Minerva

Before a diagnosis of the chronic fatigue syndrome is made other possibilities must be excluded. One that might easily be overlooked is chronic ciguatera poisoning (Medical Journal of Australia 1997;166:309-10). Most people poisoned by eating tropical fish recover quickly, but as many as 2% may go on to remain in “incomplete convalescence.” With so much exotic fish eaten in temperate countries, this condition may be seen anywhere.

The asymptomatic carotid atherosclerosis study showed clinical benefits from surgery in patients with 60% or greater stenosis in one or both internal carotid arteries. Economic analysis of the data from this study showed, however, that screening people over the age of 65 who do not have symptoms is not cost effective (Annals of Internal Medicine 1997;126:337-46). The cost for each (quality adjusted) life year gained was $120 000 (£77 400).

A case report in the British Journal of Psychiatry (1997;170:285-7) describes a woman now aged 74 who has had 430 treatments with electroconvulsive therapy without any evidence of progressive intellectual deterioration. She has bipolar disorder, and electroconvulsive therapy (given at one time twice a week and more recently twice a month) has proved by far the best regimen for preventing relapse.

Asthma should …