eLetters

270 e-Letters

  • Colorectal Investigations
    Shyam S. Menon

    Dear Editor

    There are certain inconsistencies in the results. Twenty four procedures were abandoned due to poor bowel preparation but all 316 procedures have been presented in the results. Table 1 seems to be completely erratic as it lists Transverse Colon, Ascending Colon and Caecum as sites of advancement of the Sigmoidoscope. Moreover the number of procedures upto the Splenic flexure in the table do not add upto...

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  • Comment on: paper by Stebbing et al.
    P Smith

    Dear Editor

    This study confirms what everyone knows but it is remarkable that no one has done this before. Objective evidence such as this can now be used to stop what is happening here. Why is there so much power with a few professors just because they win a few grants? Does anyone ever properly assess this sort of thing - we all know it goes on too.

  • Author's reply
    Amit Goyal

    Dear Editor

    We agree with V Ramachandran that the presence of blood in an empty hernial sac should have prompted the surgeon to perform an exploratory laparotomy. The case report reinforces this basic surgical principle and highlights that intra-abdominal malignancy may rarely present as an inguinal mass and lead to blood in the sac.

  • Improper surgical technique
    Vijay Ramachandran

    Dear Editor

    In the case reported by Goyal et al. regarding the presence of a gastrointestinal tumour in a hernial sac, it appears that poor surgery is being passed off as a "lesson" to be learnt by the readers. The presence of a haematoma in an otherwise empty hernial sac should definitely alert the surgeon to the presence of strangulated bowel which has probably reduced into the peritoneal cavity. Having ma...

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  • Compassion and Communication are the key
    Huw C Morgan

    Dear Editor

    Professor Nolan deserves congratulation on his excellent editorial on the need for humanity from doctors towards patients. As someone who has been involved for years in educating Family Doctors in both the UK and developing countries I fully endorse all that he says. Experience of Family Medicine development in many developing countries confirms that where there has been no culture of compassion or comm...

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  • Tissue oxygenation - oriented Approach to patients with ARDS
    Mohamad Abdelsalam Abdelkader

    Dear Editor

    Despite the great advances in critical care medicine, the mortality of ARDS is still high. Protective ventilatory strstegy - utilizing lower tidal volumes and PEEP levels to prevent atelectatic trauma regardless of arterial oxygenation - has been used in an attempt to reduce the mortality of ARDS. Both conventional and protective ventialtory strategies concenterate more on achieving satisfactory arteria...

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  • Authors reply to Huw Morgan
    Andrew P Bond

    Dear Editor

    Dr Morgan is absolutely right about 'imaginary' conditions, there are a number of examples in obstetrics in particular.

    Greta Beresford and I have recently returned from Azerbaijan, and were most encouraged by enthusiastic, knowledgeable seminar participants, many most willing to take on board the principles of evidence-based medicine

    Andrew Bond

  • Different disease concepts in Soviet Medicine
    Huw Morgan

    Dear Editor

    Bond and Beresford's helpful article makes many important points about health care in the former Soviet Union. One thing they don't mention however is that the long years of isolation from 'Western' science have resulted in the development of disease concepts that have no definitive scientific/pathological validity, some of which involve large numbers of the population and have concomitant social and e...

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  • Is this a case of ischemic hepatitis presenting as acute abdomen??
    Ravi V Desai

    Dear Editor

    I read with interest this case of ischaemic hepatitis mimicking intestinal ischemia by Powell et al.[1]

    This patient who presented with upper GI bleeding for three days, was in hypovolemic shock as initial examination revealed tachycardia, tachypnoea, hypotension and severe anaemia. This was certainly due to an upper GI bleed from the acute duodenal ulcer found on endoscopy. The shock...

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  • Clozapine associated with myocarditis and cardiomyopathy
    Detlef Degner

    Dear Editor

    In their article, Tanner and Culling describe the risk of cardiomyopathy in clozapine treatment.[1] Kilian et al.[2] reported about 15 patients with myocarditis and cardiomyopathy out of 8000 patients treated with clozapine (0.178%) in Australia. In the European Drug Safety Program (AMSP) in Germany,Austria , and Switzerland,3 cases of myocarditis among 10,263 monitored patients with clozapine therapy...

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