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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
Case report
Full Version
Isolated Renal Hydatid Cyst Mimicking Renal Cell Carcinoma: A Diagnostic Dilemma
Correspondence Address :
Dr. Anshu Gupta
R13/27, Raj Nagar, Ghaziabad, UP, India - 201002.
Phone: 09999 66 5416
Email ID: amitanshu75@gmail.com
Context : Hydatidosis due to Echinococcus granulosus is a parasitic zoonosis with worldwide occurence. The most common locations are liver and lung. Occasionally, it may mimic intra abdominal tumour.
Aims: Hydatid disease of the urinary tract is uncommon, occurring in only 2 to 3% of all cases. This case is presented with the aim of highlighting a giant renal echinococcus cyst, misdiagnosed as renal malignancy on imaging.
Setting: The misdiagnosis of renal carcinoma was made in the case of a 65-year-old man.
Materials and Methods: The patient presented with colicky pain in right flank with fever, nausea and vomiting. Right kidney was palpable with leucocytosis and proteinuria.
X ray abdomen revealed ring calcifications in right upper quadrant. Ultrasonography (USG) and computerised tomography (CTshowed a soft tissue mass in right kidney.
Intravenous urography with conventional tomography 15 minutes after contrast demonstrated nil nephrogram in right kidney.
CT findings were suggestive of renal cell carcinoma.
Conclusions: Hydatid cyst can attain large dimensions and can easily be misdiagnosed as a tumour. Despite its rarity, hydatid disease should be considered in the differential diagnosis of renal space-occupying lesions.
Hydatid cyst, renal cell carcinoma, Echinococcosis
Introduction
Hydatidosis which is caused by Echinococcus granulosus is a parasitic zoonosis which is seen worldwide. The most commonly involved anatomical locations are the liver and the lung. Occasionally, the cyst may mimic an intra-abdominal tumour or it may present with gross ascites (1). Hydatid disease (HD) of the urinary tract is uncommon, accounting for only 2 to 3% of all the cases (2). Herein, we are reporting the case of a 65-year-old patient with a giant renal echinococcus cyst, which was misdiagnosed as a renal malignancy on radiology, with the aim of reiterating the consideration of this diagnosis for those who deal with renal space occupying lesions.
A 65-year-old man was admitted to the emergency ward with colicky pain in the right flank, which radiated to the right, lower quadrant, along with low grade fever of 20 days duration, nausea and vomiting. His past medical history was unremarkable. His clinical examination revealed a palpable right kidney with leucocytosis (11,800 cells per cmm) and proteinuria (++).
No serological tests were performed in this case, as the diagnosis of hydatid cyst was not entertained by the clinicians pre-operatively and as the histopathological examination after nephrectomy was consistent with the diagnosis of a hydatid cyst.
Conventional abdominal radiography revealed ring-shaped calcifications in the right upper quadrant. Ultrasonography (USG) showed a soft tissue mass in the right kidney, with multiple hyperechoic septations.
Intravenous urography with conventional tomography, 15 minutes after contrast, demonstrated normal excretion in the left kidney, but a nil nephrogram in the right kidney.
Computed tomography (CT) demonstrated a solid-cystic mass in the right kidney, which measured 16x11x10cm, with a calcified cystperiphery and multiple necrotic areas. The local lymph nodes were enlarged. The renal vein was spared. The CT findings were suggestive of renal cell carcinoma, stage T2N1M0.
A right sided total nephrectomy with resection of the right 12th rib was done.
The specimen measured 17x14x10cm. The external surface was bosselated. On the cut section, the cortex and the medulla could not be delineated. The kidney was converted into a cyst which was filled with a gel like material, with multiple small daughter cysts which ranged from 0.5x0.5 to 2x2 cm in size. The renal pelvis could not be identified. At one pole, compressed kidney tissue was seen.
Microscopic examination showed that the renal parenchyma was infiltrated by lymphocytes and eosinophils. Focal epithelioid cell granulomas with giant cells were seen.
Sections from the cyst showed a hydatid cyst wall with an outer fibrotic pericyst, a middle acellular, laminated ectocyst and an inner germinal layer (endocyst). Scolices with hooklets were seen in the proteinaceous cyst fluid. Focal areas of calcification were present. There was no evidence of malignancy.
The patient made an uneventful recovery and he was discharged on the 8th postoperative day on albendazole for two months. There was no recurrence till up to nine months of follow up.
Echinococcosis is a zoonosis for which dog is the definitive host. The adult tapeworm resides in the intestine of the dog and produces larvae that cause echinococcosis. The infection occurs when humans are exposed to contaminated faeces. Once ingested, the larvae hatch and they penetrate the wall of the duodenum, and enter the portal circulation. A majority of the tapeworms are entrapped in the liver. Some organisms may proceed to the pulmonary circulation. A small percentage of the larvae may enter the systemic circulation and seed any viscus. After the infection of the visceral organ, vesiculation occurs and a hydatid cyst is formed. The rate of development of a hydatid cyst is very slow. For the cyst to attain a clinically evident size, a long period of time is required.
There are 3 zones in the wall of a hydatid cyst: a peripheral zone of fibroblasts, an intermediate hyalinized layer, and the innermost germinal layer that contains nucleated epithelium. The latter gives rise to brood capsules from which the scolices develop. The brood capsules or the daughter cysts detach and float in the fluid within. The growing cyst causes a mass effect upon the affected organ. The diagnosis of a hydatid cyst is sometimes difficult. The patient may remain asymptomatic for many years (1). When the symptoms appear, pain is the commonest feature. Fever with chills and rigors can occur if the cyst is secondarily infected. Rupture of the cyst is the most common complication and it can be the result of trauma or pressure from the growing cyst (3). This may result in an anaphylactic shock and in the formation of localized or generalized secondary echinococcosis.
The most common locations are the liver and the lung. Occasionally, the cyst may progressively increase in size, mimicking gross ascites or an intra-abdominal tumour (1). Involvement of the kidneys is uncommon and the patient can remain asymptomatic for a long period. The patients with kidney involvement may present with haematuria, abdominal discomfort and an abdominal mass. This may mimic genitourinary (GU) tumours which include complex renal cysts and renal cell carcinoma (4). A renal hydatid disease has no specific signs, except for hydatiduria. The latter is the presence of “grape skin” debris in the urine, when the cyst ruptures into the collecting system. This has been reported in 29% of the cases (5).Hydatiduria, is a rare cause of renal colic (6). Because of the risk of a fatal anaphylaxis, partial or total nephrectomy is the preferred treatment (7). Serologic testing in cases of renal hydatid cyst has proved useful, but it has a sensitivity of only 60%-90% (8).
Radiologic studies help in the diagnosis of renal HD, but they may be inconclusive, and the diagnosis may be made at the time of the cyst removal. The diagnostic accuracy has been greater ever since ultrasonography and immunologic studies have been made available (9). Ultrasonography (US) is particularly useful for the detection of the cystic membranes, septa, and the hydatid sand. Computed tomography (CT) demonstrates the cyst wall calcification and the cyst infection best (10). Spherical cysts with a peripheral calcification may be seen on a plain radiograph of the abdomen and these are indicative of HD. A thick, calcified cystic wall suggests the presence of a hydatid cyst. The most pathognomonic finding is the presence of daughter cysts within the larger cyst. The hydatid cyst appears as a unilocular or a multilocular mass on an ultrasonogram or a CT scan. The multilocular appearance indicates the presence of daughter cysts. The CT density of the viable daughter cysts is lower than those of the mother hydatid cysts. The differential density between the mother and daughter hydatid cyst fluid is a useful diagnostic sign (11).
An early diagnosis of a hydatid cyst may be life saving. Potentially lethal complications such as an anaphylactic shock may occur due to perforation of the cyst. Complete elimination of the parasite from the organism and prevention of the recurrence of the disease constitute the ideal treatment for hydatid disease (12).
The treatment options for hydatid cyst of the kidney depend on the stage, localization, size, and the complications in the respective patients and these include medical treatment and operative procedures. The operative methods include conservative and radical procedures along with minimally invasive and laparoscopic methods. The surgical options which include partial or total nephrectomy have been frequently exercised, preferred and reported (7),(9),(13). A renal-sparing surgery which involves cystectomy and pericystectomy, is possible in upto 75% of the cases. Nephrectomy must be reserved for destroyed kidneys which result from aged cysts which open into the excretory cavities and are complicated by the renal infection and this has been reported in 25% of the cases. Whether it is conservative or radical, the first surgery which is performed is cystectomy, with the removal of the germinal membrane after a careful evacuation and opening of the cyst, thus making the subsequent steps of the surgery easier (9).
Chemotherapy with antihelmintics of the benzimidazole family, when they are used alone, is of limited efficacy due to the poor accessibility of the cyst to the drug. The outcome is better when the same is used in conjunction with surgery and this aids in preventing a recurrence (4). In conclusion, we believe that a hydatid cyst can attain large dimensions, sometimes without any symptoms, and that it can easily be misdiagnosed as a tumoural/pseudotumoural mass. Despite its rarity, hydatid disease should be considered in the differential diagnosis of all renal space-occupying lesions (13).
Date of Submission: Dec 19, 2011
Date of Peer Review: Mar 17, 2012
Date of Acceptance: Apr 14, 2012
Date of Publishing: Jun 22, 2012
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