Accidental salinomycin intoxication in European fallow deer (Dama dama L.).

Salinomycin, belonging to ionophore antibiotics, has been used as a feed additive for poultry for its coccidiostatic effect. Poisoning by ionophore antibiotics has been reported in cattle and other sensitive animals due to the replacement of medicated feed and/or accidental overdoses. The aim of this paper is to report the toxicity of salinomycin for fallow deer and to describe the different levels of sensitivity of cervids to this substance. In the presented case study, a medicated feed containing ivermectin used for deworming red deer and fallow deer was accidentally contaminated with sodium salinomycinate in a concentration of 252.6 mg/kg. The contaminated feed was consumed by the animals over a period of four days. The mortality of fallow deer within 12 days was 58%. No mortality was recorded in the red deer. In the affected animals, clinical signs associated with acute and congestive heart failure were observed. The biochemical examination indicated prerenal azotaemia caused by circulatory insufficiency and ion imbalance. The histological examination revealed pronounced focal acute cardiomyopathy and massive subacute myopathy in the skeletal muscles.

Muscle Contractile Properties Measured at Submaximal Electrical Amplitudes and Not at Supramaximal Amplitudes Are Associated with Repeated Sprint Performance and Fatigue Markers.

BACKGROUND: The present study analyzes the associations between the muscle contractile properties (MCP) measured at different neuromuscular electrical stimulation amplitudes (NMESa) and the performance or transient fatigue after a bout of repeated sprints. METHODS: Seventeen physically active male subjects performed six repeated sprints of 30 m with 30 s of passive recovery. Capillary blood creatine kinase (CK) concentration, knee extension or flexion isometric peak torque, tensiomyography, and repeated sprint performance were assessed. RESULTS: Muscle displacement and contraction time were different in relation to the NMESa used in the rectus femoris and biceps femoris muscles. At rest, significant (p < 0.05) associations were found between muscle displacement and the loss of time in the repeated sprints (sprint performance) at 20 or 40 mA in the rectus femoris. At post +24 h or +48 h, the highest significant associations were found between the muscle displacement or the contraction time and CK or peak torques also at submaximal amplitudes (20 mA). The NMESa which elicits the peak muscle displacement showed lack of practical significance. CONCLUSION: Although MCP are typically assessed in tensiomyography using the NMESa that elicit peak muscle displacement, a submaximal NMESa may have a higher potential practical application to assess neuromuscular fatigue in response to repeated sprints.

Atomoxetine-induced focal seizures with contralateral hypoperfusion and hyper-CKemia.

One of the drugs used to treat attention deficit hyperactivity syndrome is atomoxetine. Usually, the drug is well tolerated but in rare cases adverse advents may occur. An 18-year-old female under atomoxetine (60 mg/d) since 2 years for attention deficit hyperactivity syndrome since age 13 years, developed sudden onset headache, hemianopia to the right, hypoesthesia of the tongue and right arm, aphasia, and depersonalisation. Blood tests revealed hyper-CK-emia of 2860U/L, cerebral magnetic resonance imaging showed disturbed perfusion on the left temporo-parieto-occipital region, and electroencephalography (EEG) revealed focal slowing and spikes and sharp waves in the same projections. After discontinuation of atomoxetine, symptoms, EEG, and magnetic resonance imaging findings resolved spontaneously within 48 hours. In conclusion, atomoxetine may rarely cause severe side effects such as complex partial seizures with CK-elevation, transient hypoperfusion of the temporal, parietal and occipital lobes, and prolonged reorientation. Atomoxetine should be discontinued if such side effects occur.

Risk factors for exertional rhabdomyolysis with renal stress.

BACKGROUND: Exercise-induced rhabdomyolysis denotes the exertional damage of myocytes with leakage of sarcoplasmic content into the circulation. The purpose of this study was to determine important risk factors for the development of exertional rhabdomyolysis in a temperate climate and to study the renal effects of myoglobinuria. METHODS: A cluster of eight military recruits was admitted to hospital due to exertional rhabdomyolysis with myoglobinuria. The patients were treated according to current guidelines with isotonic saline and alkalinisation of the urine. The eight patients were compared with a randomly selected control group of 26 healthy fellow recruits. All subjects responded to a standardised questionnaire. RESULTS: There were little differences in baseline characteristics between patients and controls. In the present study, exercise intensity, duration and type were all significant determinants of exertional rhabdomyolysis in univariate models. However, in a multivariate model, high exercise intensity on day -1 was the only significant predictor of rhabdomyolysis (p=0.02). All patients had a stable serum creatinine and cystatin C. There was a significant increase in serum neutrophil gelatinase-associated lipocalin (NGAL) in the patients, suggesting renal stress. CONCLUSIONS: Sustained maximal intensity exercise is a crucial risk factor for rhabdomyolysis with gross pigmenturia. Elevated serum NGAL concentrations indicate the presence of renal stress. It appears to be possible to quantify the risk of rhabdomyolysis by means of a simple questionnaire. In the future, this may be used as a tool to prevent rhabdomyolysis.

Rabdomiolisis inducida por ejercicio en adolescentes chilenos / Exercise-induced rhabdomyolysis in Chilean adolescents

Rabdomiolisis es la destrucción de las fibras musculares y se caracteriza clínicamente por dolor, edema y debilidad muscular, orina color rojo-café (mioglobinuria) y la elevación por un corto período de la enzima creatinquinasa en sangre. Entre las múltiples causas de rabdomiolisis está el ejercicio intenso. La rabdomiolisis inducida por el ejercicio está escasamente documentada en la población pediátrica y en general requiere descartar alguna patología metabólica de base. Las complicaciones de la rabdomiolisis pueden ser múltiples y graves: falla renal, arritmias cardíacas, síndrome compartamental, coagulación intravascular diseminada, acidosis láctica, etc. La falla renal es consecuencia de la necrosis tubular aguda secundaria al taponamiento de los túbulos renales por la mioglobina, que puede llegar a ser fatal. Comunicamos nuestra experiencia con tres adolescentes que después de iniciar un programa de entrenamiento físico, desarrollaron intenso dolor y edema muscular constatándose un significativo aumento de la enzima creatinquinasa y edema muscular en la ultrasonografía de los músculos utilizados en el ejercicio. El estudio complementario descartó una patología metabólica de base en todos ellos. El tratamiento oportuno incluyó terapia sintomática e hidratación intravenosa. No se desarrolló insuficiencia renal en ninguno. Frente al incremento no controlado del entrenamiento físico, el diagnóstico oportuno de esta patología permite evitar sus graves consecuencias.

Rhabdomyolysis implies injury to the muscle fibers. The hallmark clinical manifestations are pain, oedema, muscle weakness and dark urine (myoglobinuria). There is an increase, for a short time, of the muscle enzyme creatine kinase in blood. Exercise induced rhabdomyolysis is one of various causes of rhabdomyolysis but has been rarely documented in the pediatric population. In general it is always important to exclude an underlying metabolic pathology. Complications of rhabdomyolysis can be many and severe: renal failure, cardiac arrhythmias, compartment syndrome, disseminated intravascular coagulation, lactic acidosis, etc.. Renal failure is the consequence of the acute tubular necrosis secondary to the obstruction of the renal tubules by myoglobin, which can become fatal. We report our experience with three adolescents that after starting a program of physical training, developed intense pain and muscle oedema at the ultrasound scan of the muscles involved in the exercise. Complementary studies excluded an underlying metabolic disease in all of them. The opportune treatment included symptomatic treatment and endovenous hydratation. Fortunately, none of them developed renal failure.

Early diagnosis of malignant hyperthermia and its treatment regimen without dantrolene / 第二军医大学学报

Objective: To discuss the early diagnosis of malignant hyperthermia (MH) and its treatment regimen without dantrolene. Methods: A patient of American Society of Anesthesiologist class I had sudden muscle spasms and masseter muscle spasm during induction of anesthesia for idiopathic scoliosis surgery, and was diagnosed as having MH. Without using dantrolene, the patient was treated promptly with removal of inducement, control of temperature, adequate oxygen supply, maintaining of pH, water and electrolyte balance, and protection of renal function. The dynamic changes of the myoglobin in the blood and urine, serum creatine kinase, the blood gas indicators, and EtCO2, together with the pathological changes of the quadriceps were observed. Our experience on diagnosis and treatment was summarized. Results: The patient fully recovered and was discharged without any complications. The myoglobin in the blood and urine, serum creatine kinase and its isoenzyme increased rapidly and reached the peak one hour after MH, and maintained for about ten hours, then returned gradually to normal level about five days later. The temperature and EtCO2, increased immediately after development of MH, arterial blood gas quickly showed hypercapnic acidosis, but pH maintained normal or partial alkali during the treatment due to sodium bicarbonate administration; the alkali maintained obviously higher. Some quadriceps muscle cell had vacuolar degeneration and lysis. Conclusion: Non-ventilation induced increase of EtCO2 is a reliable indicator for early diagnosis of MH. Anesthetics, such as succinylcholine, should be avoided in patients at high risk of MH, and EtCO2 should be monitored. Once MH is diagnosed, dantrolene is the first choice. When without dantrolene, satisfactory outcome can be achieved through early diagnosis, timely removal of incentives, control of temperature, adequate oxygen supply, maintaining of stable internal environment, control of arrhythmia and protection of renal function.

A clinical study on Duchenne muscular dystrophy

No abstract available.