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

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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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Sanjay Gandhi institute of trauma and orthopedics,
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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.
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
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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.
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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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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.
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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)
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.
On April 2011

Important Notice

Case report
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 1051 - 1053

Penetrating Injury to the Neck Which was Caused by a Heavy Knife: A Case Report

Jayanta Bain, Manoj Bhargava, Pushpendra Shukla, Atul Kumar Singh

1. Post Graduate Training (MS) 2. Post Graduate Training (MS) 3. Assistant Professor 4. Associate Professor

Correspondence Address :
Dr. Jayanta Bain Village + Post Betai Dist Nadia West Bengal, India - 471163. Phone: 09575352304 E-mail:


A neck injury that extends deep into the platysma is called a penetrating injury of the neck. It is a diagnostic and a therapeutic challenge to the treating surgeon, because a number of important structures are densely packed in a small area, and the injury to any of these structures may immediately cause a life threatening situation. We are describing an interesting case, where a 40- year old woman presented with a penetrating neck injury which was caused by a heavy knife, which ran transversely from the left to the right side of the neck at zone-I. On presentation, she was found to have stable vitals and no active bleeding from the wounds; but, right ulnar nerve monoplagiea was found on examination. Bilateral exploration of the neck was done. The knife passed between the trachea and the oesophagus from the left side to reach up to the right supraclavicular fossa and it rested over the brachial plexus. The weapon was retrieved under direct vision. Surprisingly, there were no injuries to any vital structures of the neck. The patient made an uneventful recovery.

How to cite this article :

Jayanta Bain, Manoj Bhargava, Pushpendra Shukla, Atul Kumar Singh. PENETRATING INJURY TO THE NECK WHICH WAS CAUSED BY A HEAVY KNIFE: A CASE REPORT. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2018 Oct 18 ]; 6:1051-1053. Available from

Penetrating neck injuries represent approximately 5%-10% of all the trauma cases (1). Mostly they are from fire arm or stab injuries. Though the course of the stab wounds may be more limited than that of gunshot wounds, in the neck, number of vital structures are densely packed and so a stab injury can still have a clear potential to cause one or multiple major structural damages. The management should start with the Advanced Trauma Life Support (ATLS) protocol. Necessary investigations along with prompt medical and surgical therapies would minimize the morbidity and the mortality which are associated with such injuries.

Case Report

A 40-year-old female presented with a history of being stabbed in the neck 3 hours back. She was conscious and oriented; her pulse rate was 96/minute with a BP of 106/66 mm of Hg. 2 stab wounds were seen in Zone I of her neck. The 1st wound which was of size 3x2cm, was present over the anterior aspect of the left side of the neck, just lateral to the cricoid cartilage and the knife had penetrated through this wound. 2nd wound was of size 3x3cm was seen over the right side of the neck, just lateral to the cricoid cartilage. There was a 4x4cm hard swelling in the right supraclavicular area, but it did not expand in size or pulsate (Table/Fig 1). She complained of severe pain in the neck during any neck movement and during talking or swallowing. The pulsation of the carotid, superficial temporal, brachial and the radial arteries was intact and it was symmetrical bilaterally. On neurological examination, right ulnar nerve monoplagiea was noted. The expansion of the chest and the bilateral air entry in the chest were normal. No oronasopharyngeal bleeding, no active bleeding from the wound, no expanding haematoma and no subcutaneous emphysema were seen.

The patient was started on intravenous fluids and was given antibiotics, and tetanus prophylaxis. A blood specimen was collected for haemogram, blood grouping and blood chemistry studies. The cervical anteroposterior and lateral radiography showed a pointed foreign object which penetrated from the left side of the neck at the C4/C5 level, which directed medially and downwards; crossed the midline; and reached up to midclavicular line in the right supra-clavicular fossa. A tracheal deviation towards the right side was also seen (Table/Fig 2).

Exploration of the neck was done under general anaesthesia with endotracheal intubation. An oblique incision was made by extending the left sided entry wound downwards along the medial border of the left sternocleidomastoid muscle, up to the clavicle. On sharp and blunt dissection, the knife was found to be passing between the trachea and the esophagus. The right side of the neck was then explored with an oblique supra clavicular incision which was made directly over the swelling (Table/Fig 3). On dissection, the weapon was found to pass below the right sternoclidomastoid and the curved tip was found to point towards the swelling. The weapon was then gently dislodged and retrieved under direct vision. After the removal of the weapon, their was no active bleeding and all the major structures on either side of it were found to be uninjured (Table/Fig 4). The brachial plexus was also found to be uninjured. Both the right and the left sided wounds were throughly cleaned and closed in 2 layers over a Penrose drain. Intra-operative laryngoscopy, bronchoscopy and oesophagoscopy were done by using a rigid endoscope. reviled normal findings.

Post-operatively, the patient was continued on IV fluids, intravenous antibiotics and analgesics. The drain was removed on the third postoperative day. The patient had an uneventful recovery and there was no residual neuroplagiea.


The management of a penetrating neck injury should start with the Advanced Trauma Life Support (ATLS) protocol. After the stabilization of the patients’ condition, the workup should proceed in a timely manner. An immediate exploration is warned against, in the presence of an active bleeding with signs and symptoms of shock, or an expanding haematoma (2). Probing or local exploration of the neck to remove the foreign body should not be attempted in the emergency department, because the injuries in the major vessels may be tamponated by foreign bodies or a clot. Therefore, the blind removal of the objects may dislodge the clot and may initiate a life threatening haemorrhage (3). In stable patients, preliminary laboratory tests like evaluation of haemoglobin and the haematocrit level to determine the degree of blood loss, that of the glucose and electrolyte levels and toxicologic screening are also carried out. A chest and neck radiograph is very useful to evaluate the position of the foreign body; any vertebral injury; and free air in the prevertebral or the deep neck spaces, which are suggestive of an aerodigestive tract injury.

For analyzing wounds based on their craniocaudal locations, the neck is divided into 3 zones by using anatomic landmarks (4). Zone-I is the horizontal area between the clavicle/suprasternal notch and the cricoid cartilage; Zone-II is the area between the cricoid cartilage and the angle of the mandible; Zone-III is the area between the angle of the mandible and the base of the skull. Each zone has a group of vital structures that can be injured and this zonal division may determine the kind of trauma management which has to be given.

In our case, there was no clinical sign of any vascular injury and the X-ray findings were not suggestive of any injury to the aerodigestive tract. So we decided to explore the neck without any further delay. We explored the neck bilaterally, because firstly, on its long path, the knife had a clear potential to injure many structures; secondly, to confirm the nature of the swelling whether it was a haematoma or the projected tip of the knife or anything else; and lastly, to find out the cause of ulnar nerve monoplagiea. On the left side, we followed the standard neck incision which was parallel to the medial border of the sternoclidomastoid muscle and on the right side, an oblique supraclavicular incision was made, because it could provide a good exposure and vascular control at the root of the neck (5). On dissection, the swelling was found to be the projected tip of the knife and not a haematoma and the brachial plexus was also found to be uninjured. The cause of the ulnar monoplagiea was probably the local compression and the inflammation which were caused by the knife.

If an aerodigestive tract injury is suspected clinically before the neck exploration or if it is found during the exploration, intraoperative triple endoscopy (laryngoscopy, bronchoscopy, and oesophagoscopy) should be performed, because the early diagnosis and the management of the oesophageal injuries decreases the chances of devastating complications like mediastinitis (6). So, with a high suspicion of aerodigestive tract injury, we performed an endoscopy and the findings were normal.

Postoperatively, the patients are monitored closely in intensive care units with serial examinations to identify any missed injuries. Perenteral broad-spectrum antibiotics are the standard treatment and if no evidence of leak is present, drains and feeding tubes are discontinued and oral feeding is started.


To conclude, in a penetrating neck injury, where a large sharp foreign body enters the neck from one side and points on the opposite supraclavicular fossa, bilateral exploration of the neck should be done without further delay, because it gives the best opportunity to assess the whole injury tract visually and to manage such injuries properly.


Alterman DM, Daley BJ, Cheng EU, Selimanon V. Penetrating neck trauma. Medscape. [online] 2008 Sept. 9. available from: URL:http//
Tuncyurek P, Cabbarpur C, Aksu H. A case report on a foreign body which caused a penetrating neck injury. Ulusal Travma Dergisi. 2001;7:204-06.
Peloponissios N, Halkic N, Moeschler O, Schnyder P, Vuilleumier H. Penetrating thoracic trauma in arrow injuries. Ann Thorac Surg. 2001;71:1019-21.
Saletta JD, Folk FA, Freeark RJ. Trauma to the neck region. Surg Clin North Amer. 1973;53:73-86.
Demetriades D, Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, et al. Evaluation of penetrating injuries on the neck: a prospective study on 223 patients. World J Surg. 1997;21:41-47.
Singh RK, Bhandary S, Karki P. Managing a wooden foreign body in the neck. J Emerg Trauma Shock. 2009 Sept-Dec;2(3):191-95.

DOI and Others

ID: JCDR/2012/4467:2324


Date of Submission: May 05, 2012
Date of Peer Review: May 13, 2012
Date of Acceptance: May 26, 2012
Date of Publishing: Aug 10, 2012

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