Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment.

No abstract

Twenty-five patients treated by lumpectomy and radiotherapy for Stage I breast cancer were enrolled in a prospective study to measure the effects of tangential field irradiation on pulmonary function. Fractional doses of 2 Gy to a total of 50 Gy were administered with the tangential technique. An additional 10 Gy (2 Gy x 5) was given as direct booster. Dynamic and static lung volumes, distribution of ventilation and gas transfer were measured before irradiation and at varying intervals up to 1 year after the completion of therapy. There was a small, but statistically significant decrease in the forced vital capacity (mean 63 ml) and the forced expiratory volume in 1 second (mean 79 ml) measured 3 months after irradiation (p less than 0.05). These changes were reversed within 1 year. The reduction in total lung capacity (mean 240 ml) after 3 months was nearly significant (p = 0.06). The remaining variables did not change to a significant degree. We conclude that a slight restrictive ventilatory impairment may occur when a combined tangential and direct booster technique is applied. The changes are, however, small and reversible, and imply no clinical importance.

We thank A. E. Johnson for her interest in our paper. It is true that we only investigated patients without a history of respiratory disease or symptoms and with normal lung function. This was done not so much in fear of a critical reduction in lung function, but more out of concern that a reduced or variable lung function due to respiratory disease per se, would mask a radiation-induced effect.

Based on a systematic literature review it was concluded that the only documented effect of heart laser treatment is symptom relief, the mechanism for which is unclear. It could partly or totally be a placebo effect. A conflict of interest may arise when new technologies are to be implemented in health care. The communication between professionals evaluating scientific results and decision makers is challenging. Quality assurance of this process may be obtained by use of expert panels working under the auspices of an official institution.