The Journal of Gastrointestinal Surgery has retracted a 2009 article for plagiarism, but it almost seems like the editors were looking for any excuse to bail out on the troubled paper.
The article, “Conservative management of acute appendicitis,” by two researchers from Kashmir, India, purported to show that antibiotics might be a safe, surgery-sparing approach to appendicitis in some patients. The study has been cited 14 times by other papers, according to Thomson Scientific’s Web of Knowedge. It was also cited in a Consumer Reports article as evidence that as many as 10% of patients “get better without treatment” — a curious interpretation of the data.
But in February 2010, a group of surgeons from Bologna, Italy, challenged the Indian authors in a letter to the journal. The authors expressed interest in the concept, which they said had “significant clinical implications,” but took issue with the methodology of the study:
We have developed serious concerns with the study, which questions the validity of these conclusions.
In a letter published the following month, the Indian researchers, Ajaz Malik and Shams ul Bari, defended their work, in a fashion, and called for further study to “establish the superiority of antibiotic treatment over surgery” in cases of acute appendicitis.
We’re guessing that call has now lost a bit of urgency. This month, the journal issued the following notice:
The editors of the Journal of Gastrointestinal Surgery as well as the SSAT [that’s the Society for Surgery of the Alimentary Tract] Board of Directors have retracted the article Malik, A.A. & Bari, S.U. Conservative management of acute appendicitis. J Gastrointest. Surg 13, 966–970 (2009) since significant portions of the article were published earlier in the following articles:
Eriksson, S. & Granstrom, L. Randomized controlled trial of appendectomy versus antibiotic therapy for acute appendicitis. Br J Surg 82, 166–169 (1995).
Horton, M.D., Counter, S.F., Florence, M.G. & Hart, M.J. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg 179, 379–381 (2000).
We tried to reach Jeffrey Matthews, editor of the journal, for a comment, but haven’t heard back from him.
I was curious if turnitin could pick up the reported plagiarism in Malik&Bari – it doesn’t. But it did find a Feb 2011 paper which seemed to have text published in 2009 by Malik & Bari. M&B write
“Conservative approach for acute appendicitis seems to be of special benefit to peripheral health centers especially in developing countries with poor health services and other areas still lacking operating facilities. Being cost effective, it can also be applied in busy emergency setups, thereby avoiding unnecessary surgery and associated morbidity and mortality.”
Sakorafas et al. “Conservative treatment of acute appendicitis: heresy or an effective and acceptable alternative to surgery?” European Journal of Gastroenterology & Hepatology Issue: Volume 23(2), February 2011, p 121–127 write (with no citation):
“Conservative management of AA seems to be of special benefit to peripheral health centers especially in developing countries with poor health services and other areas that still lack operating facilities (such as ships, isolated areas or villages etc.). Being cost-effective, it can also be applied in busy emergency setups, thereby avoiding unnecessary surgery and workload and diverting resources to truly emergency cases.”
elsewhere M&B write:
“The basic pathophysiology of appendicitis is obstruction of the lumen of the appendix followed by infection. In 60% of patients, obstruction is caused by hyperplasia of submucosal
follicles. This form of obstruction is mostly observed in children and is known as catarrhal appendicitis. In
phlegmonous appendicitis, there is diffused inflammation of connective tissues around the appendix due to infection. Initially, there is only inflammation and congestion of the appendix. Once the elema and congestion increases, there is interference with the blood supply resulting in gangrene of the appendix. This stage of appendicitis is known as gangrenous appendicitis”.
Sakorafas et al. write:
“The basic pathophysiological mechanism involved in AA is obstruction of the lumen of the appendix followed by the infection. In 60% of patients, obstruction is caused by hyperplasia of submucosal lymphoid follicles. This form of obstruction is observed most commonly in children and is known as catarrhal appendicitis. In phlegmonous appendicitis, there is diffused inflammation of connective tissues around the appendix because of infection. Initially, there is only inflammation and congestion of the appendiceal wall. Once the edema and congestion increases, there is interference with the blood supply resulting in gangrene of the appendix. This stage of appendicitis is known as gangrenous appendicitis.”
Sakorafas et al. do cite M&B elsewhere in the paper.
Other passages in Sakorafas et al. seem similar to previously published work too. S. et al. write:
“Occasional reports of conservative treatment, however, appeared since the middle of the 20th century. The first report was presented in 1945 [4], whereas in 1959, Coldrey [5] reported 471 unselected patients who underwent treatment with antibiotics alone with low mortality and morbidity rates. A report from China in 1977 described 425 patients treated without surgery but with antibiotics or traditional Chinese medicine [6]. At the follow-up, 7% had recurrence. Antibiotic treatment of AA has also been described in 1990 in nine submariners of the USA [7].”
Styrud et al. 2006 writes:
“There have been occasional reports of conservative treatment with antibiotics in acute appendicitis. In 1959, Coldrey reported 471 patients who underwent treatment with antibiotics alone,3 and a report from China in 1977 described 425 patients who were treated without surgery, but with antibiotics or traditional Chinese medicine.4 At follow-up 7% had recurrence. Antibiotic treatment has also been described in nine U.S, submariners.”
@andrewt cites pretty clear plagiarism–not clear from who to whom…
the basic issue is that antibiotic tx alone appears to contradict a basic tenet of surgery, i.e. an infection caused by obstruction cannot be relieved except by surgical means. If most of appendicitis is caused by obstruction,either from hypertrophic follicles (which perhaps could shrink) or from appendicoliths, then most of the time antibiotics alone should fail.
So you should be very skeptical of studies which purport to show a significant portion of cases responding fully to antibiotics alone–this agrees with clinical experience too; this tx, even in emergencies when surgery is not available within a reasonable time, usually fails to relieve symptoms more than partially and doesn’t prevent rupture.
“Extraordinary claims require extraordinary proof.”
Plagiarism in a “family” style
How young ambitious capoes and soldiers from Italian Institute of Technology (IIT) under supervision of a decrepit american don-godfather from Northwestern University are successfully completed their sequential plagiaristic enterprise: http://issuu.com/r_sklyar/docs/sklyarvsmussaivaldi