eLetters

59 e-Letters

published between 2001 and 2004

  • Is "triple" therapy for heart failure validated ?
    Fahim H. Jafary

    Dear Editor

    We read the comprehensive review on drug treatment of heart failure by McKenzie and Cowley with great interest.[1]

    While they appropriately state the efficacy of the ACE inhibitor/beta-blocker and ACE inhibitor/spironolactone combinations in systolic heart failure, the average reader may get the impression that all three drugs can be used together in a patient. The article fails to clarify f...

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  • Is higher blood pressure always better for patients with post-MI cardiogenic shock ?
    Mohamad Abdelsalam Abdelkader

    Dear Editor

    Cardiogenic shock is an ominous complication of myocardial infarction (MI), occurring in 4 to 7 percent of cases. The majority of patients have an ST elevation (Q wave) MI, but cardiogenic shock can occur, although less frequently after a non-ST elevation (non-Q wave) MI .[1,4]

    The clinical definition of cardiogenic shock is decreased cardiac output and evidence of tissue hypoxia in the presence...

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  • Empyema or lung abscess?
    Martin G Kelly

    Dear Editor

    I have read the self-assessment question published by Karnak et al.[1]

    They present an apparent case of empyema due to Aspergillus fumigatus (was the thoracentesis from pleural space or cavity?). I would question the authors’ interpretation of the computed tomography (CT) in the article. I have looked carefully at the imaging. In my opinion, the CT illustrates a primarily intrapulmonary...

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  • Implementing the British Thoracic Society (BTS) COPD guidelines
    Martin G Kelly

    Dear Editor

    I have read with interest the paper by Dheda et al.[1] It deals with a very important issue – the implementation of guidelines, and whether or not these in fact alter outcomes.

    We have previously demonstrated [2] that these guidelines [3] are poorly adhered to, but equally, may be useful since the scoring systems used (such as scores for appropriateness of admission) correlated with p...

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  • Use of Spironolactone in Heart Failure
    Syed Wamique Yusuf, M.D M.R.C.P

    Dear Editor

    Shah et al [1] have nicely covered the topic of use of diuretics in heart failure.

    In the article,[1] it has been recommended that in patients with substantial edema a combination of high dose loop diuretic and a thiazide diuretic with or without potassium sparing agent is more potent than a high dose of either of these. For diuretic resistance, increasing the frequency of loop diuretic...

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  • Dilemma in traetment of Tuberculosis- Role of Surgery
    omi jindal

    Dear Editor

    As evident from this article [1] and it is also a well recognised fact that Chemotherapy stands as the first choice for treating Extrapulmonary Tuberculosis. The role of surgery is for the treatment of complications arising from the disease itself. But at times, antitubercular therapy cannot be started due to lack of pathological diagnosis even with a strong clinical suspicion and coroborative lab r...

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  • Bullying should not be accepted
    L Radamari

    Dear Editor

    This paper highlights an iceberg tip.[1] Junior doctors straining to climb the slippy hierarchical medical ladder are increasingly taking on higher degrees to better their chances of success. Unfortunately this leads to inappropriate levels of support as this piece of research exposes. Bullish behaviour from powerful academic supervisors, coupled with a lack of support systems, leaves research fellows o...

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  • Colorectal Investigations
    Shyam S. Menon

    Dear Editor

    There are certain inconsistencies in the results. Twenty four procedures were abandoned due to poor bowel preparation but all 316 procedures have been presented in the results. Table 1 seems to be completely erratic as it lists Transverse Colon, Ascending Colon and Caecum as sites of advancement of the Sigmoidoscope. Moreover the number of procedures upto the Splenic flexure in the table do not add upto...

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  • Comment on: paper by Stebbing et al.
    P Smith

    Dear Editor

    This study confirms what everyone knows but it is remarkable that no one has done this before. Objective evidence such as this can now be used to stop what is happening here. Why is there so much power with a few professors just because they win a few grants? Does anyone ever properly assess this sort of thing - we all know it goes on too.

  • Author's reply
    Amit Goyal

    Dear Editor

    We agree with V Ramachandran that the presence of blood in an empty hernial sac should have prompted the surgeon to perform an exploratory laparotomy. The case report reinforces this basic surgical principle and highlights that intra-abdominal malignancy may rarely present as an inguinal mass and lead to blood in the sac.

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