Resumo Atualmente, a quantificação da carga durante o treino e competição em todos os desportos é importante para a prevenção de lesões, sessões de treino específicas e melhoria do desempenho dos jogadores. Os objetivos do presente estudo foram descrever o perfil de carga externa dos jogadores de handebol a nível amador e comparar a posição de jogo e as diferenças relacionadas com os resultados de um jogo oficial da 2ª Divisão Regional masculino. Foram analisados 19 jogadores de handebol por meio do WIMU PROTM electronic performance and tracking systems (EPTS) com tecnologia de localização em interiores ultrawide-band (UWB). A análise estatística foi composta por um teste T para amostra independente e ANOVA unidirecional com posthoc de Bonferroni. No handebol amador, as maiores exigências são compostas por deslocamentos de intensidade aeróbica (<12 km/h, 76% de tempo de jogo) e impactos de baixa intensidade (<5G). Foram encontradas diferenças entre as posições de jogo em que os alas obtiveram os maiores valores em ações de alta intensidade, centros no volume de exigência e jogadores defensivos especializados em impactos. Além disso, as equipes vencedoras realizaram maiores exigências de alta intensidade, tanto em deslocamentos como em mudanças de velocidade. Esses resultados fazem a primeira aproximação às exigências do handebol amador, considerando as exigências relacionadas com o papel de jogo e status de jogo para desenhar planos de treino específicos.

Abstract Currently, the load quantification during training and competition in all sports is important to injury prevention, design specific training sessions, and player performance enhancement. The present study aimed to describe the external load profile of amateur-level handball players and to compare the playing position and match outcome-related differences in an official 2nd Regional Division male official match. 19 handball players were monitored by WIMU PROTM electronic performance and tracking systems (EPTS) with ultrawide-band (UWB) indoor location technology. Statistical analysis was composed of a t-student independent sample test and one-way ANOVA with Bonferroni posthoc. In amateur handball, most demands are composed of aerobic intensity displacements (<12 km/h, 76% playing time) and low-intensity impacts (<5G). Differences were found between playing positions where wingers obtained the greatest values in high-intensity actions, centers in the volume of demands, and defensive specialist players in impacts. Besides, the winning teams performed greater high-intensity demands both in displacements and speed changes. In conclusion, the present results realized the first approximation to handball amateur demands, considering the playing role and match status-related demands to design specific training plans.

INTRODUCTION: Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk. MATERIALS AND METHODS: A total of 786 laparoscopic transperitoneal urologic operations were reviewed at our institution. All procedures were performed by the same surgeon and included 213 adrenalectomies, 181 simple nephrectomies, 143 lymphadenectomies, 118 radical nephrectomies, 107 partial nephrectomies and 24 nephroureterectomies. Mean patient age was 53.2 years (range 24 to 70). Mean BMI was 28.15 Kg/m2 (range 20 to 48.9). RESULTS: A total of 6 cases (0.7%) of diaphragmatic injury were found. All reported patients had additional factors that may have contributed to diaphragmatic injury. Diaphragmatic repair was always carried out by intracorporeal suturing and only one case required chest tube placement. All patients evolved uneventfully. CONCLUSIONS: Repair of diaphragmatic injuries should always be attempted with intracorporeal suture since this is a feasible, reproducible and reliable technique.

Objective: to analyze the contribution of diffusion MR tractography imaging to determine the value of the integrity and function of the great tracts of fibers in the white matter in healthy volunteers and patients. Material and method: diffusion MR tractography imaging was analyzed using with a 1.5-T , PHILIPS Intera Archieva, 7 min. of scans, TR-6.707, TE-89, 1.44 x 1.44 x 300 mm VOXEL, 0.3 GAP, 230 mm FOV, 3 mm thick slices ,acquisition 4, 112 x 116 MATRIX, EPI tec., Single Shot 16 directions in 10 healthy volunteers and 3 patients, one of them with angioma malformation, another one with oligodendroglioma, and the last case with diffuse axonal injury. Results: the tracts in the white matter were observed in all healthy volunteers. Regarding to patients, we observed displacement of fiber in one of them, displacement and non-infiltration in another one, and partial damage of the tracts in the last one. Conclusion: diffusion MR tractography imaging is of great value for observed the fiber and beam elocuent, including their functional state.

Objetivo. Analizar la contribución de la difusión por tensión-tractografía a la información acerca de la integridad y función de los grandes tractos de fibras de la sustancia blanca en sujetos normales y en algunos casos patológicos. Material y método. Se analizan los estudios de difusión por tensión tractografía obtenidos por un resonador de 1.5 T, PHILIPS Intera Achieva. Con secuencias de tractografía, scan de 7 minutos, TR-6.707, TE-89, VOXEL en mm 1.44 x 1.44 x 300, GAP 0.3, FOV 230 mm, Slice 3, adquisiciones 4, Matriz 112 x 116, con técnica de EPI, Single Shot, utilizando 16 direcciones en diez voluntarios normales y en tres pacientes uno con un angioma, otro con un oligodendroastrocitoma y otro con una lesión axonal difusa. Resultados. En todos los casos normales se pudieron visualizar los tractos de la sustancia blanca hemisférica. En los pacientes, se observó el desplazamiento de las fibras en uno, el desplazamiento y la no infiltración en otro y en el tercero, la destrucción parcial de los tractos. Conclusión. La difusión por tensión-tractografía es de gran utilidad para valorar los fascículos o haces elocuentes, e incluso estudiar su estado funcional (Fracción Anisotrópica).

Background: Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. These patients have a high mortality (50%), derived from the procedure itself and from their abnormal physiological status. Aim: To report our experience with the Norwood procedure. Patients and methods: Retrospective analysis of all patients subjected to the Norwood procedure between February 2000 and June 2003. Results: Thirteen patients (9 females, age range 5-60 days and median weight of 3.3 kg) were operated. Eight had hypoplastic heart syndrome and five had a single ventricle with aortic arch hypoplasia. The diagnosis was done in utero in eight patients. All technical variations, according to the disposition and anatomy of the great vessels, are described. Cardiac arrest with profound hypothermia was used in all and regional cerebral perfusion was used in nine. Three patients died in the perioperative period and three died in the follow up (two, four and 10 months after the procedure). Gleen and Fontan procedures were completed in five and one patients, respectively. Conclusions: Our results with the Norwood procedure are similar to other series. There is an important mortality in the immediate operative period and prior to the Glenn procedure (Rev Méd Chile 2004; 132: 556-63).

Background: During the last five years, 65 patients with univentricular heart have been treated surgically in our institution, according to a protocol of staged operations that have been previously reported. Aim: To evaluate the early and mid-term outcome of those patients that have completed their staging protocol by means of a Fontan procedure. Patients and Methods: Between April 1996 and June 2001, 23 patients (age 16 to 223 months) underwent a Fontan procedure, 15 with an intracardiac lateral tunnel technique and 8 with an extracardiac conduit. A retrospective review of their clinical, surgical, echocardiographic, angiographic and hemodynamic data was performed, trying to identify risk factors for both mortality and functional capacity (FC). Follow up was complete in all survivors. Results: Three patients died early after surgery (13.04%). Excessive pulmonary blood flow was a risk factor for early death (p= 0.03). One patient died at 14 months. Follow up was 29.9 months (1-63). For those who survived the operation, five years survival was 93.3%. The majority of patients are in FC I or II, with no related risk factors. Conclusions: Our current results are comparable with those of larger series. Patients reach good FC and mid-term survival, irrespective of type of single ventricle or the surgical strategy (Rev Méd Chile 2002; 130: 1217-26).

A descriptive and longitudinal study that included a total of 100 patients who underwent surgical treatment (reduction mastoplasties) for presenting different degrees of deformity of the breast volume, previous preoperative evaluation at the Plastic Surgery Consulting Room and according to the operability criteria, was conducted from the second semester of 1999 to the first semester of 2000. They were operated on at "Celia Sánchez Manduley" Provincial Clinical and Surgical Teaching Hospital, in Manazanillo. The different variables that should be studied were analyzed by reviewing the medical histories and the surgical reports. J or L closure was performed in this type of surgical technique used. It was concluded that the different degrees of breast hypertrophy and/or breast ptosis produce important functional and psychological alterations in the studied patients. The postoperative was satisfactory among those patients treated with the small incision method, which may be applied to patients with gigantomasties and in the diverse known techniques of reduction mastoplaties

Se realiza un estudio descriptivo y longitudinal, que abarcó el segundo semestre de 1999 y primer semestre del 2000, donde el universo estuvo formado por un total de 100 pacientes que recibieron tratamiento quirúrgico (mastoplastias reductoras) al presentar diferentes grados de deformidad del volumen mamario, previa evaluación preoperatoria en consulta de Cirugía Plástica y en atención a los criterios de operabilidad, para lo cual fueron intervenidas quirúrgicamente en el Hospital Provincial Clinicoquirúrgico Docente «Celia Sánchez Manduley», de Manzanillo. Se analizaron las diferentes variables que se debían estudiar mediante la revisión de las historias clínicas e informes operatorios, donde se realizó el cierre en J ó en L, en este tipo de técnica quirúrgica empleada. Se concluye que los diferentes grados de hipertrofia mamaria y/o ptosis mamaria producen alteraciones funcionales y psicológicas importantes en las pacientes estudiadas. El posoperatorio fue satisfactorio en las pacientes tratadas con el método de incisiones cortas, el cual puede ser aplicado en pacientes con gigantomastias y en las diferentes técnicas de mastoplastias reductoras conocidas

A pesar de los avances registrados en el campo de la nutrición deportiva y la importancia que una adecuada alimentación tiene para mejorar el rendimiento físico-deportivo, los deportistas tanto recreacionales como profesionales olvidan con frecuencia incluir la planificación de una dieta y una pauta de hidratación óptimas dentro de la estrategia global de preparación para la práctica deportiva. Las adaptaciones fisiológicas y metabólicas del organismo como consecuencia del ejercicio físico conducen a la necesidad de aumentar la ingesta de calorías (de acuerdo al gasto energético) y de proteínas (en base a las necesidades tróficas del organismo). Igualmente, es preciso prestar una mayor atención a la ingesta de vitaminas y minerales, especialmente las vitaminas del grupo B, así como al cinc y al cromo. Esto permite optimizar el metabolismo de los hidratos de carbono, limitantes últimos de la duración del ejercicio. Durante la fase de entrenamiento, la dieta debe aportar un 60% carbohidratos, la ingesta proteica se cifra en torno a 1,2- 2 g/kg/día y, en general, se deben seguir las recomendaciones de la pirámide nutricional. Durante las fases pre-, per- y post-competición, el aspecto saludable de la dieta se complementa con la necesidad de obtener unos buenos rendimientos físico-deportivos así como garantizar una rápida y eficaz recuperación. De nuevo son los hidratos de carbono de índice glucémico alto o medio y el agua los elementos de la dieta a los que hay que prestar mayor atención. En conclusión, el deportista debe someterse a un régimen dietético adecuado al incremento del gasto que sufre y al mayor recambio metabólico a que se ve sometido. La pirámide nutricional es una representación gráfica que facilita la comprensión y el seguimiento de una dieta saludable. En el presente trabajo se adapta y presenta dicha pirámide a las características de la alimentación del deportista, considerando de una manera eminentemente práctica los tipos y cantidades de alimento que deben ser ingeridos en base al aporte nutricional que determinan para el sujeto que realiza actividad físico-deportiva

In spite of all the advances in sport nutrition and the importance of an adequate food intake in order to improve sport performance, both recreational and professional athletes forget frequently to include planning an optimum diet and fluid intake in their global strategy for performance. Physiological and metabolic adaptations produced as a consequence of physical exercise lead to the necessity of increasing caloric (in accordance to energy output) and protein (based on the trophic needs of the organism) intake. Likewise, paying major attention to vitamin and mineral intake, specifically B vitamins and zinc and chromium, is required, in order to optimize carbohydrate metabolism, the ultimate limiting factor for sport performance. During the training phase, 60% of calories should come from carbohydrates, protein intake should be 1.2 - 2 g/kg/day and athletes should follow the recommendations of the food guide pyramid. During the pre-, per- and post-competition phase the healthy aspect of the diet passes to a second level, in order to obtain good sport performance and to guarantee a fast and effective recovery. Again, carbohydrates with a high or medium glycaemic index and water are the nutrients which have to be calculated more thoroughly. In conclusion, athletes have to follow a diet that is adequate to their higher energy output and to their higher metabolic turnover. The food guide pyramid is a graphic expression which facilitates the comprehension and following of a healthy diet. In the present article, the authors introduce the pyramid adapted to the characteristics of sports nutrition, with easy-to-follow practical recommendations regarding the kind and amounts of foodstuffs that should be consumed in order to cover nutrient needs of people who exercise regularly