One Hundred Citation Classics in General Surgical Journals

The number of times an article is cited in scientific journals reflects its impact on a specific biomedical field or specialty and reflects the impact of the authors’ creativity. Our objective was to identify and analyze the characteristics of the 100 most frequently cited articles published in journals dedicated to general surgery and its close subspecialties. Using the database (1945–1995) of the Science Citation Index of the Institute for Scientific Information, 1500 articles cited 100 times and more were identified and the top 100 articles selected for further analysis. The 100 articles were published between 1931 and 1990, with more than two-thirds of them published after 1960. The mean number of citations per article was 405, (range 278–1013). Altogether, 84 of the articles originated from North America (USA 78, Canada 6) and the UK (12). New York State led the list of U.S. states with 14, and Harvard and Columbia University led the list of institutions with 6 articles each. The 100 articles were published in 10 surgical journals led by theAnnals of Surgery (n = 40), followed bySurgery (n = 15), Archives of Surgery (n = 12), Surgery, Gynecology and Obstetrics (n = 11), and British Journal of Surgery (n = 10). A total of 80 of the articles reported clinical experiences, 6 were clinical review articles, and 14 dealt with basic science. Eighteen articles reported a new surgical technique and six a prosthetic device. Gastrointestinal surgery and trauma and critical care led the list of the surgical fields, each with 25 articles, followed by vascular surgery (n = 15). Thirty-four persons authored two or more of the top-cited articles. This list of the top-cited papers identifies seminal contributions and their originators, facilitating the understanding and discourse of modern surgical history and offering surgeons hints about what makes a contribution a "top-cited classic." To produce such a "classic" the surgeon and his or her group must come up with a clinical or nonclinical innovation, observation, or discovery that has a long-standing effect on the way we practice—be it operative or nonoperative. Based on our findings, to be well cited such a contribution should be published in the English language in a high-impact journal. Moreover, it is more likely to resonant loudly if it originates from a North American or British "ivory tower."     

Pathogenesis of Persistent infertility in Men after Varicocelectomy

Pathogenese der fortwährenden Infertilität nach Varikocelenentfernung
Bei einer Gruppe von 27 Männern mit einer Varikocele und Infertilität wurden verschiedene andrologische Untersuchungen durchgeführt, wobei besonderer Wert auf die auch nach der hohen Ligatur fortbestehende Infertilität gelegt wurde. Es kann gezeigt werden, daß 12 dieser Männer eine persistierende Varikocele aufwiesen. Gelegentlich lag die Spermatozoendichte in der Gruppe der infertilen Männer höher als bei denen, die in der Zwischenzeit ein Kind gezeugt hatten. Die Spermaanalyse allein dürfte daher nicht ausreichend sein. Auch der weibliche Partner muß berücksichtigt werden. Darüberhinaus ist es wichtig, praeoperativ die Gonadotropine und Veränderungen des Keimepithels abzuklären. Auch Antikörper können eine Rolle spielen. Daraus wird die Schlußfolgerung gezogen, daß in derartigen Fällen die Varikocele nicht die ausschließliche Ursache ist.     

One Hundred Pancreas Transplants Performed in a Brazilian Institution

After decades of controversy surrounding the therapeutic validity of pancreas transplantation, the procedure has become accepted as the preferred treatment for selected patients with type 1 diabetes mellitus. Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center: 88 simultaneous pancreas-kidney transplantation and 12 pancreas transplantations alone. Pancreas graft management of the exocrine drainage technique involved enteric drainage in 8 (all simultaneous pancreas-kidney) and the bladder in 92 cases. The recipient systemic venous system was used for the pancreas graft venous effluent in all cases. Our overall results have shown that the number of functioning pancreatic grafts was 64 of 100. Graft losses were: rejection (n = 8), venous thrombosis (n = 9), arterial thrombosis (n = 1), or surgical complications such as anastomotic leak (n = 3), perigraft infection (n = 10), pancreatitis of the graft (n = 5). Most cases of pancreatitis (80%) had preservation times exceeding 18 hours. Despite surgical and immunosuppressive complications, our impression was that pancreas transplantation was a highly effective therapy for diabetes mellitus. After 7 years of the program and 100 transplantations, we believe that there is a major role for transplantation in diabetes management.     

青年人群中前列腺炎样症状及其相关因素的调查

目的:了解青年人群中前列腺炎样症状发病情况;研究与前列腺炎样症状有关的危险因素。方法:应用NIH-CPSI和自行设计的前列腺炎相关因素问卷对潍坊市潍城区2500例青年男性(年龄18~30岁)进行调查,收集相关信息,进行病例对照研究,筛选前列腺炎样症状发生的危险因素。结果:共回收问卷2382份,其中2125份填写完整。128例(6.02%)被确认有前列腺炎样症状,疼痛症状评分(6.98±0.29)分,排尿症状评分(3.77±0.25)分,其中39例有中~重度前列腺炎样症状。相关因素中久坐习惯、憋尿习惯、生活或工作中经常感巨大压力、频繁手淫、寒冷的工作环境等可能是前列腺炎样症状发生的危险因素。结论:青年人群中前列腺炎样症状常见,一些内在因素和环境因素可能是前列腺炎样症状发生的危险因素,指导患者改变不良生活习惯,避免相关危险因素,对预防和减少前列腺炎发作是有益的。     

Case-Control Study of the Pathogenesis and Sequelae of Symptomatic Vertebral Fractures in Men

To investigate the pathogenesis and sequelae of symptomatic vertebral fractures (VF) in men, we have performed a case–control study, comparing 91 men with VF (median age 64 years, range 27–79 years) with 91 age-matched control subjects. Medical history, clinical examination and investigations were performed in all patients and control subjects, to identify potential causes of secondary osteoporosis, together with bone mineral density (BMD) measurements. BMD was lower at the lumbar spine and all sites in the hip in patients with VF than in control subjects (p<0.001). Potential underlying causes of secondary osteoporosis were found in 41% of men with VF, compared with 9% of control subjects (OR 7.1; 95% CI 3.1–16.4). Oral corticosteroid and anticonvulsant treatment were both associated with a significantly increased risk of VF (OR 6.1; 95% CI 1.3–28.4). Although hypogonadism was not associated with an increased risk of fracture, the level of sex hormone binding globulin was higher (p<0.001) and the free androgen index lower (p<0.001) in men with VF than control subjects. Other factors associated with a significantly increased risk of VF were family history of bone disease (OR 6.1; 95% CI 1.3–28.4), current smoking (OR 2.8; 95% CI 1.2–6.7) and alcohol consumption of more than 250 g/week (OR 3.8; 95% CI 1.7–8.7). Men with VF were more likely to complain of back pain (p<0.001) and greater loss of height (p<0.001) than control subjects, and had poorer (p<0.001) scores for the energy, pain, emotion, sleep and physical mobility domains of the Nottingham Health Profile. We conclude that symptomatic VF in men are associated with reduced BMD, underlying causes of secondary osteoporosis such as corticosteroid and anticonvulsant treatment, family history of bone disease, current smoking and high alcohol consumption, and that they impair the perceived health of the individual. Received: 23 February 1998 / Accepted: 13 May 1998     

Prevalence of Vertebral Fractures in Chinese Men and Women in Urban Taiwanese Communities

Reports on the prevalence (or incidence) rates of vertebral fracture have been available, but they are limited concerning non-white populations and men of all races. This study used the radiomorphometric method to survey the prevalence rate of vertebral fracture for ethnic Chinese women 40 years and older and Chinese men 65 and older who were randomly selected from four major cities in Taiwan. Three sets of reference values of the height ratios were used for middle-aged women, elderly women, and elderly men. The results showed that in Chinese women, the prevalence rate of vertebral fracture was low before age 50 and showed a steady increase thereafter. In men, the increase was small until age 80. The overall adjusted prevalence rate of vertebral fracture for women older than 65 was 20% and that for men, 12.5% (95% confidence interval 18–22% and 11–14%, respectively.) If only severe deformity was counted [height ratio lower than normal mean minus 4 standard deviations (SD), or Grade II deformity], the adjusted prevalence rate was 15.5% for elderly women and 9.5% for elderly men (95% confidence interval 14–17%, and 8–11%, respectively.) The overall adjusted prevalence rate for women aged 40 and over was 6.8% (95% confidence interval 5.7–8%), or 4.5% (95% confidence interval 3.6–5.5%) for Grade II lesions. Moreover, for subjects with fracture, elderly women tended to have more fractured vertebrae per person and more Grade II fractures than elderly men. Thus, Chinese women residing in cities of Taiwan had a relatively high prevalence rate of vertebral fracture, a finding compatible with that for United States or European white women, or for Japanese women residing in America. Elderly Chinese men also have a high prevalence rate of vertebral fracture. The age-specific female-to-male ratio of prevalence rate was about 1.5 to 2.3 between age 65 and 80, and close to unity after age 80. Received: 10 August 1995 / Accepted: 13 February 1996