Influence of altitude training modality on performance and total haemoglobin mass in elite swimmers

We compared changes in performance and total haemoglobin mass (tHb) of elite swimmers in the weeks following either Classic or Live High:Train Low (LHTL) altitude training. Twenty-six elite swimmers (15 male, 11 female, 21.4 ± 2.7 years; mean ± SD) were divided into two groups for 3 weeks of either Classic or LHTL altitude training. Swimming performances over 100 or 200 m were assessed before altitude, then 1, 7, 14 and 28 days after returning to sea-level. Total haemoglobin mass was measured twice before altitude, then 1 and 14 days after return to sea-level. Changes in swimming performance in the first week after Classic and LHTL were compared against those of Race Control (n = 11), a group of elite swimmers who did not complete altitude training. In addition, a season-long comparison of swimming performance between altitude and non-altitude groups was undertaken to compare the progression of performances over the course of a competitive season. Regardless of altitude training modality, swimming performances were substantially slower 1 day (Classic 1.4 ± 1.3% and LHTL 1.6 ± 1.6%; mean ± 90% confidence limits) and 7 days (0.9 ± 1.0% and 1.9 ± 1.1%) after altitude compared to Race Control. In both groups, performances 14 and 28 days after altitude were not different from pre-altitude. The season-long comparison indicated that no clear advantage was obtained by swimmers who completed altitude training. Both Classic and LHTL elicited ~4% increases in tHb. Although altitude training induced erythropoeisis, this physiological adaptation did not transfer directly into improved competitive performance in elite swimmers.     

Physical performance decrements in children with sickle cell anemia.

Prior studies have suggested that cardiorespiratory dysfunction might contribute to the inability of children with sickle cell anemia to exercise competitively with normal children. This article presents a study designed to detect differences in performance of routine physical activities between groups of children having homozygous hemoglobin of sickle cell anemia (HbSS) and those with normal hemoglobin (HbAA). Thirty 10-year-old girls were divided into two equal groups exhibiting no significant differences in height, weight, or body surface area. Each subject performed 20-yd swimming, 40-yd swimming, and 100-yd "potato" foot-racing activities. Results showed significant performance decrements in HbSS compared with HbAA children. Performance decrements on the 20-yd swimming were found to be significantly greater than in either the 40-yd swimming or the 100-yd "potato" races. Assessment of 20-yd swim time as a fraction of 40-yd swim time showed diminished capacity of HbSS children for "burst activity." It is concluded that distance might play a role in the capacity of HbSS children to compete with HbAA children in racing activities such as those encountered in school-based physical education programs. Parents and educators should consider that short distance racing might exaggerate the inability of children with sickle cell anemia to compete with normal children.     

The influence of stroke mechanics into energy cost of elite swimmers

The purpose of this study was to analyze the relationships between energy cost (C), swimming velocity (v), stroke frequency (SF) and stroke length (SL) in top-level swimmers. Eighteen elite swimmers (four freestylers, five backstrokers, five breaststrokers and four butterflyers) performed an intermittent set of n × 200 m swims (n ≤ 8) with increasing velocity. The oxygen consumption was measured breath-by-breath by a portable metabolic cart (K4 b2, Cosmed, Rome, Italy). A respiratory snorkel and valve system with low hydrodynamic resistance was used to measure pulmonary ventilation and collect expiratory gases. Blood samples were taken from the ear lobe before and after each swim to analyze the blood lactate concentration (YSI 1500L, Yellow Springs, OH, USA). At Backstroke, Breaststroke and Butterfly strokes, increases of SF were associated to increases of C, even when controlling the v. The increases in SL only promoted significant decreases in the C in Breaststroke. There was a significant and polynomial relationship between v and SF for all competitive swimming techniques. The polynomial relationship between v and SL was significant only in Freestyle and Butterfly stroke. Partial correlations between v and SF controlling the effect of SL and between v and SL controlling the effect of SF, were positive and significant for all techniques. It is concluded that manipulation of stroke mechanics variables (SF and SL) may be one of the factors through which C in competitive swimming can be altered for a given v.     

Fixation of distal femoral osteotomies with self-reinforced poly(L/DL)lactide 70 : 30 and self-reinforced poly(L/DL)lactide 70 : 30/bioactive glass composite rods. An experimental study on rabbits

Two self-reinforced poly(L/DL)lactide 70 : 30 or self-reinforced poly(L/DL)lactide 70 : 30/bioactive glass (SR-P(L/DL)LA/bioactive glass) composite rods (2 mm × 40 mm) were implanted into the dorsal subcutaneous tissue and osteotomies of the distal femur were fixed with these rods (2 mm × 26 mm) in 36 rabbits. The follow-up times varied from 3 to 100 weeks. After the animals were killed, three-point bending and shear tests and molecular weight measurements were performed for subcutaneously placed rods. Radiological, histological, histomorphometrical, microradiographic and oxytetracycline-fluorescence studies of the osteotomized and intact control femora were performed. After 12 weeks the SR-P(L/DL)LA rods had fragmented into pieces and the mechanical properties could not be measured. The SR-P(L/DL)LA/bioactive glass rods lost their mechanical properties slower, and at 24 weeks the bending strength had decreased by 39% and the shear strength by 50%. After that the mechanical properties of the SR-P(L/DL)LA/bioactive glass rods could not be measured. All osteotomies healed well, and no gross signs of inflammatory reactions were observed. One slight displacement was seen in the three-week follow-up group with SR-P(L/DL)LA rods. Signs of resorption of the implants were seen after 48 weeks in the SR-P(L/DL)LA group and after 24 weeks in the SR-P(L/DL)LA/bioactive glass group. The SR-P(L/DL)LA/bioactive glass rods were almost totally resorbed from the bone at 100 weeks. The present investigation showed that the mechanical strength and fixation properties of the SR-P(L/DL)LA and the SR-P(L/DL)LA/bioactive glass composite rods are suitable for fixation of cancellous bone osteotomies in rabbits.     

Fixation of distal femoral osteotomies with self-reinforced poly(L/DL)lactide 70:30 and self-reinforced poly(L/DL)lactide 70: 30/bioactive glass composite rods. an experimental study on rabbits

Two self-reinforced poly(L/DL)lactide 70:30 or self-reinforced poly (L/DL)lactide 70:30/ bioactive glass (SR-P(L/DL)LA/bioactive glass) composite rods (2 mm x 40 mm) were implanted into the dorsal subcutaneous tissue and osteotomies of the distal femur were fixed with these rods (2 mm x 26 mm) in 36 rabbits. The follow-up times varied from 3 to 100 weeks. After the animals were killed, three-point bending and shear tests and molecular weight measurements were performed for subcutaneously placed rods. Radiological, histological, histomorphometrical, microradiographic and oxytetracycline-fluorescence studies of the osteotomized and intact control femora were performed. After 12 weeks the SR-P(L/DL)LA rods had fragmented into pieces and the mechanical properties could not be measured. The SR-P(L/DL)LA/bioactive glass rods lost their mechanical properties slower, and at 24 weeks the bending strength had decreased by 39% and the shear strength by 50%. After that the mechanical properties of the SR-P(L/DL)LA/bioactive glass rods could not be measured. All osteotomies healed well, and no gross signs of inflammatory reactions were observed. One slight displacement was seen in the three-week follow-up group with SR-P(L/DL)LA rods. Signs of resorption of the implants were seen after 48 weeks in the SR-P(L/DL)LA group and after 24 weeks in the SR-P(L/DL)LA/bioactive glass group. The SR-P(L/DL)LA/bioactive glass rods were almost totally resorbed from the bone at 100 weeks. The present investigation showed that the mechanical strength and fixation properties of the SR-P(L/DL)LA and the SR-P(L/DL)LA/bioactive glass composite rods are suitable for fixation of cancellous bone osteotomies in rabbits.     

Biochemical responses during recovery from maximal and submaximal swimming exercise

Summary We set out to demonstrate whether changes in plasma volume, haematocrit and some important blood constituents occurred after swimming 100 m and 800 m, as well as monitoring the duration of these changes. We measured exercise-induced changes in concentration of plasma constituents in eight subjects, and determined the expected effects of haemoconcentration on these constituents. We also investigated the different biochemical responses occurring after maximal exercise (100 m), as compared to submaximal exercise (800 m). The haematocrit increased significantly after the 100 m swim and to a lesser extent after the 800-m swim, returning to basal levels within 30 min. The plasma volume decreased by 16% on completion of the 100 m and by 8% on completion of the 800 m. The blood lactate concentration increased 15-fold and 10-fold after the 100-m and 800-m swims respectively. The plasma potassium concentration increased significantly immediately on completion of the 100-m swim, then decreased significantly at 2 1/2 and 5 min post-exercise, returning to near-basal values at 30 min. The potassium concentration measured after the 800-m event did not differ significantly from basal levels, however the measured concentrations were significantly lower than the concentrations expected on the basis of haemoconcentration. The plasma sodium concentrations measured after both 100-m and 800-m swims were significantly increased. However, calculations correcting for haemoconcentration showed significant losses in toal circulating sodium. Our study demonstrates marked changes in plasma volume and certain blood constituents after maximal intensity swimming, and less marked changes after submaximal exercise. We also demonstrated the importance of taking the effects of haemoconcentration into account when evaluating changes in concentration of plasma constituents.     

Blood lactate recovery measurements,training, and performance during a 23-week period of competitive swimming

The purpose of this study was to relate measurements of blood lactate concentration, performance during a maximal anaerobic lactic test (MANLT) and training loads during a 23-week swimming season. Six elite 200-m freestyle male swimmers [mean age 19.5 (SD 1.6) years, height 184 (SD 5) cm and body mass 77.7 (SD 9.0) kg], participated in the study. The MANLT consisted of four all-out 50-m swims interspersed with 10-s recovery periods. Blood lactate concentrations were determined at 3 and 12-min post-exercise and were performed on weeks 2, 6,10,14,18 and 21. Swimmers participated in 200-m freestyle competitions on weeks 1, 7,13 and 23 (national championships). During weeks 1–10, training mostly involved aerobic exercise, while during weeks, 11–23, it involved anaerobic exercise. At 3-min and 12-min post-MANLT lactate concentrations varied throughout the season [range from 14.9 (SD 1.2) to 18.7 (SD 1.0) mmol·l^–1] but demonstrated non-systematic variations. In contrast, the percentage of mean blood lactate decrease (% [La-]_recovery) between min 3 and min 12 of the passive recovery post-MANLT increased from week 2 to 10 with aerobic training and decreased from week 10 to 21 with anaerobic training. The MANLT performance improved continuously throughout the season, while competition performance improved during the first three competitions but declined in the final championships, coinciding with the lowest % [La-]_recovery and signs of overtraining, such as bad temper and increased sleeping heart rate. The results of this study indicated that % [La-]_recovery could be an efficient marker for monitoring the impact of aerobic and anaerobic training and avoiding overtraining in elite 200-m swimmers.     

Sodium bicarbonate ingestion improves performance in interval swimming

Summary In an effort to determine the effects of bicarbonate (NaHCO₃) ingestion on exercise performance, ten male college swimmers were studied during five different trials. Each trial consisted of five 91.4m (100-yd) front crawl swims with a two-minute rest interval between each bout. The trials consisted of two NaHCO₃ treatments, two placebo trials and one test with no-drink. One hour before the onset of swimming, the subjects were given 300 ml of citric acid flavored solution containing either 17 mmol of NaCl (placebo) or 2.9 mmol of NaHCO₃ · kg^–1 body weight (experimental), or received no drink (no-drink). Performance times for each 91.4 m swim were recorded. Blood samples were obtained before and one hr after treatment, two min after warmup, and two min after the final 91.4 m sprint. Blood pH, lactate, standard bicarbonate (SBC) and base excess (BE) were measured. No differences were found for performance or the blood measurements between the placebo and no-drink trials. Bicarbonate feedings, on the other hand, produced a significant (P<0.05) improvement in performance on the fourth and fifth swimming sprints. Blood lactate, pH, SBC and BE were significantly higher (P<0.05) at post-exercise in NaHCO₃ treatments. These data are in agreement with previous findings that during repeated bouts of exercise pre-exercise administration of NaHCO₃ improves performance, possibly by facilitating the efflux of hydrogen ions from working muscles and thereby delaying the onset of fatigue.     

Isolation, characterization, and inhibition kinetics of enolase from Streptococcus rattus FA-1.

One aspect in a broad spectrum of possible mechanisms of cariostatic reactions of fluoride is its interaction with the metabolism of oral bacteria. Information on the mechanisms and kinetics of fluoride inhibition of essential enzymes of the glycolytic pathway of the relevant bacteria is lacking. In this work, the isolation and purification of enolase from Streptococcus rattus and its characterization are described. The enzyme has been isolated in a monomeric (22 kilodaltons) and dimeric (49 kilodaltons) form. The Km for 2-phosphoglycerate is 4.35 mM. Fluoride inhibition kinetics have competitive character, while phosphate in concentrations above 2 mM and in the presence of 0.5 mM fluoride alters the inhibition kinetics from competitive to noncompetitive. Without fluoride, 2 mM phosphate has a slight stimulatory effect on the enzyme. Monofluorophosphate has a noncompetitive inhibiting effect on the enzyme. This finding suggests that the effect of phosphate may be due to an additional binding of fluoride to the enolase, resulting in a conformational change of the enzyme.     

Energy cost and intracyclic variation of the velocity of the centre of mass in butterfly stroke

The purpose of this study was to examine the relationship between the intra-cycle variation of the horizontal velocity of displacement (dV) and the energy cost (EC) in butterfly stroke. Five Portuguese national level swimmers performed one maximal and two sub-maximal 200-m butterfly swims. The oxygen consumption was measured breath-by-breath by portable metabolic cart. A respiratory snorkel and valve system with low hydrodynamic resistance was used to measure pulmonary ventilation and to collect breathing air samples. Blood samples from the ear lobe were collected before and after each swim to analyse blood lactate concentration. Total energy expenditure ( E _tot) and EC were calculated for each swim. The swims were videotaped in the sagittal plane with a set of two cameras providing dual projection from both underwater and above the water surface. The APAS system was used to analyse dV for the centre of mass. The E _tot increased linearly with the increasing V, presenting a significant correlation coefficient between these parameters ( r =0.827, P <0.001). The increase in EC was significantly associated with the increase in the dV ( r =0.807, P <0.001). All data were presented as the mean value and the standard deviation. It is concluded that high intra-cycle variation of the velocity of the centre of mass was related to less efficient swimming and vice versa for the butterfly stroke.     

Effect of intense swimming training on rhinitis in high‐level competitive swimmers

Background Rhinitis is commonly reported by swimmers. Seasonal allergic rhinitis may impair athletes' performance and quality of life (QOL). No data are currently available on the changes of nasal symptoms during and after a swimming season. We aimed to determine in competitive swimmers: (1) the prevalence of rhinitis and its impact on their QOL during an intense training programme, (2) the changes in nasal symptoms and QOL after a resting period and (3) the relationship between rhinitis and airway hyperresponsiveness (AHR). Methods Thirty‐nine swimmers and 30 healthy controls answered the Rhinitis Quality of Life Questionnaire (RQLQ) and scored nasal symptoms on a seven‐point Likert scale during the week preceding their visit. Subjects had allergy skin prick tests and a methacholine challenge. Peak nasal inspiratory flows were also measured. The athletes performed these tests during an intense training period (V1), outside the pollen season and after at least 2 weeks without swimming (V2). Results At V1, rhinitis symptoms were reported by 74% of swimmers and 40% of controls (P<0.01). Eighty‐four percent of swimmers and 72% of controls were atopic (NS). RQLQ score was higher in swimmers compared with controls at V1 (27.3 ± 28.5 vs. 9.5 ± 12.7, respectively, P<0.005). The presence of AHR during training did not correlate with the presence of rhinitis symptoms. At V2, the nasal symptoms and RQLQ scores were similar in swimmers and controls. Conclusion Intense swimming training is associated with an increase in nasal symptoms and impairment in QOL in most competitive swimmers. Such an increase is not related to seasonal allergen exposure in atopic athletes and probably results from chlorine derivative exposure. Cite this as: V. Bougault, J. Turmel and L. P. Boulet, Clinical & Experimental Allergy, 2010 (40) 1238–1246.     

Effects of three tapering techniques on the performance, forces and psychometric measures of competitive swimmers

The 100-m and 400-m swim time, tethered swimming forces, mood states and self-ratings of well-being of 27 competitive swimmers were measured before and after 4 weeks of intense training and after 1 week and 2 weeks of tapering for major competition. The swimmers were divided into three groups. Each group completed one of three taper regimes similar to those currently performed by swimmers in preparation for competition: (a) reduced training frequency according to each athlete's daily ratings of well-being, (b) reduced training volume, and (c) reduced training volume and intensity. Significant improvements in the Profile of Mood States measures of tension, depression and anger (P?P?P?P?>?0.05) were observed and no significant differences were revealed among the three tapering techniques. These data highlighted the importance of providing sufficient recovery before competition, since 1 week of reduced training was not long enough to maximise the benefits of tapering. However, none of the three types of tapering currently used by competitive swimmers could be shown to be more beneficial than the others.     

Association between ACE D allele and elite short distance swimming

The influence of ACE gene on athletic performance has been widely explored, and most of the published data refers to an I/D polymorphism leading to the presence (I allele) or absence (D allele) of a 287-bp sequence in intron 16, determining ACE activity in serum and tissues. A higher I allele frequency has been reported among elite endurance athletes, while the D allele was more frequent among those engaged in more power-orientated sports. However, on competitive swimming, the reproducibility of such associations is controversial. We thus compared the ACE genotype of elite swimmers with that of non-elite swimming cohort and of healthy control subjects. We thus sought an association of the ACE genotype of elite swimmers with their competitive distance. 39 Portuguese Olympic swimming candidates were classified as: short (<200 m) and middle (400–1,500 m) distance swimmers, respectively. A group of 32 non-elite swimmers were studied and classified as well, and a control group (n = 100) was selected from the Portuguese population. Chelex 100 was used for DNA extraction and genotype was determined by PCR-RFLP methods. We found that ACE genotype distribution and allelic frequency differs significantly by event distance only among elite swimmers (P ≤ 0.05). Moreover, the allelic frequency of the elite short distance swimmers differed significantly from that of the controls (P = 0.021). No associations were found between middle distance swimmers and controls. Our results seem to support an association between the D allele and elite short distance swimming.     

Newcastle bone disease in Hong Kong: a study of aluminum associated osteomalacia

We measured serum aluminum concentrations in 104 haemodialysis patients from 3 centres in Hong Kong. We found that the 52 patients dialyzed in unit A had much higher mean aluminium levels (100 micrograms/L) than those from the other two units (61 and 39 micrograms/L respectively). In unit A, where water treatment by reverse osmosis had been introduced only recently, 30.8% of patients had fractures/looser zones, 46.2% had rugger-jersey spine and 28.8% had skeletal erosions. When these patients were divided into two groups according to whether their serum aluminium concentration was below or above 100 micrograms/l, the latter patients had significantly lower alkaline phosphatase, serum phosphate, and higher total prescribed dose of aluminium hydroxide. It was concluded that both dialysate aluminium and oral aluminium intake seemed to have contributed to the high incidence of osteomalacic fractures among Unit A patients. In eight of these patients serum aluminium increased by more than 150 micrograms/L after four weeks of receiving 1.5 g desferrioxamine twice weekly. Serial X-rays showed that the mean time after dialysis for the appearance of fractures/Looser zones was 72 months. Three patients developed fractures/Looser zones after successful renal transplantation; and it was postulated that the prompt excretion of aluminium permitted increased osteoclastic activity, resulting in fractures in these patients.     

Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers

To investigate respiratory symptoms, increased bronchial responsiveness, and signs of airway inflammation in elite swimmers, we examined 29 swimmers from the Finnish national team and 19 healthy control subjects (nonasthmatic, symptom-free). They answered a questionnaire and were interviewed for respiratory symptoms. Lung volumes were measured and bronchial responsiveness assessed by a histamine challenge test. Induced sputum samples were also collected. Fourteen (48%) of the swimmers and three (16%) of the control subjects showed increased bronchial responsiveness (P<0.05). The sputum cell differential counts of eosinophils (mean 2.7% vs 0.2%) and neutrophils (54.7% V5 29.9%) from swimmers were significantly higher than those from controls (P<0.01). Eosinophilia (sputum differential eosinophil count of >4%) was observed in six (21%) of the swimmers and in none of the controls (P<0.05). Symptomatic swimmers had significantly more sputum eosinophils than did the symptom-free. The concentrations of sputum eosinophil peroxidase (EPO) and human neutrophil lipocalin (HNL) were significantly higher in swimmers than control subjects (P<0.001 and P=0.05). We conclude that elite swimmers had significantly more often increased tjronchial responsiveness than control subjects. Sputum from swimmers contained a higher percentage of eosinophils and neutrophils, and higher concentrations of EPO and HNL than sputum from controls. Long-term and repeated exposure to chlorine compounds in swimming pools during training and competition may contribute to the increased occurrence of bronchial hyperresponsiveness and airway inflammation in swimmers.     

Echocardiographic left atrial dimension as a predictor of maintaining sinus rhythm after conversion of atrial fibrillation

Twenty-six patients with lone atrial fibrillation were studied prospectively by M-mode echocardiography less than two months before and one month after cardioversion (CV). Seven patients had reverted to atrial fibrillation (AF) one month after CV. These patients (AF group) differed significantly with regard to mean left atrial dimension (LA) from the 19 patients (73%) who maintained sinus rhythm (S group) (p less than 0.001). Initial LA was 38.6 +/- 4.9 mm in the S group and 47.6 +/- 2.3 mm in the AF group. These values had not changed significantly in either group when measured one month after CV. The radiological heart size index showed a closely corresponding pattern. On the other hand, the mean heart size in both groups (441 +/- 100 and 544 +/- 98 ml/m2 BSA, respectively) was well below the upper normal limit (700 ml/m2) that is conventionally used as exclusion criterion from CV. In conclusion, in patients with AF and only moderate cardiac enlargement on chest X-ray, the echocardiographic LA can be used as predictor of maintaining sinus rhythm for at least one month following CV.     

Energy cost and body centre of mass’ 3D intracycle velocity variation in swimming

The purpose of this study was to examine the relationship between the energy cost (C) and the 3D intracycle velocity variation (IVV; swimming direction--x, vertical--y and lateral--z axes) throughout the 200 m front crawl event. Ten international level swimmers performed a maximal 200 m front crawl swim followed by 50, 100 and 150 m bouts at the same pace as in the 200 m splits. Oxygen consumption was measured during the bouts and blood samples were collected before and after each one. The C was calculated for each 50 m lap as the ratio of the total energy expenditure (three energy pathways) to the distance. A respiratory snorkel and valve system with low hydrodynamic resistance was used to measure pulmonary ventilation and to collect breathing air samples. Two above water and four underwater cameras videotaped the swim bouts and thereafter APAS was used to assess the centre of mass IVV (x, y and z components). The increase in the C was significantly associated with the increase in the IVV in x for the first 50 m lap (R = -0.83, P < 0.01). It is concluded that the IVV relationship with C in a competitive event does not present the direct relationship found in the literature, revealing a great specificity, which suggests that the relation between these two parameters could not be used as a performance predictor in competitive events.     

Rates of lactic acid permeation and utilization in the isolated dog brain.

The rate of lactic acid (LA) permeation from brain tissue to venous blood and utilization in brain tissue was investigated in 13 isolated dog brains before and after an ischemic period of 3 min. LA concentration in the brain, cerebral blood flow, as well as the arteriovenous differneces of LA, glucose, and O2 were determined. LA concentration in cerebral tissue increased from a control value of 254 +/- 42 to 1,606 +/- 177 mumol/100 g brain tissue in the 2nd min after ischemia (mean values +/- SE). Before ischemia no release of LA was found, whereas in the 2nd min after ischemia LA permeation rate had increased to 25.1 +/- 8.5 mumol/100 g brain tissue per minute (P less than 0.005). Up to the 4th min after ischemia no net LA utilization was observed. Thereafter LA utilization increased rapidly and exceeded the LA permeation rate by a ratio of maximally 10:1 between the 12th and 21st min after ischemia. The O2 equivalent of the cerebral metabolic rate for lactate maximally amounted to 2.82 +/- 0.42 mumol-min-1-g-1 or 181 +/- 28%. LA output may be limited by passage of LA across the brain cell and the blood-brain barrier.     

Laparoscopic appendectomy versus open appendectomy in children

This study compares the benefits, advantages and complications of laparoscopic Appendicectomy (LA) versus Open Appendectomy (OA) in children's in Dublin Ireland. Total 200 patients were studied. Hundred of LA and 100 for OA. Out of 100 LA 58 were male, 42 were female aged between 4-15 yr. and out of 100 OA 58 were male, 42 were female aged between 4-14 yr. The mean operative time of LA was 35.8 minutes and the Anaesthetic time was 46.6 minutes. Patients having LA had less post-op pain with early start of feed at 16.7 hrs, and had significantly less post-op hospital stay of 1.6 days. Post op complications rate was 3%. The patient started the normal life activities at 10.8th post op day. Wound infection rate was 3% with Re-admission rate of 2%. The mean operative time of OA was 45.66 minutes and the Anaesthetic time was 56.75 minutes. Patients having OA had post-op pain hospital stay of 2.55 days with start of feed at 24.7 hrs. Post op complications rate was 2%. The patient started the normal life activities at 15.78th post op day. Wound infection rate was 3% with Re-admission rate of 1%. Laparoscopic appendectomy is safe alternative to conventional open appendectomy, leading to early ambulation, decreased hospital stay, and better exploration of abdominal cavity.     

Laboratory diagnosis of left atrial thrombi in patients with mitral stenosis]

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and the systemic embolization due to thrombi causes a serious, occasionally fatal complication. Several clinical techniques have been used to estimate the presence of LA thrombi. However, the hitherto available methods, even an echocardiography which has been most widely used, still have some drawbacks, depending on the size and location of thrombi. The author measured D-dimer, fibrinopeptide A (FPA) and thrombin-antithrombin III complex (TAT) in the patients with MS and evaluated the diagnostic value of these molecular markers to estimate the presence of LA thrombi. Twenty six patients with MS who had undergone cardiac operation were studied. Atrial fibrillation was found in all the patients. Episode of obvious thromboembolic diseases is a criteria of exclusion. Blood was drawn from the brachial vein several days (3 +/- 1 days: mean +/- SD) before the operation. The presence or absence of thrombus was confirmed at the surgery in all the cases. 1) Both levels of D-dimer and TAT were significantly higher in the patients with thrombi than those in the patients without thrombus or those in normal controls (mean: 378, 93 and 64 ng/ml, respectively; p less than 0.01 for both and 9.1, 2.0 and 1.7 ng/ml, respectively; p less than 0.01 for both). However, levels of FPA were not significantly different among the three groups (mean: 7.9, 4.9 and 3.7 ng/ml, respectively; NS for both). 2) both levels of D-dimer and TAT were significantly correlated with the weights of LA thrombus (r = 0.87, p less than 0.01: r = 0.79, p less than 0.01, respectively). 3) LA thrombi (ca. greater than or equal to 2 g) were always confirmed at the surgery in the patients who had levels of D-dimer higher than 200 ng/ml and/or TAT higher than 4 ng/ml. The plasma levels of D-dimer and TAT were further followed after the surgery in the same 18 patients (8 patients who had thrombus, the rest who didn't). 1) In the patients who had thrombi, levels of D-dimer were significantly decreased after the surgery (mean: from 267 ng/ml to 73 ng/ml, p less than 0.05). Levels of TAT were slightly but not significantly decreased (mean: from 82 ng/ml to 76 ng/ml, NS).(ABSTRACT TRUNCATED AT 400 WORDS)