Comparison of inflammatory responses and muscle damage indices following a soccer, basketball, volleyball and handball game at an elite competitive level.

Inflammatory responses and muscle damage indices were compared between four popular team sports at an elite level. Seventy two male elite players of four team sports: soccer (n = 18), basketball (n = 18), volleyball (n = 18) and handball (n = 18), completed an official match, while 18 non-athletes served as controls. Blood samples were drawn before, immediately after and 13 and 37 h post-match. Soccer produced the greatest increase in inflammatory cytokines (tumor necrosis factor-alpha and interleukin-6), which were increased by 3-4 fold immediately after the game, as well as in C-reactive protein, which was increased by threefold in the next morning after the match. Metabolic stress (urea, ammonia and cortisol) and muscle damage indices (creatine kinase and lactate dehydrogenase) were also higher after soccer, with creatine kinase responses being almost 2-3 times higher than the other sports. Volleyball showed the smallest increase in inflammation and muscle damage markers compared with the other three sports.

Changes in the lipid profile of elite basketball and soccer players after a match.

The lipid profile of elite basketball and soccer athletes was evaluated and compared with that of inactive individuals. Total cholesterol (T-C), low and high density lipoprotein cholesterol (LDL-C and HDL-C), and triglyceride (TG) concentration were measured in the morning and after a soccer or a basketball match. All parameters of lipid profile measured at a fasted and resting state, except HDL-C, were lower in the athletes compared with the controls (p < 0.01). The soccer match resulted in a greater decrease in TG (78.3 ± 6.7 to 70.7 ± 6.3, p < 0.01), T-C (179.3 ± 10.7 to 171.6 ± 9.6, p < 0.01), LDL-C (110.9 ± 8.9 to 103.5 ± 7.5, p < 0.01) compared with the basketball match that resulted only in a decrease in LDL-C (126.8 ± 9.5 to 117.3 ± 9.1, p < 0.01) and an increase in HDL-C that was similar to that observed after the soccer match (9-12%). These findings support the beneficial effects of basketball and soccer on cardiovascular health.

Anthropometric, body composition and somatotype differences of Greek elite female basketball, volleyball and handball players.

AIM: The aims of the present study were: a) to determine the anthropometric profile, body composition and somatotype of elite Greek female basketball (B), volleyball (V) and handball (H) players, b) to compare the mean scores among sports and c) to detect possible differences in relation to competition level. METHODS: A total of 518 female athletes, all members of the Greek first National League (A1 and A2 division) in B, V and H sport teams participated in the present study. Twelve anthropometric measures required for the calculation of body composition indexes and somatotype components were obtained according to the established literature. RESULTS: V athletes were the tallest (P<0.001) among the three groups of athletes, had the lowest values of body fat (P<0.001) and their somatotype was characterized as balanced endomorph (3.4-2.7-2.9). B athletes were taller (P<0.01) and leaner (P<0.001) than H players, with a somatotype characterized as mesomorph-endomorph (3.7-3.2-2.4). H athletes were the shortest of all (P<0.01), had the highest percentage of body fat (P<0.001) and their somatotype was mesomorph-endomorph (4.2-4.7-1.8). In comparison with their A2 counterparts the A1 division players were taller (P<0.001) and heavier (P<0.01), but at the same time leaner (P<0.001), and exhibited higher homogeneity in somatotype characteristics (P<0.05). CONCLUSIONS: Anthropometric, body composition and somatotype variables of Greek female elite teamball players varied among sports; selection criteria, hours of training and sport-specific physiological demands during the game could explain the observed differences. More data are certainly needed to define the anthropometric profile of B, V and H female athletes internationally.

Physiological and technical characteristics of elite young basketball players.

AIM: The aim of this study was 2-fold: a) to describe the physiological and technical characteristics of elite young basketball players, and b) to examine the relationship between certain field and laboratory tests among these players. METHODS: Thirteen male players of the junior's Basketball National team (age: 18.5 +/- 0.5 years, mass: 95.5 +/- 8.8 kg, height: 199.5 +/- 6.2 cm, body fat: 11.4 +/- 1.9%, means+/-SD) performed a run to exhaustion on the treadmill, the Wingate test and 2 types of vertical jump. On a separate day, the field tests (control dribble, defensive movement, speed dribble, speed running, shuttle run and dribble shuttle run) were conducted. RESULTS: Maximal oxygen uptake (VO2max) and ventilatory threshold were 51.7 +/- 4.8 ml/kg/min and 77.6 +/- 7.0% VO2max, respectively. Maximum power output was 10.7 +/- 1.3 Watts/kg and mean power (Pmean) 8.0 +/- 0.7 Watts/kg. Counter-movement and squat jump height were 40.1 +/- 3.7 and 39.8 +/- 4.0 cm, respectively. Performance in control dribble (13.70 +/- 0.96 s), speed dribble (4.24 +/- 0.75 s), high intensity shuttle run (27.90 +/- 1.04 s) and dribble shuttle run (29.50 +/- 1.22 s) was correlated with Pmean (r=-0.58, r=-0.62, r=-0.56 and r=-0.73, respectively, p<0.05). Percent body fat was negatively correlated with all the above field tests (r=0.63, r=0.57, r=0.66, r=0.65, respectively, p<0.05). CONCLUSION: These players presented a moderate VO2max and anaerobic power. The significant correlation between Pmean and certain field tests indicates that these tests could be used for the assessment of anaerobic capacity of young basketball players.

Implantation of microballoons in the management of fecal incontinence.

PURPOSE: The implantation of expandable microballoons has proved successful for the treatment of stress urinary incontinence. This led us to test its effectiveness in the treatment of severe fecal incontinence. METHODS: Six patients (four male), of average age of 43 (range, 29-60) years, with severe fecal incontinence, underwent implantation of expandable microballoons in the submucosa of the anal canal. The implantation was performed under intravenous sedation as an outpatient procedure. Anal manometry, endosonography, and incontinence assessment with a scoring system were performed before and after the implantation. RESULTS: With a mean follow-up of 8.6 (range, 7-12) months, the incontinence scores improved in all patients from an average of 16.16 (standard deviation: +/- 1.6) before the implantation to an average of 5 (standard deviation: +/- 1.26) after the procedure. The anal pressure at rest was not improved in any patient (mean: 50.16 before treatment to a mean of 53 after treatment). No significant adverse events were associated with the procedure, and no serious postimplantation complications were noted. DISCUSSION: Anal implantation of expandable microballoons seems to be a simple, safe, and effective method that restores the fecal continence without hindering normal defecation.

Demonstration, the solution to successful community acceptance of water recycling.

The Department of Natural Resources in Queensland, Australia are presently carrying out a comprehensive Strategy called the Queensland Water Recycling Strategy (QWRS) to determine future Government directions in the whole area of water recycling. This strategy is considering the beneficial use of all waste streams such as domestic sewage, industrial and agricultural wastes, as well as urban stormwater. Following a workshop held during the initial phase of the strategy it was determined that a high priority must be given to the demonstration of recycling practices not being utilised in the State, or presently being practiced in an unsustainable manner. Three separate types of recycling projects are being carried out, the first being based on demonstrating recycling on a large new urban development close to Brisbane, the second associated with demonstrating the complex treatment processes associated with the higher levels of recycling, and the third associated with demonstrating community based recycling schemes.

Endoscopic implantation of Plexiglas (PMMA) microspheres for the treatment of GERD.

BACKGROUND: A gelatinous implant containing polymethylmethacrylate (PMMA) beads is successfully used to augment the diminished thickness of the chorium in patients with skin defects and wrinkles. The aim of the present study was to determine whether submucosal injection of PMMA microspheres into the lower esophageal folds decreases the severity of symptoms and acid reflux in patients with GERD. METHODS: Endoscopic submucosal implantation of PMMA was carried out in 10 patients with GERD who were either refractory to or dependent on proton pump inhibitors. Symptom severity score, 24-hour pH monitoring, upper GI endoscopy, and EUS were performed to evaluate the efficacy of implantation. RESULTS: A significant decrease in the symptom severity score and mean total time with esophageal pH less than 4 was noted after the implantation of PMMA (p < 0.05). Seven of 10 patients were taking no medication after PMMA implantation. There were no serious procedure-related complications. CONCLUSIONS: Endoscopic implantation of PMMA into the submucosa of the lower esophageal folds may be a new method for treating GERD. Further studies are required to determine the long-term efficacy of the procedure.

The use of TWH catheters in CAPD patients: fourteen-year experience in technique, survival, and complication rates.

OBJECTIVE: To evaluate the technique of insertion, complication rates, and survival rates of Toronto-Western Hospital (TWH) peritoneal catheters in continuous ambulatory peritoneal dialysis (CAPD) patients. PATIENTS AND METHODS: A total of 222 TWH catheters were inserted into 203 CAPD patients (113 males and 90 females) with end-stage chronic renal failure during a period of 14 years (1 January 1982 to 31 August 1995). The mean age of the patients was 58.5 years (range 18-86 years). For the first 6 years, the peritoneal cavity approach was performed via a lower midline incision (45 insertions), various other approaches (17 insertions), and, finally, for the last 160 insertions (for approximately 8 years) the transverse paraumbilical incision was exclusively employed. The duration of CAPD ranged between 1 to 151 months (mean time 33.2 months). RESULTS: Regarding early and late complications (namely leakages, obstructions, eviscerations, tunnel infections, herniation, and others), as well as catheter survival, the transverse paraumbilical insertion, compared to other approaches, had the smallest number of complications. Thus, early leakage occurred in 5/222 (2.25%) versus 10/222 (4.5%), obstruction nil versus 2/222 (0.9%), and evisceration nil versus 1/222 (0.45%). In addition, as far as the late complications are concerned: tunnel infections 5/222 (2.22%) versus 13/222 (5.85%), herniations 1/222 (0.45%) versus 16/222 (7.3%), and cuff protrusion nil versus 7/222 (3.1%). Finally, overall peritonitis occurred with a rate of one episode every 21.2 months. Actuarial survival for 1 and 3 years was 75% and 37%, respectively. CONCLUSIONS: The transverse paraumbilical incision seems to be the most advantageous approach in inserting (by "surgical method") theTWH catheters. We found it to be a safe, simple, versatile procedure, giving good results in all parameters concerned.

Calcium and strontium metabolic studies in patients on CAPD.

BACKGROUND: Strontium is known to affect calcium metabolism both experimentally and in clinical studies on conditions other than end-stage renal failure (ESRF) and continuous ambulatory peritoneal dialysis (CAPD). OBJECTIVE: To investigate Sr metabolism in relation to that of Ca in ESRF patients undergoing CAPD, and the possible influence of the duration of treatment. DESIGN: Cross-sectional observational study. SETTING: University medical center and Institute of Nuclear Physics. PATIENTS: Twenty-four patients on CAPD; 14 chronic renal failure (CRF) patients not on dialysis, and 52 healthy controls. MEASUREMENTS: Calcium and Sr content of serum, urine or dialysate effluent, and selected dietary products. RESULTS: Calcium and Sr are absorbed by the intestinal tract of healthy subjects with equal efficiency. Serum Ca levels were considerably lower in CRF patients than in healthy subjects and patients on CAPD (p < 0.001). Serum Sr was significantly higher in both CAPD and CRF patients than in healthy controls (p < 0.001). The Sr/Ca ratio in the sera of the healthy subjects was defined by the preferential excretion of Sr over Ca by the kidney. This preferential excretion was lost during renal failure. During treatment there was a tendency for the uptake of both Ca and Sr to increase. CONCLUSIONS: Strontium is accumulated in the body during renal failure and CAPD cannot restore normal levels. Considering the varying effects of different doses of Sr on bone metabolism experimentally, it would be interesting to determine by further studies the possible significance of the observed Sr accumulation for renal bone disease.

Duodenal obstruction caused by pancreatic head carcinoma: palliation with self-expandable endoprostheses.

BACKGROUND: The risks of palliative operative intervention of gastric outlet obstruction for advanced pancreatic head carcinoma has been reported to be quite high. The present study reports the results of attempted endoscopic palliation of duodenal obstruction in these patients. METHODS: Ten patients with endoscopically documented malignant duodenal strictures from pancreatic head carcinoma in whom self-expandable endoprostheses were placed are retrospectively analyzed. In three patients with jaundice, biliary stents were also placed. Standard esophageal type (not membrance coated) Wallstent self-expandable endoprostheses were used. PATIENTS: Gastric outlet obstruction was relieved in all patients after implantation of duodenal endoprostheses, and jaundice was palliated in those with additional biliary obstruction after bile duct stenting. One case of gastric ulceration was the major complication. No recurrence of gastric outlet obstruction was noted in the follow-up period of 1 to 5 months. CONCLUSION: The preliminary data suggest that self-expandable duodenal endoprostheses can effectively relieve gastric outlet obstruction in patients with advanced pancreatic head carcinoma.

Palliation of large-bowel obstruction due to recurrent rectosigmoid tumor using self-expandable endoprostheses.

When large-bowel obstruction supervenes in patients with rectal tumor recurrence and extensive nonresectable disease, a proximal diverting colostomy may be indicated. In this study, nonsurgical palliation of the obstruction was attempted by inserting self-expandable endoprostheses to bridge the stenotic lesion. The endoprostheses were positioned in two patients with large-bowel obstruction due to recurrent stenotic tumor, and extensive disease excluding palliative resection. Self-expandable endoprostheses with inner diameters of 18 mm and 22 mm were successfully inserted under endoscopic and radiographic control. Proper expansion of the endoprostheses was achieved in both patients, resulting in immediate decompression of the bowel and lasting relief of the obstruction.

Palliation of malignant gastric outlet obstruction with self-expanding metal stents.

BACKGROUND AND STUDY AIMS: Self-expanding metal stents have long been used in the management of patients with malignant esophageal and malignant biliary obstruction. The aim of the present study was to report on the palliation of malignant gastric outlet obstruction using self-expanding endoprostheses. PATIENTS AND METHODS: Between March 1993 and December 1994, 12 patients (eight women, four men, mean age 64 years) suffering from malignant gastric outlet obstruction due to recurrent gastric carcinoma (seven patients) and pancreatic head carcinoma (five patients) presented with an inability to eat and intractable vomiting. The patients were managed with peroral insertion of self-expanding metal stents. RESULTS: Peroral introduction of the stent with the aid of a stabilizing overtube was successful in all patients, with the stent being supported as it was being advanced through the stenosis. Proper release of the stent into the stenotic area was achieved in all cases, relieving the intractable vomiting. The procedure was accomplished without any complications. All patients were able to eat semisolid food four days after the stent insertion. Apart from an asymptomatic partial stent occlusion in one patient, no other complications were seen during the short-term follow-up one, two, and three months after discharge. CONCLUSIONS: These preliminary results suggest that self-expanding stents can effectively relieve malignant gastric outlet obstruction.

Lipomatosis of the ileocecal valve leading to episodes of partial small bowel obstruction.

The cases of two female patients with lipomatosis of the ileocecal valve inducing episodes of intestinal obstruction are presented. A barium enema with air contrast was performed in patient 1; patient 2 was operated on to treat ileus. Resection of the fatty tissue from the ileocecal valve was performed at operation, after histologic diagnosis on frozen section. These cases suggest that limited resection removing fatty tissue is effective and preferable to more radical resection.

N-butyl-2-cyanoacrylate (Histoacryl) plus sclerotherapy versus sclerotherapy alone in the treatment of bleeding esophageal varices: a randomized prospective study.

BACKGROUND AND STUDY AIMS: N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding. The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates. PATIENTS AND METHODS: One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polidocanol, and 59 patients (Group B) were treated with conventional sclerotherapy with polidocanol alone. Histoacryl was injected intravariceally during the first session in the Group A patients. RESULTS: A significantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Group A: 2 of 20, Group B: 8 of 18, p < 0.05). The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B: 9 of 18, p < 0.05). CONCLUSIONS: The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophageal bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management.

Laparoscopic transcystic papillotomy under endoscopic control for bile duct stones.

We present here a laparoscopic transcystic papillotomy technique for the management of bile duct stones discovered either preoperatively or on intraoperative cholangiogram. Papillotomy is performed orthogradely with a hydrophilic wire-guided spincterotome inserted through the cystic duct. The correct position of the diathermic wire is verified with peroral duodenoscopy. The method has proved save and effective in our first 12 consecutive patients. Further evaluation is required to clarify its potential role in laparoscopic biliary surgery.

Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk.

Emergency biliary surgery for acute obstructive cholecystitis in the elderly is associated with an increased hospital mortality. We therefore attempted to drain the obstructed gallbladder via the transpapillary route in 18 patients (mean age: 67 years) who had cystic duct obstruction on ERC and who were at an increased surgical risk. A cholecystonasal catheter was successfully introduced after a small EPT in sixteen of them (89%). This resulted in effective bile drainage, obviating the need for emergency surgery in all patients. No procedure-associated morbidity or mortality was found. Following clinical remission, elective treatment consisted of ESWL/direct stone dissolution (n = 10) or elective surgery (n = 3). Three patients received no further therapy. Our results show that endoscopic gallbladder drainage may be a valuable alternative to emergency surgery in high risk patients with acute obstructive cholecystitis.

Peritonitis associated with continuous ambulatory peritoneal dialysis: the pseudo-surgical abdomen.

In this work, 12 patients undergoing continuous ambulatory peritoneal dialysis with peritonitis showing clinical symptomatology of "acute surgical abdomen" were studied. The infective cause of peritonitis was Staphylococcus epidermidis (eight cases) and Staphylococcus aureus (four cases). All patients, under strict and continuous observation, were managed with conventional chemotherapy and showed improvement within 6 to 24 hours. The need of prompt recognition and correct evaluation of this condition by surgeons familiar with it is emphasized in order to avoid an unnecessary surgical procedure.

Combination of serum carcino-embryonic antigen and C-reactive protein--a useful test in preoperative staging of colorectal cancer.

The value of the simultaneous estimation of serum carcino-embryonic antigen (CEA) and C-reactive protein (CRP) concentrations in staging patients with colorectal neoplasias was evaluated. The study included 95 patients with benign or malignant epithelial tumors of colon and rectum. The simultaneous negative values of CEA and CRP were able to exclude stage D tumors with a specificity of 92.6% (P less than 0.001). Simultaneously positive values of CEA and CRP were able to diagnose stage C or D tumors with a specificity of 92.1% (P less than 0.001). It is concluded that the combination of CEA and CRP tests can substantially contribute to the preoperative staging and assessment of the extent of colorectal cancer.

Endoscopic transpapillary catheterization of the gallbladder followed by external shock wave lithotripsy and solvent infusion for the treatment of gallstone disease.

Herein we describe the techniques and early results of attempted endoscopic transpapillary catheterization of the gallbladder (ETCG) in combination with external shock wave lithotripsy (ESWL) and solvent infusion in the treatment of 23 consecutive, symptomatic patients with gallstones. Despite anticipated difficulty in advancing wires and catheters through the cystic duct, impeded by tortuosity of its lumen, ETCG was successfully accomplished in 20 of the 23 patients (86.9%). Through an indwelling catheter, obstructed gallbladders were drained in 4 patients and combined treatment with ESWL and infused solvents was carried out in 18 patients. Combined treatment resulted in elimination of gallstones from the gallbladders of 14 of 18 patients (77.7%). Treatment was complicated by mild pancreatitis in only 1 of 20 successfully catheterized patients; there was no mortality.