Objective-To investigate biochemical changes related to muscle breakdown, hepatic damage, hyponatraemia, and a number of other variables in the serum of participants in a 1600 km ultramarathon run. Methods-Blood samples were obtained from nine participants (seven men, two women) in a 1600 km foot race before, after 4 and 11 days of running, and at the conclusion of the event. Samples were analysed by standard methods and results corrected, where appropriate, for changes in plasma volume. Results-Significant (p<0.05) increases in the following variables were found during or at the conclusion of the event: plasma volume, sodium, chloride, urea, alkaline phosphatase, -glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, bilirubin, total protein, albumin, glucose, calcium, and phosphate. Significant (p<0.05) decreases in the following variables were found during or at the conclusion of the event: globulin, uric acid, and cholesterol. No change occurred in serum potassium, bicarbonate, creatinine, and triglycerides. Conclusion-A wide range of biochemical perturbations occur during ultramarathon running but a number of variables remain within normal limits despite severe physical stress. Large increases in plasma volume occur, and hyponatraemia is rare in events of this duration. The time course of increases in enzymic indicators of muscle damage indicates that duration of running is not the sole determinant of such increases. This study provides indirect evidence of possible hepatic damage during prolonged exercise and an increase in serum calcium both of which warrant further investigation. (Br J Sports Med 1999;33:264-269)

Objective-To investigate haematological variations and iron related changes in the serum of participants in a 1600 kilometre ultramarathon run. Participants-Seven male and two female participants in a 1600 km foot race. Methods-Blood samples were obtained from the participants before, after four and 11 days of running, and at the end of the event. Samples were analysed by standard methods for haemoglobin, packed cell volume, total red cell count, mean red cell volume, mean red cell haemoglobin, total white cell count and diVerential, platelets, reticulocytes, iron, ferritin, total iron binding capacity, percentage transferrin saturation, haptoglobin, and bilirubin and corrected for changes in plasma volume. Results-The following variables decreased during the event (p<0.05): haemoglobin, packed cell volume, mean red cell volume, percentage lymphocytes, percentage monocytes, serum iron, total iron binding capacity, and percentage transferrin saturation. Increases (p<0.05) were found in plasma volume, total red cell count (day 4 only), total white cell count, percentage and absolute numbers of neutrophils and reticulocytes, absolute numbers of lymphocytes and monocytes (day 4 only), absolute numbers of eosinophils (day 11 and race end), absolute numbers of basophils (race end only), platelets, ferritin, haptoglobin, and bilirubin (day 4 only). Conclusion-Ultramarathon running is associated with a wide range of changes in haematological parameters, many of which are related to the normal acute phase response to injury. These should not be confused with indicators of disease. (Br J Sports Med 1999;33:27-32)

This is a case study of a female patient diagnosed with superficial spreading melanoma who decided to treat the lesion by the application of a preparation known as black salve. Persistence of the melanoma was documented five years later with subsequent evidence of metastatic spread to the regional lymph nodes, lungs, liver, subcutaneous tissues and musculature. A literature search has revealed one other case study of the use of black salve for the treatment of melanoma.

A 16-year-old girl presented with general skin tanning, multiple dark melanocytic nevi and an enlarging nevus in her left groin following self-injections of Melanotan 2 and attending a UV tanning studio. She had been referred by her GP who was concerned that some of the darkened nevi were potentially malignant.

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