Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Original article / research
Year : 2011 | Month : December | Volume : 5 | Issue : 8 | Page : 1510 - 1513

A Research Study of Santorini Duct

Anterpreet Kaur Arora, Monika Lalit Piplani, Sonney Singh Kapoor, B.S. Bhatia, Adarsh R.K. Singh, Poonam Verma, Sanjay Piplani

1. Professor, Dept. of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab. 2. Assistant Professor, Dept. Of Anatomy, Chintpurni Medical College & Hospital, Bungal, Pathankot, Punjab. 3. Senior Resident,Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMS & Research), Amritsar. Punjab. 4. Associate Professor,Department of Surgery, Adesh Medical college, Bathinda. 5. Professor,Department of Radiology, Adesh Medical college, Bathinda. 6. Associate Professor, Dept. Of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. Punjab. 7. Associate Professor, Dept. Of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. Punjab.

Correspondence Address :
Monika Lalit Piplani
24, Lane 5, Gopal Nagar, Majitha Road,
Amritsar, Punjab.
Phone: 09814325454
E-mail: monika.lalit@yahoo.com

Abstract

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.

Keywords

Accessory pancreatic duct, Dorsal pancreatic duct, Minor duodenal papilla

How to cite this article :

Anterpreet Kaur Arora, Monika Lalit Piplani, Sonney Singh Kapoor, B.S. Bhatia, Adarsh R.K. Singh, Poonam Verma, et al.. A RESEARCH STUDY OF SANTORINI DUCT. Journal of Clinical and Diagnostic Research [serial online] 2011 December [cited: 2019 Aug 19 ]; 5:1510-1513. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=December&volume=5&issue=8&page=1510-1513&id=1793

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).

Material and Methods

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).

Results

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%.

Discussion

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.

Conclusion

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).

References

1.
Kamisawa T, Egawa N, Nakajima H, Sakaki N, Tsuruta K, Okamoto A Clinical significance of the accessory pancreatic duct. Hepatogastroenterology 2003; 50(54): 2196-98.
2.
Kamisawa T. Clinical significance of the minor duodenal papilla and accessory pancreatic duct. Gastroenterol 2004; 39(7): 605-15.
3.
Suda K. Histopathology of the minor duodenal papilla. Dig Surg 2010; 27(2): 137-39.
4.
Birnstingl. A study of pancreatography. The British Journal of Surgery 1959; 47: 128-39.
5.
Anand B, Vij J, Mac V, Chowdhary V, Kumar A. Effect of aging on the pancreatic ducts: a study based on endoscopic retrograde pancreatography. Gastrointestinal Endoscopy 1989; 35(3): 210-13.
6.
Kamisawa T, Takuma K, Tabata T, Egawa N. Clinical implications of accessory pancreatic duct. World J Gastroenterol 2010; 16(36): 4499–03.
7.
Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK. Pancreas divisum: implications for di agnostic and therapeutic pancreatography. AJR 1999; 173: 193 -98.
8.
Singh I. Observations on the mode of termination of the bile and pancreatic ducts. Anatomical factors in pancreatitis. J. Anat. Soc. India 1956; 5: 54-60.
9.
Kozu T, Suda K, Toki F. Pancreatic development and anatomic variation. Gastrointest Endosc Clin N Am 1995; 5: 1-30.
10.
Hoffmann JM. Dissertationes anatomico-physiologicae. Johannes van Horne Swammerdamii, Altdorfii Noricorum 1685; 164. Cited By John M and Walter H. Johann Georg Wirsüng and the pancreatic duct. Journal of the American College of Surgeons 1998; 187(2): 201-11
11.
Lehman GA, Sherman S. Diagnosis and therapy of pancreas divisum. Gastrointest Endosc Clin N Am 1998; 8: 55-77.
12.
Reinhoff and Pickrell. Pancreatitis: An anatomic study of the pancreatic and extrahepatic biliary systems. Archieves of Surgery. 1946; 51 (4): 945.
13.
Mering J V and Minkowski O. Diabetes mellitus nach Pankreasextirpation. Arch. exp. Path. und. Pharm 1889; XXVI: 371
14.
Soto JA, Lucey BC, Stuhlfaut JW. Pancreas di visum: depiction with multi-detector row CT. Radiology 2005; 235: 503-08.
15.
Santorini GD. Septendecim tabulae quas nunc primum edit atque explicat iisque alias addit de structura Parmensi universitate anatomes professor primarius, etc. Parmae ex regia typographia. Fol. British Library Wellcome Institute Hist. Med 1775; 59: 12.
15.
Lankisch PG, Banks PA. General considerations: Embryology. Pancreatitis. 1st edition. Berlin-Heidelberg, Germany: Sringer-Verlag; 1998: 1-14.
16.
Bret PM, Reinhold C, Taourel P, Guibaud L, Atri M, Barkun AN. Pancreas divisum: evaluation with MR cholangiopancreatography. Radiology 1996; 199: 99-103.
17.
Voldsgaard P, Kryger-Baggesen N, Lisse I. Agenesis of pancreas. Acta Paediatr 1994; 83: 791-93.
18.
Guclu M, Serin E, Ulucan S, Kul K, Ozer B, Gumurdulu Y, et al. Agenesis of the dorsal pancreas in a patient with recurrent acute pancreatitis: case report and review. Gastrointest Endosc 2004; 60: 472-75.

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