eLetters

77 e-Letters

published between 2000 and 2003

  • Reply: Clinical validity of negative CTPA
    Andrew C Miller

    Dear Editor

    Dr Latour-Perez's concerns[1] are anticipated on page 474 of our article, which summarises the results of three good quality studies using CTPA (not multi-slice) as the only imaging modality (references 187-189). Just after going to press we became aware of a recent excellent large multicentre study [2] with similar results. Combining these four of similar design (well conducted, CTPA only, no anticoagul...

    Show More
  • Anticoagulation in suspected pulmonary embolism and negative Computed Computed tomographic pulmonary
    Jaime Latour-Perez

    Dear Editor

    I would like to express my concern about the recent British Thoracic Society guidelines for the management of suspected acute pulmonary embolism,[1] which suggest that “Patients with a good quality negative CTPA do not require further investigation or treatment for PE.” [grade A recommendation]:

    1. According to a recent well designed study,[2] the negative likelihood ratio of CTPA f...

    Show More
  • Author's Reply
    Michael T Henry

    Dear Editor

    We thank Dr Chan for his comments relating to the recently published guidelines for the diagnosis and management of spontaneous pneumothorces.[1] Dr Chan raises the contentious issue of estimation of the size of a pneumothorax from a plain chest radiograph. We have attempted to use a variation of the method of Axel based on the largest distance from the chest wall to the pleural line and using the assum...

    Show More
  • Paradigm shift in surgical approaches to spontaneous pneumothorax: VATS
    Dr. Calvin S.H. Ng

    Dear Editor

    "It is not the strongest of the species that survives, nor the most intelligent, it is the one most adaptable to change."
    Charles Darwin (1809-1882)

    The article "BTS guidelines for the management of spontaneous pneumothorax" by Henry et al.[1] has recently stimulated some discussion among our respiratory physicians and thoracic surgeons.

    We found it in...

    Show More
  • Ventilation and drainage of pleural effusions
    Jeremy S Bewley

    Dear Editor

    The BTS guideline on chest drain management unfortunately fails to recognise the severity of illness of patients who generally require chest drain insertion on an intensive care unit. In our practice chest drainage for pleural effusions only occurs in ventilated patients who require more than 5cm H20 PEEP and still have significantly impaired oxygenation limiting their ability to be weaned fr...

    Show More
  • Beta-2 receptor genotpye in COPD
    Brian J Lipworth

    Dear Editor

    The negative findings of Joos et al. can be explained by the small signal for bronchodilator reversibility,such that one would not expect to detect any putative differences in beta-agonist response between genotypes ,as compared to asthma where the signal is much bigger. With repect to bronchial hyperresponsiveness (BHR), we have previously shown in asthmatics ,that the glycine genotype is associ...

    Show More
  • Insertion of chest drain guidelines:other experiences
    Calvin S.H. Ng

    Dear Editor

    I read with interest the latest comprehensive BTS guidelines on chest drain insertion. We would like to share with you some tips and words of caution accumulated by experience from our institute.

    During chest drain insertion, we routinely monitor oxygen saturation continuously with or without prior sedation. Patient with secondary pneumothorax i.e. from COAD can deteriorate during chest drai...

    Show More
  • Estimation of size of pneumothorax under the new BTS guidelines
    Stewart S Chan

    Dear Editor

    I read, with interest, the new BTS guidelines for the management of spontaneous pneumothorax.[1] Arnold and colleagues acknowledged that the plain radiograph was a poor method of quantifying the size of a pneumothorax, yet then went on to use one radiographic method of assessment to estimate the degree of lung collapse.

    Under the new guidelines, the size of a pneumothorax is divided into "...

    Show More
  • Long-term inhaled steroid response testing should be done in heterogeneous COPD-population
    Niels H Chavannes

    Dear Editor

    These clinically important papers [1,2] by the Isolde researchers provide excellent data questioning the rationale behind inclusion of patients in the large COPD-studies that have been reported in past few years. Selection of patients on the basis of absence of reversibility means ruling out the easiest measurable variable that may correlate with steroid response. When assessing effects of two weeks pred...

    Show More
  • Validation of the BTS pre-test probability score
    A C Miller

    Dear Editor

    British Thoracic Society guidelines for the management of suspected acute pulmonary embolism

    It is indeed unsatisfactory to make such recommendations in the absence of prospective studies; three have now been published.[1-3] Although differing in the way clinical probability was evaluated and in the D-dimer assays used, all found that in combination many patients with suspected pulmonary embo...

    Show More

Pages