Positive diagnosis was established at pathology.

Pulmonary hypertension associated with POEMS syndrome.

Pulmonary hypertension (PH) is an uncommon but lethal complication of some connective tissue diseases. We describe two cases of PH associated with plasma cell dyscrasia, with polyneuropathy (P), organomegaly (O), endocrinopathy (E), M protein (P) and skin changes (S) described as POEMS syndrome. Two patients, one female and one male, were hospitalized for dyspnoea. Both had a history of POEMS syndrome a few years previously. PH was diagnosed from cardiac catherization, and complete investigations did not reveal other underlying disease. In Case No. 1, mean pulmonary artery pressure was 40 mmHg and pulmonary vascular resistance was 775 dyne x s x cm-5 x m2, with a significant reversibility to vasodilators. Nifedipine and fluindrone treatment was initiated. The patient was still alive 18 months later. In Case No. 2, mean pulmonary artery pressure was 28 mmHg and pulmonary vascular resistance was 243 dyne x s x cm-5x m2, with a slight reversibility to vasodilators. The patient died 6 months later. Our observations suggest that pulmonary hypertension (PH) may be associated with the POEMS syndrome, and that patients suffering from the POEMS syndrome and dyspnoea should be tested for PH.