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practical conclusions It seems highly improbable that the majority of cases of especially fatal heatstroke are simply the result of abnormal heat retention in otherwise healthy humans Rather, it seems far more likely that heatstroke occurs as a result of accelerated thermogenesis in the skeletal muscles of a few genetically susceptible individuals and which continues even after collapse This thermogenesis must be so great that it overwhelms the heat-losing mechanisms of the immobile human Such accelerated thermogenesis most probably originates in the skeletal muscles as a result of genetic predisposition and the action of agents toxic to muscle Such agents are likely to include drugs and latent viral infections amongst many others Persons with a variety of genetic disorders of skeletal muscle metabolism, known collectively as the malignant hyperthermia disorders, may be at risk of developing heatstroke during exercise.

(2003) Management of urinary tract infection in patients with spinal cord injuries Clinical Microbiology and Infection 9, 780 785 Grossman, E, Messerli, FH, Grodzicki, T, et al (1996) Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies JAMA 276, 1328 1331 Hagobian, TA, Jacobs, KA, Kiratli, BJ, et al (2004) Foot cooling reduces exercise-induced hyperthermia in men with spinal cord injury Medicine and Science in Sports and Exercise 36, 411 417 Halpern, BC, Boehm, R & Cardone, DA (2001) The disabled athlete In Principles and Practice of Primary Care Sports Medicine (Garrett, WE, Kirkendall, DT & Squire, DL, eds) Lippincott Williams & Wilkins, Philadelphia: 115 129 History of Sport for Persons with a Disability http:/ /wwwparalympicorg Accessed January 29, 2006.

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The widespread adoption of Skype VoIP services throughout the world is a solid example of how the legacy telephone network is essentially unable to keep pace with the advances in technology, which are far ahead of the regulatory framework that is completely inadequate to oversee the widespread effects and implications of the Internet coupled with VoIP technology The combination of broadband IP voice services seamlessly connected to the legacy telephone networks, which allows for a call to be originated in one domain and terminated in the other, is a hugely disruptive capability Given that PC-to-PC connections are at rate and free of metered service charges, regardless of their location anywhere in the world, and that termination to traditional telephone numbers only costs a few cents per minute under these new hybrid service providers, the impact on traditional telephone company economics is devastating.

When exposed to a variety of different stressors which may include: 1 Exercise, whether or not it is in the heat; 2 Anesthesia with speci c drugs; 3 Fasting; or alternatively; 4 Eating a low carbohydrate diet while continuing to exercise vigorously; or 5 The use of certain recreational drugs, including amphetamines or the ephedra compounds the muscles of affected persons undergo a rapid and apparently irreversible breakdown (rhabdomyolysis) associated with an uncontrolled metabolic activity that generates inordinate amounts of heat (malignant hyperthermia) Toxic substances released from dying muscle further complicate the disease because they cause kidney and ultimately heart failure, leading to death.

Jacobs, PL, Nash MS (2004) Exercise recommendations for individuals with spinal cord injury Sports Medicine 34, 727 751 Jiang, SD, Dai, LY & Jiang, LS (2006) Osteoporosis after spinal cord injury Osteoporosis International 17, 180 192 Maimoun, L, Fattal, C, Micallef, JP, Peruchon, E & Rabisching, P (2006) Bone loss in spinal cord-injured patients: from physiopathology to therapy Spinal Cord 44, 203 210 Making sense of the categories http:/ /newsbbccouk/sport1/hi/olym pics2000/paralympics/959701stm Accessed January 29, 2006 Malanga, GA (2005) Athletes with disabilities emedicine http:/ /wwwemedicinecom Moran de Brito, CM, Battistella, LR, Saito, ET, et al (2005) Effect of alendronate on bone mineral density in spinal cord injury patients: a pilot study Spinal Cord 43, 341 348 Nichols, AW (1996) Sports medicine and the Americans with Disabilities Act.

Clinical Journal of Sports Medicine 6, 190 195 Nyland, J, Snouse, S, Anderson, M, et al (2000) Soft tissue injuries to USA paralympians at the 1996 summer games Archives of Physical Medicine and Rehabilitation 81, 368 373 Paralympic Games http:/ /wwwparalympicorg Accessed January 29, 2006 Price, MJ & Campbell, IG (2003) Effects of spinal cord lesion level upon thermoregulation during exercise in the heat Medicine and Science in Sports and Exercise 35, 1100 1107 Reynolds, J, Stirk, A, Thomas, A, et al (1994) Paralympics: Barcelona 1992 British Journal of Sports Medicine 28, 14 17 Rose, J, Haskell, WL & Gamble, JG (1993) A comparison of oxygen pulse and respiratory exchange ratio in cerebral palsied and nondisabled children Archives of Physical Medicine and Rehabilitation 74, 702 705 Special Olympics History http:/ /wwwspecialolympicsorg Accessed January 29, 2006.

When this condition occurs in predisposed persons during exercise, it should be labeled exercise-induced malignant hyperthermia (EIHM) to differentiate it from the condition of environmentally and exercise-induced heatstroke (EEIH) that would, by de nition, occur only in otherwise healthy athletes (without such muscle disorders) who exercise in environmental conditions that are too hot The condition of EIHM explains why some athletes can develop what.

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