I have read with surprise the case report which makes rather wide
sweeping claims about green tea being of health concern. After a quick
literature review there have been rare cases after prolonged ingestion of
green tea extract - but none ever analyzed the extract for components
besides green tea.
It is not a secret that there are problems with food safety in china,
especially pesticide use, so making claims about the p...
I have read with surprise the case report which makes rather wide
sweeping claims about green tea being of health concern. After a quick
literature review there have been rare cases after prolonged ingestion of
green tea extract - but none ever analyzed the extract for components
besides green tea.
It is not a secret that there are problems with food safety in china,
especially pesticide use, so making claims about the plant instead of
doing at least a rough test for chemicals in the extract (or in that case
the tea) seem in my opinion very much warranted prior to claims with such
impact.
This case report is interesting and revealing for 2 reasons. Gall
stone ileus is usually due to benign fistula due to pressure necrosis and
duodenal wall eroding through. Gall stone gets impacted in the terminal
ileum and cannot pass the so called physiological ileo caecal valve.
In this case the gall stone got impacted in (1)the decending colon and not
in the terminal ileum and the cause of the fistula turned out to be(2)...
This case report is interesting and revealing for 2 reasons. Gall
stone ileus is usually due to benign fistula due to pressure necrosis and
duodenal wall eroding through. Gall stone gets impacted in the terminal
ileum and cannot pass the so called physiological ileo caecal valve.
In this case the gall stone got impacted in (1)the decending colon and not
in the terminal ileum and the cause of the fistula turned out to be(2)
malignant- carcinoma gall bladder.
[Apologies for late edits to letter submitted yesterday, please note
there are 3 new references addressing hepatotoxicity of fluoroquinolones
that were not in orginal letter].
Lugg et al (2015) reported a case study of a 16 year old girl born
who presented with signs of chronic joint pain, dizziness and non-specific
abdominal pains after consuming 3 cups per day of imported herbal green
tea (as tea bags) for a p...
[Apologies for late edits to letter submitted yesterday, please note
there are 3 new references addressing hepatotoxicity of fluoroquinolones
that were not in orginal letter].
Lugg et al (2015) reported a case study of a 16 year old girl born
who presented with signs of chronic joint pain, dizziness and non-specific
abdominal pains after consuming 3 cups per day of imported herbal green
tea (as tea bags) for a period of 3 months [1]. There are a number of
interesting points not addressed in the case study which physicians may
not be aware of that are of clinical significance.
Firstly, the description of the ailments which the subject presented
with strongly suggest chronic fluoride intoxication. Hallanger et al
(2007) reported that the clinical features associated with fluoride
intoxication resulting from habitual tea consumption can include joint
pain and gastrointestinal complaints and that fluoride toxicity is often
overlooked by clinicians [2]. Despite the publication of a large number of
reports addressing fluoride intoxication from habitual tea drinking [3]
many health care professionals remain unaware of the risk of fluoride
intoxication from tea and lack an understanding of the pathophysiology of
fluoride toxicosis. The United States National Academy, National Research
Council (2006) reported that excessive intake of fluoride will manifest
itself in a musculoskeletal disease with associated symptoms including
chronic joint pain and arthritic symptoms [4]. However, perhaps one the
most detailed explanations of the pathophysiology of fluoride toxicosis is
provided by Professor Alexander V. Akleyev [5]. In addition to
musculoskeletal disorders, Akleyev reported that stage 2 fluorosis, the
following symptoms are observed: subatrophic and atrophic rhinitis,
pharyngitis, laryngitis, chronic conjunctivitis, retinal degeneration with
visual impairment, hearing loss, increasing impairment of bronchial
patency, and pulmonary insufficiency; mycrodial dystrophy with reduced
contractility, chronic gastritis mainly with the reduction of secretory
and acid forming function of the stomach, and chronic hepatitis with
persistent liver failure; distinct astheno-vegetative syndrome, toxic
polyneuritis and decrease in glucocorticoid function of adrenal cortex;
and microhematuria and proteinura [4]. Kessabi et al (1986) also reported
that acute hepatitis and degeneration in the liver develop following
chronic fluoride intake [6]. Other studies have also found that fluoride
toxicosis can induce hepatotoxicity and oxidative stress in humans [7-8]
and animals [9].
In the case study described by Lugg and associates [1], the fluoride
concentration in the tea samples ingested by the patient are unknown, as
they were not tested. Chan et al (2013) reported high fluoride levels in
tea infusions in the United Kingdom including green tea leaves which were
found to contained up to 6.67mg/L when made with deionized water [10]. The
European Food Safety Authority (EFSA) have reported that drinking just 2
cups of tea per day (with a fluoride content of 5mg/l), combined with an
average consumption of fluoridated drinking water and use of fluoridated
tap water in the preparation of food, but excluding all other sources
(including solid foods, toothpaste and dental products), would provide a
daily dietary intake of 6 mg per day [11]. The EFSA have established
daily recommended intake levels (AI) and Tolerable Upper Intake Levels
(ULs) for fluoride. For an adult female the AI is 2.9mg per day while the
UL is 7mg per day [11-12]. Birmingham is the largest city in the England
with artificially fluoridated water. Thus, the patient having consumed 3
cups of tea per day, is likely to have exceeded the recommended UL for
fluoride, thereby increasing the risk of chronic fluoride intoxication.
Secondly, Lugg and associates noted that the condition of the subject
worsened following prescribing of amoxicillin [1]. Amoxicillin is a
fluoroquinolone. The name fluoroquinolone comes from the presence of
fluorine which is found in all fluoroquinolones. Hong et al (2005)
reported that amoxicillin was associated with dental fluorosis in children
[13]. Thus, it is likely that administration of amoxicillin resulted in
further contributing to chronic fluoride intoxication of the subject and a
worsening of her condition. Other fluoroquinolones such as ciprofloxacin
have been found to significantly increase plasma fluoride levels in
individuals [14]. Fluoroquinolones have also been found to be associated
with severe hepatotoxicity [15-18]. It is likely that the toxicity of
fluoroquinolones would be more immediate in persons with elevated
background plasma fluoride levels.
Thirdly, on cessation of the herbal tea and treatment with
intravenous fluids and N-acetylcysteine, her condition resolved [1]. N-
acetylcysteine is known to protect against fluoride-induced oxidative
damage [19].
Overall the evidence indicates the symptoms reported may be due
fluoride toxicosis caused by high fluoride intake from tea, combined with
other fluoride sources such as fluoridated drinking water and medications.
There is a need for healthcare workers to be aware of the pathophysiology
of fluoride toxicosis as well as dietary fluoride sources, particularly
among habitual tea drinkers in communities with artificially fluoridated
drinking water. Urinary or blood fluoride levels should be routinely
monitored in patients with muscleoskeletal and gastrointestinal disorders.
Fasting serum fluoride concentrations ranging from 2.5 - 8.0 ?M/L can
result in chronic fluoride intoxication and stage I and stage II skeletal
fluorosis [20].
[1] Lugg ST, Menezes DB, Gompertz S. Chinese green tea and acute
hepatitis: a rare yet recurring theme. BMJ Case Rep 2015, doi:10.1136/ bcr
-2014-208534.
[2] Hallanger-Johnson JE, Kearns AE, Doran PM, Khoo TK., Wermers RA.
Fluoride-related bone disease associated with habitual tea consumption.
Mayo Clinic Proceedings 2007;82(6):719-24.
[3] Yi J, Cao J. Tea and fluorosis. Journal of Fluorine Chemistry,
2008, 129: 76-81.
[4] National Research Council, Review of Fluoride in Drinking Water,
U.S. National Research Council 2006.
[5] Neurological Disorders of Non-Radiation Nature, Fluorosis, In
Chronic Radiation Syndrome, Alexander V. Akleyev, Spriner-Verlag Berlin
Heidelberg 2014. ISBN 978-3-642-45116-4.
[6] Kessabi M, Hamliri A. Experimental fluorosis in sheep:
Alleviating effects of aluminum. Vet. Hum. Toxicol., 1986, 28: 300-304.
[7] Michael M, Barot VV, Chinoy NJ. Investigations of Soft Tissue
Functions In Fluorotic Individuals of North Gujarat. Fluoride 1996, Vol.29
No.2 63-71.
[8] Medvedeva VN. Characteristics of the course of chronic hepatitis
in workers coming in contact with flourine compounds. Gigiena Truda;
Professional'nye Zabolevaniia, Jan 1985. pg 24-6.
[9] AL-Harbia MS, Hamzaa RZ, Dwarya AA. Ameliorative effect of
selenium and curcumin on sodium fluoride induced hepatotoxicity and
oxidative stress in male mice. J Chem Pharma Res, 2014, 6(4):984-998.
[10] Chan L, Mehra A, Saikat S, Lynch P. Human exposure assessment
of fluoride from tea (Camellia sinensis L.) Food Res Internat. 2013; 51:
564-570.
[11] European Food Safety Authority, Scientific Opinion on Dietary
Reference Values for fluoride, EFSA Panel on Dietetic Products, Nutrition,
and Allergies: EFSA Journal. 2013;11(8):3332.
[12] European Food Safety Authority, Scientific Opinion of the Panel
on Dietetic Products, Nutrition, and Allergies (NDA) on the tolerable
upper intake level of fluoride. The EFSA Journal. 2005, 192, 1-65.
[13] Hong L, Levy SM, Warren JJ, Dawson DV, Bergus GR, Wefel JS.
Association of Amoxicillin Use During Early Childhood With Developmental
Tooth Enamel Defects, Arch Pediatr Adolesc Med. 2005;159:943-948, 995-996.
[14] Pradhan KM, Arora NK, Jena A, Susheela AK, Bhan MK. Safety of
ciprofloxacin therapy in children: magnetic resonance images, body fluid
levels of fluoride and linear growth. Acta Paediatr. 1995, 84:555-560.
[15] Hautekeete ML. Hepatotoxicity of antibiotics. Acta
Gastroenterol Belg. 1995 May-Aug;58(3-4):290-6.
[16] Vial T, Biour M, Descotes J, Trepo C. Antibiotic-associated
hepatitis: update from 1990. Ann Pharmacother. 1997 Feb;31(2):204-20.
[17] Thiim M, Friedman LS. Hepatotoxicity of antibiotics and
antifungals. Clin Liver Dis. 2003 May;7(2):381-99, vi-vii.
[18] Robles M, Andrade RJ. Hepatotoxicity by antibiotics: update in
2008. Rev Esp Quimioter. 2008 Dec;21(4):224-33. Article in Spanish.
[19] Paw?owska-G?ral K, Kurzeja E, Stec M. N-acetylcysteine protects
against fluoride-induced oxidative damage in primary rat hepatocytes.
Toxicology in Vitro, December 2013, Volume 27, Issue 8, Pages 2279-2282.
doi:10.1016/j.tiv.2013.09.019.
[20] Xiang QY, Chen LS, Chen XD., Wang CS, et al. Serum Fluoride And
Skeletal Fluorosis In Two Villages In Jiangsu Province, China. 178
Fluoride 2005;38(3):178-184
We read with great interest the case report by Demirel (1) et al. in
the journal. The authors described the case showing severe hyponatremia
and critical hypoxia during transurethral resection of the prostate (TURP)
surgery in the patient under general anaesthesia. TURP syndrome is
initiated by absorption of irrigating fluid (2) and is characterized by
decreasing a serum sodium concentration, inducing cardiovascular
depr...
We read with great interest the case report by Demirel (1) et al. in
the journal. The authors described the case showing severe hyponatremia
and critical hypoxia during transurethral resection of the prostate (TURP)
surgery in the patient under general anaesthesia. TURP syndrome is
initiated by absorption of irrigating fluid (2) and is characterized by
decreasing a serum sodium concentration, inducing cardiovascular
depression and developing neurological abnormality (3). The large volume
of fluid absorption is a major dangerous complication in patients
undergoing endoscopic surgery (4) and the severity of TURP syndrome is
dependent on the dose and the type of irrigating fluid used (5).
The case presentation1 was well documented by the authors, however,
some of interpretation for the results has a room for discussion. First,
notwithstanding a lack of precise description, the irrigation fluid,
"Resectisol", they used (1) would contain mannitol. The solute minimizes a
change in serum osmolality when it is largely absorbed (6). Thus, the
attempt of aggressive treatment to avoid intravascular haemolysis by
increasing of osmolality with administrating hypertonic saline1 is not
acceptable despite of severe hyponatremia. Second, as the authors
discussed, the fluid overload would reach maximal by the absorption of
irrigation fluid in addition to 3-l intravenous hydration by the
anesthesiologists. The findings of hypoxia could be developed as a result
of pulmonary edema and further sodium loading is unsafe for the
cardiovascular hemodynamics.
Wang et al. (7) reported the two cases of patients developed
pulmonary edema in the TURP syndrome induced with mannitol 5%. The lowest
serum sodium concentration was 99 and 97 mmol/l, respectively. They
discussed that no convulsions or seizures were observed in their patients
and severe neurological abnormalities have never been reported with
mannitol 5% during TURP surgery (7). The vascular overload by hypertonic
saline was also mentioned as a risk of cardiovascular complications during
the treatment for TURP syndrome. We had also encountered the case of TURP
syndrome induced with 3%-sorbitol irrigating fluid (8). The serum sodium
concentration was decreased to 101 mmol/l. Despite of no sign of
intravascular hemolysis, we administered much of physiological saline to
recover sodium concentration and critical pulmonary edema was developed in
the patient by misunderstandings of the pathophysiology.
When distilled water was used as irrigating fluid (9), hyponatremia
simultaneously indicates the decrease in serum osmolality and lethal
hemolysis could be followed. However, mild hypotonic or isotonic
irrigating fluid reduces the risk of hemolysis-induced renal failure (10)
and induces another threat of heart failure and pulmonary edema as a
result of excessive volume overloading during TURP surgery (7,8).
Hypervolemia with hypoosmolality are more pathogentetic factors than
hyponatremia in TURP syndrome.
REFERENCES
1. Demirel I, Ozer AB, Bayar MK, Erhan OL. TURP syndrome and severe
hyponatremia under general anaesthesia. BMJ Case Rep. 2012; Nov 19 2012.
2. Hahn RG. Fluid absorption in endoscopic surgery (review). Br J Anaesth
2006; 96: 8-20.
3. Olsson J, Nilsson A, Hahn RG. Symptoms of the transurethral resection
syndrome using glycine as the irrigant. J Urol 1995; 154: 123-8.
4. Ichai C, Ciais JF, Roussel LJ, Levraut J, Candito M, Boileau P, Grimaud
D. Intravascular absorption of glycine irrigating solution during shoulder
arthroscopy: a case report and follow-up study. Anesthesiology 1996; 85:
1481-5.
5. Hahn RG, Stalberg HP, Gustafsson SA. Intravenous infusion of irrigating
fluids containing glycine or mannitol with and without ethanol. J Urol
1989; 142: 1102-5.
6. Kirschenbaum MA. Severe mannitol-induced hyponatraemia complicating
transurethral prostatic resection. J Urol 1979; 121: 687-8.
7. Wang JH, He Q, Liu YL, Hahn RG. Pulmonary edema in the transurethral
resection syndrome induced with mannitol 5%. Acta Anaesthesiol Scand 2009;
53: 1094-6.
8. Adachi Y, Takigami J, Nakai T, Watanabe K, Uchihashi Y, Aramaki Y,
Satoh T. Negative-pressure pulmonary edema associated with transurethral
resection syndrome. Masui 2000; 49: 1226-30. [Japanese with English
abstract]
9. McLaughlin WL, Holyoke JB, Bowler JP. Oliguria following transurethral
resection of the prostate gland. J Urol 1947; 58: 47-60.
10. Nesbit RM, Glickman SI. The use of glycine solution as an irrigating
medium during transurethral resection. J Urol 1948; 59: 1212-6.
Thank you very much Mr M.A Warner for reviewing our article and
sharing your views from the same. We do agree with your suggestion that,
there in no 'strong' correlation between the use of peripheral nerve
blockage and delay in diagnosis of acute compartment syndrome following
surgical procedures on extremities. Among the reported cases of peripheral
nerve blockage use in extremity surgeries and where the compartment
syn...
Thank you very much Mr M.A Warner for reviewing our article and
sharing your views from the same. We do agree with your suggestion that,
there in no 'strong' correlation between the use of peripheral nerve
blockage and delay in diagnosis of acute compartment syndrome following
surgical procedures on extremities. Among the reported cases of peripheral
nerve blockage use in extremity surgeries and where the compartment
syndrome was diagnosed and prompt fasciotomy preformed, all the patients
were within the "hospital or clinical setting". The clinicians were
vigilant with high index of suspension of acute compartment syndrome hence
there were no delays in making the diagnosis nor in performing the
fasciotomy surgery to adequately decompress the compartments, thus avoided
the potential long-term complications and disabilities.
Our patient received 10mls of 0.25% Chirocaine and 13mls of 2%
lignocaine with adrenaline 1:200000 strength, in total for his left
axillary nerve block. The procedure was performed with ultrasound guidance
and confirmed with nerve stimulator of adequate block in Radial, Ulnar,
Median and Musculoskeletal nerve. He was discharged 8 hours following his
surgery as he was quite comfortable with no pain in the operated limb and
unfortunately there was no clear documentation with regards to distal
muscular activity, prior to discharge .
We also agree with you in that, this patient underwent a revision
procedure that would involve more soft tissue dissection and stripping,
which itself contribute to increased post operative swelling compared to
fractures with minimal displacement.
We believe, learning points in addition to aforementioned in the case
report are, clinicians and all health care professional involved in
providing care, should have awareness of compartment syndrome risk in
extremity injuries and caution with clinical vigilance is needed when
treating patients with extremity fractures and regional block is still in
effect.
Impressive story and inspiring for a lot of people I think. This case
report again shows that mindfulness-based cognitive therapy is a really
effective way of treatment for this particular, persisting disorder and
should surely be investigated further!
I read with interest the case reported by Diaz and Valdez (1)
regarding a patient who was successfully resuscitated from ventricular
fibrillation cardiac arrest while running in a marathon race. The patient
had a posterior diagnosis of anomalous right coronary artery arising from
the aorta above the left sinus of Valsalva that subsequently runs between
the aorta and the pulmonary artery, discovered by a 64-slice multidet...
I read with interest the case reported by Diaz and Valdez (1)
regarding a patient who was successfully resuscitated from ventricular
fibrillation cardiac arrest while running in a marathon race. The patient
had a posterior diagnosis of anomalous right coronary artery arising from
the aorta above the left sinus of Valsalva that subsequently runs between
the aorta and the pulmonary artery, discovered by a 64-slice multidetector
coronary computerized tomography. However, the title of this article is
not in accordance with current standards defined by the American College
of Cardiology, the American Heart Journal, and the Heart Rhythm Society
(2). In this document, it was postulated that "sudden cardiac death should
not be used to describe events that are not fatal", restricting the use of
this term only to the events directly resulting in death, in order to
avoid misinterpretations. Thus, I do believe that the best title for this
interesting report would be: 'Cardiac arrest associated with an anomalous
right coronary artery'.
References:
1) Diaz RA, Vald?s J. Aborted sudden cardiac death associated with an
anomalous right coronary artery. BMJ Case Rep 2015; doi:10.1136/bcr-2015-
210850.
2) Buxton AE, Calkins H, Callans DJ, et al. ACC/AHA/HRS 2006 key data
elements and definitions for electrophysiological studies and procedures:
a report of the American College of Cardiology/American Heart Association
Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to
Develop Data Standards on Electrophysiology). Circulation
2006;114(23):2534-70.
I too have dimples in both shoulders. I have never met or heard of
anyone else having them, not even a family member. Until 2 years ago when
my youngest grandson was born. He has them on both shoulders as well.
This report is the first I've seen on this and hope to learn more.
Thankyou
I thank Dr. Veloso for his comments regarding our case report [1].
Directly from the consensus statement he cites [2], his opinion is
valuable, but feel that aborted sudden death conveys a better picture due
to successful resuscitation with CPR and defibrillation, a description
already used by other authors [3].
Rienzi A Diaz, MD, FACC, EACVI,
Professor of Cardiology
I thank Dr. Veloso for his comments regarding our case report [1].
Directly from the consensus statement he cites [2], his opinion is
valuable, but feel that aborted sudden death conveys a better picture due
to successful resuscitation with CPR and defibrillation, a description
already used by other authors [3].
Rienzi A Diaz, MD, FACC, EACVI,
Professor of Cardiology
References: 1) Diaz RA, Valdes J. Aborted sudden cardiac death
associated with an anomalous right coronary artery. BMJ Case Rep 2015;
doi: 10.1136/bcr-2015- 210850. 2) Buxton AE, Calkins H, Callans DJ, et al.
ACC/AHA/HRS 2006 key data elements and definitions for
electrophysiological studies and procedures: a report of the American
College of Cardiology/American Heart Association Task Force on Clinical
Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on
Electrophysiology). Circulation 2006; 114(23):2534-70. 3) Kaushik S,
Subramanian SR, Rafii S, Castillo R. Aborted sudden cardiac death (SCD) in
a patient with hypertrophic cardiomyopathy (HCM) with low-risk factors for
SCD. BMJ Case Reports 2013; doi: 10.1136/bcr-2012-006459
I read with interest the case report of "Spinal epidural abscess
treated with antibiotics alone" by Pathak et al. This patient had
presented with paraparesis and incontinence of bladder and bowel, which by
itself is an indication for emergency surgery. Such a case should not be
managed medically. It is a surprise that the patient had recovered. But
this should not mislead the clinician into managing all the acute spinal...
I read with interest the case report of "Spinal epidural abscess
treated with antibiotics alone" by Pathak et al. This patient had
presented with paraparesis and incontinence of bladder and bowel, which by
itself is an indication for emergency surgery. Such a case should not be
managed medically. It is a surprise that the patient had recovered. But
this should not mislead the clinician into managing all the acute spinal
epidural abscesses medically; on the other hand,the acute spinal epidural
abscess is a neurosurgical emergency and should be managed surgically as
soon as the diagnosis is made.
I have read with surprise the case report which makes rather wide sweeping claims about green tea being of health concern. After a quick literature review there have been rare cases after prolonged ingestion of green tea extract - but none ever analyzed the extract for components besides green tea. It is not a secret that there are problems with food safety in china, especially pesticide use, so making claims about the p...
This case report is interesting and revealing for 2 reasons. Gall stone ileus is usually due to benign fistula due to pressure necrosis and duodenal wall eroding through. Gall stone gets impacted in the terminal ileum and cannot pass the so called physiological ileo caecal valve. In this case the gall stone got impacted in (1)the decending colon and not in the terminal ileum and the cause of the fistula turned out to be(2)...
[Apologies for late edits to letter submitted yesterday, please note there are 3 new references addressing hepatotoxicity of fluoroquinolones that were not in orginal letter].
Lugg et al (2015) reported a case study of a 16 year old girl born who presented with signs of chronic joint pain, dizziness and non-specific abdominal pains after consuming 3 cups per day of imported herbal green tea (as tea bags) for a p...
We read with great interest the case report by Demirel (1) et al. in the journal. The authors described the case showing severe hyponatremia and critical hypoxia during transurethral resection of the prostate (TURP) surgery in the patient under general anaesthesia. TURP syndrome is initiated by absorption of irrigating fluid (2) and is characterized by decreasing a serum sodium concentration, inducing cardiovascular depr...
Thank you very much Mr M.A Warner for reviewing our article and sharing your views from the same. We do agree with your suggestion that, there in no 'strong' correlation between the use of peripheral nerve blockage and delay in diagnosis of acute compartment syndrome following surgical procedures on extremities. Among the reported cases of peripheral nerve blockage use in extremity surgeries and where the compartment syn...
Impressive story and inspiring for a lot of people I think. This case report again shows that mindfulness-based cognitive therapy is a really effective way of treatment for this particular, persisting disorder and should surely be investigated further!
Conflict of Interest:
None declared
I read with interest the case reported by Diaz and Valdez (1) regarding a patient who was successfully resuscitated from ventricular fibrillation cardiac arrest while running in a marathon race. The patient had a posterior diagnosis of anomalous right coronary artery arising from the aorta above the left sinus of Valsalva that subsequently runs between the aorta and the pulmonary artery, discovered by a 64-slice multidet...
I too have dimples in both shoulders. I have never met or heard of anyone else having them, not even a family member. Until 2 years ago when my youngest grandson was born. He has them on both shoulders as well. This report is the first I've seen on this and hope to learn more. Thankyou
Conflict of Interest:
None declared
I thank Dr. Veloso for his comments regarding our case report [1]. Directly from the consensus statement he cites [2], his opinion is valuable, but feel that aborted sudden death conveys a better picture due to successful resuscitation with CPR and defibrillation, a description already used by other authors [3].
Rienzi A Diaz, MD, FACC, EACVI, Professor of Cardiology
References: 1) Diaz RA, Valdes J. A...
I read with interest the case report of "Spinal epidural abscess treated with antibiotics alone" by Pathak et al. This patient had presented with paraparesis and incontinence of bladder and bowel, which by itself is an indication for emergency surgery. Such a case should not be managed medically. It is a surprise that the patient had recovered. But this should not mislead the clinician into managing all the acute spinal...
Pages