Virostatic Therapy for Advanced Lymphoproliferation Associated with the Epstein–Barr Virus in an HIV-Infected Patient

To the Editor: The placebo effect of surgery for the treatment of angina that is mentioned by Lange and Hillis (Sept. 30 issue) 1 in their editorial on transmyocardial laser revascularization deserves elaboration. In the era before direct coronary revascularization, internal-thoracic-artery ligation was touted as a method to increase myocardial blood flow and relieve anginal symptoms. Initial reports by Ellis et al. 2 and Kitchell et al. 3 indicated that 68 to 75 percent of patients had clinical improvement, including approximately 35 percent who had complete relief and 42 percent with objective improvements, as measured electrocardiographically. These investigators were honest and intelligent but not impartial observers. Double-blind studies conducted later by Cobb et al. 4 and Dimond et al. 5 demonstrated that a sham thoracotomy alone could decrease the need for nitroglycerin and increase exercise tolerance and that it produced subjective improvement in more than 35 percent of patients. These results are similar to the improvement among 34 percent of the patients in the British study of transmyocardial laser revascularization mentioned by Lange and Hillis.