Pica - a case of acuphagia or hyalophagia?

Pica is an eating disorder typically defined as the persistent eating of nonnutritive substances for a period of at least 1 month at an age in which this behavior is developmentally inappropriate. Acuphagia being consumption of sharp objects and Hyalophagia consumption of glass materials. Majority of the foreign bodies ingested into the gastrointestinal tract pass through the rectum asymptomatically, where as objects which are sharp, long, jagged may not be able to pass through. These types of objects may cause complications like impaction, leading to intestinal obstruction, ulceration, perforation and bleeding, thus need surgical exploration. In this case of young female with impacted bunch of bangles in the stomach and few in the small and large bowel, who was completely asymptomatic, needed gastrotomy with enterotomy for complete and successful retrieval of glass bangles.

Metabolic and appetite responses to prolonged walking under three isoenergetic diets.

The effects of three isoenergetic diets on metabolic and appetite responses to prolonged intermittent walking were investigated. Eight men undertook three 450-min walks at intensities varying between 25-30 and 50-55% of maximal O2 uptake. In a balanced design, the subjects were given breakfast, snacks, and lunch containing total carbohydrate (CHO), protein (P), and fat (F) in the following amounts (g/70 kg body mass): mixed diet, 302 CHO, 50 P, 84 F; high-CHO diet, 438 CHO, 46 P, 35 F; high-fat diet, 63 CHO, 44 P, 196 F. Substrate balance was calculated by indirect calorimetry over the 450-min exercise period. Blood samples were taken before exercise and every 45 min during the exercise period. The high-fat diet resulted in a negative total CHO balance (-140 +/- 1 g) and a lower negative fat balance (-110 +/- 33 g) than the other two diets (P < 0.05). Plasma glucagon, nonesterified fatty acids, glycerol, and 3-hydroxybutyrate were higher with the high-fat diet (P < 0.05 vs. high CHO), whereas plasma insulin was lower after high fat (P < 0.05 vs. mixed and high CHO). Subjective ratings of fatigue and appetite showed no differences between the three trials. Although diet influenced the degree of total CHO and fat oxidation, fat was the main source of energy in all trials.

Early onset myotonic dystrophy in association with polyneuropathy.

A patient with early onset of myotonic dystrophy, with associated neuropathy and epilepsy, is presented. It is postulated that his disorder was inherited through a recessive, pleomorphic gene. His differential diagnosis is discussed and the literature reviewed. The clinical variability of myotonic dystrophy is stressed and the diagnostic difficulties encountered in the younger age group.

False localization of seizure activity in the EEG.

Traditional theories of EEG localization are discussed, along with their limitations and contemporary attempts to minimize false localization. Sources of error include: erratic epileptiform activity, local destruction of generators, evoked responses, and autonomous secondary foci. Several cases are presented which are thought to represent false localization by virtue of incompetent generators. It is emphasized that "epileptiform activity" and "epileptogenicity" are not synonomous.