This Month in Archives of Surgery FREE

In reviewing the major American and British surgical journals throughout a 15-year period (1983-1998) for the absolute number of articles and the proportion of national and international papers published, it has become apparent that internationalization has occurred. Asian and European manuscripts showed the most striking increase in all journals, with national papers down by 19% among American monthlies and by 28% in the British Journal of Surgery. The number of basic research papers declined by 15% in US surgical journals, with a simultaneous 2.4% decrease in government funding. Is this a result of multiple new specialty journals siphoning away our national output? Is it closely related to the national government funding reduction? Is it part and parcel of the pressures of managed care on many academic faculty members? Or is it an example of the globalization process we see all around us in other professionals and markets? Dr Tompkins and his group, representing American academia; Dr Bernard F. Ribeiro, a distinguished British surgeon; and Dr Leigh Delbridge of Sydney, Australia, present their analyses. Surely, after reviewing all of this, one can formulate his or her own opinion. Let us hear from you!

Dr Lewis Flint's reminiscence regarding surgeons who helped him understand evidence-based surgical practice deserves mention for its warmth and logic as its author looks at both sides of the issue. Emphasis is placed on a commitment to mastery of the surgical scientific literature and synthesizing it with keeping track of one's own results and listening to each patient. We need to recognize that evidence-based medicine is a fact of our clinical lives.

With the advent of more violent trauma and bigger operations, the closure of the complex abdomen following massive intra-abdominal swelling and compartment syndrome is a real challenge. In this article, Koniaris and associates at the University of Rochester (Rochester, NY) provide us with a modified technique enabling all the advantages of delayed primary closure, as well as the ability to reapproximate the abdominal fascia at the bedside, without herniation or fistulization. This permits great latitude in the management of the difficult abdomen. (See also Dr Lucas' Invited Critique.)

For those who believe that ductal drainage is the procedure of choice for the complications of chronic pancreatitis, Drs Ho and Frey re-emphasize the value of Dr Frey's procedure in affording relief to those unfortunate individuals. The technique is beautifully described in this paper, along with appropriate illustrations. Reference is made to the excellent results achieved.

This lucid article points out the change in indications for the surgical intervention for ulcerative colitis in elderly persons, from toxic megacolon and carcinoma to treatment-refractory disease and dysplasia. Mortality and morbidity markedly decreased.