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One of the most difficult symptoms to control in old age is restless legs. A particularly good review suggests that this may be due to vascular impairment or a minor neuropathy (Eur J Endovasc Surg 1997; 14: 430-2). Characteristics are that that the problem only occurs at rest, is worse at night, forces movements of the lower limbs and causes discomfort deep within the legs. Patients may benefit from massage and movement, and a wide range of drugs has been used. None is particularly effective and all should be avoided if there is a high risk of toxicity.
Bromocriptine, asbestos and pleural fibrosis
Drugs used in Parkinson's disease cause many side effects. Among the more unusual is that of bromocriptine in causing pleural fibrosis in patients previously exposed to asbestos (Eur Resp J 1997; 10: 2711-5). Eleven cases from Sweden and four from Australia were reviewed recently. When the drug was stopped, patients felt better, were less breathless and lost a previously persistent cough. The mechanism behind the side effect has not been defined yet.
Old people with broken hearts
There is considerable interest in the effects of …