1577 e-Letters

  • Re: Factors delaying diagnosis of appendicitis in children
    VC Cappendijk

    Dear Editor

    In reply to the comments by Yim Yee Chan and R Lakshman in which they ask if all patients truely suffered from appendicitis in our study group. The answer is that histopathological investigation confirmed the diagnosis appendicitis in all cases.

    Yours sincerely,

    VC Cappendijk, MD and FWJ Hazebroek, MD, PhD
    Department of Paediatric Surgery, Sophia Children's Hospital...

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  • Factors delaying diagnosis of appendicitis in children
    Yim Yee Chan

    Dear Editor

    The paper by Cappendijk and Hazebroek[1] successfully demonstrates the problems with diagnosis of appendicitis in the young child.

    It makes the important point that diarrhoea may be a feature of appendicitis and lead to misdiagnosis. In addition, children can have coexisting pathologies leading to delayed diagnosis. We have seen a cystic fibrosis child with DIOS (distal intestinal obstruction...

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  • Re: Consider absolute risks in SIDS prevention
    Peter Blair

    Authors response

    Poor postnatal weight gain was a significant factor in the multivariate analysis despite controlling for low birthweight, prematurity, neonatal problems, poor socio-economic status and many other potential confounding factors and remained significant when further highly predictive covariates of SIDS such as infants put down prone, infants found with head covered and tobacco exposure were added...

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  • Recommendations or guidelines regarding MMR vaccination in children allergic to egg should be clear
    Cantani Arnaldo

    Dear Editor

    I thank doctors Lakshman and Finn for their kind reply, and recognise that my use of the word "hospital" has given rise to a misunderstanding. My letter was based on the analysis the authors have made, not in the ADC article,[1] but in their eLetter to BMJ.[2]

    They wrote:
    (1) immunisation with any vaccine in any child always carries a risk of potentially fatal anaphylaxis...

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  • Using a modified nasopharyngeal airway in Pierre Robin syndrome
    Maria Galogavrou

    Dear Editor:

    Masters et al describe how a modified endotracheal tube can be used as a nasopharyngeal airway in infants with Pierre Robin syndrome.[1] We describe further modifications made to overcome some problems which we encountered in using the technique in one of our patients.

    In the original description the protruding part of the airway is cut into four strands and the upper one cut off. We found t...

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  • Re: Controversy about MMR vaccinations in children with or without egg allergy
    R Lakshman

    Dear Editor

    Professor Cantani's[1] experience is very similar to what we found in our review[2] - that egg allergic children do not appear to be at any greater risk to severe allergic reactions with MMR vaccine.

    In our review, we do not advocate hospitalisation of children with egg allergy for MMR immunisation; on the contrary we suggest that all children (including children with egg allergy) can be immu...

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  • Should use of home-made spacers be incorporated into guidelines for asthma management?
    SK Agarwal

    Dear Editor

    Zar et al[1] found that lung deposition of aerolised technetium-99DTPA inhaled via modified 500 ml plastic bottle was higher compared to a Babyhaler in both young and other children. There was no difference in lung deposition when a mask was used. Though other workers[2] have recommended the attachment of facemasks to treat patients of all ages.

    In another study[3] children aged 5 to 13 years...

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  • Intestinal inflammation in cystic fibrosis
    G L Briars

    Dear Editor

    Following their studies of whole gut lavage fluid Smyth et al have suggested that a non-idiopathic intestinal inflammation occurs constituitively in CF patients, as a consequence of a proinflammatory effect of the patient's CFTR mutations.[1] They reported marginally elevated excretion of IgG, IgM, IL-1 , neutrophil elastase and eosinophil cationic protein, and much more significant increase in excreti...

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  • Controversy about MMR vaccinations in children with or without egg allergy
    Arnaldo Cantani

    Dear Editor,

    According to our studies 1803 children allergic to egg have been safely received the MMR vaccine. Systemic reactions were present only in 0.1% of cases and untoward reactions only in 1.7% cases (p = 0.0001).[1] No child vaccinated by us has manifested immediate reactions.[1] According to Sampson et al[2] the MMR vaccine is safe in such children, evaluating on the basis of confidence intervals (95%) t...

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  • Consider absolute risks in SIDS prevention
    Stuart Logan


    The demonstration by Blair et al[1] of an association between poor postnatal growth and an increased risk of SIDS, is a useful addition to our understanding of the aetiology of this condition. It is unfortunate that the conclusion in the abstract that "Poor postnatal weight gain was independently associated with an increased risk of SIDS and could be identified at the routine six week assessment" (italics added...

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