Comparison of the effect of two sports training methods on the flexibility of rhythmic gymnasts at different levels of biological maturation.

AIM: The present study aimed to assess the effects of two different sports training methods - traditional and maturational - on the flexibility of female rhythmic gymnasts at different levels of biological maturation. METHODS: The sample consisted of 120 children, randomly divided (by draw) into six groups of 20 children (eight and nine-years old): traditional training group (TG); maturational training group (MG); and the control group (CG). These were subdivided into early, normal and late, based on biological maturation assessment by hand/wrist X-ray examination. Flexibility was evaluated by angle goniometer testing, applying the LABIFIE protocol. A Lafayette Goniometer Set and Hoorn-Brasil exercise mat were used and the following exercises were performed: external shoulder rotation (ESR) and lumbar flexion (LF). Both the TG and MG participated in twice-weekly, 45-minute rhythmic gymnastics classes over 16 weeks. The TG used the traditional sports training method while the MG executed sporting activities according to biological maturation. The CG received no special treatment. RESULTS: The results showed a significant improvement (P<0.001) in the subgroups (late, normal and early) for both variables (∆ESR=7.54º and ∆LF=7.51º) in the eight and nine-year age groups. Moreover, in relation to division by biological maturity, better results were recorded in the early subgroups. CONCLUSION: Thus, it can be inferred that, due to the changes in important physical parameters as a result of maturation, selecting children for physical education should not be based solely on chronological, but primarily on biological maturation.

Determinants of health-related quality of life in morbid obese candidates to gastric banding.

OBJECTIVE: To analyse determinants of self reported health-related quality of life (HR-QoL) in morbid obese patients candidates to laparoscopic adjustable gastric banding (LAGB). METHODS: Determinants of HR-QoL were investigated in 383 morbid obese patients (82 M and 301 F) with BMI≥40 kg/m² (BMI≥35 kg/m² if complicated obesity) and age 18-60 years. HR-QoL was determined with the SF-36 questionnaire. Determinants of the two summary measures of SF-36 (physical component and mental component) were analysed by stepwise multiple linear regression analysis with age, BMI, physical comorbidites, mental comorbidites and eating behaviour disorders as independent variables. Physical comorbities (diabetes, hypertension, hypertriglyceridemia, low HDL, sleep apnea and osteoarthritis) were coded as present or absent on the basis of simple diagnostic clinical criteria; mental comorbidities (depression) and eating behaviour disorders (binge eating, sweet eating and nibbling) on the basis of an unstructured clinical interview. RESULTS: Mean age was 38.8±10.2 years and mean BMI was 41.5±5.4 kg/m². Scores in the eight SF-36 subscales were lower in women than in men and lower than in the general Italian population. However, 18.4-43.5% of the participants had HR-QoL levels above the normative values, depending on the scale. In both genders, low scores in the mental component of the SF-36 were associated to the presence of depression and eating behaviour disorders and not to physical comorbidities or BMI levels. Low physical self-perceived well being was associated to high BMI levels in men and to depression, hypertension and hypertriglyceridemia in women. CONCLUSION: HR-QoL was poor in morbid obese candidates to LAGB, particularly in women, and was negatively affected more by mental comorbidites and eating behaviour disorders than by physical comorbidities or BMI levels.

[Spontaneous pneumoperitoneum: a case secondary to thoracic trauma]. / Pneumoperitoneo spontaneo: presentazione di un caso secondario a trauma toracico.

Spontaneous pneumoperitoneum is the radiographic manifestation of free air in the peritoneal cavity without visceral perforations and peritoneal signs, and it occurs in about 10% of the cases of pneumoperitoneum. The etiology can be postoperative, thoracic, abdominal, gynecologic, idiopathic; it generally introduces a benign evolution and does not require surgical treatment but just a conservative approach. The authors describe here a case of spontaneous pneumoperitoneum secondary to thoracic trauma. This case is interesting for the occurrence of pneumoperitoneum without clinical peritoneal signs such as fever and leucocytosis, after closed thoracic trauma in absence of pneumothoracic and pneumomediastinum. Correct clinical approach has allowed a conservative treatment avoiding an useless laparotomy.

Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery.

PURPOSE: The purpose of the present study was to evaluate prospectively the abdominal wall recurrence rate after laparoscopic resection for colorectal cancer, to analyze the impact of the learning curve on abdominal wall recurrence, and to assess the outcome of those patients. METHODS: The Italian Registry of Laparoscopic Colorectal Surgery database was analyzed to obtain data on cancer patients with abdominal wall recurrence, concomitant local or distant metastases, and interval between initial surgery and diagnosis of trocar site or minilaparotomy recurrences. The records of the initial procedures and the technique of specimen removal were reviewed. RESULTS: From January 1992 to July 2000, 2,583 patients (1,753 cases of carcinomas and 830 cases of benign diseases) were recorded. The malignant lesions were located on the right colon in 19 percent, the left colon in 48.8 percent, and rectum in 32.2 percent. Sixteen patients with histologic evidence of colorectal adenocarcinoma recurrences at the abdominal wall were observed (0.9 percent). Ten patients presented an advanced stage (III for 7 patients and IV for 3 patients). Eleven cases occurred during the learning curve period (the first 50 consecutive cases). The median survival time after abdominal wall recurrence diagnosis was 16 (range, 12-60) months. By July 2000 only two patients were alive. CONCLUSIONS: The results of the Italian prospective Registry of Laparoscopic Colorectal Surgery confirm that the incidence of abdominal wall recurrences is similar to that reported in open studies (<1 percent). Most abdominal wall recurrences occurred in the learning curve period, suggesting that surgical experience may play a role in the development of this outcome. The prognosis of these patients is very poor.

[Laparoscopic surgery of the colorectum: analysis of results of the National Registry of the Italian Society of Endoscopic Surgery and New Technologies (S.I.C.E.)]. / La chirurgia laparoscopica del colon-retto: analisi dei risultati del Registro Nazionale della Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie (S.I.C.E.).

The aim of this paper was to review the data from the Italian Registry of Laparoscopic Colo-Rectal Surgery sponsored by SICE. The Italian Registry was set up in January 1993 by the merging of two Registries existing since November 1991. Thirty-five centres, up to March 2001, had participated in the Registry, with 2,793 patients recorded (F = 1,409, M = 1,384), 1878 for malignancy and 915 for benign diseases. The median age was 63.7 years. The conversion rate was 10.8%. Mortality was 0.6% (18 cases) and major abdominal complications occurred in 11.1% of patients. The reoperation rate was 5.1%. After a median follow-up of 59 months, 16 patients (0.9%) presented abdominal wall metastases. Relapses occurred in 18.5% of patients after curative resections for rectal cancer, and in 12.7% after curative resections for colon cancer. Laparoscopic colo-rectal surgery has gained widespread acceptance. The reproducibility and safety of all the major laparoscopic colo-rectal procedures has been demonstrated. Nevertheless, the lack of long-term results of randomised trials in terms of oncological efficacy and the technical difficulties of the procedures suggests that laparoscopic colo-rectal surgery should be performed only in referral centres by skilled surgeons.

Laparoscopic adjustable silicone gastric banding: prospective evaluation of intragastric migration of the lap-band.

Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was to assess prospectively the incidence of Lap-Band intragastric migration and to establish the safety and effectiveness of minimally invasive band removal. Between January 1996 and June 2000, 148 consecutive patients enrolled in a multidisciplinary bariatric program underwent laparoscopic adjustable silicone gastric banding. In the follow-up treatment, gastrointestinal endoscopy was performed routinely. One hundred twenty-three patients with a minimum follow-up period of 12 months were entered into the study group. Eleven (9.2%) patients had long-term major complications. Intragastric band migration was observed in nine (7.5%) patients. The diagnosis was established by routine endoscopy between 10 and 41 months after surgery. Five erosions occurred in the first 30 cases (learning curve period). In six patients, the band was removed by an intragastric endoscopic-assisted approach avoiding laparotomy. The remaining three patients are under endoscopic surveillance. The results of this study show that routine upper gastrointestinal endoscopy can discover asymptomatic band migrations early. Band erosion did not require emergency treatment and can be removed safely by a minimally invasive approach.

[Diagnostic problems and results of laparoscopic cholecystectomy in chronic acalculous cholecystitis]. / Problemi diagnostici e risultati della colecistectomia laparoscopica nella colecistite cronica alitiasica.

We report on our experience with laparoscopic cholecystectomy in 15 patients, 12 females and 3 males (mean age: 44 years), with chronic acalculous cholecystitis. These patients presented with recurrent episodes of biliary colic together with a dysmorphic or dysfunctioning gallbladder as confirmed by ultrasound and/or cholescintiscan with 99m-Tc HIDA performed in fasting conditions and after meals. First of all, we considered the possible presence of concomitant digestive disease (peptic ulcer disease, recurrent pancreatitis, irritable bowel syndrome, chronic hepatitis) potentially responsible for the pain. Ultrasound investigations revealed a pathological gallbladder in 10 patients. Cholecystectomy was curative in 8/10. Cholescintiscan revealed a pathological gallbladder in 8 patients and cholecystectomy was curative in only 5 of these. No postoperative deaths or significant complications occurred. The mean duration of the operation (35 vs 48 min) and hospital stay (2.1 vs 2.8 days) were reduced in comparison to 346 cholecystectomies performed for gallstones. After 6-36 months' follow-up, resolution of symptoms was successful in 10/15 cases (66.6%); in 3 cases, only dyspepsia was reduced, whilst in the other 2 cases, who also presented concomitant irritable bowel syndrome and gastroduodenitis, there was no improvement in pain. In all but the latter two cases (86.6%), histological examination revealed chronic gallbladder inflammation. In conclusion, laparoscopic cholecystectomy was curative (66.6%) or led to an improvement in symptoms (20%) in patients with chronic acalculous cholcystitis. Cholescintiscans were not always diagnostic for the disease, whereas ultrasound findings were more useful as an indication for surgery.

Urinary polyamines are noninvasive markers of heart allograft rejection.

Histologic evaluation of the heart allograft biopsy is currently the generally accepted method to monitor for rejection after transplantation. A noninvasive marker of host prerejection immunologic activation might be a useful clinical tool and provide the basis for a more continuous evaluation than is available with the biopsy technique. Urinary polyamine levels, in the context of immune activation, may fluctuate as an indicator of lymphocyte proliferation and organ rejection. To test this hypothesis cervical heterotopic heart transplantation was performed in six dogs that did not receive immunosuppression therapy. Daily percutaneous transmural biopsy of the transplanted heart and urine samples were collected. Urinary polyamines were measured by high-pressure liquid chromatography. Between 2 and 4 days after transplantation all allografts showed a histologic picture of mild to moderate rejection. The urinary excretion of total polyamines and putrescine fraction increased during the rejection process after transplantation, attaining a maximum from the first to the third day after operation. This early elevation suggests that urinary polyamines are markers of immune activation and unmodified heart allograft rejection. Further studies need to be done to define a potential clinical application of urinary polyamines as markers of cellular metabolic activity of the immune system and allograft rejection.