340 e-Letters

  • Coeliac plexus block for Gastro Esophagel Reflux plain
    Rakesh Biswas

    Hi Dr Wu and Dr Mueller,

    Thanks for your excellent case report. I have a patient of proven refractory reflux pain even after fundoplication .

    Do you think coeliac plexus or other blocks may help in such situations? What other such interventions may help to relieve his reflux pain?

    What happened to your patient's pain after 11 weeks?

    Would be grateful for your response to these queri...

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  • Axial, Sagittal, or Coronal?
    Osama SM Amin

    Thanks to the author and his colleagues. Two notes only:

    1. Figure 2 is a sagittal, not a coronal MRI view.

    2. The addition of "T2-weighted" to the phrases of both figures would be helpful; the surrounding CSF signal is hyper-intense. Many doctors don't know how to interpret the brain MRI images and we should deliver the information as complete as possible.

    Conflict of Interest:

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  • Harm Reduction
    jason d gough

    As a former iv drug user of some 20 years I can certainly confirm the existence of needle fixation and its considerable prevelence amongst iv drug users.

    Commonly this expresses itself in withdrawing and injecting blood after the injection of drugs, known as "flushing". It is more readily seen in longer term iv users or for those who finding a vein involves a lot of stabbing about and then a release from the pain...

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  • Incontinence and mood disorder
    Dr Osama Hammer

    I really congratulate the hard work which was done to report this case as we all know that we have some in patients presenting in our psychiatric inpatients/community with incontinence .we always seek the medical help to roll out any underlying cause for the incontinence. However if we study the pathogeneses of incontinence and the depression it purely eradicate our doubt ,that with severity of illness the more 5HT2A in...

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  • The common is common!
    Osama SM Amin

    Dear Editor

    We are thankful to Lonergan and his colleagues for reporting this very interesting case of stroke that has been linked to sunitinib therapy. I have a few notes:

    1. The very first thing is the age of the patient? How old is he?

    2. The author did mention that the patient had several risk factors for ischaemic stroke, but he linked this stroke mainly to sunitinib. What evidence points...

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  • Wallenberg's lateral medullary syndrome and its rare signs
    Osama SM Amin

    Dear Editor

    Thanks to von Heinemann et al for reporting this brainstem stroke as a reminder of a grave complication of brainstem lesions, and that is cardiac arrest.

    The writer of this case report has mentioned lateral medullary syndrome of Wallenberg after providing us with abbreviated neurological findings, and he has linked his observation with this type of brainstem stroke. The given brain imaging fi...

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    Dear Editor

    We are pleased to go through the interesting articles published by BMJ Case Reports. Having gone through this article ,the lesson is very good, but the fig 1A looks that of an adolscent--just look on the upper arm and elbow. Also thyroid hormone replacement alone leading to regression of such a big mass, does not explain why tumors from other pitutary cell types do not regress without other intevent...

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  • Is rowing atrauamtic?
    davinder p s baghla

    Dear Editor

    I read with interest your case report of bilateral meniscal tears in a 17 year old rower. Admittedly meniscal tears are not as common as Chondromalacia patellae, Iliotibial Band syndrome or Patella tendonitis, however they have been reported in a survey of knee injuries in rowers (Hosea TM et al. Rowing injuries. Postgraduate Advances in Sports Medicine 1989;3:1–16)

    The act of rowing comb...

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  • Unexpected Untoward Effect of Evidence-Based Medicine
    Taopheeq B. Rabiu

    Dear Editor

    The report by Fremault and Rodenstein1 is a significant contribution to our knowledge of the hazards posed by generalization rather than individualization of patient care. While there is no doubt that evidence- based medicine(EBM) has come to stay in health care services and that that the practice has helped to reduce cost of health care services by avoiding a waste of efforts and resources, complete adh...

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  • Loss of heterozygosity in SDHB locus on chromosome 1 in a subject with a metastatic papillary type I
    Dr. Umasuthan Srirangalingam
    A recent case report in this journal presented the case of a subject with an SDHB mutation who developed a metastatic type II papillary renal cell carcinoma which therapeutically responded to the tyrosine kinase inhibitor, sunitinib 1 2. SDHB germline mutations account for the familial paraganglioma syndrome type 4 (PGL-4) which is characterised by predominantly extra-adrenal paragangliomas with high malignant potential 2. SDHB...
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