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.

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.

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.

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 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.

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.

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.

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.

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.

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.

Influence of test duration and event specificity on maximal accumulated oxygen deficit of high performance track cyclists

This study examined the relationship between the time required to fully utilise the maximal accumulated oxygen deficit (MAOD) and event specificity of track cyclists. Twelve track endurance and 6 sprint high performance track cyclists performed four treatments of 70 s, 120 s, 300 s and 115% VO2max of maximal cycling on an air-braked ergometer. Peak blood lactate was measured immediately after each test with VO2 kinetics being assessed during the 115% VO2max time to exhaustion test. When the two cycling groups were combined there was no significant difference in the MAOD when assessed under the four different exercise durations. However, when the groups were analysed separately the following results were apparent: (1) the sprint cyclists achieved a significantly greater MAOD (66.9 +/- 2.2 ml.kg-1) compared to the track endurance cyclists (57.6 +/- 6.7 ml.kg-1) when a 70 s test duration was employed (2) even though the track endurance cyclists achieved their greatest MAOD during the 300 s test protocol (62.1 +/- 11.0 ml.kg-1), it was not significantly different to the MAOD's measured during the three other test durations and (3) the sprint cyclists recorded their greatest MAOD during the 70 s supramaximal test protocol (66.9 +/- 2.2 ml.kg-1). This was not significantly different to the 120 s test MAOD, but it was significantly higher than the MAOD values recorded during the 115% VO2max and 300 s test durations. There was no significant difference between the two groups in the peak post-exercise blood lactate concentrations for any of the tests and only the 70 s test produced a significant correlation between peak blood lactate and the MAOD. The VO2 kinetics (VO2 t1/2) of the sprinters was significantly slower than that of the track endurance cyclists (26.3 +/- 2.3 vs 23.9 +/- 2.8 s.). The findings of this study demonstrate that sprint cyclists can fully express their anaerobic capacity within an event specific 70 s all-out test and that these cyclists progressively decrease their anaerobic capacity during a 120 s, 115% VO2max (mean time = 210 s) or 300 s test, despite giving all-out efforts. Conversely, track endurance cyclists achieve their highest mean score during an event specific 300 s test and their lowest during a 70 s test. These findings have important implications when testing high performance cyclists for determination of MAOD, with the implication that it is necessary to assess MAOD under exercise conditions (i.e., duration, pacing) specific to the cyclist's chosen event.

Modeling road-cycling performance

This paper presents a complete set of equations for a "first principles" mathematical model of road-cycling performance, including corrections for the effect of winds, tire pressure and wheel radius, altitude, relative humidity, rotational kinetic energy, drafting, and changed drag. The relevant physiological, biophysical, and environmental variables were measured in 41 experienced cyclists completing a 26-km road time trial. The correlation between actual and predicted times was 0.89 (P < or = 0.0001), with a mean difference of 0.74 min (1.73% of mean performance time) and a mean absolute difference of 1.65 min (3.87%). Multiple simulations were performed where model inputs were randomly varied using a normal distribution about the measured values with a SD equivalent to the estimated day-to-day variability or technical error of measurement in each of the inputs. This analysis yielded 95% confidence limits for the predicted times. The model suggests that the main physiological factors contributing to road-cycling performance are maximal O2 consumption, fractional utilization of maximal O2 consumption, mechanical efficiency, and projected frontal area. The model is then applied to some practical problems in road cycling: the effect of drafting, the advantage of using smaller front wheels, the effects of added mass, the importance of rotational kinetic energy, the effect of changes in drag due to changes in bicycle configuration, the normalization of performances under different conditions, and the limits of human performance.

The effects of altered exercise distribution on lymphocyte subpopulations

The effects of exercise distribution on lymphocyte count, lymphocyte subpopulations and plasma cortisol concentration in peripheral blood were assessed in 19 healthy subjects. The subjects were randomly divided into group A (n = 10) or group B (n = 9) according to exercise distribution. Both groups underwent a 10-week programme involving 5 x 2-week blocks: baseline (B), training period 1 (TP1), stabilisation 1 (S1), training period 2 (TP2), and stabilisation 2 (S2). During B, S1 and S2 normal training was undertaken. During TP1 and TP2 the subjects increased the amount of training by 50% in week 1 and by 100% in week 2. During TP1 subjects in group A exercised 6 days.week-1, while during TP2 these subjects exercised on 3 alternate days.week-1, but doubled the duration of each training session. The subjects in group B reversed this training order. Blood was collected 36-42 h following exercise period B, and at the end of periods TP1, S1, TP2 and S2, and also 12-18 h following completion of exercise at the end of TP1 and TP2. There were no significant differences (P > 0.05) between the 6 day.week-1 programme and the 3 alternate day.week-1 programme in total lymphocyte count, CD3+, CD4+, CD8+, CD16+, or CD19+ cells, the CD4:CD8 ratio, HLA-DR+ (activated) T cells or plasma cortisol concentrations. Following both TP1 and TP2 there was a nonsignificant decrease in lymphocyte subpopulations. However following both S1 and S2 (baseline training) there was a significant increase in total lymphocyte count, CD3+, CD4+ and CD8+ lymphocytes. The S2 variables statistically significant from B were: total lymphocyte count (P < 0.01), CD3+ T-cells and percentage of circulating lymphocytes (P < 0.01), CD4+ cells (P < or = 0.0001), CD8+ cells (P < 0.05), and HLA-DR+ (activated) T-cells (P < 0.05). The results indicated that provided the amount of exercise is constant for a given period, then exercise distribution is not a critical variable in the alteration of lymphocyte subpopulations that may occur in response to overload training. However 2 weeks of overload training followed by 2 weeks of active recovery (baseline) training may induce an increase in the lymphocyte count.

Exercise stimulus increases ventilation from maximal to supramaximal intensity

This study investigated the influence of an exercise stimulus on pulmonary ventilation (VE) during severe levels of exercise in a group of ten athletes. The altered ventilation was assessed in relation to its effect on blood gas status, in particular to the incidence and severity of exercise induced hypoxaemia. Direct measurements of arterial blood were made at rest and during the last 15 s of two intense periods of cycling; once at an intensity found to elicit maximal oxygen uptake (VO2max; MAX) and once at an intensity established to require 115% of VO2max (SMAX). Oxygen uptake (VO2) and ventilatory markers were continually recorded during the exercise and respiratory flow-volume loops were measured at rest and during the final 30 s of each minute for both exercise intensities. When compared to MAX exercise, the subjects had higher ventilation and partial pressure of arterial oxygen (PaO2) during the SMAX intensity. Regression analysis for both conditions indicated the levels of PaO2 and oxygen saturation of arterial blood (SaO2) were positively correlated with relative levels of ventilation during exercise. It was apparent that mechanical constraints to ventilate further were not present during the MAX test since the subjects were able to elevate VE during SMAX and attenuate the level of hypoxaemia. This was also confirmed by analysis of the flow volume recordings. These data support the conclusions firstly, that overwhelming mechanical constraints on VE were not present during the MAX exercise, secondly, the subjects exhibiting the most severe hypoxaemia had no consistent relationship with any measure of expiratory flow limitation, and thirdly, ventilatory patterns during intense exercise are strong predictors of blood gas status.

Inflammatory pseudotumor of the maxillary sinus in a 15-year-old boy

Inflammatory pseudotumor is a benign neoplasm composed of fibroblasts, histiocytes, and inflammatory cells. Its occurrence in the paranasal sinuses is rare. We report a case of a 15-year-old boy with a maxillary sinus inflammatory pseudotumor that simulated an aggressive neoplasm on CT scan.

Mathematical model of cycling performance

A model of cycling performance is presented. The model is based on equating two expressions for the total amount of work performed. One expression is deduced from biomechanical principles deriving energy requirements from total resistance. The other models the energy available from aerobic and anaerobic energy systems, including the effect of oxygen uptake kinetics at the onset of exercise. The equation can then be solved for any of the variables. Empirically derived field and laboratory data were used to assess the accuracy of the model. Model estimates of 4,000-m individual pursuit performance times showed a correlation of 0.803 (P < or = 0.0001) with times measured in 18 high-performance track cyclists, with a mean difference (predicted--measured) of 4.6 s (1.3% of mean performance time). The model enables estimates of the performance impact of alterations in physiological, biomechanical, anthropometric, and environmental parameters.

Aerobic and anaerobic indices contributing to track endurance cycling performance

A group of 18 male high performance track endurance and sprint cyclists were assessed to provide a descriptive training season specific physiological profile, to examine the relationship between selected physiological and anthropometric variables and cycling performance in a 4000-m individual pursuit (IP4000) and to propose a functional model for predicting success in the IP4000. Anthropometric characteristics, absolute and relative measurements of maximal oxygen uptake (VO2max), blood lactate transition thresholds (Thla- and Th(an),i), VO2 kinetics, cycling economy and maximal accumulated oxygen deficit (MAOD) were assessed, with cyclists also performing a IP4000 under competition conditions. Peak post-competition blood lactate concentrations and acid-base values were measured. Although all corresponding indices of Thla- and Th(an),i occurred at significantly different intensities there were high intercorrelations between them (0.51-0.85). There was no significant difference in MAOD when assessed using a 2 or 5 min protocol (61.4 vs 60.2 ml.kg-1, respectively). The highest significant correlations were found among IP4000 and the following: VO2max (ml.kg-2/3.min-1; r = -0.79), power output at lactate threshold (Wthla) (W; r = -0.86), half time of VO2 response whilst cycling at 115% VO2max (s; r = 0.48) and MAOD when assessed using the 5 min protocol (ml.kg-1; r = -0.50). A stepwise multiple regression yielded the following equation, which had an r of 0.86 and a standard error of estimate of 5.7 s: IP4000 (s) = 462.9 - 0.366 x (Wthla) - 0.306 x (MAOD) - 0.438 x (VO2max) where Wthla is in W, MAOD is in ml.kg-1 and VO2max is in ml.kg-1 x min-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Atypical arthropathy associated with Crohn's disease

Inflammatory bowel disease may be associated with a variety of rheumatologic abnormalities. The patterns of described enteropathic arthritis, not associated with the HLA B27 antigen, include non-deforming peripheral arthritis, bilateral, symmetric sacroiliitis, an on occasion, destructive monoarthritis. We report three patients with Crohn's disease and patterns of joint disease that have not been previously described. The patients ranged in age from 16 to 31 yr. In all cases, both joint and bowel disease were present since childhood. Antinuclear antibody, rheumatoid factor, and HLA B27 antigen determinations were negative. The distribution and pattern of joint disease were similar to that seen in rheumatoid arthritis. We propose that these cases do not represent coincident rheumatoid arthritis and Crohn's disease, but, rather, atypical manifestations of enteropathic arthritis.

Retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst in a newborn

Retrograde intussusception is a rare occurrence. We report a retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst, which presented as intermittent biliary and upper gastrointestinal (UGI) obstruction and a mobile abdominal mass in a newborn infant.

Accuracy of pulse oximetry during exercise stress testing

Pulse oximetry is used extensively during exercise stress-testing in the clinical and sports medicine settings. There are few validation studies to assess the appropriateness of using pulse oximetry under conditions of potentially compromised peripheral blood flow. To study the accuracy of pulse oximetry during severe exercise stress, 10 athletes undertook 3 bouts of exhaustive exercise; once at an intensity requiring VO2max (max), once at 115% of VO2max (Smax), and once at Smax while FIO2 was increased to 0.30. The results indicate relatively large underestimations occur when pulse oximetry is used to estimate %SaO2 during exercise, when compared to the criterion samples of gas analysis in arterial blood. These differences were exacerbated as the exercise intensity increased from a mean(+/- SE) difference of 2.9 +/- 0.7 %SaO2 at max to 4.6 +/- 0.7 %SaO2 at Smax. Breathing a higher FIO2 reversed the hypoxemia that occurred during the normoxic exercise, however, pulse oximetry measurements failed to detect this alteration in %SaO2. Estimates of oxygen saturation during severe exercise using pulse oximetry should be viewed with caution, as potentially large errors may occur.

Effect of regular voluntary exercise on resting cardiovascular responses in SHR and WKY pregnant rats

The purpose of this study was to assess the influence of regular voluntary exercise in pregnant normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats on 1) uteroplacental perfusion and mean arterial pressure in the resting conscious condition and 2) fetal number, fetal weight, and number of fetal resorptions. WKYs and SHRs were randomly assigned to standard cages [CWKY (n = 10); CSHR (n = 6)] or cages with activity wheels [EWKY (n = 7); ESHR (n = 8)]. EWKYs and ESHRs exercised for 12 wk, and then all rats were bred and experiments were conducted on gestational day 17. Resting blood flow (microspheres), heart rate (HR), and mean arterial pressure (Pa) were measured. No significant difference was found in Pa, HR, uterine blood flow (ESHRs 52 +/- 8 ml.min-1.100 g-1; CSHRs 28 +/- 6 ml.min-1.100 g-1), or maternal placental blood flow (ESHRs, 122 +/- 31 ml.min-1.100 g-1; CSHRs 78 +/- 21 ml.min-1.100 g-1) among the groups. Exercise altered the relationship between maternal placental and uterine blood flow and Pa in the SHR; SHRs with lower Pa maintained higher placental and uterine blood flow after training. Before gestation ESHRs ran on average more kilometers per week than EWKYs (43 +/- 3 vs. 34 +/- 4), but during gestation ESHRs averaged fewer kilometers per week than EWKYs (16 +/- 4 vs. 22 +/- 4). Succinate dehydrogenase activity was higher in the white vastus lateralis (1.02 +/- 0.2 mumol cytochrome c reduced.min-1.g wet wt-1) and vastus intermedius (3.1 +/- 0.5 mumol cytochrome c reduced.min-1.g wet wt-1) muscles of ESHRs.(ABSTRACT TRUNCATED AT 250 WORDS)

Sonographic demonstration of annular pancreas and a distal duodenal diaphragm in a newborn

A case of duodenal obstruction in a newborn is presented where sonographic examination demonstrated duodenal obstruction by both an annular pancreas and a duodenal diaphragm.

The Drinkwater-Ross anthropometric fractionation of body mass: comparison with measured body mass and densitometrically estimated fat and fat-free masses

The Drinkwater-Ross anthropometric fractionation of body mass (mass = sigma skeletal, residual, fat and muscle masses), lean body mass (LBM = sigma skeletal, residual and muscle masses) and fat mass (FM) were compared with the measured body mass, together with the densitometrically estimated fat-free mass (FFM) and fat mass (FM), of 205 male (mean +/- S.D.: 74.66 +/- 10.55 kg; 10.1 +/- 3.7% BF by densitometry) and 177 female (mean +/- S.D.: 59.14 +/- 8.85 kg; 18.5 +/- 5.1% BF by densitometry) South Australian State representatives in a variety of sports. Most absolute differences (d) between the measured body masses and those resultant from the sum of the four fractionated masses (male: d = 2.15 kg or 2.9%; female: d = 1.27 kg or 2.2%) were within what one would expect from random day-to-day variation. However, this was not so for the comparisons between the fractionated LBM (male: d = 2.54 kg or 3.8%; female: d = 2.45 kg or 5.2%) and FM scores (male: d = 1.67 kg or 30.0%; female: d = 2.40 kg or 20.0%) and their densitometric counterparts. These differences are probably related to a combination of the densitometric and fractionation assumptions.

Epiphyseal involvement in osteosarcoma

Plain radiography and magnetic resonance (MR) imaging were used to assess the extent of transphyseal involvement in 15 consecutive patients with long bone osteosarcoma and nonfused epiphyses. The findings were correlated with those from surgical and microscopic pathologic examinations. There were no cases of false-positive findings with either MR imaging or plain radiography. Conventional radiography accurately helped predict transphyseal spread in only nine of 15 cases (60%). Spread to the epiphysis was present in 12 of the 15 cases (80%) and was accurately predicted with MR imaging in all 12 cases. This finding contradicts the common misconception that the physis acts as a "barrier" to tumor spread.

Complete spontaneous disruption of the common bile duct: a late complication of necrotizing enterocolitis?

A 20-month-old infant had bile peritonitis from spontaneous complete avulsion of the distal common bile duct. The patient had recovered from extensive neonatal necrotizing enterocolitis that included the duodenum. We believe that this late unusual biliary catastrophe was a consequence of the neonatal necrotizing enterocolitis.

Lesions that manifest as medial cheek and nasolabial fold masses

Seventeen cases were collected in which the patient presented with a medial cheek or nasolabial fold mass. Most of these lesions were uncommon, and some were rare. The most reliable differentiating finding was the type of associated bone involvement. The malignancies had bone erosion and as a group could be distinguished from the other masses. Computed tomographic attenuation and magnetic resonance imaging signal intensities were nonspecific and did not allow a definitive diagnosis to be made. The types of pathologic conditions and their sectional imaging findings are reviewed.

Effects of training on reproductive tissue blood flow in exercising pregnant rats

The purpose of this study were to investigate 1) whether treadmill training would attenuate the reduction in reproductive (RBF) and visceral tissue blood flow (VBF) that occurs during an acute bout of submaximal exercise (EX) in pregnant rats and 2) whether fetal number of fetal weight would be affected by training. One group (T) of female rats trained on a treadmill (10 degrees incline, 30 m/min) for 1 h/day 5 days/wk for 10 wk before becoming pregnant. A second group (UT) was run at the same speed and incline for 10 min/day 5 days/wk for 2 wk. T and UT rats were bred until pregnant. Skeletal muscle blood flow, RBF, and VBF were measured at pre-EX and at 1 and 10 min of EX (10 degrees incline, 30 m/min). No differences were observed before or during exercise between the two groups in RBF and VBF, heart rate, or mean arterial pressure. Both groups experienced decreases in VBF (except liver) and RBF from pre-EX to EX. In most muscles skeletal muscle blood flow increased for both groups from pre-EX to EX. Neither group experienced a change in mean arterial pressure from pre-EX to EX, but heart rate increased significantly for both groups. No differences were observed between groups in fetal number, fetal weight, or fetal resorptions. It was concluded that training does not significantly attenuate the reduction in RBF and VBF in pregnant rats that occurs during an acute bout of submaximal EX and that training does not affect fetal weight or fetal number.

Hemodynamic responses during exercise at and above VO2max in swine

Mean arterial pressure (Pa), heart rate, cardiac output (Q), and Q distribution (with radiolabeled microspheres) were measured in miniature swine as they ran at high levels on a motor-driven treadmill. Each animal ran on two occasions: once during exercise at maximal O2 uptake (VO2max) and once at an intensity estimated to require approximately 115% VO2max. The purpose was to assess these cardiovascular variables to determine whether the calculated resistance to blood flow during supramaximal exercise was different from that during maximal exercise. A total of 114 tissues/organs were dissected for blood flow analysis. Pa and Q were unaltered between the two exercise conditions. Blood flow to all but one of the 62 skeletal muscles sampled was unchanged between conditions as were the blood flows to the visceral organs and brain. The results demonstrate that vascular resistance was constant in all these tissues between maximal and supramaximal exercise intensities. Elevated blood flows were measured in 7 of the 11 coronary sites sampled. Calculated resistance to blood flow indicated that a decrease in resistance occurred in most of the samples having elevated blood flow. Because heart rate was elevated during the supramaximal exercise, the increase in blood flow was probably in response to the greater myocardial work and concomitant elevation in O2 demand. In summary, it was shown that Pa, Q, and Q distribution in most tissues remained unchanged during exercise at intensities above VO2max. Thus a precise matching occurs between the increasingly powerful vasoconstrictor drive initiated by the sympathetic nervous system and the elevated local vasodilatory drive responding to the greater O2 demand during the supramaximal exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of blood flow during exercise after blood volume expansion in swine

To study the distribution of blood flow after blood volume expansion, seven miniature swine ran at high speed (17.6-20 km/h, estimated to require 115% of maximal O2 uptake) on a motor-driven treadmill on two occasions: once during normovolemia and once after an acute 15% blood volume expansion (homologous whole blood). O2 uptake, cardiac output, heart rate, mean arterial pressure, and distribution of blood flow (with radiolabeled microspheres) were measured at the same time during each of the exercise bouts. Maximal heart rate was identical between conditions (mean 266); mean arterial pressure was elevated during the hypovolemic exercise (149 +/- 5 vs. 137 +/- 6 mmHg). Although cardiac output was higher and arterial O2 saturation was maintained during the hypervolemic condition (10.5 +/- 0.7 vs. 9.3 +/- 0.6 l/min), O2 uptake was not different (1.74 +/- 0.08 vs. 1.74 +/- 0.09 l/min). Mean blood flows to cardiac (+12.9%), locomotory (+9.8%), and respiratory (+7.5%) muscles were all elevated during hypervolemic exercise, while visceral and brain blood flows were unchanged. Calculated resistances to flow in skeletal and cardiac muscle were not different between conditions. Under the experimental conditions of this study, O2 uptake in the miniature swine was limited at the level of the muscles during hypervolemic exercise. The results also indicate that neither intrinsic contractile properties of the heart nor coronary blood flow limits myocardial performance during normovolemic exercise, because both the pumping capacity of the heart and the coronary blood flow were elevated in the hypervolemic condition.

Prediction of oxygen uptake on a bicycle wind-loaded simulator

The primary purpose of this study was to determine the accuracy of estimating oxygen uptake (VO2) from the flywheel revolution rate of a bicycle wind-loaded simulator. VO2 at four different flywheel revolution rates was measured on a Findlay Road Machine (FRM). Ten male trained cyclists, 10 male untrained cyclists, 10 female trained cyclists and 10 female untrained cyclists served as subjects. Significant curvilinear relationships (P less than 0.01) were found between road speed estimated from flywheel revolution rate and VO2 expressed as 1.min-1, ml.kg-1.min-1, 1.min-1.m-2 (r = 0.97, 0.96, 0.98, respectively). The absolute standard error of the mean VO2 was 0.21 l.min-1 (9.6%), 3.71 ml.kg-1.min-1 (11.5%) and 0.10 l.min-1.m-2 (7.9%), respectively. The relationship between VO2 and speed was similar to that reported during road cycling. To determine the magnitude of between-machine differences in VO2, six subjects randomly performed cycling using two different FMR. Significant (P less than 0.05) differences between machines were found at only the highest speed. The present study indicates that it is possible to accurately predict VO2 from flywheel revolution rate using a FRM. Since the FRM appears to approximate the resistance a cyclist experiences on the road and allows cyclists to use their own bicycle, it provides a good alternative to traditional laboratory ergometers.

Sonographic evaluation of portal hypertension in children

Portal hypertension, an expected consequence of cirrhosis, often has an insidious course in children. A noninvasive technique using abdominal sonography has been previously employed by several investigators as a means of diagnosing this condition. Their technique involves sonographically measuring the diameter of the lesser omentum, which increases as a result of engorged collaterals. In this communication, the method is successfully employed in two children, an infant in whom cirrhosis developed who eventually died from acquired immunodeficiency syndrome, and one whose portal hypertension was relieved after orthotopic liver transplantation. Although successful in these two instances, the theoretical basis on which this technique is based is critically evaluated. Anatomical relationships are reviewed that would caution sonographers who attempt to duplicate these studies. Modifications of the technique that will minimize potential false positive results are also discussed.

Oxygen consumption and distribution of blood flow in rats climbing a laddermill

The purpose of this study was threefold: 1) to determine whether untrained rats that refused to run on treadmill would climb on a laddermill (75 degrees incline); 2) to determine O2 consumption (VO2) in untrained rats as a function of laddermill climbing speed; and 3) to determine whether the circulatory response of untrained rats to laddermill climbing is similar to that previously reported for treadmill running at an equivalent VO2. Eighteen female Sprague-Dawley rats that would not perform on a treadmill as part of another study were used to measure VO2 as a function of laddermill speed (5-17 m/min). Data were obtained from all 18 rats; VO2 increased linearly as a function of laddermill speed (r = 0.83, y = 3.0 x + 63.2). Twenty-four female Sprague-Dawley rats that also refused to run on a treadmill were used to measure mean arterial pressure, heart rate, and blood flow distribution (with microspheres) during climbing at 5 and 10 m/min. These exercise intensities were metabolically equivalent to level treadmill running at 45 and 60 m/min (VO2 approximately 78 and 93 ml.min-1.kg-1, respectively). Of the 24 animals, 23 were willing to climb. Mean arterial pressures were higher (approximately 10%) during laddermill climbing than during equivalent treadmill running, but heart rates were the same. General blood flow distribution among muscles as a function of fiber type (with red muscles receiving higher flows) and between muscles and visceral tissues (muscle blood flow increased as a function of exercise intensity while visceral blood flows decreased) were similar to data for rats running on the level.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracranial human immunodeficiency virus infection in an infant: sonographic findings

Multiple hyperechoic foci were noted on a head sonogram in the basal ganglia and periventricular white matter of an eleven month old, human immunodeficiency virus (HIV) seropositive male infant. The infant presented with failure to thrive, recurrent viral and bacterial infections, and progressive neurologic impairment. Toxoplasmosis, Cytomegalo-inclusion virus and other "TORCH" infections were excluded. A computed tomography (CT) scan of the brain demonstrated multiple punctate calcifications in the above areas. The literature indicates that these changes might be the result of direct HIV infection of the brain. To our knowledge this is the first reported case of the sonographic findings.

A comparison of methods used to determine VO2 of exercising humans and animals

The purpose of these experiments was to compare two systems for measuring oxygen uptake (VO2): the open circuit method of indirect calorimetry (Rv), which is commonly used in human studies, and the open flow method, which has been adopted in a variety of animal studies. VO2 measured using the Rv system (procedure 1) was accepted as the criterion value. Two procedures were used to calculate VO2 in the open flow system: MCO2 (where O2 and CO2 were measured in mixed expired gas) and MO2 (O2 measured only). VO2 was measured in ten human subjects during three continuous incremental cycling tests to peak power output administered on three separate occasions--once using each of the three procedures. The results indicated a relatively small difference in VO2 between the Rv and MCO2 procedures (6.2 +/- 4.5%) and between the Rv and MO2 procedures (3.7 +/- 1.7%), across a broad range of power outputs (40-100% VO2 peak). The difference between the Rv and MCO2 procedures decreased as power output increased, while that between the Rv and MO2 procedures remained relatively constant. Therefore, the open flow method is shown to be a valid and reproducible technique for assessment of the metabolic activity of humans and animals.