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

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On Sep 2018




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"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."



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On Sep 2018




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




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




Dr. Rajendra Kumar Ghritlaharey

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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.


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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.
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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.
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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

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 159 - 162

The Morphological Variations of the Human Spleen

Prashant Nashiket Chaware, Swati Milind Belsare, Yashwant Ramkrishna Kulkarni, Sudhir Vishnupant Pandit, Jaideo Manohar Ughade

1. Assistant professor, Anatomy department, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India. 2. Professor and Head of department, Anatomy Department, Maharashtra Institute of Medical Education and Research, Talegaon [Dabhade], Pune, Maharashtra, India. 3. Associate professor and Head of department, Anatomy Department, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India. 4. Associate professor and Head of department, Anatomy Department, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India. 5. Assistant professor, Anatomy Department, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India

Correspondence Address :
Prashant Nashiket Chaware
Assistant professor, Anatomy department,
Shri Vasantrao Naik Government Medical College,
Yavatmal, Maharashtra – 455001, India.
Phone: 09822928591
E-mail: prashantnchaware@gmail.com

Abstract

Introduction: The spleen is an important lymphatic organ in the human body. Its immunological and haematological functions are being well realized now-a-days. The aim of this study was to find out the morphological variations of the spleen and to compare them with the findings of previous studies.

Materials and Methods: The present study included 111 human cadaveric spleens. The morphological features of the spleen like its length, breadth, width and weight were measured. The shape, poles, borders, surfaces and the impressions on the spleen were observed. Accessory splenic tissues, if they were present, were noted.

Results: The lengths of the spleens varied between 5 cm to 13 cm, with an average of 9.66 cm. Their breadth was between 3.5 and 9.5 cm. The average breadth was 6.22 cm. Their widths varied between 1.5 and 5.5 cm, with an average of 3.06 cm. The weights of the spleens showed great variations, ranging between 80 and 300 gm, with an average of 145.76 gm. Various shapes of the spleens were observed in the present study. Most of the spleens were wedge shaped [61.26%], followed by tetrahedral [21.61%] and triangular [12.61%] shapes. Additional oval and irregular shapes of the spleens were observed in 3.60% and 0.09% cases respectively. In all the spleens, two poles, two borders and two surfaces were observed. The diaphragmatic surface of the spleen showed a uniform morphology while its visceral surface showed gastric, renal, colic and pancreatic impressions. The splenic notches were present on the superior as well as on the inferior borders. In most of the cases [74.76%], the notches were found on the superior border. The number of notches varied from zero to six, but in most of the cases [58.55%], there were 1 or 2 notches. Accessory spleens were found in 4.50% cases, in the form of roundish nodules. They were observed at the hilum of the spleen.

Conclusion: The findings of the present study will be of fundamental importance to the physicians, surgeons and radiologists and of course, this knowledge is very important for the anatomists during their routine classroom dissections.

Keywords

Spleen, Splenic variations, Accessory spleen

Introduction
In humans, the spleen is the largest lymphatic organ. It is connected to the blood vascular system. It consists of a large encapsulated mass of lymphoid and vascular tissues. It is situated in the left hypochondrium and partly in the epigastrium, between the fundus of the stomach and the diaphragm. The shape of the spleen varies from a slightly curved wedge to a domed tetrahedron (1). The size and weight of the spleen vary with age (1). In adults, it is usually 12 cm long, 7 cm broad and 3 to 4 cm wide. Its average adult weight is 150 gm, but the normal range is wide, between 80 and 300 gm (1),(2). The spleen has two surfaces; superolateral or diaphragmatic and inferomedial or visceral; it has two poles, the anterior and the posterior; it has two borders, superior and inferior (1),(2),(3). The diaphragmatic surface is convex and smooth. The visceral surface is irregular and it is marked by gastric, renal, colic and pancreatic impressions. The posterior pole usually faces the vertebral column. The anterior pole is broad and it is directed laterally. On the superior border, near the anterior pole, there may be one or two notches, persisting from the lobulated form of the spleen in early foetal life. The additional collection of fully functional splenic tissue may exist near the spleen, which is called as accessory spleen (1). Accessory spleens are found at the hilum of the spleen, in the gastrosplenic ligament and in the lienorenal ligament in the greater omentumArticlealong the splenic vessels and along the pancreas, but rarely in the scrotum (2),(4),(5),(6).

The filtration of unwanted elements from the blood by phagocytosis is the major function of the spleen (7). In the foetal life, the spleen manufactures erythrocytes and after birth, it produces lymphocytes. The spleen is the centre where both the B and T lymphocytes multiply and play an important role in the immune responses. The spleen is the only site where an immune response can be started against antigens which are present in the circulating blood [but are not present in the tissues] (8). Thus, the spleen performs both haematological and immunological functions. However, the importance of the spleen in protection from infection was neglected and it was thought that the other lymphatic organs of the body could take over its functions. But a series of animal experiments and patients’ follow up studies revealed its actual importance in protection from blood born sepsis, where its role as a blood filter was found to be very significant (9),(10).

Hence, now, despite the overwhelming indications for splenectomy, like traumatic rupture, hypersplenism, neoplasia, splenic cyst, etc., the present tendency of the surgeons is to try for conservative management and to conserve as much splenic tissue as possible. Thus, the knowledge of the variational anatomy of the spleen is offundamental importance. So, the aim of this study was to find out the variations in the morphology of the spleen.

Material and Methods

The present study was conducted in the anatomy departments of Shree Vasantrao Naik Government Medical College, Yavatmal and Indira Gandhi Government Medical College, Nagpur. The study included 111 human adult cadaveric spleens. Apparently normal human cadaveric spleens of both the sexes were selected. Out of the 111 spleens, only 15 specimens of the spleen belonged to female cadavers. As only very less number of spleens of female cadavers were available, it was difficult to do a comparative study between the males and females. So, spleens from both sexes were added together and a statistical analysis was done, without considering the sexual dimorphism. To remove the spleens from the abdominal cavity, they were detached from their various attachments and the splenic vessels were cut near the hilum after ligation. Then they were washed with tap water to clean the debris and the fatty tissue. The shapes of all spleens were noted. They were weighed on an electronic weighing machine and their lengths, breadths and widths were measured. As in the study which was done by Michels (3), we considered the greatest distance between the two poles of the spleen as its length, the greatest distance between two points at the same level on the superior and inferior borders as its breadth and the greatest width as the width of the spleen. We measured these values with the help of spreading and sliding calipers. The borders, surfaces and poles of the spleen were determined. The notches on the borders and the impressions on the surfaces of the spleen were observed carefully. Accessory spleens, if they were present, were searched for at the hilum of the spleen. The data which was thus obtained, was tabulated, statistically analyzed and compared with that of previous studies.

Results

In the present study, out of 111 spleens, 68 [61.26%] were wedge shaped (Table/Fig 1) and (Table/Fig 6), 24 [21.62%] were tetrahedral (Table/Fig 2) and (Table/Fig 6), 14 [12.61%] were triangular (Table/Fig 3) and (Table/Fig 6), 4 [3.60%] were oval (Table/Fig 4) and (Table/Fig 6), and 1 [0.90%] was irregular (Table/Fig 5) and (Table/Fig 6) in shape. 104 [93.69%] spleens had weights in the range of 80 to 300 gm, with a maximum number i.e. 73 [65.76%] of specimens with weights in the range of 80 to 150 gm (Table/Fig 7). The average weight of the spleens was 145.76 gm. In the present study, the lengths of the spleens varied between 5 cm and 13 cm, with an average length of 9.66 cm. But in most of the spleens i.e. in 78 specimens [70.27%] the length was in the range of 9 cm to 12 cm (Table/Fig 8) and (Table/Fig 11). Their breadth was observed to vary between 3.5 cm and 9.5 cm, with an average breadth of 6.22 cm. But in 69 spleens [62.16%], the breadth was in the range of 5.5 cm to 7 cm (Table/Fig 9) and (Table/Fig 11). It was found that the widths of the spleens varied from 1.5 cm to 5.5 cm, with an average width of 3.06 cm. In most of the spleens i.e. in 80 [70.07%] specimens, the width was in the range of 2.5 cm to 3.5 cm (Table/Fig 10). In all the spleens two poles, two borders and two surfaces were observed. The diaphragmatic surface of the spleen showed a uniform morphology, while its visceral surface showed gastric, renal, colic and pancreatic impressions due to their pressure on the spleen. In most of the specimens i.e. in 83 spleens [74.76%],splenic notches were found on the superior border, but in 27 spleens [24.32%], the notches were found on the inferior border also (Table/Fig 12) and (Table/Fig 13). The number of notches varied from zero to six, but in most of the specimens [58.55%] there were one or two notches (Table/Fig 12) and (Table/Fig 14). Among the 111 specimens, accessory spleen (Table/Fig 15) was found in 4.50% specimens in the hilar region. They were in thespleenform of roundish nodules, approximately of the size of a peanut and they were supplied by one of the branches from the splenic artery (Table/Fig 16).

Discussion

The spleen is a mystery organ whose structural and functional relationships have started being realized only now. As reported by Michels (3) and as mentioned in Gray’s anatomy (1), in the present study also, so many variations were found in the morphology of the spleen. In the present study, five different shapes of the spleen were observed. Amongst those, the most common one was the wedge shape (61.26%), followed by the tetrahedral (21.62%) and thetriangular (12.61%) shapes. This was not in accordance with the findings of previous studies (2),(3) in which the wedge shape was found in 44% specimens, the tetrahedral shape in 42% and the triangular shape in the remaining 14% specimens. As opposed to the findings of previous studies, additional oval (3.60%) and irregular shapes (0.90%) of the spleen were also observed in the present study. The present study has shown similar observations for the size of the spleens as in previous studies. In the present study, the length of the spleen varied from 5 to 13 cm, with an average of 9.66 cm. The breadth varied from 3.5 to 9.5 cm, with average of 6.22 cm and the width was between 1.5 cm and 5.5 cm, with an average of 3.06 cm. The mean values of the length, breadth, and width of the spleen in our study were, 9.66 cm, 6.22 cm and 3.06 cm respectively, which were 11cm, 7cm and 3cm in the study which was done by Michels (3). In the Textbook of Gray’s Anatomy (1), these values have been mentioned as 12 cm, 7 cm and 3 to 4 cm respectively.

As was seen in the earlier studies (2), in our study also, the weight varied between 80 and 300 gm, except in 6.30% of the specimens, in which it was below 80 gm. The average adult weight of the spleen is 150 gm, which varies from 80 to 300 gm (1). In our study, the average weight of the spleens was 145.76% gm. The values for the length, breadth, width and weight of the spleen in the present study were slightly lower than those which were reported from previous studies. This may be due to the differences in the genetic factors, body constitution, geographical conditions, feeding habits and the better socioeconomic status, in the western countries where these studies were done. The spleen develops from the mesoderm. During its development, different lobules are formed, which fuse with each other later on. The indication of the lobulation in adult spleen is its notched upper border (4). Sometimes, this lobulated appearance may persist in the spleen. That is why we can get many notches on the spleen, which can be seen on the superior as well as on the inferior borders. In the present study, the splenic notches were found on the superior as well as on the inferior borders. The number of notches varied from zero to six, but commonly, there were only one or two notches. These findings of the present study were in accordance with those of the earlier studies (2),(3). During the development of the spleen, small masses of the splenic tissue may become detached from the main mass and may develop into accessory spleens (11). In the present study, accessory spleen was found in 4.50% specimens. But some research workers (2),(5),(6) reported the incidence of the accessory spleen to vary from 10 to 35% specimens. They found the accessory spleen at the hilum of the spleen, in the gastrosplenic ligament, in the greater omentum, along the splenic vessels, along the pancreas and in the scrotum also. But in the present study, only the hilar region was taken into consideration, which may be the reason why we found only a small number of accessory spleens. Awareness on the possible presence of the accessory spleen is of importance, because if they are not removed during splenectomy, they may result in the persistence of the symptoms which indicated the removal of the spleen (eg. splenic anaemia) (12). The knowledge on the anatomical variations of the spleen is of fundamental importance to the clinicians during the routine clinical examinations of the abdomen, to the surgeons while they perform surgical procedures which are related to the spleen, to the radiologists for their diagnostic procedures and of course, this knowledge is very important for anatomists during their routine classroom dissections.

References

1.
Standring S: Gray’s Anatomy: The Anatomical Basis of the Clinical Practice, 39th edition. Edinburg: Elsevier Churchill Livingstone, 2006; 1239-44.
2.
Hollinshead WH. Anatomy for Surgeons. 3rd ed. vol-2. New York: Harper and Row, 1982; 436-45.
3.
Michels NA. The variational anatomy of the spleen and the splenic artery. American Journal of Anatomy 1942; 70: 21-72.
4.
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DOI and Others

DOI: JCDR/2012/3890:2003

Financial OR OTHER COMPETING INTERESTS:
None.


Date Of Submission: Dec 30, 2011
Date Of Peer Review: Jan 14, 2012
Date Of Acceptance: Jan 20, 2012
Date Of Publishing: Apr 15, 2012

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