Changes in lactate kinetics underpin soccer performance adaptations to cycling-based sprint interval training.

In adolescent soccer, 23% of the distance covers happens at speeds above onset of blood lactate accumulation which suggests that lactate kinetics may be important for soccer performance. We sought to determine the effectiveness of sprint interval training (SIT) on changing performance and lactate kinetics in adolescent soccer players. Thirteen elite soccer academy players (age 15 ± 0.5y) underwent baseline testing (0-10 m and 10-20 m sprint performance, Wingate anaerobic Test (WaNT) with blood lactate measurements and incremental VO2 peak test) before being allocated to control or SIT group. The control group maintained training whilst the HIT group carried out twice-weekly all-out effort cycle sprints consisting of 6 × 10 s sprint with 80 s recovery. There were significant time x group interactions for 10-20 m sprint time (Control pre: 1.32 ± 0.07 s post: 1.35 ± 0.08 s; SIT pre: 1.29 ± 0.04 s post: 1.25 ± 0.04 s; p = 0.01), Peak Power (Control pre: 13.1 ± 1.3 W.kg-1 post: 13.2 ± 1.47 W.kg-1; SIT pre: 12.4 ± 1.3 W.kg-1 post: 15.3 ± 0.7 W.kg-1; p = 0.01) and time to exhaustion (Control pre: 596 ± 62 s post: 562 ± 85 s; SIT pre: 655 ± 54 s post: 688 ± 55 s; p = 0.001). The changes in performance were significantly correlated to changes in lactate kinetics (power: r = 0.55; 10-20 m speed: r = -0.54; time to exhaustion: r = 0.55). Therefore, cycle based SIT is an effective training paradigm for elite adolescent soccer players and the improvements in performance are associated with changes in lactate kinetics.

Perianal pseudoverrucous papules and nodules in Hirschsprung's disease: Rapid resolution with oral loperamide.

We report the case of a 2-year-old boy with Hirschsprung's disease who developed perianal pseudoverrucous papules and nodules subsequent to persistent diarrhea and stool leakage after Giardia infection. Bleeding from the papules resulted in iron deficiency anaemia requiring blood transfusion and iron infusion. Topical therapies used over 6 months were of limited benefit and colostomy was considered, but the condition completely resolved after commencement of oral loperamide. This demonstrates that perianal pseudoverrucous papules and nodules can be severe but are entirely reversible upon removal of the source of skin irritation.

Perforating foreign body reaction to unheated liquid contents of lava lamp.

A 21-month-old girl developed a local skin reaction after the unheated liquid contents of a broken lava lamp were in contact with her skin overnight. Several weeks later, small umbilicated erythematous papules containing central keratotic spines developed within the affected areas. Biopsy showed a granulomatous foreign body reaction with focal transepidermal elimination. Electron microscopy and energy-dispersive X-ray spectroscopy analysis of the tissue revealed carbon-based material, consistent with substances reported to be present in lava lamp liquid.

Acute haemorrhagic oedema of infancy in a 5-week-old boy referred to the Child Protection Unit.

We describe the case of a 5-week-old infant boy presenting with purpura and oedema to both hands and torso. He was otherwise well, with no antecedent history of illness or trauma. Laboratory investigations were within normal limits. A review by the Child Protection Unit was organised during his admission for consideration of inflicted trauma as a cause of the lesions; this was felt most unlikely. A clinical diagnosis, following a dermatology consultation, of acute haemorrhagic oedema of infancy (AHO) was made.

Leukocytoclastic vasculitis masking chronic vascular changes in previously undiagnosed erythropoietic protoporphyria.

A 31-year old man presented with swelling and purpura of the dorsum of the hands following sun exposure. There was a preceding lifelong history of photosensitivity, but this episode, which occurred after the recent commencement of oral iron therapy, and after recent alcohol ingestion, was much more severe than any preceding episode. Skin biopsy performed 48 h after the onset of symptoms showed features consistent with the early stages of leukocytoclastic vasculitis. Direct immunofluorescence showed homogeneous thick staining of the vessel walls with IgG, IgM and IgA, together with abundant perivascular fibrinogen. A subsequent periodic acid-Schiff (PAS) stain on the skin biopsy revealed thickening of the walls of dermal vessels, which was not discernible in routinely stained (hematoxylin/eosin) sections. The diagnosis of erythropoietic protoporphyria (EPP) was confirmed by significantly elevated erythrocyte protoporphyrin levels and positive plasma fluorimetry. The diagnosis of porphyria may have been missed by routine skin microscopy if not for the additional information provided by clinical history, direct immunofluorescence and PAS stain. The pathogenesis and histopathology of acute and chronic vascular changes in EPP are reviewed.

Office based dermatological surgery and Mohs surgery: a prospective audit of surgical procedures and complications in a procedural dermatology practice.

BACKGROUND/OBJECTIVES: Dermatologists commonly perform surgical procedures, including Mohs micrographic surgery, in an outpatient, office-based setting. Although this may be widely perceived to be safe and effective, formal data on the practice are limited. The aim of this study was to examine the range of surgical procedures and associated complications in an Australian specialist dermatology and Mohs surgery practice. METHODS: All surgical procedures over a 55-week period were prospectively logged, with data collection on sex, age, type of procedure, body site, diagnosis and complications. All procedures were performed under conditions that were usual for the practice, with a combination of sterile and clean surgical techniques, depending on the procedure. RESULTS: In all, 2370 surgical procedures were performed during the study period, including 934 Mohs surgery cases. Most procedures (68%) were performed on head and neck sites. A total of 56 complications were recorded in 51 patients. Bacterial wound infections occurred in 13 cases (0.5%). Bleeding complications occurred in five cases (0.2%). There were no complications requiring hospital admission or i.v. antibiotics. CONCLUSIONS: This study supports the view that dermatological surgery, including significant procedures such as Mohs micrographic surgery, flaps and grafts, can be performed on an ambulatory basis in an office-based procedure room setting, with low complication rates.

Azathioprine hypersensitivity presenting as a neutrophilic dermatosis in a man with ulcerative colitis.

We report a case of a 46-year-old man with ulcerative colitis being treated with oral prednisolone and azathioprine. Two weeks after the initiation of azathioprine he presented with fever, fatigue, myalgias and arthralgias and a painful cutaneous eruption that was most marked in a sun-exposed distribution. This was accompanied by loose, non-bloody diarrhoea. Histopathological assessment of a skin biopsy supported a diagnosis of a neutrophilic dermatosis. The azathioprine was temporarily withheld and oral prednisolone was increased as it was thought that the neutrophilic dermatosis was associated with the underlying ulcerative colitis. The patient's symptoms and cutaneous eruption resolved quickly and azathioprine was re-introduced. Within 24 h, systemic symptoms returned along with a florid recrudescence of his cutaneous eruption. This rapidly improved upon withdrawal of azathioprine.

Inverted follicular keratosis simulating malignant melanoma.

A 93-year-old woman was noted to have a single pigmented lesion on the posterior aspect of her neck. Clinical examination revealed a 12 x 8-mm flat lesion, with an irregular border and variegated pigmentation. Dermatoscopic examination revealed a lesion with multiple colours, featureless areas and black dots, suggestive of malignant melanoma. With a presumed clinical diagnosis of malignant melanoma, an elliptical excision was performed, with a 1-cm margin. However, histological examination revealed the unexpected diagnosis of pigmented inverted follicular keratosis.

Three-year retrospective review of superficial radiotherapy for skin conditions in a Perth radiotherapy unit.

Western Australia has only two superficial radiotherapy units, one of which is located at Fremantle Hospital, and run by the radiation oncologists of Perth Radiation Oncology Centre. A 3-year retrospective review was undertaken of all patients who underwent treatment at this unit from 1999 to 2001. Patients were identified from the unit's log book, and data was collected from their files. For malignant skin conditions, 369 lesions were treated in 259 patients over the study period. The patients' median age was 76 years. A wide variety of conditions were treated, but the most common diagnoses were basal cell carcinoma (237 lesions) and squamous cell carcinoma (92 lesions), most commonly located in the head region. The most frequently used treatment schedule was 36 Gy in six fractions over a 3-week period. Where radiotherapy was administered as primary treatment, the diagnoses had been biopsy-proven in only 53% of cases. Fifty-four patients underwent treatment of benign skin disease over the study period; most commonly keloid scars (41 patients) followed by warts (six patients). We conclude that superficial radiotherapy has a distinct role in dermatology, particularly for skin carcinomas around the nose and eyes, which cannot presently be superseded by electron beam therapy.

Paediatric atopic dermatitis in Perth general practice.

Ninety-seven Perth general practitioners completed a self-administered postal questionnaire that aimed to examine their caseload and management practices for childhood atopic dermatitis (AD). General practitioners saw a median of two new cases and three follow-up consultations per month for childhood AD, and referred a median of 10% of cases to a specialist, usually a dermatologist. Most (77%) recommended emollients for all patients, but only 21% specifically reported advising their use immediately after bathing. Sixty-one percent would use topical corticosteroids in all or most patients, but cream preparations were more commonly used (58%) than ointments (40%). Atrophy was rated as a common or very common side-effect of topical corticosteroid therapy by 23% of general practitioners. Twenty-six percent reported using oral corticosteroids in children with AD. Dietary changes would be recommended in at least a few AD patients by 79% of general practitioners, and 31% would recommend a change from cow's milk to soy in the absence of a history of dietary triggers. We conclude that general practitioners appeared generally well informed about AD management. However, dermatologists, through targeted education, may be in a position to help general practitioners further improve outcomes for these patients.

The general practice management of epilepsy in Perth, Western Australia.

Ninety randomly selected general practitioners from the Perth metropolitan area completed a self-administered postal questionnaire aiming to examine the extent of their involvement with epilepsy and how closely their management mirrored best practice guidelines. GPs saw a median of 6 patients with epilepsy, mainly adults. They perceived complementary roles for GPs and neurologists: the GP providing ongoing support and education, monitoring treatment and making dosage adjustments; with the neurologist largely making the formal diagnosis and other management decisions. Only 42% regarded their knowledge of epilepsy as adequate for their practice. About half advised patients on the existence of the Epilepsy Association. Some respondents overestimated the usefulness of EEG. Plasma antiepileptic drug (AED) measurements were overvalued, with 69% of respondents performing plasma levels without regard to symptoms, and 20% would alter AED doses solely on the basis of plasma levels. GPs may tolerate very frequent seizures before referring their patients for more specialised evaluation.