Minerva

Stents are now used in 30-60% of all coronary angioplasty procedures at most interventional centres, says a viewpoint article in Heart (1998;79:541-2). It warns that stents are permanent implants and that over time millions of patients will have been given them with little evidence about the long term risks — loss, migration, infection, and metal fatigue. Long term assessment is needed in randomised trials if cardiologists are not to relive the uncertainties associated with Shiley prosthetic valves and the Teletronics pacemakers.

Most patients with hepatic encephalopathy have raised serum concentrations of natural benzodiazepines either derived from the diet or derived from synthesis by bacteria or fungi in the intestines (Gut 1998;42:764-5). These compounds escape hepatic clearance in patients with substantial liver disease and accumulate in the blood. In some patients they contribute to hepatic encephalopathy by simulating the action of prescription benzodiazepines, but much has still to be learnt about their interaction with other toxins such as ammonia.

People who are struck by lightning and lose consciousness may develop late symptoms of fatigue and lack of energy. This is the tentative conclusion of a paper from the Netherlands in the Journal of Neurology, Neurosurgery, and Psychiatry (1998;64:763-9). It describes six patients who were left …