Peripheral neuropathy in ulcerative colitis: a case report

Inflammatory bowel diseases [IBD] were systemic disorders involving many organ systems. Besides intestinal manifestations, extra intestinal manifestations [EIMs] including neurologic complications have been reported among 6%-40% of IBD patients. Ulcerative colitis [UC] was a subtype of IBD only affecting the colonic mucosa and sub mucosa. Although the EIMs of UC could affect any organ system, central and peripheral neurological manifestations were relatively rare. Here, we described a case of UC and concurrent primary sclerosing cholangitis [PSC] who complained about paresthesia and weakness of his upper and lower limbs for the past two months. Through physical examination revealed decreased muscle tone in his legs and arms. Electrophysiological studies were compatible with the diagnosis of chronic mixed polyneuropathy which improved after administration of intravenous immunoglobulin [IVIG] and the patient was discharged in good general condition. Although both immunologic and non-immunologic mechanisms we considered to play a role in development of neuropathies, further investigations were still required to accurately understand the underlying mechanism

[Levetiracetam and lamotrigine in old aged onset of epilepsy: a randomized double-blind clinical trial]

Choosing the right drug with the least side effects and highest effectiveness for the control of seizures in the elderly is important. The aim of this study was compare the efficacy of lamotrigine and levetiracetam in the management of epilepsy in the elderly. This study was performed as a double-blind randomized clinical trial in patients that referred to the neurologic clinic at Sina University Hospital, Tehran, Iran in 2012. The patients over sixty years old with a diagnosis of epilepsy were selected. They had one seizure in year at least and one attack in the last 6 months. First, the patients divided to two groups; Group one were treated with lamotrigine, 25 mg per day and group two were treated with levetiracetam, 250 mg per day for 24 weeks. In the absence of drug complications, the dose was increased to the maximum dose listed in the treatment protocol. Second the patients were followed in number of attacks, abnormalities in laboratory data and side effects of drug in 2, 4, 8, 12 and 20 weeks. The collecting data of the study were analyzed using descriptive and analytical statistics methods. Forty nine cases, 28 males and 21 females in lamotrigine group and 46 cases in levetiracetam group, 27 males and 19 females participated in the final analysis. Mean age of patients was 72.40 +/- 5.87 [63-85]. Drug side effects were observed in 57 cases, 26 cases of lamotrigine group and 31 cases of levetiracetam group. Seizure frequency showed a declining trend in both groups but in lamotrigine group more than levetiracetam group in last week [P = 0.039]. The findings of the study showed lamotrigine and levetiracetam were effective in management of epilepsy in the elderly. Levetiracetam has a higher seizure-free effect than lamotrigine but lamotrigine is better tolerated than levetiracetam

[Surgical outcome of acetabular fracture using trochanteric flip osteotomy]

One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale [VAS], Harris hip score [HHS], force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13. The mean HHS was 82.5 [55-95]. Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition. It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases

Sexual dysfunction in Epileptic men

The aim of this study was to evaluate the frequency of sexual dysfunction among epileptic patients. Eighty married men between 22 and 50 years with a confirmed diagnosis of epilepsy were enrolled in this study. Patients with other neurological diseases, hypertension, cardiovascular diseases, diabetes mellitus, underlying urogenital diseases, and impaired general health status were excluded. Furthermore, those with mental health problems were identified by the standardized General Health Questionnaire-28 and were excluded. Demographic and clinical characteristics of the disease were evaluated, and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function-15 [IIEF-15]. Of 80 patients, 34 [42.5%] had erectile dysfunction. There were no differences between the patients in the 3 age groups [>30 years, 30 to 40 years, and > 40 years] in the IIEF scores. Type of seizure had a significant correlation with erectile function score [P=.008]. None of the IIEF domains scores were different between the patients with controlled epilepsy and those with uncontrolled epilepsy during the previous 6 months. However, frequency of epileptic seizures [before treatment] correlated with the scores for erectile function [r=0.31; P=.005], orgasmic function [r=0.23; P=.04], and sexual desire [r=0.24'P=.03]. It seems that the main aspects of sexual activity such as erectile function, orgasmic function, and sexual desire are frequently impaired in epileptic patients. Our findings were also indicative of a higher risk of sexual dysfunction in patients with partial seizures