118 e-Letters

published between 2010 and 2013

  • A role for MRI or PET?
    Swaroop Revannasiddaiah

    After reading this article, we are prompted to ask whether the use of functional magnetic resonance imaging (fMRI) or a fluoro-desoxy-glucose positron emission tomography (FDG-PET) can help solve ambiguities associated with clinical and computed tomography angioraphy (CTA) based techniques for affirming brain-death.

    Conflict of Interest:

    None declared

  • ID Please
    Paul E. Verweij

    The fungal kingdom is characterized by significant biodiversity within genera and species. Several hundred of fungi have been described as cause of disease in humans. Abdulaziz and colleagues describe a case of invasive fungal disease that supports their plea for more research into polyene and azole combination therapy. In their case report the authors make assumptions that do not take into account the fungal biodiversity...

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  • Missing Clues for the Radiologist
    Amitav Banerjee

    This oversight indicates the shortcomings of present day medical training. The emphasis is on technology and newer diagnostics at the cost of patient centered clinical skills, which included detailed history taking. We are in danger of churning out technicians rather than doctors.

    This case report is a wake up call.

    Conflict of Interest:

    None declared

  • Re:Missing clues for a radiologist
    Tushar Sahasrabudhe

    Many thanks for raising another important point here. The primary responsibility of making diagnosis of a patient lies with the clinician. The radiology is a modality that helps in reaching diagnosis. The clinician is expected to give a detailed note to the radiologist mentioning the case history, clinical findings and his probable diagnosis. This input is of utmost importance to a radiologist for concluding the radiolog...

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  • Missing clues for a radiologist
    David P. O'Keeffe

    The case report unfortunately reflects a common problem where the referring clinician omits to include relevant clinical information. "The chest radiogram was reported by a radiologist, who neither saw the patient personally nor enquired into the patient's history." might well be amended to read "the referring clinician omitted to mention the presence of multiple large cutaneous neurofibromata"

    Rubbish in-rubbish...

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  • Re:The Risk of Probiotic Sepsis
    Alexandre Hertig

    Thank you for the opportunity to reply to the correspondant. Although we agree with him/her on one point, which is that there is no large, randomized study that would allow us to recommend the use of probiotics on a systematic basis in patients receiving a broad spectrum antibiotherapy, we would like to stress out that the majority of the cases reported here are from patients who developed a sepsis after being to probiotic...

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  • The Risk of Probiotic Sepsis
    Antoine Kass-Iliyya

    I read with interest this rare case report of ureteric obstruction secondary to fungal mycella.

    The authors concluded that antibiotics dramatically reduce the commensal flora, compromising the physiological balance that prevents the outgrowth of fungi and they recommended that probiotics should be considered to prevent this complication, which can be severe and life threatening in immunocompromised patients....

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  • The digital thoracic drainage could be a new tool for very selected ambulatory patients.
    Jose M Mier

    I have read with interest the paper by Jenkins et al on discharging a patient to home with a Thopaz drain thus avoiding a surgical procedure. I agree with the author on the benefits of digital thoracic drainage devices. The author does reference previous work by Cerfolio RJ and Brunelli A, in our experience (Mier JM, Molins L, Fibla JJ Cir Esp. 2010(6):385-9) in a prospective and comparative study we demonstrate the benefi...

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  • Re:lactation ketoacidosis-bmj case report
    Arthur J Henderson

    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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  • 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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