Michael Berkwits, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Berkwits M.; What's Wrong with This Picture?. Ann Intern Med. 1998;128:323-324. doi: 10.7326/0003-4819-128-4-199802150-00029
Download citation file:
Published: Ann Intern Med. 1998;128(4):323-324.
TO THE EDITOR:
In his description of a syncopal patient with aortic stenosis and gastrointestinal bleeding caused by cancer, Brody  nicely portrayed some of the perils of fee-for-service care. He did not acknowledge, however, the lingering question about whether a significant association between these clinical conditions exists. Heyde  first suggested a link between aortic stenosis and idiopathic gastrointestinal bleeding in 1958. Since then, the Heyde syndrome (as it has sometimes been called) has been different things to different people. Subsequent authors both confirmed and challenged Heyde's impressions. Some found a risk for idiopathic bleeding, others a link with gastrointestinal ulceration, and others an association with angiodysplasias. This lack of consensus is largely attributable to the hazards of anecdotal reporting. A review of the subject in 1988 showed methodologic flaws in the controlled studies done up to the time that had claimed to have detected an association . A more recent investigation improved on these study designs . It failed to find an association between aortic valve disease and gastrointestinal bleeding in patients with angiodysplasia, but it, too, did not meet all of the rigorous standards of evidence proposed by the authors of the 1988 review [3, 4].
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only