No change in hemoglobin mass after 40 days of physical activity in previously untrained adults.

A high hemoglobin mass (Hb(mass)) is associated with a high maximum aerobic power (VO(2max)), however, the extent to which Hb(mass) is influenced by training is currently unclear. Accordingly, this study monitored changes in Hb(mass) and VO(2max) in 12 previously untrained adults (aged 18-25 years) following 40 days of regular physical activity. Hb(mass) and VO(2max) were assessed at the start and end of a 40-day physical activity program, which comprised of approximately 40 min of daily, moderate-intensity physical activity. Relative VO(2max) increased by 11.3%, yet there was no significant change in relative Hb(mass) (1.7%) and body mass (0.2%) during the 40-day period. There was a significant correlation between Hb(mass) and VO(2max) at the start of the study (r=0.58, P=0.05), but not between the change in relative VO(2max) and the change in relative Hb(mass) (r=-0.07, P=0.83). Our results support the concept of relative stability in Hb(mass) with approximately 1 month of moderate-intensity physical activity suggesting that Hb(mass) may be used for talent identification and possibly for anti-doping purposes.

Profile of movement demands of national football players in Australia.

Descriptive data on game movement demands of contemporary players in the Australian National Soccer League (NSL, now the A League) are lacking. The purpose of this study was to profile movement demands of NSL games and specifically analyse distance covered, time in various speed categories (e.g., walking, jogging, striding, etc.), number of sprint speed efforts and overall mean player speed. Video tapes of 45 players from the 2002 to 2003 NSL season were analysed for whole- and half-game movement patterns and game statistics using Trak Performance software. Bivariate and ANOVA statistics were used for between game halves and positional comparisons. Results showed no changes to the frequency and speed of high intensity demands in both halves of the game. However, a 14% slower overall speed in the second half of the game when compared with the first half was attributed to fewer observations of the low intensity movements (9.0% less walking and 12.4% less jogging) and more stationary periods. Engagement in game events such as kicking and passing was also 11.2% less frequent in the second versus first half of games. Position-specific results of higher movement speeds of midfield players (7.2kmh(-1)), compared with defenders (6.1kmh(-1)), agree with previous results from international professional leagues. The results provide position-specific directions for future conditioning drills and benchmark fitness requirements in high level soccer players. The results also highlight the challenge to ensure consistency of second-half performances for elite level soccer players in Australia.

Comparison of global positioning and computer-based tracking systems for measuring player movement distance during Australian football.

Sports scientists require a thorough understanding of the energy demands of sports and physical activities so that optimal training strategies and game simulations can be constructed. A range of techniques has been used to both directly assess and estimate the physiological and biochemical changes during competition. A fundamental approach to understanding the contribution of the energy systems in physical activity has involved the use of time-motion studies. A number of tools have been used from simple pen and paper methods, the use of video recordings, to sophisticated electronic tracking devices. Depending on the sport, there may be difficulties in using electronic tracking devices because of concerns of player safety. This paper assesses two methods currently used to measure player movement patterns during competition: (1) global positioning technology (GPS) and (2) a computer-based tracking (CBT) system that relies on a calibrated miniaturised playing field and mechanical movements of the tracker. A range of ways was used to determine the validity and reliability of these methods for tracking Australian footballers for distance covered during games. Comparisons were also made between these methods. The results indicate distances measured using CBT overestimated the actual values (measured with a calibrated trundle wheel) by an average of about 5.8%. The GPS system overestimated the actual values by about 4.8%. Distances measured using CBT in experienced hands were as accurate as the GPS technology. Both systems showed relatively small errors in true distances.

Characteristics of track cycling.

Track cycling events range from a 200 m flying sprint (lasting 10 to 11 seconds) to the 50 km points race (lasting approximately 1 hour). Unlike road cycling competitions where most racing is undertaken at submaximal power outputs, the shorter track events require the cyclist to tax maximally both the aerobic and anaerobic (oxygen independent) metabolic pathways. Elite track cyclists possess key physical and physiological attributes which are matched to the specific requirements of their events: these cyclists must have the appropriate genetic predisposition which is then maximised through effective training interventions. With advances in technology it is now possible to accurately measure both power supply and demand variables under competitive conditions. This information provides better resolution of factors that are important for training programme design and skill development.

Chronic radiographic lung changes in children with vertically transmitted HIV-1 infection.

OBJECTIVE: We prospectively studied children with and without maternally transmitted HIV-1 infection born to mothers infected with HIV-1 to determine the incidence of chronic radiographic lung changes (CRC) and to correlate these changes with clinical assessments. SUBJECTS AND METHODS: Between 1990 and 1997, we scored 3050 chest radiographs using a standardized form. Group I children (n = 201) were HIV-1-infected at enrollment. Group II children (n = 512) were enrolled prenatally or before 28 days postpartum and subsequently subdivided into group IIa (n = 86), children identified as HIV-1-infected; and group IIb (n = 426), those who were HIV-1-uninfected. CRC were defined as parenchymal consolidations or nodular disease lasting 3 months or more or increased bronchovascular markings or reticular densities lasting 6 months or more. Morbidity was assessed by CD4 counts, viral load, the presence of low oxygen saturation, wheezing, tachypnea, crackles, and clubbing. RESULTS: The cumulative incidence of chronic radiographic lung changes in HIV-1-infected children was 32.8% by 4 years old, with increased bronchovascular markings or reticular densities being most common. Chronic changes were associated with lower CD4 cell counts and higher viral loads. Resolution of these chronic changes was associated with decreasing CD4 cell counts but not with lower rates of clinical findings, viral load, or difference in survival. CONCLUSION: With increased survival, CRC are becoming more common. The resolution of these changes may indicate immunologic deterioration rather than clinical improvement.

The role of magnetic resonance cholangiography in the management of children and young adults after liver transplantation.

We reviewed the results of 50 magnetic resonance (MR) cholangiograms to evaluate their usefulness in directing clinical management in young patients after liver transplantation (LTx). Thirty-two patients underwent 50 MR cholangiograms on a 1.5-T unit. Studies were performed from 1 week to 16 yr after LTx. Indications included biochemical abnormalities with (n = 19) or without (n = 16) biopsy evidence for chronic rejection, sepsis (n = 14), and intractable ascites (n = 1). Original interpretations were compared to laboratory and ultrasound findings, and clinical outcome. Of 19 studies performed on 14 patients with biopsy evidence of chronic rejection, 16 were abnormal on MR (but only one was abnormal on ultrasound), resulting in corrective surgery (n = 1), re-Tx (n = 1), and endoscopic dilatation (n = 1). Of 16 studies on 16 patients with biochemical abnormalities without evidence of chronic rejection on biopsy, 14 were abnormal on MR (but only five of 13 on ultrasound), leading to corrective surgery (n = 3) and re-listing for Tx (n = 3). Thirteen of 14 studies on six patients with sepsis were abnormal on MR (five of nine were abnormal on ultrasound), identifying surgically correctable strictures (n = 2), and leading to re-Tx (n = 1) and percutaneous biliary drainage procedures (n = 2). The one patient with ascites had a normal study. We advocate usage of MR cholangiography for the detection of biliary complications after LTx, particularly in those patients who present with biochemical abnormalities that are not easily explained by acute cellular rejection or viral infection and in those with biliary sepsis.

MR cholangiography in children and young adults with biliary disease.

OBJECTIVE: Our objective was to describe the MR cholangiography findings for young patients with suspected biliary disease who underwent half-Fourier acquisition fast spin-echo technique with respiratory triggering. SUBJECTS AND METHODS: Twenty-eight MR cholangiography studies were performed in 22 patients on a 1.5-T MR unit. Ten of these 22 patients had undergone liver transplantation. RESULTS: MR cholangiography revealed abnormalities of both the extrahepatic and the intrahepatic major and minor bile duct systems, despite the small diameter of the duct system in this group of patients. Four patterns of biliary disease were shown: global dilatation of extrahepatic or intrahepatic ducts (n = 7); segmental, uniform dilatation of central or peripheral intrahepatic ducts (n = 9); segmental, nonuniform dilatation of central or peripheral intrahepatic ducts (n = 2); and fusiform ectasia with segmental, irregular intrahepatic dilatation and bile lakes (n = 2). The findings of eight studies were interpreted as normal. The four patterns of abnormalities were correlated with the results from percutaneous transhepatic cholangiography, T-tube cholangiography, and liver biopsy and with clinical and surgical information, as available. CONCLUSION: MR cholangiography is a noninvasive technique for evaluation of biliary disease. The improved resolution afforded by respiratory triggering permits evaluation of both major and minor bile ducts, even in young, uncooperative subjects. Four patterns of abnormalities were prospectively identified, correlated with other information, and used to direct clinical treatment.

Diaphyseal medullary stenosis with malignant fibrous histiocytoma: a hereditary bone dysplasia/cancer syndrome maps to 9p21-22.

Diaphyseal medullary stenosis with malignant fibrous histiocytoma (DMS-MFH) is an autosomal dominant bone dysplasia/cancer syndrome of unknown etiology. This rare hereditary cancer syndrome is characterized by bone infarctions, cortical growth abnormalities, pathological fractures, and eventual painful debilitation. Notably, 35% of individuals with DMS develop MFH, a highly malignant bone sarcoma. A genome scan for the DMS-MFH gene locus in three unrelated families with DMS-MFH linked the syndrome to a region of approximately 3 cM on chromosome 9p21-22, with a maximal two-point LOD score of 5.49 (marker D9S171 at recombination fraction [theta].05). Interestingly, this region had previously been shown to be the site of chromosomal abnormalities in several other malignancies and contains a number of genes whose protein products are involved in growth regulation. Identification of this rare familial sarcoma-causing gene would be expected to simultaneously define the cause of the more common nonfamilial, or sporadic, form of MFH-a tumor that constitutes approximately 6% of all bone cancers and is the most frequently occurring adult soft-tissue sarcoma.

The evolution of Australian football.

Australian football has undergone considerable change over the past century. This evolution seems to have accelerated more recently since the introduction and major influence of the media, increased professionalism and the start of a national competition. In this study we have attempted to quantify the evolution in game 'style' by measuring events during elite football games (from video analysis) and gathering physical information on players involved at the highest level. These data are important to gain insight into the game demands so that player preparation may be enhanced and when predicting the nature of the game in the future. Understanding the patterns of play within the game may also be useful when assessing the possible impact of rule changes, for example, increasing the number of interchange players on the potential for injury. Four games were selected, one from each of the past 4 decades to determine the rate at which specific, measurable events occurred in the games. Height and mass data on players were also obtained from official records of registered players in the VFL/AFL competitions. The results indicate the 'speed' of the game has approximately doubled in the period 1961-1997. The proportion of the total game which involves 'play' time has been reduced significantly while breaks in play are more frequent and longer. Despite this pattern, however, the average game tempo has increased along with player height and mass and we present a case which suggests these are likely determinants of the increased incidence of player injuries and lost match time.

Accuracy of two pulse oximeters during maximal cycling exercise.

This study compared the measurement of oxygen saturation of haemoglobin (SaO2) by two pulse oximeters (Ohmeda Biox 3700e and Criticare 504 USP) with the measurement of SaO2 in arterial blood samples by CO-oximetry. Unlike many previous validation studies, arterial blood was sampled in ground glass rather than plastic syringes. Twenty men, 11 well-trained cyclists (mean +/- SE, age = 23.3 +/- 1.5 years, mass = 71.4 +/- 1.1 kg VO2max = 77 +/- 1 ml.kg1.min-1) and 9 relatively untrained subjects (age = 27.1 +/- 2.8 years, mass = 78.1 +/- 2.2 kg VO2max = 51 +/- 3 ml.kg 1.min-1) performed two maximal cycle ergometer tests each in an hypobaric chamber. The tests were at 745 mm Hg or 695 mm Hg with simultaneous measurement of SaO2 by the pulse oximeters and the CO-oximeter at rest, minute 7 of exercise and at VO2max. The best correlations, to the Co-oximeter measurement (SCO-OXO2) were found when all data from rest and exercise were combined (Criticare: r = 0.94; Ohmeda: r = 0.91). The bias measurements showed the Ohmeda underestimated SCO-OXO2 at all levels (mean = -2.5 +/- 1.9%) and the Criticare overestimated SCO-OXO2 at all levels, although to a lesser degree (mean = 0.9 +/- 1.5%). In conclusion, these results highlight the need for validation of individual pulse oximeters and that the effect of dyshaemoglobins must also be considered.

Leiomyosarcoma of the kidney in an HIV-infected child.

Spindle cell tumors (leiomyoma and leiomyosarcoma) have been described in immunocompromised children after transplantation and in association with HIV infection. Previous reports have described tumors of respiratory (lung, bronchi), gastrointestinal (stomach, bowel, liver), and subcutaneous origins. We report a case of leiomyosarcoma of the kidney in an HIV-infected child.

Subcutaneous fat necrosis of the newborn: CT findings of head and neck involvement.

We present the CT findings in two newborns with subcutaneous fat necrosis. This is an uncommon disease that occurs in neonates who have had difficult deliveries. The CT findings varied from discrete subcutaneous nodules to a diffuse subcutaneous fullness. Although the subcutaneous disease tends to spontaneously resolve within weeks to months, an associated hypercalcemia may have a fatal outcome.

Reduced performance of male and female athletes at 580 m altitude.

This study examined the effect of mild hypobaria (MH) on the peak oxygen consumption (VO2peak) and performance of ten trained male athletes [x (SEM); VO2peak = 72.4 (2.2) ml x kg(-1) x min(-1)] and ten trained female athletes [VO2peak = 60.8 (2.1) ml x kg(-1) x min(-1)]. Subjects performed 5-min maximal work tests on a cycle ergometer within a hypobaric chamber at both normobaria (N, 99.33 kPa) and at MH (92.66 kPa), using a counter-balanced design. MH was equivalent to 580 m altitude. VO2peak at MH decreased significantly compared with N in both men [-5.9 (0.9)%] and women [-3.7 (1.0)%]. Performance (total kJ) at MH was also reduced significantly in men [-3.6 (0.8)%] and women [-3.8 (1.2)%]. Arterial oxyhaemoglobin saturation (SaO2) at VO2peak was significantly lower at MH compared with N in both men [90.1 (0.6)% versus 92.0 (0.6)%] and women [89.7 (3.1)% versus 92.1 (3.0)%]. While SaO2 at VO2peak was not different between men and women, it was concluded that relative, rather than absolute. VO2peak may be a more appropriate predictor of exercise-induced hypoxaemia. For men and women, it was calculated that 67-76% of the decrease in VO2peak could be accounted for by a decrease in O2 delivery, which indicates that reduced O2 tension at mild altitude (580 m) leads to impairment of exercise performance in a maximal work bout lasting approximately 5 min.

A Painless Retroauricular Mass in A Patient with Myotonic Dystrophy: Computed Tomographic Documentation of the Bone Changes that Occur in the Skull Base.

A 16-year-old male with a history of neonatal myotonic dystrophy had a painless enlarging left retroauricular mass. Computed tomography showed an enlarged frontal sinus, thickened apparently normal bone in the anterior left clinoid process, doresum sellae, and all portions of the temporal bones. In particular, there was bone production in the left retroauricular region and along the margins of the left internal auditory canal. The left temporomandibular joint was also dislocated. This is the first case report to document the dynamic aspect of the bone changes in this dystrophy.

Chest radiographic data acquisition and quality assurance in multicenter studies.

BACKGROUND: Multicenter studies rely on data derived from different institutions. Forms can be designed to standardize the reporting process allowing reliable comparison of data. OBJECTIVE: The purpose of the report is to provide a standardized method, developed as a part of a multicenter study of vertically transmitted HIV, for assessing chest radiographic results. MATERIALS AND METHODS: Eight hundred and five infants and children were studied at five centers; 3057 chest radiographs were scored. Data were entered using a forced-choice, graded response for 12 findings. Quality assurance measures and inter-rater agreement statistics are reported. RESULTS: The form used for reporting chest radiographic results is presented. Inter-rater agreement was moderate to high for most findings, with the best correlation reported for the presence of bronchovascular markings and/or reticular densities addressed as a composite question (kappa = 0.71). The presence of nodular densities (kappa = 0.56) and parenchymal consolidation (kappa = 0.57) had moderate agreement. Agreement for lung volume was low. CONCLUSION: The current tool, developed for use in the pediatric population, is applicable to any study involving the assessment of pediatric chest radiographs for a large population, whether at one or many centers.

Diaphyseal medullary stenosis (sclerosis) with bone malignancy (malignant fibrous histiocytoma): Hardcastle syndrome.

Hardcastle syndrome is a rare, autosomally dominant inherited skeletal dysplasia, characterized by diaphyseal sclerosis, medullary stenosis, pathological fractures, bony infarction, and malignant transformation. A 19-year-old proband is presented and discussed, adding a fourth family to the world literature. Radiographic screening of family members is suggested from puberty onward. Thallium scanning is proposed as a more tumor-sensitive screening agent in affected individuals.

Regression of skeletal changes in type 1 Gaucher disease with enzyme replacement therapy.

A 9-year-old patient presented with an acute onset of pain of the right femur showing destructive changes with periosteal elevation mimicking osteomyelitis. Technetium-99m sulfur colloid (99mTc SC) marrow scan revealed lack of uptake in the right femoral head and the entire shaft of the right femur. Eight months following enzyme replacement therapy, radiography showed almost complete reconstitution of the femoral shaft, and 99mTc SC marrow scan uptake returned to normal.

Increased arterial desaturation in trained cyclists during maximal exercise at 580 m altitude.

This study utilized a hypobaric chamber to compare the effects of mild hypobaria (MH; 50 mmHg, approximately 580 m altitude) on blood O2 status and maximal O2 consumption (VO2max) in 9 untrained and 11 trained (T) cyclists with VO2max values of 51 +/- 3 and 77 +/- 1 ml.kg-1.min-1, respectively. In both groups, arterial O2 saturation (SaO2) decreased significantly during maximal exercise, and this effect was enhanced with MH. Both these responses were significantly greater in the T cyclists in whom the final SaO2 during MH was 86.5 +/- 0.9%. When the group data were combined, approximately 65% of the variance in SaO2 could be attributed to a widened alveolar-arterial Po2 difference. The arterial PO2 during maximal exercise at sea level in the T group was on the steeper portion of the hemoglobin-O2-loading curve (T, 68.3 +/- 1.3 Torr; untrained, 89.0 +/- 2.9 Torr) such that a similar decrease in arterial PO2 in the two groups in response to MH resulted in a significantly greater fall in both SaO2 and calculated O2 content in the T group. As a consequence, the VO2max fell significantly only in the T group (mean change, -6.8 +/- 1.5%; range, + 1.2 to - 12.3%), with approximately 70% of this decrease being due to a fall in O2 content. This is the lowest altitude reported to decrease VO2max, suggesting that T athletes are more susceptible to a fall in inspired PO2.