Sixty individuals including 17 competitive weight lifters (CWL), 12 competitive long-distance runners (LDR), 7 amateus (noncompetitive) weight lifters (AWL), 14 heavy controls (HC), and 10 light controls (LC) were studied at supine rest with echocardiographic determination of the left venticular mass (LVM) by the Penn convention. Lean body mass (LBM) was estimated by the Wilmore-Behnke method. The absolute LVM (mean +/- SE) was increased in the two competitive athlete groups compared to controls (LDR: 195 +/- 12; CWL: 190 +/- 10 vs. LC: 122 +/- 10; HC: 151 +/- 9 g). The AWL had a mass (174 +/- 20 g) intermediate between the LDR-CWL and the HC-LC groups. A significant (P = 0.033) correlation of LVM was found with LBM although the correlation coefficient was low (r = 0.276). Normalizing LVM by LBM revealed a significantly higher mass for LDR compared to all other groups but equalized CWL and HC (LDR: 3.2 +/- 0.2; CWL: 2.5 +/- 0.1; AWL: 2.5 +/- 0.2; HC: 2.3 +/- 0.2; LC: 2.0 +/- 0.2 g). These data suggest that training for competitive long-distance running (dynamic training) elevates LVM compared to nonathletic controls and CWL. On the other hand, training for weight lifting (static training) increases absolute LVM but only to the extent that LBM is increased.

Administration of empiric antimicrobial therapy is standard practice in the management of neutropenic fever, but there remains considerable debate about the selection of an optimal regimen. In view of emerging evidence regarding efficacy and toxicity differences between empiric treatment regimens, and strong evidence of heterogeneity in clinical practice, the current guidelines were developed to provide Australian clinicians with comprehensive guidance for selecting an appropriate empiric strategy in the setting of neutropenic fever. Beta-lactam monotherapy is presented as the treatment of choice for all clinically stable patients while early treatment with combination antibiotic therapy is considered for patients at higher risk. Due consideration is given to the appropriate use of glycopeptides in this setting. Several clinical caveats, accounting for institution-and patient-specific risk factors, are provided to help guide the judicious use of the agents described. Detailed recommendations are also provided regarding time to first dose, timing of blood cultures, selection of a first-line antibiotic regimen, subsequent modification of antibiotic choice and cessation of therapy.

Sixty individuals including 17 competitive weight lifters (CWL), 12 competitive long-distance runners (LDR), 7 amateur (noncompetitive) weight lifters (AWL), 14 heavy controls (HC), and 10 light controls (LC) were studied at supine rest and during static exercise at 40% of maximal voluntary contraction. Blood pressures were similar in all groups at rest (R) and exercise (EX), but the heart rate (HR) and calculated double product (DP) of the LDR were lower at rest (HR: 53 +/- 2.9 beats/min, DP: 6,346 +/- 402) and at fatigue (HR: 78 +/- 5.4 beats/min. DP: 12,739 +/- 1,011) compared to the control group (R-HR: 69 +/- 2.2 beats/min, DP: 8,553 +/- 372; EX-HR: 97 +/- 3.5 beats/min, DP: 16,345 +/- 836). The LDR demonstrated higher end-diastolic volume index (EDVI) and higher end-systolic volume index (ESVI) at rest (EDVI: 84 +/- 3.7, ESVI: 31 +/- 2.7 ml/m2) and at the time of fatigue (EDVI: 90 +/- 5, ESVI: 37 +/- 2.7 ml/m2) compared to the LC group (R-EDVI: 61 +/- 4.4, ESVI: 22 +/- 2.2; EX-EDVI: 75 +/- 3.4, ESVI: 27 +/- 3.2 ml/m2). The CWL, AWL, and control groups had similar HR, DP, and cardiac volumes at rest and during exercise. These data suggest that competitive endurance (dynamic exercise) training alters the cardiovascular response to static exercise. On the other hand, weight lifting (static exercise) training does not alter the cardiovascular response to static exercise.

Ependymomas are neoplasms which arise from the radial glial cells, which many recent studies have proposed are neural stem cells. Extracranial ependymomas are rare. We present the case report and supporting multimedia of a 37-year-old man who presented with a painless intergluteal swelling which was diagnosed clinically as a pilonidal cyst. However, on excision, he was found to have a subcutaneous sacrococcygeal myxopapillary ependymoma based on histological findings. His management and follow-up are presented and discussed. Given the rare nature of this condition, there is a lack of published guidelines on management and follow-up protocols. Supporting evidence is limited to sporadic case reports. This case highlights the diagnostic challenges and management strategies adopted supported by the best available evidence.

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