$516 Friday, November 11, 2005 Poster Abstracts

Background: A 34 year old man had presented 4 years previously to his GP. After starting an exercise regimen he noted tingling in the tips of Iris big toes. Investigations revealed he was mildly anaemic and folate and B12 deficient. He was given supplements but ssanptoms progressed with thighs, front of torso and dorsal aspects of his forearms becoming affected. An MRI of Iris cervical cord showed high T2 signal posteriorly, extending from the cranio-cervical junction to TI0 / l l consistent with sub-acute combined degeneration. Methods: Over the next two years his symptoms progressed with more intense dysaesthesia and marked delay of Iris visual evoked potentials. At that time he was further investigated, the clinical opinion being that he had features consistent with BI2 deficiency which had not responded to treatment. However, total homocysteine was low normal. Serum iron and his binding saturation were low, but ferritin normal. A bone marrow showed marrow dysplasia. A penicillanffne challenge revealed no rise in urinary copper excretion. Serum copper was low, 0.7 umol/L as was caeruloplasnffn 0.02 umol/L. Resltlts: A fresh frozen plasma challenge test showed an unequivocal normalisation of his iron p rofile. A trial of intravenous copper resulted in a mild improvement of his serum iron status and two weeks later marked restoration of haematological parameters; Hb 11.2g/dL from 8.9 and neutroplffls 1.81 × 109/L fi'om 0.02. Serum zinc was noted to be raised (32.4 umol/L Ref range 11-18) with free zinc also raised at 2.8 umol/L. Conclusion: A diagnosis of zinc toxicity was made.

I640 Percutaneons dosure of patent Foramen Ovale - longtenn results

Leetz, M ~, Fischer, E 1, Taaffee, M 1, Hein, R 1, Reschke, M ~, Bayard, y1, Bfischek, F ~, Ostermayer, S 1, Billinger, K 1, Trepels, T ~, Hoffinann, 11, Rtmer , A 1, Sievert, H 1. 1Cardiol/ascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany

Background: A PFO may cause paradoxical embolism and embolic stroke. Catheter closure of PFO has been recommended to prevent further events and is performed now in many centers. Limited information is available about long term- results. Methods: Since 1994 1037 patients underwent percutaneous PFO closure in our center. 518 of these patients experienced a stroke, 579 a TIA and 42 patients a peripheral embolism before closure The annual recurrence rate from the first embolic event until PFO closure was 20.7% Mean PFO stretched diameter was 9.4 -c 3.6 m_m. The age ranged fi'om 17-84 years, on average 49 ± 13. The following devices were used: 365 Amplatzer, 308 Helex, 23 CardioSeal, 263 STARflex, 11 ASDOS, 55 Premere, 4 PFO Star, 21 AngelWings, 2 Cardiostar, 26 Sideris. The patients underwent TEE and X-ray one and six month after the procedure, thereafter follow up was performed clinically and by questionnaires (follow-up 1-108 mo). Results: PFO closure was techuically successful in all patients. In 32 patients the device was implanting during a second procedure. Mean procedure time was 35.2 ± 18 min, mean X-ray time: 6.1 ± 4.9 rain and mean hospital stay: 0.9 ± 0.7 days. The occhider embolished in one patient. One patient underwent surgery because of a tamponade and one more had a hemipericardium. Other complications during follow- up: The occluder embolished in two patients (no sequelae). 3.4% developed paroxysmal atrial fibrillation, seven patients experienced a stroke. The annual recurrence rate after PFO closure was 1.5%. Conclusion: Percutaneous PFO closure is a feasible and safe procedure. Our results suggest that it prevents further embolic events also during longtime follow-up.

1641 A ease series of Metfonnin ~elated vitamin BI2 deficiency in Diabetes elderly correlated with Neurological Manifegtations

Liu, K 1, Dai, D 1,Ma, R 1, Woo, 31. 1Division of Geriatric and Endocrinology Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China

Background: M e t f o n ~ n has been used for the treatment of diabetes for many years and its effectiveness was highlighted in the United Kingdom Prospective Diabetes Study (UKPDS). Its side effect in causing Vitanffn B12 deficiency, in particular in the elderly, has received less attention. Methods: A retrospective case series of Subacute Combined Degenera- tion of Cord (SACD) in elderly diabetic patients taking metformin, who were found to be deficient in vitamin B12. (The B12 deficiency was attributed to metformJn use following exclusion of other common causes of B12 deficiency). Results: Patients who had early diagnosis of the Subacute Combined Degeneration of Cord associated with metformin and treated with cyanocobalamin replacement had a favourable recovery of function. Since metfonnin can be associated with malabsorption of vitamin B12 especially in elders who already have a lffgh prevalence of food cobalanffn malabsorption, the recognition of the vitanffn deficiency is vital in prompt treatment of neurological complications. Conclusion: Clinicians should be alerted to the possibility of metformin related B12 deficiency, especially in the elder patient receiving high daily doses of metfon-nin for a long period. Regular checking of BI2 levels in diabetic patients on the drug is recommended.

1642 Devie's Neuromyelilis Optiea occurring as a Paraneoplastie Phenomenon

Manasseh, R G l, Kermode, A G 1, Lai, N Y1, Blacker, D J~, Carroll, W M ~. ZSir Charles Gairdner Hospital, Perth, Australia

Background: Devic's neuromyelitis optica is characterised by acute or subacute myelitis associated with ruff lateral or bilateral optic neuritis. There is increasing evidence that it is a primary autoimmune disorder (1). We describe a case of neuromyelitis optica in a patient after resection of glioblastoma multiforme, that responded to immunother- apy. Tiffs is the only case report of neuromyelitis optica potentially occurring as a paraneoplastic phenomenon. CASE: A 51 year old man with no sigtffficant past medical history presented with a 3 month history of headache and symptoms suggestive of complex partial seizures. M R imaging was consistent with right temporal glioblastoma multiforme. 9 days after surgical resection, the patient developed severe paraparesis, ascending pansen- sory loss and splffncteric dysfunction. This was followed 9 days later by severely impaired visual acuity due to bilateral optic neuritis. MR imaging of the brain and spinal cord demonstrated longitudinal thoracic myelopathy and bilateral optic neuritis. CSF examination demonstrated lymphocytic pleocytosis. Paraneoplastic and other autoantibodies, including NMO-IgG (performed at the Mayo Clinic) were negative (12). The patient responded to pulsed intravenous methylprednisolone with sigtffficant recovery of function. Conclusion: We propose that paraneoplastic-mediated immune attack against the patient's spinal cord and optic nerves may have been precipitated by surgical resection of the tumour, resulting in increased onconeural antigen presentation to the inmmne system (13). Histo- pathology demonstrated glioblastoma multiforme with heavy inflam- matory infiltrate, wlffch is often a feature of tumours in paraneoplastic disorders (4).

1643 El'l~ct of C~ocus Salivus L. (satl2on} on Depression Among Sludents of Zabol Faculty of Medical Sciences 2005

Masinaei Nezhad, N 1, Abdullahi Mohanmlad, AQ 1, Hasherni Bonjar, Z S 1, Assadi Bidmeshki, E 1, Arbabi Sarjou, A 2, Rahnama, M ~ . 1Zabo[ Faculty of Medical Sciences, Zabol, lran; 2Zahedan University of Medical Sciences, Iron

Inhroduefion and Aims: Depression is one of the four major diseases in the world and it is the most common cause of disabilities due to mental disease. Saffion is used to treat depression. Herbalists indicated that