154 e-Letters

published between 2013 and 2016

  • Misleading sentence in Summary
    Shawn Weldon

    In the summary of this article is the following:

    "Only following specific questioning did she reveal that she had, in the preceding 3 months, regularly consumed internet ordered Chinese green tea, which contained Camellia sinensis."

    My issue with this sentence is the word "contained". Chinese green tea, or any other true tea, must come from Camellia sinensis.

    The word "contained" gives the imp...

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  • Green tea toxicity?
    Jeffrey B. Blumberg

    Lugg et al. present a case of acute hepatitis in a 16-year old girl and, using the CIOMS/RUCAM scale, conclude the probable cause as a 3-month exposure to a Chinese green tea ordered via the internet. Other case reports have associated an idiosyncratic hepatoxicity with green tea though other factors, including adulterants, can contribute to its causality (Blumberg et al.). Regrettably, like many of these reports, this on...

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  • Response to eLetter submitted to BMJ Case Reports
    Ramnik V Patel
    We are grateful for your comments in our images in medicine article in BMJCR entitled "'Neonatal duodeno-duodenostomy and missed duodenal stenosis with windsock deformity: a rare intraoperative error of technique and judgement by an unwary surgeon"1 We agree that finding bile in what is considered a distal segment of an atretic duodenum does not exclude all possible pathology. We are in agreement with your statement that duodena...
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  • Bifid bile duct duodenal web bypass
    Dimitrios Sfoungaris

    Indeed, this is a very interesting case illustrating that a positive intraoperative sign (finding bile in what is considered a distal segment of an atretic duodenum) does not exclude every possible pathology. However, I am still not convinced about the underlying pathology in this case. In my opinion, a perforated duodenal windsock web would allow a greater amount of air to pass through (and more gas appearing in the ab...

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  • Re:Metastatic lung cancer, an interesting stroke mimic - Authors reply.
    Hew D. Torrance

    Dear Dr Artul,

    Thank you for your question and kind comments regarding the case report. The mass seen is the same as in the Computerised Tomography (CT) and the Magnetic Resonance (MR) images. It is an isolated, large (3x2.5 cm) mass lesion. The CT was taken almost 48 hours prior to the MR as the patient had been incorrectly diagnosed and triaged to the stroke unit. As a result this time-frame may account for c...

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  • Metastatic lung cancer, an interesting stroke mimic
    Suheil Artul

    Dear author Nice case This case emphasizes the importance in differentiation between vasogenic edema of white matter due to SOL and edema due to stroke. The vasogenic edema due to SOL in general doesn't respect the anatomy and in the other hand edema due to stroke in general yes it respect the anatomy of the vessels territory and anatomical lobes. However I have one question: Is the mass seen in the CT is the same mass...

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  • ?Zebras
    Alexander M Bobinskas

    Dear Editor,

    I read with interest the description of an orbital floor and nasal bone fractures associated with orbital and subcutaneous emphysema(1).

    The presentation of orbital floor fracture with orbital emphysema in the absence of a history of trauma is indeed unusual as noted by the author. Even more unusual is a nasal bone fracture caused by nose blowing, with the current case apparently being the...

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  • Water and Ketones as Sources of Alternative Cellular Energy
    W. John Martin

    It was a pleasure to see the article by Dr. Goldhammer and colleagues published in a mainstream medical journal. As discussed elsewhere (1) activated water can potentially provide tumor cells with sufficient cellular energy via the alternative cellular energy (ACE) pathway to either undergo apoptosis or complete the maturation process. Moreover, the provision of cellular energy probably explains the effectiveness of homeo...

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  • Ketamine administration by which specialty?
    Tom E Mallinson

    Thank for your this interesting case.

    In the United Kingdom this is a medication used rarely within the hospital environment, although it is gaining popularity in the pre- hospital field. I would be intrigued to know the specialty of the attending physician in this case, and his or her prior experience with ketamine.

    In addition, do the authors feel that ketamine is a superior first choice analgesi...

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  • What if
    Mohammed Hasan Nemat

    What if the patient gave in his history that he went to Nigeria? Would it be mandatory to do all the tests for infectious diseases in Nigeria?. His travel history would give no indication for any further investigation unless we find something relevant clinically. What is always important is to have full history always regardless whether he is undergoing elective surgery or not, he is traveling or not.

    What I wan...

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