We read with interest the paper of Oliver Richard Waters, Tawfique
Daneshmend, and Tarek Shirazi on "An incidental finding of a gastric
foreign body 25 years after ingestion".
It is quite interesting as well as surprising. We feel it may be the
longest period that a pen sat idle and was detected so late.
In addition, the pen was still OK !!!!
We have an interesting case of FB in stomach and G...
We read with interest the paper of Oliver Richard Waters, Tawfique
Daneshmend, and Tarek Shirazi on "An incidental finding of a gastric
foreign body 25 years after ingestion".
It is quite interesting as well as surprising. We feel it may be the
longest period that a pen sat idle and was detected so late.
In addition, the pen was still OK !!!!
We have an interesting case of FB in stomach and GI tract who had
consumed 99 Nails !!!
We were searching the net for FB in the Stomach and came across this
rare case report by Richard Waters et al. It encourages us to submit our
article too.
The article remarks the importance of reviewing the clinical history
when the diagnosis or management of the patient is not completely defined,
especially in an emergent situation.
I read with interest your case report regarding migration of Filshie
clips. I have come across a migrated Filshie clip as well while reviewing
a lumbosacral radiograph done for a patient with prolapsed intervertebral
disc. She had been asymptomatic and had not conceived since the
sterilisation procedure. There have been quite a few case reports of such
incidences in PubMed (eg Connolly D et all,...
I read with interest your case report regarding migration of Filshie
clips. I have come across a migrated Filshie clip as well while reviewing
a lumbosacral radiograph done for a patient with prolapsed intervertebral
disc. She had been asymptomatic and had not conceived since the
sterilisation procedure. There have been quite a few case reports of such
incidences in PubMed (eg Connolly D et all, 2005; Verma A, 2007; Kalu E,
2006; to name a few). I just wonder how many of these cases go
undetected, in view that we do not routinely follow up these cases.
The effect of Filshie clip migration on sterilisation failure is not
known and to the best of my knowledge, has never been reported yet. What,
then, are the implications of this phenomenon? Would we need to do
periodic abdominal radiographs of women who were sterilised using Filshie
clips? Would we need to ask women incidentally diagnosed with migration
of Filshie clips to practice extra protection?
In view of the rarity of this phenomenon as well as the lack of data
on sterilisation failure, it would not be practical to do periodic
screening nor offer additional contraception to these women. However,
doctors need to be aware of these phenomenon and counsel patients on the
risks, albeit small, when offering tubal ligation with Filshie clips to
their patients.
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...
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 practical
discussion, all helped me in ehnacing my clinical awareness of this
entity.Hence,I decided to write to you and thank for taking time and
reporting the case.
Hopkins et al: Thank you for an interesting article highlighting the
importance of exploring and ruling out medical conditions that present
with psychotic symptoms.
Potentially, there could be near misses and one cannot over emphasize the
importance of maintaining high clinical skills in averting this.
This article also goes to point that we need to bear in mind that a
medical illness can present with symptoms akin to a p...
Hopkins et al: Thank you for an interesting article highlighting the
importance of exploring and ruling out medical conditions that present
with psychotic symptoms.
Potentially, there could be near misses and one cannot over emphasize the
importance of maintaining high clinical skills in averting this.
This article also goes to point that we need to bear in mind that a
medical illness can present with symptoms akin to a psychiatric
condition.It can be very difficult sometimes distinguishing which is the
actual case especially if there is already an established history of
either of the conditions.Sometimes one condition may be aggravated by the
presence of the other.The coexistence of medical and psychiatric
conditions is also not uncommon.
Whilst as psychiatrists we are not always able to decipher some medical
presentations especially when they are not common, it is important that we
liaise early with our medical colleagues when there is ambiguity about
clinical presentations or little or no response to treatment.
There may be a role for incorporating relevant medical rotations at some
point in the training as this would be invaluable in keeping us up to date
with medical knowledge as much as we strive to attain all other skills.
Delay can be costly. We must act swiftly.
The nature and time course of temporal lobe abnormalities in
psychotic illness remain notorious. Confounds include disease chronicity,
demographic data, and handedness etc . Temporal lobe epilepsy is
associated with a substantial risk of psychosis but there are only
restricted studies investigating the underlying changes and causes.
momentous grey and white matter deficits occur in temporal lobe epilepsy
with psychosis....
The nature and time course of temporal lobe abnormalities in
psychotic illness remain notorious. Confounds include disease chronicity,
demographic data, and handedness etc . Temporal lobe epilepsy is
associated with a substantial risk of psychosis but there are only
restricted studies investigating the underlying changes and causes.
momentous grey and white matter deficits occur in temporal lobe epilepsy
with psychosis. Some of these deficits overlap with those found in
schizophrenia.I read the case report of Professor Amin Gadit with great
interest, As I can see in this case report which it shows clear and
valuable information .The findings of this report taken in conjunction
with the findings of previous studies that Epilepsy is one of the main
causes of functional disability, and it is usually associated to
psychiatric comorbidity, such as psychosis of epilepsy . the epileptic
psychosis management requires more careful pharmacological treatment,
considering the propensity of the antipsychotics to provoke seizures and
the risk of pharmacokinetic interaction with antiepileptic drugs also
threshold possible interactions. Electroconvulsive therapy (ECT) is a
useful yet controversial mode of treatment. Despite being in use for over
70 years, its mechanism of action is still not clearly understood. Also
various speculations on mode of actions of ECT have been anticipated over
the years. These have included looking at psychological, neuro
physiological, neuro chemical, neuro endocrine, and neuro peptides
mechanisms. Although ECT well established as safe and effective, some
basic questions about ECT remain unrequited.One study showed that ECT had
a significantly greater antidepressant/antipsychotics effect compared to
medication therapy. receptors were considered potential targets for
therapeutic efficacy of (ECT), but pre- clinical studies showed that
electroconvulsive shock up-regulates 5-HT2 receptors in contrast to
antidepressant medications, which down-regulate brain 5-HT2 receptors. I
personally believe that further studies and case reports are needed, to
look at longer-term effects of either ECT or role of
medications on organic psychosis and to better understand why quick
response changes occur. The role of ECT in schizophrenia and other non
affective (atypical) psychotic disorders remains controversial, but some
agreement exists about its usefulness in certain psychotic presentations.
This case example underscore the role of ECT in atypical psychotic
presentations, particularly when the symptoms resemble those found in
Temporal lobe epilepsy associated with psychosis .
References
Abrams R, Taylor MA, Volavka J. ECT- induced EEG asymmetry and therapeutic
response in melancholia: relation to treatment electrode placement. Am J
Psy-chiatry, 1987; 144: 327-329.
Abrams R, Taylor MA. Diencephalic stimulation and the effects of ECT
in endogenous depression. Br J Psy- chiatry. 1976; 129: 482-5.
UK ECT Review Group. Efficacy and safety of electroconvulsive therapy
in depressive disorders: a systematic review and meta- analysis. Lancet
2003; 361: 799-808.
The Use of Electroconvulsive Therapy in Atypical Psychotic Presentations:
A Case Review John H. Montgomery et al 2007.
Yatham LN, Liddle PF, Lam RW, Zis AP, Stoessl AJ, Sossi V, et al.
Effect of electroconvulsive therapy on brain 5-HT2 receptors in major
depression.Br J Psychiatry 2010 196: 474-479.
We read with interest the article by Braithwaite et al. This article
has helped us in diagnosis and management of a patient here in Mumbai,
India.Dengue Eye Disease has become more common and has been investigated
extensively with many diagnostic modalities (1 to 33) and has been
suspected to have 10 percent prevalence in some outbreaks of dengue .
Dengue could present to an eye surgeon first as subconjunctival
haemorrh...
We read with interest the article by Braithwaite et al. This article
has helped us in diagnosis and management of a patient here in Mumbai,
India.Dengue Eye Disease has become more common and has been investigated
extensively with many diagnostic modalities (1 to 33) and has been
suspected to have 10 percent prevalence in some outbreaks of dengue .
Dengue could present to an eye surgeon first as subconjunctival
haemorrhage and ecchymosis (17) , or some patients may be suffering from
dengue eye disease without symptoms .A subtle foveolitis may be missed
without OCT.Dengue may also cause symptomatic retinochoroiditis,
vasculitis, choroidal neovascularisation (19) secondary to immune damage ,
central retinal artery occlusion (14) , AION, frosted branch angitis (11)
and even panophthalmitis (23) , bilateral vitreous haemorrhage (31) ,
bilateral stellar neuroretinitis , bilateral choroidal effusion (33) and
may be suspected as an etiology even for bilateral acute angle closure
glaucoma (28) and also oculomotor paralysis (26) . We used iPad softwares
to examine severely ill dengue patients at bedside. We used it to identify
optic neuropathy and foveolitis in one patient and confirmed it on the
basis of this present article. A 32 year old female patient was admitted
with dengue and a routine examination was sought for eye check up at
bedside because of the patient complaining of "funny vision " . The
patient was tested with iPad based softwares encompassing everything from
visual acuity, contranst sensitivity , colour sensitivity, Amslers, Stero
vision , bedside iPad based visual field testing in order to give patients
a state of the art management (4) The diagnosis of optic neuropathy was
confirmed on OCT following dengue related micropsia which was diagnosed
and monitored with Amslers test. The patient was observed to see if
spontaneous resolution takes place as reported in some cases (2) . OCT
was repeated when the Amsler was reported to be worse and the macular
thickness was documented to be increased and so the patient was given
steroids following which the micropsia resolved and the macular thickness
reduced .Recently we have seen quite a few cases of Dengue with visual
involvement including a patient who lost both eyes to dengue
panophthalmitis like that reported earlier (23) and we would suggest that
not asking for an eye check if a patient reports distortion or "funny
vision" or reports the " Seet Quek Lim triad" of flashes of light,floaters
and blurring of vision(29) , may now be construed as being negligence if
patient loses vision eventually because dengue vision loss can be
irreversible and may be seen in upto 10 percent of cases and severe cases
may include cerebral venous thrombosis (13) which may be picked up by
papillodema which can be diagnosed by a fundoscopy and very severe cases
may proceed to even proptosis and globe rupture secondary to Dengue as
seen by Nagaraj et al (18)
References:-
1) Juanarita, Jaafar et al. "Dengue Related Maculopathy and Foveolitis."
Asian Pacific Journal of Tropical Biomedicine 2.9 (2012): 755-756.
2) Luk F, O, Chan C, K, Lai T, Y, A Case of Dengue Maculopathy with
Spontaneous Recovery. Case Rep Ophthalmol 2013;4:28-33
3) Chan, David P.L. et al. "Ophthalmic Complications of Dengue." Emerging
Infectious Diseases 12.2 (2006): 285-289.
4) Gan VC. Dengue: Moving from Current Standard of Care to State-of-the-
Art Treatment. Current Treatment Options in Infectious Diseases.
2014;6(3):208-226. doi:10.1007/s40506-014-0025-1.
5)Ng AW, Teoh SC. Dengue eye disease. Surv Ophthalmol. 2015
Mar-Apr;60(2):106-14. doi: 10.1016/j.survophthal.2014.07.003. Epub 2014
Aug 12.
6) Teoh SC, Chee CK, Laude A, Goh KY, Barkham T, Ang BS; Eye Institute
Dengue-related Ophthalmic Complications Workgroup. Optical coherence
tomographypatterns as predictors of visual outcome in dengue-related
maculopathy. Retina. 2010 Mar;30(3):390-8. doi:
10.1097/IAE.0b013e3181bd2fc6.
7) Su DH, Bacsal K, Chee SP, Flores JV, Lim WK, Cheng BC, Jap AH; Dengue
Maculopathy Study Group. Prevalence of dengue maculopathy in patients
hospitalized for dengue fever. Ophthalmology. 2007 Sep;114(9):1743-7.
8) Chee E, Sims JL, Jap A, Tan BH, Oh H, Chee SP. Comparison of prevalence
of dengue maculopathy during two epidemics with differing predominant
serotypes. Am J Ophthalmol. 2009 Dec;148(6):910-3. doi:
10.1016/j.ajo.2009.06.030.
9) Mendes TS, Sobrinho EF, Rosa AA, dos Anjos LM, da Costa GM, Souza Gda
S, Gomes BD, Saito CA, da Silva Filho M, Silveira LC. Dengue maculopathy:
visual electrophysiology and optical coherence tomography. Doc Ophthalmol.
2009 Oct;119(2):145-55. doi: 10.1007/s10633-009-9178-5.
10) Tan MH, Tan PE, Wong EN, Chen FK. Structure and function correlation
in a patient with dengue-associated maculopathy. Clin Experiment
Ophthalmol. 2014Jul;42(5):504-7. doi: 10.1111/ceo.12269.
11) Rani PK, Chhablani J, Bhargava A. Frosted Branch Angiitis in a Patient
Co Infected With Dengue Hemorrhagic Fever and Malaria. JAMA Ophthalmol.
2015 Jun;133(6):e1568. doi: 10.1001/jamaophthalmol.2015.68.
12) Lim WK, Mathur R, Koh A, Yeoh R, Chee SP. Ocular manifestations of
dengue fever. Ophthalmology. 2004 Nov;111(11):2057-64. PubMed PMID:
15522372.
13) Vasanthi N, Vairamon PM, Gowtham T, Das AK. Unusual Presentation of
Dengue Fever-Cerebral Venous Thrombosis. J Clin Diagn Res. 2015
Jun;9(6):OD09-10. doi: 10.7860/JCDR/2015/13132.6068.
14) Sadiq N, Naqaish T, Arif A, Mohammad K, Jalis M. Central retinal
artery occlusion secondary to dengue fever. J Ayub Med Coll Abbottabad.
2014 Jan-Mar;26(1):98-9.
15) Kanungo S, Shukla D, Kim R. Branch retinal artery occlusion secondary
to dengue fever. Indian J Ophthalmol. 2008 Jan-Feb;56(1):73-4.
16)Gupta S, Das D. Subhyaloid haemorrhage in dengue fever. J Indian Med
Assoc. 2013 Sep;111(9):623-4.
17) Jain S, Goswami A, Singh N, Kaur S. Bilateral eyelid ecchymosis and
sub conjunctival haemorrhage manifesting as presenting feature in a case
of dengue haemorrhagic fever. Trop Doct. 2014 Dec 24. pii:
0049475514565429.
18) Nagaraj KB, Jayadev C, Yajmaan S, Prakash S. An unusual ocular
emergency in severe dengue. Middle East Afr J Ophthalmol. 2014 Oct-
Dec;21(4):347-9. doi:10.4103/0974-9233.142276.
19) Veloso CE, Schmidt-Erfurth U, Nehemy MB. Choroidal neovascularization
induced by immunogenic alteration of the retinal pigment epithelium in
dengue Fever. Case Rep Ophthalmol. 2015 Jan 17;6(1):18-23. doi:
10.1159/000371791.
20) Rhee TK, Han JI. Use of optical coherence tomography to evaluate
visual acuity and visual field changes in dengue fever. Korean J
Ophthalmol. 2014
Feb;28(1):96-9. doi: 10.3341/kjo.2014.28.1.96.
21) Yamamoto K, Takahashi H, Kanno M, Noda Y, Fujino Y. Changes in
parafoveal retinal thickness and subfoveal choroidal thickness in a
patient with dengue fever-associated maculopathy. J Ophthalmic Inflamm
Infect. 2013 Oct 31;3(1):63.doi: 10.1186/1869-5760-3-63.
22) Koh YT, Sanjay S. Characteristics and Ophthalmic Manifestations of the
Classic Dengue Fever Epidemic in Singapore (2005-2006). Asia Pac J
Ophthalmol (Phila).2013 Mar-Apr;2(2):99-103. doi:
10.1097/APO.0b013e31828a1917.
23) Saranappa S B S, Sowbhagya HN. Panophthalmitis in dengue fever. Indian
Pediatr. 2012 Sep;49(9):760.
24) Chhavvi N, Venkatesh C, Soundararajan P, Gunasekaran D. Unusual ocular
manifestations of dengue fever in a young girl. Indian J Pediatr. 2013
Jun;80(6):522-3. doi: 10.1007/s12098-012-0871-0.
25) Tabbara K. Dengue retinochoroiditis. Ann Saudi Med. 2012 Sep-
Oct;32(5):530-3. doi: 10.5144/0256-4947.2012.30.4.1105.
26) Donnio A, B?ral L, Olindo S, Cabie A, Merle H. [Dengue, a new etiology
in oculomotor paralysis]. Can J Ophthalmol. 2010 Apr;45(2):183-4. doi:
10.1139/i09-207.
27) Sanjay S, Wagle AM, Au Eong KG. Dengue optic neuropathy.
Ophthalmology. 2009Jan;116(1):170; author reply 170. doi:
10.1016/j.ophtha.2008.08.015.
28) Pierre Filho Pde T, Carvalho Filho JP, Pierre ET. Bilateral acute
angle closure glaucoma in a patient with dengue fever: case report. Arq
Bras Oftalmol. 2008 Mar-Apr;71(2):265-8.
29) Seet RC, Quek AM, Lim EC. Symptoms and risk factors of ocular
complications following dengue infection. J Clin Virol. 2007 Feb;38(2):101
-5.
30) Chia A, Luu CD, Mathur R, Cheng B, Chee SP. Electrophysiological
findings in patients with dengue-related maculopathy. Arch Ophthalmol.
2006 Oct;124(10):1421-6.
31) Sanjay S, Au Eong KG. Bilateral vitreous haemorrhage associated with
dengue fever. Eye (Lond). 2007 Jan;21(1):144-5.
32) de Amorim Garcia CA, Gomes AH, de Oliveira AG. Bilateral stellar
neuroretinitis in a patient with dengue fever. Eye (Lond). 2006
Dec;20(12):1382-3.
33) Cruz-Villegas V, Berrocal AM, Davis JL. Bilateral choroidal effusions
associated with dengue fever. Retina. 2003 Aug;23(4):576-8.
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...
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 reports there
are in the literature.
The bilateral loss of vision in a case of dengue is very unfortunate
and the present case report (1) is very interesting because it has been
written quite well and helped in management of a case with bilateral
visual loss seen in Mumbai in a case referred to the author for opinion.
Dengue causes visual loss due to various reasons ranging from uveitis (2)
to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5...
The bilateral loss of vision in a case of dengue is very unfortunate
and the present case report (1) is very interesting because it has been
written quite well and helped in management of a case with bilateral
visual loss seen in Mumbai in a case referred to the author for opinion.
Dengue causes visual loss due to various reasons ranging from uveitis (2)
to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5) and
branch retinal artery occlusion (6)
Bilateral visual loss has been documented due to stellar
neuroretinitis (8),vitreous haemorrhage (9),vasculitis and macular oedema
(10) angle closure glaucoma (11),choroidal effusion (12), optic neuritis
(13) ,pituatory haemorrhage (14) and is also known to be recurrent in both
eyes (15)due to recurrent maculopathy
The patient in question in Mumbai had a bilateral uveitis which
caused bilateral visual loss following dengue.The review of literature
shows that bilateral visual loss is becoming pretty common over the last
10 years
This only proves that routine eye examination should be made
mandatory in cases presenting with diagnosis of dengue because they are
prone to bilateral visual loss due to various conditions
References
1) Braithwaite T, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-200542
2) Gupta A, Srinivasan R, Setia S, Soundravally R,
Pandian DG. Uveitis following dengue fever. Eye
(Lond). 2009;23:873-6.
3) Sanjay S, Wagle AM, Au Eong KG. Optic
neuropathy associated with dengue fever. Eye
(Lond). 2008;22:722-4.
4) Zohar Halbot Wilner et al. A returned traveller with Dengue fever
and visual impairment.IMAJ 2005;7:200-201
5)Loh BK, Bacsal K, Chee SP, Cheng BC, Wong D.
Foveolitis associated with dengue fever: a case
series. Ophthalmologica. 2008;222:317-20
6)Kanungo S, Shukla D, Kim R. Branch retinal artery
occlusion secondary to dengue fever. Indian J
Ophthalmol. 2008;56:73-4.
7)Chlebicki MP, Ang B, Barkham T, Laude A. Retinal
hemorrhages in 4 patients with dengue fever.
Emerg Infect Dis. 2005;11:770-2.
8) de Amorim Garcia CA, Gomes AH, de Oliveira AG.
Bilateral stellar neuroretinitis in a patient with
dengue fever. Eye (Lond). 2006;20:1382-3
9)Nainiwal S, Garg SP, Prakash G, Nainiwal N.
Bilateral vitreous haemorrhage associated with
dengue fever. Eye. 2005;19:1012-3
10)Tan CS, Teoh SC, Chan DP, Wong IB, Lim TH.
Dengue retinopathy manifesting with bilateral
vasculitis and macular oedema. Eye (Lond).
2007;21:875-7.
11)Pierre Filho Pde T, Carvalho Filho JP, Pierre ET.
Bilateral acute angle closure glaucoma in a patient
with dengue fever: case report. Arq Bras Oftalmol.
2008;71:265-8
12)Cruz-Villegas V, Berrocal AM, Davis JL. Bilateral
choroidal effusions associated with dengue fever.
Retina. 2003;23:576-8.
13)Preechawat P, Poonyathalang A. Bilateral optic
neuritis after dengue viral infection.
J Neuroophthalmol. 2005;25:51-2.
14)Vimal Kumar et al. Dengue hemorrhagic fever: A rare cause of
pituitary tumor hemorrhage and reversible vision loss.Indian J Ophthalmol.
2011 Jul-Aug; 59(4): 311-312
15)Quek DT, Barkham T, Teoh SC. Recurrent bilateral
dengue maculopathy following sequential
infections with two serotypes of dengue virus. Eye
(Lond). 2009;23:1471-2.
Ketoacidosis is a direct result of exteremly low cellular magnesium
levels. Gluconeogenesis is impaired at Glucose6 Phosphatase G6-Pase. G6-
Pase is very magnesium dependent so if magnesium levels are severely
reduced blood glucose levels plummet starving neurons of energy. The
neurons in the hypothalamus signal the gut get more in 'the hunger pangs
in Obesity'.
Pyruvate carboxylase is also very magnesium dependent and if...
Ketoacidosis is a direct result of exteremly low cellular magnesium
levels. Gluconeogenesis is impaired at Glucose6 Phosphatase G6-Pase. G6-
Pase is very magnesium dependent so if magnesium levels are severely
reduced blood glucose levels plummet starving neurons of energy. The
neurons in the hypothalamus signal the gut get more in 'the hunger pangs
in Obesity'.
Pyruvate carboxylase is also very magnesium dependent and if impaired by
low magnesium levels and will also shutdown gluconeogenesis. Ketoacidosis
is a direct result of beta oxidation of fat converting to AcetylCoA and
Ketones. This continuous manufacture of ketones results in acid blood.
Kidney failure in severe obesity and Diabetes-2 are other complications
caused by a failure of gluconeogenesis.
A magnesium sulphate injection would rectify the condition in amatter of
minutes. If you require a comprehensive article please email. Arthur
Henderson
We read with interest the paper of Oliver Richard Waters, Tawfique Daneshmend, and Tarek Shirazi on "An incidental finding of a gastric foreign body 25 years after ingestion".
It is quite interesting as well as surprising. We feel it may be the longest period that a pen sat idle and was detected so late.
In addition, the pen was still OK !!!!
We have an interesting case of FB in stomach and G...
The article remarks the importance of reviewing the clinical history when the diagnosis or management of the patient is not completely defined, especially in an emergent situation.
Conflict of Interest:
None declared
Dear Dr Wong,
I read with interest your case report regarding migration of Filshie clips. I have come across a migrated Filshie clip as well while reviewing a lumbosacral radiograph done for a patient with prolapsed intervertebral disc. She had been asymptomatic and had not conceived since the sterilisation procedure. There have been quite a few case reports of such incidences in PubMed (eg Connolly D et all,...
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...
Hopkins et al: Thank you for an interesting article highlighting the importance of exploring and ruling out medical conditions that present with psychotic symptoms. Potentially, there could be near misses and one cannot over emphasize the importance of maintaining high clinical skills in averting this. This article also goes to point that we need to bear in mind that a medical illness can present with symptoms akin to a p...
The nature and time course of temporal lobe abnormalities in psychotic illness remain notorious. Confounds include disease chronicity, demographic data, and handedness etc . Temporal lobe epilepsy is associated with a substantial risk of psychosis but there are only restricted studies investigating the underlying changes and causes. momentous grey and white matter deficits occur in temporal lobe epilepsy with psychosis....
We read with interest the article by Braithwaite et al. This article has helped us in diagnosis and management of a patient here in Mumbai, India.Dengue Eye Disease has become more common and has been investigated extensively with many diagnostic modalities (1 to 33) and has been suspected to have 10 percent prevalence in some outbreaks of dengue . Dengue could present to an eye surgeon first as subconjunctival haemorrh...
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...
The bilateral loss of vision in a case of dengue is very unfortunate and the present case report (1) is very interesting because it has been written quite well and helped in management of a case with bilateral visual loss seen in Mumbai in a case referred to the author for opinion. Dengue causes visual loss due to various reasons ranging from uveitis (2) to optic neuropathy (3)to retinal haemorrhages (4,7), foveolitis (5...
Ketoacidosis is a direct result of exteremly low cellular magnesium levels. Gluconeogenesis is impaired at Glucose6 Phosphatase G6-Pase. G6- Pase is very magnesium dependent so if magnesium levels are severely reduced blood glucose levels plummet starving neurons of energy. The neurons in the hypothalamus signal the gut get more in 'the hunger pangs in Obesity'. Pyruvate carboxylase is also very magnesium dependent and if...
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