Complications occur regardless of the management strategy chosen for DIACFs and despite management by experienced surgeons. Complications are a cause of significant morbidity for patients. Outcome scores in this study tend to support ORIF for calcaneal fractures. However, ORIF patients are more likely to develop complications. Certain patient populations (WCB and Sanders type IV) developed a high incidence of complications regardless of the management strategy chosen.

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Objective. To provide physicians with a clinical approach to metastatic Crohn's disease (MCD). Main Message. Metastatic Crohn's disease, defined as skin lesions present in areas noncontiguous with the gastrointestinal tract, is the rarest cutaneous manifestation of Crohn's disease. MCD lesions vary in morphology and can arise anywhere on the skin. MCD presents equally in both sexes and across age groups. Cutaneous findings may precede, develop concurrently with, or follow gastrointestinal involvement. A detailed history and thorough physical examination including a full-skin exam may help to exclude other dermatoses, as MCD can mimic other common disorders. A biopsy is required for a definitive diagnosis. Treatment options for MCD remain underwhelming due to the lack of randomized control studies and varying responses of reported therapeutic methods. Topical, intralesional, and systemic corticosteroids, antibiotics, traditional immunosuppressants, and surgery have shown mixed results. Recently, biologics have shown promise, even with refractory cases of MCD. Conclusion. MCD is an important cutaneous manifestation of this inflammatory disorder. Although a rare entity, early recognition can provide opportunity for successful therapeutic intervention.

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Oxygen uptake-velocity regression equations were developed for floor and level treadmill walking by having two groups of men, aged 19-29 years (n = 20) and 55-66 years (n = 22), walk at four self-selected paces, from "rather slowly" to "as fast as possible". A two-variable quadratic model relating VO2 (ml X kg-1 X min-1) to velocity (m X s-1) was adopted for prediction purposes. However, age and fatness significantly (P less than 0.05) interacted with treadmill walking speed, while age alone significantly interacted with floor speed. In addition, a significant difference was found between the energy cost of floor and treadmill walking. For example at the normal walking speed of 1.33 m X s-1, the energy cost for the treadmill (age 55-66 years) was 10.58 ml X kg-1 X min-1 and for the floor, 11.04 ml X kg-1 X min-1 (P less than 0.05). Four quadratic equations are therefore presented, one each for floor and treadmill in each of the two age-groups. The percent variance explained was between 87 and 95% for each of these equations.

The effects of one year of exercise training on cardiorespiratory fitness, levels of daily leisure activity, and blood lipids (cholesterol and high density lipoproteins) were studied in a prospective, randomized clinical trial. Two hundred and twenty-four men aged 55 to 65 years volunteered for the study and were randomly allocated to a control (n = 111) or an activity (n = 113) group with stratification on blue or white collar job classification. After the attrition due to loss to follow-up, 100 men remained in each of the control and activity groups. The exercising men met an average of 2.5 times per week over the year and their VO2 max or peak VO2 (ml X kg-1 X min-1) increased significantly (p = .001, 11%) compared with controls. There were no significant changes in maximal heart rate (155 bpm) and respiratory exchange ratio (1.1), although ventilation (80 to 90 l X min-1) increased significantly in the trained group. In addition, the VO2 at a heart rate of 125 bpm increased significantly (p less than .001) in the trained group (14.7%) over that observed in the control (1.9%). There were no significant differences between the groups with respect to the remaining end-points.

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