113 e-Letters

published between 2004 and 2007

  • Treatment of Acute Adrenal Crisis.
    Robert James

    Adrenal crisis is a medical emergency. If suspected treatment should be started as soon as possible. Every emergency physician should be familiar with adrenocortical insufficiency—a potentially life-threatening entity. The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, occasionally, laboratory findings. Delay in treatment while attempting to confirm this diag...

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  • The evidence applies to all individualised herbal medicine
    Peter H Canter

    In reply to Dr Koprowski's letter, we would like to point out that the absence of rigorous evidence supporting the efficacy of individualised herbal medicine shown by our systematic review remains fact - regardless of how the various types of individualised herbal medicine are categorised. If we had examined only individualised traditional oriental herbal medicine, we would have found even less evidence. If there is "act...

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  • A startling inadequacy in the links between the review evidence and the authors’ conclusions.
    Ally Broughton

    Response to: R Guo, PH Canter, E Ernst. A systematic review of randomised clinical trials of individualised herbal medicine in any indication. Postgrad Med J 2007;83:633-637

    From: Ally Broughton Bsc (Hons) MNIMH Director of Research for, and Member of, the National Institute of Medical Herbalists (NIMH) Contact: ally.broughton@blueyonder.co.uk

    I am a trained herbal practitioner of 12 years and teach resea...

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  • Oriental Medicine Doctors Licensed As Primary Care Providers in the U.S.
    E.J. Koprowski

    Thank you, Peter Canter, for your e-letter in the Postgraduate Medical Journal.

    We find it somewhat shocking that you think herbal medicines are no better than a "placebo." This belies the facts.

    In America, in states like Florida, acupuncturists are licensed as "acupuncture physicians" and are considered by medical regulatory authorities to be primary care practitioners, who can also dispense herbs, a...

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  • Testis cancer
    Srijit Das

    I enjoyed reading the article on 'testis cancer' by Khan et al.I agree with the authors that the survival rate has increased over the past few years.The authors have rightly pointed out the role of chromosome in causing such anomalies while the primordial germ cells are undergoing cell division.While going through the risk factors,I would certainly like to highlight the exposure of dyes and paints.The dyeing agents are kn...

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  • The place of death - a key issue also in Cuba
    Alfredo A Espinosa-Roca

    Editor - We carefully read the recent Wheatley and Baker paper. (1) As they emphasised, the place of death persists at present as a very important issue for every person and for health care services.

    One of the most typical signs of western societies during the past century was the ever-increasing proportion of patients who died at hospitals. This new panorama was due to several reasons, but undoubtedly it was...

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  • Use of empirical hydrocortisone in suspected adrenal crisis
    Mark A R Jadav


    In their helpful review article, Kearney and Dang advocate giving hydrocortisone to suspected adrenal crisis pending ACTH stimulation testing. Many authorities suggest the use of dexamethasone prior to testing as it does not interfere with cortisol assay (eg. Webb et al 1999, Shenker et al 2001). Can the authors justify their postponement of confirmatory tests?

    Yours sincerely


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  • Systematic review of individualised herbal medicine misunderstood
    Peter H Canter

    Dear Editors

    We thank E. J. Koprowski for her/his comments on our recent systematic review of individualised herbal medicine which reveal that s/he has totally misunderstood the nature of our review in several respects.

    Firstly, we were not at all interested in homeopathy as s/he seems to believe. We can only surmise that s/he is confusing homeopathy with Western medical herbalism which was included....

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  • Fatally Flawed Study Design in Herbal Medicine Review Article
    E. J. Koprowski, M.A.

    Dear Editors,

    A recent article, A systematic review of randomized clinical trials of individualized herbal medicine in any indication, published in October, 2007 in the Postgraduate Medical Journal, by R. Guo , P. H. Canter , E. Ernst, of the Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, U.K., warns public health authorities that the effectiveness of individualized, herbal medicine...

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  • CPR Guidelines: Differences and changes
    Ricardo J Jose

    Dear Editor,

    It is with interest that I have read the article by Dr Wanis Ibrahim titled Recent advances and controversies in adult cardiopulmonary resuscitation (1) in which the changes to the guidelines and the evidence for these is summarised.

    I note that the differences in the cardiopulmonary resuscitation (CPR) guidelines between the American Heart Association (AHA) and the European resuscitati...

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