1349
Chronic fatigue syndrome Most patients with chronic fatigue syndrome (CFS) attribute their symptoms to an infectious or immunological rather than a
psychological cause. But the evidence for a viral aetiology seems to be weakening. By contrast, a high prevalence of psychiatric disorder has been found in most studies of CFS patients. About half of them have a major depressive illness. The syndrome was the subject of a Ciba Foundation symposium held in London earlier this month. The muscle pains that gave the disorder its other name, "myalgic encephalomyelitis" (ME), show no correlation with changes in fibre type, fibre size, or any other alterations in muscle physiology. CFS seems not to be a myopathy. The three groups of viruses that have attracted attention as possible aetiological agents in CFS are herpesviruses (most notably Epstein-Barr virus, cytomegalovirus, and herpesvirus type 6), a retrovirus, and enteroviruses. In most studies of CFS patients the prevalence of viral antibodies has been higher than that in the general population, but the consensus view is that none of the viruses under investigation is a dominant cause of the syndrome or even necessary to the perpetuation of the illness. Many virological studies of CFS are criticised on methodological grounds. Evidence of infection with a retrovirus related to human T-cell lymphotropic virus type II has been obtained in some CFS patients, but its contribution to the aetiology and pathogenesis of the disease is unknown, as is its prevalence in healthy people. In one study, enteroviral RNA sequences were identified in muscle biopsy specimens from 53% of CFS patients, compared with 16% of controls. At the heart of the ME controversy lie the perceived stigma of psychiatric illness and the belief that psychological distress is less "real" than organic disease. Correct diagnosis is important, because treatable disorders may be missed. The high rate of psychiatric disorders in CFS (which do not include the "hysteria" publicised by the popular press) is as yet unexplained. However, the evidence is against psychiatric disorder solely as a reaction to physical illness. Hypothalamic dysfunction, particularly that involving 5hydroxytryptamine metabolism, has been reported in some CFS patients, and cerebral abnormalities are seen as a promising area for future research. Do psychiatric disorder and CFS have a common cerebral cause? Do infective agents indirectly cause subtle biochemical changes in parts of the brain that control energy, mood, and sleep?
from Texas, and a brain hormone specialist from Georgia. Hubert Curien, the Minister of Research and Technology, who will be retiring as a scientist in two years time also supports the association. Chercheurs Toujours welcomes more members from abroad. Annual membership fee is Fr200; Mr Huppert may be contacted at the Institut de Cancerologie et d’lmmunogenetique, 94804 Villejuif, France.
Directory of clinical trials registers An international directory giving details of 24 existing and 6 planned registers of clinical trials is now available.1 Registers based in 13 countries are covered, although most are in the US. The majority are AIDS and oncology registers-but subjects such as neurosurgery, cardiovascular disease, dentistry, and perinatology registers are also included. The directory’s author recommends that organisers of clinical trials should make their trials known to doctors and patients, even though the primary purpose is research. The directory will be updated regularly. Details of registers not already included should be sent to Dr P. J. Easterbrook, Kobler Research Clinic, St Stephen’s Hospital, London SW10 9TH. 1. Easterbrook PJ. Directory of registries of clinical trials. Statist Med
1992; 11: 345-423.
Health carers, patients, and HIV Prevention of transmission of HIV and other bloodborne
pathogens between patients and health care workers has been under scrutiny. Earlier this month, the Royal College of Pathologists recommended unlinked, anonymous research into the prevalence of HIV infection among health-care workers who undertake invasive procedures.! A statement by the UK Central Council for Nursing, Midwifery, and Health Visitingz reiterates that occupational risk of HIV transmission is slight or even negligible and that practitioners cannot be selective about the categories for whom they will care. And accidental pathogen transmission from hypodermic needles in intravenous (IV) tubing assemblies is the subject of a US Public Health Service safety alert. Research shows that rates of needlestick injuries from IV tubing assemblies can be six times as high as from
disposable syringes. 1. HIV infection: hazards of transmission to patients and health care workers during invasive procedures. London: Royal College of Pathologists. 1992. Pp11. £3.50. 2. Council Position Statement: April 1992. UK Central Council for Nursing, Midwifery and Health Visiting, 23 Portland Place, London W1N 3AF, UK.
Retirees have knowledge, will share French scientists who retire now have an option other than just to go fishing. Once a scientist, always a scientist, is the thinking that led to the formation of Chercheurs Toujours, a group of retired scientists-or of those close to retirement-who are willing to offer their skills, in some instances of the type not readily available elsewhere, free to any individual or group. In France scientists in state-run institutions retire at 65 (in a few at 68). Many of these individuals fmd it difficult to cut all links with scientific work and are eager to help junior scientists. It was Joseph Huppert, a former molecular biologist from an INSERM (Institut National de la Recherche Medicale) biology unit in Lyon, who set up Chercheurs Toujours 2 years ago. Among the group’s activities have been the reactivation of a paleontology laboratory and a botany laboratory at the Museum of Natural History in Paris, the helping of students from underdeveloped countries, and the exposure of fraudulent claims in a cosmetics television advertisement. Members have also served as consultants for a researcher in plant science development, and helped to classify a collection of fossils. There are now 120 members, mainly from life sciences and medicine. They will also be available for the design of science research or evaluation programmes. Philippe Lazar, director of INSERM, not only endorses the idea but would also like scientists in other age groups-perhaps the junior scientists belonging to the INSERM-Jeunesse clubs-to participate as the donor in competence sharing. Chercheurs Toujours has recently gained its first two members from the USA—a virologist
Emergency and
Disaster Relief
register
The UK’s first Emergency and Disaster Relief (EDR) register for health professionals has been created by the charity International Health Exchange (IHE). The minimum entry requirement is 2 years’ work experience in a developing country or at least 6 months’ experience in emergency work overseas. For further details contact IHE, Africa Centre, 38 King Street, London WC2E 8JT.
In
England Now
My office is on the top floor of the hospital, near the lift-winding a small room housing the pump which provides suction to the wards. A sign on my door states my name but does not identify my position in the hospital hierarchy. However, another sign has been placed on the wall. It seems to express someone’s opinion of my usefuleness. It points directly at my office door and reads simply MEDICAL VACUUM.
gear and beside
*
*
*
It was my first time in an operating theatre for many years, and I was trying to look intelligent and not ask silly questions. So, when I heard an irregular beeping that didn’t sound like a cardiac monitor, I glided discreetly up to the head end to see what it was. It was the anaesthetist’s video game.
Chronic fatigue syndrome Most patients with chronic fatigue syndrome (CFS) attribute their symptoms to an infectious or immunological rather than a
psychological cause. But the evidence for a viral aetiology seems to be weakening. By contrast, a high prevalence of psychiatric disorder has been found in most studies of CFS patients. About half of them have a major depressive illness. The syndrome was the subject of a Ciba Foundation symposium held in London earlier this month. The muscle pains that gave the disorder its other name, "myalgic encephalomyelitis" (ME), show no correlation with changes in fibre type, fibre size, or any other alterations in muscle physiology. CFS seems not to be a myopathy. The three groups of viruses that have attracted attention as possible aetiological agents in CFS are herpesviruses (most notably Epstein-Barr virus, cytomegalovirus, and herpesvirus type 6), a retrovirus, and enteroviruses. In most studies of CFS patients the prevalence of viral antibodies has been higher than that in the general population, but the consensus view is that none of the viruses under investigation is a dominant cause of the syndrome or even necessary to the perpetuation of the illness. Many virological studies of CFS are criticised on methodological grounds. Evidence of infection with a retrovirus related to human T-cell lymphotropic virus type II has been obtained in some CFS patients, but its contribution to the aetiology and pathogenesis of the disease is unknown, as is its prevalence in healthy people. In one study, enteroviral RNA sequences were identified in muscle biopsy specimens from 53% of CFS patients, compared with 16% of controls. At the heart of the ME controversy lie the perceived stigma of psychiatric illness and the belief that psychological distress is less "real" than organic disease. Correct diagnosis is important, because treatable disorders may be missed. The high rate of psychiatric disorders in CFS (which do not include the "hysteria" publicised by the popular press) is as yet unexplained. However, the evidence is against psychiatric disorder solely as a reaction to physical illness. Hypothalamic dysfunction, particularly that involving 5hydroxytryptamine metabolism, has been reported in some CFS patients, and cerebral abnormalities are seen as a promising area for future research. Do psychiatric disorder and CFS have a common cerebral cause? Do infective agents indirectly cause subtle biochemical changes in parts of the brain that control energy, mood, and sleep?
from Texas, and a brain hormone specialist from Georgia. Hubert Curien, the Minister of Research and Technology, who will be retiring as a scientist in two years time also supports the association. Chercheurs Toujours welcomes more members from abroad. Annual membership fee is Fr200; Mr Huppert may be contacted at the Institut de Cancerologie et d’lmmunogenetique, 94804 Villejuif, France.
Directory of clinical trials registers An international directory giving details of 24 existing and 6 planned registers of clinical trials is now available.1 Registers based in 13 countries are covered, although most are in the US. The majority are AIDS and oncology registers-but subjects such as neurosurgery, cardiovascular disease, dentistry, and perinatology registers are also included. The directory’s author recommends that organisers of clinical trials should make their trials known to doctors and patients, even though the primary purpose is research. The directory will be updated regularly. Details of registers not already included should be sent to Dr P. J. Easterbrook, Kobler Research Clinic, St Stephen’s Hospital, London SW10 9TH. 1. Easterbrook PJ. Directory of registries of clinical trials. Statist Med
1992; 11: 345-423.
Health carers, patients, and HIV Prevention of transmission of HIV and other bloodborne
pathogens between patients and health care workers has been under scrutiny. Earlier this month, the Royal College of Pathologists recommended unlinked, anonymous research into the prevalence of HIV infection among health-care workers who undertake invasive procedures.! A statement by the UK Central Council for Nursing, Midwifery, and Health Visitingz reiterates that occupational risk of HIV transmission is slight or even negligible and that practitioners cannot be selective about the categories for whom they will care. And accidental pathogen transmission from hypodermic needles in intravenous (IV) tubing assemblies is the subject of a US Public Health Service safety alert. Research shows that rates of needlestick injuries from IV tubing assemblies can be six times as high as from
disposable syringes. 1. HIV infection: hazards of transmission to patients and health care workers during invasive procedures. London: Royal College of Pathologists. 1992. Pp11. £3.50. 2. Council Position Statement: April 1992. UK Central Council for Nursing, Midwifery and Health Visiting, 23 Portland Place, London W1N 3AF, UK.
Retirees have knowledge, will share French scientists who retire now have an option other than just to go fishing. Once a scientist, always a scientist, is the thinking that led to the formation of Chercheurs Toujours, a group of retired scientists-or of those close to retirement-who are willing to offer their skills, in some instances of the type not readily available elsewhere, free to any individual or group. In France scientists in state-run institutions retire at 65 (in a few at 68). Many of these individuals fmd it difficult to cut all links with scientific work and are eager to help junior scientists. It was Joseph Huppert, a former molecular biologist from an INSERM (Institut National de la Recherche Medicale) biology unit in Lyon, who set up Chercheurs Toujours 2 years ago. Among the group’s activities have been the reactivation of a paleontology laboratory and a botany laboratory at the Museum of Natural History in Paris, the helping of students from underdeveloped countries, and the exposure of fraudulent claims in a cosmetics television advertisement. Members have also served as consultants for a researcher in plant science development, and helped to classify a collection of fossils. There are now 120 members, mainly from life sciences and medicine. They will also be available for the design of science research or evaluation programmes. Philippe Lazar, director of INSERM, not only endorses the idea but would also like scientists in other age groups-perhaps the junior scientists belonging to the INSERM-Jeunesse clubs-to participate as the donor in competence sharing. Chercheurs Toujours has recently gained its first two members from the USA—a virologist
Emergency and
Disaster Relief
register
The UK’s first Emergency and Disaster Relief (EDR) register for health professionals has been created by the charity International Health Exchange (IHE). The minimum entry requirement is 2 years’ work experience in a developing country or at least 6 months’ experience in emergency work overseas. For further details contact IHE, Africa Centre, 38 King Street, London WC2E 8JT.
In
England Now
My office is on the top floor of the hospital, near the lift-winding a small room housing the pump which provides suction to the wards. A sign on my door states my name but does not identify my position in the hospital hierarchy. However, another sign has been placed on the wall. It seems to express someone’s opinion of my usefuleness. It points directly at my office door and reads simply MEDICAL VACUUM.
gear and beside
*
*
*
It was my first time in an operating theatre for many years, and I was trying to look intelligent and not ask silly questions. So, when I heard an irregular beeping that didn’t sound like a cardiac monitor, I glided discreetly up to the head end to see what it was. It was the anaesthetist’s video game.
