letters

KIDS AND CT SCANS In his Think Tank column “All Will Be Revealed” (Winter 2011), Brian Gilchrist is right to say that CT scans should never be done on children in lieu of a thorough history and physical examination. But I disagree with his statement that such tests “are not at all accurate in skinny kids” for diagnosing appendicitis. While a general radiologist may feel that the size of a child can make interpreting an abdominal CT challenging, it is my experience that this is not the case with subspecialty-trained pediatric radiologists.

Gilchrist’s article also creates the impression that CT in general is not a worthwhile emergency examination because of cost, radiation dose, and limited diagnostic accuracy. Yet the truth is that CT is immensely valuable in assessing trauma (especially head trauma) and kidney stones.

Finally, I object to the statement that “pediatric surgery has documented the potential ravages of this very costly imaging modality.” In fact, it was the radiology literature that first alerted us to the potential adverse effects of radiation at doses used in diagnostic CT. Moreover, radiologists have worked hard to minimize CT risks ever since.

Gilchrist oversimplifies the issues regarding the use of CT in children. Current technology allows the radiologist to significantly reduce radiation exposure while still gaining diagnostic information. Examine first, avoid testing if it will not add to the diagnosis, but never hesitate to consult the one person who is best trained to make informed decisions about the safety and use of CT—the diagnostic radiologist.
David A. Bloom, A85
Associate Professor of Radiology and Pediatrics
William Beaumont School of Medicine, Oakland University
Pediatric Radiologist
Beaumont Children’s Hospital
Royal Oak, Michigan

Brian Gilchrist responds: I presented data at the American Academy of Pediatrics showing that skinny kids are at a marked disadvantage for having their diagnosis of acute appendicitis made by CT. My data was based on scans that were read by a pediatric radiologist. In addition, I never said that CT was not a worthwhile modality. I just said that it needs to be avoided when diagnosing appendicitis in kids. No one argues about the efficacy of CT scans for evaluating head trauma.

David Bloom is correct in saying that the pediatric radiology literature first brought up the issue of risk; however, we in the clinical trenches learned of it from our national pediatric surgery conferences. I don’t believe I oversimplified anything. I merely stated a fear that we all now have regarding issues of radiation.

HELP FOR HAITI Thank you for “On Call in Haiti,” by Leslie Macmillan (Fall 2010). It was well written and clear, and moved me very much.

The issue of Haiti is close to my heart, as I’ve worked there for two years, through both the World Bank, and, now, the Inter-American Development Bank. To see that Tufts has been active in the country and is planning on a rotation for med students there is wonderful. With the recent cholera outbreak, it will be more important than ever to help.
Nara C. Meli, A03
Washington, D.C.

DEPARTMENT OF EXTRAVAGANT PRAISE I suspect you’ve been told more than once, but Tufts Magazine is truly excellent. I receive the publications of [my postgraduate institution], and they do not even approach the value of your work. Thank you very much. I read with relish.
R. Paul St. Amand, A48, M52
Associate Clinical Professor of Endocrinology, UCLA
Marina del Rey, California

I have been reading the various iterations of the alumni magazine for almost sixty years, but never with the rewards I found in the Winter 2011 issue.

As a “legacy” at Tufts, entering in 1948 on an NROTC scholarship, I found a school that was long on tradition and short on diversity—not only short on attitudinal flexibility, but alive with bigotry. The Protestant origin of Tufts had yet to feel the stimulus of diverse religions, and exhibited very little cultural inclusion.

The Winter issue defines the new Tufts. It was with a great deal of interest and appreciation that I read “House of Israel,” Earl Ganz’s wonderful account of his search for his religious roots. I am disappointed that the athletic proficiency he cites in his prep school days did not carry over to any of the teams on which I played while at Tufts.

Then there was “Edible History,” by my favorite provost and baseball aficionado, Sol Gittleman—Sol the Magnificent.

The mostly critical letters to the editor about doubting ministers (“The Pastor’s Secret,” by Daniel Dennett, Fall 2010) prove that debate is alive and well among the excitable.

Professor Amar Bhidé’s comments (“Another Fine Mess”) on the withdrawal of thought in favor of computer-generated answers reminds me of current experiences with my doctor’s attention to his laptop, in lieu of my aging corpus.

After the Haiti earthquake, the health-care organization featured in “A Tough Pond to Fish”—Konbit Sante—was our nonprofit of choice. We saw that they were working with the people on their own terms, and not just throwing money at the problem.

“Best of Both Worlds” shows the humanness of Tufts President Larry Bacow. How many university presidents would hold a special commencement ceremony for members of an athletic team who were graduating but couldn’t make it to the regular ceremony because they were competing for a national title?

Finally, “To Better Society,” the Q&A on the incoming president, Anthony Monaco, provided a much enlarged picture of this man, his experience, strength, and hopes for Tufts. He seems a worthy successor to the superb dynamic duo of Larry B. and his wife, Adele.

By its leadership, its student body, and its alumni, Tufts continues to be the best . . . and getting better.
David Lincoln, A52
Kittery, Maine

Your magazine is wonderful. I look forward to it, and learn new and exciting things every time I receive one. I love to see the pictures of the brides, too. I never contributed to Tufts before last year, but the magazine made it clear that I had to support this institution.
Ann Davis, G71
Summerville, South Carolina

I greatly appreciated your well-written editorial “The Rankings” (Winter 2011).
Roger Condit, M63
Farmington, Maine