OBJECTIVE: To determine whether greater changes in plasma endothelin-1 (ET-1) concentrations and right ventricular systolic pressure occur after major thoracic surgery than after major abdominal operations. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Patients undergoing elective thoracotomies (n = 12) or laparotomies (n = 10). INTERVENTIONS: ET-1 was measured from blood obtained before anesthesia and again on postoperative days 1, 2, 3, and 5 (or 6). Transthoracic echocardiography was performed before surgery and on postoperative day 2 to evaluate right-sided heart function. MEASUREMENTS AND MAIN RESULTS: After abdominal and thoracic surgery, systemic and estimated pulmonary vascular pressures were normal in both groups and unaffected by surgery. Plasma ET-1 concentrations decreased from baseline values during the first postoperative week with no differences between the groups. CONCLUSIONS: In patients without organic heart disease, plasma ET-1 levels do not increase in response to major abdominal or thoracic surgery. Whether or not plasma ET-1 concentrations are elevated in patients developing clinically significant postoperative pulmonary hypertension requires further study.

OBJECTIVES: We sought to determine whether early prophylaxis with an L -type calcium channel blocker reduces the incidence and morbidity associated with atrial fibrillation/flutter and supraventricular tachyarrhythmia after major thoracic operations. METHODS: In this randomized, double-blind, placebo-controlled study, 330 patients were given either intravenous diltiazem (n = 167) or placebo (n = 163) immediately after lobectomy (> or =60 years) or pneumonectomy (> or =18 years) and orally thereafter for 14 days. The primary end point with respect to efficacy was a sustained (> or =15 minutes) or clinically significant atrial arrhythmia during treatment. RESULTS: Postoperative atrial arrhythmias (atrial fibrillation/flutter = 60; supraventricular tachyarrhythmias = 5) occurred in 25 (15%) of the 167 patients in the diltiazem group and 40 (25%) of the 163 patients in the placebo group (P = .03). When compared with placebo, diltiazem nearly halved the incidence of clinically significant arrhythmias (17/167 [10%] vs. 31/163 [19%], P = .02). The 2 groups did not differ in the incidence of other major postoperative complications or overall duration or costs of hospitalization. No serious adverse effects caused by diltiazem were seen. CONCLUSIONS: After major thoracic operations, prophylactic diltiazem reduced the incidence of clinically significant atrial arrhythmias in patients considered at high risk for this complication.

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SIR—I have recently read with much interest a paper by Taylor et al. entitled “Staging the Baboon Response to Group A Streptococci Administrated Intramuscularly: Descriptive Study of the Clinical Symptoms and Clinical Chemical Response Patterns” in Clinical Infectious Diseases [1]. While reading through the paper, it became apparent to me that articles published since 1959, which had described in great detail the pathophysiology of group A streptococcal injury (animal models), had not been cited in this article [2–7]. One review had already covered, in detail, many of the aspects related to your article [2], and had described a steep rise in glutamic oxaloacetic transaminase levels, sorbitol dehydro-genase (SOD), and in total lipids in animals injected with extracellular products [6]. In addition, Taylor et al. cite a study (reference 48) on theta toxin. Why not cite studies that show the effects of streptolysins S and O? Furthermore, the possible effects of streptolysin O (reference 52) and cysteine proteinase (reference 53) are mentioned. I would also like to note, for the interest of the readers, a paper by Ginsburg [8] that had shown that tumor cells could be killed and disintegrated, in a synergistic manner, by combining streptolysins S with a proteinase. The cysteine proteinase employed was isolated from streptococci and kindly supplied by Dr. Elliot from the Rockefeller Institute (New York City). Moreover, I would like to draw the attention of the authors to a more recent publication that has discussed in great detail synergistic mechanisms of cell injury. I refer to a review by Ginsburg and Kohen [9]. It is of great concern that the avoidance of citations of “old” and pioneering publications has assumed epidemic dimensions, especially among younger investigators. Today, although without abstracts, MEDLINE already offers citations from 1960 and later; however, a search for “older and obsolete” literature necessitates a review of the Index Medicus. This apparently might be too cumbersome for those who tend to read only titles and abstracts and not the full texts of articles. This dangerous trend in science is self-defeating, unscholarly, unacceptable, and also unethical. Unfortunately, this is how basic observations and ideas are “lost and buried for good.” The phrase “sic transit gloria mundi” is very appropriate. It is even more disturbing that the learned referees of the paper by Taylor et al., who have been expected to be knowledgeable of the older literature on streptococci, have failed to draw their attention to the existence of such “obsolete” and apparently unimportant publications. Unfortunately this is how basic observations are “rediscovered,” leading to the suffocation of the literature with “novel,” but redundant information. I shall greatly appreciate receiving your comments regarding these issues and am also looking forward to learn what might be the future policies of the editorial board of the journal regarding strategies taken to better cope with lack of appropriate citations to support scientific publications.