118 e-Letters

published between 2010 and 2013

  • Pubertal Gingivitis-
    Jayendra R Gohil

    A 13 yr old adolescent girl could be a fussy eater. Her ht/ wt is not mentioned; if she is underweight. she may not be eating citrus fruits. Her gingivitis could also be due to scurvy due to dietary vitamin C deficiency that should have been excluded or treated. Suggested investigations are vitamin C levels and x-rays of knee and wrist joints. Examination for bone aches.

    Conflict of Interest:

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  • Comments on Icatibant and ACE inhibitor angioedema
    Neil H Crooks

    We read with interest the article by Illing et al which described the management of a patient with life threatening ACE inhibitor-induced angioedema (ACEiA).1 We would like to make some comments on the investigation and management of this condition. Complement C3, C4 and C1 inhibitor levels should be checked in all patients presenting with isolated angioedema (i.e. without urticaria) to rule out hereditary, and some forms...

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  • Ectopic anal opening
    mahesh masand

    Congratulations for publishing this important clinical lesson as this is unfortunately missed in post natal ward from time to time. I therefore tell the 'busy' junior doctors to spare some time to clean the perineum at 1st day check if it is soiled with meconeum so that the anal opening can be identified and documented as meconeum can be passed from a perineal fistula too. If he does not wish to clean then he should come b...

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  • Similar Presentation
    Rodrigo J. Daly

    We read with interest your unusual case of migraine presenting with complete body paralysis and aphasia. We recently witnessed a similar presentation in our emergency department.

    A 45-year-old lady with no past medical history was "blue-lighted" to our facility by the ambulance service after her husband discovered her to be very upset and confused upon awakening in the morning. On examination by the ambulance...

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  • Complications of transthoracic needle lung biopsy
    Devi priya Rathnasabapathi

    Computed tomography-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy and acceptable rate of complications. Complications of the procedure include pneumothorax, haemoptysis, and pulmonary haemorrhage. Whereas hemorrhage is an infrequent complication of transthoracic needle lung biopsy, pneumothorax is common and often necessitates chest tube placement. Only a...

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  • Interesting case report
    Antoine Kass-Iliyya

    I read with enjoyment your unusual case report of mucinous adenocarcinoma arising from a villous adenoma in the terminal ileum and invading the bladder.

    This case represents the importance of team collaboration i.e. urology and colorectal surgeons in complicated and rare cases.

    It would be interesting to know what percentage of small bowel tumours fistulae to the bladder? and how many similar case re...

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  • Interesting case report
    Mehrnaz Asadi Gharabaghi

    Dear authors

    I read your article thoroughly and in my opinion it was magnificent.For a while I worked in an emergency department of a referral university hospital where, I must admit ,I rarley thought about WE in the context out side of alcoholism,diabetes and malnutrition. When I read your report ,I learnt so many clinical hints.The patient's presentation,the way you manged her and the comprehensive and practic...

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  • An interesting diagnostic approach
    Mehrnaz Asadi Gharabaghi

    Dear Dr Sedat Isikay I read your case report with enjoyment.It was great and increased my knowledge on this topic.I am writing to you to ask what made you looked for CD when her iron deficiency anemia could be attributed to pulmonary haemosiderosis and she had no gastro intestinal complaint?

    Conflict of Interest:

    None declared

  • A hard fact
    Swaroop Revannasiddaiah

    The author Mallinson T must be commended for the detailed and informative description of existing reality in Nepal. Hailing from the neighboring nation, India, I have personally traveled across the sub- continent, and have witnessed an entire spectrum of health-care facilities - ranging from the most modern, to the utterly rudimentary.

    Health-care receives a low priority, not just from the financial aspect, but a...

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  • Poor conclusions
    Amy Mayes

    The correct learning points from this case study would be to dissuade physicians from the circumcision of minors. When describing it as 'relatively safe', you fail to recognise that all circumcision causes harm - pain, both short and long term, and the removal of tissue and penile structures that can never be replaced. This makes it an unethical surgery when you consider that a) There is a wealth of evidence to suggest tha...

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