eLetters

59 e-Letters

published between 2001 and 2004

  • Parkinson' disease - multidisciplinary team
    Sunku H Guptha

    Dear Editor

    I read with interest the review article by Thanvi and Lo on the long term motor complications of levodopa.[1] The authors describe the role of pulsatile stimulation of the post-synaptic dopamine receptors as a possible mechanism for these complications and describe the various strategies currently in use to prevent them. They however fail to acknowledge the role of a multidisciplinary team in the ma...

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  • More about the urine in alkaptonuria
    Tamilarasu Kadhiravan

    Dear Editor

    I would like to mention a few interesting points about the urine in alkaptonuria.[1] When testing for the presence urine sugar by Benedict's method, an alkaptonuric specimen gives a strongly positive (falsely, of course) reaction, producing an orange precipitate. However, the clue lies in the supernatant which turns black. Glucose oxidase-based test does not give a positive reaction in this setting....

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  • Alas animal models
    Alfred N Jackson
    Dear Editor

    Is it feasible to extrapolate animal findings to human medicine? We did not evolve (see http://www.kean.edu/~breid/chrom2.htm ). These chromosome numbers certainly do not support any evolutionary suppositions. Furthermore the mechanisms of meiosis serve to "fix" the chromosome numbers of sexually reproducing species. Is it not, therefore, dange...

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  • "Permissive Hypotension" in Hibernated Patients with Severe Chronic Heart Failure
    Mohamad Abdelsalam Abdelkader

    Dear Editor

    Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac abnormality that impairs the ability of the left ventricle to fill with or pump blood.

    The cardinal manifestations of heart failure are dyspnoea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary congestion and peripheral oedema. Heart failure is cha...

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  • Ketoacidosis and HHS
    Anand CV

    Dear Editor

    We read with interest the educative review by Drs English and Williams,[1] and would like to congratulate the authors for their effort.

    The authors have raised a question- namely why ketoacidosis does not occur in HHS. Accumulation of ketone bodies in the blood in DKA stems from a greatly accelerated hepatic production rate, such that the capacity of non-hepatic tissues to use them, is exceeded....

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  • Pathophysiology of diabetic ketoacidosis
    Viktor Rosival
    Dear Editor

    In their recent review English and Williams state "The primary mechanism for the development of ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) is ... insulin deficiency per se ... together with a concomitant elevation of the counter-regulatory hormones" but "why ketoacidosis does not occur in HHS is unknown".[1]

    However, the pure existence of HHS is strong evidence against the sta...

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  • Medical profession is already paying the price for its poor public relations skills
    Kieran M Walsh

    Dear Editor

    Persaud is quite right when he says that the medical profession will pay the price for its poor public relations skills.[1]

    Already there have been a number of investigations into the practice of GPs in the UK who had higher than average mortality rates. So far all of the investigations proved to be unfounded - the GPs simply had a lot of patients in nursing homes.

    References...

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  • Author's Reply
    Jonathan M Rhodes

    Dear Editor,

    We think Gordon has been rather selective with his citation of the literature.[1] The issue here is whether serum C reactive protein estimation has acceptable sensitivity in undiagnosed patients presenting for the first time with symptomatic Crohn’s disease. It was first reported for this purpose by Shine et al who found that 19 of 19 newly presenting symptomatic Crohn’s disease patients had...

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  • Serotonin toxicity
    P Ken Gillman

    Dear Editor

    This is a most complex subject. It is difficult to make adequate and constructive comment about this case without going into lengthy details concerning the latest research on serotonin syndrome, which letter space will not allow. [1,2]

    It will be helpful for your readers to appreciate that this report cannot reasonably be upheld to represent serotonin syndrome (better referred to as serot...

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  • Inflammatory Markers in Crohn's Disease
    John N Gordon

    Dear Editor

    I read with interest the review of the management of inflammatory bowel disease by Nayar et al, in which the authors elegantly highlight the major points for the general physician. However I was concerned by the potentially seriously misleading statement that serum C-reactive protein (CRP) concentration is raised in over 95% of patients with symptomatic Crohn's disease, and is useful in distingu...

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