eLetters

77 e-Letters

published between 2000 and 2003

  • Metabolic Alkalosis in Cystic Fibrosis
    John W Wilson

    Dear Editor

    We are grateful to Dr Kelly for highlighting the important finding of hypochloraemic metabolic alkalosis in patients with acute exacerbation's of cystic fibrosis.[1,2] It is important to consider the need to correct this abnormality in a timely and appropriate way, by avoiding potential added metabolic acidosis on an established respiratory acidosis in sick patients with severe CF lung disease. The role fo...

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  • Forgotten Whooping Cough
    Márcio Gueiros

    Dear Editor

    Chronic cough is a common problem in childhood. Sometimes we have dificulties to harvest the ethiology, specially when we are not alert for others diagnosis. The authors skipped one of those diseases that are reemerging in first wolrd countries - whooping cough, pressed for a lack in mantaining the pertussis vaccination. This disease takes part in differencial diagnosis in emerging world. So, we all, ped...

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  • Inpatient management of acute COPD: A cause for concern?
    Roger J Wolstenholme

    Dear Editor

    I was intrigued by Mike Rudolf's editorial on Inpatient Management of Acute COPD. He states that mortality was highest in small DGH's and lowest in teaching hospitals. Roberts et al. article, in fact, indicated that large DGH's had a smaller mortality than even teaching hospitals. I would not be surprised, as stated, that small DGH's had fewest resources but certainly working in a large DGH I ha...

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  • Reply to Dr Ng
    Michael T Henry

    Dear Editor

    We thank Dr Ng for his comments on the recently published guidelines on the management of spontaneous pneumothorax.[1] Dr Ng points out that recurrence rates for pneumothorax after VATS preventative procedures were lower than those quoted in the guidelines. It should be pointed out that in the multiple drafts of this document, it was recognised that recurrence rates after VATs were falling and that f...

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  • Cardiac output using thermodilution following atrial septostomy
    Fiona McCann

    Dear Editor

    In their recent paper on atrial septostomy as a treatment for severe pulmonary arterial hypertension, Reichenberger and colleagues measured cardiac output before and after this intervention, using both the thermal dilution and Fick methods. We were puzzled by their choice of the dilution technique. In these patients atrial septostomy was intended to produce, and presumably achieved, a right-to-left inte...

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  • Authors' reply
    Enrico Lombardi

    Dear Editor

    We thank Drs Dundas and McKenzie for their comments.[1] We agree with them that the interrupter resistance (Rint) is able to detect short- term changes in airway calibre after bronchodilator inhalation. However, we must disagree on their comment that Rint has a poor long-term repeatability and their consequent conclusion that Rint is not useful for routine clinical purposes. The long-term (38 days apart)...

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  • Is the measurement of lung function using the interrupter technique useful for the clinician?
    Isobel Dundas

    Dear Editor

    Sly and Lombardi [1] in their recent editorial suggest that interrupter resistance (Rint) measurements are useful in the management of lung disease in young children. We believe this claim needs further consideration.

    Rint measurements can be helpful when change following an intervention, such as the administration of bronchodilator, is greater than its within-occasion repeatability but for a m...

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  • Reference for evidence: error in citation?
    Stewart S. Chan

    Dear Editor

    I am grateful for Dr Henry's reply and further comments on 4 September, 2003.[1] Dr Henry stated that the use of '2 cm' correlating to '50%' as an indication for chest tube drainage in secondary spontaneous pneumothorax was supported by evidence, and that this had become a clear and unambiguous guideline. However, the evidence cited [2] was a 'consensus statement' by the American College of Chest Physici...

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  • Oxygen supplementation before or after submaximal exercise in patients with COPD
    Mary E Dodd

    Dear Editor

    This study describes the use of oxygen supplementation before exercise and during the recovery period in patients with severe COPD, who were hypoxic at rest and showed exertional desaturation. The conclusion of this study does not accurately reflect the findings in relation to the use of oxygen in the recovery period and we would be concerned that patients with such severe disease and exercise limitatio...

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  • Sputum examination in massive hemoptysis
    Dr UC Ojha

    Dear Editor

    I must congratulate the authors for such lucid presentation of a difficult clinical entity which we all face in day to day practice. I wish to submit one comment regarding sputum examination in such cases; patients should not be asked to cough and expectorate until their acute bleeding stops. You should wait a day or two, otherwise they may dislodge the formed clot and bleeding will continue.

    ...
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