eLetters

311 e-Letters

  • 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...

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  • 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 "...

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  • 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...

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  • 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...

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  • TB ASAP?
    Ms Sayennah Roberts

    Dear Editor

    Whilst one must of course take into account the mortality figures whilst treating multi-drug resistant tuberculosis, there may be other aspects that need to be studied. The collegues would to well perhaps to address some part of their research to the mortality of those patients who had been prescribed for a protected period antituberculous chemotherapy: (this can be for up to two years), and who have been m...

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  • 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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