MB's Articles of Interest - December 2001

 

ARTICLE TITLE: Desperate diseases, desperate measures: Tackling malignant hypertension in the 1950s
ARTICLE SOURCE: Am Heart J (United States), Aug 2001, 142(2) p197-203
AUTHOR(S): Ventura HO; Mehra MR; Messerli FH
AUTHOR'S ADDRESS: Department of Cardiology, and the Section of Hypertension, Department of Medicine, Ochsner Medical Institutions, New Orleans, La.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: The conquest of malignant hypertension is one of the most important medical achievements of the second half of the 20th century. As we enter the new millennium, it is critical to examine the efforts that have led to our ability to treat this once incurable disease. METHODS: Review was performed of the literature from 1900 to the 1950s regarding the etiology, clinical evaluation, and treatment of hypertension, focusing on malignant hypertension. RESULTS: Fifty years ago, in a time of sparse treatment options, the occurrence of malignant hypertension was a dreaded event that taxed the aptitude of the clinician. Confronted with an "extreme disease," physicians chose to use "extreme methods of cure" in conformity with the teaching of Hippocrates. In the 1950s malignant hypertension was treated with such drastic measures as rice diet, sympathectomy, and intravenous pyrogens. CONCLUSIONS: In the practice of medicine today, while work is being done to reassert biomolecular mechanisms, we still face patients who have reached the end stages of failure and manifest devastating morbidity. These patients are subjected to "extreme therapies" reminiscent of those that surrounded malignant hypertension in the past. In an era when adequate treatment of hypertension has become a reality for so many patients, it is appropriate to give credit to those who paved the way to such great progress.

ARTICLE TITLE: Urgent coronary bypass surgery for failed percutaneous coronary intervention in the stent era: Is backup still necessary?
ARTICLE SOURCE: Am Heart J (United States), Jul 2001, 142(1) p190-6
AUTHOR(S): Shubrooks SJ; Nesto RW; Leeman D; Waxman S; Lewis SM; Fitzpatrick P; Dib N
AUTHOR'S ADDRESS: Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., USA. sshubroo@caregroup.harvard.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Although use of urgent coronary bypass surgery (UCABG) for a failed percutaneous coronary intervention (PCI) is currently very low, there are no satisfactory predictors, patients requiring UCABG are frequently clinically unstable, and availability of stenting does not reliably eliminate the need for UCABG or result in a decrease in mortality. This small group of patients continues to require readily available surgical standby.
MB: I am not surprised. There would obviously need to have the facilities to fix up the mess ups.

ARTICLE TITLE: Body morphology and the speed of cutaneous rewarming.
ARTICLE SOURCE: Anesthesiology (United States), Jul 2001, 95(1) p18-21
AUTHOR(S): Szmuk P; Rabb MF; Baumgartner JE; Berry JM; Sessler AM; Sessler DI
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Texas, Houston Medical School, 77030, USA. pszmuk@anes1.med.uth.tmc.edu.
MAJOR SUBJECT HEADING(S): Body Surface Area; Body Weight [physiology]; Rewarming
MINOR SUBJECT HEADING(S): Adult; Child, Preschool; Child; Hypothermia, Induced; Infant; Middle Age; Neurosurgical Procedures
INDEXING CHECK TAG(S): Comparative Study; Female; Human; Male; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS: Infants and children rewarm two to three times faster than adults, thus rapidly recovering from accidental or therapeutic hypothermia.

ARTICLE TITLE: Complications and treatment of mild hypothermia
ARTICLE SOURCE: Anesthesiology (United States), Aug 2001, 95(2) p531-43
AUTHOR(S): Sessler DI
AUTHOR'S ADDRESS: Outcomes Research Institute and Department of Anesthesiology, University of Louisville, Kentucky 40202-3866, USA. sessler@louisville.edu.
PUBLICATION TYPE: Journal Article
MB: I am wondering if there is not some repetition herre.

ARTICLE TITLE: Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses
ARTICLE SOURCE: Anesthesiology (United States), Aug 2001, 95(2) p349-56
AUTHOR(S): Kotani N; Hashimoto H; Sato Y; Sessler DI; Yoshioka H; Kitayama M; Yasuda T; Matsuki A
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Hirosaki School of Medicine, Japan. nao@cc.hirosaki-u.ac.jp.
PUBLICATION TYPE: Journal Article
CONCLUSION: Preoperative insertion of intradermal needles reduces postoperative pain, the analgesic requirement, and opioid-related side effects after both upper and lower abdominal surgery. Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies surgery.
MB: Dr Sessler travels s lot. Texas, Kentucky, Japan. In the year 2001 he also has publications from France, Belgium, Austria & Missouri.

ARTICLE TITLE: Fiberoptic orotracheal intubation on anesthetized patients: do manipulation skills learned on a simple model transfer into the operating room?
ARTICLE SOURCE: Anesthesiology (United States), Aug 2001, 95(2) p343-8
AUTHOR(S): Naik VN; Matsumoto ED; Houston PL; Hamstra SJ; Yeung RY; Mallon JS; Martire TM
AUTHOR'S ADDRESS: Centre for Research in Education, Department of Anesthesia, Mt Sinai Hospital, Univesity of Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSION: Fiberoptic orotracheal intubation skills training on a simple model is more effective than conventional didactic instruction for transfer to the clinical setting. Incorporating an extraoperative model into the training of fiberoptic orotracheal intubation may greatly reduce the time and pressures that accompany teaching this skill in the operating room.

ARTICLE TITLE: Effectiveness of epidural blood patch in the management of post-dural puncture headache [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Aug 2001, 95(2) p334-9
AUTHOR(S): Safa-Tisseront V; Thormann F; Malassine P; Henry M; Riou B; Coriat P; Seebacher J
AUTHOR'S ADDRESS: Department of Emergency Medicine and Surgery, Groupe Hospitalier Pitie-Salpetriere, Universite Pierre et Marie Curie, Paris, France. valerie.safa@psl.ap-hop-paris.fr.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Epidural blood patch is an effective treatment of severe post-dural puncture headache. Its effectiveness is decreased if dura mater puncture is caused by a large bore needle.

ARTICLE TITLE: Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section [In Process Citation]
ARTICLE SOURCE: Anesthesiology (United States), Aug 2001, 95(2) p307-13
AUTHOR(S): Ngan Kee WD; Lau TK; Khaw KS; Lee BB
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin. warwick@cuhk.edu.hk.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: When used by infusion to maintain arterial pressure during spinal anesthesia for cesarean section, metaraminol was associated with less neonatal acidosis and more closely controlled titration of arterial pressure compared with ephedrine.

ARTICLE TITLE: The upper respiratory tract infection (URI) dilemma: fear of a complication or litigation?
ARTICLE SOURCE: Anesthesiology (United States), Aug 2001, 95(2) p283-5
AUTHOR(S): Cote CJ
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Comparison of closed-loop controlled administration of propofol using Bispectral Index as the controlled variable versus "standard practice" controlled administration.
COMMENTS: : Anesthesiology. 2001 Jul; 95(1):1-2/21358073
ARTICLE SOURCE: Anesthesiology (United States), Jul 2001, 95(1) p6-17
AUTHOR(S): Struys MM; De Smet T; Versichelen LF; Van De Velde S; Van den Broecke R; Mortier EP
AUTHOR'S ADDRESS: Department of Anesthesia, Ghent University Hospital, Belgium. Michel.Struys@rug.ac.be.
PUBLICATION TYPE: Clinical Trial; Evaluation Studies; Journal Article
CONCLUSION: A closed-loop system for propofol administration using the Bispectral Index (BIS) as a controlled variable together with a model-based controller is clinically acceptable during general anesthesia.

ARTICLE TITLE: Automated anesthesia: fact or fantasy?
COMMENTS: : Anesthesiology. 2001 Jul; 95(1):6-17/21358075
ARTICLE SOURCE: Anesthesiology (United States), Jul 2001, 95(1) p1-2
AUTHOR(S): Glass PS; Rampil IJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Spinal anesthesia at the cervicothoracic level.
ARTICLE SOURCE: Anesthesiology (United States), Jul 2001, 95(1) p266-8
AUTHOR(S): Hatzakorzian R; Robbins R; Plourde G
AUTHOR'S ADDRESS: Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
PUBLICATION TYPE: Journal Article
MB: They choose neuraxial block because the patient did not want a GA. They choose high puncture because there was spinal deformity. It just show how resilient humans are.

ARTICLE TITLE: Road traffic fatalities in Victoria, Australia and changes to the trauma care system
ARTICLE SOURCE: Br J Surg (England), Aug 2001, 88(8) p1099-104
AUTHOR(S): McDermott FT; Cordner SM; Tremayne AB
AUTHOR'S ADDRESS: The Consultative Committee on Road Traffic Fatalities in Victoria, Southbank, Victoria, Australia. annt@vifp.monash.edu.au; Collective Name: Consultative Committee on Road traffic Fatalities.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: The aim was to identify organizational and clinical errors in the management of road traffic fatalities and to use this information to improve Victoria's trauma care system. METHODS: A multidisciplinary committee evaluated the complete ambulance, hospital and autopsy records of 559 consecutive road traffic fatalities, who were alive on arrival of ambulance services, in five substantial time periods between 1992 and 1998. Patients who survived more than 30 days were excluded. Errors or inadequacies in each phase of management, including those contributing to death, were identified and an assessment was made of the potential preventability of death. RESULTS: Findings between 1992 and 1998 were similar. In 1998, 1672 problems were identified in 110 deaths with 1024 (61 per cent) contributing to death. Eight hundred and forty-two (50 per cent) of the total problems occurred in the emergency department. There were frequent problems in initial patient reception and medical consultation, resuscitation, investigation and assessment (especially of the abdomen and head), and in transfer to the operating theatre or to a higher-level hospital. Victoria's combined preventable and potentially preventable death rate has been unchanged between 1992 and 1998 (34-38 per cent). CONCLUSION: The problems identified led to a Ministerial Taskforce on Trauma and Emergency Services in Victoria as a consequence of which a new trauma system is now being implemented.

ARTICLE TITLE: Need for secondary interventions after endovascular repair of abdominal aortic aneurysms. Intermediate-term follow-up results of a European collaborative registry (EUROSTAR)
ARTICLE SOURCE: Br J Surg (England), Aug 2001, 88(8) p1127-34
AUTHOR(S): Nyamekye IK
AUTHOR'S ADDRESS: The Vascular Unit; Worcester Royal Infirmary; Ronkswood Branch; Newtown Road; Worcester WR5 1HN; UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair [In Process Citation]
ARTICLE SOURCE: Br J Surg (England), Aug 2001, 88(8) p1059-65
AUTHOR(S): Cuypers PW; Gardien M; Buth J; Peels CH; Charbon JA; Hop WC
AUTHOR'S ADDRESS: Departments of Surgery and Cardiology, Catharina Hospital, Eindhoven, Department of Surgery, St Joseph Hospital, Veldhoven and Department of Epidemiology and Biostatistics, Erasmus University, Rotterdam, The Netherlands.
PUBLICATION TYPE: Journal Article
CONCLUSION: Haemodynamic changes were less severe and there was a lower incidence of myocardial ischaemia during endovascular repair(EVAR) than during open repair (OR). Studies are needed to demonstrate whether this may reduce the operative mortality rate.
MB: I don't think that those studies wiil be done.

ARTICLE TITLE: Performance indicators from routine hospital data: death following aortic surgery as a potential measure of quality of care.
ARTICLE SOURCE: Br J Surg (England), Jul 2001, 88(7) p964-8
AUTHOR(S): Rigby KA; Palfreyman S; Michaels JA
AUTHOR'S ADDRESS: Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSION: Crude mortality rates used as an indicator of performance are subject to bias and distortion owing to the collection of incorrect information, variation in patient selection between hospitals and case-mix differences. There was a considerable variation in selection and outcomes of patients undergoing aortic surgery in this study.

ARTICLE TITLE: Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery.
ARTICLE SOURCE: Br J Surg (England), Jul 2001, 88(7) p913-30
AUTHOR(S): Mismetti P; Laporte S; Darmon JY; Buchmuller A; Decousus H
AUTHOR'S ADDRESS: Thrombosis Research Group, Clinical Pharmacology Unit, University Hospital, Saint-Etienne and Medibridge Clinical Research, Velizy, France.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSION: Asymptomatic asymptomatic deep vein thrombosis (DVT) may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. Low molecular weight heparin (LMWH) seems to be as effective and safe as of unfractionated heparin (UFH). Determination of the optimal dose regimen of LMWH for this indication requires further investigation.

ARTICLE TITLE: Detecting coagulation disorders of pregnancy: bleeding time or platelet count\
ARTICLE SOURCE: Can J Anaesth (Canada), Jun 2001, 48(6) p515-8
AUTHOR(S): Samama CM; Simon L
PUBLICATION TYPE: Editorial
MB: They don't really know.

ARTICLE TITLE: Compound A: does it matter?
ARTICLE SOURCE: Can J Anaesth (Canada), May 2001, 48(5) p427-30
AUTHOR(S): Eger EI
PUBLICATION TYPE: Editorial
MB: It's written by Eger so you can blame him if you get into trouble.

ARTICLE TITLE: Management and outcome of cardiogenic shock complicating acute myocardial infarction in hospitals with and without on-site catheterisation facilities.
ARTICLE SOURCE: Heart (England), Aug 2001, 86(2) p145-9
AUTHOR(S): Barbash IM; Behar S; Battler A; Hasdai D; Boyko V; Gottlieb S; Leor J
AUTHOR'S ADDRESS: Cardiology Department, Soroka Medical Centre, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: The greater use of invasive and interventional procedures in hospitals with catheterisation facilities is associated with improved survival of patients with acute myocardial infarction complicated by cardiogenic shock. Immediate availability of invasive care facilities will improve the outcome of cardiogenic shock in the community setting.

ARTICLE TITLE: Physical training as a therapeutic measure in chronic heart failure: time for recommendations.
ARTICLE SOURCE: Heart (England), Jul 2001, 86(1) p7-11
AUTHOR(S): Tavazzi L; Giannuzzi P
PUBLICATION TYPE: Editorial; Review; Review, Tutorial

ARTICLE TITLE: Antibiotics before dental procedures for endocarditis prophylaxis: back to the future.
ARTICLE SOURCE: Heart (England), Jul 2001, 86(1) p3-4
AUTHOR(S): Morris AM; Webb GD
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Do not resuscitate.
ARTICLE SOURCE: Heart (England), Jul 2001, 86(1) p1-2
AUTHOR(S): Handley AJ
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Role of stenting in coronary revascularisation.
ARTICLE SOURCE: Heart (England), Jul 2001, 86(1) p104-12
AUTHOR(S): Gershlick AH
AUTHOR'S ADDRESS: Glenfield Hospital, Leicester, UK. agershlick@aol.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Advances in hepatocyte transplantation: a myth becomes reality
ARTICLE SOURCE: J Clin Invest (United States), Aug 2001, 108(3) p367-9
AUTHOR(S): Lee LA
AUTHOR'S ADDRESS: Division of Gastroenterology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 1012, Baltimore, Maryland 21205, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effect of controlled hypercapnia on cerebrospinal fluid pressure and operating conditions during transsphenoidal operations for pituitary macroadenoma.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jul 2001, 13(3) p255-9
AUTHOR(S): Korula G; George SP; Rajshekhar V; Haran RP; Jeyaseelan L
AUTHOR'S ADDRESS: Department of Anesthesia, Christian Medical College Hospital, Vellore, India.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
The authors conclude that controlled hypercapnia is effective in producing descent of the suprasellar portion of a pituitary adenoma.

ARTICLE TITLE: Effect of prophylactic ondansetron on postoperative nausea and vomiting after elective craniotomy.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jul 2001, 13(3) p207-12
AUTHOR(S): Kathirvel S; Dash HH; Bhatia A; Subramaniam B; Prakash A; Shenoy S
AUTHOR'S ADDRESS: Department of Neuroanesthesia, All India Institute of Medical Sciences (AIIMS), New Delhi, India. kathirvels@yahoo.com.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
We conclude that ondansetron 4 mg given at the time of dural closure is safe and effective in preventing emetic episodes after elective craniotomy in adult patients.

ARTICLE TITLE: A case in point.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jul 2001, 13(3) p187-8
AUTHOR(S): Cottrell JE; Hartung J
PUBLICATION TYPE: Editorial
MB: It's about therapeutic hypothermia and why earlier studies were enthusiastic but the big study was not. ie NEJM 2001;344:556.

ARTICLE TITLE: Twelve weeks of exercise training increases muscle function and walking capacity in elderly predialysis patients and healthy subjects.
ARTICLE SOURCE: Nephron (Switzerland), May 2001, 88(1) p48-56
AUTHOR(S): Heiwe S; Tollback A; Clyne N
AUTHOR'S ADDRESS: Department of Physiotherapy, Karolinska Hospital, Stockholm, Sweden. Susanne.Heiwe@ks.se.
PUBLICATION TYPE: Journal Article
Elderly predialysis patients had lower muscle function and mobility as compared with elderly healthy subjects, but were able to improve both after 12 weeks of exercise training to the same extent as elderly healthy subjects.

ARTICLE TITLE: Effect of postural change on blood volume in long-term hemodialysis patients.
ARTICLE SOURCE: Nephron (Switzerland), Jan 2001, 87(1) p27-34
AUTHOR(S): Ookawara S; Suzuki M; Yahagi T; Saitou M; Tabei K
AUTHOR'S ADDRESS: Department of Internal Medicine, Yamagata Prefectural Central Hospital, 428-8 Nishikawa-machi, Nishimurayama-gun, Yamagata-ken, 990-0702 Japan.
MAJOR SUBJECT HEADING(S): Blood Volume [physiology]; Kidney Failure, Chronic [physiopathology]; Posture [physiology]; Renal Dialysis
MINOR SUBJECT HEADING(S): Aged; Hematocrit; Kidney Failure, Chronic [therapy]; Middle Age; Serum Albumin
INDEXING CHECK TAG(S): Female; Human; Male
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Epidural anesthesia-analgesia shortens length of stay after laparoscopic segmental colectomy for benign pathology.
ARTICLE SOURCE: Surgery (United States), Jun 2001, 129(6) p672-6
AUTHOR(S): Senagore AJ; Whalley D; Delaney CP; Mekhail N; Duepree HJ; Fazio VW
AUTHOR'S ADDRESS: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Aggressive postoperative care plans after open colectomy may allow earlier discharge, especially in conjunction with preoperative thoracic epidural anesthesia-analgesia using a local anesthetic and narcotic. The purpose of this study was to evaluate the role of thoracic epidural anesthesia-analgesia using bupivacaine and fentanyl citrate in reducing lengths of stay after laparoscopic colectomy (LAC). METHODS: A consecutive cohort of patients who underwent LAC and who received perioperative thoracic epidural anesthesia-analgesia (TEG) was compared with a standard group of patients (STD) undergoing LAC during the 2 months preceding the implementation of the epidural management protocol. Patients with TEG received 6 to 8 mL bupivacaine (0.25%) and fentanyl citrate (100 microg) through a T8-9 or a T9-10 epidural catheter before the incision was made and a postoperative infusion of bupivacaine (0.1%) and fentanyl citrate (5 microg/mL) at 4 to 6 mL/h for 18 hours. STD patients had supplemental intravenous morphine. The postoperative care plan was otherwise identical between the 2 groups. Patients were matched by sex, age, and type of segmental resection. Discharge criteria included tolerance of 3 general diet meals, passage of flatus or stool, and adequate oral analgesia. Length of stay was defined as the time from admission for the surgical procedure to discharge from the hospital. Statistical analysis included a Student t test, Wilcoxon rank sum test, chi-square trend test, and Fisher exact test where appropriate. Data are presented as mean +/- SEM. RESULTS: Procedures performed were: right hemicolectomy-ileocolectomy (TEG, n = 5; STD, n = 5); or sigmoid colectomy-rectopexy (TEG, n = 17; STD, n = 17). There was no significant difference with respect to operating room (OR) time (TEG, 102 +/- 12 minutes; STD, 87 +/- 17 minutes), body mass index (TEG, 26 +/- 2; STD, 26 +/- 2), or American Society of Anesthesiologists class (I-III) distribution (TEG, 3/12/10; STD, 4/11/7), or mean incision length (TEG, 3.5 +/- 0.4 cm; STD, 3.7 +/- 0.3 cm.) No postoperative complications or readmissions occurred in either group. The length of stay decreased in the TEG group (TEG, 2.8 +/- 0.2 days; STD, 3.9 +/- 0.3; P <.001) and the median length of stay for the 2 groups was similarly less (TEG, 2 days; STD, 3 days). CONCLUSIONS: These data suggest that thoracic epidural anesthesia-analgesia has a significant and favorable impact on dietary tolerance and length of stay after LAC. A thoracic epidural appears to be an important component of a postoperative care protocol, which adds further advantage to after laparoscopic colectomy (LAC without the need for labor-intensive and costly patient care plans.
MB: Not randomised so there was probably no real difference. How could one justify such an invasive form of post-operative analgesia?

ARTICLE TITLE: Redundant surgical publications: tip of the iceberg?
COMMENTS: : Surgery. 2001 Jun; 129(6):653-4/21287436
ARTICLE SOURCE: Surgery (United States), Jun 2001, 129(6) p655-61
AUTHOR(S): Schein M; Paladugu R
AUTHOR'S ADDRESS: Department of Surgery, New York Methodist Hospital and Cornell University Medical College, 516 Sixth St., Brooklyn, NY 11215, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: A redundant publication is one which duplicates previous, simultaneous, or future publications by the same author or group or, alternatively, could have been combined with the latter into one paper. As there is no information about the extent of this problem in the surgical literature, we set out to assess the incidence, spectrum, and salient characteristics of redundant publications in 3 leading surgical journals. METHODS: Original articles (excluding reviews, editorials, abstracts, and letters) published during 1998 in the journals Surgery, The British Journal of Surgery, and Archives of Surgery were searched by using the on-line search engine PUBMED. Each original article was scrutinized to identify redundancy by combining the names of the first, second, and last authors with a few key words from the title. Papers were defined as "suspected" redundant publications if they were found to address the same topic as the "index" article and shared some or most of the elements of methodology, results, or conclusions. The full versions of all suspected papers were retrieved and compared with the index articles. A grading system was developed to define several types of redundant publications: A. "dual"; B. "potentially dual"; C. "salami-slicing." RESULTS: A total of 660 articles were screened. There were 92 index articles (14%) leading to 147 suspected papers found in other journals, representing some potential form of a redundant publication. The vast majority of suspected papers were published within approximately a year of the index paper and were not cited by the latter. Most (69%) of the suspected papers were also published in surgical journals. Only 12 (8.1%) appeared in, or originated from, a "local-foreign" journal. Twenty (13.6%) of the suspected papers met the criteria for dual publications, 50 (34%) for potentially dual publications, and 77 (52.4%) were considered products of salami-slicing. CONCLUSIONS: Almost 1 in every 6 original articles published in leading surgical journals represents some form of redundancy. Current on-line search technology provides an effective tool for identifying and tracing such publications, but it is not used routinely as part of the peer review process. Redundancies occur in several well-defined patterns; the phenomenon is widespread, and it cuts across the entire spectrum of surgeons in the United States and abroad. Redundant publications must be recognized not as a mere nuisance but as a real threat to the quality and intellectual impact of surgical publishing.