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Treatment of acute colonic pseudo-obstruction
422
J Am Coll Surg
Letters to the Editor
4. Coady MA, Adler F, Davila J, Gahtan V. Nonrecurrent laryngeal nerve during carotid artery surgery: case report and literature review. J Vasc Surg 2000;32:192–196. 5. Pelizzo MR. Il nervo laringeo inferiore destro a decorso non ricorrente. Min Chir 1985;40:1617–1621. 6. Soustelle J, Vuillard P, Tapissier J, et al. La non-recurrence du nerf larynge inferieur. A propos de neuf cas. Lyon Chir 1976;72:67.
Reply Gabriele Materazzi, MD, Pietro Iacconi, MD, Piero Berti, MD, Paolo Miccoli, MD Pisa, Italy The authors would like to thank Drs Toniato and Pelizzo for their observations on the short report on a case of nonrecurrent laryngeal nerve predicted before thyroidectomy on the basis of preoperative imaging.1 This is a very rare anomaly and is usually discovered intraoperatively, but the knowledge of embryologic development abnormalities can be useful to predict it preoperatively.2,3 The patient, complaining of dysphagia and moderate dyspnea, had a CT of the neck and mediastinum to evaluate the substernal extension of the goiter. The CT showed the abnormal course of the right brachiocephalic artery and then MRI was proposed by the radiologist to confirm the vascular anomaly. That is the reason why the barium swallow was not performed as the first choice. About the risk of damaging the nonrecurrent nerve, during the ligature of the upper pole, especially in case of the “high variant” (type I), we reply that: a) Selective ligature of the upper pole vessels is the worldwidepreferred technique to preserve the laryngeal nerves (both superior and eventually inferior), and the vessels to the upper parathyroid gland. b) After ligature of the upper pole it is mandatory to identify the inferior laryngeal nerve before cutting anything else. When the nerve is not found in the usual pathway, the presence of a nonrecurrent nerve must be supposed. Not so rarely (1% to 5% of patients), the anastomotic branch of the laryngeal nerve to the sympathetic chain can be confused with a false nonrecurrent nerve, and the “normal” recurrent nerve, not identified, is jeopardized.4
In conclusion, the aim of the report was just to stress this point: in a patient who is a candidate for thyroidectomy, if the imaging (neck CT or MRI), in our case, a preoperative evaluation of the thyroid disease, suggests the presence of the vascular anomaly known as the “arteria
lusoria,” the surgeon should be alert to look for a nonrecurrent laryngeal nerve because that nervous anomaly will surely be present. REFERENCES 1. Materazzi G, Berti P, Iacconi P, Miccoli P. Nonrecurrent laryngeal nerve predicted before thyroidectomy by preoperative imaging. J Am Coll Surg 2000;191:580. 2. Nagayama I, Okabe Y, Katoh H, Furukawa M. Importance of pre-operative recognition of the nonrecurrent laryngeal nerve. J Laryngol Otol 1994;108:417–419. 3. Avisse C, Marcus C, Delattre JF, Marcus C. Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Surg Radiol Anat 1998;20:227–232. 4. Raffaelli M, Henry F. The “false” non-recurrent inferior laryngeal nerve. Presented at the Millennium Meeting of the BAES. London, Lille, 22–25 May 2000.
Treatment of Acute Colonic Pseudo-Obstruction L Peter Fielding, MB, FRCS, FACS, Suzanne M Shultz York, PA We read with interest the article by Paran and colleagues1 on the treatment of colonic pseudo-obstruction with neostigmine. In their introduction, they refer to “the pioneering work by Hutchinson and Griffiths in 1992, using the parasympathomimetic drug neostigmine.” In fact, it was Bernard Catchpole of Perth, Australia, in 1969, who was the first to suggest the use of guanethidine followed by neostigmine to treat the imbalance of the sympathomimetic and parasympathomimetic system for treatment of obstruction in an article entitled, “Ileus: use of sympathetic blocking agents in its treatment.”2 Hutchinson and Griffiths3 do credit Catchpole’s original article and a later one coauthored by Julian Neely in 1971.4 Paran and colleagues failed to mention the works by Catchpole. This lapse is interesting for several reasons. Using the Medical Subject Headings indexing assigned to the Paran paper, colonic pseudo-obstruction and neostigmine, only 18 citations resulted. None was older than 1993 and neither Hutchinson and Griffiths nor Catchpole were among them. Why? The National Li-
Vol. 192, No. 3, March 2001
brary of Medicine (NLM) changed indexing terms in 1991. Before that time, the term used was intestinal pseudoobstruction. Matching intestinal pseudo-obstruction with neostigmine produced 30 citations (the original 18 plus 12 more), which did include Hutchinson and Griffiths, but not Catchpole. No citation from this group was older than 1987. Going back again to NLM’s indexing, we discover that before 1987, the term was intestinal obstruction and by using that in the search strategy, there were 58 citations (the original 18, plus 12, plus 28 more.) This group includes both the Hutchinson and Griffiths and the Neely and Catchpole articles. It does not however, include Catchpole’s original article published in 1969. That article does not use the indexing term neostigmine, but rather guanethidine. We have shown by the simple exercise above that even with a structured index and controlled vocabulary, older applicable material can be missed in literature searching. NLM’s current indexing does not automatically map back to older citations. To fully appreciate the breadth and depth of a topic, one must be a creative investigator or must have a thorough fund of knowledge in a specific area. Not everyone is a facile searcher. There is a worrisome trend in research today that assumes that if a topic is not on the Internet, it doesn’t exist. There are vast quantities of older print materials not in electronic indexes. Even when electronic indexes are consulted, researchers must be adept enough to sift back through the literature to find the seminal article, the pioneering author, or the initial case report. Perhaps it would be useful for journals to include some advice in this regard under the References section in “Instructions for Authors.” Additionally, referees selected by journals to review submitted manuscripts need to be sufficiently familiar with a topic so that they may provide an appropriate critique of the work. And, finally, bearing in mind that no two people search literature in the same way, one should ask a reference librarian for assistance in search formulation and literature retrieval.
Letters to the Editor
423
REFERENCES 1. Paran H, Silverberg D, Mayo A, et al. Treatment of acute colonic pseudo-obstruction with neostigmine. J Am Coll Surg 2000;190: 315–318. 2. Catchpole BN. Ileus: use of sympathetic blocking agents in its treatment. Surgery 1969;66:811–820. 3. Hutchinson R, Griffiths C. Acute colonic pseudo-obstruction: a pharmacological approach. Ann R Coll Surg Eng 1992;74:364– 367. 4. Neely J, Catchpole B. Ileus: the restoration of alimentary-tract motility by pharmacological means. Br J Surg 1971;58:21–28.
Reply Haim Paran, MD, FACS, Daniel Silverberg, MD, Ami Mayo, MD, Ivan Schwartz, MD, David Neufeld, MD, Uri Freund, MD, FACS Kfar-Sava, Israel We appreciate the comments of Dr Fielding and acknowledge the early works by Catchpole in the late 1960s and early 1970s. It was not the scope of our study to present a full literature historical review on the subject, but merely to cite some of the previous experiences with the use of neostigmine in acute colonic pseudoobstruction. In a similar manner, other recent articles on this subject have also failed to cite Catchpole’s articles, probably because they too related specifically to the acute pseudo-obstruction syndrome. REFERENCES 1. Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute pseudo-obstruction. N Eng J Med 1999;341: 137–141. 2. Laine L. Management of acute colonic pseudo-obstruction (editorial). N Eng J Med 1999;341:137–141. 3. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome): an analysis of 400 cases. Dis Colon Rectum 1986;29:203–210.
J Am Coll Surg
Letters to the Editor
4. Coady MA, Adler F, Davila J, Gahtan V. Nonrecurrent laryngeal nerve during carotid artery surgery: case report and literature review. J Vasc Surg 2000;32:192–196. 5. Pelizzo MR. Il nervo laringeo inferiore destro a decorso non ricorrente. Min Chir 1985;40:1617–1621. 6. Soustelle J, Vuillard P, Tapissier J, et al. La non-recurrence du nerf larynge inferieur. A propos de neuf cas. Lyon Chir 1976;72:67.
Reply Gabriele Materazzi, MD, Pietro Iacconi, MD, Piero Berti, MD, Paolo Miccoli, MD Pisa, Italy The authors would like to thank Drs Toniato and Pelizzo for their observations on the short report on a case of nonrecurrent laryngeal nerve predicted before thyroidectomy on the basis of preoperative imaging.1 This is a very rare anomaly and is usually discovered intraoperatively, but the knowledge of embryologic development abnormalities can be useful to predict it preoperatively.2,3 The patient, complaining of dysphagia and moderate dyspnea, had a CT of the neck and mediastinum to evaluate the substernal extension of the goiter. The CT showed the abnormal course of the right brachiocephalic artery and then MRI was proposed by the radiologist to confirm the vascular anomaly. That is the reason why the barium swallow was not performed as the first choice. About the risk of damaging the nonrecurrent nerve, during the ligature of the upper pole, especially in case of the “high variant” (type I), we reply that: a) Selective ligature of the upper pole vessels is the worldwidepreferred technique to preserve the laryngeal nerves (both superior and eventually inferior), and the vessels to the upper parathyroid gland. b) After ligature of the upper pole it is mandatory to identify the inferior laryngeal nerve before cutting anything else. When the nerve is not found in the usual pathway, the presence of a nonrecurrent nerve must be supposed. Not so rarely (1% to 5% of patients), the anastomotic branch of the laryngeal nerve to the sympathetic chain can be confused with a false nonrecurrent nerve, and the “normal” recurrent nerve, not identified, is jeopardized.4
In conclusion, the aim of the report was just to stress this point: in a patient who is a candidate for thyroidectomy, if the imaging (neck CT or MRI), in our case, a preoperative evaluation of the thyroid disease, suggests the presence of the vascular anomaly known as the “arteria
lusoria,” the surgeon should be alert to look for a nonrecurrent laryngeal nerve because that nervous anomaly will surely be present. REFERENCES 1. Materazzi G, Berti P, Iacconi P, Miccoli P. Nonrecurrent laryngeal nerve predicted before thyroidectomy by preoperative imaging. J Am Coll Surg 2000;191:580. 2. Nagayama I, Okabe Y, Katoh H, Furukawa M. Importance of pre-operative recognition of the nonrecurrent laryngeal nerve. J Laryngol Otol 1994;108:417–419. 3. Avisse C, Marcus C, Delattre JF, Marcus C. Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Surg Radiol Anat 1998;20:227–232. 4. Raffaelli M, Henry F. The “false” non-recurrent inferior laryngeal nerve. Presented at the Millennium Meeting of the BAES. London, Lille, 22–25 May 2000.
Treatment of Acute Colonic Pseudo-Obstruction L Peter Fielding, MB, FRCS, FACS, Suzanne M Shultz York, PA We read with interest the article by Paran and colleagues1 on the treatment of colonic pseudo-obstruction with neostigmine. In their introduction, they refer to “the pioneering work by Hutchinson and Griffiths in 1992, using the parasympathomimetic drug neostigmine.” In fact, it was Bernard Catchpole of Perth, Australia, in 1969, who was the first to suggest the use of guanethidine followed by neostigmine to treat the imbalance of the sympathomimetic and parasympathomimetic system for treatment of obstruction in an article entitled, “Ileus: use of sympathetic blocking agents in its treatment.”2 Hutchinson and Griffiths3 do credit Catchpole’s original article and a later one coauthored by Julian Neely in 1971.4 Paran and colleagues failed to mention the works by Catchpole. This lapse is interesting for several reasons. Using the Medical Subject Headings indexing assigned to the Paran paper, colonic pseudo-obstruction and neostigmine, only 18 citations resulted. None was older than 1993 and neither Hutchinson and Griffiths nor Catchpole were among them. Why? The National Li-
Vol. 192, No. 3, March 2001
brary of Medicine (NLM) changed indexing terms in 1991. Before that time, the term used was intestinal pseudoobstruction. Matching intestinal pseudo-obstruction with neostigmine produced 30 citations (the original 18 plus 12 more), which did include Hutchinson and Griffiths, but not Catchpole. No citation from this group was older than 1987. Going back again to NLM’s indexing, we discover that before 1987, the term was intestinal obstruction and by using that in the search strategy, there were 58 citations (the original 18, plus 12, plus 28 more.) This group includes both the Hutchinson and Griffiths and the Neely and Catchpole articles. It does not however, include Catchpole’s original article published in 1969. That article does not use the indexing term neostigmine, but rather guanethidine. We have shown by the simple exercise above that even with a structured index and controlled vocabulary, older applicable material can be missed in literature searching. NLM’s current indexing does not automatically map back to older citations. To fully appreciate the breadth and depth of a topic, one must be a creative investigator or must have a thorough fund of knowledge in a specific area. Not everyone is a facile searcher. There is a worrisome trend in research today that assumes that if a topic is not on the Internet, it doesn’t exist. There are vast quantities of older print materials not in electronic indexes. Even when electronic indexes are consulted, researchers must be adept enough to sift back through the literature to find the seminal article, the pioneering author, or the initial case report. Perhaps it would be useful for journals to include some advice in this regard under the References section in “Instructions for Authors.” Additionally, referees selected by journals to review submitted manuscripts need to be sufficiently familiar with a topic so that they may provide an appropriate critique of the work. And, finally, bearing in mind that no two people search literature in the same way, one should ask a reference librarian for assistance in search formulation and literature retrieval.
Letters to the Editor
423
REFERENCES 1. Paran H, Silverberg D, Mayo A, et al. Treatment of acute colonic pseudo-obstruction with neostigmine. J Am Coll Surg 2000;190: 315–318. 2. Catchpole BN. Ileus: use of sympathetic blocking agents in its treatment. Surgery 1969;66:811–820. 3. Hutchinson R, Griffiths C. Acute colonic pseudo-obstruction: a pharmacological approach. Ann R Coll Surg Eng 1992;74:364– 367. 4. Neely J, Catchpole B. Ileus: the restoration of alimentary-tract motility by pharmacological means. Br J Surg 1971;58:21–28.
Reply Haim Paran, MD, FACS, Daniel Silverberg, MD, Ami Mayo, MD, Ivan Schwartz, MD, David Neufeld, MD, Uri Freund, MD, FACS Kfar-Sava, Israel We appreciate the comments of Dr Fielding and acknowledge the early works by Catchpole in the late 1960s and early 1970s. It was not the scope of our study to present a full literature historical review on the subject, but merely to cite some of the previous experiences with the use of neostigmine in acute colonic pseudoobstruction. In a similar manner, other recent articles on this subject have also failed to cite Catchpole’s articles, probably because they too related specifically to the acute pseudo-obstruction syndrome. REFERENCES 1. Ponec RJ, Saunders MD, Kimmey MB. Neostigmine for the treatment of acute pseudo-obstruction. N Eng J Med 1999;341: 137–141. 2. Laine L. Management of acute colonic pseudo-obstruction (editorial). N Eng J Med 1999;341:137–141. 3. Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome): an analysis of 400 cases. Dis Colon Rectum 1986;29:203–210.