Exercise-induced arterial adaptations in elite judo athletes.

The purpose of this study was to examine exercise-induced arterial adaptations in elite Judo male and female athletes. 27 male Judo athletes (age 24.06 ± 2 years), 11 female Judoka (age 24.27 ± 1 years), 27 sedentary healthy men (age 24.01 ± 2 years) and 11 women (age 24.21 ± 1 years) participated in the current study. The examined vessels included brachial, radial, ulnar, popliteal, anterior and posterior tibial arteries. The experimental parameters were recorded with the use of Duplex ultrasound at rest. Diastolic diameter and blood mean flow velocity of the examined arteries in Judo athletes were found to be both significantly increased (p < 0.05) compared to the findings of the control groups. In male Judo athletes the brachial (p < 0.001), radial (p < 0.001), and anterior tibial artery (p < 0.001) presented the highest difference on the diastolic diameter, compared with the control male group. In female Judo athletes, ulnar (p < 0.001), radial (p < 0.001), and brachial (p < 0.001) arteries illustrated the highest diastolic diameter. The highest blood mean flow velocity was recorded in ulnar (p < 0.001) and popliteal arteries (p < 0.001) of the Judo athletes groups. Recording differences between the two genders, male participants presented larger arteries than females. Conclusively, Judo has been found to be a highly demanding physical sport, involving upper and lower limbs leading to significant arterial adaptations. Obtaining vascular parameters provide a useful tool to the medical team, not only in the direction of enhancement of the efficacy of physical training, but in unknown so far parameters that may influence athletic performance of both male and female elite Judokas. Key pointsJudo athletes demonstrated a general homogenous increase of the arterial functionality of the upper and lower limbs compared to the control groups.Diastolic diameter found to be significantly increased in male and female Judo athletes, highlighting the effects of exercise training on the vascular system.Judo athletes had had statistically significant increase of the blood mean flow velocity in all examined arteries, compared with the relevant control group.The current study underscores the impact of Judo training on the structure and the function of the arterial system.Clinically, the increased arterial parameters in elite Judo athletes may be essential elements for improved athletic performance.Sports medicine practitioners should give special concern to the vascular functionality for several physiological and medical tests.

Intervertebral disc calcification in thalassemia intermedia.

OBJECTIVES: Intervertebral disc calcification, an age-related phenomenon of variable clinical significance is described in hemochromatosis. As beta-thalassemia is characterized by excessive tissue iron deposition and secondary hemosiderosis, and skeletal abnormalities are often observed in these patients, this study is conducted to identify the prevalence of Intervertebral Disc Calcification (IDC) in thalassemia intermedia population. METHODS: We investigated all the elder than 30 years beta-thalassemia intermedia patients of our Department thalassemia unit. Patients underwent thoracic and lumbar spinal X-rays for IDC presence. Patients presenting IDC were compared to those not presenting, regarding back pain anamnesis, presence of back pain, extramedullary hemopoiesis, sex, age, Hb levels, ferritin levels, reticulocytes, bilirubin values, thyroid-parathyroid abnormalities. Student's t-test was used to compare variables between patients with and without IDC. A P-value under 0.05 was considered statistically significant. RESULTS: We investigated 30 beta-thalassemia intermedia patients (19 women) with an age range 38-61 yr (42.5 +/- 11.46 yr). Intervertebral disc calcifications were observed in seven patients (23.33%). No sex and laboratory parameters statistically significant differences were observed differences for IDC prevalence, while mean age and back pain history was statistically significantly different between the two groups. CONCLUSIONS: In thalassemia patients, the big variety of spinal deformities may hide the presence of IDC and thus, this entity may be overlooked or underestimated. The clinical significance of IDC development as well as the possible prevention by early transfusion chelation therapy should be further investigated.

Hydroxyapatite-coated total hip arthroplasty: the impact on thigh pain and arthroplasty survival.

The purpose of this study was to evaluate the long-term clinical outcomes of primary total hip arthroplasty using an uncemented, hydroxyapatite-coated implant. We followed a consecutive series of 164 patients, who underwent total hip arthroplasty with the Furlong fully-hydroxyapatite coated implant over a mean time period of 12.8 years. Clinical and radiological analyses were performed. Roentgenographic evaluation for the femoral side of the hip was performed using the Gruen zones, for the acetabular side using the DeLee and Charnley zones. Engh's radiological score was employed to assess fixation and stability of the stem. Clinical results were evaluated by Harris Hip Score. The mean Harris hip score was 46 preoperatively and 85 at last follow-up. The mean Engh score was 23. No hips had been revised for aseptic loosening of the femoral component. Thigh pain incidence was very low (1.2%). Survival analysis showed excellent results (95.8% at end point). The Furlong hydroxyapatite-coated implant appears as a reliable and safe option for hip arthroplasty.

Pre, during, and post exercise anterior tibial compartment pressures in long distance runners.

The aim of the study was to assess pre, during, and postexercise compartment pressures in the anterior tibial compartment in asymptomatic long distance runners (5000 m) and recreational athletes. Forty-eight participants (n = 48, 24 females and 24 males) underwent the experimental procedures. The participants were assigned into 4 groups of 12 volunteers. Intracompartmental pressures measurements were recorded 1 minute before, at the 1(st) minute after the onset of exercise, and finally 5 minutes after the completion of the exercise on treadmill. The wick catheter technique was the method of choice for measuring intracompartmental pressure values. Post hoc analysis of the groups by measures interaction indicated that all pairwise comparisons among pre-test (1 minute before exercise), during-test (1(st) minute during exercise), and post-test measures (5 minutes after exercise) were statistically significant for male controls (p < .001), male athletes (p < .001), female controls (p < .001) and female athletes (p < .001). The results confirm the correlation between long distance runners and the increased risk of chronic exertional compartment syndrome (CECS) development. Key pointsCompartment syndrome is a condition characterised by increased intracompartmental pressures within inelastic fascia which surrounds muscular compartmentsInitial CECS symptomatology is not clear and increases graduallyAll the study participants presented the lowest intra-compartment pressure values one minute before the beginning of exercise (at rest) with the highest value being recorded at the first minute of exercise.Control population had lower intra-compartment pressure than professional runners.One minute after the beginning of exercise control and athlete men group showed higher intra-compartment pressure than control and athlete women group, indicating a probable sex difference both for athletes and controls.Further studies on predisposing factors of CECS, such as increased intracompartmental pressure values in asymptomatic population is needed to establish the diagnosis in a proper time.

Marketed nonsteroidal anti-inflammatory agents, antihypertensives, and human immunodeficiency virus protease inhibitors: as-yet-unused weapons of the oncologists' arsenal.

Experimental data indicate that several pharmacological agents that have long been used for the management of various diseases unrelated to cancer exhibit profound in vitro and in vivo anticancer activity. This is of major clinical importance, since it would possibly aid in reassessing the therapeutic use of currently used agents for which clinicians already have experience. Further, this would obviate the time-consuming process required for the development and the approval of novel antineoplastic drugs. Herein, both pre-clinical and clinical data concerning the antineoplastic function of distinct commercially available pharmacological agents that are not currently used in the field of oncology, ie, nonsteroidal anti-inflammatory drugs, antihypertensive agents, and anti-human immunodeficiency virus agents inhibiting viral protease, are reviewed. The aim is to provide integrated information regarding not only the molecular basis of the antitumor function of these agents but also the applicability of the reevaluation of their therapeutic range in the clinical setting.

An Isolated Dorsal Dislocation of the Lateral Cuneiform.

UNLABELLED: We present a case of an isolated dorsal dislocation of the lateral cuneiform bone. This particular injury is extremely rare and quite often escapes the initial assessment of the medical examiner. Timely and accurate diagnosis of the injury is very important as the treatment is usually surgical. LEVEL OF EVIDENCE: Therapeutic, Level IV: Case Report.

The impact of knee surface alignment on ankle sprain occurrence.

BACKGROUND: Knee position provides useful information for the anatomical alignment of the lower extremity. Analyzing the geometric components of this alignment should yield useful information about how these factors affect the occurrence of an ankle sprain. The aim of this study is to investigate the correlation among these anthropometric characteristics and the possible future occurrence of ankle sprain injuries. MATERIAL AND METHODS: A total of 60 elite athletes (25.2 ± 3.2 years) participated in the current study. The data used for measuring knee surface alignment were the following: anatomical alignment angle (AA), condylar hip angle (CH), tibial plateau angle (PA), and joint surface (condylar plateau) angle (CP). Standardized radiography was used in all measurements. All knee alignment measurements were made on digital radiographs. The study lasted for 18 months. A logistic regression (probit) was used for the statistical analysis of the outcomes. A significance level of P = .05 was considered. RESULTS: The knee angle factors (AA, CH, PA, and CP) proved to be statistically nonsignificant (P > .05). CONCLUSIONS: The geometric knee surface alignment factors do not seem to be a decisive factor that would increase the probability of spraining an ankle. LEVELS OF EVIDENCE: PROGNOSTIC LEVEL IV: Case Series.

Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols.

Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in recreational athletes using the Pain and Disability Scale for the evaluation. A total of 38 participants with PF were randomly allocated to 2 different groups of 19 male participants in each group. Group 1 was treated with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. Group 2 received the same therapeutic procedures as group 1, reinforced by acupuncture treatment. The primary outcomes, nominated a priori, were pain description and mobility-function at 1 and 2 months. Outcomes were measured with the pain scale for PF. The mean total score of the acupuncture group at the third measurement was statistically minor compared with the mean total score of the first group. Acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.

Osteoarthritis of the ankle and foot complex in former Greek soccer players.

UNLABELLED: Sports activities cause increased loads in elite athletes' joints. Current scientific knowledge highlights the importance of applied mechanical loads on the physiology and pathophysiology of the articular cartilage. Thus, it is possible that sporting activity has a role in the development of osteoarthritis (OA), a painful and damaging joint disease. The aim of the present study was to investigate and record osteoarthritic alterations in the ankle and foot complex in former Greek soccer players and also compare them with those in the general population. The study sample consisted of 170 male, former elite soccer players, aged between 42 and 55 years (mean = 49.8 years, standard deviation [SD] = 7.4). A control group of 132 men, aged between 42 and 55 years (mean, 50.7 years, SD = 9.9), with no regular athletic activity were examined. The development of osteoarthritic alterations was recorded through a questionnaire and clinical and radiological examination. Radiographic analysis of the images in former athletes group showed not only more signs of cartilage degeneration in comparison with the control group (P < .05) but also similar clinical manifestations (pain and impaired mobility; P > .05). Osteophyte formation is a frequent disease among former soccer players--with variations on radiographic images--but it does not appear in their clinical picture. However, it is likely that both spurs and subchondral sclerosis (main findings) are preclinical manifestations of OA. LEVELS OF EVIDENCE: Prognostic, Level II.

The effect of Q angle on ankle sprain occurrence.

The intersegmental joint forces and the structures that must resist them (articular surfaces, ligaments, and musculature) are related through anatomical alignment of the joints and skeletal system. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the quadriceps (Q) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains, because its value, when assessed correctly, provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). Q angle measurements were made on radiographs. The study lasted for 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type ( P < .01) followed by body mass index (BMI; P < .10) and age (P < .10). On the contrary, Q angle was proven to be statistically nonsignificant (P > .10). The results were valid even when the BMI variable was substituted by body inertia propensity, a derived variable. The Q angle remained statistically nonsignificant ( P > .10). The Q angle magnitude does not seem to be a decisive factor that could increase the probability of spraining an ankle. The most important factors that could affect the probability of sustaining an ankle sprain are the athlete's age, anthropometric characteristics, and prior injuries.

The impact of the Spartathlon ultramarathon race on athletes' plantar pressure patterns.

More than 90% of injuries in runners are recorded in the lower extremity, equally affecting the regions of the knee, shank, and foot. Stress fractures are responsible for numerous running-related injuries. In the current study, the plantar pressure patterns of prerace, immediately postrace, and 24 hours after long-distance running in the Spartathlon were analyzed to compare foot loading in the respective conditions. Forty-six male participants of the Spartathlon ultramarathon were examined before, immediately after completion of the race, and 24 hours later with plantar pressure measurements during barefoot walking on a capacitive platform. The results revealed a significant increase in the peak pressure and impulse values in the forefoot areas and a decrease under the toes before and immediately after the race. On the contrary, no significant differences were found between the prerace and the 24-hour postrace values. The present findings indicate that the Spartathlon race leads to significant variations in foot-loading characteristics, especially in the peak pressure and impulse values under the forefoot and toe regions. Twenty-four-hour postrace data measurements reveal insignificant differences from the prerace statement, probably because of the restoration of local muscular activity.

Tibiofemoral angle and its relation to ankle sprain occurrence.

The lack of a normal joint orientation generates translational or shear forces across the joint. These forces can put abnormally high strain on the cartilage and the surrounding capsuloligamentous tissues. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the tibiofemoral (TFA) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains because its value provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). TFA measurements were made on radiographs. The study lasted 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type followed by body mass index (BMI) and age. On the contrary, TFA was proven to be statistically nonsignificant. When the BMI variable was substituted with body inertia propensity, a derived variable, the TFA remained statistically nonsignificant. TFA magnitude does not seem to be a determinant factor that could increase the probability of spraining an ankle.

Exercise-induced scalenus syndrome.

BACKGROUND: Thoracic outlet syndrome is described as a group of distinct disorders producing signs and symptoms attributed to compression of nerves and blood vessels in the thoracic outlet region. PURPOSE: To describe the exercise-induced scalenus anticus syndrome attributed to the anterior scalenus hypertrophy as a thoracic outlet syndrome underlying mechanism and to give recommendations for a safe and effective surgical treatment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve young professional athletes admitted for thoracic outlet syndrome (8 cases of neurologic thoracic outlet syndrome, 4 cases of mixed neurologic and vascular thoracic outlet syndrome) who reported numbness, tingling, early fatigue, muscle weakness, and pain were enrolled in the study. Scalenus hypertrophy was suspected to be the causative factor. Scalenectomy was performed in all cases. RESULTS: All patients had moderate to severe hypertrophy of the anterior scalenus muscle. Scalenectomy was performed, and there were no intraoperative or postoperative complications. Full activity was quickly achieved, and no recurrence of symptoms was documented. CONCLUSION: Surgical intervention for scalenus anticus syndrome can allow an athlete to return to full activity and improve quality of life. Surgical intervention seems to be the treatment of choice in terms of restoring quality of life and physical activity.

Extracapsular hip fracture management: cost-consequences analysis of two alternative operative methods.

OBJECTIVES: The aim of this prospective study was to perform a cost and outcome comparison between two alternative operative techniques (osteosynthesis and hemiarthroplasty) used in the treatment of elderly patients with unstable trochanteric hip fracture. MATERIALS AND METHODS: One hundred seventy-three trochanteric hip fracture patients were followed-up for 1 year after surgery. For each operative technique, hospital treatment's cost per patient was computed. Mortality and complication rate in-hospital and at specific time points after surgery were used as outcome measures. Patients' functional level before and after hip fracture was estimated according to their mobility and ability to perform basic and instrumental activities of daily living. RESULTS: The cost for patients undergoing osteosynthesis reached euro 1,931 per case, whereas for those treated with hemiarthroplasty reached euro 3,719 per case (2001 rates). There was no statistically significant difference regarding in-hospital mortality and complication rate, as well as mortality and complication rate 1 year after surgery, between the two patient groups. CONCLUSIONS: The quite similar performance of the two operative techniques suggests that cost could be the key factor for choosing between them. However, it is critical that many more randomized studies, with larger sample sizes and wider follow-up time periods should be conducted.

Involvement of the p38 MAPK-NF-kappaB signal transduction pathway and COX-2 in the pathobiology of meniscus degeneration in humans.

Meniscal tears are attributed to either trauma or degeneration processes. Clinical data suggest that meniscal degeneration (MD) is associated with knee osteoarthritis; however, the molecular events underpinning the pathogenesis of MD in humans remain elusive. Here we immunohistochemically examined the expression of p38 MAPK, its phosphorylated/activated form (p-p38), its target NF-kappaB (p50-p65 dimer), and COX-2 in ruptured menisci and investigated their involvement in MD development. Our findings demonstrate increased expression of the p38-NF-kappaB axis elements and COX-2 in disintegrated fibrocartilage, suggesting a role of these molecules in the pathobiochemistry of MD and consequential rupture.

Popliteal artery entrapment syndrome: anatomic or functional syndrome?

PURPOSE: The purpose of this retrospective study is to present our clinical experience in the diagnosis and treatment of young athletes with popliteal artery entrapment syndrome. DESIGN: Retrospective Case Series. METHODS: We report our experience with 5 patients with lower leg pain in a population of 2000 athletes in whom popliteal artery entrapment diagnosed with the use of duplex ultrasonography, computed tomography, digital subtraction angiography or conventional arteriography. Posterior surgical approach performed to offer better view of the anatomic structures compressing the popliteal artery. RESULTS: In 4 patients in whom compression had not yet damaged the arterial wall, no anatomical abnormalities found within the popliteal fossa during surgical exploration. Hypertrophy of gastrocnemius muscle was the only finding. In the fifth patient an anatomical abnormality found in which the artery following the classic aberrant course, looped medially to and then beneath the medial head of gastrocnemius. All patients recovered completely. CONCLUSIONS: We conclude that physicians who encounter athletes with progressive lower leg pain should consider functional popliteal artery entrapment surgery, which can prevent the disease's progression. We discuss clinical symptoms of the syndrome, radiological and ultrasonographical findings, and diagnostic criteria. Early diagnosis is of great importance in order to avoid vascular complications, and aid in athletes' early rehabilitation.

Intense basketball-simulated exercise induces muscle damage in men with elevated anterior compartment pressure.

The purpose of the present investigation was to examine the levels of muscle soreness, muscle damage, and performance output in men with (S, n = 24) or without (A, n = 24) chronic compartment syndrome (CACS)-related symptoms after an intense 10-minute basketball-simulated exercise. Anterior compartment pressure (ICP), muscle soreness perception, creatine kinase (CK) and lactate dehydrogenase (LDH) activities, myoglobin (Mb) concentration, leg strength, and knee joint range of motion (KJRM) were measured at rest, immediately after exercise, and at 24, 48, 72 and 96 hours postexercise (ICP was also measured at 5, 15, and 30 minutes postexercise). ICP, muscle soreness, CK, LDH, and myoglobin increased (p < 0.05) immediately postexercise and during the next 4 days of recovery in both groups. However, S demonstrated a far more pronounced and prolonged (p < 0.05) response than A. Leg strength and KJRM declined (p < 0.05) in both groups, but S demonstrated a greater (p < 0.05) performance deterioration than A. The results of this study suggest that intense basketball-simulated exercise increases ICP, muscle soreness, and indices of muscle damage with a concomitant decrease of performance. Men with CACS-related symptoms and/or history appear more sensitive to muscle damage and soreness than asymptomatic men, probably due to a compromised blood flow to the muscle producing fluid shifts from vascular to interstitial space and further increasing compartment pressure and muscle cell disruption. Results of the present investigation provide evidence to support proper diagnosis, monitoring, care, and preventive measures for symptomatic individuals prior to participation in activities such as basketball.