Three patients with Parkinson's disease are described who developed pericardial, retroperitoneal, and pleural fibrosis associated with pergolide treatment. Surgical intervention was required in all three cases, either to reach a tissue diagnosis or for potentially life threatening complications. Symptoms emerged on average 2 years after the institution of treatment, and were suYciently non-specific to cause significant delays in diagnosis in all cases. The erythrocyte sedimentation rate (ESR) was raised in the two patients in whom it was measured. Serosal fibrosis is a rarely reported adverse eVect of pergolide treatment, although it is well described with other dopamine agonists. We suggest that patients with Parkinson's disease who receive pergolide treatment should be regularly monitored for the development of such complications. (J Neurol Neurosurg Psychiatry 1999;66:79-81)

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SYNOPSIS Six patients with idiopathic Parkinsonism were treated with a combination of amantadine and L-dopa and after 12 to 24 weeks amantadine was replaced by placebo for a six week period in a double-blind trial. Although there was a tendency for clinical disability ratings and scores on objective ratings of motor skills to deteriorate initially after amantadine removal, there was no significant deterioration in clinical improvement or motor performance during the period of amantadine withdrawal. Amantadine withdrawal also failed to cause any significant change in plasma concentrations of L-dopa or its metabolite 3-methoxy-dopa in these patients. In a group of 27 patients seen regularly as outpatients measurements of plasma L-dopa failed to correlate significantly with either oral dose or with clinical improvement scores. The plasma concentration of 3-methoxy-dopa, however, was on average 2.8 times higher than that of L-dopa, and there was a significant correlation between plasma levels of this metabolite and clinical improvement. It is suggested that 3-methoxy-dopa may contribute significantly to the therapeutic actions of L-dopa in Parkinsonism.Amantadine and L-dopa are in widespread use, either singly or in combination, in the treatment of patients with Parkinsonism. The combination of amantadine and L-dopa has been claimed to be more effective than L-dopa alone, although not all trials have confirmed this synergism (for review see Parkes et al., 1973). Amantadine has also been shown to decrease the daily L-dopa therapeutic dosage requirements and it has been suggested that amantadine may decrease the extracerebral metabolism of L-dopa, thus rendering more drug available to the central nervous system (Peaston et al., 1973). In the present study we present clinical and biochemical findings in a group of patients treated with the combination preliminary experiments showed that both compounds were stable under these storage conditions. Plasma samples (4 ml) were deproteinized by addition of 4 ml ice-cold O.4N perchloric acid, and stand-

SYNOPSIS The ocular fundi of 20 patients were examined before and after pneumoencephalography. In four of these, fresh venous retinal haemorrhages were seen, and a further patient had developed an exudate. Possible reasons for a rise in retinal venous pressure include bodily inverting the patient, compression of the thorax, the use of positive pressure respiration, and the air injection itself. It may be advisable to take steps to limit the effects of such possible causative factors.In 1973, Simon and colleagues published an account of several cases of intraocular haemorrhage resulting from air myelography carried out under general anaesthesia. They described three cases of symptomatic haemorrhage occurring in an uncontrolled series of 480 gas myelographies, while in a pilot series of 19 patients examined before and after myelography there were five patients with asymptomatic retinal or preretinal haemorrhages. At the time of the original presentation of this work, the authors were criticised for what appeared to be 'faulty' techniques and, indeed, they pointed out in a footnote that, after certain modifications to the procedure, no further haemorrhagic incidents occurred. It was also claimed that such complications were specific to gas myelography and did not occur with, for example, pneumoencephalography.Retinal haemorrhage is not a recognised complication of pneumoencephalography (Milkowski, 1969;Clark et al., 1970;Bergeron and Rumbaugh, 1971), although intracranial haemorrhage, usually subdural, is well documented