NEJM 7 Jun 2007 Vol 356

Using traditional British medical metaphors for rarity, you could call this week’s NEJM the Hen’s Dental Journal (or indeed The Rocking Horse’s Lavatory). It had me sweating back on Nightmare Street, as I’ve never seen anything described in the main papers, beginning with renal amyloidosis and proceeding via adrenocortical carcinoma to syphilitic hepatitis, taking in along the way a previously undescribed form of bartonellosis. The correspondence ends with a description of Wiiitis; by which time you can catch the editor hiding a faint Brahmin smile.
In many ways the most useful piece in the journal is this commentary on the US Food and Drug Administration’s decision to compel a warning sign on the packaging of antidepressants, suggesting that they can increase the risk of suicidal ideas and behaviour under the age of 25. The odds ratios of the randomised studies suggest this, but there is of course a circularity about the fact that those who most need them are at the highest risk of suicidal behaviour.

The bacterial genus Bartonella first rose to fame as a solitary human pathogen when it caused trench fever in the Great War, but in the last 15 years, an extra 18 species have been described, and now here is another one. If you try very hard, you can get it by backpacking across Peru. As a group, the Bartonellae are not rare: your beloved cat may indeed be a reservoir of Bartonella claridgeiae since 36% of European domestic cats carry it in their blood – a fact which almost defines the expression “little-known”. Cat-scratch disease is caused by another species of Bartonella, called henselae . But the new species described here still awaits a name, and surely the vote of all right-thinking people must go to Bartonella simpsoni.

A Special Article explores why there has been such a dramatic fall in coronary disease deaths in the USA between 1980 and 2000. Is it due to a reduction in risk factors? Hard to believe, but about half of it is, due to reduction in total cholesterol, blood pressure and smoking. This has of course been partly offset by an increase in obesity and diabetes. The other half is due to better treatment of the acute event and after. This is an area where cynics can shut up and appreciate the benefits of evidence-based medicine.

And so, finally, to Wiiitis, as described in a splendid short letter from Barcelona (p.2431). I read it hurriedly and rushed to check it out with my 17 year-old stepdaughter.
“Libby, is there a new Nintendo game out called Wii?”
“No. There’s a games console out from Nintendo called Wii and it’s not that new, duh!”
“I’ve read this thing saying you can hurt your arm playing on it.”
“I once played on it and you have to wave your arm about and after about ten minutes I couldn’t carry on and everybody who plays it says it’s well painful if you play too long.”
So there we have it: scientific testimony to the dangers of this variant of Nintendinitis. In his letter, Julio Bonis goes on to warn us that “Future games could involve different and unexpected groups of muscles. Physicians should be aware that there may be multiple, possibly puzzling presentations of Wiiitis.” Physicians, prepare to be possibly puzzled.