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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
A Research Study of Santorini Duct
Correspondence Address :
Monika Lalit Piplani
24, Lane 5, Gopal Nagar, Majitha Road,
Amritsar, Punjab.
Phone: 09814325454
E-mail: monika.lalit@yahoo.com
Introduction: The accessory pancreatic duct also called as dorsal pancreatic duct or Santorini duct as it is formed from the portion of dorsal bud and was first described by Santorini in 1775. It is the main drainage duct of the dorsal pancreatic bud in the embryo and enters the duodenum at the minor duodenal papilla.
Methods: The study was conducted on 30 pancreas and duodenum enblock obtained from adult cadavers in the Forensic medicine Department of Govt. Medical College, Amritsar. Length and width of accessory pancreatic duct were measured and the results were compared according to the sex and were also analysed statistically. The shape of terminal part of the accessory pancreatic duct has also been discussed with reference to patency of the duct.
Results: Length of accessory pancreatic duct ranged between 2.0-6.2cm with a mean of 3.89+ 0.85cm. Width of accessory pancreatic duct ranged between 1.33-2.01cm with a mean of 1.67+ 0.48cm.The most common terminal shape of accessory pancreatic duct observed was stick type in 63.33% and the least common was saccular type i.e. 3.33%. In decade wise division into group I (<40 yrs) and group II (>40 yrs), length of the accessory pancreatic duct did not show any alteration with age but width was significantly greater in group II as compared with group I in male and in female subjects.
Conclusion: The anatomical aberrations in the duct system of pancreas have clinical importance because they can predispose to various clinical disorders including pancreatitis and carcinogenesis. Aging also results in increase in the diameter of the pancreatic duct. Pancreas divisum is a common anatomical variation, in which the dorsal and ventral pancreatic ducts do not unite leading to inadequate pancreatic juice drainage resulting in dorsal pancreatitis.
Accessory pancreatic duct, Dorsal pancreatic duct, Minor duodenal papilla
INTRODUCTION
The accessory pancreatic duct also called as dorsal pancreatic duct or Santorini duct is the smaller and less constant pancreatic duct in comparison with the main pancreatic duct (1) but is the main drainage duct of the dorsal pancreatic bud in the embryo. It enters the duodenum at the minor duodenal papilla (MIP) (2) which is the orifice of the accessory pancreatic duct, mostly accompanied by pancreatic tissue, situated about 2 cm ventroproximal to the major duodenal papilla (3). Accessory pancreatic duct (APD) shows gradual increase in its dimensions with advancement of age (4),(5). On this basis the length and width of accessory pancreatic duct was studied and the results were compared according to sex and analysed statistically. The clinical significance of the study has also been thus discussed with reference to patency of the accessory pancreatic duct (APD) which depends upon duct caliber, course and its terminal shape. The most common stick type accessory pancreatic duct shows higher patency as compared to saccular type accessory pancreatic duct that shows lower patency (6). Pancreas divisum is a common anatomical anomaly in which the ventral and dorsal pancreatic ducts do not unite embryologically (7). With the introduction of a popular investigation like ERCP, it will not be advisable to interpret an ERCP picture without the knowledge of the normal pattern of the duct system and its variations. Keeping all the discrepancies in mind, it is thought to be worth while to study the anatomy of pancreatic ducts in the pancreas of available human cadavers (8).
HISTORY Studies of the anatomy of the pancreas have been carried out for over 200 years. About 80 years later, Santorini 1775 described the accessory pancreatic duct (3). The first pancreatic observation performed on autopsy was described by the Greek, Erasistratus of Chios (319-250 B.C) (5),(9). From the historical aspect, the duct of pancreas was discovered first of all in a rooster by Moritz- Hoffmann (1641) (10). This was followed by the demonstration of Wirsung (1642) who dissected out the duct in human pancreas (11). This was further elaborated by the discovery of pancreatic juices as the secretion of the pancreas by Regnier-De-Graff and Franciscus Sylvius (1664) (12) Hence a proper interpretation of pancreatic physiology was possible for the first time. The relationship between the pancreas and diabetes-mellitus was established by Van Mering and Minkawski (1889) (13). The relationship between pancreatic embryogenesis and the anatomy of the duct was established later on. The role of the pancreas and understanding it led to the development of pancreatic surgery. The first pancreatic resection was described by Kausch in 1912 (14).The pancreas varied in size, density and in the location of the pancreatic duct within the cut-line. Various authors have suggested that a uniform system of locating the pancreatic duct would be useful for future anatomical studies and comparisons. The credit for the first description of the accessory pancreatic duct goes to Santorini (1775) (15) who gave the idea of arrangement of ducts in adult human pancreas.
EMBRYOLOGY
The variations in the accessory pancreatic ductal anatomy result from abnormalities in embryological development of the pancreas from dorsal bud. Pancreas develops by the formation of ventral and dorsal buds that communicate with the foregut through a duct. The pancreas presents a complicated embryogenesis between the 5th and the 7th week of gestation (16) when the ventral pancreas fuses with the dorsal pancreas. During the fusion, the ventral and the dorsal ducts form the main pancreatic duct. The accessory pancreatic duct is formed from the portion of the dorsal bud which gives rise to the upper pancreatic head. A disorder during the complicated embryological development of the pancreas at this stage can lead to congenital abnormalities like Pancreatic divisum (7),(17), complete agenesis of the pancreas which is incompatible with life (18) and agenesis of the ventral pancreas (19).
Inclusion Criteria
1. 30 pancreas and duodenum enblock 2. The specimens were completed in all respects, in order to give the correct observations
Our findings are based on the investigation and study of 30 pancreas and duodenum enblock of both the sexes obtained from adult cadavers. The dissection was done in the Forensic medicine Department of Govt. Medical College, Amritsar. Length and width of accessory pancreatic duct were measured and compared between males and female cadavers.
The duodenum was opened along the convex. Contrast medium was injected through the catheter The patencies of major and minor duodenal papillae were checked by observing the exit of injected material through them and were finally visualized by magnifying lens. Based on this Kamisava T (2010) (6) showed the relationship between the patency of the accessory pancreatic duct and its terminal shape.
The specimens were fixed by keeping in 10% formalin for 3 days and then washed and fixed on wooden board with paper pins. The main pancreatic duct and accessory pancreatic ducts along with their tributaries and pancreatic portion of common bile duct were dissected in situ from its posterior aspect. The measurement of the length of accessory ducts was measured from the minor duodenal papilla to the junction of the accessory duct with the main pancreatic duct. The width of accessory ducts was measured from the mid point of the length of accessory pancreatic duct. The readings were statistically compared in male and female cadavers as shown in (Table/Fig 1). In the total number of 30 specimens 20 belonged to the male subjects and 10 belonged to female subjects and they were divided by decade from 17 to 62 years and for statistical analysis into young group i.e group I which was less than 40 years (<40yrs.) and older group that was more than 40 years i.e (≥40 yrs). The findings of the present study were compared with the previous observations, as shown in the (Table/Fig 2).
In total number of 30 specimens 20 male subjects and 10 female subjects were studied for length and width of accessory pancreatic duct as in one female specimen the accessory pancreatic duct was not seen.. Based on these observations, the range and mean were calculated for each parameter according to the sex and results were also analysed statistically.
The length of accessory pancreatic duct ranged in males (20) ranged between 2.9 -6.2 cm with a mean of 4.26+ 0.89 cm and in females (9) the length ranged between 2.0 - 4.5 cm with a mean of 3.19 + 0.76 which was found to be statistically significant.
The width of accessory pancreatic duct ranged between 1.38- 2.01cm with a mean of 1.69+0.44cm in males (20) and 1.33-1.96cm with a mean of 1.64+0.44cm in females (9) and was statistically significant.
When divided decade wise into group I (<40 yrs) and group II (>40 yrs) Length of the accessory pancreatic duct (APD) did not show any alteration with age but width was significantly greater in group II (1.98 ±0.020) as compared with group I (1.42 ±0.024) in male subjects and also greater in group II (1.82+0.024) as compared to group I (1.34+0.013) in female subjects.
Relationship between the patency of the accessory pancreatic duct and its terminal shape was also observed. The most common shape observed was stick type in 63.33% and least common was saccular type in 3.33%.
In the present work the total number of specimens taken were 30, out of which 20 belonged to male subjects and 10 belonged to female subjects. In males the age ranged between 17-62 years In females the age ranged between 22-55 years In the total series the minimum age taken was 17 years while as maximum age was 62 years. As can be depicted from (Table/Fig 1) that the length of accessory pancreatic duct ranged between 2.0 -6.2 cm with a meanof 3.89+ 0.85 cm in 29 specimens. In males (20) the length ranged between 2.9 -6.2 cm with a mean of 4.26+ 0.89 cm. In females (9) the length of accessory duct ranged between 2.0-4.5 cm with a mean of 3.19 + 0.76 It was statistically significant. In one case which was belonged to female series, the accessory duct was not seen. It was concluded that aging results in the dilation of both the MPD and APD; this alteration was seen mainly after the sixth decade.
A glance at (Table/Fig 1) also shows that the width of accessory pancreatic duct ranged between 1.33-2.01cm with a mean of 1.67+ 0.48cm in 29 specimens. In males (20) the width ranged between 1.38–2.01cm with a mean of 1.69+0.44cm. In females (9) the width of accessory duct ranged between 1.33-1.96cm with a mean of 1.64 + 0.44cm. It was statistically significant. In one case belonging to female series, the accessory duct was not seen.
The findings of the present study were compared with the previous observations, as shown in the (Table/Fig 2). They were divided by decade from 17 to 62 years into younger group i.e group I (<40yrs.) and older group i.e group II (≥40 yrs.). Length of the accessory pancreatic duct (APD) did not show any alteration with age but width was significantly greater in group II as compared with group I as shown in (Table/Fig 2). Not much difference was observed in the length and width of the accessory pancreatic duct (APD) between male and female subjects of either group. It is concluded that aging results in the dilation of accessory pancreatic duct and this alteration is seen mainly after the sixth decade. The results thus were obtained in accordance with the work done by Anand et al (5), none of the earlier authors have mentioned the comparison between male and female group.
Contrast medium was injected through the catheter to judge the patencies of major and minor duodenal papillae. Excretion of the dye from the minor duodenal papilla was observed by magnifying lens. Thus different Shapes of terminal accessory pancreatic duct was observed as Stick, Spindle, Cudgel, Saccular and Branch. Based on this Kamisava T showed the relationship between the patency of the accessory pancreatic duct and its terminal shape as seen in (Table/Fig 3),(Table/Fig 4),(Table/Fig 5). In the present study the most common shape observed was stick type in 63.33% which shows significantly higher patency of accessory pancreatic duct (APD) and the least common was saccular type i.e. 3.33% which shows significantly lower patency of APD. These values were in accordance with the work done by Kamisava (6).
In one case belonging to female series, the accessory duct was not seen.
Thus to conclude, it can be stated that: 1. Aging results in the dilation of accessory pancreatic duct; this alteration is seen mainly after the sixth decade. Studies in the West have shown that with advancing age there is progressive atrophy and fibrosis of the pancreas. In addition, there is a gradual increase in diameter of the pancreatic duct with age (4),(5).
2. The problem of pancreatitis happens to be old one. Possibilities suggests that anatomical anomalies in the duct system of pancreas can cause pancreatitis and various clinical disorders (8).A patent accessory pancreatic duct may prevent acute pancreatitis by lowering the pressure in the main pancreatic duct (3).
3. A patent accessory pancreatic duct also lowers the incidence of carcinogenesis of the biliary tract in cases of the pancreaticobiliary maljunction with patent APD, as the refluxof the pancreatic juice to the bile duct might be reduced by the flow of pancreatic juice from the upper dorsal pancreatic duct (APD) into the duodenum via the minor duodenal papilla (3).
4. Pancreas divisum is a common anatomical variation, in which the dorsal and ventral pancreatic ducts do not unite embryologically. In cases of pancreas divisum, inadequate pancreatic juice drainage from the minor papilla might occur, resulting in dorsal pancreatitis (6),(17). Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations are more frequently found in patients with pancreas divisum associated with idiopathic pancreatitis than in those with pancreas divisum without pancreatitis (7).
5. Sometimes ventral pancreatic duct anastomosis with dorsal pancreatic duct is narrower than dorsal pancreatic duct (DPD) itself. Such groups are known as DPD dominance and it is suggested that Dorsal Pancreatic Duct (DPD) dominant group patients have less chance of gall bladder carcinoma as compared to normal duct group (6).
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