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Recent eLetters

Displaying 11-20 letters out of 243 published

  1. Re:Antenatal management of Cystic Pulmonary adenomatoid malformation

    Dear Dr Kumar,

    Thank you for your letter.

    In relation to the points raised:

    1. Much of the evidence for successful use of steroids in CPAMs relates to microcystic lesions. In this case, the lesion was a large macrocystic CPAM. The case was discussed at an antenatal MDT, and the decision not to treat with steroids was reached.

    2. We thank you for your comment on measuring baseline and subsequent cyst volume ratio, to monitor progression/resolution. That was not measured in this case.

    Conflict of Interest:

    None declared

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  2. Antenatal management of Cystic Pulmonary adenomatoid malformation

    We read case report by Cullen et al and found it very interesting. It was a successfully managed case however, I have certain queries regarding management in the index case.

    1. In a prenatally detected CPAM (previously known as CCAM) with hydrops detected prior to 32 weeks, there is a well-defined role of maternal steroids.(1) Even multiple courses of betamethasone can be tried. Whether it was thought off in index case or not.

    2. Instead of two-dimensional size, measurement of baseline, as well as subsequent Cyst volume ratio (CVR), is a good indicator of progression/ resolution of the cyst.

    References: 1. David M, Lamas-Pinheiro R, Henriques-Coelho T. Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation. Neonatology. 2016 Apr 13;110(2):101-15.

    Conflict of Interest:

    None declared

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  3. Rheumatic fever with chronic carditis: still prevalent in Germany

    Dear Sir,

    1953 born I was never treated with antibiotics as child.

    1985 a post-streptococcal-myocarditis was diagnosed in the University -hospital Goettingen. Treatment with penicillin and oral penicillin- prophylaxis. Many episodes of respiratory infections, complicated by arrhythmias.

    2004 atrial fibrillation.

    2017, July 4., anticoagulation with heparin/coumarin changed the intra-articular pressure at once: Less pain in hand and foot. A severe polyneuropathy was caused by unknown agents (Could this be a post- streptococcal-neuritis 2003, in the heat-wave of Southern France, combined with severe Myocarditis.)

    And so many of my patients, seen in 40 years, suffered from recurrent rheumatic fever attacks. Very often penicillin V could change the disease.

    We are all one. Suffering from streptococcal-reactive diseases.

    And penicillin/coumarin still is the best. Cheap and good.

    Best wishes

    Yours Friedrich

    Conflict of Interest:

    None declared

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  4. A field level reality

    I am impressed by the straight forward write up with giving emphasis on practical aspects in field.

    Conflict of Interest:

    None declared

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  5. Re:isolated gastric sarcoidosis

    Dear Reader,

    Thank you for your comments and review of our case. You raise an interesting point regarding the connection between coniosis and sarcoidosis. Mineral particles were not originally commented on in our pathology samples, although the patient did not have characteristic occupational exposures.

    Best, Ronak V. Patel, MD

    Conflict of Interest:

    None declared

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  6. isolated gastric sarcoidosis

    A very intriguing and well described case !

    I just think useful some further diagnostic qualification starting from the following description of the histological characterization of the disease.

    "Gastric biopsies revealed severe chronic active granulomatous gastritis (figure 3). Additional studies from her gastric biopsies,including gram stain, fungal stain and acid-fast stain, were negative."

    Possible to research and, if present, characterize mineral particles inside the biopsed granulomas, following recent hypotheses interpreting sarcoidosis like a peculiar form of coniosis ?

    Conflict of Interest:

    None declared

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  7. Case verification

    Hello, how recent is the case that's just been published about Anisakiasas? Is it recent?

    Do you have more details on the case I can read?

    Conflict of Interest:

    None declared

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  8. cutis aplasia congenita and amniotic band syndrome

    I have read the phenotype description of a child with aplasia cutis congenita as well as transverse limb defects; although this association is not common it is the presentation of Adams Oliver syndrome [OMIM 100300]; in this condition both manifestations are present and often the limb defects resemble the damage caused by the amniotic band sequence. The identification is important as patients with Adams Oliver have an identifiable genetic etiology as well as are at risk of further medical issues ivcluding congenital heart defects; neuronal migration disorders; ocular manifestations etc

    Conflict of Interest:

    None declared

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  9. Query about site of metastasis

    Hello Mam, I would gladly like to know that the site of metastasis was in the upper extremity or in the lower extremity? and if it was upper extremity then at what site?

    Conflict of Interest:

    None declared

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  10. Choice of antibiotic

    This is a well written Case Report and helpfully describes some pathology (as well as the phenomenon of S. aureus disease relapse). It should be noted, however, that whilst the supporting evidence for i.v. Linezolid is that it is non-inferior to Vancomycin, it is abundantly clear in the literature that i.v. Vancomycin is wholly inferior to i.v. Flucloxacillin. Regarding data on disc penetration, Gibson et al tested this for fluclox in an animal model, but only after a single i.v. bolus. It is likely that after repeated high doses that fluclox does penetrate, otherwise there would be thousands of cases in the literature of relapse with zero cures. Furthermore, the source referenced for penetration of tissue by Linezolid is actually of skin blisters, not bone, whereas it is widely accepted that beta-lactams penetrate skin and soft tissue beautifully.

    My conclusion is that whilst this is a helpful addition to the literature, there are currently no grounds for withholding i.v. flucloxacillin in invasive MSSA disease and that Linezolid (a bacteriostatic agent) is a long way from having been validated for this setting.

    Conflict of Interest:

    Nil

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