Comparison of urine toxic metals concentrations in athletes and in sedentary subjects living in the same area of Extremadura (Spain).

Cadmium (Cd), tungsten (W), tellurium (Te), beryllium (Be), and lead (Pb), are non-essential metals pervasive in the human environment. Studies on athletes during training periods compared to non-training control subjects, indicate increased loss of minerals through sweat and urine. The aim of this study was to compare the level of these trace elements, determined by inductively coupled plasma mass spectrometry (ICP-MS) in urine samples, between athletes and age-matched sedentary subjects living in the same geographical area, although anthropometric and cardiovascular measurements showed that athletes have significantly (P ≤ 0.001) lower BMI, body fat and heart rate, whereas the muscle and bone percentage was significantly (P ≤ 0.001) higher than in sedentary subjects. The validity of the methodology was checked by the biological certified reference material. Trace element analysis concentrations, expressed in µg/mg creatinine, of five toxic elements in urine from athletes (n = 21) versus sedentary subjects, (n = 26) were as follows: Cd (0.123 ± 0.075 vs. 0.069 ± 0.041, P ≤ 0.05); W (0.082 ± 0.053 vs. < limit of detection); Te (0.244 ± 0.193 vs. 0.066 ± 0.045, P ≤ 0.001), Be (0.536 ± 0.244 vs. 0.066 ± 0.035, P ≤ 0.001); Pb (0.938 ± 0.664 vs. 2.162 ± 1.444 P ≤ 0.001). With the exception of Pb, urine toxic metal concentrations from athletes were higher than from sedentary subjects. This fact suggests that physical activity counteracts, at least in part, the cumulative effect of toxic environment by increasing the urine excretion of toxic metals in trained people.

Effects of aerobic exercise on urinary estrogens and progestagens in pre and postmenopausal women.

The purpose of this study was to elucidate the effect of 6 months of aerobic exercise on urinary excretion of female steroid hormones in pre and postmenopausal women and to check the basal values of urinary steroid. To this end, 20 premenopausal (age 45.56 ± 4.06 years) and 20 postmenopausal (age 52.27 ± 3.80 years) women, all sedentary, were studied before and after a supervised 6-month exercise training program (at 60-70% of maximal heart rate, 60 min/day, 3 days/week), based on aerobic dance. The exercise included standing on one leg, squatting, walking, and touching their heels. Before and after the program, anthropometric data and VO(2max) were measured and urine samples were collected and analyzed by gas chromatography/mass spectrometry (GC/Q-MS). Both, pre and postmenopausal women, improved their VO(2max) after the aerobic exercise program. Regarding the urinary steroids, on the one hand, important differences were observed between urinary estrogens and progestagens in pre and postmenopausal women in basal values. Estrone (P < 0.05), pregnanediol (P < 0.01), pregnanetriol (P < 0.05), and estriol (P < 0.01) levels were lower in postmenopausal women than in premenopausal women. On the other hand, the aerobic exercise program did not affect postmenopausal women in the same way as premenopausal women. After the exercise program, no changes in urinary steroid levels were observed in premenopausal women. However, the aerobic exercise program caused an increase in urinary excretion of pregnanediol (P < 0.05) and pregnanetriol (P < 0.05) in postmenopausal women.

Effects of regular and abusive intake of alcohol at weekends on physiological parameters in Spanish young.

OBJECTIVES: The aim of this study was to evaluate the effects of excessive intake at weekends, on different parameters in young university students. STUDY DESIGN: Cross sectional, descriptive study. METHODS: A group of 180 subjects were selected (young males between 18 and 22 years old) and were classified into three groups by their alcohol consumption habits: The control group of non-drinkers (ND; n = 60), the group of one day/weekend drinkers (1D/W, n = 60) and the group of two day/weekend drinkers (2D/W, n = 60). An evaluation of the body composition, a spirometry test (FVC, PEF and MVV), a maximal cycle ergometer test (Heart rate, blood pressure, VO2 max, total watts and time test until exhaustion), a blood sample (GOT, Triglycerides, Total Cholesterol, HDL cholesterol, LDL cholesterol and Glucose) were performed. RESULTS: It was observed that 2D/W group presented significantly higher levels than ND in the following parameters: total cholesterol [185.66 (16.06) compared to 154.28 (25.53) mg/dl]; triglycerides [113.66 (22.47) compared to 45.75 (12.76) mg/dl]; systolic blood pressure [130 (9.50) compared to 115 (5.77) mmHg] and waist to hip ratio [0.92 (0.08) compared to 0.84 (0.05)], and 1D/W group also showed significantly higher levels of triglycerides [71.04 (24.31) compared to 45.75 (12.76) mg/dl] than ND. Moreover, it was confirmed that the accumulation of triglycerides in weekend drinkers is influenced by smoking and the lack of physical activity, and that the relationship between alcohol drinking and systolic blood pressure could be modified by smoking. CONCLUSIONS: Young people's abusive intake of alcohol at weekends can cause negative changes in various health parameters, similar to those observed in alcoholics that drink regularly during the week.

The effect of high level tennis matches on urine steroid profiles in professional tennis players.

AIM: Modern day, tennis matches are characterized by shorter and more intense efforts with players enduring great physical and psychological stress. The aim of this study was to evaluate acute changes in the urinary steroid profile of elite tennis players following professional tournament matches. METHODS: Eight professional male tennis players participated in this study. Urine samples were collected before and after tennis matches corresponding to the quarter finals of the Spanish Tennis Masters. RESULTS: After the match, there was a significant fall (P<0.05) in testosterone, androsterone, etiocholanolone, and dehydroepiandrosterone (DHEA). Cortisone increased whereas tetrahydrocortisone (THE) decreased. The anabolic/catabolic hormone ratio also decreased, although only the fall in total suprarenal androgen (TSA)/total corticosteroid (TC) and DHEA/(THE+THF) ratios had a significant decrease (P<0.05). CONCLUSION: These results indicate that a professional tennis match modifies the urine steroid profiles of players, increasing corticosteroid and decreasing androgen excretion in urine, suggesting an important adrenal activation.

Effect of different exercise intensities on oxidative stress markers and antioxidant response in trained cyclists.

Traditionally, physical activity has been associated with beneficial effects on the organism. However, exercise has been shown to increase the production of reactive oxygen species (ROS) to a point that can exceed antioxidant defences, causing oxidative stress. Characteristics of exercise such as the intensity or duration seem to be associated with oxidative damage. The aim of this study was to evaluate the effect of exercise of two different cycling intensities on oxidative stress and antioxidant response in trained males. Twenty male trained cyclists participated in this study. The maximal exercise test consisted of an incremental cycling test until voluntary exhaustion, and the submaximal test was a steady state at 75% VO(2max) for 30 min on a cycloergometer. In maximal exercise test (16+/-4 min of cycling), the results showed an increase in malondialdehyde (MDA) from 40.6+/-2.0 to 45.4+/- 18.4 microM (p<0.05) in plasma and from 0.21+/-0.10 to 0.23+/-0.12 micromol/g Hb (P<0.05) in erythrocytes, also vitamin C increased in plasma from 3.80+/-1.60 to 5.20+/-2.16 mg/mL (P<0.05) and it decreased from 130.5+/-34.7 to 83.4+/-30.0 mg/g hemoglobin (P<0.05) in erythrocytes, whereas there were no changes in vitamin E concentrations. In submaximal exercise, no significant differences were obtained in MDA, vitamin C or vitamin E. In conclusion, short time of high intensity cycling leads to oxidative stress increasing plasma and decreasing erythrocyte vitamin C levels.

Salvage of a subacute failure in femoral dialysis loop graft using stent covering the arterial and venous anastomosis.

Endovascular treatment can be considered the first line therapy in the majority of dysfunctioning arteriovenous fistula. However, when early thrombosis of the arteriovenous access occurs, surgical treatment is recommended. In these cases, technical problems are the most frequent cause of the malfunction. We report a case of a subacute thrombosis of an arteriovenous fistula, femoral artery to femoral vein looped ePTFE with venous anastomosis occlusion and subocclusion lesion at the arterial anastomosis. Both anastomoses were treated using self-expandable stents, and no other intervention was necessary until the one-year follow-up for maintain patency.

Erythrocyte concentrations of chromium, copper, manganese, molybdenum, selenium and zinc in subjects with different physical training levels.

BACKGROUND: The aim of the present study was to determine changes occurring in the erythrocyte concentrations of chromium (Cr), copper (Cu), manganese (Mn), molybdenum (Mo), selenium (Se) and zinc (Zn) in male subjects with different training levels living in the same region (Spain). METHODS: Thirty sedentary subjects (24.34 ± 3.02 years) formed the control group (CG); 24 moderately trained (4-7 h/week) subjects (23.53 ± 1.85 years) formed the group with a moderate degree of training (MTG) and 22 professional cyclists (23.29 ± 2.73 years), who performed more than 20 h/week of training, formed the high-level training group (HTG). Erythrocyte samples were collected from all subjects in fasting conditions, washed and frozen at - 80 °C until analysis. Erythrocyte analysis of trace elements was performed by inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: The results showed that there was a statistically significant lower erythrocyte concentration of Cu, Mn, Mo and Zn in the MTG and HTG than CG. Se was only significantly lower in HTG than CG. The correlation analysis indicates that this change was correlated with training in the case of Cu, Mn, Se and Zn. All results are expressed in µg/g Hb. CONCLUSIONS: We can conclude that physical training produces a decrease in erythrocyte concentrations of Cu, Mn, Se and Zn, which can cause a decrement in athletes' performance given the importance of these elements. For this reason, erythrocyte monitoring during the season would seem to be advisable to avoid negative effects on performance.

Urinary steroid profile after the completion of concentric and concentric/eccentric trials with the same total workload.

High intensity strength training causes changes in steroid hormone concentrations. This could be altered by the muscular contraction type: eccentric or concentric. The aim of this study was to compare the effect of the completion of a short concentric (CON) and concentric/eccentric (CON/ECC) trial on the urinary steroid profile, both with the same total work. 18 males performed the trials on an isokinetic dynamometer (BIODEX III) exercising quadriceps muscles, right and left, on different days. Trial 1 (CON): 4 x 10 Concentric knee extension + relax knee flexion, speed 600/second; rest 90 seconds between each series and 4 minutes between each leg exercise. Trial 2 (CON/ECC): 4 x 5 concentric knee extension + Eccentric knee flexion under similar conditions. Urine samples were taken before the exercise and one hour after finishing it. Androsterone, Etiocholanolone, DHEA, Androstenedione, Testosterone, Epitestosterone, Dehydrotestosterone, Estrone, B-Estradiol, Tetrahydrocortisone, Tetrahydrocortisol, Cortisone and Cortisol (free, glucoconjugated and sulfoconjugated) urinary values were determined using gas chromatography/mass spectrometry techniques. No significant differences were noted in Total Work and Average Peak Torque, although Maximum Peak Torque in the CON/ECC trial was higher than in the CON trial. These results demonstrate no changes in the steroid profile before and after trials, or when comparing CON to CON/ECC trials. The data suggest that eccentric contractions do not cause hormonal changes different to the ones produced by concentric contractions, when they are performed in strength short trials with the same total workload.

Influence of a 6-month physical training program on serum and urinary concentrations of trace metals in middle distance elite runners.

BACKGROUND: The aim of this survey was to determine the effects of an aerobic physical training program of six months duration on the serum and urinary concentrations of essential trace elements among middle distance runners and untrained, non-sportsmen participants. METHODS: 24 well-trained, middle-distance (1500 and 5000 m), aerobic male runners (AG) were recruited at the beginning of their training season and 26 untrained males formed the control group (CG). All participants were from the same region of Spain, and all of them had been living in this area for at least two years. Serum and urine of samples of Cobalt (Co), Copper (Cu), Manganese (Mn), Molybdenum (Mo), Selenium (Se), Vanadium (V) and Zinc (Zn) were obtained at the beginning of the training season, and six months later, from all participants. All samples were analyzed with inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: Two-way ANOVA showed significant differences relative to group effect in serum concentrations of Co, Cu, Mn, Mo, Se and Zn. Attending to time effect, there were differences in Mn (p = 0.003) and Zn (p = 0.001). The group x time interaction revealed differences only in the case of Mn (p = 0.04). In urine, significant differences between group were obtained in Co, Cu, Mn, Se and V. Time effect showed changes in Co, Cy, Mo and Se. Finally, the group and time interaction revealed significant differences in urinary Cu (p = 0.001), Mn (p = 0.01) and Se (p = 0.001). CONCLUSIONS: A six-month aerobic training program for well-trained athletes induced modifications in the body values of several minerals, a fact which may reflect adaptive responses to physical exercise. The obtained data could be interesting for physicians or coaches in order to consider specific modifications in sportsmen's diets as well as to determine specific nutritional supplementation strategies.

Evaluation of urinary steroid profile in highly trained cyclists.

AIM: A regular and intense physical exercise significantly modifies hormonal metabolism and there are many reports of a change in urine steroid levels accompanying the practice of sport. The aim of this study was to compare the urinary steroid profile between highly trained cyclists and untrained subjects. METHODS: Urine levels of testosterone (T), epitestosterone (Epit), androstenedione, dehydroepiandrosterone (DHEA), androsterone (A), etiocholanolone (E), beta-estradiol (E2), estrone (E1) and the most abundant urine metabolites of cortisol and cortisone, tetrahydrocortisone (THE) and tetrahydrocortisol (THF) were determined by gas chromatography-mass spectrometry in urine samples from a group of professional cyclists (n=15) submitted to maximum level training for several years and compared with urine samples from sedentary subjects (n=15). The relationships between T/Epit, A+E/ THE, A+E/ THF, DHEA/THE and DHEA/THF were also studied. RESULTS: Cyclists showed lower urine levels of T, A, E and E2 and higher urine levels of androstenedione and E1 than sedentary individuals. A+E/THE and A+E/ THF ratios were higher in sedentary subjects than in cyclists. CONCLUSION: We conclude that cyclists showed a urinary steroid profile different from sedentary individuals, probably due to an adaptation to regular and intense physical training .

Influence of an exercise until exhaustion in serum and urinary concentrations of toxic minerals among professional athletes, a preliminary approach.

The aim of the present survey was to determine differences in the serum and urinary concentrations of several toxic trace elements (As, Be, Cd, Cs and Pb) between long distance runners and non-sportsmen living in the same area of Extremadura (Spain) in basal conditions as well as after the performance of a maximal effort test until exhaustion. 21 Spanish national long-distance runners were recruited before the start of their training season and 26 untrained students. All of them had similar ages. The effort test consisted in running on a treadmill incrementally in stages, until exhaustion. Serum and urine analysis of trace metals was performed by inductively coupled plasma mass spectrometry (ICP-MS). In the statistics the urine and blood basal concentrations was analyzed first using Student t test. Then the differences between the pre and post-test values were analyzed using Wilcoxon test. The serum concentrations of Be (p < 0.001), Cd (p < 0.01), Cs (p < 0.001) and Pb (p < 0.001) were higher in the athletes than the control groups in basal conditions. In relation to the exercise, the results showed that there were lower serum concentrations of Be, Cd and Pb after the test, but without statistically significance, in both groups. Cs (p < 0.001) concentrations were statistically lower after the exercise tests in both groups, but if the parameters were corrected in relation to hematocrit and hemoglobin concentrations the differences were significant only among the athletes. In urine, the concentrations of Be (p < 0.001) and Cd (p < 0.01) were higher among athletes than among controls, being the opposite case for urinary Pb values. In relation to the exercise-induced effect of the test, the results showed that among controls only Cd values were modified, but if creatinine corrections are applied this difference does not reach statistical significance. However, sportsmen suffered a diminution in Be values, that can be observed only if urine values are corrected. Also, an increase in Cd, both in corrected and normal values, was observed, fact that occurred also in the case of Cs, but only if urinary values are corrected. It can be concluded that an incremental exercise to exhaustion among elite athletes of long distance modalities can produce changes in serum and urinary concentrations of toxic trace elements which may reflect an adaptive mechanism to prevent toxicity, and which could be an interesting outcome for physicians in the treatment and prevention of toxic situations.

Carotid stenting without use of balloon angioplasty and distal protection devices: preliminary experience in 100 cases.

BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices. MATERIALS AND METHODS: Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals. RESULTS: Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10-36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after. CONCLUSIONS: In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

Use of Gianturco self-expandable stents in the tracheobronchial tree.

Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.

A simplified arteriovenous malformation model in sheep: feasibility study.

BACKGROUND AND PURPOSE: Recently, a swine model of a cerebral arteriovenous malformation (AVM) has been developed that closely resembles a human AVM of the brain. The creation of such a model requires sophisticated neurointerventional techniques. The purpose of this study was to develop a simple and cost-effective AVM animal model that does not require additional endovascular techniques. METHODS: A surgical anastomosis was created in seven sheep between the common carotid artery and the ipsilateral jugular vein, followed by ligation of the jugular vein above the anastomosis and of the proximal common carotid artery below the anastomosis. The anastomosis was created on the left side in four animals and on the right side in three. Cerebral angiography from the contralateral carotid artery was performed before and immediately after surgery to delineate the relevant cerebral vascular anatomy and to determine the direction of blood flow. RESULTS: An angiographic appearance simulating an AVM was found in all the animals. The ramus anastomoticus and arteria anastomotica functioned as the feeding vessels to the rete mirabile, which represented the nidus in our model, and to the jugular vein, which represented the draining vein from the malformation. Extensive collateral flow through the rete mirabile into the distal segment of the external carotid artery above the ligature was observed angiographically, with retrograde flow through the surgical anastomosis into the jugular vein. CONCLUSION: A simple surgically created experimental model for cerebral AVMs was developed in sheep without the need for additional complex endovascular catheter manipulations of intracranial branches. Such an animal model can substantially reduce the cost of research and training in the neurointerventional or radiosurgical management of AVMs.

Animal model of bile duct dilatation created with minimally invasive surgery.

RATIONALE AND OBJECTIVES: The purpose of the study was to evaluate a method of producing obstruction of the common bile duct and concomitant biliary duct dilatation in an animal model. MATERIALS AND METHODS: Laparoscopic placement of a double-balloon occlusion device was used to produce common bile duct obstruction and bile duct dilatation in pigs. RESULTS: One week after the procedure, common bile duct obstruction and dilatation of the biliary tree were demonstrated with either percutaneous transhepatic cholangiography or percutaneous cholecystography. CONCLUSION: The use of this method is technically feasible and provides a useful subacute and chronic animal model of common bile duct obstruction and dilatation of the biliary tree for percutaneous interventional training and research purposes.

CO2 as a contrast medium in endoluminal treatment of high flow vascular malformations.

PURPOSE: To evaluate the diagnostic usefulness of CO2 as a radiologic contrast medium in pre and post-embolization of hemodynamically active vascular malformations. MATERIAL AND METHODS: Eight pre-and post-embolization angiographies were performed on five patients with hemodynamically active vascular malformations. In all cases sequentially iodinated contrast medium and CO2 were used. Procedures were performed using Philips Integris V equipped with specific software to process images obtained with CO2 as contrast medium and with a purpose-built gas injector pump. The images were assessed by three interventional radiologists who evaluated the findings by consensus. They were asked whether uptake of the malformations were better, worse or the same with iodinated contrast and CO2. The images were judged according to the following characteristics; quality, the filling in of the contrast in afferent artery of the HAVM, caliber and number of vessels and existence of pathologic communications in HAVM. These characteristics were assessed in all the patients of the study, both before and after embolization. RESULTS: The CO2 angiographic results were compared to those obtained using iodinated contrast material. Iodinated contrast provided superior image quality in all performed studies. The filling of arterial afference of HAVM was well defined with both contrast media. In all performed cases with CO2, the malformations showed more vessels. No inmediate nor subsequent complications developed with CO2 injections, except in one female patient, who presented an intense sensation of cramps in the lower limbs. CONCLUSION: CO2 is a useful diagnostic and assessment tool before and especially during the embolization of hemodynamically active vascular malformations. It improves quantification and uptake of the malformation's vascular architecture, detecting collateral circulation and arteriovenous shunts. It also detects residual post-embolization disease when iodinated contrast agent is unsuccessful.

Intramuscular low flow vascular malformations: treatment by means of direct percutaneous embolization.

PURPOSE: Intramuscular hemodynamically inactive vascular malformations are infrequent entities whose surgical treatment is often impossible, crippling, or inefficient. We describe a nonsurgical therapeutic approach consisting on embolization by direct puncture with sclerosant substances. METHODS: Four patients have been treated from April to November 1994, three female and one male, ranging in age from 13 to 31 years. Three vascular malformations were located in the quadriceps and one in the deltoid muscle. The point of access was determined with information provided by MR. The skin was cleaned with an antiseptic solution and puncture was performed with a 22 gauge Chiva needle. Blood flow inside the malformation was slow in all cases and no afference to the normal venous system was detected. We embolized with 5-15 cc (mean 7.5 cc) of a mixture of ethibloc and ethanol. RESULTS: The mean follow-up period was 17 months (range 14-21). All patients remain asymptomatic and have resumed normal daily life activities. There were no complications. CONCLUSION: Percutaneous embolization by direct puncture of intramuscular vascular malformations is a feasible and simple procedure. Our preliminary results are promising, although more extensive studies need to be to performed in order to reach definite conclusions.

The Simpson atherectomy catheter in the management of complete obstructions.

The Simpson atherectomy catheter has been used successfully to recanalise eleven complete occlusions of the iliac and femoropopliteal arteries. Atherectomy and angioplasty were used in combination in 8 cases. Following atherectomy, all patients showed clinical improvement. Distal pulses returned in 7; rest pain and/or claudication disappeared in the other 4. Ischaemic ulcers healed in the 2 affected patients. Overall, ankle-arm indices (AAI) improved by an average of 0.43, with the improvement being greatest (0.55) in patients in whom the lumen was recanalised to within 91-100% of the native luminal diameter. Seven patients have remained with stable AAI values and without change in their clinical status at 18 months follow-up.