We describe a rare case of acute pulmonary artery thromboembolism in a 17-year-old male patient who presented to our emergency department following a syncopal episode. A chest radiograph showed a convex pulmonic cone and an increased cardiothoracic index, and two-dimensional echocardiogram suggested near-occlusion of both pulmonary arterial branches. Multi-slice pulmonary angio-tomography revealed massive thrombosis of the pulmonary artery. He was treated with systemic anticoagulation and subsequently required surgical thrombectomy, with favourable early outcome. Although the cause of the thromboembolism remains unproven, we discuss possible etiologies.

Objectives: Nalbuphine (Nubain) is a synthetic opioid analgesic with agonist-antagonist properties. This study describes a characteristic patient profile, pattern of use and treatment outcome for a series of nalbuphine dependent subjects.

Method: Retrospective systematic case-note review of uniformly collected clinical data on 11 cases of nalbuphine dependence presenting to a substance misuse service.

Results: There were nine males and two females with a mean age of 31 years of whom nine were currently employed. At presentation the mean duration of nalbuphine use was three years, the average daily dosage was 60mg (range lOmg-lOOmg) and all subjects reported injecting between two and eight times daily (mean five times daily). All subjects met opioid dependence criteria (ICD-10). Drug-related problems were multiple and varied while forensic history was uncommon. Exposure to nalbuphine occurred exclusively within the gymnasium environment and was used by bodybuilders to enhance weight training and bodybuilding. Eight subjects admitted previous anabolic steroid use, and seven current cocaine use. Eleven subjects represented 14 separate treatment episodes of which 11 treatment episodes involved the use of methadone substitution therapy. The mean stabilisation dose of methadone was 29mg (range 15mg-40mg) and in eight episodes (73%) patients were successfully retained in treatment to completion of detoxification.

Conclusions: Dependence on nalbuphine, an agonist-antagonist opioid previously believed to have low abuse potential, does occur and may be particularly associated with bodybuilders who use its analgesic properties to facilitate pain free training. Its use appears linked not only with other performance enhancing drugs (viz. anabolic steroids) but may also be associated with other psychoactive drugs such as cocaine. Methadone substitution therapy appears to be a viable treatment option.

A case is described of a severe depressive episode following withdrawal from anabolic steroids which were being misused to enhance body-building. The subject was a twenty-two year old unemployed male who had left school without formal qualifications and had been brought up by his grandparents since his parents' separation. He had been a bodybuilder for four years and misused combinations of oral and parenteral anabolic steroids in increasing doses for two years. His depressive symptoms included lowered mood, loss of energy, anhedonia, suicidal preoccupations, disturbed sleep, poor appetite and impaired concentration. It is proposed that unusually prolonged exposure to steroids followed by withdrawal was the most likely cause of the depression in this case and that biological vulnerability to affective disorder may explain the severity of the episode. Misuse of steroids needs to be considered in young physically active people presenting with depression.

Twenty-two weanling foals, about 7 months (215 days) old, were allotted to two groups. One group received high-quality protein (HP; milk powder) and the other received poor-quality protein (PP; barley protein). In addition, six foals in each group were injected intramuscularly (1 mg/kg body weight) with an anabolic steroid (Nandrolon lauras, Laurabolin vet®) at intervals of 3 weeks from weaning to 12 months (362 days) of age. Skeletal and muscular measurements from foals were also made at intervals of 3 weeks. Closure of the right distal growth plate was assessed radiographically in 13 colts in their 2nd and 3rd years of life. Blood samples were taken to investigate the blood chemistry. The HP-group foals gained weight faster from weaning to 12 months of age and were heavier at the age of 12 months than the PP-group foals. The growth of longissimus dorsi muscle and cannon bone circumference were also significantly greater in the HP-group foals. The high-quality dietary protein supplement also increased serum amino acid concentrations and haemoglobin and packed cell volume values. The foals treated with the anabolic steroid increased in body length more slowly from weaning to 12 months of age than the untreated foals. Growth plates closed about 1·5 months later in the horses treated with anabolic steroid than in the untreated horses. Weanling foals seem to require a protein supplement rich in lysine for their optimal growth. More than 31 g/day (0·46 g/MJ metabolizable energy) lysine can be recommended up to 10 months of age.

Twenty-four Hereford ♂ × Friesian ♀ heifers were divided into four equal treatment groups and given subcutaneous ear implants as appropriate 14 days after prostaglandin treatment for the induction of synchronized cycles. Subsequently, they were observed for 75 days. One group was an untreated control, one was given 300 mg trenbolone acetate, one 36 mg zeranol and one 45 mg oestradiol-176. Growth and ovarian cyclicity, assessed by periodic progesterone measurement, were monitored. Trenbolone acetate-treated heifers grew faster (P < 0·05) than other groups which did not differ significantly. Trenbolone acetate shortened the oestrous cycle in which treatment was started in two of five heifers and lengthened it in two others. Subsequent cycles were either suppressed or of short duration. Zeranol and oestradiol-176 treatment had little effect on ovarian cyclicity apart from a small increase in the number of short cycles. It is concluded that, at the doses used, trenbolone acetate suppresses mechanisms leading to ovulation or pre-ovulatory follicular development.