Minerva

Empirical treatment with an antibiotic without serological testing is the recommended management for a patient with a rash resembling erythema migrans and a high probability of having Lyme disease, says a review in Annals of Internal Medicine (1998;128:37-48). The review argues that it is the doctor's estimate of the probability that a particular patient has Lyme disease that determines whether withholding treatment, testing, or giving empirical treatment is the optimal strategy.

Patients with psychiatric disorders often use cannabis: in a small survey reported in the Scottish Medical Journal (1997;42:171-2) half of those admitted to a psychiatric unit who were asked about the drug admitted to using it. One third of these were taking other drugs as well. Cannabis may decrease the side effects of neuroleptic drugs, but it may also interfere with their action, and the report warns that its use may be harmful to people with mental illness.

Vigorous shaking of an infant may lead to fatal brain damage, and it now seems that this may also happen in adults. A case report in the American Journal of Forensic Medicine and Pathology (1997;18:312-4) describes a Palestinian man aged 30 who collapsed under interrogation in Israel and died. Necropsy showed an acute subdural haemorrhage and bruising of the chest and shoulders. The investigators admitted having shaken the man violently.

Lung cancer is still the most common cancer in the United States so the search is continuing for a means of early diagnosis, ideally while the lesion is still in a …