Journal of Chronic Fatigue Syndrome: Volume 7, Issue 3, 2000

Volume 7, Issue 3, 2000

 * Editorial by Roberto Patarca-Montero
 * Vegetative-Vascular Dystonia and Osteoalgetic Syndrome or Chronic Fatigue Syndrome as a Characteristic After-Effect of Radioecological Disaster: The Chernobyl Accident Experience "'Abstract - The aim of this study was to determine whether the Chronic Fatigue Syndrome (CFS) definition could be applicable to the assessment of the medical aftermath of radioecological disasters and to investigate a possible psychophysiological basis of fatigue in Chernobyl accident survivors. One hundred randomly selected clean-up workers of the Chernobyl accident who presented with complains of fatigue were examined neuropsychiatrically using MMPI profiles, Quantitative Electroencephalography (QEEG) and Somatosensory evoked potentials (SSEP). Twenty-six percent of them met the CFS diagnostic criteria. Their absorbed radiation doses were less than 0.3 Sv, an exposure level that is not expected to produce a clear deterministic radiation effect. Clinical symptomatology included persistent fatigue, odd skin sensations, bizarre feelings in bones, muscles and joints, irritability, headache, vertigo, pain in the chest area, emotional lability, irritability, lack of concentration and memory, cognitive deterioration, depression signs and sleep disorders. Liquidators with CFS had the characteristic MMPI profile with increased hypochondria, depression, clear hypochondria, schizophrenia, hysteria, psychasthenia, and bizarre sensory perception scales. Spectral analysis of QEEG showed lateralised (left-sided) increase of θ-power (P < 0.001) and lateralised (left-sided) decrease of a-power (P < 0.001) and lateralised (left-sided) increase of β-power (P < 0.01). SSEP were characterized by increased latencies and decreased amplitudes. SSEP significantly differed by topographic abnormalities in the left temporoparietal area in liquidators with CFS. Associations between schizophrenia-like, hypochondriac and psychasthenic psycho-pathology and an increase of latency of SSEP P300 and N400 in liquidators with CFS were revealed. Thus, “Vegetative-Vascular Dystonia” and “Osteoalgetic Syndrome” cases following exposure to ionizing radiation as a result of the Chernobyl accident can be classified as CFS cases. The psychophysiological basis of fatigue in liquidators consists of dysfunction of the cortico-limbical structures of the left, dominating, hemisphere. CFS is one of the most important consequences of radio-ecological disaster, which results from an interaction of different hazardous environmental factors.'"
 * Defining Chronic Fatigue Syndrome: Methodological Challenges"'Abstract - Accurate diagnosis of Chronic Fatigue Syndrome (CFS) is greatly complicated by the vague wording of many of the major diagnostic criteria (i.e., substantial reductions in previous levels of occupational, educational, social, or personal activities) and the absence of guidelines for health care professionals to follow. The lack of operationally explicit criteria has forced health care professionals to rely heavily on their own clinical judgement, which may be biased by personal and highly idiosyncratic factors. Thus, in the case of CFS, the lack of consensus among clinicians regarding the interpretation and application of the diagnostic criteria has likely produced problems in diagnostic reliability. Data from a recent community based epidemiologic study are presented to illustrate these problems and provide recommendations for improving criterion reliability.'"
 * Severe and Very Severe Patients with Chronic Fatigue Syndrome: Perceived Outcome Following an Inpatient Programme"'Abstract - The Chronic Fatigue Syndrome (CFS) Service within the Essex Neuroscience's Centre has been developing since 1990. The service was established as a comprehensive diagnostic and management service in July 1994. From May 1990 to March 1998, 318 patients with CFS were admitted into the programme and since November 1994, 1189 patients seen as outpatients. A previous survey indicated a positive perceived change in level of ability following the inpatient programme for all levels of CFS from mild to very severe. of those admitted since 1990, 14% (43/318) were severely affected (extremely restricted mobility) and 9% (29/318) very severely affected (totally bedbound). Most studies on CFS do not include the more severe expressions of the disease; therefore, this descriptive paper aims to show the perceived outcome of these more severely affected patients following the inpatient programme. In particular, the eventual diagnosis, the specific approach to treatment and management and grading of patients will be described and the potential influence of the programme presented. The patients not diagnosed with CFS on discharge appeared to do least well at follow up.'"
 * Psychosocial Responses of Sufferers of Chronic Fatigue Syndrome"'Abstract - Chronic Fatigue Syndrome (CFS) is a chronic debilitating disease that affects two to five million persons in the United States. Previous studies examined theories of etiology and have resulted in contradictory findings. This study explored the psychosocial factors associated with CFS. Questionnaires were administered to 49 CFS sufferers and a matched sample of non-CFS sufferers. Significant differences were found in the perception of stress and its causes, coping styles, and emotional responses to affective states as measured by the Ways of Coping, Derogatis Stress, Trait Anger, Perceived Stress, and Profile of Moods scales. Groups were not different on the measure of trait anger. The findings indicated that associated psychosocial factors do influence the illness trajectory and the quality of life of CFS sufferers. These findings have implications for nursing practice.'"
 * Comparative Analysis of Lymphocytes in Lymph Nodes and Peripheral Blood of Patients with Chronic Fatigue Syndrome"'Abstract - Blood and lymph node samples were obtained from patients with chronic fatigue syndrome (CFS) who had volunteered to undergo a lymph node biopsy while participating in a phase 1 clinical trial of a novel immunomodulatory therapy. The surface marker phenotypes of the peripheral blood and lymph node samples were examined using four-color flow cytometry and compared to published proportions of cells in peripheral blood and lymph nodes from control individuals. While a greater proportion of T lymphocytes from both lymph nodes and peripheral blood of control subjects are immunologically “naive” (CD45RA+), the proportions of lymphocytes with a “memory” phenotype predominate in lymph nodes and peripheral blood of CFS patients. CFS has been proposed to be a disease of autoimmune etiology and in this respect it is interesting to note that decreased proportions of CD45RA+ T (“naive”) cells are also seen in the peripheral blood of patients with autoimmune diseases.'"
 * Raised Plasma Adenosine Associated with Chronic Fatigue Syndrome: A Preliminary Study"'Abstract - Plasma adenosine levels were measured in a small trial study of eighteen volunteers, aged 36-85 years. Volunteers comprised nine with chronic fatigue syndrome (CFS), four with ‘other fatigue’ illnesses, and five with no history of fatigue illnesses but some of whom were related to chronic fatigue sufferers. Plasma adenosine was slightly raised above the minimum detectable level (approx. 1 micromole/L) in one healthy non-fatigued volunteer and grossly raised (greater than 5 micromoles/L) in two non-fatigued volunteers, both of whom were related to CFSs. Among the nine CFSs, all had plasma adenosine raised above baseline, and seven were grossly raised. High adenosine levels were also seen in two of the volunteers with ‘other fatigue.’ Raised adenosine occurred among certain families, suggesting a genetic metabolic element. Instability of adenosine in frozen stored plasma was noted. High levels of adenosine probably do not exist freely within peripheral plasma but may be released from blood cells locally within tissues or in response to venipuncture stress or other factors. The results may be highly relevant to other pathologies such as heart disease.'"
 * Letter to the Editor