The age of peak performance has been well investigated for elite athletes in endurance events such as marathon running, but not for ultra-endurance (>6 h) events such as an Ironman triathlon covering 3.8 km swimming, 180 km cycling and 42 km running. The aim of this study was to analyze the changes in the age and performances of the annual top ten women and men at the Ironman World Championship the 'Ironman Hawaii' from 1983 to 2012. Age and performances of the annual top ten women and men in overall race time and in each split discipline were analyzed. The age of the annual top ten finishers increased over time from 26 ± 5 to 35 ± 5 years (r (2) = 0.35, P < 0.01) for women and from 27 ± 2 to 34 ± 3 years (r (2) = 0.28, P < 0.01) for men. Overall race time of the annual top ten finishers decreased across years from 671 ± 16 to 566 ± 8 min (r (2) = 0.44, P < 0.01) for women and from 583 ± 24 to 509 ± 6 min (r (2) = 0.41, P < 0.01) for men. To conclude, the age of annual top ten female and male triathletes in the 'Ironman Hawaii' increased over the last three decades while their performances improved. These findings suggest that the maturity of elite long-distance triathletes has changed during this period and raises the question of the upper limits of the age of peak performance in elite ultra-endurance performance.

Diagnosis of appendicitis, particularly in young women, may be challenging. In case of abdominal pain in the postoperative period of laparoscopic surgery, one should not only think of complications such as bleeding and injury of the bowel but also such as acute appendicitis. We report a case of a 26-year-old female patient with a post-laparoscopic acute appendicitis with appendicolithiasis 3 days after a laparoscopic ovarian cystectomy during which the appendix appeared inconspicuous. Appendicitis after gynecologic laparoscopy is a rare but potentially dangerous condition. One should consider the possibility of a postoperative appendicitis in case of an acute abdomen after laparoscopic surgery. Further studies might be of value to re-evaluate incidental appendectomy especially in cases of appendicolithiasis.

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