This is regarding the
article 'Current controversies in the management of Warthin's tumour' by T Thangarajah, V M Reddy, F Castellanos-Arango, A Panarese , published in Postgrad Med J 2009;85:3-8.
Dear Editor,
This is regarding the articleâ Current controversies in the management of Warthin tumour by T Thangarajah, V M Reddy, F Castellanos-Arango, A Panarese , published in Postgrad M...
This is regarding the
article 'Current controversies in the management of Warthin's tumour' by T Thangarajah, V M Reddy, F Castellanos-Arango, A Panarese , published in Postgrad Med J 2009;85:3-8.
Dear Editor,
This is regarding the articleâ Current controversies in the management of Warthin tumour by T Thangarajah, V M Reddy, F Castellanos-Arango, A Panarese , published in Postgrad Med J 2009;85:3-8. The authors are of the opinion that though Fine needle aspiration cytology has high sensitivity and specificity and plays a key role in the diagnosis yet it is not widely followed by different centres. We just wish to state that cell block technique can be used to improve the specificity of diagnosis of Warthinâs tumour. They are similar to paraffin sections and as they recapitulate the histology, they help in arriving at the correct diagnosis in difficult cases.
It can be done by either obtaining the material by a needle and fixing with 10% buffered isotonic formalin [1,2] or by the another time saving technique as described by Vielh[3].
Thanks
Regards
Rashmi patnayak M.D.
Assistant Professor
Department of Pathology
Sri Venketeswar Institute Of Medical Sciences
Tirupati
Andhra Pradesh-517507
Mobile
9912619708
Fax: 0877-2286803
e-mail
rashmipatnayak2002@yahoo.co.in
Amitabh Jena M.S.FSOG
Assistant Professor
Department of Surgical Oncology
Sri Venketeswar Institute Of Medical Sciences
Tirupati
Andhra Pradesh-517507
Cell No. 91- 9912616708
Fax no. 0877-2286803
e-mail-dramitabh2004@yahoo.com
Reference:
1. Bell D A,Carr C P,Szyfelbeen W M: Fine needle aspiration cytology of focal liver lesions .Results obtained with both cytologic and histologic preparations. Acta Cytol 1986; 30:397-402.
2. Kern W H, Haber H: Fine needle aspiration microbiopsies. Acta Cytol 1986;30:402-408.
3. With P Vielh. The techniques of FNA cytology.In Orell S R(ed).Manual and Atlas of Fine Needle Aspiration Cytology,3rd edition.London,Harcourt Brace and Company Limited,1999;16-17.
I would like to emphasize the fact that the antitrypsin polymorphism
is the prevalent susceptibility factor with one in ten Caucasians
presenting the MS or MZ configuration of their circulating antitrypsin.
The antiprotease has known roles in inflammation (1). It may also be an
important factor in occupational lung diseases, like organic diisocyanate
asthma (2). The latter may be related to the cho...
I would like to emphasize the fact that the antitrypsin polymorphism
is the prevalent susceptibility factor with one in ten Caucasians
presenting the MS or MZ configuration of their circulating antitrypsin.
The antiprotease has known roles in inflammation (1). It may also be an
important factor in occupational lung diseases, like organic diisocyanate
asthma (2). The latter may be related to the cholinergic control of
inflammation (3).
1 Savolainen H, Berode M. Human leucocyte elastase and
serum alpha-1-antitrypsin. Res Commun Chem Pathol
Pharmacol 1988; 62: 519-522.
2 Berode M, Jost M, Ruegger M, Savolainen H. Host factors
in occupational diisocyanate asthma: a Swiss longitudinal
study. Int Arch Occup Environ Health 2005; 78: 158-163.
3 Rosas-Ballina M, Tracey KJ. Cholinergic control of
We reply your questions as below:
There was no history of radiotherapy or surgery to urinary bladder, which
was a risk factor for cystitis and superimposed coliform infection, in our
present case. There was no evidence of presentations of colitis, such as
abdominal pain or diarrhea, and no gallbladder stones...
We reply your questions as below:
There was no history of radiotherapy or surgery to urinary bladder, which
was a risk factor for cystitis and superimposed coliform infection, in our
present case. There was no evidence of presentations of colitis, such as
abdominal pain or diarrhea, and no gallbladder stones demonstrating on CT
scan. The finding of gaseous distension of large bowel might be secondary
to severe infection and irritation with spraying to adjacent large bowel
from emphysematous cystitis with perforation. We agree that emphysematous
cystitis requires aggressive treatment with antibiotics, fluids and
surgical therapy either along with emphysematous cholecystitis or not. We
also agree that clinicians should keep into consideration possibility of
emphysematous cholecystitis when dealing with patients with cystitis.
Your sincerely,
Sung-Yuan Hu, MD
Department of Emergency Medicine, Taichung Veterans General Hospital,
Taiwan, Republic of China
No 160, Section 3, Chung-Kang Road, Taichung,
Taiwan, Republic of China 00407
E-mail: song9168@pie.com.tw
Dear Editor,
This is interesting clinical case of emphysematous cystitis in non
diabetic patient who previously had radiotherapy and surgery on urinary
bladder. This type of cystitis is nearly seen always in diabetic patient
but because of past medical history, this patient became more likely of
such disease.
We very much agree that cases which I have seen are mostly in diabetic
patients but radiotherapy is a recognised...
Dear Editor,
This is interesting clinical case of emphysematous cystitis in non
diabetic patient who previously had radiotherapy and surgery on urinary
bladder. This type of cystitis is nearly seen always in diabetic patient
but because of past medical history, this patient became more likely of
such disease.
We very much agree that cases which I have seen are mostly in diabetic
patients but radiotherapy is a recognised factor for radiation induced
cystitis and superimposed coliform infection complicates the underlying
diagnosis.
Along with emphysematous cholecystitis,emphysematous cystitis requires
aggressive treatment with antibiotics ,fluids and surgical therapy.
On CT scan, there is gaseous distension of large bowel and can we ask was
there any clinical features suggestive of colitis. Gall stones are seen in
about 28-80% of such patients, did this patient had evidence of gall
stones?
We will emphasize that clinicians should keep into consideration
possibility of such diagnosis when dealing with patients with cystitis.
Given the fact that thrombolysis confers survival benefit in patients
with myocardial infarction(MI), not only when the clinical presentation is
associated with an electrocardiogram(ECG) characterised by ST segment
elevation, but also when the admission ECG shows LBBB, regardless of
whether or not LBBB is of recent onset(1),among the patients targeted by
the treatment goals proposed by the authors of the review(2), we also...
Given the fact that thrombolysis confers survival benefit in patients
with myocardial infarction(MI), not only when the clinical presentation is
associated with an electrocardiogram(ECG) characterised by ST segment
elevation, but also when the admission ECG shows LBBB, regardless of
whether or not LBBB is of recent onset(1),among the patients targeted by
the treatment goals proposed by the authors of the review(2), we also
ought to include those with old LBBB in the event of enzymatic validation
of MI. In MI, prevalence of old LBBB can be nearly as high as prevalence
of new-onset LBBB as shown by a study where, among 1125 patients in whom
criteria including "typical increases" in serum creatine phosphokinase,
serum glutamic oxaloacetic acid transaminase, and lactic dehydrogenase,
had been utilised to validate MI, there were 34 with new-onset LBBB,and 30
with old LBBB(3). In the modern era enzymatic validation of MI can be made
within 4 hours of symptom onset using heart fatty acid binding protein(H-
FABP) which is characterised by sensitivity, specificity, positive
predictive value, and negative predictive value amounting to 73%, 71%,
71%, and 73%, respectively, within that time frame(4), predictive accuracy
of that biomarker having the potential to be enhanced by simultaneous as
well as serial evaluation of other early biomarkers(5).Accordingly, the 12
hour therapeutic time window for pharmacological reperfusion with
fibrinolytic, antiplatelet, and antithrombotic modalities should be
recognised as a golden opportunity to offer these tests to suspected MI
patients who present with old LBBB so that they should have the
opportunity to benefit from the full range of therapeutic modalities
outlined in the review should they test positive for MI.
References
(1) ISIS-2(Second International Study of Infarct Survival) collaborative
group
Randomised trial of intravenous streptokinase, oral aspirin, both, or
neither among 17,187 cases of suspected acute myocardial infarction
Lancet 1988 II:349-60
(2)Edmond JJ., Juergens CP., French JK
The pharmaco-invasive approach to STEMI: when should fibrinolytic-treated
patients go to the "cath lab"?
Postgraduate Medical Journal 2009;85:331-334
(3)Gann D., Balachandran PK., Sherif NE., Samet P
Prognostic significance of chronic versus acute bundle branch block in
acute myocardial infarction
CHEST 1975;67:298-303
(4)McCann CJ., Glover BM., Menown IBA et al
Novel biomarkers in early diagnosis of acute myocardial infarction
compared with cardiac troponin T
European Heart Journal 2008;29:2843-50
(5) Balk EM., Ioannidis JPA., Salem D., Chew PW., Lau J
Accuracy of biomarkers to diagnose acute cardiac ischemia in the Emergency
Department: A Meta-Analysis
Annals of Emeregency Medicine May 2001;37.5:478-94
The article from Dr. Srinivassan is very interesting. Recent
management is aimed to get a better control of glycemic level in type 2
DM. Better glycemic control is hoped to prevent some complication of type
2 DM. One of the most common complications of diabetes is diabetic
neuropathy. Hyperglycemia appears to be the determinant of microvascular
and metabolic complications. However, glycemia is much less related to
macro...
The article from Dr. Srinivassan is very interesting. Recent
management is aimed to get a better control of glycemic level in type 2
DM. Better glycemic control is hoped to prevent some complication of type
2 DM. One of the most common complications of diabetes is diabetic
neuropathy. Hyperglycemia appears to be the determinant of microvascular
and metabolic complications. However, glycemia is much less related to
macrovascular disease. Insulin resistance with concomitant lipid (ie,
small dense low-density lipoprotein [LDL] particles, low high-density
lipoprotein-cholesterol [HDL-C] levels, elevated triglyceride-rich remnant
lipoproteins) and thrombotic (ie, elevated type-1 plasminogen activator
inhibitor [PAI-1], elevated fibrinogen) abnormalities, as well as
conventional atherosclerotic risk factors (eg, family history, smoking,
hypertension, elevated low-density lipoprotein-cholesterol [LDL-C], low
HDL-C), determine cardiovascular risk.
Stdies mentioned the role of Hemoglobin A1c (HbA1c or A1c) or glycosylated
hemoglobin (GHb) measurements for monitoring long-term glycemic control
and reflect glycemia for the previous 3 months. In many developing
countries, we did not perform it routinely because of the cost. Newer
drugs is also more costly than older ones. Some guidelines showed that
patients with HbA1c less than 8% are usually treated initially with single
oral agents. Patients with initial HbA1c greater than 9-10% may benefit
from initial therapy with 2 oral agents. Better control is very nessecary.
Improved glycemic control early may alleviate some of the of diabetic
complication's symptoms, although sometimes symptoms actually worsen with
lowering blood glucose levels.
References
Bressler R, Johnson DG. Pharmacological regulation of blood glucose levels
in non-insulin-dependent diabetes mellitus. Arch Intern Med. Apr 28
1997;157(8):836-48
Brown JB, Pedula KL, Bakst AW. The progressive cost of complications
in type 2 diabetes mellitus. Arch Intern Med. Sep 13 1999;159(16):1873-80
Clark CM Jr, Lee DA. Prevention and treatment of the complications of
diabetes mellitus [published erratum appears in N Engl J Med 1995 Sep
21;333(12):810]. N Engl J Med. May 4 1995;332(18):1210-7.
Letter to Swaminathan et al. entitled Search for secondary
osteoporosis: are Z scores useful predictors?
N. Defne Altintas, Mustafa Sahin
Medicana International Ankara Hospital, Department of Internal Medicine1,
Ankara, Gaziantep State Hospital, Departments of Endocrinology2,
Gaziantep, TURKEY
Dear Sirs,
In their recent article, a marker to define secondary osteoporosis is
being evaluated by Swaminathan et al (...
Letter to Swaminathan et al. entitled Search for secondary
osteoporosis: are Z scores useful predictors?
N. Defne Altintas, Mustafa Sahin
Medicana International Ankara Hospital, Department of Internal Medicine1,
Ankara, Gaziantep State Hospital, Departments of Endocrinology2,
Gaziantep, TURKEY
Dear Sirs,
In their recent article, a marker to define secondary osteoporosis is
being evaluated by Swaminathan et al (1), to eliminate missed diagnosis of
secondary osteoporosis and to decrease the unnecessary laboratory costs.
However certain points deserve discussion. First of all, steroid induced
osteoporosis is not included in the patient evaluation, and a laboratory
search for subclinical Cushing’s disease is not performed. However,
steroid excess is a well known cause of secondary osteoporosis and its
diagnosis may affect the treatment scheme (2). Next, of the 55 patients
with secondary osteoporosis only 24 is included in the analysis, excluding
the patients already known to have a cause and the ones on steroids. Of
these included in the analysis, 63 % have been found to suffer vitamin D
deficiency. However monitoring and replacement of vitamin D levels are
routinely recommended with the diagnosis of osteoporosis (2). Besides it
is difficult to differentiate osteoporosis form osteomalacia in these
patients. Therefore, an analysis of the 9 patients with unrecognized
secondary osteoporosis excluding those with vitamin D deficiency may have
been more valuable to decide if Z score is valuable in detecting other
secondary causes of osteoporosis. Thirdly, the predictive value of this
test requires further attention, since in the study cohort about 84 % of
the patients with primary osteoporosis requires complete laboratory
evaluation to rule out secondary causes, and still 13 % of patients with
secondary osteoporosis is missed. It is necessary to explain why
utilization of Z scores is still being proposed and to perform a receiver
operating characteristic (ROC) curve analysis to further evaluate clinical
benefit. Last of all, it would be more informative if sensitivity of Z
scores for patients on steroids and for patients previously known to have
a cause were presented.
References:
1- Swaminathan K, Flynn R, Garton M, et al. Search for secondary
osteoporosis: are Z scores useful predictors? Postgrad Med J 2009; 85:38-
39.
2- Mauck KF, Clarke BL. Diagnosis, screening, prevention, and treatment of
osteoporosis. Mayo Clin Proc 2006;81:662-72.
I was long searching for an article on Omega-3 fatty acids and this
systematic review couldn't have come at a more opportune moment.
The authors conclusion that more studies are needed in this exciting
area is appropriate but I am worried that the guidelines of the UK
Scientific Advisory Committee (on Nutrition guidelines2004)that a healthy
adult should consume a minimum of two portions of fish a week to obtain...
I was long searching for an article on Omega-3 fatty acids and this
systematic review couldn't have come at a more opportune moment.
The authors conclusion that more studies are needed in this exciting
area is appropriate but I am worried that the guidelines of the UK
Scientific Advisory Committee (on Nutrition guidelines2004)that a healthy
adult should consume a minimum of two portions of fish a week to obtain
the health benefit, may not go down well with vegetarians.
Perhaps different recommendations for them may be appropriate?
We thank Dr. Rakesh Biswas for his valuable comments.
Considering the potential benefits of regular ω-3 fatty acid consumption, the recommendations apply to all those who can consume fish.
For those who do not like the taste of fish and for vegetarians and vegans, the issue of ω-3 fatty acid alternatives were discussed and included at the end of the full text article - Although the recommendations from various p...
We thank Dr. Rakesh Biswas for his valuable comments.
Considering the potential benefits of regular ω-3 fatty acid consumption, the recommendations apply to all those who can consume fish.
For those who do not like the taste of fish and for vegetarians and vegans, the issue of ω-3 fatty acid alternatives were discussed and included at the end of the full text article - Although the recommendations from various professional bodies are for consumption of fish, vegetarians who do not consume fish may use fish oil capsules or certain vegetable oils with significant ω-3 FA content. The following vegetable seed oils are listed in decreasing order of their ω-3 FA content: linseed oil, flaxseed oil, pumpkin seed oil, canola oil, soybean oil, safflower oil and sunflower oil.1
In addition, seaweed1 (marine algae) and microalgae2 have also been recommended as a source of ω-3 fatty acids that are suitable for vegetarians.
Incidentally, three of the review's authors are strict vegetarians too.
References:
Gebauer SK, Psota TL, Harris WS, Kris-Etherton PM. n-3 fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits. Am J Clin Nutr 2006;83(6 Suppl):1526S–35S. [Abstract/Free Full Text]
Doughman SD, Krupanidhi S, Sanjeevi CB. Omega-3 fatty acids for nutrition and medicine: considering microalgae oil as a vegetarian source of EPA and DHA. Curr Diabetes Rev. 2007 Aug;3(3):198-203. [Abstract]
Dear Editor, I was happy to read the editorial by Doyal,Doyal and
Sokol concerning good medicine and rights. They comment that doing the
right thing in difficult clinical circumstances can demand courage,
prudence and levels of personal and professional maturity, and I would
also add knowledge. It may be like the good news bad news scenario -
you're doing well 90 miles per hour but sorry your going in the wrong
directio...
Dear Editor, I was happy to read the editorial by Doyal,Doyal and
Sokol concerning good medicine and rights. They comment that doing the
right thing in difficult clinical circumstances can demand courage,
prudence and levels of personal and professional maturity, and I would
also add knowledge. It may be like the good news bad news scenario -
you're doing well 90 miles per hour but sorry your going in the wrong
direction. Ethics at times is self evident - do not kill, but lower levels
of clarity can be difficult to tease out. This often requires one to
revert to first principles such as - don't do evil that good may come of
it; or - that the end never justifies the means. The objective morality of
acts is also a guiding light, especially when motivation and personal
circumstance cloud the situation. Everyone does not accept everyone elses
moral code or ethical stance, and so an ethics based on objective reality
rather than relativism or determinism, is a better basis for decision
making. The doctor also has to be true to his own ethical code regardless
of patient requests, and should be facilitated to opt out of proceedures
or decisions he feels are not in keeping with his code. A doctors rights
should enshrine the dignity to adhere to a chosen established ethical code
without being pressurised by anyone.
To the Editor,
This is regarding the article 'Current controversies in the management of Warthin's tumour' by T Thangarajah, V M Reddy, F Castellanos-Arango, A Panarese , published in Postgrad Med J 2009;85:3-8. Dear Editor, This is regarding the articleâ Current controversies in the management of Warthin tumour by T Thangarajah, V M Reddy, F Castellanos-Arango, A Panarese , published in Postgrad M...
Dear Editor,
I would like to emphasize the fact that the antitrypsin polymorphism is the prevalent susceptibility factor with one in ten Caucasians presenting the MS or MZ configuration of their circulating antitrypsin. The antiprotease has known roles in inflammation (1). It may also be an important factor in occupational lung diseases, like organic diisocyanate asthma (2). The latter may be related to the cho...
Reply to dear Dr. Tanvir ABBASS and co-authors:
First, thanks for your attention to our article.
We reply your questions as below: There was no history of radiotherapy or surgery to urinary bladder, which was a risk factor for cystitis and superimposed coliform infection, in our present case. There was no evidence of presentations of colitis, such as abdominal pain or diarrhea, and no gallbladder stones...
Dear Editor, This is interesting clinical case of emphysematous cystitis in non diabetic patient who previously had radiotherapy and surgery on urinary bladder. This type of cystitis is nearly seen always in diabetic patient but because of past medical history, this patient became more likely of such disease. We very much agree that cases which I have seen are mostly in diabetic patients but radiotherapy is a recognised...
Given the fact that thrombolysis confers survival benefit in patients with myocardial infarction(MI), not only when the clinical presentation is associated with an electrocardiogram(ECG) characterised by ST segment elevation, but also when the admission ECG shows LBBB, regardless of whether or not LBBB is of recent onset(1),among the patients targeted by the treatment goals proposed by the authors of the review(2), we also...
The article from Dr. Srinivassan is very interesting. Recent management is aimed to get a better control of glycemic level in type 2 DM. Better glycemic control is hoped to prevent some complication of type 2 DM. One of the most common complications of diabetes is diabetic neuropathy. Hyperglycemia appears to be the determinant of microvascular and metabolic complications. However, glycemia is much less related to macro...
Letter to Swaminathan et al. entitled Search for secondary osteoporosis: are Z scores useful predictors? N. Defne Altintas, Mustafa Sahin Medicana International Ankara Hospital, Department of Internal Medicine1, Ankara, Gaziantep State Hospital, Departments of Endocrinology2, Gaziantep, TURKEY
Dear Sirs, In their recent article, a marker to define secondary osteoporosis is being evaluated by Swaminathan et al (...
I was long searching for an article on Omega-3 fatty acids and this systematic review couldn't have come at a more opportune moment.
The authors conclusion that more studies are needed in this exciting area is appropriate but I am worried that the guidelines of the UK Scientific Advisory Committee (on Nutrition guidelines2004)that a healthy adult should consume a minimum of two portions of fish a week to obtain...
We thank Dr. Rakesh Biswas for his valuable comments.
Considering the potential benefits of regular ω-3 fatty acid consumption, the recommendations apply to all those who can consume fish.
For those who do not like the taste of fish and for vegetarians and vegans, the issue of ω-3 fatty acid alternatives were discussed and included at the end of the full text article - Although the recommendations from various p...
Dear Editor, I was happy to read the editorial by Doyal,Doyal and Sokol concerning good medicine and rights. They comment that doing the right thing in difficult clinical circumstances can demand courage, prudence and levels of personal and professional maturity, and I would also add knowledge. It may be like the good news bad news scenario - you're doing well 90 miles per hour but sorry your going in the wrong directio...
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