[3] Heyneman LE, Herndon JE, Goodman PC, Patz Jr EF. Stage distribution in patients with a small (< or =3 cm) primary non-small cell lung carci- noma. Implication for lung carcinoma screening. Cancer 2001; 92:3051—5. § The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer. §§ I am a principle investigator in the International Early Lung Cancer Action Program (IELCAP) lung cancer screening project. I have received $30,000 in data management support as well as travel, meals and accommodations to semi-annual IELCAP meetings. Last week an article in the New York Times revealed that IELCAP had accepted a gift of $2.4 million from a foundation created largely by the Vector Corporation, parent company to Liggett Tobacco in 2000 and subsequently another $1.1 million. I was not aware of this tobacco industry funding before the Times article. This money comprises approxi- mately 6% of IELCAP funding. * Corresponding author. Tel.: +1 626 359 8111x64119; fax: +1 626 301 8855. E-mail address: fgrannis@coh.org. doi:10.1016/j.ejcts.2008.03.013 Letter to the Editor Re: Is the Allen test reliable enough? § Mohammed Asif * , Pradip Sarkar Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, UK Received 28 February 2008; accepted 11 March 2008 Keywords: Radial artery; Coronary artery bypass grafting; Allen test We agree with Kohonen et al. [1] that a negative Allen’s test is safe to harvest the radial artery. This is well known. We have harvested the radial artery in 881 patients with a negative Allen’s test without postoperative hand ischaemia [2]. Barner has done the same in 1364 patients [3] and Meharwal and Trehan in 3977 cases [4]. What to do in the event of a positive test is not as straightforward. Kohonen et al. report 23% tests as positive and suggest further investigation prior to radial artery harvest [1]. Other series have reported much lower rates of positive tests. At our institution 3.5% of Allen tests are positive. In a study of 2940 arms Hosokawa et al. found positive tests in 3.6% [5]. The incidence of a positive test is dependent on the time allowed for capillary refill, hyperextension of the hand and the length of the ischaemic interval prior to the release of the ulnar artery. We have previously described our technique in detail [2]. We would suggest in the event of a positive test to immediately repeat it using an alternative technique and taking great care to prevent hyperextension of the hand. This should reduce the number of positive tests and still allow safe harvest of the radial artery reserving more complex investigations for cases with two positive tests with two different techniques. References [1] Kohonen M, Teerenhovi O, Terho T, Laurikka J, Tarkka M. Is the Allen test reliable enough? Eur J Cardiothoracic Surg 2007;32:902—5. [2] Asif M, Sarkar PK. Three-digit Allen’s test. Ann Thorac Surg 2007;84:686—7. [3] Barner HB. Allen’s test.. Ann Thorac Surg 2008;85:690. [4] Meharwal ZS, Trehan N. Functional status of the hand after radial artery harvesting: Results in 3977 cases. Ann Thorac Surg 2001;72:1557—61. [5] Hosokawa K, Hata Y, Yano K, Matsuka K, Ito O, Ogli K. Results of the Allen test in 2940 arms. Ann Plast Surg 1990;24:149—51. § The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer. * Corresponding author. Tel.: +44 114 271 5800; fax: +44 114 261 0350. E-mail address: m.asif@ntlworld.com (M. Asif). doi:10.1016/j.ejcts.2008.03.011 Letter to the Editor Re: Perivascular tissue of internal thoracic artery releases potent nitric oxide and prostacyclin-independent antic- ontractile factor Michael Richard Dashwood a,* , Domingos S.R. Souza b , Maria S. Ferna´ndez-Alfonso c a Clinical Biochemistry (First Floor), Royal Free and University College Medical School, Pond Street, London NW3 2QG, United Kingdom b O ¨ rebro University Hospital, SE-701 85 O ¨ rebro, Sweden c Instituto Pluridisciplinar, Universidad Complutense, Madrid, Spain Received 22 February 2008; accepted 19 March 2008 Keywords: CABG; Perivascular tissue; Nitric oxide; Saphenous vein; Internal thoracic artery We read with interest the recent article by Malinowski et al. [1] on the release of a soluble anticontractile factor from perivascular tissue (PVT) of the internal thoracic artery (ITA). In this study the authors show that the PVTsurrounding the ITA, the ‘gold standard’ graft in coronary artery bypass surgery (CABG), releases a nitric oxide (NO) and prostacyclin- independent anticontractile factor. The authors suggest that the presence of an active PVT might explain the functional difference between skeletonised and non-skeletonised ITA and influence vascular function after graft implantation. Possible drawbacks of removing PVT should be taken into account since preservation of this tissue might be beneficial. Malinowski et al. suggest that the influence of PVT removal on the function of other vessels used for CABG, such as the saphenous vein, the radial or the gastroepiploic arteries should be analysed. Although we have not performed functional studies, we have recently shown that the PVT surrounding saphenous veins used as grafts in patients undergoing CABG exhibits positive endothelial nitric oxide synthase (eNOS) immunoreactivity, contains eNOS mRNA and Letters to the Editor / European Journal of Cardio-thoracic Surgery 33 (2008) 1159—1163 1161