This article provides a comprehensive but practical discussion of four anabolic agents used by athletes. Anabolic-androgenic steroids, dehydroepiandrosterone, human growth hormone, and insulin-like growth factor are discussed. A thorough review of available literature on the basic chemistry and physiology, epidemiology, reasons for use, and performance and side effects of each agent are also presented.

Much has been written about the evaluation and management of mild brain trauma in sports. No less than 10 different 'guidelines' have been proposed and published to aid the clinician in the diagnosis of the condition. Too often, these guidelines have creating confusion instead of promoting an understanding of the spectrum of brain injury. As the understanding of the basic science of mild brain injury evolves, so must the approach to the concussed athlete. This article presents an up-to-date and clinically useful approach to the management of the athlete with a mild brain injury. The definition of 'concussion' is discussed and clarified and pertinent epidemiological data which highlight the importance of management skills as applied to athletes in a wide variety of sports are also reviewed. There is really no such thing as a 'mild concussion' if one considers the rare but catastrophic outcome of the second impact syndrome. For this reason, we review and expand upon the mechanisms of injury and pathophysiology. The accurate diagnosis of mild brain injury requires considerable experience, a high index of suspicion, a careful history and a series of examinations of the athlete, and a working knowledge of the athlete's personality and the likelihood of minimising their symptoms. The value of orientation questions pertinent to the athlete is now well established. Any focal neurological deficit or the deterioration of an athlete's condition warrants immediate hospitalisation, brain imaging and neurosurgical consultation. More commonly, athletes present with a brief alteration of consciousness, headache and amnesia and require careful examination and observation before returning to competition. The astute clinician will always err on the side of conservative management. The complete resolution of all symptoms before a return to play is imperative. Computerised tomography is very sensitive in the imaging of mild brain injuries. Neuropsychological testing is also very sensitive in the evaluation of brain injuries in athletes, and may become more clinically useful in the future.

In brief Numerous physiologic derangements can result when body-builders attempt to augment their muscle definition by using diuretics, potassium supplements, and dietary restrictions. A case report describes a 27- year-old male professional bodybuilder who employed these strategies and presented with profound muscle weakness and muscle cramps. He was found to have life-threatening hyperkalemia, ECG changes, mild rhabdomyolysis, and prerenal azotemia. Vigorous volume expansion and potassium-lowering maneuvers reversed the skeletal muscle and cardiac complications. The patient's symptoms resembled those of another professional bodybuilder who died after employing similar drug and diet strategies.

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