Drug use and abuse and the risk of adverse events in soccer players: results from a survey in Italian second league players.

Summary: Objective. Drug use in athletes has been frequently investigated in the last three decades, especially regarding its misuse for doping. However, little is known about the use of permitted drugs for medical purposes and less studies have investigated the relationship between adverse drugs reactions (ADRs) and sports. Methods. An observational cross-sectional investigation analyzing a group of second league soccer players (the second-highest division in Italy) was performed. Anamnestic and physical examinations as well as a validated questionnaire (AQUA©) were performed in a group of 378 Italian second league soccer players. Results. Most players (91.8%) reported the use of NSAIDs in the previous year, and one third of them were regular users. Analgesics were used in 64% of the players, while 52.1% had taken antibiotics in the previous year. 29.20% of players used intraarticular treatments in the previous year. In 7,4% of players, an ADRs was reported: 3,47% reacted to NSAIDs, 2,6% to antibiotics, 1,05% to analgesics and 1 of them to supplements. For intra-articular injections, only 2 players experienced ADRs. One quarter of players experienced reactions as urticaria-angioedema syndrome or more severe conditions as bronchospasm or anaphylaxis. Conclusions. This study shows that drug misuse/abuse in soccer is a real matter of debate, especially with regards to NSAIDs, exposing athletes to predictable and/or unpredictable risks for their health.

Two-year treatment with oral contraceptives in hyperprolactinemic patients.

The aim of this prospective study was the follow-up for 2 years in symptoms, serum prolactin (PRL) levels, and radiological aspects of a group of young patients using oral contraceptives (OC) with hyperprolactinemia. A total of 16 hyperprolactinemic women (eight with idiopathic hyperprolactinemia and eight with pituitary microadenoma) who started OC use were admitted in the study. After 2 years of OC use, the assessable patients showed a nonsignificant decrease in plasma PRL level (26.8 +/- 29.4 micrograms/mL, range 4.2-97.1 micrograms/mL vs 56.3 +/- 31.5 micrograms/mL, range 23.5-144 micrograms/mL). No patient experienced any radiological changes during OC treatment. In conclusion, although the number of observations is limited, the data suggest that after 2 years of follow-up, no harmful effect of OC use was observed in these patients.

PIP: Recent case-control studies have failed to document any growth of pituitary adenomas following oral contraceptive (OC) use. The present study, involving 16 hyperprolactinemic OC users (8 with idiopathic and 8 with pituitary microadenoma) from Milan, Italy, also suggested exogenous estrogen has no harmful effects on these patients. Study participants underwent two blood collections before OC initiation for measurement of basal prolactin levels as well as a pituitary computed tomography or nuclear magnetic resonance scan. During OC use, prolactin measurements were taken between days 5-10 during cycles 6, 12, 18, and 24. At the end of the 24-month treatment period, all women underwent a second radiologic examination. After 2 years of OC use, women showed a nonsignificant decrease in plasma serum prolactin levels (median, 26.8 +or- 29.4 mcg/ml; range, 23.5-144 mcg/ml). No radiologic changes occurred. No patient experienced a prolactinoma enlargement during OC use. Despite a lack of evidence, OC administration is often considered contraindicated in hyperprolactinemic women.

Effect of low intensity electrical stimulation on quadriceps muscle voluntary maximal strength.

BACKGROUND: Evaluate the effect of low intensity electrical stimulation (ES) training on strength. We purposefully used a low ES stimulation intensity to have it well accepted by middle aged and low performing people. Relate strength to metabolic parameters. METHODS: Experimental design. Protocol 1: effects of 11 day low intensity ES training on quadriceps muscle maximal voluntary contraction (MVC). Protocol 2: effects of 3 day training at low intensity ES + voluntary contraction at 60% of MVC (co-contraction). VARIABLES MEASURED: maximal voluntary strength (FMAX), strength during ES (FES), strength developed during co-contraction (FES-C), oxygen consumption, heart rate. Experimental design included a basal session, a training program and controls of measured variables during and at the end of the training program. PARTICIPANTS: protocol 1: experiments were done on 13 healthy and sedentary subjects (6 males and 7 women, mean age 50.6 years). Protocol 2: experiments done on 6 healthy sedentary men (mean age 31.5 years). RESULTS: Protocol 1: FMAX increased significantly (p<0.05) to 14 and 19% at day 6 and 11, respectively. During ES, oxygen consumption increased by 20%, but no change in heart rate was observed. Protocol 2: FMAX significantly increased (about 5%) in subjects who trained with co-contraction; conversely, FMAX did not significantly increase in a control group matched for age who trained only with voluntary contractions. CONCLUSIONS: Low intensity ES in sedentary and poorly performing people increases significantly FMAX during MVC possibly via facilitatory neurogenic mechanism.

Hormonal contraception and ovarian pathology.

Despite sporadic ovarian follicle development, hormonal contraception consistently and uniformly prevents steroidogenesis and ovulation. For their suppressive activity on ovarian androgen production, oral contraceptives remain the treatment of choice for acne and hirsutism in most hyperandrogenic women. Inhibition of the synthesis of endometrial estrogen receptors explains the effectiveness of hormonal contraception in the therapy of dysfunctional uterine bleeding and in the treatment of pain associated with pelvic endometriosis. Through the inhibition of ovarian cyclicity, the contraceptive pill lowers the incidence of functional ovarian cysts, benign breast disease, dysmenorrhea and premenstrual syndrome and shows a consistent and long-lasting protection against ovarian and endometrial cancer.

Management of anovulatory infertility.

Chronic anovulation is probably the major cause of human infertility and is essentially associated with four distinct endocrine conditions; hyperprolactinemic anovulation, hypogonadotrophic anovulation, normo-gonadotrophic anovulation and hypergonadotrophic anovulation. Hyperprolactinaemia and microprolactinoma are frequent findings in young women and excessive prolactin secretion impairs ovarian function causing anovulatory subfertility. Dopaminergic treatment restores ovarian function and shrinks prolacinoma. In these patients restoration of fertility with prolactin lowering drugs does not increase the incidence of multiple pregnancies or early pregnancy loss. In the vast majority of hyperprolactinemic women pregnancy is safe and could be beneficial. Cabergoline is the most effective and tolerated of the antiprolactinemic drugs. Hypogonadotrophic anovulation is frequently associated with acute or chronic emotional stress and in this case the patient should be counselled. Explanation and reassurance are the first important management steps. The use of pulsatile gonadotrophin-releasing hormone is the best strategy to induce fertility. Patients with normogonadotrophic anovulation are likely to have polycystic ovary. The most cost effective profertility treatment is the administration of an anti-oestrogen such as clomiphene or tamoxifen. The second choice therapy for patients with normogonadotrophic anovulation is ovarian stimulation with human gonadotrophin preparations. Low dose modifications give pregnancy rates lower than that with the traditional high-dose step-up protocol and intensive monitoring is required, but multiple pregnancies are less frequent. No treatment is available to enable women with hypergonadotrophic anovulation to conceive. Fertility in these patients can be promoted only by an egg donation programme.