288 e-Letters

  • Was it from the breast? Was it from the muscle?
    Swaroop Revannasiddaiah
    We commend the authors for highlighting a difficult clinical scenario. We read the article with interest and would like to share a small thought of ours. The possibility of the tumour's origin being the underlying pectoralis muscles can not be discounted. The appearance on the CT scan does suggest a breast lesion, which appears to be inseparable from the muscle underneath. Moreover, another point which prompted us to feel so was t...
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  • Diagnosing Sarcoidosis: Still a challenge
    Rahul srivastava

    Sarcoidosis most of the times mimics tuberculosis symptomatically as well as radiologically and poses diagnostic dilemma. It is nice to see case report on Sarcoidosis with caseating granuloma as biopsy usually differentiate it from tuberculosis as tuberculosis produces caseating granuloma and sarcoidosis non caseating type. Anergy produced by sarcoidosis can lead to loss of induration in PPD testing. As bronchoscopy was...

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  • Re Atrial fibrillation and pneumothorax after transthoracic needle lung biopsy
    Devi priya Rathnasabapathi

    Dear Editors,

    I read with interest the case report on complications of trans thoracic lung biopsy. Only a few studies have systematically evaluated risk factors for pneumothorax and pulmonary haemorrhage in computed tomographically (CT)-guided transthoracic lung biopsy (TLB). One study looking into the factors affecting diagnostic yield and complication rates, by Heyer CM and colleagues in 2008, showed that the...

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  • Exercise Testing To Risk Stratify Patients with WPW Pattern
    Arunkumar Panneerselvam
    To the Editor: I read with interest the article by Liu A et al (1). The authors have described the management of asymptomatic patient with electrocardiographic (ECG) evidence of pre-excitation. Certain aspects of this report needs to be highlighted. Asymptomatic patients with ECG evidence of pre-excitation of the ventricles are labelled as Wolf-Parkinson-White (WPW) pattern. On the contrary patients with documented tachyarrhythmia...
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  • abdominal perforation and decubitus view
    mahesh masand

    A very interesting case report but a common omission seen again in this report as is seen in real life in the wards . Any x -ray for an acute abdomen should always include both the domes of diaphragm which I cannot see in the AP view in figure A (only left dome visible) as compared to B where both domes are clearly visible ( unless it was done originally but cut off in the view shown here in this report) whic...

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  • wpw syndrome
    Naresh K Bansal

    A quick review of the condition helps keep the condtion in mind and help decision making

    Conflict of Interest:

    None declared

  • Diagnosing Aortic Dissection
    John A. Chambers

    This case report about aortic dissection is a good reminder to always consider this condition in acute chest pain particularly in patients with hypertension or a connective tissue disorder such as Marfans, SInce using this blood test as a rule out investigation in recent years we have made the diagnosis increasingly early in our institution.. A Google search revealed 5040 hits. Doctors have been missing this diagnodis for...

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  • Erythrocytosis versus polycythaemia in Eisenmenger syndrome: not a conundrum
    Matina Prapa

    We should comment on the case report by Liu et al. highlighting the difficulties in treating patients with Eisenmenger syndrome(1). The haematological complications of cyanotic congenital heart disease are well described in literature, since the systematic description of the condition by Paul Wood in 1958(2). This paradoxical state of affair between bleeding and thrombotic diathesis continues to puzzle us. Bleeding, typical...

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  • Comments
    Sajal De

    I read with interest the recently published case report by Frazer and coworker.1 History of decompensated alcoholic liver disease with gross ascites and presence of right sided pleural effusion raise the clinical suspicion of hepatic hydrothorax. The transudative nature of pleural fluid confirms this diagnosis. In absence of any cytological analysis of pleural fluid (total and differential count) it is difficult to understa...

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  • Differential diagnoses for Roth spots
    Leo Sheck

    Thank you to the authors for providing an interesting case study suggesting an association between Roth spots and pyridoxine dependent epilepsy. The documented causes of Roth spots include severe anaemia, leukaemias, dysproteinaemia, HIV retinopathy and endocarditis (Kanski, 2002).

    Within the manuscript, infection has been ruled out as the cause of Roth spots. However, details on tests regarding the other diff...

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