Case reports by William C. Roberts, MD, and colleagues (1961–2022)

Case reports have had a long history. Many diseases have been reported initially as a case report. The first publication of many authors, including the present author, was a case report. William Osler’s curriculum vitae (CV) is loaded with individual case studies on a variety of conditions. Paul Dudley White’s CV, particularly his early publications, is loaded with individual case reports. Indeed, he indicated that he tried to write a case report on a variety of cardiovascular conditions to familiarize himself quickly with them.

The physician-patient relationship is a one-on-one encounter. Although randomized clinical trials are favored today, often it is difficult to fit a single patient into these types of studies due mainly to the heterogeneous nature of the populations. Some patients or circumstances cannot be described except in the case-report format. An example might be case #342 included here (miscellaneous), which described a man who was shot; the bullet coursed through the right atrium and then through the right ventricular outflow tract, preventing flow to the left side of the heart. Autopsy disclosed the left atrial appendage to have protruded through the mitral orifice, suggesting that the left ventricle had a negative pressure during ventricular diastole, something confirmed physiologically in a subsequent publication. We recently received a manuscript describing a young boy who was thrown from his vehicle and landed on a rattlesnake who bit him on his leg that was the site of a compound fracture suffered during the accident. The case-report format is the only mechanism to report such events.

Many disease entities have been described initially as case reports: Ochronosis by Rudolph Virchow (1821–1920), sickle-cell anemia by James B. Herrick (1861–1954), and the Pickwickian syndrome (obesity-hyperventilation syndrome) by Charles Sydney Burwell (1893–1967) are just a few examples. Multiple first operations were described initially in the case report format, as well as the first effective anesthetic drug.

Another benefit of case reports is that they provide the opportunity for young physicians to break into the medical publishing arena. They can be used to describe a new facet of a disease or provide a fuller description of an entity described previously. New journals often begin by publishing case reports. (See the early issues of the Mayo Clinic Proceedings or the Cleveland Clinic Medical Quarterly or the Baylor University Medical Center Proceedings.)

Some authors, editors, and readers minimize the usefulness of case reports to medical education. We recently received a case report from an important and established investigator who indicated that he was really not in favor of publishing case reports but that his was “special” and deserved rapid acceptance and publication. This type of comment is fairly frequent.

In more modern times, several collections of case reports have been published. The New England Journal of Medicine calls them “Images in Clinical Medicine” or “Case Records of the Massachusetts General Hospital”; The Lancet calls them “Clinical Picture”; Circulation calls them “Cardiovascular Images” or “Cases and Traces” or “ECG Challenge”; JAMA Cardiology calls them “JAMA Cardiology Clinical Challenge”; and The American Journal of Medicine calls them “Diagnostic Dilemma” or “Images in Dermatology” or “Images in Radiology” or “ECG Image of the Month,” to name a few examples. The Journal of the American College of Cardiology has an entire journal devoted to case reports (JACC Case Reports).

The reference list includes case reports by the present author and his colleagues. An early collection of case studies was by Ambroise Pare called Oeuvres in 1628 (in French) and compiled and edited by Wallace B. Hamby and titled The Case Reports and Autopsy Records of Ambroise Pare (in English) in 1960. These short descriptions of patients are fascinating and enjoyable reading. Richard C. Cabot, who started the clinicopathologic conferences at the Massachusetts General Hospital, published Case Teaching in Medicine—A Series of Graduated Exercises in the Differential Diagnosis, Prognosis and Treatment of Actual Cases of Disease in 1906. Cabot described 78 patients, most of whom went to autopsy and some to surgery. The collection included patients with a variety of conditions. Cabot’s 1906 book led to “The Case History Series”: Case Histories in Pediatrics by John Lovett Morse; Surgical Problems by James G. Mumford in 1911 (100 cases); and Case Histories in Neurology by E. W. Taylor in 1911.

In more modern times, several collections of case reports have been published. The most popular are under the general heading of Clinicopathologic Conferences of The Massachusetts General Hospital: the collection of cases, published as individual books, are variously titled Selected Medical Cases; Surgical; Bone and Joint; Neurologic; and Cardiac. The latter by Benjamin Castleman and Roman W. De Sanctis presents 50 cases of various cardiovascular diseases studied both clinically and at necropsy.

Finally, case reports are fun reading (particularly Ambroise Pare’s Selections). They are a “break” from the data-heavy multicenter placebo-controlled trials and metaanalyses.

The two volumes of case reports written by William C. Roberts and colleagues were published over a 60-year period (1961 to 2022). All 269 describe a single patient with a cardiovascular disease, nearly all of whom were studied both clinically and morphologically, i.e., at autopsy or after cardiac transplantation or after another cardiovascular operation. Thus, the collection is unique. Each report is numbered as it appears in WCR’s CV, which includes, as of August 11, 2022, a total of 1784 publications, some of which are published interviews of prominent physicians or published symposia in which WCR participated (Table 1). Most, however, include peer-reviewed publications authored by WCR and colleagues.

Table 1. Number and types of articles published by William C. Roberts, MD, 1961–2022

Article type		N
1. Patient-centered studies		952
a. Single patient	269
b. Multipatient	666
c. Nonpatient	17
2. From-the-editor columns		342
a. AJC (1982–2022)	234
b. BUMC (1994–2021)	108
3. Other editorials, mini reviews, forewords, historical pieces (all journals)		67
4. Chapters in books		143
5. Interviews		197
a. AJC	77
b. BUMC	96
c. Visiting professors	24
6. Published symposia (“AJC editor’s roundtable”)		43
7. AJC in month (25 years earlier) (May 1983–August 1988)		40
Total		1784

AJC indicates American Journal of Cardiology; BUMC, Baylor University Medical Center Proceedings.

              —William C. Roberts, MD

                    August 15, 2022

CASE REPORTS BY WCR