Cases Journal - Latest Comments

Did the authors forget about the booze involved?

John McKenna — 2010-01-19T14:34:33Z

It is curious that no mention was made of the patient's measured blood alcohol level; a strong possibility seems indicated that an interaction among the patient's recreational drugs may have led to this incident!

Future of Cases Journal

Subramanian Vaidyanathan — 2009-12-02T15:25:22Z

I understand that Cases Journal has stopped accepting new manuscripts.
Whatever version replaces Cases Journal, the new online database or repository of doctor-patient narratives should be
1. Peer-reviewed
2. Indexed in Medline, PubMed, PubMed Central
3. Open acccess online medical repository, which is reliable
4. The article processing fee or its equivalent should be affordable; say, £99 plus VAT
5. Prompt publication

Thanks
Dr S Vaidyanathan

applause for your philosophy on the journal!

S. Calvin Li — 2009-12-02T15:24:58Z

Dear Honorable Editor Smith,

Reading your "Editorial, Standards of English in a democratic, mass publication journal." Your courage and vision have impressed me tremendously. You are making a historic breakthrough by doing what you are doing! I admire the following points.

"So where do we draw the line? How low will we go? As low as we can" is the answer."

I don't think that is a low standard as long as you can get the most raw materials - People preserve their own style of using English and their way of expression - a precious moment of inspiration in writing. Many cases in the history have showed that it was those not so sophisticated in writing discovered the most important facts. When those "language fanatics" found “infelicities of language in the journal” as you pointed out, however, they missed the real meaning of your journals, recording those “facts” – the raw precious materials. Even those "‘good books’ – Dickens, Trollope, Hemingway, Powell, Austen, Eliot, Conrad, James, Proust, Balzac, Roth, Updike, McEwan, and the like,” had inspired by “raw materials.”

The following idea of "dialogue" is an invention in the scientific publishing business.

"Then because Cases Journal is electronic we have the possibility of dialogue. Being misunderstood is routine even if your language is perfect. Wise doctors, for example, will ask patients to repeat back to them what they have understood. Often they find that patients have misunderstood even when they say they have understood clearly. So if readers cannot understand what authors have written then they should ask them to explain, and we will ensure that authors respond."

I applause for your philosophy on the journal! An article written with the depth and beauty is recognised more about its well-balanced thought and inspiration than its eloquent rhetoric. Simply state, facts are more important than rhetoric.

Respectfully,

A reader

What was the cause of death and impressed by the report of pain relief

Melvin Hayden — 2009-12-02T15:23:30Z

Thank you for sharing you interesting case report with calciphylaxis.

I thought the relief of pain was rather classical and seems to be a an exciting outcome for the pain is horrendous and actually horrific.

What was the cause of death in your patient as this was not discussed in your case report. Also what was the time interval between the onset of the eschar you shared and death?

How can we be certain that the sodium thiosulfate was not promoting wound healing if the patient died as it frequently takes 3-6 months for these lesions to heal. Do you have any images of the skin ulceration after 2 months as there could be evidence of healing at the wound margin.

I look forward to your comments and response.

If you prefer you may feel free to correspond with me by e-mail: mrh29@usmo.com

Thank you again for sharing this most interesting case report and I wish to thank Cases Journal and their editors for allowing case reports such as this case to be reported and shared with the readers of Bio Med Central. M.R. "Pete" Hayden, MD.

Regarding new thoughts and ideas in evolution. There is growing interest in the development of low levels of hepatic synthesized fetuin-A,which is surpressed concurrent with albumin when the innate immune system is activated due to redox stress and activation of NFkappaB by reactive oxygen species and subsequent downstream inflammatory cytokines. pete hayden

Is it a manifestation of immune deficiency?

aisha marsafy — 2009-12-02T15:23:03Z

I agree with you that splenic abscess is a relatively rare presentation.
I wished to know some data such as the details of the blood picture, if blood culture was done, if culture from the removed spleen was obtained,what was the organism?
Did you perform any immunological screening in this case?

Differential diagnosis: apical ballooning syndrome

Eduardas Subkovas — 2009-02-12T16:06:33Z

Would be interesting to know, when coronary angiogram/LV study and echocardiogram were performed in relation to the time of the onset of his symptoms. Myocardial bridge in his case could be coincidental finding. Differential diagnosis in this case might be Takatsubo cardiomyopathy (stress induced CMP). Otherwise, very interesting case.

Value of case report

imtiaz wani — 2009-02-09T14:29:46Z

This is a case report of excellence.A common problem of constipation can turn in malady is reflected.Importnce of case report and how teaching it can be is exemplified in this case report

Probable sequele of Midfoot Amputation

Siddhartha Sharma — 2009-01-14T09:55:03Z

I read this unusual case report with great interest. The patient had a midfoot amputation on the left side, which is almost equivalent to performing a Lisfranc amputation (done at the tarso-metatarsal level). Such amputations are usually followed by initially an equinus and then an equinovarus deformity. n such cases, it is recommended that either Tendo Achilles tenectomy or transfer of one or more dorsiflexors of the ankle be done prophylactically (1) I would like to ask the authors if they had discussed the possibility of an equinus deformity with the patient and the need for tenectomy / tendon transfer. Also, it would be interesting to know if she has any deformity on subsequent follow up. Reference: 1. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics. 11th ed. Philadelphia: Mosby, 2003: 587

Hypokalemia due to excessive cola consumption

Vasilis Tsimihodimos — 2008-12-15T12:14:17Z

Dear Sir We read with great interest the case report recently described by Dr Packer of chronic hypokalemia due to excessive cola consumption [1]. The author suggested that excessive cola consumption is associated with an exaggerated fructose load leading to osmotic diarrhea and gastrointestinal potassium wasting . However, other mechanisms may also contribute to the decreased potassium levels such as 1) cola consumption is also associated with glucose loading resulting in hyperinsulinemia and potassium entry into cells, 2) caffeine is also one of the main ingredients of cola. It is well known that caffeine-induced hyperventilation as well as sympathetic overactivity is also associated with potassium entry in to cells whereas caffeine may also increase the renal excretion of potassium. In fact, several cases of hypokalemia due to cola-induced caffeine intoxication have been described in individuals not experiencing symptoms suggestive of osmotic diarrhea [2,3,4,5]. In conclusion, we propose that the etiology of cola-induced hypokalemia may be multifactorial and that apart from fructose overload other mechanisms may also contribute in the pathogenesis of this rare condition. References 1. Packer CD: Chronic hypokalemia due to excessive cola consumption: a case report. Cases.J. 2008, 1: 32- 2. Lee HJ, Kim DW, Cho HS, Jung EY, Lee DW, Chang SH, Park DJ: Hypokalaemic paralysis induced by large amounts of cola consumption. Nephrol Dial Transplant 2007, 22: 2729. 3. Matsunami K, Imai A, Tamaya T: Hypokalemia in a pregnant woman with long-term heavy cola consumption. Int.J.Gynaecol.Obstet. 1994, 44: 283-284. 4. Appel CC,Myles TD: Caffeine-induced hypokalemic paralysis in pregnancy. Obstet.Gynecol. 2001, 97: 805-807. 5. Rice JE,Faunt JD: Excessive cola consumption as a cause of hypokalaemic myopathy. Intern.Med.J. 2001, 31: 317-318. Vasillis Tsimihodimos and Moses Elisaf

Role of rFVIIa in hemorrhage control

Philip Stahel — 2008-12-02T11:16:20Z

I read with high interest the case report by Konstantinos Vlachos and colleagues entitled "Successful use of recombinant factor VII for postoperative associated hemorrhage" (Cases Journal 2008, 1:361).

The authors have to be congratulated for their excellent management of a coagulopathic patient with massive postoperative bleeding secondary to a renal biopsy.

However, I was disappointed regarding the adequacy of the work-up of the pertinent, peer-reviewed literature in the field. The authors state that "published clinical experiences for the use of rFVIIa in trauma are limited to small series and case reports" (abstract) and "data supporting the use of rFVIIa within trauma have been limited to case series and anecdotal reports" (conclusion).

These statements are inaccurate and highly misleading.

Multiple prospective studies, including double-blind randomized trials, as well as meta-analyses, systematic reviews and formal guidelines on the use of rFVIIa in trauma have been published in the past few years. While the authors adequately reference the "key" paper by Ken Boffard in J Trauma 2005 on two prospective randomized studies on rFVIIa in blunt and penetrating trauma patients (reference #8), they fail to cite some recent publications which provide level 1 evidence on the topic, for example:

- Rizoli SB, et al., "Recombinant activated factor VII as an adjunctive therapy for bleeding control in severe trauma patients with coagulopathy: subgroup analysis from two randomized trials", Crit. Care 2006, 10:R178.

- Vincent JL, et al. "Recommendations on the use of recombinant activated factor VII as an adjunctive treatment for massive bleeding - a European perspective", Crit. Care 2006, 10:R120.

- Kluger Y et al., "Safety of rFVIIa in hemodynamically unstable polytrauma patients with traumatic brain injury: post hoc analysis of 30 patients from a prospective, randomized, placebo-controlled, double-blind clinical trial", Crit. Care 2007, 11:R85.

- Spahn DR et al., "Management of bleeding following major trauma: a European guideline", Crit. Care 2007, 11:R17.

- Squizzato A, Ageno W, "Recombinant activated factor VII as a general haemostatic agent: evidence-based efficacy and safety", Curr. Drug Saf. 2007, 2:155-61.

- Moltzan CJ et al., "The evidence for the use of recombinant factor VIIa in massive bleeding: development of a transfusion policy framework", Transfus. Med. 2008, 18:112-20.

In the current times of fast open-access publishing with short peer-review and turn-over times until publication, the onus remains on the author to provide scientifically accurate information. This is a sign of respect to the reader, who should be able to trust the scientific content of the growing number of peer-reviewed publications in biomedical journals.

Philip F. Stahel, MD

Attending Surgeon

Denver Health Medical Center