Objective: To verify presence and severity of muscular and/or intravascular damage during a subterranean exploration of long duration. Methods: We measured serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) as markers of muscular damage. We also measured haptoglobin as a marker of intravascular haemolysis, and platelets and leucocytes as markers of inflammation. Results: We found in all the participants an increase in CK, LDH, and platelets and leucocytes (mainly due to neutrophilia and monocytosis), and a decrease in the level of haptoglobin and circulating lymphocytes. Conclusions: The observed data suggest that continuous effort during long alpine subterranean explorations, environmental conditions, sleep deprivation, multiple impacts on rocks, and compression caused by bindings of the caving harness cause muscle damage, intravascular haemolysis, inflammation response, and immunological changes.
Alpine spelunking is practiced in darkness, isolation, cold and high humidity. In this paper we study the acute haematological effects of prolonged strenuous activity in five spelunkers who spent about 20 hours in a 700-meter deep cave without resting much or sleeping. On four occasions, we measured their red cell counts, haemoglobin, mean corpuscular volume and percentage changes of plasma volume. We also measured their rectal temperature to estimate, in the limits of this parameter, thermoregulatory response. After the spelunkers descended 5 hours to the bottom of the cave, we detected, in all of them, a significant increase in red cell counts and haemoglobin and a drop in mean corpuscular volume and plasma volume. The day after recovery, we found a significant drop in all red cell parameters and a rise in plasma volumes. Rectal temperatures peaked at the exit. These findings suggest that alpine spelunking induces an initial haemoconcentration (bottom of the cave) followed by a haemodilution (the day after recovery). Sport anaemia was not detected. The rise of rectal temperature suggests that spelunking is a very strenuous sport with possible transpiration problems.
We studied the hypothalamus-pituitary adrenocortical, hypothalamus-pituitary and hypothalamus-pituitary thyroid system responses to a long duration activity (about 20 h) practiced in a demanding environment, characterized by darkness, low temperature and high humidity, namely alpine potholing. We performed four blood drawings in five elite potholers: (1) the morning before the performance, (2) at the bottom of the cave (-700 m), (3) at the end of the ascent, and (4) after 24 h of recovery. Two blood drawings as controls were performed on the same potholers, at the same resting time and with the same experimental procedures as the previous ones. Friedman two-way ANOVA test evidenced significant changes through the different time intervals for detrended (i.e., test values minus control values) growth hormone (GH) (P = 0.003), detrended cortisol (P = 0.004) and FT4 (P = 0.002), while this was not true for TSH and FT3. Successively pairwise comparisons were done both through the different time intervals and between test and control values. The rise of GH values during the performance underlines the great intensity and long duration characteristic of potholing as well as the possibility that the climbing sit harness can cause problems due to vascular hypo-perfusion. Cortisol data, peaking before entering the cave, suggest that there was a marked anticipatory stress reaction followed by less stressing phase during the performance. Finally, the rise of FT4 is likely due to the typical increase of free fatty acids that usually occurs during endurance exercise.
These preliminary findings show that scuba diving and dry hyperbaric exposure, although at the same environmental pressure, cause different effects on ventricular loads in healthy subjects.
The IGRAs (Interferon-γ Release Assays) are commercial assays which measure T-cell-mediated response in vitro after specific stimulation, and represent the alternative to TST (Tuberculin Skin Test) in the diagnosis of latent tuberculosis infection (ILTB) and of active tuberculosis (TB). Among these we choose the assay QuantiFERON ® -TB Gold IT (Cellestis Ltd, Carnegie,Victoria, Australia) (QFT) in which interferon-γ (IFN-γ) was measured after lymphocyte stimulation with 3 antigens of the RD1 region of M. tuberculosis: ESAT-6, CFP-10 and TB 7.7. We wanted to assess the sensitivity of the method in cases of pulmonary TB, using cultured isolates of M. tuberculosis as gold-standard. From August 2006 to July 2009 there were 54 suspected cases of pulmonary TB, confirmed by culture. The QFT was requested for 32 patients before any microbiological confirmation and therapy. Of these patients 14 aged 20-50 years, 6 aged 50-70 years and 12 were more than 70-year-old. The QFT was positive in 25 patients (INF-γ> 0.35 IU/mL) and negative in 7 patients (INF-γ <0.35 IU/mL) while 2 patients had an INF-γ value of 0.34 IU/mL. Susceptibility to pulmonary TB is very high in young subjects and decreases with increasing age. In elderly population it is frequent a TB reactivation due to a decline in T-cell-immune response.Therefore, a negative or borderline value of IFN-γ should be interpreted with care.
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