Reviewer's report 
 Outcome following emergency surgery for refractory severe ulcerative colitis in a tertiary care Title: 
centre in India 
 2  25 July 2005 Version: Date: 
 Willem A A Bemelman Reviewer: 
Reviewer's report: 
General 
The presented manuscript represents a retrospective study of the results of emergency surgery for refractory ulcerative colitis. A total of 72 patients are decribed operated during an 18-years period. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
Patients&Methods: Since the authors look at timing of surgery, "lack of response" must be defined. Why was a period of 
5 days chosen to compare the surgical results. It is not clear of this period is 5 days after admittance 
or 5 days after falure of therapy. 
Results 
A table with patient data is missing: It is important to have information with respect to sexe, age, 
malnutrition, duration of in hospital therapy, steroid treatment, other immunosuppressives etc, type 
of procedure, management of the rectosigmoid. 
It is not logic to have a patient group operated for complications and one operated for failure of 
medical therapy. Mortality was an efficacy parameter to look at early and late surgery in the 
refractory group. It is not clear from this results section which complications occurred in which group. 
Discussion 
It is difficult to interpretate the conclusion that early surgery is beneficial if there are no definitions of 
"refractory to medication", if it is ill defined why one patient was operated < 5 days and the other > 5 
days, and if it is unclear how long patients had intensive medical treatment. The patients that had surgery for complications are probably also within the delayed group. 
It makes more sense to perform a regression analysis of several factors (timing of surgery, 
nutritional state, period in time, type of surgery, medical treatment) in relation to morbidity and mortality. 
In the discussion results are discussed that have not been reported earlier in the manuscript. This is 
unusual. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Abstract: 
It is not clear from the abstract what happened with 72-51=21 patients 
poor nutritional sate must be defined. 
 Reject because scientifically unsound What next?: 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Reviewer's report 
 Outcome following emergency surgery for refractory severe ulcerative colitis in a tertiary care Title: 
centre in India 
 2  25 July 2005 Version: Date: 
 Willem A A Bemelman Reviewer: 
Reviewer's report: 
General 
The presented manuscript represents a retrospective study of the results of emergency surgery for refractory ulcerative colitis. A total of 72 patients are decribed operated during an 18-years period. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
Patients&Methods: Since the authors look at timing of surgery, "lack of response" must be defined. Why was a period of 
5 days chosen to compare the surgical results. It is not clear of this period is 5 days after admittance 
or 5 days after falure of therapy. 
Results 
A table with patient data is missing: It is important to have information with respect to sexe, age, 
malnutrition, duration of in hospital therapy, steroid treatment, other immunosuppressives etc, type 
of procedure, management of the rectosigmoid. 
It is not logic to have a patient group operated for complications and one operated for failure of 
medical therapy. Mortality was an efficacy parameter to look at early and late surgery in the 
refractory group. It is not clear from this results section which complications occurred in which group. 
Discussion 
It is difficult to interpretate the conclusion that early surgery is beneficial if there are no definitions of 
"refractory to medication", if it is ill defined why one patient was operated < 5 days and the other > 5 
days, and if it is unclear how long patients had intensive medical treatment. The patients that had surgery for complications are probably also within the delayed group. 
It makes more sense to perform a regression analysis of several factors (timing of surgery, 
nutritional state, period in time, type of surgery, medical treatment) in relation to morbidity and mortality. 
In the discussion results are discussed that have not been reported earlier in the manuscript. This is 
unusual. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Abstract: 
It is not clear from the abstract what happened with 72-51=21 patients 
poor nutritional sate must be defined. 
 Reject because scientifically unsound What next?: 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
Please review this paper.
user
Reviewer's report 
 Outcome following emergency surgery for refractory severe ulcerative colitis in a tertiary care Title: 
centre in India 
 2  25 July 2005 Version: Date: 
 Willem A A Bemelman Reviewer: 
Reviewer's report: 
General 
The presented manuscript represents a retrospective study of the results of emergency surgery for refractory ulcerative colitis. A total of 72 patients are decribed operated during an 18-years period. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
Patients&Methods: Since the authors look at timing of surgery, "lack of response" must be defined. Why was a period of 
5 days chosen to compare the surgical results. It is not clear of this period is 5 days after admittance 
or 5 days after falure of therapy. 
Results 
A table with patient data is missing: It is important to have information with respect to sexe, age, 
malnutrition, duration of in hospital therapy, steroid treatment, other immunosuppressives etc, type 
of procedure, management of the rectosigmoid. 
It is not logic to have a patient group operated for complications and one operated for failure of 
medical therapy. Mortality was an efficacy parameter to look at early and late surgery in the 
refractory group. It is not clear from this results section which complications occurred in which group. 
Discussion 
It is difficult to interpretate the conclusion that early surgery is beneficial if there are no definitions of 
"refractory to medication", if it is ill defined why one patient was operated < 5 days and the other > 5 
days, and if it is unclear how long patients had intensive medical treatment. The patients that had surgery for complications are probably also within the delayed group. 
It makes more sense to perform a regression analysis of several factors (timing of surgery, 
nutritional state, period in time, type of surgery, medical treatment) in relation to morbidity and mortality. 
In the discussion results are discussed that have not been reported earlier in the manuscript. This is 
unusual. 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
Abstract: 
It is not clear from the abstract what happened with 72-51=21 patients 
poor nutritional sate must be defined. 
 Reject because scientifically unsound What next?: 
 An article of limited interest Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests' 
assistant