ommends steroid treatment for all such children: "Nous recommandons un traitement aux steroides pour tout enfant admis a l'h6pital avec un diagnostic de laryngotracheite aigue grave." Which recommendation is correct? Kenneth Brown, MD Canadian Forces Base Borden Borden, Ont.
[A Canadian Paediatric Society official (and consultant to the committee) responds.] We thank Dr. Brown for bringing to our attention the discrepancy in our position statement. The official statement is the English text. We said "could" and not "should" because the metaanalysis did not show a statistically significant advantage to using steroids, although there seems to be some clinical benefit. Victor Marchessault, MD Executive vice-president Canadian Paediatric Society Ottawa, Ont.
Nasogastric tube placement A fter reading the case report
"Inadvertent intracranial placement of a nasogastric tube in a patient with severe head trauma," by Drs. Julian S. Adler, Douglas A. Graeb and Robert A. Nugent (Can Med Assoc J 1992; 147: 668-669), I would like to remind readers of a simple technique to clinically confirm the placement of these devices. Injecting 40 to 60 mL of air from a 60-mL catheter-tip (Toomey) syringe (Becton Dickinson and Co., Rutherford, NJ) while ascultating the stomach region quickly confirms that the tip of the nasogastric tube is within the stomach cavity. If air bubbles are not heard the tube should be 1756
CAN MED ASSOC J 1992; 147
(12)
immediately withdrawn and a more cautious insertion attempted. Placing fingers in the posterior pharynx to guide the catheter tip downward is also sometimes helpful (lidocaine topical anesthesia may be required in alert patients).
that the procedure is cost-effective and the results are encouraging. It is difficult to accept as an independent, unbiased investigator someone who has invested $850 000 in the device and who charges $5000 for a 1-hour treatment. Allen R. Huang, MD, CM, FRCPC In the United States thermoDivision of Geriatrics is currently available only therapy Royal Victoria Hospital as an investigative procedure Montreal, Que. under Food and Drug Administration regulations. It seems unfortunate that in Canada devices can be introduced and used to treat patients without having underThermotherapy still gone similar evaluation, and it is investigational disturbing to find unproven techniques being offered in such entreW r ith the funding con- preneurial fashion by members of x straints of our health the medical profession. care system the introduction of new, effective treat- Ernest W. Ramsey, MB, FRCSC ments can be difficult, often in- Professor, Section of Urology of Manitoba volving a great deal of effort and University Winnipeg, Man. frustration. The article by Pam Harrison "Innovative approaches Reference proving attractive to growing number of entrepreneurial MDs" 1. Barry MJ: Epidemiology and natural history of benign prostatic hyperplasia. (Can Med Assoc J 1992; 147: 512Urol Clin North Am 1990; 17: 495-507 513, 516-517) describes how some physicians have dealt with this problem. However, new technology does not necessarily equate with medical care of high quality. Transurethral microwave Conflict of interest thermotherapy is a highly innova- among researchers tive treatment for the common r. Douglas Waugh recentproblem of benign prostatic hyly reported on a joint pleperplasia (BPH). However, as innary session of the Assodicated in the article, it is still investigational. There are various ciation of Canadian Medical Colnew treatments for BPH under leges and the Association of Canevaluation, and these have dem- adian Teaching Hospitals in "Poonstrated the very marked pla- tential for conflict of interest cebo effect in this disease. In ran- among researchers increasing, domized studies of drug therapy meeting told" (Can Med Assoc J 20% to 40% of patients given a 1992; 147: 940). Waugh provided a succinct placebo demonstrated improveof three presentations summary controlled ment.' Randomized of conflict of inon the problem and therefore are studies essential, such studies of thermotherapy for terest. One cannot argue with the BPH are ongoing. Until they show three preventive measures proit to be of value, thermotherapy posed: that clear guidelines be provided for researchers (e.g., the should remain investigational. The Windsor group profiled policy at Johns Hopkins Universiin the article is quoted as claiming ty of permitting no more than a LE 15
DECEMBRE 1992
[A Canadian Paediatric Society official (and consultant to the committee) responds.] We thank Dr. Brown for bringing to our attention the discrepancy in our position statement. The official statement is the English text. We said "could" and not "should" because the metaanalysis did not show a statistically significant advantage to using steroids, although there seems to be some clinical benefit. Victor Marchessault, MD Executive vice-president Canadian Paediatric Society Ottawa, Ont.
Nasogastric tube placement A fter reading the case report
"Inadvertent intracranial placement of a nasogastric tube in a patient with severe head trauma," by Drs. Julian S. Adler, Douglas A. Graeb and Robert A. Nugent (Can Med Assoc J 1992; 147: 668-669), I would like to remind readers of a simple technique to clinically confirm the placement of these devices. Injecting 40 to 60 mL of air from a 60-mL catheter-tip (Toomey) syringe (Becton Dickinson and Co., Rutherford, NJ) while ascultating the stomach region quickly confirms that the tip of the nasogastric tube is within the stomach cavity. If air bubbles are not heard the tube should be 1756
CAN MED ASSOC J 1992; 147
(12)
immediately withdrawn and a more cautious insertion attempted. Placing fingers in the posterior pharynx to guide the catheter tip downward is also sometimes helpful (lidocaine topical anesthesia may be required in alert patients).
that the procedure is cost-effective and the results are encouraging. It is difficult to accept as an independent, unbiased investigator someone who has invested $850 000 in the device and who charges $5000 for a 1-hour treatment. Allen R. Huang, MD, CM, FRCPC In the United States thermoDivision of Geriatrics is currently available only therapy Royal Victoria Hospital as an investigative procedure Montreal, Que. under Food and Drug Administration regulations. It seems unfortunate that in Canada devices can be introduced and used to treat patients without having underThermotherapy still gone similar evaluation, and it is investigational disturbing to find unproven techniques being offered in such entreW r ith the funding con- preneurial fashion by members of x straints of our health the medical profession. care system the introduction of new, effective treat- Ernest W. Ramsey, MB, FRCSC ments can be difficult, often in- Professor, Section of Urology of Manitoba volving a great deal of effort and University Winnipeg, Man. frustration. The article by Pam Harrison "Innovative approaches Reference proving attractive to growing number of entrepreneurial MDs" 1. Barry MJ: Epidemiology and natural history of benign prostatic hyperplasia. (Can Med Assoc J 1992; 147: 512Urol Clin North Am 1990; 17: 495-507 513, 516-517) describes how some physicians have dealt with this problem. However, new technology does not necessarily equate with medical care of high quality. Transurethral microwave Conflict of interest thermotherapy is a highly innova- among researchers tive treatment for the common r. Douglas Waugh recentproblem of benign prostatic hyly reported on a joint pleperplasia (BPH). However, as innary session of the Assodicated in the article, it is still investigational. There are various ciation of Canadian Medical Colnew treatments for BPH under leges and the Association of Canevaluation, and these have dem- adian Teaching Hospitals in "Poonstrated the very marked pla- tential for conflict of interest cebo effect in this disease. In ran- among researchers increasing, domized studies of drug therapy meeting told" (Can Med Assoc J 20% to 40% of patients given a 1992; 147: 940). Waugh provided a succinct placebo demonstrated improveof three presentations summary controlled ment.' Randomized of conflict of inon the problem and therefore are studies essential, such studies of thermotherapy for terest. One cannot argue with the BPH are ongoing. Until they show three preventive measures proit to be of value, thermotherapy posed: that clear guidelines be provided for researchers (e.g., the should remain investigational. The Windsor group profiled policy at Johns Hopkins Universiin the article is quoted as claiming ty of permitting no more than a LE 15
DECEMBRE 1992
