Side effects of ropinirole in patients with idiopathic Parkinson's disease.

OBJECTIVE: Results achieved in treating the Parkinson's disease (PD) by the dopamine receptor agonist, ropinirole, have been hampered by its side effects. According to the MEDLINE, the most common side effects of ropinirole are extreme sleepiness and/or sudden sleep attacks, nausea, dyspepsia, vertigo, orthostatic hypotension and leg oedema. METHODS: The prospective research included PD patients who were administered non-ergoline dopamine agonist, ropinirole, over this period of time. The control group of patients were treated with levodopa. RESULTS: The research included 50 patients: 31 women and 19 men, of the mean age of 61.4 +/- 4.3 years. One patient reported sleepiness and one of them sudden sleep attacks. Nausea was experienced by three patients, and vertigo by two. Depression, orthostatic hypotension, leg oedema, dyspepsia, dry cough and hypersalivation were registered in particular cases. The control group of PD patients, treated with levodopa, comprised 52 patients, 33 women and 19 men of the mean age of 63.2 +/- 4.1 years. In the control group, nausea was registered in two patients. CONCLUSIONS: The non-ergoline dopamine agonist, ropinirole, most commonly causes nausea and sleepiness, less commonly uncontrollable sleep attacks, vertigo, dyspepsia, orthostatic hypotension, leg oedema. Dry cough and hypersalivation are recorded sporadically (Tab. 1, Ref. 22).

Effects of APACHE II score on mechanical ventilation; prediction and outcome.

AIM: To evaluate the influence of Acute Physiology and Chronic Health Evaluation (APACHE II) score on the choice of mechanical ventilation method and treatment outcome. METHODS: A prospective, randomized trial was carried out at the multidisciplinary Intensive Care Unit over 22 months. Research sample consisted of 129 patients who required mechanical ventilation, divided in two groups: APACHE II < or = 20 and APACHE II > 20. Both groups were than randomized for either noninvasive or invasive mechanical ventilation. Comparison was made based on patient characteristics, objective parameters and influence of APACHE II score on treatment success and failure. RESULTS: APACHE II scoring was shown to have statistical significance on outcome assessment. Statistical significance was in favour of patients with APACHE II score < or = 20 vs > 20 (ventilator associated pneumonia 0 vs. 10, tracheotomy 0 vs. 16, Intensive Care Unit mortality 0 vs 12). Furthermore, in the group with APACHE II score > 20, after randomization, there was a statistical significance in favour of noninvasive mechanical ventilation in need for tracheotomy 2 (4%) vs. 14 (28%) (p < 0.001). CONCLUSION: Using good patient selection and applying strict protocols, in the group of patients with APACHE II < or = 20 all patients had successful mechanical ventilation, while in the group of patients with APACHE II > 20, noninvasive mechanical ventilation can be applied.

Neurocysticercosis--non-specific clinical and neuroradiological presentation.

Neurocysticercosis (cysticercosis cerebri) is a rare neurological diagnosis in Croatia. It is classically divided into four types: intraparenchymal, basilar cisternal, ventricular and diffuse. Computerized tomography (CT) and magnetic resonance imaging (MRI) established the diagnosis by demonstrating cysticercosis disseminated throughout the cerebral parenchyma. The authors emphasize the potential of the ELISA test to detect anticysticercosis antibodies in blood and cerebrospinal liquor (CSF). Diagnostics of neurocysticercosis is enabled jointly by clinical signs, neuroradiological, serum and liquor tests. We report the case of a 70-year old man with clinical and neuroradiological signs of cysticercosis cerebri. The neurological status is dominated by ataxia, corticospinal pathways damages and cognitive capacity impairments. CT of the brain shows calcificated and cystic lesions of various sizes. MRI of the brain enables the final diagnosis of the cysticercosis cerebri with multiple and multicentric lesions that indicate various stages of the cerebral cysticercosis (Fig. 2, Ref 20). Full Text (Free, PDF) www.bmj.sk.