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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
A Study on the Anatomical Organization of the Aortic Arch Anomalies
Correspondence Address :
Dr. Sunitha Vinnakota
Department of Anatomy, MIMS, Nellimarla,
Vizianagaram (Dist.), AP., India.
Phone: 9848759297
E-mail: laksaca@gmail.com
Background:
The day to day advances in the fields of cardiac and vascular surgeries need to revive interest in the developmental and the adult anatomies of the Aortic Arch (AA) and its great vessels. A variant aortic arch branching pattern may occur with different embryological mechanisms. The variations in the branching pattern of the aortic arch may range from differences in the distance between the origins of the different branches to the number of branches. The present study was undertaken to study the variations in the branching pattern of the arch of the aorta and their surgical applications.
Aim:
In the present study, the anatomical characteristics of the aortic arch and its branches were evaluated by doing a macroscopic examination which has diagnostic and surgical importance.
Methods:
This study was conducted on 35 cadavers from the Anatomy Department, 100 aortic angiographic studies were done at the Care Hospital, Visakhapatnam and 300 CT angiographic studies were done at Vijaya Medical Centre, Visakhapatnam. This study was carried out by the conventional dissection method and by doing angiograms.
Results:
The normal branching pattern was observed in 26 specimens out of the 35 cadavers. The common trunk for both the brachiocephalic and the left common carotid arteries was present in 5 specimens. The left vertebral artery arose from the aortic arch between the left common carotid and the left subclavian artery in 4 specimens. Among these 4 cases, in 1 cadaver, the cervical segment of the left vertebral artery was very long and it entered through the foramen transversarium of the 3rd cervical vertebra. Whereas, in 1 cadaver, there were three branches which arose from the aortic arch, (1) the common trunk of the brachiocephalic and the left common carotid arteries (2) the left vertebral artery and (3) the left subclavian artery.
Conclusions:
Knowledge on the variations in the classical branches of the aortic arch is important in the diagnosis of intracranial aneurysms which occur after a subarachnoid haemorrhage. Clinicians and surgeons should be aware of the aortic arch variations. Prior identification of these vascular anomalies through diagnostic interventions is crucial, in order to avoid complications during heart and vascular surgeries.
Variation, Common trunk, Aortic arch, Aortic angiogram, CT angiogram
Introduction
The frequency of the congenital aortic arch abnormalities is less than 1% of the congenital cardiovascular defects. The aortic arch is a continuation of the ascending aorta, as it is located in the superior mediastinum. 3 classical branches spring from the convex aspect of the aortic arch, the Brachiocephalic Trunk (BCT), the Left Common Carotid artery (LCC) and the Left Subclavian Artery (LSA) (1). These branches may arise from the beginning of the aortic arch or from the convex part of the aortic arch with varying distances between them. The approximation of the left common carotid artery to the brachio cephalic trunk is an important observation in invasive surgeries, which helps in preventing injuries to these branches (2). Bernardi et al., (3) hypothesized that the anomalous origins and the distribution of the large aortic arch vessels could cause changes in the cerebral haemodynamics that could lead to cerebro vascular catastrophies. The detection of the anomalous origins of the great vessels prior to surgery has great diagnostic importance, as well as importance in the critical analysis of the further treatment. Intensive care patients should be screened before the long term placement of a nasogastric tube, in order to avoid fistulization and fatal haemorrhage (4). Momma et al., (5) described that aortic arch anomalies were also associated with the chromosome 22q11 deletion. The common brachiocephalic trunk may be a marker for the presence of accompanying congenital cardiac defects and coronary arterial abnormalities (6). The anatomical and the morphological variations of the vertebral artery are of great importance in surgery, angiography and in all non-invasive procedures (7). The present study has described the branching pattern of the aortic arch in Indian subjects, as the literature on the Indian population is meagre
This study was conducted on 435 specimens of both sexes by the routine dissection method and the angiographic method. The radio graphical imaging of the arch of the aorta and its branches were obtained by doing an angiogram which combined the use of cineangiography and aortography. The variant specimens were injected with glass sealant silicone gel and the models were preserved in the museum.(Table/Fig 13)
Cadaveric Study
During the routine dissection which was conducted over 35 cadavers of both sexes who were aged 50-70 years, at the Maharajah’s Institute of Medical Sciences, Nellimarla, the origins and the diameters of all branches at the sites of their origins from the aortic arch were recorded as morphological parameters with the help of vernier calipers and the variations in the branching pattern of the aortic arch were also noted. The variant specimens were injected with silicon glass sealant gel with the help of a pumping gun and they were allowed to dry for 48 hours in air. Then, the models were secured by cutting along the inferior margin of the aortic arch.
Angiogaphic Study
Aortic angiograms which were done in 100 patients in the year 2010 at the Care hospital, Visakhapatnam and 3OO CT angiographic studies which were done at the Vijaya Medical Centre, Visakhapatnam were studied for the clinical implications of the aortic arch anomalies (Table/Fig 1).
Cadaveric Study
In the present study, the aorta commenced from the upper part of the left ventricle, ascended for a short distance and arched backwards and downwards along the left side of the vertebral column, after arching over the root of the left lung in all the specimens. The most common aortic arch branching pattern was found in 26 (74.28%) of the 35 specimens. In this pattern, the 3 major branches, the BCT, LCC and the LSA originated independently from the arch of the aorta (Table/Fig 2). The most common variant branching pattern i.e., common Sharing (CT) for both the BCT and the LCC was found to be present in 14.2% of the cases (in 5 cases out of the 35 specimens) (Table/Fig 3). In 11.4% of the cases (4 out of 35 specimens), the Left Vertebral Artery (LVA) originated directly from the aortic arch (Table/Fig 4). Except in 1 specimen, where the cervical segment of the LVA was very long (Table/Fig 5) and where it entered the foramen transversarium of the 3rd cervical vertebra, the course of the cervical segment of the LVA was normal. In 3 specimens, the 4 branches, the BCT, LCC, LVA and the LSA originated from the aortic arch, whereas in 1 specimen, the LVA arose in between the common sharing of the BCT with the LCC and the LSA (Table/Fig 6)
Angiographic Study
In the aortic angiographic study, coarctation of the aorta was noticed in 2 out of 100 cases. So, the normal aortic arch pattern was noted in 98% of the cases.10 variant presentations of the aortic arch were noted among the 300 cases by the CT angiographic study; the types of variants included( a) the aberrant subclavian artery in 1 case (Table/Fig 7), (b) the right sided aortic arch in 2 cases (Table/Fig 8), (c) the Bi carotid trunk in 1 case (Table/Fig 9), (d) the double aortic arch in 2 cases (Table/Fig 10) and (e) co-arctation of the aorta in 4 cases (Table/Fig 11). Hence, the typical branching pattern was found in 96.6% of the cases.
The developmental anomalies in the aortic arch’s branching pattern arise from the unusual patterns of development of the embryonic aortic arch system of the pharyngeal arches, so that there may be persistence of the aortic arches that normally disappear or disappearence of the parts that normally persist. The proximal part of the third aortic arch normally gets extended and absorbed into the left horn of the aortic sac. If it gets absorbed into the right horn of the aortic sac, it can lead to anomalies where the left common carotid artery arises from the brachiocephalic trunk. A variation in the distance between the origin of these vessels has also been reported, the most frequent one being the approximation of the left common carotid artery to the brachiocephalic trunk (8). The origin of the vertebral arteries from the aorta suggests that a part of aortic arch arose from the left 7th inter-segmental artery or that there was an increased absorption of the embryonic tissue of the left subclavian artery between the origin of the aortic arch and the vertrebral artery (8). According to Satti SR (9), the possible cause for the origin of the left vertebral artery from the aortic arch is the persistence of the dorsal intersegmental arteries more cranial than the 7th intersegmental artery, which is the typical site of anastomosis. Albayaram et al., (10) suggested that the aberrant origin of the LVA directly from the aortic arch was due to the persistence of the 8th intersegmental artery. Koenisberg RA (11) reported that the left vertebral artery arose from the arch of the aorta, usually between the left common carotid and the left sub clavian artery in 6% of the population. According to the studies which were done by Hong Jae Taek MD (12), the vertebral artery entered the foramen transversarium of the C6 vertebra in 94.9% of the specimens (in 664 out of 700 cases) with an incidence of 5.1%, with an incidence of 1.6% through C4, with an incidence of 3.3% through C5 and with an incidence of 0.3% through the C7 foramen. A study which was done by Nayak et al., (13) reported the classical branching pattern of the aortic arch in 91.4% cases, and the arising of the LVA from the AA in 1.6% of the cases. Bergman et al., (14) reported a case of the RVA directly arising from the aortic arch. The frequency of the BCT which provided an origin to the LCCA was 11%, with the LSA arising independently from the arch. The common carotid arteries were the derivatives of the 3rd aortic arch and the left limb of the aortic sac normally formed the part of the arch that intervened between the origin of the BCT and the LCC arteries. If the aortic sac failed to bifurcate into the right and left limbs, then, the LCC artery would connect to the aortic sac directly, resulting in a common origin of the carotid trunk. In the present study, the bicarotid trunk was found in 1 case out of 300 CT angiograms. The persistence of the right dorsal aorta distal to the origin of the right 7th intersegmental artery resulted in the formation of a double aortic arch, which was noted in 2 CT angiograms. The right dorsal aorta persisted below the 7th intersegmental artery and the disappearance of the corresponding portion of the left dorsal aorta resulted in the right sided aortic arch. This variant was noted in 2 cases out of 300 angiograms. When the right 4th aortic arch degenerated, the right 7th intersegmental artery and the distal part of the right dorsal aorta continued as the right aberrant subclavian artery, which was noted in 1 case out of 300 CT angiograms. In a study which was done on the aortic arches of 516 Japanese cadavers, Adachi (15) found an aberrant right subclavian artery in 0.2% of the cases. 1% of the cases showed this anomaly in a study which was done by Williams GD and Edmonds HW (16) on 407 American cadavers. The congenital narrowing of the arch of the aorta distal to the origin of the left subclavian artery is co arctation of the aorta. This is of 2 types (a) pre-ductal and (b) post-ductal. In the pre-ductal type, the ductus arteriosus remains patent, whereas in the latter type, it is obliterated. In the present study, 4 CT angiograms and 2 aortic angiograms showed the post-ductal type of the co-arctation of the aorta.
The present study revealed a significant rise in the anomalies like the aberrant right subclavian artery, the right sided aortic arch, the Bi carotid trunk, the double aortic arch and the co arctation of the aorta. The aortic arch anomalies are associated with the anomalies of the heart. An irregular and imperfect development of the septum between the aorta and the pulmonary trunk may produce variations, as it develops from the conus arteriosus (14). Knowledge on the variations in the classical branches of the aortic arch is important in the diagnosis of intracranial aneurysms which occur after a subarachnoid haemorrhage (19). Keeping abreast with the latest tendencies of the variations of the aortic arch is utmost essential for clinicians and CT surgeons, as the prior identification of these vascular anomalies through diagnostic interventions is crucial, in order to avoid complications during heart and vascular surgeries.
We are grateful to our Dean Dr. T.A.V. Narayana Raju & management for their kind support and encouragement. Our special thanks to Dr. K. Damodar (Care Hospital) & Dr. K. Suman (Vijaya Medical Centre) for their help, suggestions and co-operation.
ID: JCDR/2012/4245:2460
Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Mar 07, 2012
Date of Peer Review: Jun 08, 2012
Date of Acceptance: Jun 13, 2012
Date of Publishing: Sep 30, 2012
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