eLetters

856 e-Letters

  • Move immediate coronary care out of the hospital into the community - Authors' response
    Harvey White

    Dear Editor,

    I agree wholeheartedly with many of Dr Rawles' comments. There are five components of delay in the "pain-to-needle" time. My editorial focused on administration of thrombolytic therapy in the emergency department, and as such I did not discuss other important components of delay.

    Patient delays in summoning medical assistance have proven to be very difficult to influence. Delays in the arr...

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  • Move immediate coronary care out of the hospital into the community
    John Rawles
    Dear Editor,

    The major factor influencing the outcome of thrombolytic therapy for acute myocardial infarction is not door-to-needle time, as Harvey White claims, but pain-to-needle time. The largest component of the overall delay from onset to thrombolytic treatment is attributable to the patient's delay in calling for medical help. There is then an appreciable delay between calling for an ambulance or a doctor and arr...

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  • Clinical and functional relevance of PFO relates to size - Authors' response
    Adrian Banning

    Dear Editor,

    I am grateful to Dr Turner and Dr Bryson for their interest in our Editorial.

    I think they are right, all PFOs are "not equal". As stated in the editorial, there is only conclusive data that large patent foramen ovale capable of passage of more than 20 micro bubbles without provocative manouvers are implicated in crytogenic stroke. It seems reasonable to infer that the situation with d...

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  • Guidelines should consider troponin assay performance
    M W France
    Dear Editor,

    We have concerns about the role of troponin measurements in the recently published guidelines on the management of acute coronary syndromes not associated with ST elevation on the ECG.[1] We feel that following the guideline in its present form will blunt the usefulness of troponin measurements as a decision support tool.

    The recommended decision limits seem to reflect an insufficiently critical appraisal...

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  • Clinical and functional relevance of PFO relates to size
    Mark Turner
    Dear Editor,

    We were interested to read the review about the exciting topic of patent foramen ovale (PFO).[1]

    The authors raise the interesting conundrum that has prevented PFO being considered an important abnormality - How can a problem affecting one-quarter of all individuals be associated with disease? Indeed with regard to decompression illness (DCI) the authors state that whilst many divers have a PFO,...

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  • Homocysteine and coronary heart disease
    Nicholas Wald
    Dear Editor:

    Fallon and colleagues reported no association between serum homocysteine and coronary heart disease in the Caerphilly cohort study,[1] and contrasted their result with the "positive results" shown in other studies including our own BUPA (British United Provident Association) cohort study of 21,520 men.[2] Fallon and colleagues may be incorrect in interpreting their results as negative. They express them as...

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  • Homocysteine and coronary heart disease - Authors' reply
    Una B Fallon
    Dear Editor

    We wish to thank Professor Wald and colleagues for highlighting an error in our paper.1 We misreported the standard deviation for total plasma homocysteine concentration (tHcy) in table 2 so that this was, as Wald infers, too small. This error occurred because our analyses were based on the log transformed data. The true value of the back-transformed standard deviation is between 3.4 and 4.8...

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  • Marfan syndrome and pregnancy
    K Dhital
    Dear Editor:

    We read with interest Professor Treasure's recent paper on the cardiovascular surgical aspects of Marfan syndrome.[1] We wish to add to the discussion by raising the significant cardiovascular risks faced by Marfan patients during pregnancy, a problem that he touched on in a previous editorial.[2] This is an important and controversial issue in the management of adult cardiovascular manifestations of Marfa...

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  • Cystic media necrosis - Authors' response
    Constantinos G Missouris

    Dear Editor,

    We agree that cystic medial necrosis may in a small number of patients be the cause of spontaneous coronary artery dissection.[1] However, the pathogenesis of spontaneous coronary artery dissection remains poorly understood. Indeed, no uniform histological findings have been identified and it is improbable that a single mechanism operates in all these patients. Our patient had none of the featur...

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  • Sensitivity of the risk assessment tool should be the most important parameter - Authors' response
    A F Jones

    Dear Editor,

    Of the paper-based coronary heart disease (CHD) risk prediction methods, the modified Sheffield tables,[1] which include the patient's HDL cholesterol, and the revised charts published by the joint British societies[2] most accurately classify subjects' risks. In our evaluation of their performance,[3] the only statistically significant difference between them was the lower specificity of the modi...

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