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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e13518 Background: Anticancer drug dosing recommendations in kidney dysfunction are often empirical, based on non-standardised creatinine assays calculated via the Cockcroft-Gault equation, and lack applicability to globally accepted kidney dysfunction classifications. ADDIKD aims to provide a standardised approach to assessing kidney function in cancer patients, and to apply evidence and consensus-based recommendations to anticancer drug dosing in kidney dysfunction. Methods: An expert international multidisciplinary working group was established to develop anticancer drug dosing recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to critically appraise the quality and strength of evidence and formulate recommendations. The working group participated in workshops to achieve > 80% consensus for a standardised approach to assessing and classifying levels of kidney function, its application to anticancer drug dosing in kidney dysfunction, and dosing recommendations for individual drugs. Upcoming public consultation will refine these recommendations and facilitate acceptance as an international benchmark. Results: Three key recommendations formed the basis of ADDIKD: Application of estimated glomerular filtration rate via the Chronic Kidney Disease-Epidemiology Collaboration equation (eGFRCKD-EPI) to guide the assessment of kidney function, except where directly measured glomerular filtration rate (mGFR) is clinically necessary. Where the anticancer drug dose is dependent on kidney function and mGFR is not clinically necessary, eGFRCKD-EPI is suggested to guide dosing. Application of the Kidney Disease Improving Global Outcomes (KDIGO) Chronic Kidney Disease categories to guide stepwise dose adjustments of anticancer drugs in kidney dysfunction. A review of 2263 published articles and 177 registered product information monographs enabled 127 GRADE assessments by the working party, resulting in evidence and consensus-based dosing recommendations for 59 anticancer drugs. 'Quick reference’ dosing tables incorporated a traffic light system for alerting clinicians to caution around levels of kidney function and specific patient risk factors for consideration. Conclusions: eGFRCKD-EPI is the most accurate and convenient method for assessing kidney function in diverse populations (including cancer patients) and accounts for the standardisation of the creatinine assay. ADDIKD’s expert acceptance of this standardised approach, together with anticancer drug dosing recommendations in kidney dysfunction, provides a practical tool to establish clinically relevant dosing in this patient population.

Endoleaks are a frequent indication for reintervention after endovascular repair of an abdominal aortic aneurysm. Here we present a method of open repair of a persistent type II endoleak involving graft component separation and reconstruction, in a patient with symptomatic interval aneurysmal sac enlargement despite endovascular coiling and embolization. This case report demonstrates an alternative open technique of endograft component separation and reconstruction that may be required in cases where open repair with sac exploration and vessel oversewing is hindered by the graft position.

Objective: Pseudomonas aeruginosa is a Gram-negative bacillus that commonly colonises lower limb venous ulcers. Its effects on venous ulcer healing are widely debated. It produces exotoxins and elastase, as well as forming biofilms in hard-to-heal wounds. It is postulated that these virulence factors lead to slower healing times in patients with lower limb venous ulcers colonised with Pseudomonas. This review aimed to summarise the available evidence pertaining to this topic. Method: A systematic review was performed in August 2019, where the Pubmed, Cochrane and Embase databases were searched for relevant literature according to PRISMA guidelines. Retrospective and prospective studies examining the effect of Pseudomonas colonisation on any measure of ulcer healing were included. Results: Some 282 articles were screened, of which seven studies including 491 patients were ultimately included for analysis. Of these, no study demonstrated a significant association between Pseudomonas colonisation and delayed healing of venous ulcers. In five of the seven studies, the effect of Pseudomonas aeruginosa on initial ulcer size at presentation was recorded. Conclusion: All the studies demonstrated an association between ulcer size and the presence of Pseudomonas aeruginosa. While Pseudomonas aeruginosa may colonise larger ulcers or those with a worse prognosis, no evidence was found to support the hypothesis that this colonisation had a negative impact on lower limb venous ulcer healing.