The principal investigator reviewed the data and submitted the final paper to a well respected USA-based medical journal. The editor and reviewers believed that the information learned from this study addressed an important question and provided useful information regarding management of this disease The editor commented, however, that this article breeched an important ethical standard in that patients were not informed that they were part of a research study and thus could not voluntary consent to be research subjects. Despite this shortcoming, the editor thought that the quality of the study and the importance of its findings outweighed the ethical transgression, and the paper was published..