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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Branching Pattern of the Anterior Nerve of Latarjet and Its Clinical Significance
Correspondence Address :
K.C.Shanthi MS (Anatomy)
Department of Anatomy,
Vinayaka Mission’s Kirupananda Variyar Medical College,
Salem, Tamil Nadu, India.
Phone: (0)9443370319
E-mail: drshan74@yahoo.com
Highly selective or proximal gastric vagotomy is one of the definitive treatments for gastric ulcers. The results of this operation, in comparison to truncal vagotomy, is well appreciated by the surgeons. On the contrary, the incomplete and inadequate performance of this procedure results in the recurrence of the ulcers, post vagotomy diarrhoea and the dumping syndrome. The knowledge about the normal and abnormal patterns of the anterior and posterior gastric nerves is an imperative to the surgeons who perform highly selective vagotomy. Most of the studies in this region have been done on the western population and the perspective of truncal and highly selective vagotomy is based on the western literature only. However, Indian studies regarding this topic, are only few and far inbetween. This nature of study on the Indian population in this part of the country was an initiative. 55 stomach specimens were utilized for the study. The anterior gastric nerve was dissected out from the level of commencement to the level of termination by the dissection method. The branching pattern, plexus formation and crow’s foot appearance at the level of the termination of the anterior gastric nerve were studied. The results which were obtained are analyzed and discussed in detail.
Ulcers, Truncal vagotomy, Highly selective vagotomy, Anterior nerve of latarjet
Introduction
The surgical therapy for peptic ulcer began as an empiric extension of the procedures which were first used in the nineteenth century for gastric cancer. The technique of highly selective vagotomy represents the culmination of decades of surgical research and appears to have greatly improved the functional outcome of ulcer surgery. Currently, there is no pharmacological agent that permanently controls the peptic ulcer diathesis.
Highly selective vagotomy is the newest addition to the armamentarium of definitive ulcer operations. This procedure limits the vagotomy to the fundus of the stomach and preserves the antral innervations, thereby avoiding the need for a drainage or resectional procedure. According to JC Thomson (1) and Petropoulos (2), the sparing of the antropyloric innervation results in near normal gastric emptying and with the preservation of the extragastric vagal innervations, the incidence of post vagotomy diarrhoea and dumping minimal. The recurrence of the ulcers was observed to be minimal. The incidence of wound infection, anastomotic leakage and afferent or efferent limb obstruction were greatly reduced. The success which was reported in the early European series and the duplication of these promising results in the prospective trials was reported by Jordan (3). The major issue concerning highly selective vagotomy is ulcer recurrence. There is compelling evidence that the success of the procedure in terms of ulcer recurrence depends primarily on the experience of the surgeon and the knowledge of the anatomy of the gastric branches of the vagus nerve in theabdomen. The present study was done to identify the anterior gastric nerve pattern in our population and to compare the results with the western literature.
This study was conducted on 55 specimens including 12 cadaveric, 40 autopsy and 3 foetal specimens. This study was conducted during the period from 2006 to 2008 in the Department of Anatomy, Government Stanley Medical College, Chennai. The specimens were acquired from hospital resources after obtaining the necessary permissions from the concerned departments.
The stomach was dissected out by the routine dissection method (4). The abdomen was opened by a midline incision which extended from the xiphisternum to the pubic symphysis. A transverse incision was made at the lower end of the midline incision and at the sub costal plane, upto the mid-axillary line. The peritoneal cavity was opened. The lesser omentum was cut closer to the liver and the gastrophrenic and the gastrosplenic ligaments were cut to release the stomach. The greater omentum was cut along the greater curvature of the stomach. The stomach was then eviscerated.
The collected cadaveric stomach specimens were washed thoroughly and were dissected to visualize the anterior gastric nerve, which is otherwise known as the nerve of latarjet. The serous layers of the stomach were dissected carefully to trace the nerve and care was taken not to injure the nerve and its branches. At thecardio oesophageal junction, the lower end of the left vagus and its cardiac branches were visualized.
The autopsy specimens were washed thoroughly in running water to remove the contents within it and to clean the surface. The collected specimens were immersed in a 10% formalin solution for the fixation of the tissue. The fat over the surface of the stomach and along the lesser curvature were removed piece meal by taking care to avoid damage to all the neurovascular structures. The serosal layer of the stomach was dissected carefully to trace the anterior gastric nerve of latarjet.
The foetuses were embalmed by injecting a 10% formalin solution by using an 18 gauge needle for their preservation and fixation. The stomach was dissected out by a routine method as is mentioned above. Then, the specimen was dissected carefully and the course of the anterior nerve of latarjet and its branches were studied.
OBSERVATIONS
11 of the 12 cadaveric specimens showed branching of the nerve of latarjet, with plexus formation over the anterior surface of the stomach. The nerve terminated at the level of the incisura angularis, forming a crow’s foot appearance in those cases (Table/Fig 1). In one specimen, the anterior nerve of latarjet alone was observed without branches and in its termination, the usual crow’s foot appearance was not observed (Table/Fig 2).
In 35 of the 40 autopsy specimens, the anterior nerve of latarjet showed branching and plexus formation over the anterior surface of the stomach (Table/Fig 3). In the remaining 5 specimens, the branching alone was observed without the plexus formation and the crow’s foot appearance (Table/Fig 4). The level of termination of the nerve in all the specimens were observed at the level of the incisura angularis .
All the foetal specimens which were studied were full term babies. The observations in the foetal specimens were unique. The anterior nerve of latarjet alone was observed with its usual course ,without branching and plexus formation and the crow’s foot appearance was not seen at the level of the termination (Table/Fig 5).
At the end of this study, the anterior nerve of latarjet was observed in all the 55 specimens (100%). The level of termination of the anterior nerve of latarjet was at the level of the incisura angularis in all the specimens which were studied (n = 55). 83.6% of the specimens (i.e 46 out of 55) showed plexus formation over the anterior surface of the stomach. In 9.1% of the specimens (5 out of 55), the branching alone was observed without a plexus or crow’s foot appearance. In 7.3% (4 out of 55) of the specimens, only the anterior nerve of latarjet was observed. The crow’s foot formation was found in 46 out of the 55 specimens (83.6%).
The stomach is supplied by sympathetic fibres from the coeliac plexus and the parasympathetic fibres from the vagus nerves.
The sympathetic innervations of the stomach are through the greater and lesser splanchnic nerves (T5–T12 ) and the coeliac plexus. The parasympathetic supply is derived from the anterior and posterior vagus nerves. The right and left vagus nerves enter the abdomen through the oesophageal opening. The left and right vagi are now called as the anterior and posterior vagus nerves. This change in terminology is due to the clockwise rotation of the stomach which it undergoes during its development (5).
The anterior vagus nerve supplies the cardiac orifice and then divides near the upper end of the lesser curvature into gastric branches, pyloric branches and hepatic branches. The gastric branches, about four to ten in number, run towards the anterior surface of the body and the fundus and supplies them. The anterior gastric nerve is the major gastric branch that lies along the lesser curvature of the stomach. This nerve is also called as the anterior gastric nerve of latarjet. The anterior gastric nerve ends at the incisura angularis by forming a crow’s foot appearance. The posterior vagus nerve divides into the gastric and coeliac branches. The gastric branches supply the posterior surface of the stomach. The largest branch is called as the greater posterior gastric nerve or the posterior gastric nerve of latarjet. This nerve also ends at the incisura angularis. The coeliac branches run along the left gastric artery and join the coeliac plexus of the nerves (6).
The results of our study demonstrated the presence of the anterior nerve of latarjet in all the specimens (100%). This coincides with the findings of Latarjet (7), who also observed the presence of this nerve in all his specimens (100%). Skandalakis (8) reported the presence of the nerve in 96% of his specimens, Shuang Qui Yi (9) reported it in 70% and Jackson (10) reported it in 56% of the cases only.
Skandalakis8 reported that the level of termination of the anterior nerve of latarjet was at the incisura angularis in 79% of his cases,but Shuang Qin Yi9 observed the termination at this level in 40% cases only. In the present study, the anterior nerve of latarjet was terminated at the level of the incisura angularis in all the specimens. This coincides with the observations of Latarjet7. In the present study, it became evident that the surgical anatomy of the anterior nerve of latarjet conformed to a pattern which was similar to that of the western population.
McCrea (11), Loeweneck (12) and Brizzi et al (13) observed a plexus formation over the anterior surface of the stomach. Few other authors have reported the absence of such a plexus (14),(15),(16),(17). 83.6 % of the specimens showed the formation of a plexus over the anterior surface of the stomach. Andrews and T.W. Mackay (18) observed the plexus formation in 58.6% of their cases. Brizzi (13) observed it in 20% of the cases, whereas Dia A et al (19) observed the same in 8% of the cases only.
The crow’s foot appearance at the level of termination was noted in 83.6% of our cases, whereas Shuang Qin Yi (9) observed this appearance in all his cases (100%). In case of the crow’s foot formation, the branches will also be given to the body of the stomach. In such cases, the failure to identify the branches and the division of this branch leads to the recurrence of the ulcers (2). Therefore, the knowledge of the crow’s foot formation and the distribution of its branches is important for surgeons.
In 9.1 % of our cases, only the branches were observed to arise from the anterior nerve of latarjet without any plexus formation. The same observation was also reported by Shuang Qin Yi (9) and Skandalakis et al (8) in their studies. However, the literature regarding the branches of the anterior nerve of latarjet is scarce in the Indian population. The results of the present study were compared with those of previous studies (Table/Fig 6).
In highly selective vagotomy, the branches of the anterior and posterior gastric nerves are cut to reduce the gastric acid secretion. The branches are divided just before their level of termination, to retain the antral nerve supply. An incomplete and inadequate vagotomy results in ulcer recurrence. Therefore, the knowledge of the variants of the branching and disposition of the anterior gastric nerve decreases the risk of ulcer recurrence in highly selective vagotomy. In the present study, the pattern of the posterior gastric nerve of latarjet has not been observed.
To our knowledge, all the studies which were done so far by various authors were done in cadaveric specimens only. The unique feature of the present study is that the authors have included foetal specimens also in it. The authors recommend further studies involving the innervation pattern of the posterior gastric nerve.
The study of the pattern of the anterior nerve of latarjet in the present study showed wide variations in terms of its branching pattern, plexus formation and crow’s foot appearance. Such variations have also been reported in the western literature. The discussion part emphasises the most important anatomical details which are relevant to the achievement of adequate, highly selective vagotomy. The knowledge of these variations is of great importance for the surgeons who perform highly selective vagotomy, to achieve better results.
To give an idea about the various branching patterns of the anterior nerve of latarjet in the anterior surface of the stomach, to the surgeons during a highly selective vagotomy procedure.
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