316
DETAILS OF PATIENTS WITH SECONDARY HYPOPITUITARISM
offspring, screening of animals from herds that had contained an infected individual, improved abattoir methods, and research to investigate transmission from cows to non-human primates. Our results reflect a high level of concern among informed medical staff that the Government’s and Chief Medical Officer’s reassurances about the safety of "British beef’ may be premature. They also have obvious implications for menu planners in hospital canteens.
R. HOWARD D. CASTLE
Maudsley Hospital, London SE5 8AZ, UK ___
__ -
i
_
_
i
__ -
._
i
i
i
*Free T4 (RIA) (normal 10
4-24-2). tThyrotropin (immunoradiometric assay) (normal
03-6 0; detection limit 01) by Becton Dickinson ’SimulTRAC’. tCortlsol RIA by Farmos Diagnostica (Turku, Finland). CT= computed tomographic, ND=notdone; +ve= positive; -ve= negative
We agree with your statement that secondary hypothyroidism should never be diagnosed solely on the basis of a low thyroxine, even in patients with growth hormone deficiency. In patients with low thyroxine and normal thyrotropin, and in whom secondary hypothyroidism is thought to be a possibility, we find the thyrotropin releasing hormone (TRH) test useful to confirm central hypothyroidism,z especially when radiological features of the pituitary gland are negative. There might be a case for revival of a test that has been largely forgotten. Department of Chemical Pathology, Newham General Hospital,
S. BULUSU J. CRANFIELD
A.
London E13 8RU, UK
Toft AD, Seth J. Sensitive thyrotropin assays: excellent when properly used. Br Med J 1987; 295: 1503. 2. Mardell RJ, Gamblen TR. Thyroid function test in clinical practice. Bristol: John Wright, 1985: 105-11. 1.
Concern about bovine
spongiform encephalopathy
SIR,-The report by Dr Collinge and colleagues (July 7, p 9), demonstrating that spongiform encephalopathy cannot be excluded by neuropathological techniques, suggests that the true prevalence of such diseases is underestimated and will cause fresh concern about the impact of the current bovine spongiform encephalopathy (BSE) outbreak. We suspected that the advice of the Government and Chief Medical Officer that eating beef carries no risk of transmission of a BSE-like illness in man had failed to reassure our colleagues. To test this, we circulated a questionnaire to 104 medical staff at our hospital. 68% of the questionnaires were completed and returned. Of those responding, 92% were psychiatrists, 4% neurosurgeons, and 4% neurologists, neuroradiologists, and neurophysiologists. 10% of respondors were professors, 30% consultants, and 60% junior medical staff. 3 respondents were vegetarians. 65% answered yes to the question "have your attitudes to beef eating changed recently?" Of these, 96% attributed this change to concerns about BSE. When asked how this change of attitude had affected their beef consumption, 2% claimed to be eating more, 4% the same amount, 52% significantly less, and 41 % had stopped eating beef altogether. Several respondents added that although they continued to eat beef they were not offering it to their children. When asked about the possible risk of transmission of a BSE-like illness to man via infected beef, only 1 % thought there was absolutely no risk, 75% thought that the risk was small but could not be excluded, and 24% answered that eating beef from infected animals "almost certainly" carries a risk. 94% expressed concern that meat from pigs or chickens fed BSE-infected offal products might carry a risk. Only 28% felt that the public had been fully informed about the possible dangers of eating infected beef and the risk of consequent spongiform encephalopathy. We asked what measures would give full reassurance that beef was safe. The most common suggestions were slaughter of all infected animals and their
Ropinirole without levodopa
in Parkinson’s
disease stimulators are effective in the of Parkinson’s disease. They are usually given at low doses with levodopa,’ but sometimes alone.Z,3Ropinirole (SKF 101468) is a potent selective D agonist4 that in low doses up to 2 mg twice daily, in combination with levodopa, has antiparkinsonian activity and is well tolerated. We show here that the drug may be as active as levodopa when given by itself. Patients were treated with single increasing doses of ropinirole to find the ideal dosage and to compare motor improvement with that obtained with levodopa. Four men and two women in stage 111-IV Parkinson’s diseasewith motor oscillations were studied. Their average age was 58 years (SE 5) and mean disease duration was 10 (2) years. All were responding to levodopa at daily doses of 650 (148) mg plus a dopa-decarboxylase inhibitor. All regular drugs, including levodopa, were withheld 12-18 hours before administration of ropinirole. Motor response to a single supraliminal morning dose of levodopa was evaluated’ (mean of 2 tests). Over ensuing days patients were given a series of single oral doses of (1, 2, 4, 6, 8, and 10 mg) ropinirole 30 min after 20 mg domperidone.8 The patients proceeded to the next dose of ropinirole if the previous one had been well tolerated. Parkinsonian motor disability was rated9 before and 15, 30, 45, 60, 90, 120, 150, 180, 240, and 300 min after drug administration. The effects (delay of onset, duration of action, improvement in motor disability score) of levodopa and ropinirole were compared. A significant dose-dependent improvement in motor disability was observed in all patients (table). "On" periods similar to those obtained with levodopa, were seen in all patients when doses of ropinirole above 4 mg were used. One patient improved after 1 and 2 mg of the drug. Benefit was noted 30-40 min after administration and the duration of the response became longer as the dose increased. Doses giving greatest clinical improvement produced in all patients dyskinesias similar to those experienced with levodopa. Adverse effects consisted of drowsiness and euphoria (three patients at doses of 6 and 8 mg, 2 at 10 mg), and nausea (one patient at doses of 8 and 10 mg). One patient had transient symptomatic postural hypotension with bradycardia at a dose of 6 mg, and the 8 mg test was not done. No haematological or biochemical changes occurred. These findings indicate that ropinirole is a powerful antiparkinsonian agent with dose-dependent activity comparable to
SIR,-Dopamine Dz receptor
treatment
EFFECT OF SINGLE ORAL DOSES OF ROPINIROLE OR LEVODOPA ON PARKINSONIAN DISABILITY
Results
as mean
*p
DETAILS OF PATIENTS WITH SECONDARY HYPOPITUITARISM
offspring, screening of animals from herds that had contained an infected individual, improved abattoir methods, and research to investigate transmission from cows to non-human primates. Our results reflect a high level of concern among informed medical staff that the Government’s and Chief Medical Officer’s reassurances about the safety of "British beef’ may be premature. They also have obvious implications for menu planners in hospital canteens.
R. HOWARD D. CASTLE
Maudsley Hospital, London SE5 8AZ, UK ___
__ -
i
_
_
i
__ -
._
i
i
i
*Free T4 (RIA) (normal 10
4-24-2). tThyrotropin (immunoradiometric assay) (normal
03-6 0; detection limit 01) by Becton Dickinson ’SimulTRAC’. tCortlsol RIA by Farmos Diagnostica (Turku, Finland). CT= computed tomographic, ND=notdone; +ve= positive; -ve= negative
We agree with your statement that secondary hypothyroidism should never be diagnosed solely on the basis of a low thyroxine, even in patients with growth hormone deficiency. In patients with low thyroxine and normal thyrotropin, and in whom secondary hypothyroidism is thought to be a possibility, we find the thyrotropin releasing hormone (TRH) test useful to confirm central hypothyroidism,z especially when radiological features of the pituitary gland are negative. There might be a case for revival of a test that has been largely forgotten. Department of Chemical Pathology, Newham General Hospital,
S. BULUSU J. CRANFIELD
A.
London E13 8RU, UK
Toft AD, Seth J. Sensitive thyrotropin assays: excellent when properly used. Br Med J 1987; 295: 1503. 2. Mardell RJ, Gamblen TR. Thyroid function test in clinical practice. Bristol: John Wright, 1985: 105-11. 1.
Concern about bovine
spongiform encephalopathy
SIR,-The report by Dr Collinge and colleagues (July 7, p 9), demonstrating that spongiform encephalopathy cannot be excluded by neuropathological techniques, suggests that the true prevalence of such diseases is underestimated and will cause fresh concern about the impact of the current bovine spongiform encephalopathy (BSE) outbreak. We suspected that the advice of the Government and Chief Medical Officer that eating beef carries no risk of transmission of a BSE-like illness in man had failed to reassure our colleagues. To test this, we circulated a questionnaire to 104 medical staff at our hospital. 68% of the questionnaires were completed and returned. Of those responding, 92% were psychiatrists, 4% neurosurgeons, and 4% neurologists, neuroradiologists, and neurophysiologists. 10% of respondors were professors, 30% consultants, and 60% junior medical staff. 3 respondents were vegetarians. 65% answered yes to the question "have your attitudes to beef eating changed recently?" Of these, 96% attributed this change to concerns about BSE. When asked how this change of attitude had affected their beef consumption, 2% claimed to be eating more, 4% the same amount, 52% significantly less, and 41 % had stopped eating beef altogether. Several respondents added that although they continued to eat beef they were not offering it to their children. When asked about the possible risk of transmission of a BSE-like illness to man via infected beef, only 1 % thought there was absolutely no risk, 75% thought that the risk was small but could not be excluded, and 24% answered that eating beef from infected animals "almost certainly" carries a risk. 94% expressed concern that meat from pigs or chickens fed BSE-infected offal products might carry a risk. Only 28% felt that the public had been fully informed about the possible dangers of eating infected beef and the risk of consequent spongiform encephalopathy. We asked what measures would give full reassurance that beef was safe. The most common suggestions were slaughter of all infected animals and their
Ropinirole without levodopa
in Parkinson’s
disease stimulators are effective in the of Parkinson’s disease. They are usually given at low doses with levodopa,’ but sometimes alone.Z,3Ropinirole (SKF 101468) is a potent selective D agonist4 that in low doses up to 2 mg twice daily, in combination with levodopa, has antiparkinsonian activity and is well tolerated. We show here that the drug may be as active as levodopa when given by itself. Patients were treated with single increasing doses of ropinirole to find the ideal dosage and to compare motor improvement with that obtained with levodopa. Four men and two women in stage 111-IV Parkinson’s diseasewith motor oscillations were studied. Their average age was 58 years (SE 5) and mean disease duration was 10 (2) years. All were responding to levodopa at daily doses of 650 (148) mg plus a dopa-decarboxylase inhibitor. All regular drugs, including levodopa, were withheld 12-18 hours before administration of ropinirole. Motor response to a single supraliminal morning dose of levodopa was evaluated’ (mean of 2 tests). Over ensuing days patients were given a series of single oral doses of (1, 2, 4, 6, 8, and 10 mg) ropinirole 30 min after 20 mg domperidone.8 The patients proceeded to the next dose of ropinirole if the previous one had been well tolerated. Parkinsonian motor disability was rated9 before and 15, 30, 45, 60, 90, 120, 150, 180, 240, and 300 min after drug administration. The effects (delay of onset, duration of action, improvement in motor disability score) of levodopa and ropinirole were compared. A significant dose-dependent improvement in motor disability was observed in all patients (table). "On" periods similar to those obtained with levodopa, were seen in all patients when doses of ropinirole above 4 mg were used. One patient improved after 1 and 2 mg of the drug. Benefit was noted 30-40 min after administration and the duration of the response became longer as the dose increased. Doses giving greatest clinical improvement produced in all patients dyskinesias similar to those experienced with levodopa. Adverse effects consisted of drowsiness and euphoria (three patients at doses of 6 and 8 mg, 2 at 10 mg), and nausea (one patient at doses of 8 and 10 mg). One patient had transient symptomatic postural hypotension with bradycardia at a dose of 6 mg, and the 8 mg test was not done. No haematological or biochemical changes occurred. These findings indicate that ropinirole is a powerful antiparkinsonian agent with dose-dependent activity comparable to
SIR,-Dopamine Dz receptor
treatment
EFFECT OF SINGLE ORAL DOSES OF ROPINIROLE OR LEVODOPA ON PARKINSONIAN DISABILITY
Results
as mean
*p
