Electrocardiographical case. Young man with generalised myalgia.

A 24-year-old man presented with generalised malaise and myalgia for three days. He presented to the Emergency Department after a fall at his workplace due to weakness. 12-lead electrocardiogram (ECG) showed normal sinus rhythm with ST depression in the leads V4 to V6, with a U wave. The tallest U wave appeared in V3. These ECG features are characteristic of hypokalaemia. ECG changes in hypokalaemia and differential diagnosis are discussed. A second case of thyrotoxic periodic paralysis with similar ECG changes of hypokalaemia is also presented.

Discriminative stimulus and antinociceptive effects of dihydroetorphine in rhesus monkeys.

RATIONALE: Although dihydroetorphine has micro opioid agonist activity there is evidence to suggest that it is not identical to that of morphine. OBJECTIVE: This study compared dihydroetorphine to other opioids under behavioral conditions that are sensitive to micro opioid agonism. METHODS: The acute effects of dihydroetorphine, etorphine and morphine were evaluated using two procedures. In one procedure, monkeys received 3.2 mg/kg per day of morphine and discriminated naltrexone from saline while responding under a fixed-ratio 5 schedule of stimulus shock termination. In addition, a warm-water, tail-withdrawal procedure was used in untreated monkeys. RESULTS: When acutely deprived of morphine, monkeys responded on the naltrexone lever, and this effect was reversed by dihydroetorphine, etorphine and morphine. Each agonist produced the maximum (20-s latency) antinociceptive effect in 50 degrees C water. Naltrexone antagonized the discriminative stimulus and antinociceptive effects of dihydroetorphine and etorphine, although Schild analyses yielded large variability in slopes and pA(2) values. Naltrexone reversed established effects of dihydroetorphine and morphine in both procedures and pretreatment with dihydroetorphine (2, 6 or 24 h) did not alter the discriminative stimulus effects of morphine. CONCLUSIONS: Taken together, these data support the notion that dihydroetorphine is a micro agonist with a short duration of action; however, variability in antagonism of dihydroetorphine and morphine might be a manifestation of differences that have been reported for these drugs at the cellular level.

A review of the cat liver fluke Platynosomum fastosum Kossack, 1910 (Trematoda: Dicrocoeliidae).

Platynosomum fastosum is a small hepatic trematode found in the biliary ducts and gall bladder of cats and other mammals. It is commonly found in tropical and subtropical regions. Some aspect of the life cycle of this parasite is not fully understood, however terrestrial snails, lizards and isopods are implicated as intermediate/paratenic hosts. The disease caused by P. fastosum is platynosomiais (named after the parasite) or 'lizard poisoning' since it is assumed that affected cats acquire the parasite by eating infected lizards. The clinical signs due to infection with P. fastosum may range from asymptomatic to progressive disease and at times death due to biliary tract obstruction and hepatic failure. Infection with this parasite should, therefore, be included in the differential diagnosis of cats with signs of hepatic diseases.

Cardiac arrest in the skies.

Cardiac arrest occurring on board aeroplanes is rare, but remains a common cause of inflight incidents. This review examines some of the management problems unique to inflight cardiac arrests, and emphasises the use of cardiopulmonary resuscitation and automated external defibrillators.

Arsenic and trace metal contents in sediment profiles from the Admiralty Bay, King George Island, Antarctica.

Admiralty Bay (Antarctica) hosts three scientific stations (Ferraz, Arctowski and Macchu Picchu), which require the use of fossil fuel as an energy source. Fossil fuels are also considered the main source of pollution in the area, representing important inputs of major pollutants (organic compounds) and trace metals and metalloids of environmental interest. Accordingly, this work presents the results of As, Cd, Cr, Cu, Ni, Pb and Zn in sediment profiles from Admiralty Bay. The sediment results from Ferraz station were slightly higher than the other sampling sites. The highest contents were observed for Cu and Zn (from 44 to 89 mg kg(-1)). Otherwise, by using enrichment factors and geochronology analysis, the most relevant enrichment was observed for As in the samples collected close to the Ferraz station, indicating that increasing As content may be associated with the activities associated with this site.

Point-of-care blood ketone testing: screening for diabetic ketoacidosis at the emergency department.

INTRODUCTION: We piloted the use of a blood beta-hydroxybutyrate meter as a point-of-care testing in an emergency department (ED) to establish its role in distinguishing ketosis/ketoacidosis from simple hyperglycaemia, and develop guidelines for its use in the ED. METHODS: 111 consecutive patients presenting with capillary glucose levels exceeding 14 mmol/L had a simultaneous blood ketone measurement at triage. This was correlated with clinical diagnosis, venous bicarbonate levels and urine ketone testing. RESULTS: The median beta-hydroxybutyrate levels was 5.7 (range 4.3-6.0) mmol/L for patients with diabetic ketoacidosis (DKA) and 0.1 (0.0-3.2) mmol/L for the remaining patients. Only 47.7 percent could provide urine samples in the ED. A blood ketone result of 3.5 mmol/L yielded 100 percent specificity and sensitivity for the diagnosis of DKA. CONCLUSION: This is a useful tool that allows clinicians to immediately distinguish between simple hyperglycaemia and potentially life-threatening ketotic states. We formulated simple guidelines for its utilisation in an ED setting.