59 e-Letters

  • MOC-and the Certification Industrial Complex: Taking money and providing no value
    Paul Kempen

    Hirsh and Meyers espouse that same party line of the many private non -governmental agencies (and academics who will personally benefit from this program) who wish to impose private interest group-unproven corporate interests upon practicing physicians. They continue to state MOC is "voluntary" and then describe the many ways these "non-profit" corporations (who earn handsomely and have over $400 million in assets and as g...

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  • Abolishing Neurointerventional Fellowship Training: A Reality Check
    David A. Rubin

    Dear Sir:

    I am not a neurosurgeon, neuroradiologist, nor interventionalist. In fact, I am not a regular reader of your journal. However, the article entitled "Should Neurointerventional Fellowship Training Be Suspended Indefinitely?" by David Fiorella, et al., was brought to my attention, unsolicited, by several different medical web sites. I have no objection to the logic and opinions expressed, and actually h...

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  • Re:Caution during use of DDAVP in IPSS
    Rahmi Oklu

    Dear Sir,

    We thank the authors for their letter entitled, "Caution during use of DDAVP in IPSS," by Drs. Pecori Giraldi, Federici, and Cavagnini. The authors suggest that because of the hypercoagulable state that characterizes Cushing disease, DDAVP may not be safe since it has been shown to increase the level of von Willebrand factor (vWF) and could therefore lead to platelet adhesion and cause thromboembolism...

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  • Caution during use of DDAVP in IPSS
    Francesca Pecori Giraldi

    Dear Sir, we have read with great interest the paper by Deipolyi and co-workers on the use of desmopressin during inferior petrosal sinus sampling (IPSS) in alternative to corticotropin-releasing hormone (CRH) for the diagnostic work-up of Cushing's disease (1). As the Authors report, evidence collected in small series suggests that desmopressin achieves an equivalent diagnostic accuracy to CRH, thus appears a tempting...

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  • Revisionist History
    Colin P. Derdeyn

    The reply from Perez et al to my letter of March 2012 is misleading and wrong in two important regards.1 First, they state that their report of the use of the solitaire stent for thrombectomy was just a case report, "nothing else". 2 This is not true. In fact, they explicitly use this report, both in the abstract and conclusion to lay claim for developing the stentreiever concept for thrombectomy: "This was the first...

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  • Yes, Neurointerventional Fellowship Training Should Absolutely be Suspended!
    Kennith F. Layton

    We would like to add our strong support to the recent editorial by Fiorella, et al. Dr. Fiorella and his colleagues should be congratulated for pointing out the giant elephant in the room. The government, insurers and patients are increasingly demanding more quality, safety and value from the healthcare dollar and, like it or not, we can no longer ignore their pleas. Dr. Fiorella has eloquently shown us with widely ava...

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  • Efficacy of Endovascular Stroke Management in Elderly Patients
    Stavropoula I. Tjoumakaris

    We would like to thank Dr Hirsch and colleagues from Massachusetts General Hospital for their insightful comment on our paper.1 The authors advocate a more cautious conclusion regarding the efficacy of endovascular stroke intervention in the elderly since a control group of younger patients is lacking in our study. Although comparison to a younger group of patients is interesting, such data can hardly be used for drawing...

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  • Efficacy of IAT in elderly requires further study
    Joshua A. Hirsch

    We salute Dr. Ghobrial and colleagues for their important contribution regarding the endovascular management of elderly ischemic stroke patients.1 Although this topic is relatively new to the literature, it is of critical importance to the field of intra-arterial therapy (IAT) given the increasing use of catheter-based stroke therapies2 and the expanding population of elderly Americans, who are at the highest risk for isc...

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  • Patient Selection, Physician Experience, and Anti-platelet Therapy Testing are Critical
    Michael J. Alexander

    The response from the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial principal investigators (PIs) is greatly appreciated. Healthy debate helps us weed out the details that are important in these studies and future trial design. Although the PIs label some of the editorial comments as "inaccuracies", one could disagree based on the information listed below....

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  • Response from the SAMMPRIS Trial Principal Investigators regarding inaccuracies in this editorial
    Colin P Derdeyn

    As the Principal Investigators for the Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke (SAMMPRIS) trial, we are compelled to address a few inaccuracies regarding this study in the recent editorial by Dr. Alexander.

    The first point is the patient population. The SAMMPRIS population was the right patient population to test. We had very good data from the Warfarin vers...

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