Letter from the Editor

Cold Cases

According to your ambitious US resident in cardiothoracic surgery the major problem with being on call every second night is that “you're missing half the good cases”. In a way, this sums up surgical education in a nutshell: it is basically an eternal series of case reports. Undoubtedly, you need to profoundly know the basics and scientific foundations of what you surgically do every day. Practical experience, however, will always remain the key part of training in a surgical discipline, a true “hands-on” experience. This is probably the reason why surgeons are still fond of written-up case reports in their various journals.

A Case Report is usually the first official publication the aspiring novice in a clinical field will get published [1]. He eagerly awaits the peer review, diligently follows all the suggestions made therein on time, and then, before the age of electronic records, proudly used to order an enormous amount of reprints, destined to gather dust in the corner of a cupboard over decades. Fortunately the latter vice is no longer an issue. In the course of further scientific education, guidance by seniors is readily adopted (“Don't submit the manuscript before the patient has left the hospital, preferably alive.”). Much later in life, an experienced surgeon generally still enjoys reading a case report, because it will inevitably evoke a memory of personal experience. This is why a responsible editor will suggest to an author not to claim originality in definite numbers, especially not “firsts” – you never know.

A serious publisher reminds his editors not to publish too many case reports if they care about the ominous “Impact Factor”. Although widely read, the poor things hardly ever get cited, and become cold cases. A good case is by definition a very unique one, after all – so why/when would one want to cite it?

If you look critically at this issue, dealing with intrathoracic tumors, you will find that 21 of 62 pages are dedicated to 10 case reports: 12.5 to 6 cardiac and 8.5 to 4 thoracic ones. Original Cardiovascular papers seem to be missing – but for a reason. Cardiac tumors are exceedingly rare. The instances reported here illustrate the enormous variety of clinical symptoms and surgical options encountered, in summary almost providing an original article as an overview. Intrathoracic tumors are, however, much more commonly associated with a pulmonary or mediastinal origin. This is supported by the one Basic Science and 6 Original Thoracic papers presented and exemplified by a How-to-do-it suggestion and the already mentioned case reports.

Looking at this form of short communication in general, it is, interestingly enough, usually the more critical reports even with a negative outcome which gain the most attention. These tend to confirm to the wary reader in his secret fears that things at St. Elsewhere's might be going in a wrong direction [2]. Moreover it is always comforting to learn that it did not happen in your own hospital that a woman who experienced atypical chest pain when raising her right arm ended up receiving a heart transplantation [3] – but it might have. Just to drive home my point I did cite these two recent prime examples – and by doing so contributed to the increase of the impact factor of their respective journals.

The Thoracic and Cardiovascular Surgeon intends to keep publishing case reports too. Please imagine your editor, constantly craving for the perfect case: one which reports a scenario of highest originality in the unpredictable chaos that is our everyday world [4].

PS: You will find our manuscript submission system under: http://mc.manuscriptcentral.com/tcsurgeon

References

• 1 Heinemann M, Probst M, Ungeheuer E. Der fibrovaskuläre Ösophaguspolyp (A fibrovascular polyp of the esophagus).  Med Klinik. 1986;  81 299-300
• 2 Khouzam R N, Dahiya R, Schwartz R. A heart with 67 stents.  J Am Coll Cardiol. 2010;  56 1605
• 3 Becker M C, Galla J M, Nissen S E. Left main trunk coronary artery dissection as a consequence of inaccurate coronary computed tomographic angiography.  Arch Intern Med. 2010;  DOI: 10.1001/archinternmed.2010.464
• 4 Arya C L, Gupta R, Arora V K. Accidental condom inhalation.  Indian J Chest Dis Allied Sci. 2004;  46 55-58