Jiří Fiedler

Pramipexole and pergolide in the treatment of depression in Parkinson's disease:a national multicentre prospective randomized study.

An 8‐month multicentre prospective randomized study aimed at comparing the effects of dopamine receptor agonists pramipexole (PPX; Mirapexin®) and pergolide (PRG; Permax®) as add‐on to L‐dopa therapy on depression [Montgomery and Asberg Depression Rating Scale (MADRS)] in 41 non‐demented patients (25 men, 16 women) suffering from both mild or moderate depression and advanced Parkinsons disease (PD). The assessment was performed by a blinded independent observer. Motor symptoms (UPDRS III), motor complications (UPDRS IV), activities of daily living (UPDRS II and VI) and depressive symptoms as measured by Self – Rating Depression Scale by Zung were evaluated in an open‐label design.

Cognitive performance in people with Parkinson's disease and mild or moderate depression: effects of dopamine agonists in an add‐on to l‐dopa therapy

In a randomized prospective multi‐centre study, we evaluated the cognitive performances of a group of 41 non‐demented patients, all with advanced Parkinsons disease (PD) and a current depressive episode, in whom the effects of pramipexole (PPX) and pergolide (PRG) in an add‐on to l‐dopa therapy were also studied and published with regard to motor symptoms of PD, motor complications and depression. The Trail Making Test, the Stroop test and four subtests (arithmetic, picture completion, digit symbols and similarities) of the Wechsler Adult Intelligence Scale‐Revised were performed prior to and 8 months after the administration of either PPX or PRG. We found no statistically significant difference between the two tested drugs or between the first and the last visit in any of the above‐listed neuropsychological tests. All patients’ motor outcomes significantly improved and we conclusively demonstrated the anti‐depressive effect of PPX. The dissociation of dopaminomimetic effects on the different tested domains indicates that there are different pathological mechanisms of cognitive, motor and affective disturbances in advanced PD patients. In our non‐demented group of fluctuating depressed PD subjects, both PPX and PRG administration in combination with l‐dopa were safe in terms of the effect on cognitive performance.

Effect of catheter-based patent foramen ovale closure on the occurrence of arterial bubbles in scuba divers.

OBJECTIVES This study sought to evaluate the effect of catheter-based patent foramen ovale (PFO) closure on the occurrence of arterial bubbles after simulated dives. BACKGROUND PFO is a risk factor of decompression sickness in divers due to paradoxical embolization of bubbles. To date, the effectiveness of catheter-based PFO closure in the reduction of arterial bubbles has not been demonstrated. METHODS A total of 47 divers (age 35.4 ± 8.6 years, 81% men) with a PFO (PFO group) or treated with a catheter-based PFO closure (closure group) were enrolled in this case-controlled observational trial. All divers were examined after a simulated dive in a hyperbaric chamber: 34 divers (19 in the PFO group, 15 in the closure group) performed a dive to 18 m for 80 min, and 13 divers (8 in the PFO group, 5 in the closure group) performed a dive to 50 m for 20 min. Within 60 min after surfacing, the presence of venous and arterial bubbles was assessed by transthoracic echocardiography and transcranial color-coded sonography, respectively. RESULTS After the 18-m dive, venous bubbles were detected in 74% of divers in the PFO group versus 80% in the closure group (p = 1.0), and arterial bubbles were detected in 32% versus 0%, respectively (p = 0.02). After the 50-m dive, venous bubbles were detected in 88% versus 100%, respectively (p = 1.0), and arterial bubbles were detected in 88% versus 0%, respectively (p < 0.01). CONCLUSIONS No difference was observed in the occurrence of venous bubbles between the PFO and closure groups, but the catheter-based PFO closure led to complete elimination of arterial bubbles after simulated dives. (Nitrogen Bubble Detection After Simulated Dives in Divers With PFO and After PFO Closure; NCT01854281).

Multiple mobile aortic thrombosis treated by thrombolysis. A case report.

Mobile aortic thrombosis is a relatively rare condition with a high morbidity particularly due to peripheral embolisation. The most frequent management is anticoagulant or surgical therapy but the number of cases reported is limited and therapeutic approaches are still not well established. We present a case of large multiple mobile pedunculated thrombosis in descending aorta treated by thrombolysis.

Effect of conservative dive profiles on the occurrence of venous and arterial bubbles in divers with a patent foramen ovale: A pilot study

Patent foramen ovale (PFO) is a risk factor for decompression sick-ness(DCS)indiversduetoparadoxicalembolizationofnitrogenbubblesformed in peripheral blood during decrease of ambient pressure [1].Inour previous study we have demonstrated that catheter-based PFO clo-sure prevented right-to-left shunting of bubbles and might preventDCS recurrence [2]. However, the question of PFO closure is still debat-able [3].Also,randomizedclinicaldataarelackinginthis field.Therefore,the majority of divers are currently not referred for PFO closure, andvarious conservative dive profiles (CDP) are recommended to preventunprovoked DCS (i.e., without violation of decompression regimen) [4].Unfortunately, to date, the safety of these CDP has not been tested in di-verswithPFO.Theaimofthisstudywastotesttheeffectofdivetimeandascent rate restrictions on the occurrence of venous and arterial bubblesin diverswith PFO after simulated dives.We compareda standardly rec-ommended no-decompression dive [5] and a stricter regimen withslower ascent to the same control dive, which was previously used totest the efficacy of catheter-based PFO closure [2].Wescreenedatotalof 532 consecuti vediversforPFOusingtranscra-nialcolorcodedsonography(TCCS).ThediagnosisofPFOwascon firmedbytransesophagealechocardiography.Forty-sixdivers(36.4±10 years;72% men) with a significant PFO (grade 3 according to the internationalconsensus criteria [6]) who had previously not undergone PFO closurewere enrolled in this pilot study. All divers performed a simulated diveto 18 m in a hyperbaric chamber. Divers were randomized into threegroups: group A (n = 13; 36.5 ± 9 years; 77% men) performed a stan-dard Buhlmann regimen no-decompression dive (dive time 51 min,ascent rate 10 m/min), group B (n = 14, 40.9 ± 12 years; 64% men)performed the same regimen with a slower ascent (51 min, 5 m/min),and a control group (n = 19; 33.0 ± 8 years; 74% men) performed astaged-decompression dive according to the US Navy decompressionregimen (80 min, 9 m/min, decompression stop 7 min at 3 m). Within60 min of surfacing, the presence of venous and arterial bubbles wasassessed. Venous bubbles were assessed by pulse wave Doppler in therightventricularout flowtract (RVOT),andarterialbubbles byTCCS dur-ing native breathing and after Valsalva maneuvers, as described previ-ously [2]. The study was approved by the local ethics committee and allpatients signed an informed consent.In all divers, visualization of RVOT and the middle cerebral artery waspossible. The occurrence of arterial and venous bubbles is summarized inFig. 1. There was significantly lower occurrence of venous bubbles ingroups A and B compared to controls (for group A, 31% vs. 74%, p =0.03; for group B, 14% vs. 74%, p b 0.01). The reduction in arterial bubbleoccurrencewasnotsigni ficantingroupAcomparedtocontrols,buttherewas elimination of arterial bubbles in group B (for group A, 8% vs. 32%,p = 0.42;forgroupB,0%vs.32%,p= 0.03).Therewasnosigni ficantdif-ference in venous or arterial bubble occurrence between groups A and B(venous, 31% vs. 14%, p = 0.38; arterial, 8% vs. 0%, p = 0.48). All diverswere observed for any DCS symptoms 24 h after the simulated dive. Inthe control group transient neurological symptoms (headache, unusualfatigue, and transitory visual disturbances) were present in 21% of divers,no DCS symptoms were observed in group A (p = 0.13) or B (p = 0.12).Generally, the aim of our research is to stratify the risk of DCS indiverswithPFOandtofindtheoptimalmanagementstrategyforsymp-tomatic divers, including potential catheter-based PFO closure. In our