eLetters

286 e-Letters

  • Re: Surgical Pulmonary Embolectomy
    Andrew C Miller

    Dear Editor

    The letter from Dr Eltzschig [1] refers to their paper showing that surgical embolectomy remains an option in severe pulmonary embolism. Firstly, this required "a multidisciplinary evaluation team with a widespread reputation for 24-hour availability, 7 days per week" (and over half of their patients had surgery during the weekend); there must be very few centres in the world who can offer such a service,...

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  • Validation of the BTS pre-test probability score
    Christopher W.H. Davies

    Dear Editor

    I would be grateful if the PE Guidelines Development Committee could clarify the validity of the pre-test probability (PTP) score which was quoted in the 1997 guidelines for PE and which reappears in the latest PE guidelines.

    In the 1997 guidelines it clearly states that the suggested PTP score had not been validated, but was derived from the works of others in particular Wells in Canada. Howe...

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  • Authors' reply
    Vito Brusasco

    Dear Editor

    In his letter, Dr Devoy is questioning the strength of the conclusion in our publication regarding the clinical efficacy of salmeterol on dyspnea, quality of life and reductions of exacerbations. We had stated that the effects with long-acting ß2-adrenergic bronchodilators on COPD exacerbations and on other health outcomes has provided inconsistent results [1] We note that Dr Devoy’s argument is mo...

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  • Reflecting the balance of evidence for salmeterol in COPD
    Michael B Devoy

    Dear Editor

    We would like to comment on strength of conclusions of the recent publication by Dr Brusasco et al,[1] particularly that no consideration is given to how the results compare to the balance of evidence that exists.

    The paper’s conclusions imply superior efficacy of tiotropium over salmeterol in patients with COPD by emphasising endpoints in which tiotropium shows a difference compar...

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  • Surgical Pulmonary Embolectomy
    Holger Klaus Eltzschig

    Dear Editor

    With great interest, we read the guidelines for the management of suspected acute pulmonary embolism (PE) by the British Thoracic Society (June issue 2003).[1] In the discussion of treatment options, the guidelines state that surgical embolectomy should only be considered in cases with absolute contraindications to thrombolysis, which is rarely an important consideration in a life-threatening situat...

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  • New asthma gene
    Dr S K Agarwal

    Dear Editor

    One of the paradoxes of modern medicine is the rapid growing incidence of immune-based diseases over the last half of the century.

    Despite enormous advances in our understanding of the immune system, and our ability to manipulate immunity in experienced animals and man, we have not been able to curtail these diseases. In fact, it is becoming increasing evident that immune hypersensitivity response...

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  • Inappropriate outcomes and flooring/ ceiling effects invalidate study conclusion
    Sarah B Brien

    Dear Editor

    The efficacy and clinical effectiveness of homeopathy engenders considerable debate; it is therefore essential that clinical trials are accurately interpreted and reported. The recent publication by White et al.[1] has highlighted this issue.

    The study, assessing classical homeopathy as an adjunctive treatment for childhood asthma concluded that, based on the primary outcome (the active qua...

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  • Author's reply to Robert Leckridge
    Adrian R White

    Dear Editor

    Dr Leckridge[1] is correct to state that the children in the study had mild to moderate symptoms of asthma at the time of recruitment. Children with more severe symptoms were excluded at the request of the Ethics Committee, because of the risks that could arise if they stopped their conventional medication. Our study tested homeopathy as an adjunct to standard medical management, not an alternative.

    ...
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  • Homeopathy and childhood asthma
    Robert Leckridge

    Dear Editor

    This study of quality of life in children with asthma treated with homeopathy is fatally flawed.[1] The Childhood Asthma Quality of Life instrument used was validated in a study by French et al.[2] The children entered into White’s study had scores consistent with those of normal children who don’t have asthma. For a statistically significant improvement to occur in this score, the treated group wo...

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  • Salbutamol vs aminophylline in severe asthma in children
    Florens GA Versteegh

    Dear Editor

    It is indeed a pity that there was no comparison between continuous aminophylline and continuous salbutamol. The authors did not make it very clear why they did not choose this option. The conclusion that there is some favourable outcome with aminophylline is therefore, in my opinion, too strong for the data they present. Another query is: Why did the authors use aminophylline, instead of theofylline, wit...

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