8mg or 800 microgram dose of folate? (Denise O'Keefe, 21 October 2011)
This is an intriguing case report, which if relevant to more men with prostate cancer could have a major impact on both the survival of patients with androgen-independent disease, and their quality of life. In Figure 1, the implication is that the patient was taking 8mg (8000 micrograms) of folate/folic acid per day, or as described within the case presentation, a total of 800 micrograms of folate/folic acid (0.8mg). This is important as most multivitamins contain 400 micrograms of folic acid, and adding a B-complex vitamin would easily get a patient to 800 micrograms, but not 8mg per day. Furthermore, it is not cited in the manuscript, but another recent paper has shown increased prostate cancer cell proliferation in patients with high serum folates, supporting this work. For more info...
read full comment
Comment on: Tisman et al. Journal of Medical Case Reports, 5:413
Leptospirosis in Baltimore and New York! Wow! (Noah Hoskins, 26 May 2011)
This case presentation of Weil's Syndrome is very similar to the case of urban leptospirosis seen in inner-city Baltimore in November 2010 which was just published May 2011. Is this the beginning of an east coast Leptospirosis epidemic? The baltimore case found here: http://www.jchimp.net/index.php/jchimp/article/view/7042.
read full comment
Comment on: Maroun et al. Journal of Medical Case Reports, 5:7
Importance of fixing a Neck of Femur fracture in a bilateral amputee. (Kareem Elsorafy, 26 May 2011)
Dear Author,
Thank you for your effort to explain a technique which helps with a challenge that can be met by any surgeon. It is obvious that there is some displacement in the fracture pre-operatively which has not changed post-operatively. I would like to know wether any traction was attempted during this procedure? If this was the case, then an assistant would have had to maintain traction for an average of thirty minutes and not be expected to fatigue. It may have been easier to pass a Schteinmenn through the distal femur to maintain traction throughout the procedure because it is easier to maintain a sustained continuous grip. The pin can then be attached to the traction device, available on DHS tables. It would have been also valuable to have x-rays of the lateral...
read full comment
Comment on: Aqil et al. Journal of Medical Case Reports, 4:390
KLIPPEL-TRENAUNAY SYNDROME: IMPRECISE TERMINOLOGY AND DIAGNOSTIC UNCERTAINTY (Ahmad Alomari, 04 May 2011)
KLIPPEL-TRENAUNAY SYNDROME: IMPRECISE TERMINOLOGY AND DIAGNOSTIC UNCERTAINTY
Pradeep Govender, MD, Ahmad I. Alomari, MD, MSc, FSIR
Division of Interventional Radiology and Vascular Anomalies Center, Children’s Hospital Boston and Harvard Medical School, Boston, MA, USA.
To the Editor We read with interest the case report by Beier et al [1] in which the author presented a child with numerous vascular abnormalities in her extremities. The author described an 11-year-old girl “diffuse hemangioma”, “varicosities”, arteriovenous malformations (AVMs) of involving the soft tissues of the pelvis and the bilateral lower extremities with bilateral lower extremity hypertrophy. The patient carried a diagnosis of “Klippel-...
read full comment
Comment on: Beier et al. Journal of Medical Case Reports, 4:92
rationale for Amputation (balakumar balasubramanian, 16 November 2010)
The authors have suggested amputation for the child, then what is the rational for doing a club foot correction when they have suggested amputation for the child at a later date? Second issue is that the authors have not mentioned the limb length discrepancy and proportion of shortening which warrants amputation and which determines the line of management. They have not mentioned regarding the presence or absence of active knee extension that is a functional quadriceps which is an important prerequisite for reconstruction.
read full comment
Comment on: Khan et al. Journal of Medical Case Reports, 2:102
Therapeutic approach in polycystic kidney disease associated to glomerulopathy is better defined after renal biopsy (Gianna Mastroianni Kirsztajn, 06 July 2010)
We agree with D’Cruz et al.1 in their paper “Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis – an unusual association” that renal biopsy should be performed in polycystic kidney disease when proteinuria is present. We believe it would be especially indicated if proteinuria is above 1 g/day, a level at which an immunosuppressive treatment could be initiated in case IgA nephropathy was diagnosed, for example 2. We disagree with the statement that the renal biopsy should be indicated to “exclude coexisting glomerular disease”, as nephrotic range proteinuria is always a manifestation of glomerular disease, and in their case it was present. The actual biopsy indication would be to define the histological type of...
read full comment
Comment on: D'Cruz et al. Journal of Medical Case Reports, 4:125
Von Recklinghausen Disease Nipple-Areolar Neurofibromas (Vincent M. Riccardi, 10 June 2010)
Von Recklinghausen Disease Nipple-Areolar Neurofibromas
M.R. Bongiorno, et al., might want to reconsider several lines of text in their recent article about neurofibromas of the nipple and areola among women patients with von Recklinghausen disease (VRD), known to be due a mutation in the NF1 gene.1 I wish to comment with specific reference to the third complete paragraph on page 5. First, while technically the number of women studied by Bongiorno, et al., was 8 more than in the study by Riccardi and Eichner2, the order of magnitude is the same. Further, contradicting the paragraph’s final statement, substantial data were provided for the Riccardi-Eichner series of 123 women and 115 men. Second, and most important, nipple-areolar neurofibromas are not “rare,” as...
read full comment
Comment on: Bongiorno et al. Journal of Medical Case Reports, 4:22
Biomedicine and culture-bound health: is it a double-deaf conversation? (Nasser Al-Azri, 11 February 2010)
Dear sir,
I've read with great interest the article of Guenedi, et al,[1] on investigating biomedically a supposed "spirit possession" case. The idea is interesting but it seems we are missing the point in here. Biomedicine is a wholly different paradigm that has its' own epistemological foundations and assumptions on which it bases its' interpretation and management of events. A particular culture, on the other hand, has its' own. With such significant differences in the input (epistemology) and output (interpretation and management), the description of the process (event) is a mere de facto. Therefore, “linking possession to brain abnormality' empirically is like building a bridge on the earth to reach the moon. It takes us no further than our eyesight does within our...
read full comment
Comment on: Guenedi et al. Journal of Medical Case Reports, 3:9325
Author name (mehmet ali erkurt, 05 February 2010)
Author title "Mehmet ALI Erkurt" should be corrected "Mehmet Ali Erkurt". No Additional comment. Thank you for kind interest.
read full comment
Comment on: Erkurt et al. Journal of Medical Case Reports, 3:50
Very minor changes in the conclusion (Suresh Krishnamoorthy, 05 February 2010)
In paragraph B.4.1 sentence 2.
"There should be a high index of clinical suspicion in considering a thyrotoxic state when cachexia is associated with heart rhythm abnormalities, particularly heart blocks."
Why wasn't carcinoid syndrome considered? (Rajesh Sankar, 07 December 2009)
Why wasn't carcinoid syndrome considered, and 5HIAA, serotonin, tryptophan, and Chromogranin A levels looked for, in this patient?
read full comment
Comment on: Gaur et al. Journal of Medical Case Reports, 3:106
Previous reports of ruptures absent of the use of steroids (david fuller, 13 February 2009)
WHO Pharmaceuticals Newsletter No. 1, 2002 reported that Levofloxacin (Tavanic) had been associated with a number of adverse reactions, including 12 cases of tendinitis, which had been reported to the Belgian centre for pharmaco-vigilance since the drug's launch in August 2000. Of the 12 reports of levofloxacin-associated tendinitis, 6 cases involved tendon rupture. Of the six cases of tendon rupture associated with the use of levofloxacin, only in five of these cases the concomitant corticosteroid therapy may have been a contributing risk factor. Here we have a report of rupture in which the use of corticosteroids was NOT a factor.
Within a correspondence published in the Journal of Antimicrobial Chemotherapy ((2003) 51, 747-748) Haddow et al report upon spontaneous...
read full comment
The authors reply to Dr Horvarth (Effrossyni Gkrania-Klotsas, 05 January 2009)
We thank Dr Horvarth for his comments. HSE remains a difficult diagnosis. We feel that this patient's clinical history, clinical presentation and outcome strongly suggest it as well. Our original screen for other viruses included, by local protocols, a PCR for VZV and a PCR for enterovirus, both from CSF specimens, which were both negative. The lack of any relevant exposure history, paired with a negative HIV test from the peripheral blood by ELISA, made us not pursue further an acute HIV diagnosis, for instance by doing a peripheral viral load. Similarly, the patient had serological evidence of past but not recent EBV infection at the time, so EBV was not considered as a diagnosis. No evidence of immunodeficiency was present at the time or during follow-up. Although an EEG was ordered, it...
read full comment
Uncertainity of the diagnosis (Szatmar Horvath, 05 January 2009)
The diagnosis of viral CNS infections are undoubtedly one of the clinical challenges. However, there are well defined steps and clinical protocols that everyone who is involved in clinical practice should keep in mind (1). <br>Based on a single PCR result and an MRI scan Gkrania-Klotsas & Lever claim that the presented case is a HSE, but have neither screened for other, clinically relevant neurotropic viruses (e.g. EBV, HIV), nor performed EEG for HSE specific brain activity. <br>Now, however, it is clear the relatively high frequency of false positive and the large number of false-negative results stress the need for improvement in the quality of HSV nucleic acid amplification tests and for external quality control programmes(2, 3). Hence, we propose that PCR should never...
read full comment
correction on GFAP (Clinton mcelroy, 18 December 2008)
GFAP, or glial fibrillary acidic protien is a type III intermediate filament (just like desmin in muscle). Neuronal cells do not express GFAP, which is positive in glial cells such as astrocytes.
read full comment
Comment on: El-Bahrawy et al. Journal of Medical Case Reports, 2:189
reactive arthritis and it effects on breast implants (kamal SALEH, 03 November 2008)
In my experience in breast implants in al emadi hospital-qatar for more than 2 years only one case of silicon breast implant get abnormal capsuler metaplasia, but the patients also coplaining from reactive arthrites (diagnosed by lab) so at that time we considered that the reaction in site of breast implant due to her actual diseases (reactive arthritis)
read full comment
updated on pubished cases (Axel Petzold, 29 September 2008)
coinciding with our publication Dr Arthur Siegel and colleagues published in The American Journal of Medicine 2007;120:461.e11-461.17 a study on 'hyponatremia in marathon runners due to inappropriate arginine vasopressin secretion'. In their paper the authors refer to one of the cases reported by us [reference 1]. In order to update the data in our Table 1; the serum Na of this 32 year old runner was 123 mM, CT brain showed diffuse cerebral and pulmonary oedema. One further case not know to us at time of publication was a 24 year old female participating at a Marine Corps marathon. She had a serum Na of 113 mM, again with diffuse cerebral and pulmonary oedema.Axel Petzold
read full comment
Comment on: Petzold et al. Journal of Medical Case Reports, 1:186
Best Treatment for MSSA (Jaques Sztajnbok, 27 August 2008)
Dear authors. I read with great interest your article and I have a question: Why didn't you use oxacillin plus clindamycin since the strain was MSSA and its a wellknokwn fact that oxacillin usually performs very well when treating MSSA associated pneumonias.Yours Jaques
read full comment
Comment on: Schefold et al. Journal of Medical Case Reports, 1:165
Diabetic acidosis due to D-lactate (Heikki Savolainen, 30 July 2008)
Lactic acidosis is very common in diabetes and probably caused by methylglyoxal from excessive glucose metabolized in the glyoxalase system to d-lactic acid (1). Metformin seems to increase the d-lactic acid formation.D-lactate causes a neurotoxic syndrome by an unknown mechanism. The long metabolic half-life of the acid may contribute to this as its oxidation by the high Km mitochondrial D-lactate oxidase is slow.1 Talasniemi JP, Pennanen S, Savolainen H, et al. Analytical investigation: Assay of D-lactate in diabetic plasma and urine. Clin Biochem (2008), doi:10.1016/j.clinbiochem.2008.06.011
read full comment
Comment on: Silvestre et al. Journal of Medical Case Reports, 1:126
Possible ranitidine anaphylaxis in an acutely ill patient (Ghanshyam Palamaner Subash Shantha, 29 July 2008)
Dear Editor, greetings from India. I thank Antonio oliva et al and his co-authors for their effort to publish this case report. It is interesting to understand that a commonly used drug like ranitidine can produce such a fatal anaphylactic reaction. In this context I would like to share one such experience with you.In May 2007 a 50year old male patient got admitted to the intensive care unit of our hospital in Chennai, India with extensive anterior wall acute myocardial infarction and acute pulmonary edema. He was a chronic smoker. He was a diabetic for 15 years and was on insulin for the same. He was not an asthmatic and gave no history of drug allergies. In view of respiratory distress he was intubated and mechanically ventilated. He was thrombolysed with streptokinase and his pulmonary...
read full comment
Comment on: Oliva et al. Journal of Medical Case Reports, 2:232
Age prevalence, prior abdominal operations in internal abdominal hernias (Senthil Nachimuthu, 14 July 2008)
Dear Sir / Madam, I read with great interest about the article "Incarcerated transmesosigmoid hernia presenting in a 60-year-old man: a case report" by Danielle Collins and co-workers. I really appreciate the authors enthusiasm in presenting a case of internal abdominal hernia (IH) which, although rare, is increasing in incidence. At the same time I like to draw attention on two aspects of the conclusional remarks. First of all, it was mentioned in the conclusion that congenital internal hernias are more common in the paediatric population(1). It was originally thought that IH were more common in the paediatric age group but subsequent studies show that adult and elderly seem to have greater prevalence than the children(2) and the mean age was reported between 38 and 45...
read full comment
Comment on: Collins et al. Journal of Medical Case Reports, 2:161
Response (Nnamdi Nwaejike, 02 July 2008)
Dear Dr Gupta,Thank you for your question..The patient required specialist care (psychiatry in this case) for optimised treatment, which we realised after our interventions (analgesia including bier blocks)did not provide definitive relief from his symptoms..Once refered, the patient had no further problems with pain control or other symptoms and signs for reflex sympathetic dystrophy and so we (trauma and orthopaedics) did not continue follow-up..He was adequately managed by psychiatry, but we do not have details of his subsequent treatment..The learning point is the recognition of the factitous disorder by non-psychiatrists and early referal to appropriate specialists..SincerelyNnamdi Nwaejike
read full comment
Comment on: Nwaejike et al. Journal of Medical Case Reports, 2:216
Psychiatric evaluation would have been interesting (Maneesh Gupta, 01 July 2008)
It is an interesting case report. Factitious disorder is a difficult diagnosis to make and it would have been intersting to read about the psychiatric evaluation and the conclusions thereof about factitious diorder. Could the authors shed some light on the psychiatric assessment and treatment??
read full comment
Comment on: Nwaejike et al. Journal of Medical Case Reports, 2:216
Delayed-onset Heparin-Induced Thrombocytopenia (HIKMAT ABDEL-RAZEQ, 10 December 2007)
Delayed-onset Heparin-Induced ThrombocytopeniaHikmat N. Abdel-Razeq, MD.American Board of Internal MedicineAmerican Board of HematologyAmerican Board of Medical OncologyChief, Section of Hematology and Medical OncologyChairman, Department of Internal...
read full comment
Comment on: Omran et al. Journal of Medical Case Reports, 1:131
The clandestine key: 1,25-dihydroxyvitamin D3 (Thomas Hiemstra, 03 August 2007)
Surprisingly Lyell et al attribute hypercalcaemia in a patient with ATLL solely to a modest elevation in PTHrP. The features of this case suggest the paraneoplastic production of the active vitamin D hormone calcitriol. Lymphocytes and macrophages express the enzyme vitamin D 1-α hydroxylase [1] and the production of calcitriol by lymphomas is well described [2].First, the authors report a normal serum phosphate although a value is not provided. PTHrP induced hypercalcaemia is often accompanied by hypophosphataemia due to its phosphaturic effects. Second, PTH was markedly suppressed in keeping with calcitriol toxicity, although hypercalcaemia would contribute.In addition the authors describe increased expression of RANKL in ATLL patients, promoting osteoclastogenesis. RANKL expression...
read full comment
Comment on: Lyell et al. Journal of Medical Case Reports, 1:56
RSS
Latest comments
8mg or 800 microgram dose of folate? (Denise O'Keefe, 21 October 2011)
This is an intriguing case report, which if relevant to more men with prostate cancer could have a major impact on both the survival of patients with androgen-independent disease, and their quality of life. In Figure 1, the implication is that the patient was taking 8mg (8000 micrograms) of folate/folic acid per day, or as described within the case presentation, a total of 800 micrograms of folate/folic acid (0.8mg). This is important as most multivitamins contain 400 micrograms of folic acid, and adding a B-complex vitamin would easily get a patient to 800 micrograms, but not 8mg per day. Furthermore, it is not cited in the manuscript, but another recent paper has shown increased prostate cancer cell proliferation in patients with high serum folates, supporting this work. For more info... read full comment
Comment on: Tisman et al. Journal of Medical Case Reports, 5:413
Leptospirosis in Baltimore and New York! Wow! (Noah Hoskins, 26 May 2011)
This case presentation of Weil's Syndrome is very similar to the case of urban leptospirosis seen in inner-city Baltimore in November 2010 which was just published May 2011. Is this the beginning of an east coast Leptospirosis epidemic?
The baltimore case found here: http://www.jchimp.net/index.php/jchimp/article/view/7042. read full comment
Comment on: Maroun et al. Journal of Medical Case Reports, 5:7
Importance of fixing a Neck of Femur fracture in a bilateral amputee. (Kareem Elsorafy, 26 May 2011)
Dear Author,
Thank you for your effort to explain a technique which helps with a challenge that can be met by any surgeon. It is obvious that there is some displacement in the fracture pre-operatively which has not changed post-operatively. I would like to know wether any traction was attempted during this procedure? If this was the case, then an assistant would have had to maintain traction for an average of thirty minutes and not be expected to fatigue. It may have been easier to pass a Schteinmenn through the distal femur to maintain traction throughout the procedure because it is easier to maintain a sustained continuous grip. The pin can then be attached to the traction device, available on DHS tables. It would have been also valuable to have x-rays of the lateral... read full comment
Comment on: Aqil et al. Journal of Medical Case Reports, 4:390
KLIPPEL-TRENAUNAY SYNDROME: IMPRECISE TERMINOLOGY AND DIAGNOSTIC UNCERTAINTY (Ahmad Alomari, 04 May 2011)
KLIPPEL-TRENAUNAY SYNDROME: IMPRECISE TERMINOLOGY AND DIAGNOSTIC UNCERTAINTY
Pradeep Govender, MD, Ahmad I. Alomari, MD, MSc, FSIR
Division of Interventional Radiology and Vascular Anomalies Center, Children’s Hospital Boston and Harvard Medical School, Boston, MA, USA.
To the Editor
We read with interest the case report by Beier et al [1] in which the author presented a child with numerous vascular abnormalities in her extremities. The author described an 11-year-old girl “diffuse hemangioma”, “varicosities”, arteriovenous malformations (AVMs) of involving the soft tissues of the pelvis and the bilateral lower extremities with bilateral lower extremity hypertrophy. The patient carried a diagnosis of “Klippel-... read full comment
Comment on: Beier et al. Journal of Medical Case Reports, 4:92
rationale for Amputation (balakumar balasubramanian, 16 November 2010)
The authors have suggested amputation for the child, then what is the rational for doing a club foot correction when they have suggested amputation for the child at a later date? Second issue is that the authors have not mentioned the limb length discrepancy and proportion of shortening which warrants amputation and which determines the line of management. They have not mentioned regarding the presence or absence of active knee extension that is a functional quadriceps which is an important prerequisite for reconstruction. read full comment
Comment on: Khan et al. Journal of Medical Case Reports, 2:102
Therapeutic approach in polycystic kidney disease associated to glomerulopathy is better defined after renal biopsy (Gianna Mastroianni Kirsztajn, 06 July 2010)
We agree with D’Cruz et al.1 in their paper “Autosomal dominant polycystic kidney disease with diffuse proliferative glomerulonephritis – an unusual association” that renal biopsy should be performed in polycystic kidney disease when proteinuria is present. We believe it would be especially indicated if proteinuria is above 1 g/day, a level at which an immunosuppressive treatment could be initiated in case IgA nephropathy was diagnosed, for example 2.
We disagree with the statement that the renal biopsy should be indicated to “exclude coexisting glomerular disease”, as nephrotic range proteinuria is always a manifestation of glomerular disease, and in their case it was present. The actual biopsy indication would be to define the histological type of... read full comment
Comment on: D'Cruz et al. Journal of Medical Case Reports, 4:125
Von Recklinghausen Disease Nipple-Areolar Neurofibromas (Vincent M. Riccardi, 10 June 2010)
Von Recklinghausen Disease Nipple-Areolar Neurofibromas
M.R. Bongiorno, et al., might want to reconsider several lines of text in their recent article about neurofibromas of the nipple and areola among women patients with von Recklinghausen disease (VRD), known to be due a mutation in the NF1 gene.1 I wish to comment with specific reference to the third complete paragraph on page 5. First, while technically the number of women studied by Bongiorno, et al., was 8 more than in the study by Riccardi and Eichner2, the order of magnitude is the same. Further, contradicting the paragraph’s final statement, substantial data were provided for the Riccardi-Eichner series of 123 women and 115 men. Second, and most important, nipple-areolar neurofibromas are not “rare,” as... read full comment
Comment on: Bongiorno et al. Journal of Medical Case Reports, 4:22
Biomedicine and culture-bound health: is it a double-deaf conversation? (Nasser Al-Azri, 11 February 2010)
Dear sir,
I've read with great interest the article of Guenedi, et al,[1] on investigating biomedically a supposed "spirit possession" case. The idea is interesting but it seems we are missing the point in here. Biomedicine is a wholly different paradigm that has its' own epistemological foundations and assumptions on which it bases its' interpretation and management of events. A particular culture, on the other hand, has its' own. With such significant differences in the input (epistemology) and output (interpretation and management), the description of the process (event) is a mere de facto. Therefore, “linking possession to brain abnormality' empirically is like building a bridge on the earth to reach the moon. It takes us no further than our eyesight does within our... read full comment
Comment on: Guenedi et al. Journal of Medical Case Reports, 3:9325
Author name (mehmet ali erkurt, 05 February 2010)
Author title "Mehmet ALI Erkurt" should be corrected "Mehmet Ali Erkurt". No Additional comment. Thank you for kind interest. read full comment
Comment on: Erkurt et al. Journal of Medical Case Reports, 3:50
Very minor changes in the conclusion (Suresh Krishnamoorthy, 05 February 2010)
In paragraph B.4.1 sentence 2.
"There should be a high index of clinical suspicion in considering a thyrotoxic state when cachexia is associated with heart rhythm abnormalities, particularly heart blocks."
- which sounds better, I think. read full comment
Comment on: Krishnamoorthy et al. Journal of Medical Case Reports, 3:9303
Why wasn't carcinoid syndrome considered? (Rajesh Sankar, 07 December 2009)
Why wasn't carcinoid syndrome considered, and 5HIAA, serotonin, tryptophan, and Chromogranin A levels looked for, in this patient? read full comment
Comment on: Gaur et al. Journal of Medical Case Reports, 3:106
Previous reports of ruptures absent of the use of steroids (david fuller, 13 February 2009)
WHO Pharmaceuticals Newsletter No. 1, 2002 reported that Levofloxacin (Tavanic) had been associated with a number of adverse reactions, including 12 cases of tendinitis, which had been reported to the Belgian centre for pharmaco-vigilance since the drug's launch in August 2000. Of the 12 reports of levofloxacin-associated tendinitis, 6 cases involved tendon rupture. Of the six cases of tendon rupture associated with the use of levofloxacin, only in five of these cases the concomitant corticosteroid therapy may have been a contributing risk factor. Here we have a report of rupture in which the use of corticosteroids was NOT a factor.
Within a correspondence published in the Journal of Antimicrobial Chemotherapy ((2003) 51, 747-748)
Haddow et al report upon spontaneous... read full comment
Comment on: Gottschalk et al. Journal of Medical Case Reports, 3:1
The authors reply to Dr Horvarth (Effrossyni Gkrania-Klotsas, 05 January 2009)
We thank Dr Horvarth for his comments. HSE remains a difficult diagnosis. We feel that this patient's clinical history, clinical presentation and outcome strongly suggest it as well. Our original screen for other viruses included, by local protocols, a PCR for VZV and a PCR for enterovirus, both from CSF specimens, which were both negative. The lack of any relevant exposure history, paired with a negative HIV test from the peripheral blood by ELISA, made us not pursue further an acute HIV diagnosis, for instance by doing a peripheral viral load. Similarly, the patient had serological evidence of past but not recent EBV infection at the time, so EBV was not considered as a diagnosis. No evidence of immunodeficiency was present at the time or during follow-up. Although an EEG was ordered, it... read full comment
Comment on: Gkrania-Klotsas et al. Journal of Medical Case Reports, 2:387
Uncertainity of the diagnosis (Szatmar Horvath, 05 January 2009)
The diagnosis of viral CNS infections are undoubtedly one of the clinical challenges. However, there are well defined steps and clinical protocols that everyone who is involved in clinical practice should keep in mind (1). <br>Based on a single PCR result and an MRI scan Gkrania-Klotsas & Lever claim that the presented case is a HSE, but have neither screened for other, clinically relevant neurotropic viruses (e.g. EBV, HIV), nor performed EEG for HSE specific brain activity. <br>Now, however, it is clear the relatively high frequency of false positive and the large number of false-negative results stress the need for improvement in the quality of HSV nucleic acid amplification tests and for external quality control programmes(2, 3). Hence, we propose that PCR should never... read full comment
Comment on: Gkrania-Klotsas et al. Journal of Medical Case Reports, 2:387
correction on GFAP (Clinton mcelroy, 18 December 2008)
GFAP, or glial fibrillary acidic protien is a type III intermediate filament (just like desmin in muscle). Neuronal cells do not express GFAP, which is positive in glial cells such as astrocytes. read full comment
Comment on: El-Bahrawy et al. Journal of Medical Case Reports, 2:189
reactive arthritis and it effects on breast implants (kamal SALEH, 03 November 2008)
In my experience in breast implants in al emadi hospital-qatar for more than 2 years only one case of silicon breast implant get abnormal capsuler metaplasia, but the patients also coplaining from reactive arthrites (diagnosed by lab) so at that time we considered that the reaction in site of breast implant due to her actual diseases (reactive arthritis) read full comment
Comment on: Krishnanandan et al. Journal of Medical Case Reports, 2:277
updated on pubished cases (Axel Petzold, 29 September 2008)
coinciding with our publication Dr Arthur Siegel and colleagues published in The American Journal of Medicine 2007;120:461.e11-461.17 a study on 'hyponatremia in marathon runners due to inappropriate arginine vasopressin secretion'. In their paper the authors refer to one of the cases reported by us [reference 1]. In order to update the data in our Table 1; the serum Na of this 32 year old runner was 123 mM, CT brain showed diffuse cerebral and pulmonary oedema. One further case not know to us at time of publication was a 24 year old female participating at a Marine Corps marathon. She had a serum Na of 113 mM, again with diffuse cerebral and pulmonary oedema.Axel Petzold read full comment
Comment on: Petzold et al. Journal of Medical Case Reports, 1:186
Best Treatment for MSSA (Jaques Sztajnbok, 27 August 2008)
Dear authors. I read with great interest your article and I have a question: Why didn't you use oxacillin plus clindamycin since the strain was MSSA and its a wellknokwn fact that oxacillin usually performs very well when treating MSSA associated pneumonias.Yours Jaques read full comment
Comment on: Schefold et al. Journal of Medical Case Reports, 1:165
Diabetic acidosis due to D-lactate (Heikki Savolainen, 30 July 2008)
Lactic acidosis is very common in diabetes and probably caused by methylglyoxal from excessive glucose metabolized in the glyoxalase system to d-lactic acid (1). Metformin seems to increase the d-lactic acid formation.D-lactate causes a neurotoxic syndrome by an unknown mechanism. The long metabolic half-life of the acid may contribute to this as its oxidation by the high Km mitochondrial D-lactate oxidase is slow.1 Talasniemi JP, Pennanen S, Savolainen H, et al. Analytical investigation: Assay of D-lactate in diabetic plasma and urine. Clin Biochem (2008), doi:10.1016/j.clinbiochem.2008.06.011 read full comment
Comment on: Silvestre et al. Journal of Medical Case Reports, 1:126
Possible ranitidine anaphylaxis in an acutely ill patient (Ghanshyam Palamaner Subash Shantha, 29 July 2008)
Dear Editor, greetings from India. I thank Antonio oliva et al and his co-authors for their effort to publish this case report. It is interesting to understand that a commonly used drug like ranitidine can produce such a fatal anaphylactic reaction. In this context I would like to share one such experience with you.In May 2007 a 50year old male patient got admitted to the intensive care unit of our hospital in Chennai, India with extensive anterior wall acute myocardial infarction and acute pulmonary edema. He was a chronic smoker. He was a diabetic for 15 years and was on insulin for the same. He was not an asthmatic and gave no history of drug allergies. In view of respiratory distress he was intubated and mechanically ventilated. He was thrombolysed with streptokinase and his pulmonary... read full comment
Comment on: Oliva et al. Journal of Medical Case Reports, 2:232
Age prevalence, prior abdominal operations in internal abdominal hernias (Senthil Nachimuthu, 14 July 2008)
Dear Sir / Madam, I read with great interest about the article "Incarcerated transmesosigmoid hernia presenting in a 60-year-old man: a case report" by Danielle Collins and co-workers. I really appreciate the authors enthusiasm in presenting a case of internal abdominal hernia (IH) which, although rare, is increasing in incidence. At the same time I like to draw attention on two aspects of the conclusional remarks. First of all, it was mentioned in the conclusion that congenital internal hernias are more common in the paediatric population(1). It was originally thought that IH were more common in the paediatric age group but subsequent studies show that adult and elderly seem to have greater prevalence than the children(2) and the mean age was reported between 38 and 45... read full comment
Comment on: Collins et al. Journal of Medical Case Reports, 2:161
Response (Nnamdi Nwaejike, 02 July 2008)
Dear Dr Gupta,Thank you for your question..The patient required specialist care (psychiatry in this case) for optimised treatment, which we realised after our interventions (analgesia including bier blocks)did not provide definitive relief from his symptoms..Once refered, the patient had no further problems with pain control or other symptoms and signs for reflex sympathetic dystrophy and so we (trauma and orthopaedics) did not continue follow-up..He was adequately managed by psychiatry, but we do not have details of his subsequent treatment..The learning point is the recognition of the factitous disorder by non-psychiatrists and early referal to appropriate specialists..SincerelyNnamdi Nwaejike read full comment
Comment on: Nwaejike et al. Journal of Medical Case Reports, 2:216
Psychiatric evaluation would have been interesting (Maneesh Gupta, 01 July 2008)
It is an interesting case report. Factitious disorder is a difficult diagnosis to make and it would have been intersting to read about the psychiatric evaluation and the conclusions thereof about factitious diorder. Could the authors shed some light on the psychiatric assessment and treatment?? read full comment
Comment on: Nwaejike et al. Journal of Medical Case Reports, 2:216
Delayed-onset Heparin-Induced Thrombocytopenia (HIKMAT ABDEL-RAZEQ, 10 December 2007)
Delayed-onset Heparin-Induced ThrombocytopeniaHikmat N. Abdel-Razeq, MD.American Board of Internal MedicineAmerican Board of HematologyAmerican Board of Medical OncologyChief, Section of Hematology and Medical OncologyChairman, Department of Internal... read full comment
Comment on: Omran et al. Journal of Medical Case Reports, 1:131
The clandestine key: 1,25-dihydroxyvitamin D3 (Thomas Hiemstra, 03 August 2007)
Surprisingly Lyell et al attribute hypercalcaemia in a patient with ATLL solely to a modest elevation in PTHrP. The features of this case suggest the paraneoplastic production of the active vitamin D hormone calcitriol. Lymphocytes and macrophages express the enzyme vitamin D 1-α hydroxylase [1] and the production of calcitriol by lymphomas is well described [2].First, the authors report a normal serum phosphate although a value is not provided. PTHrP induced hypercalcaemia is often accompanied by hypophosphataemia due to its phosphaturic effects. Second, PTH was markedly suppressed in keeping with calcitriol toxicity, although hypercalcaemia would contribute.In addition the authors describe increased expression of RANKL in ATLL patients, promoting osteoclastogenesis. RANKL expression... read full comment
Comment on: Lyell et al. Journal of Medical Case Reports, 1:56