In our study, premedication with midazolam increased the patient-reported tolerance of the bronchoscopy. However, the absence of premedication did not affect the diagnostic yield of the procedure.

Introduction ‐ A multicentre randomized double‐blind parallel group study was carried out on 68 patients suffering from idiopathic Parkinson's disease (PD) treated with l‐dopa for at least 1 year with inadequate therapeutic responsiveness. The aim of the study was to compare the efficacy of α‐dihydroergocryptine (α‐DHEC) vs lisuride as an adjunct therapy to l‐dopa on dyskinesias and clinical fluctuations (Unified Parkinson's Disease Rating Scale [UPDRS] part IV), on the symptoms pattern (Columbia University Rating Scale [CURS]), on disability (Northwestern University Disability Scale [NUDS]), and to evaluate the incidence of adverse events. Patients and methods ‐ Thirty‐two patients (18 males, 14 females with a mean age of 64.5 ± 1.5 SEM) were randomized to α‐dihydroergocryptine and 36 (16 males, 20 females with a mean age of 61.8 ± 1.4) to lisuride. The treatment lasted 3 months and the dosage was increased until it reached 60 mg/day of α‐dihydroergocryptine and 1.2 mg/day of lisuride, while the l‐dopa dosage was kept constant in both groups. Per protocol and intention to treat analyses were performed on response variables. Results ‐ The adjunctive treatment with the two dopamine agonists determined a significant improvement of PD symptoms in both groups. Alpha‐dihydroergocryptine showed a superior efficacy in reducing the clinical complications (P <0.01 by ANOVA). The number of patients complaining of adverse events was 8 out of 32 (25%) for α‐dihydroergocryptine and 24/36 (67%) for lisuride (P<0.05). Conclusion ‐ Alpha‐dihydroergocryptine effect seems to be superior to that of lisuride both in terms of reduction of l‐dopa therapy long term motor complications (UPDRS part IV) as well as in terms of the incidence and severity of adverse events.

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Described is a case of peripheral neuropathy secondary to essential cryoglobulinemia. This complication of the disease is exceptional. One month prior to admission, a 28-year-old woman complained of paresthesias in the distal parts on her limbs; this was followed by impairment of sensation, with difficulties in standing and walking. Finally, there was an almost total loss of motion of the fingers of both hands. The clinical picture and laboratory studies demonstrated a damage of the nerve trunks, of equal intensity in the arms and the left leg. In the right leg it was less marked. The cryoprecipitate was composed of IgG and IgM. The possible mechanisms of the immunological reactions, and the pathogenesis of the neurological manifestations are discussed.

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