Anabolic steroid use among adolescents in a rural state.

BACKGROUND: Anabolic-androgenic steroid use is an increasing problem among high school students. Previous reports have been mainly from metropolitan areas. METHODS: We report the first study of anabolic-androgenic steroid use to concentrate on rural communities. The study was conducted using an anonymous survey of a random sample of male high school students (N = 3900) in grades 10 through 12 encompassing 31 high schools in a predominantly rural state. RESULTS: Two-hundred five (5.3%) students reported using steroids. The prevalence of illicit drug use was significantly higher (P < .05) in steroid users (74%) than in nonusers (31%) (P < .001). The association was between anabolic-androgenic steroid use and illicit drug use rather than between sports participation of any type and illicit drug use (P > .2). Comparison of the prevalence of illicit drug use among athletic (63.2%) and nonathletic (36.8%) steroid users found no significant difference. Findings were similar with cigarette use. There was no difference in the rate of steroid use by school enrollment (69 to 1495) or by city population size (< 200 to 64,000). The predominant reason for steroid use was to improve appearance (43%). CONCLUSIONS: This study found the prevalence of steroid use throughout a predominantly rural state to be similar to that found by previous studies conducted in metropolitan areas; prevalence was not affected by city or school size. Steroid use was closely associated with illicit drug and cigarette use, a new finding that deserves further examination.

Large soft tissue tumor of the chest occurring after trauma.

The unusual soft tissue tumor we have described may be the largest yet reported. The tumor was considered benign, and its histologic features were most consistent with fibromatosis arising in a region that had been previously traumatized. Although the patient is doing well, it is premature (2 years later) to conclude that the tumor will not recur.

Cardiac conduction manifestations of Reiter's syndrome.

This study shows that conduction abnormalities may occur frequently in Reiter's syndrome of new onset or short duration. Since these conduction defects may be initially life threatening or may progress to life-threatening abnormalities, anyone with RS should be followed up. Because of the strong association between RS and HIV infection, we suggest HIV testing for all patients with RS. Anyone with RS should have an electrocardiogram, either to study symptoms or as a baseline if no symptoms exist.

Self-mutilation resulting in bacterial meningitis.

Self-mutilation and particularly self-destructive dermatoses are not usually life-threatening. This case involves a man who met the DSM-III R diagnostic criteria for delusional (paranoid) disorder, somatic type. His destructive behavior involving the face and scalp resulted in osteomyelitis and pneumococcal meningitis. He responded to treatment initially, but was later lost to follow-up. No similar case of self-mutilation has been reported.

Tracheal carinal angle and left atrial size.

Left atrial enlargement is a significant finding, usually indicating elevated left ventricular end-diastolic pressure. An increased tracheal carinal angle has been reported as one indicator on chest radiography of left atrial enlargement. This study retrospectively compared echocardiographically determined left atrial size with carinal angle on plain films. Enlarged left atria and paired, age-matched normal left atria by echocardiography were selected. The carinal angle was measured on roentgenogram (standard and portable films) by goniometer. The left atrium could be accurately predicted to be larger than 5.0 cm in diameter if the carinal angle was 100 degrees or greater. A carinal angle greater than 100 degrees is an easy, inexpensive, reliable method of predicting left atrial enlargement.

Effectiveness of low-dose lovastatin in lowering serum cholesterol. Experience with 56 patients.

This study reviews the progress of 56 consecutive patients with type IIa and IIb hyperlipoproteinemia following treatment with lovastatin. Lovastatin, a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, has been shown to have a cholesterol-lowering effect in doses ranging from 10 to 80 mg/d. Thus far, however, no large study has been performed to show the effectiveness of low-dose lovastatin (20 mg/d) for more than a 6-week duration. Fifty-six patients with known coronary artery disease were prospectively studied, with fasting lipid values being measured at baseline and after 6, 12, 18, and 24 weeks of 20-mg/d lovastatin therapy given as a single evening dose. The total cholesterol level fell 26% from a mean baseline of 8.12 mmol/L (314 mg/dL) and triglyceride levels fell by 12% from a mean baseline of 2.46 mmol/L. The high-density lipoprotein levels increased 7.6%. One patient with known preexisting liver disease was withdrawn from the study owing to an asymptomatic significant rise in liver function test results; one subject complaining of proximal muscle weakness was also withdrawn. The maximal decrease in total cholesterol level occurred within 6 weeks of initiation of therapy. We conclude that low-dose (20-mg/d) lovastatin was effective in lowering serum cholesterol levels in patients with primary type IIa or IIb hyperlipoproteinemia with minimal short-term side effects. Further studies are needed to establish the long-term safety and effectiveness of this drug.

Sudden Death: Myocardial Infarction in a Runner With Normal Coronary Arteries.

In brief: Sudden death during or following exercise is a dramatic event. In people over 40 years of age, coronary artery disease Is implicated in nearly 90% of exercise-related deaths. For those under 30 years of age, hypertrophic cardiomyopathy, abnormal coronary arteries, and coronary artery disease are the largest contributors. The authors report a case of myocardial infarction during exercise in which no clear cause could be determined. Only three similar cases have been previously reported. The authors speculate that coronary artery spasm was the cause, and they provide a literature review on sudden death and exercise.

Endurance athletes: physiologic changes and nonorthopedic problems.

The current increased participation in long distance running and endurance events brings new challenges to the physician. Adaptive changes of exercise must be differentiated from disease states. Left ventricular hypertrophy, Wenckebach rhythm, elevated creatine kinase (myocardial fraction), gastrointestinal bleeding, hematuria, hemoglobinuria, amenorrhea, and apparent anemia may all be exercise related. New syndromes have arisen--from "runner's high" to athletic amenorrhea. These dedicated athletes can be difficult patients. They are highly motivated and will continue training despite significant pain and danger of permanent damage. Speaking their language--carbohydrate loading, "the bonk," "slow twitch," "the wall"--is helpful in their treatment. Traditional health problems are less likely to bring the fitness addict to the physician than some new and peculiar disorders.