298 e-Letters

  • Boston keratoprosthesis for visual rehabilitation in porphyria cutanea tarda
    Elisabeth I. Minder

    Sir, We read with interest the case report by Sati et al. The described procedure of replacement of a damaged cornea appears to be promising in other porphyria cases wiht severe eye onvolvement. We just question whether the diagnosis of porphyria cutanea tarda (PCT) is correct taking into consideration the severity of the symptoms in this patient. Unfortunately, the authors did not provide quantitative data of the porp...

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  • ALK amplification or rearrangement
    WL Lam

    Dear Sir,

    I read with great interest the article concerning amplification of ALK gene detected in a IMT of breast, largely because ALK gene amplification was recently described in inflammatory breast cancer. However, judging from the figure 3B illustrated, I suspect that a rearrangement rather than amplification occur as most nuclei demonstrate one yellow fused signal, one red signal and one green signal. ALK g...

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  • AD variants posterior cortical atrophy
    os hammer MBBch.,MSc.,MRCPsych.,IAPA

    Thanks to Dr Kai Ivar M?ller and Dr Svein Ivar Bekkelund for their very interesting case presented regarding Visual impairment and posterior cortical atrophy preceding rapid progressive dementia. Posterior cortical atrophy (PCA) is a neurodegenerative condition regarded as a progressive loss of visual processing skills and other posterior functions. Patients have difficulty integrating visual scenes, locating objects...

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  • cannon ball lung masses
    bala chandran

    sir, I disagree with the author in calling them nodules.In fact they are masses. The x-ray findings are quite characteristics to be called as a spotter. In a known case of malignancy elsewhere this is metastasis,unless proved otherwise If history is not known,which is the case most often,then it becomes difficult to make a convincing diagnosis.Therefore a differential diagnosis is a must.How to differentiate lung masses...

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  • Response to "Pneumoperitoneum in a perforated gastric ulcer"
    Thomas C Morris

    Dear Dr Lobao

    Thank you for your very clear and concise case report of this elderly patient who suffered a perforation of a previously undetected gastric ulcer.

    The Xrays and case are good from a basic teaching perspective, but I'm a bit confused as to what the "learning point" is supposed to be. What other clinical features would you have expected in the "non-elderly" to indicate a perforated viscu...

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  • Antibiotic prophylaxis fore dental treatment
    Audoen Healy

    In this BMJ case report the authors make conclusions which would shame a medical or dental undergraduate student. They dismiss the long term epidemiological data which demonstrates no increase in incidence of or mortality from infective endocarditis since the introduction of the NICE guidelinesseveral years ago, using a highly spurious explanation suggesting that dentists are somehow identifying the most at risk patients...

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  • Importance of a good history and physical examination
    Ashish Pathak

    Dear Editor, This case demonstrates the importance of accurate history taking combined with imaging. However, the authors have discredited the importance of history in the case report. Studies have proven the importance of symptom clusters in predicting testicular torsion. The triad of a) previous trauma, b) pain attacks, and c) nausea and vomiting along with absence of urinary complaints has high sensitivity and positiv...

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  • Chlorhexidine application to vaginal mucosal membranes before birth to decrease GBS
    Judy Cohain

    This article is extremely relevant in light of the recent increase in use of chlorhexidine to achieve GBS negative vaginal cultures at the end of pregnancy.

    "Gynahex" from a company called "Concept" is selling an aqueous vaginal gel with 1% chlorhexidine. It is inserted vaginally twice a day for 8-10 days to result in a negative GBS culture. Then the woman continues to apply the gel vaginally once a day until l...

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  • Spinal epidural abscess treated with antibiotics alone
    Vengalathur G. Ramesh

    I read with interest the case report of "Spinal epidural abscess treated with antibiotics alone" by Pathak et al. This patient had presented with paraparesis and incontinence of bladder and bowel, which by itself is an indication for emergency surgery. Such a case should not be managed medically. It is a surprise that the patient had recovered. But this should not mislead the clinician into managing all the acute spinal...

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  • shoulder dimples
    Diana L Jackson

    I too have dimples in both shoulders. I have never met or heard of anyone else having them, not even a family member. Until 2 years ago when my youngest grandson was born. He has them on both shoulders as well. This report is the first I've seen on this and hope to learn more. Thankyou

    Conflict of Interest:

    None declared