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The use of anabolic-androgenic steroids (AS) to enhance appearance as well as physical/physiological capacities has increased dramatically over the past four decades in all age groups from early adolescence to adulthood. Although higher AS use rates are reported by elite and competitive athletes, a significant number of recreational athletes appear to be using AS. The scientific literature is inconsistent and at times at odds with the conventional wisdom and empirical experiences of the athletic community regarding the ergogenic effects of AS. However, individuals experienced in weight training, with an adequate diet, and who continue training during AS administration seem to consistently increase their strength and lean mass over what would have been expected from training alone. Previous research documenting deleterious but transient and mostly asymptomatic acute changes in physiology, risk factors and behavior has been inconclusive regarding the long term health impact. The abuse of AS constitutes a special challenge to society. AS are not euphorigenic or mood altering immediately following administration, as are other illicit drugs; the appetite for AS has been created predominantly by our societal fixations on winning and physical appearance. Consequently any successful intervention in this area must go beyond education, law enforcement and drug testing, and attempt to change a social environment which currently encourages the use of AS.

The preparticipation evaluation (PPE) is the first step toward meeting the responsibility of maintaining the health and safety of the athlete. The ideal timing for the PPE is 6 weeks prior to the competitive season to allow adequate time for treatment and rehabilitation of problems. It is suggested that a complete screening evaluation be performed prior to entrance into a new level of school with annual limited reevaluations thereafter. The annual reevaluation should focus on the medical history with the physical examination emphasizing the cardiovascular system and interim injuries and medical problems. Currently, there are no data to support routine screening laboratory, radiographic, or cardiovascular testing in the asymptomatic athlete with an unremarkable history and normal examination. Two different methods for performing the PPE can be used (station-type mass screening and office setting), with each having its own distinct advantages and disadvantages. The most important and difficult decision for the physician screening young athletes is determining clearance for activity. Guidelines based on the demands of the sport and specific medical problems have been established; however, the physician's clinical judgement should be used in interpreting these recommendations for each individual athlete. The PPE is an excellent opportunity for the physician to positively influence the health care and safety of a local sports program. Through genuine interest, thorough evaluation, and knowledgeable counseling, the athlete will develop confidence in the evaluating physician. This confidence can translate into a good relationship and hopefully this interaction will encourage the athlete to trust the physician's judgement and seek early evaluation and treatment for problems that arise.

In brief: A retrospective study of 1,067 college athletes was done to determine the prevalence of certain abnormalities in their preseason complete blood cell count. The authors analyzed the values for white blood cell count, hemoglobin, mean corpuscular volume, and platelet count. In addition, they reviewed the literature to determine if an abnormality in any of these parameters alters athletic performance. Their conclusion: Only a hemoglobin level is useful in preseason evaluations.

The authors studied the lateral positional desviations of the mandible, in relation to the facial median line in 30 (thirty) full edentulous patients, with the purpose to verify the influence of the unstrained guided (chinpoint guidance) and deglutition methods for the determination of centric relation. According the results obtained they conclude that the unstrained guided method produced a mandibular lateral desviation with a mean value of the 0.752 mm and in the deglutition method the mean value observed was 1.109 mm. The statistical analysis of the results revealed for the unstrained guided method a proportion of the "points" to the right and left of the median line not statistically significant, while for the deglutition method the difference was statistically significant at a level of 5%.

Nerve lesions are frequently overlooked in the differential diagnosis of shoulder pain, and there have been few reports in the literature of injuries of the supracapsular nerve that involve only the infraspinatus. We report four cases of suprascapular nerve injuries which involve solely the infraspinatus in which each patient presented with shoulder pain and weakness. The diagnosis can be suspected by careful history and physical examination, but must be confirmed by the appropriate electrical studies. Our patients required 6 months to 1 year to regain full function, and isokinetic testing revealed near normal return of strength. Further diagnostic work-up and surgery may be necessary for those cases which fail to demonstrate satisfactory improvement in the expected time period.

Stress fractures of the femoral shaft in athletes occur most commonly in the proximal third of the femur. They can, however, also be found in the mid- or distal third. Conservative treatment is highly successful in healing these fractures without complications. Athletes can usually return to activity in 8 to 14 weeks. Recognition of the symptoms characteristic of these fractures (vague thigh pain, diffuse tenderness, no trauma) will assist early diagnosis. Early definitive diagnosis can be made by radionuclide scanning or later, by plain radiography, if symptoms have been present for a sufficient period. Diagnosis is not limited to novice runners since runners with significant mileage, or baseball or basketball players, can develop femoral shaft stress fractures.

Cell lines derived from a murine neuroblastoma, Clone N18, were cured of their M. hyorhinis infection by in vivo passage. The major variable determining success of this method was found to be the incubation time in vivo. Infected cells maintained in vivo for 27 d or more and then placed in culture were free of mycoplasma whereas those maintained in vivo for 7 or 14 d were found to still be infected. This approach to eliminating mycoplasma infection may be successful using other tumor cell lines.

In brief: Some athletes use amphetamines and caffeine to fight fatigue, but the effects of these substances on athletic performance are unclear. Both can be harmful. Amphetamines affect the central nervous system (CNS) and can cause tremulousness, anxiety, insomnia, and fever. Caffeine can increase free fatty acid utilization, mask fatigue through CNS stimulation, and increase the force of skeletal muscle contraction. The International Olympic Committee has banned the use of amphetamines altogether, and has banned caffeine when its values are greater than 15 μ g· ml(-1) in a urine test.

Massive lobar pulmonary hemorrhage related to Swan-Ganz catheterization represents a catastrophic complication that, to our knowledge, has received little attention in the literature. Our experience with two recent cases emphasizes the life-threatening nature of such bleeding as well as the potential for patient salvage after urgent resectional therapy. A spectrum of pulmonary vascular injuries is incurred after the insertion of a balloon-tipped catheter, and there are therapeutic approaches for each. The anticoagulation associated with cardiac surgical procedures prompts us to suggest that the technique of insertion and the use of the Swan-Ganz catheter in these patients be modified to avoid this complication.

Modeling techniques were used to model moderate disclosure to high and low disclosers. Eighty female undergraduates (40 low disclosers and 40 high disclosers) listened to a model select items that were rated as moderate disclosures for discussion. Two modeling conditions were employed; in one condition the model was reinforced by the E (vicarious reinforcement), in the second condition the model was not reinforced. Two control conditions, one with the model present, the other with the model absent were also included. The results of two separate 2 X 4 X 2 repeated measures, hierarchical analyses of variance on the subject distance from modeled intimacy, and the number of moderate items selected on pre- and posttests, indicated that both modeling conditions were successful in producing moderation of self-disclosure.

The frequency of positive serological tests for Chlamydia trachomatis, the most common sexually transmitted pathogen in the United States, was assessed in 18,622 specimens derived from New Jersey clinics. From the results, 13 percent female patients and 17 percent male patients were reactive for chlamydial antigen.

The variability and discordance of human immunodeficiency virus type 1 (HIV-1) antibody enzyme immunoassay determinations on serial specimens derived, to our knowledge, from the first documented case of HIV-2 infection in North America are described. The initial specimen was weakly reactive, but two subsequent serum specimens were both nonreactive by enzyme immunoassay. All specimens were indeterminate for HIV-1 antibody by HIV-1 Western blot analysis. Serum HIV-2 antibody was demonstrated by enzyme immunoassay using whole virus lysate, HIV-2-specific synthetic peptide assays, and HIV-2 Western blot analysis. Human immunodeficiency virus type 2 genomic sequences were demonstrated in peripheral blood mononuclear cells using gene amplification technology. Human immunodeficiency virus type 2, isolated from peripheral blood lymphocytes, had typical morphologic features of lenti-virus by electron microscopy. Western blot analysis and other specific assays should be considered in individuals with clinical evidence suggesting HIV infection who are nonreactive for HIV-1 antibody by enzyme immunoassay or who have atypical reactivity patterns.

Fifty bone marrows from patients with AIDS were studied to identify the abnormalities related to marrow failure. Prominent reticulin fibrosis and increased atypical megakaryocytes were the major changes associated with the aberrant hematopoietic microenvironment.

In brief: A 16-year-old high school football player and wrestler began experiencing groin and pubic pain, and a popping sensation with abduction movements, after sustaining an abduction injury to his lower extremities. Stress roentgenographs revealed instability of the pubic symphysis; there was no evidence of fracture or gross instability of the sacroiliac joints or the posterior sacrum. The patient was treated conservatively for one year, with an initial period of limited weight-bearing and rest followed by progressive stretching and strengthening exercises and a gradual return to full sports activity.

In brief: The subspecialty of sports medicine is not reserved for the physician, who is just one member of the team. Sports scientists, psychologists, dentists, optometrists, athletic trainers, physical therapists, orthotists and prosthetists, podiatrists, nutritionists, and others play an integral part on the sports medicine team. However, the primary care physician can be the key to optimal performance of the sports medicine team-by being familiar with the talent and capability of specialists, communicating effectively, and knowing his or her own limitations.

Internals (n=35) and externals (n=38) responded to Rotter's (12) I-E scale under two sets of instructions: standard (as the kind of persons they really were) and ideal-self instructions (as if they were the types of persons they would like to be) and the self-acceptance questionnaire (4). Results indicated (a) on both instruments the discrepancy between real and ideal-self was significantly larger in externals: (b) the external ideal-self includes an internal locus of control; (c) a significant discriminatory factor between internals and externals is their perceived control over their own destiny and not social institutions. The results were discussed in terms of the relationship of externality to maladjustment, neuroticism, and possible causes for this relationship.

Rotary pursuit performance (time on target) and reminiscence data were collected for 113 androgynous and feminine men and women under massed or distributed practice conditions. On the final (eighth) block of practice men performed better than women under conditions of massed practice; while no sex differences were found under distributed practice conditions. Under distributed practice conditions androgynous women performed better than feminine women. In addition, men performed better over-all than women, and subjects in the distributed practice condition performed better than subjects in the massed practice condition. Reminiscence data indicated that under massed practice feminine women obtained larger scores than did feminine men and androgynous women. For women sex-role as well as practice condition influenced performance and reminiscence.

This study tested the hypothesis that a high level of self-disclosure is indicative of psychological adjustment and self-actualization. The self-disclosure scale, Social Avoidance and Distress, Fear of Negative Evaluation, Alienation and Repression-Sensitization scales were administered to 60 Ss. The results for all scales indicated that a high level of disclosure was associated with adjustment as measured by these scales. A second group of 94 Ss completed the self-disclosure scale and the Personal Orientation Inventory, a measure of self-actualization. The results indicated that high disclosers compared to low disclosers had achieved a higher level of self-actualization. That is, there were significant correlations between self-disclosure and measures of self-actualization such as Time Competence, Internal Support, Existentiality, Self-Acceptance and Capacity for Intimate Contact.

The pigeon's metapatagialis muscles, containing fast fibers in two slips and slow fibers in another slip, were excised for a third of their length, minced, and replaced into their previous sites. After regeneration, the pattern of fiber types and their ATPase and oxidative enzymes were examined histochemically. Ultrastructural examination was carried out on the fast fibers. After 4-17 wk the muscles had regenerated into patterns histochemically similar to the controls only within the slip containing fast fibers. The slow slip was much less regenerated, and had a histochemically embryonic composition. Fiber types were characterized and their cross-sectional areas measured, and the degree of atrophy was greatest in the large fast fibers and the slow fibers. Ultrastructural studies revealed a number of alterations of the mitochondria, including dense and light areas in the matrix and an altered pattern of the cristae into parallel tubular or vesicular aggregations. Other changes included dilated sarcoplasmic reticulum, myofibril disorganization, and a compaction of filaments. The slow fibers were thought to be slower in their regeneration rates because of the pattern of multiple innervation's producing a more complex regenerative pattern.

The pre-participation physical evaluation is an integral part of any sports or activity program. There are many alternative methods for completing this evaluation, using varying degrees of frequency and thoroughness. A practical approach to the pre-participation physical evaluation is presented for use in an office as well as in a mass-screening situation.

This group of disorders has a number of causes. Early in the course of the disease, tubular malfunction is out of proportion to glomerular disease. The early presentation may be inability to concentrate urine, salt wasting, distal or proximal renal tubular acidosis and/or Fanconi's syndrome. With early diagnosis and treatment, progression of the renal disorder can be prevented or at least delayed. One can easily discontinue the antibiotic or analgesic, remove the heavy metal, treat the electrolyte abnormality, lower the uric acid or remove the genitourinary tract obstruction.

Flat variant clones were isolated from both the N18 neuroblastoma cell line and from a subclone of the parent line exhibiting the typical round cell morphology. Several revertant clones exhibiting the round parental morphology were also isolated from one of the flat variant clones. The flat variants exhibit decreased cloning efficiency in suspension and increased amounts of myosin heavy chain when compared to the round cell clones. Intracellular cAMP levels were increased from two- to fivefold over those in clones representative of the parent line and in the round cell revertants. Treatment with the phosphodiesterase inhibitor RO20-1724 increased cAMP levels and reduced suspension cloning efficiency without altering doubling time or attached cloning efficiency. Increasing cAMP levels of two of the round cell clones by treatment with the phosphodiesterase inhibitor caused increased flattening of the cell body and increased myosin heavy chain content. Thus, even though increased cAMP level may be sufficient to explain the reduced cloning efficiency of the flat variants, it is not the sole cause of the flat morphology.

Social facilitation theory states that an audience functions as a conditioned stimulus for generalized drive and that this drive effect is learned through classical conditioning. In the present study an attempt was made to classically condition an aversive drive to an audience by having a subject fail a task in front of an audience. A sample of 72 subjects (12 per group) took part in a 3 × 2 factorial design. Half of the subjects were exposed to failure in front of an audience on a first task. These subjects then performed a second complex motor task in front of the same audience who were described as either experts on this second task or as students who were interested in the task (non-expert audience). No differences in performance were found between those groups that had failed a first task and those that had not. However, significant differences in performance were found between the no-audience control, non-expert audience, and expert audience conditions.

In brief: Cocaine and nicotine are among the stimulants that some athletes use in their quest for better performance or simple escape (amphetamines and caffeine were discussed in part 1 of this series [November, page 128]). Cocaine can cause paranoia and insomnia, and an overdose can lead to arrhythmias, coma, seizures, hyperthermia, and death. Nicotine affects several body systems and processes, and the impact of smoking on performance is negative in most cases. So far, little is known about how chewing tobacco influences performance.

A group of experts met to discuss a case from the Cleveland Clinic Foundation. This case conference is part of a series featuring a variety of sports medicine topics.

In brief: Stretching may influence an athlete's susceptibility to injury. To evaluate individual stretching programs of intercollegiate athletes, 238 athletes (164 male, 74 female) in ten sports were surveyed about their stretching practices. Almost all of the athletes stretched, but to varying degrees. Only 39% stretched every day, and only 33% stretched both before and after activity. Overall, the women stretched significantly more than the men, but male swimmers appeared to have the most well-rounded stretching programs. Muscle groups that were stretched by the fewest athletes were the adductors, plantar flexors, hips, and neck. Comparison of these results with flexibility and injury in this study group could prove valuable.

In a study of the effects that instructions have on self-disclosure, two groups of male and female college students (N = 120) were asked to select items for discussion with a same sexed stranger under one of two sets of instructions: (a) Ss were asked to select items that they were interested in discussing or (b) Ss selected items they were willing to discuss. Results indicated that changing one word from "interested" to "willing" produced significantly higher potential disclosures in all Ss from low to high disclosers.

To determine if activity of the renal glutamate dehydrogenase (GD) pathway changes during chronic acidosis in intact dogs, we assessed the deamination of glutamate formed within renal cells during glutamine and alanine infusions. Infusing glutamine into chronically acidotic, normal and acutely alkalotic dogs enhanced renal ammonia production; more was formed as glutamine loading increased. In 4 acidotic dogs, the ratio of ammonia produced to glutamine extracted by the kidneys during exogenous glutamine loading was 1.93 compared with 0.99 for 5 alkalotic dogs and 1.23 for 2 control dogs. Little glutamate and alanine were released into the renal vein in acidotic dogs, whereas over 50% of the exogenous glutamine extracted in acutely alkalotic dogs could be accounted for as glutamate and alanine released into the renal vein. Renal glutamate concentrations were not elevated in acidosis compared with alkalosis despite greater deamidation. When glutamine infusions increased renal ammoniagenesis in acutely alkalotic and control dogs to levels seen in chronically acidotic dogs receiving no exogenous glutamine, approximately 4 to 6 times more glutamate was released from the kidneys. Infusing alanine into 7 chronically acidotic dogs enhanced ammoniagenesis significantly (p less than 0.01), but lesser augmentation was seen in 3 control dogs and no augmentation was seen in 6 acutely alkalotic dogs. The increases were secondary to enhanced glutamate deamination, not secondary to any changes in glutamine extraction and/or transaminase activity. We conclude that the glutamate dehydrogenase pathway is more active in intact acidotic dogs than it is in control and alkalotic dogs.

The immune response was assessed in 13 competitive bodybuilders self-administering anabolic-androgenic steroids and ten competitive bodybuilders not administering these drugs. Laboratory assessment included the number and relative distribution of T-cells, T-helper/inducer cells, T-cytotoxic/suppressor cells, activated T-cells, lymphocyte transformation to the mitogens, pokeweed mitogen (PWM), phytohemagglutinin (PHA), Concanavalin-A (CON-A), Staphylococcus aureus Cowan strain I (SAC), serum immunoglobulins, and natural killer (NK) activity. There were no significant differences in T-cell subsets among steroid users and non-users, but lymphocyte transformation studies revealed that the anabolic-androgenic steroid-using group had enhanced proliferative ability to the B-cell mitogen, SAC, in comparison to non-bodybuilding controls. NK activity was significantly (P less than 0.05) augmented in the anabolic-androgenic steroid users but not in the non-using bodybuilders. Serum immunoglobulin levels, in particular IgA, were significantly (P less than 0.017) lower in the steroid-using group. Four of 13 steroid users and three of eight non-steroid-using bodybuilders had detectable antinuclear antibodies. These studies indicate that 1) anabolic-androgenic steroid use as practiced by contemporary athletes is a potent modulator of immune responsiveness and 2) autoantibodies are prevalent in strength-trained men even in the absence of anabolic steroid use.

Jourard's 40-item Self-disclosure Questionnaire was administered to 50 students in a training and selection program for a quasi-counseling position and 52 randomly selected students. Subjects indicated past disclosures to three target persons, parents, best friend, and stranger. Results indicated: highest disclosures were reported to best friends, lowest to strangers; subjects interested in the quasi-counseling position reported more disclosure than subjects not interested in this position; females reported more disclosure than males only to strangers.

We evaluated a 26-year-old man with hyperkalaemic acidosis, apparently inherited as an autosomal dominant trait. Type II pseudohypoaldosteronism was suggested by normal aldosterone production and renal sodium conservation. The cause of acidosis in this syndrome is unknown. Both urinary ammonium excretion and bicarbonate threshold were low during hyperkalaemia. After correcting the hyperkalaemia ammonium excretion was normal, but bicarbonate threshold remained low. Maximum bicarbonate reabsorption, urine to blood pCO2 gradients, and minimum urine pH were normal. These findings suggest that hyperkalaemia might contribute to the acidosis by limiting urinary buffer, but that the primary defect is reduced mineralocorticoid effect on hydrogen ion secretion. When the poorly reabsorbed anion, sulphate, was infused, hydrogen ion and potassium secretion were normal. When the relatively reabsorbable anion, chloride, was infused, potassium secretion was decreased. These findings suggest that the attenuated mineralocorticoid effect on hydrogen ion secretion is due to increased reabsorptive avidity for chloride in the distal nephron. To determine if this defect caused resistance to mineralocorticoid we increased mineralocorticoid by dietary sodium restriction and later administered desoxycorticosterone and fludrocortisone. Both endogenous and exogenous mineralocorticoid caused increased net acid excretion and corrected the acidosis, indicating no resistance to mineralocorticoid. Hydrochlorothiazide 50 mg daily promptly corrected the acidosis and the hyperkalaemia by increased urinary potassium excretion. We conclude that the acidosis of type II pseudohypoaldosteronism is due in part to attenuation of the voltage-dependent moiety of mineralocorticoid-driven acidification caused by enhanced distal chloride reabsorption. Suppression of ammoniagenesis by hyperkalaemia exaggerates the acidosis. The acidosis and hyperkalemia are corrected by hydrochlorothiazide.

A 41-year-old woman from the Cape Verde Islands, Africa, who had been residing in the United States for 11 months was found to have human immunodeficiency virus type 2 (HIV-2)-associated acquired immunodeficiency syndrome (AIDS). Antibody to HIV-2 was found by enzyme immunoassay and was verified by radioimmunoprecipitation. The patient was being treated for pulmonary tuberculosis at the time of her admission to our institution. Further laboratory and clinical evaluation at our facility revealed depressed CD4 lymphocytes, oral candidiasis, and cryptococcal meningitis with indeterminate results on serologic testing for HIV type 1 (HIV-1). The biopsy specimen of a lesion in the right occipital lobe of the brain documented Toxoplasma gondii, indicating a clinical diagnosis of AIDS. To our knowledge, our study presents the first known patient with HIV-2-associated AIDS in the United States. Our patient provides further evidence that HIV-2 causes severe immunodeficiency and opportunistic infection. The condition should be suspected in the face of normal or repeatedly equivocal HIV-1 antibody test results in the presence of clinically documented AIDS.

Androgynous, traditional, and undifferentiated male and female subjects indicated their attraction to three opposite-sex strangers who were described as having an androgynous, traditional, and undifferentiated sex-role. Subjects' ability to describe the sex-roles of the strangers was also measured. Androgynous strangers were most preferred, undifferentiated strangers least preferred. The least preferred undifferentiated strangers' sex-role was most accurately described. Subjects were least successful in describing the androgynous sex-role.