Impaired cardiac structure and systolic function in athletes using supra-physiological doses of anabolic androgenic steroids.

OBJECTIVES: Athletes are increasingly using supra-physiological doses of anabolic androgenic steroids without weighing health side effects. This study aims to conjointly evaluate the effect of supraphysiological doses of anabolic androgenic steroids on global cardiovascular structure and functional capacity. DESIGN: Cross-sectional study. METHODS: 92 males enrolled in the study, including 18 sedentary subjects, 26 anabolic androgenic steroid non-user athletes, and 48 anabolic androgenic steroid-user athletes. Two-dimensional echocardiography was done to evaluate the cardiovascular structure and function. RESULTS: Anabolic androgenic steroid-users presented increased cardiac remodeling of the left ventricle and left atrium compared to control groups (p < 0.001). Anabolic androgenic steroid-users showed increased left ventricular mass/body surface area versus control groups (p < 0.001), with 28 steroid-users (58.3 %) having cardiac remodeling, which is more than control groups (p < 0.001). Anabolic androgenic steroid-users presented lower diastolic function (E and E/A) compared to non-users (p = 0.003 and <0.001, respectively). Ejection fraction was decreased among anabolic androgenic steroid-users versus the sedentary group only (p = 0.020), while anabolic androgenic steroid-users presented reduced global longitudinal strain of 15.43 % compared to both control groups (p < 0.001). Moreover, anabolic androgenic steroid-users experienced more tricuspid valve regurgitation (p = 0.001). CONCLUSIONS: Anabolic androgenic steroid consumption is associated with global cardiac remodeling with increased dimensions of the left ventricle, and atrium. Anabolic androgenic steroid-users present left ventricular hypertrophy with reduced subclinical systolic function. Moreover, anabolic androgenic steroid consumption is correlated with valve regurgitation and dilation of the sino-tubular junction.

Chronic anabolic androgenic steroid administration reduces global longitudinal strain among off-cycle bodybuilders.

BACKGROUND: Supra-physiologic doses of anabolic androgenic steroids (AAS) lead to multiple cardiovascular complications. The long-term clinical effect of AAS overuse on cardiac structure and function, which persists during off-cycle periods, remains unclear. METHODS: A total of 15 sedentary subjects and 79 bodybuilders (26 AAS non-users and 53 AAS-users), matched for age and male gender, were assessed in a cross-sectional design for echocardiography measures. AAS-users were included during an off-cycle phase, abstained from AAS for at least 1 month. 2D standard M-mode and speckle tracking echocardiography were used to measure cardiac dimensions and functions. RESULTS: Inter-ventricular septum and posterior wall thickness were significantly higher among chronic off-cycle AAS-users compared to AAS non-users and sedentary group. Off-cycle AAS-users showed lower E/A ratio of the diastolic function. Left ventricular systolic function was not affected in terms of ejection fraction, but significant subclinical systolic dysfunction, assessed by GLS, was observed for chronic off-cycle AAS-users compared to AAS non-users (GLS = -16.8% vs. -18.5%, respectively; p = 0.001). Diameter of left atrium and right ventricle were significantly enlarged among off-cycle AAS-user bodybuilders (p = 0.002 and 0.040). TAPSE and RV S', and cardiac vasculature of aorta were comparable in all groups. CONCLUSIONS: This study demonstrates that during off-cycle phase, AAS-users show long-term impaired GLS, even after considerable AAS abstain, despite normal LVEF. It highlights the importance of following GLS to predict hypertrophy and heart failure events, and not relying on LVEF alone. In addition, the hypertrophic effect of chronic AAS consumption is transitional during AAS washout periods.

Lamb Head as a Training Model for Septoplasty and Rhinoplasty.

Septoplasty and rhinoplasty are difficult operations to learn and teach. Many modalities have been proposed to make the teaching process of these operations easier. In this study, it was investigated if lamb heads were good training models to teach septoplasty and rhinoplasty to trainees or experienced surgeons. In the first part of the study, 21 lamb heads were dissected according to a dissection protocol and several anatomical distances were measured to compare them with human cadavers. In the second part, eight lamb heads were dissected and different preservation rhinoplasty techniques were practiced. The study on 21 lamb heads used showed that the lateral crura were 17.8 × 11.6, the average interdomal distance was 8.1 mm, and the average domal width was 3.7 mm. The average length of the upper lateral cartilages was 31.1 mm laterally and 21.2 medially. The average length of the nasal bones was 63.9 mm, and the width was 16 mm. In the second part of the study, 8 lamb heads were used to experience where high-strip techniques were used in 5 and the Cottle technique in 3. This study revealed that lamb heads should be considered as an excellent training model for septoplasty and rhinoplasty. Its very low cost, ease of availability, and close similarity to the human cadavers can be counted as the main advantages. This study also proved that it was not only a tool for beginners, but also a very helpful tool for experienced surgeons to try new methods.

Which Lighting Option Is the Best for Photography in Rhinoplasty?

Photography for preoperative analysis and follow-up is indispensable for the facial plastic surgeon. The use of strobe flash units, light-emitting diode (LED) lamps, and their position related to axis of the patient can affect the nasal contours and nasal measurements. The aim of this study was to compare the rhinoplasty pictures taken under three different lighting settings and two different positioning at 30- and 45-degree angles, and with direct measurements taken by caliper from the subjects. Standardized rhinoplasty pictures from 10 patients were taken in frontal view in a studio. These pictures were taken under three different lighting settings: built-in flash of the camera, two strobe flashes, and two LED continuous lights placed at 30 to 45 degree angles to the patient. All the pictures were uploaded to Rhinobase 2.0. In five subjects, direct measurements were done by using a Vernier caliper and compared with the computer measurements. In this study, when comparing the light sources and the angles without taking single flash into account, no relation was found between strobe lights at 30 and 45 degrees and between LED lights at 30 and 45 degrees regarding tip width, base bony width, dorsum width, interalar width, and nasal length. However, a statistically significant difference was found when the angle was changed from 30 to 45 degrees for tip width, interalar width and nasal length. The use of two LED continuous lights or two strobe lights in a studio setting has given similar results. Changing the angles of the light sources from 30 to 45 degrees affected only the tip width and the interalar width; otherwise the rest of the nasal measurements did not show any significant changes. The pictures taken at 45-degree angles to the subject showed the closest values to the direct measurements done on the patient.