Partial Kluver-Bucy syndrome: two cases.

Kluver-Bucy syndrome (KBS) is a rare neuropsychiatric disorder that may be characterized by visual agnosia, placidity, altered sexual activity, hypermetamorphosis, and hyperorality. Patients with KBS present with a complex behavioral syndrome. KBS is usually associated with lesions of the amygdala or amygdaloid pathways. However, partial KBS may occur in the absence of the classic bilateral temporal lesions. Pharmacologic treatment options have been developed from the results of case reports, which suggest that carbamazepine and antipsychotics may be helpful. We present the cases of two patients with partial KBS who responded favorably to antipsychotic medication.

Effects of caffeine on muscle glycogen utilization and the neuroendocrine axis during exercise.

To examine the effect of caffeine ingestion on muscle glycogen utilization and the neuroendocrine axis during exercise, we studied 20 muscle glycogen-loaded subjects who were given placebo or caffeine (6 mg/kg) in a double blinded fashion 90 min before cycling for 2 h at 65% of their maximal oxygen consumption. Exercise-induced glycogen depletion in the thigh muscle was noninvasively measured by means of 13C nuclear magnetic resonance spectroscopy (NMR) spectroscopy, and plasma concentrations of substrates and neuroendocrine hormones, including beta-endorphins, were also assessed. Muscle glycogen content was increased 140% above normal values on the caffeine trial day (P < 0.001). After cycling for 2 h, caffeine ingestion was associated with a greater increase in plasma lactate (caffeine: +1.0 +/- 0.2 mmol/L; placebo, +0.1 +/- 0.2 mmol/L; P < 0.005), epinephrine (caffeine, +223 +/- 82 pg/mL; placebo, +56 +/- 26 pg/mL; P < 0.05), and cortisol (caffeine, +12 +/- 3 mg/mL; placebo, +2 +/- 2 mg/mL; P < 0.001) levels. However, plasma free fatty acid concentrations increased (caffeine, +814 +/- 133 mmol/L; placebo, +785 +/- 85 mmol/L; P = NS), and muscle glycogen content decreased (caffeine, -57 +/- 6 mmol/L muscle; placebo, -53 +/- 5 mmol/L muscle; P = NS) to the same extent in both groups. At the same time, plasma beta-endorphin levels almost doubled (from 30 +/- 5 to 53 +/- 13 pg/mL; P < 0.05) in the caffeine-treated group, whereas no change occurred in the placebo group. We conclude that caffeine ingestion 90 min before prolonged exercise does not exert a muscle glycogen-sparing effect in athletes with high muscle glycogen content. However, these data suggest that caffeine lowers the threshold for exercise-induced beta-endorphin and cortisol release, which may contribute to the reported benefits of caffeine on exercise endurance.

Catatonic signs in medical and psychiatric catatonias.

Patients with psychiatric catatonias vs those with medical catatonias may differ in catatonic phenomenology. To determine if these could be distinguished, the following methods were used: 1) a review of the literature; 2) a chart review; and 3) a prospective series. The literature review of 467 reports of medical catatonias yielded 240 cases that met research criteria. A chart review of 47 episodes of catatonia revealed a higher frequency of negativism in patients with medical catatonias. Prospective data obtained from rating scales revealed an increased frequency of echophenomena in patients with medical catatonias; however, no discriminate pattern of catatonic signs for medical catatonias arose. Overall, catatonic signs appear to share a similar distribution. These findings suggest that psychiatric and medical catatonias are indistinguishable based upon catatonic sign.

Topographic detection of photorefractive keratectomy.

PURPOSE: This study aimed to evaluate the sensitivity and specificity of subjective review of corneal topography to detect patients who have undergone photorefractive keratectomy (PRK). METHODS: Topographic maps from 3 different devices were obtained from 19 patients with postoperative PRK and 9 control subjects with emmetropia and 10 control subjects with myopia. Each image was printed in an absolute and relative scale (total of 228 maps) and graded for overall shape and pattern. Fifteen masked reviewers independently rated each map as either postoperative PRK or not. RESULTS: The overall sensitivity (ability to detect PRK) and specificity rates (ability to exclude control subjects) by reviewers were 65% and 93%, respectively. Sensitivity was influenced independently by the scale (relative, 68%; absolute, 62%; P < 0.01), experience of reviewer (experienced, 77%; inexperienced, 53%; P < 0.001), and device (Alcon, 67 +/- 29.9; Eyesys, 75 +/- 29.4%; and Tomey, 54 +/- 31.7%; P < 0.001). Low levels of preoperative myopia were consistently more difficult to detect than higher levels (low myopia -1.50 to -2.99 diopters [D] sensitivity: 53 +/- 34.5%; medium level -3.00 to -4.49 D: 67 +/- 28.9%; and high level -4.50 to -6.00 D: 77 +/- 21.1%; P < 0.0001). Differences in specificity between experienced and inexperienced reviewers were obtained when maps had a homogeneous topographic pattern (97 +/- 5.6% and 85 +/- 13.7%, respectively; P < 0.05). Several control topography patterns (e.g., homogeneous, focal, and keyhole) were disproportionately more difficult to correctly identify on the Eyesys device. CONCLUSIONS: Topographic experience is a significant factor influencing the correct identification of PRK. Techniques also can be used to enhance detection, such as the use of different devices and scales. However, if subjective review of topography is used as the only method of detection, many patients with PRK will not be identified properly. In addition, the most prevalent preoperative myopic category in the general population (myopia < -3.00 D) also is the most difficult to detect after treatment. This reduces the usefulness of topography as a screening tool. Other techniques are needed to improve the detection of patients with postoperative PRK.

Persistence of supercompensated muscle glycogen in trained subjects after carbohydrate loading.

Several carbohydrate (CHO)-loading protocols have been used to achieve muscle glycogen supercompensation and prolong endurance performance. This study assessed the persistence of muscle glycogen supercompensation over the 3 days after the supercompensation protocol. Trained male athletes completed a 6-day CHO-loading protocol that included cycle ergometer exercise and dietary manipulations. The 3-day depletion phase began with 115 min of cycling at 75% peak oxygen uptake followed by 3 x 60-s sprints and included the subjects consuming a low-CHO/high-protein/high-fat (10:41:49%) diet. Subjects cycled 40 min at the same intensity for the next 2 days. During the 3-day repletion phase, subjects rested and consumed a high-CHO/low-protein/low-fat (85:08:07%) diet, including a glucose-polymer beverage. A 3-day postloading phase followed, which involved a moderately high CHO diet (60%) and no exercise. Glycogen values for vastus lateralis biopsies at baseline and postloading days 1-3 were 408 +/- 168 (SD), 729 +/- 222, 648 +/- 186, and 714 +/- 196 mmol/kg dry wt, respectively. The CHO-loading protocol increased muscle glycogen by 1.79 times baseline, and muscle glycogen remained near this level during the 3-day postloading period. Results indicate that supercompensated muscle glycogen levels can be maintained for at least 3 days in a resting athlete when a moderate-CHO diet is consumed.

Preliminary results of photorefractive keratectomy in active-duty United States Navy personnel.

PURPOSE: To evaluate the safety, efficacy, and quality of vision after photorefractive keratectomy (PRK) in active-duty military personnel. METHODS: Photorefractive keratectomy (6.0-mm ablation zone) was performed on 30 navy/marine personnel(-2.00 to -5.50 diopters [D]; mean, -3.35 D). Glare disability was assessed with a patient questionnaire and measurements of intraocular light scatter and near contrast acuity with glare. RESULTS: At 1 year, all 30 patients had 20/20 or better uncorrected visual acuity with no loss of best-corrected vision. By cycloplegic refraction, 53% (16/30) of patients were within +/- 0.50 D of emmetropia and 87% (26/30) were within +/- 1.00 D. The refraction (mean +/- standard deviation) was +0.45 +/- 0.56 D (range, -1.00 to 1.63 D). Four patients (13%) had an overcorrection of more than 1 D. Glare testing in the early (1 month) postoperative period demonstrated increased intraocular light scatter (P<0.01) and reduced contrast acuity (with and without glare, (P<0.01). These glare measurements statistically returned to preoperative levels by 3 months (undilated) and 12 months (dilated) postoperatively. Two patients reported moderate to severe visual symptoms (glare, halo, night vision) worsened by PRK. One patient had a decrease in the quality of night vision severe enough to decline treatment in the fellow eye. Intraocular light scatter was increased significantly (>2S D) in this patient after the procedure. CONCLUSIONS: Photorefractive keratectomy reduced myopia and improved the uncorrected vision acuity of all patients in this study. Refinement of the ablation algorithm is needed to decrease the incidence of hyperopia. Glare disability appears to be a transient event after PRK. However, a prolonged reduction in the quality of vision at night was observed in one patient and requires further study.

Mania due to general medical conditions: frequency, treatment, and cost.

OBJECTIVE: Mania due to general medicine conditions may occur in patients in a variety of settings. METHODS: We reviewed the charts of patients admitted to an adult psychiatric service over a nine-year period (Jan. 1985 to Dec. 1993). Patients were diagnosed with Organic Affective Syndrome (ICD-9 code 293.83) in 241 episodes (N = 227 patients). There were forty-seven manic or mixed episodes in forty patients (0.72% of all admissions). RESULTS: When DSM-IV criteria for Mood Disorder due to a General Medical Condition manic or mixed type (MDGMC) was applied, we found twenty-five patients with twenty-seven episodes (N = 30 treatment trials). Irritable mood predominated in twenty-seven (90%) of the thirty trials. CONCLUSIONS: Treatment included anticonvulsants in 63 percent, neuroleptics 63 percent, and lithium 40 percent. Favorable responses to anticonvulsants were seen; however combination therapy was used more frequently. Further research in this area is needed.

Failure to reduce body water loss in cold-water immersion by glycerol ingestion.

The efficacy of ingesting an aqueous glycerol solution to enhance body water retention during prolonged cold-water dives was evaluated. Nine Naval Special Warfare divers performed a 3-h dive in 13 degrees C water. Divers were assigned to either a water-treatment group (WT) or a glycerol-treatment (GT) group. WT ingested 30 ml water/kg lean body mass (LBM). GT ingested a solution consisting of 1.2 ml glycerol/kg LBM and 30 ml water/kg LBM. Blood was drawn at prehydration, 90 min after hydration, and 20 min after the 3-h dive for serum glycerol, glucose, free fatty acids, lactate, and electrolyte determinations. Fluid intake and output was recorded and urine analyzed for osmolality, electrolytes, and specific gravity. Serum glycerol values in GT were 200 times greater at posthydration than prehydration and 100 times greater at postdive than at prehydration. Urine output, total body weight loss, and non-urine weight loss during posthydration and dive sampling periods were not significantly different between treatment groups. Hyperhydration with an aqueous glycerol solution of 1.2 ml glycerol/kg LBM seems ineffective in significantly reducing body water loss in divers during prolonged cold-water immersion.

Elevated plasma hydroxyproline. A possible risk factor associated with connective tissue injuries during overuse.

Basal plasma hydroxyproline was measured in 104 male Navy Seal candidates 1 week into their intense physical training program, which lasted 7 weeks, and correlated to the incidence of connective tissue injuries incurred later in the training program. Eleven subjects (10.6%) were diagnosed as having connective tissue injuries. Those subjects with connective tissue injuries had a significantly higher (P less than 0.05) mean plasma hydroxyproline value (4.02 micrograms/ml) than subjects without injury (3.10 micrograms/ml). The majority of graduates (75%) had plasma hydroxyproline values less than 3.3 micrograms/ml. These graduates represented the strongest and most enduring injury-free subjects. Of the subject pool who incurred connective tissue injuries, only 27% had plasma hydroxyproline values less than 3.3 micrograms/ml. The majority of the injured subjects (73%) had plasma hydroxyproline values greater than or equal to 3.3 micrograms/ml. In conclusion, there is a relationship between initial training basal plasma hydroxyproline levels and connective tissue injuries later incurred in an intense physical training program. These data suggest that elevated plasma hydroxyproline levels may represent a risk factor associated with connective tissue injuries.