Cardiac surgery in a patient with retroperitoneal fibrosis and heart valvulopathy, both due to pergolide medication for Parkinson's disease

Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25% of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d = 5.8 cm) ascending aorta. Retroperitoneal fibrosis improved with pergolide cessation and corticosteroid treatment. This is the second case reported in the literature, of a patient who had double valve and ascending aorta replacement surgery because he suffered from this rare but serious adverse effect of dopamine agonists used for managing Parkinson's disease

Modeling the Longitudinal Asymmetry in Sunspot Emergence -- the Role of the Wilson Depression

The distributions of sunspot longitude at first appearance and at disappearance display an east-west asymmetry that results from a reduction in visibility as one moves from disk centre to the limb. To first order, this is explicable in terms of simple geometrical foreshortening. However, the centre-to-limb visibility variation is much larger than that predicted by foreshortening. Sunspot visibility is also known to be affected by the Wilson effect: the apparent dish shape of the sunspot photosphere caused by the temperature-dependent variation of the geometrical position of the tau=1 layer. In this article we investigate the role of the Wilson effect on the sunspot appearance distributions, deducing a mean depth for the umbral tau=1 layer of 500 to 1500 km. This is based on the comparison of observations of sunspot longitude distribution and Monte Carlo simulations of sunspot appearance using different models for spot growth rate, growth time and depth of Wilson depression.Comment: 18 pages, 10 figures, in press (Solar Physics