Effect of impact load and active load on bone metabolism and body composition of adolescent athletes.

PURPOSE: It is unclear whether adolescents involved in nonweight-bearing activities experience a delay in bone growth acquisition and sexual maturation. The purpose of this study was to compare bone mineral density (BMD), body composition, hormonal profile, and bone biochemical markers of adolescent athletes active in sports involved in impact load sports with those participating in active load sports. METHODS: Forty-five male Caucasian athletes aged 12--18 yr were divided into two groups according to type of skeleton loading, impact (N = 18), or active (N = 27). Twenty-four male Caucasian adolescents (12--18 yr) served as controls and only performed the activities included in their physical education classes. All subjects were assessed for bone mass, body composition, and bone age by dual x-ray absorptiometry (DXA). Serum calcium (Ca), phosphorus (P), bone-specific alkaline phosphatase (BAP), total testosterone, FSH, LH, urinary calcium to creatinine ratio (Ca/Cr), and urinary deoxypyridinoline crosslinks to creatinine ratio (DPD/Cr) were measured. RESULTS: The impact load group presented the highest BMD among the three groups for all studied sites. Lean mass and absolute weight were correlated with all of the bone mass measurements. BAP levels were significantly higher and testosterone levels significantly lower in the active load group compared with the impact group. CONCLUSION: High-impact load exercises have a beneficial effect on bone mass in male adolescents. There is also a positive correlation of weight and body composition with BMD. However, further longitudinal studies are necessary to determine whether there is a delay in bone growth acquisition among adolescents involved in a nonweight-bearing exercise regimen and its association with sex hormones.

Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament.

The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average internal between occurrence of the injury and assessment was 10.2 months (range 2-48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60 degrees/sec and 240 degrees/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60 degrees/sec was greater than that at 240 degrees/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60 degrees/sec or at 240 degrees/sec. The average value for the flexor-extensor relationship at 60 degrees/sec on the injured was 60% ((6), compared to 57% ((10) on the contra-lateral side. At 240 degrees/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60 degrees/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor muscle group to approach that of the extensor muscle group, and this tendency was more pronounced on the side of the injury.

[Iron deficiency in female athletes]. / Deficiência de ferro em atletas femininas.

Iron deficiency and anemia have been reported frequently in athletes. In São Paulo-Brazil among elite athletes overt anemia is uncommon, but our studies showed that they were in a borderline anemic state. Sports anemia is used to describe both pseudodilutional anemia and the true anemia of athletes. We studied 12 female young athletes, all with normal hemoglobin. Four athletes had laboratory features (serum ferritin, red cell volume, and/or transferrin saturation) suggestive of iron deficiency. There are association of high iron body stores with cardiac arrhythmia, carotid atherosclerosis, myocardial infarction, liver and colorectal cancer but minor iron deficiency may impair the physical fitness.

[Hematologic aspects of the national hockey team athletes]. / Aspectos hematológicos da seleção nacional de hóquei.

Athletes tend to have lower hemoglobin (Hb) concentrations than sedentary counterparts. Sports anemia is used to describe both pseudodilutional anemia and the true anemia of athletes. Pseudodilutional anemia is a beneficial adaptation to endurance training; the two most common causes of true anemia are iron deficiency and intravascular hemolysis. We used questionnaires, physical examination and laboratory investigation to study 19 highly trained hockey athletes and laboratory investigation to study 32 outpatients without hematological diseases. One athlete had anemia (Hb 10.5 g/ dL; 5.44 million red cells/mL; serum iron-13 micrograms/dL; without parasites in the stools); the athletes had Hb = 14.88 +/- 1.33 g/dL and the outpatients had 15.24 +/- 0.74 g/dL; the maximal oxygen uptake of the athletes was 54.0 +/- 6.03 ml/kg/min (112.15 +/- 14.35% of the predicted values). The maximal oxygen uptake of the anemic athlete was 86% of the predicted value. The three athletes with the best maximal uptake had a mean Hb = 15.8 g/dL. In São Paulo-Brazil anemia is uncommon among males but elite athletes are in a borderline anemic state, that may impair the physical fitness.

[Knowledge retention. II--Orthopedics and traumatology programs]. / Retenção de conhecimentos. II--Programa de ortopedia e traumatologia.

The authors present the results of an educational investigation of knowledge retention concerning a Orthopedics and Traumatology program. The research was developed by comparing the marks obtained in the fourth and sixth years. The examinations had the same content but were not identical. Between the two examinations, the loss of knowledge was -17.5% +/- 1.0% (average +/- standard error) and was not influenced by the time between the two examinations.

[Transfer of the pronator teres tendon to the extensor carp radialis tendon in wrist flexion deformity in cerebral palsy]. / Transferência tendínea do pronador redondo aos extensores radiais do carpo na deformidade em flexão do punho de pacientes portadores de paralisia cerebral.

The flexion deformity of the wrist in cerebral palsy is quite common, carrying disability to the effective use of the hands. From 1980 to 1990, 36 transferences of the pronator teres to the extensor carpi radialis were reviewed. The authors describe the operative technique by a unique incision, that may be used in cerebral palsy, and conclude that it is a good method for correction of deformity.

[Typology of performance of graduate course disciplines in medicine at the Medical School of the University of São Paulo]. / Tipologia do desempenho das disciplinas do curso de graduação em medicina da Faculdade de Medicina da Universidade de São Paulo-analise trienal.

The results of the program for the evaluation of the curriculum of the graduation course of the Medical Faculty of the University of São Paulo are presented and discussed. Following disciplines received special attention: practice in a hospital for infections diseases, orthopedics and traumatology, medical imagery, propedeutics and preventive and social pediatrics. These disciplines were chosen in an aleatory way among those that correspond to the four models of the behaviour: increasing, decreasing, decreasing/increasing and increasing/decreasing.

[The ideal age for starting sportive practice]. / A idade ideal para o início da prática esportiva.

The authors analyse the benefits of physical activities for the different systems of the organism. They discuss four basic phases of the human being as to of his motor and physical development since his birth until the end of puberty. The physical activities that should be performed in each one of these phases are described.

Periprosthetic fractures in patients with total knee arthroplasties.

Ten patients with total knee arthroplasties sustained periprosthetic fractures. Nine of these were supracondylar fractures, and one occurred in the middle one-third of the tibia. These patients were treated with conservative methods in two cases and internal fixation with plate and screws in three cases. The remaining five patients were treated with intramedullary fixation using a specially designed revision prosthesis with long intramedullary stems. The best results wer achieved through the revision arthroplasty, based on walking ability, range of motion, and early rehabilitation.

Artroplastia múltipla nos membros inferiores de pacientes com artrite reumatóide e espondilite anquilosante / Lower limb multiple arthroplasty in patients with rheumatoid arthritis and ankylosing spondylitis

Foram operados 12 pacientes com artrite reumatóide e um com espondilite anquilosante que necessitaram de artroplastia múltipla de quadris e joelhos; destes, três receberam três e os restantes precisaram de quatro artroplastias para sua recuperaçäo. Os resultados foram bons na quase totalidade dos casos, havendo apenas cinco resultados maus e regulares, num total de 49 operaçöes. Levando em consideraçäo as dificuldades para a recuperaçäo, o número de internaçöes e de anestesias, bem como as doses de medicamentos necessárias em cada intervençäo, propusemo-nos a operar dois quadris ou dois joelhos numa só sessäo operatória, em dois casos selecionados, a realizar três e quatro intervençöes (um quadril e dois joelhos) de uma só vez. Tal procedimento teve a justifica-lo o fato de serem pacientes altamente incapacitados, guardando o leito, sem condiçöes para deambulaçäo, cuja recuperaçäo teria sido muito mais difícil se operássemos uma articulaçäo de cada vez. Teve ainda a vantagem de demonstrar que é possível assim proceder, desde que os pacientes sejam bem selecionados, motivados e preparados clinicamente para o ato cirúrgico. Todos os pacientes receberam corticóides durante a operaçäo e nos primeiros três dias de pós-operatório, permanecendo na terapia intensiva por 24 horas, a fim de prevenir possível choque por falência adrenal

Tratamento dos pacientes altamente incapacitados pela artrite reumatóide e pela espondilite anquilosante

Os autores analisam 14 casos de "pacientes altamente incapacitados" pela artrite reumatóide e pela espondilite anquilosante que receberam tratamento cirrurgico-reumatológico de 1962 a 1977. Esses pacientes recuperaram, total ou parcialmente, a capacidade de execuçäo dos atos da vida diária, depois de serem submetidos a no mínimo quatro e no máximo 18 operaçöes ortopédicas. O tempo de evoluçäo foi de 10 a 21 anos e os resultados perduraram até hoje; houve um óbito por pneumonia intercorrente e, dos 13 casos remanescentes, apenas quatro vieram a necessitar de novo tratamento cirúrgico, na maioria por artroplastias totais. Concluem pela validade da conduta que permitiu transformar pacientes altamente incapacitados ou totalmente dependentes em indivíduos relativamente incapacitados e parcialmente dependentes