Robert J. Dimeff

Psychiatric Effects and Psychoactive Substance Use in Anabolic-androgenic Steroid Users

The purpose of this study was to assess the psychiatric effects of anabolic-androgenic steroid (AAS) use and assess the frequency of other psychoactive substance use in a population of AAS users compared with non-AAS-using weight-lifter controls. One hundred sixty-four subjects were administered a demographic survey, including psychiatric history, substance use history, AAS use history, and medical history. Psychiatric diagnoses were made and psychological testing was performed. User categories were determined by history and urine testing. The user categories did not differ significantly on psychological testing. Past AAS users had a higher incidence of psychiatric diagnosis than the nonuser and current user groups. Hypomania was correlated with AAS use, and major depression with AAS discontinuation. Present psychoactive substance abuse or dependence was relatively low across all user categories. AAS dependence was seen in 12.9% of current users and 15.2% of past users of AAS. In conclusion, AAS use may lead to psychiatric disorders in certain individuals. Concurrent use of psychoactive drugs other than AAS does not appear to be common in intensively training weight lifters and bodybuilders.

Extracorporeal Shock Wave Therapy in the Treatment of Chronic Tendinopathies

Many clinical trials have evaluated the use of extracorporeal shock wave therapy for treating patients with chronic tendinosis of the supraspinatus, lateral epicondylitis, and plantar fasciitis. Although extracorporeal shock wave therapy has been reported to be effective in some trials, in others it was no more effective than placebo. The multiple variables associated with this therapy, such as the amount of energy delivered, the method of focusing the shock waves, frequency and timing of delivery, and whether or not anesthetics are used, makes comparing clinical trials difficult. Calcific tendinosis of the supraspinatus and plantar fasciitis have been successfully managed with extracorporeal shock wave therapy when nonsurgical management has failed. Results have been mixed in the management of lateral epicondylitis, however, and this therapy has not been effective in managing noncalcific tendinosis of the supraspinatus. Extracorporeal shock wave therapy has consistently been more effective with patient feedback, which enables directing the shock waves to the most painful area (clinical focusing), rather than with anatomic or image-guided focusing, which are used to direct the shock wave to an anatomic landmark or structure.

Iron and the athlete

Iron is an important mineral necessary for many biologic pathways. Different levels of deficiency can occur in the athlete, resulting in symptoms that range from none to severe fatigue. Iron deficiency without anemia may adversely affect athletic performance. Causes of iron deficiency include poor intake, menstrual losses, gastrointestinal and genitourinary losses due to exercise-induced ischemia or organ movement, foot strike hemolysis, thermohemolysis, and sweat losses. A higher incidence of deficiency occurs in female athletes compared with males.

Seizure disorder in a professional American football player.

ConclusionsThis 27-year-old previously healthy professional football player developed a tonic-clonic seizure and delirium due to acute hyponatremia. This appears to be the first case of hyponatremia in an American football player. Hyponatremia was due to acute water intoxication; sodium losses through sweat and emesis may have partially contributed. There may have also been some contribution from renal dysfunction and diuresis due to his supplement use. Proper education regarding appropriate type and volume of fluid consumption, additional dietary salt intake, general nutrition, and close monitoring of body weight should prevent this disorder. The CT scan and chest radiograph findings appear to have been artifacts, but complicated the treatment of this patient. Because of these radiographic findings and the history of chronic excessive water consumption, the patient was treated as having chronic hyponatremia. In retrospect, he should have been treated as having acute hyponatremia with water restriction, and possibly diuretics or IV 3% saline.

Sideline Management of Sport-related Concussions

Concussions remain one of the most troublesome injuries sports physicians face. Studies suggest recovery takes hours to weeks, but at what point is the concussed brain no longer at increased risk for reinjury is unknown. Physicians must be alert to the symptoms of concussion and be familiar with the available tools to assess neurocognitive dysfunction. Prospectively validated signs and symptoms include amnesia, loss of consciousness, headache, dizziness, blurred vision, attention deficit, memory, postural instability, and nausea. A player with any signs or symptoms of a concussion should not be allowed to return to the current game or practice and should be monitored closely for deterioration of symptoms. Return-to-play should be individually based and proceed in a step-wise manner. The ongoing risk-benefit analysis of return-to-play must currently be based on experience, corollary data from traumatic brain injuries in animals and humans, and limited prospective data with sports-related concussions.

Preventing Cauliflower Ear With a Modified Tie-Through Technique.

In brief: Hematoma following trauma to the external ear is a common problem among wrestlers and boxers. If the hematoma is not treated promptly, infection, fibrosis, scarring, and calcification may develop, leading to the gross deformity known as cauliflower ear or wrestlers ear. Evacuation of the hematoma followed by compression of the auricle is commonly regarded as the treatment of choice. However, fluid frequently reaccumulates after this procedure. The authors describe a tie-through suture technique in which a collodion packing is secured to the auricle with two buttons. Multiple treatments for fluid reaccumulation are rarely necessary when this technique is used.

Complications of corticosteroid therapy in athletic injuries: a review.

COMMENTARY The timely analysis of data from the Women’s Health Study by Conroy et al adds an interesting twist to the issue of past physical activity and the risk of coronary heart disease. The findings suggest that past physical activity is important, but that its effect on coronary heart disease in middle-aged women may operate indirectly through improving other lifestyle risk factors (ie, diet and current physical activity). According to the data, women who reported an average of 10 to 12 months of bouts of vigorous activity at least 2 times a week during high school or at ages 18 to 22 (college age) were more likely to report more fiber intake, less saturated fat intake, more fruit and vegetable consumption, and more physical activity at the middle-aged baseline than women who were less active in the past. Whether these women were actually more active in the past may be a function of memory (playing high school or college sports may be easier to remember than other types of activity). These ‘‘past active’’ women also reported more use of hormone therapy and more alcohol consumption, both of which may have an effect on coronary heart events. Some of the findings were unexpected. For example, ‘‘past active’’ women were more likely to be smokers and have a higher BMI at baseline—not exactly healthy lifestyle characteristics. However, all of the differences were small and much of the statistical significance may have been driven by the large sample sizes of the groups. The measurement of physical activity differed during the study. Baseline physical activity included weekly energy expenditure classified into approximate quartiles, and ‘‘active’’ was Z1000 kcal/wk which was embedded into one of the quartiles (Q3: 600–1499). Past physical activity was estimated from the average number of months that vigorous activity Z2 times per week was reported in high school or at age 18 to 22 years. The study findings might be substantially different if it were possible to use the same measurement of physical activity for each time period of the study, or at least obtain more detail on the earlier periods. This might be especially important given the suggestion of reduced risk of coronary heart disease that may be associated with more energy expenditure in late middle age (>200 kcal/d). Even with its limitations, this is yet another report that emphasizes the importance of physical activity at all ages, especially given the current obesity epidemic among young women. Whether the ultimate effect is an increase in physical activity during middle age or a healthier lifestyle in general, this study supports the encouragement of physical activity at young ages.