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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
Variations in the Branching Pattern of the Coeliac Trunk
Correspondence Address :
Dr. Jyothi Krishnarajanagar Chandrachar
Assistant Professor, Department of Anatomy,
MS. Ramaiah Medical College Msrit Post
Bangalore, 560054, India.
Phone: 9731346464, 9448713013.
E-mail: jyothimohankc@gmail.com.
The knowledge on the anatomical variations of the abdominal aorta is important due to its clinical significance. The variations of the coeliac trunk are common but asymptomatic; they may become important during surgeries and in some radiological procedures. The coeliac trunk, in the present case report, in addition to the left gastric, splenic and the common hepatic arteries, was also giving origin to the accessory right hepatic artery and to both the right and the left inferior phrenic arteries. The hepatic artery proper was trifurcating into two right hepatic arteries and one left hepatic artery. The cystic artery was arising from the accessory right hepatic artery, instead of taking origin from the right hepatic artery. The left gastric artery was giving origin to the accessory left hepatic artery. The findings of our case study could help in minimizing the operative and the post-operative complications which are related to abdominal surgeries and they may facilitate better and accurate radiological interpretations. The clinical implications of the variations have been stressed upon.
Coeliac trunk, Left gastric artery, Cystic artery, Accessory hepatic artery, Inferior phrenic artery
INTRODUCTION
The Coeliac Trunk (CT) is the first ventral branch of the abdominal aorta and it arises just below the aortic hiatus, at the level of the intervertebral disc, between the T12 and the L1 vertebrae. It is 1.5cm-2cm long and it divides into the left gastric (LGA), the common hepatic (CHA) and the splenic arteries (SA) (1). This usual branching pattern is referred to as a classical trifurcation and it was observed by Haller as Tripus Halleri. The branching pattern may vary from a classical trifurcation to an abnormal trifurcation, a bifurcation, a quadrifurcation, a pentafurcation and even an exafurcation of the trunk (2). The prevalence of this trifurcation has been reported by Malnar et al., (72%) (3), Song et al., (89.1%) (4), Ugurel et al., (89%) (5), Bergman et al., (86%) (6) and Prakash et al., (86%) (7). Though the variations in the CT are usually common but asymptomatic, they may become important in the patients who undergo a diagnostic angiography for gastrointestinal bleeding or prior to an operative procedure. Recognizing these variations, enables the clinicians in distinguishing the features which merit further investigations and treatment. The aim of the present cadaveric case study was to describe the variations in the branching pattern of the CT and its clinical implications.
During the routine dissection teaching of the abdominal region to undergraduate students in the Anatomy Department, MSRMC, Bangalore, India. we found a variation in the branching pattern of the CT in an adult male cadaver which was aged 60 years. All the branches were carefully dissected and photographed.
OBSERVATION
The CT was 1.5cm long and it arose from the ventral surface of the abdominal aorta, at the level of the intervertebral disc, between the T12 and the L1 vertebrae. It gave origin to the right and the left inferior phrenic arteries and to the accessory right hepatic arteries (ARHA), instead of its usual three branches. The LGA was the smallest branch, it coursed upwards and to the left and about 4cm from its origin, the accessory left hepatic artery was given off. The calibre of this accessory left hepatic artery was the same as that of the LGA, which entered the liver between the caudate and the left lobes of the liver.lapThe CHA was slightly larger than the LGA in caliber passing towards right and at the right free margin of lesser omentum, it provided origin to right gastric and gastroduodenal artery as usual. It continued upwards later as the proper hepatic artery and trifurcated immediately, giving two branches to the right lobe and one branch to the left lobe, all being 2mm in diameter. The right hepatic artery, without giving the cystic artery, entered the right lobe of the liver. The SA was the largest branch of the CT without any variations. The ARHA was approximately 4mm in diameter and 2 times wider than the hepatic arteries, traversing behind the common hepatic duct. About 8cm from its origin, a branch was given off, which entered the inferior surface of the right lobe. Further, at about a distance of 0.5cm-1cm, the cystic artery originated and at the neck of the gall bladder, it divided into the superficial and the deep branches. Finally, the ARHA terminated at the inferior surface of the right lobe of the liver (Table/Fig 1). Both the right and the left inferior phrenic arteries arose independently from the right and left contours of the CT respectively. The right inferior phrenic artery was 0.6mm in diameter, whereas the left inferior phrenic artery was 0.4mm in diameter. Both these branches terminated themselves on the abdominal surface of the respective domes of the diaphragm. (Table/Fig 2).
The anatomical variations of the CT were first classified by Adachi and Michels in 1928, based on 252 dissections on Japanese cadavers, where six types of divisions of the CT and the superior mesenteric artery were described (8),(9). The types of CT according to Michel‘s classification (9) are as follows:
Type1: normal branching,
Type 2: the hepatosplenic trunk and the LGA from the aorta.
Type 3: the hepatosplenomeseteric trunk and the LGA from the aorta.
Type 4: the hepatogastric trunk and the SA from the superior mesenteric artery.
Type 5: the SA and the LGA from the CT and the CHA from the superior mesenteric artery.
Type 6: the coeliacomesenteric trunk, the SA, the LGA, the CHA and the superior mesenteric artery arise from a common trunk. Lipshutz gave a detailed account of the CT, based on the mode of origin and the distribution of the gastric, splenic and the hepatic arteries and classified his findings into 4 types.
Type I: (75% cases) The coeliac axis (CA) was the common trunk of origin for the LGA, the SA and the CHA.
Type II: (15% cases) The HA and the SA arose from the CT, but the LGA had a varied origin, either from the HA or directly from the abdominal aorta.
Type III: (6% cases) The LGA and the HA took origin from the CA, but the SA was a separate branch from the abdominal aorta.
Type IV: (4% cases) The CA was the trunk of origin for the gastric artery and the SA, but the CHA occurred as a separate branch from the aorta (10). Wadhwa reported that among his 30 cases, type 1 CA was found in 28 cases and that the type 2 CA was found in 2 cases (11).
The anamolous origins of the cystic artery are commonly encountered during cholecystectomy. The variant origins of the cystic artery include its origin from the left hepatic artery (4%), the gastroduodenal artery (1.4%), the superior pancreaticoduodenal and the retroduodenal arteries (1.4%), CT (1.4%) and from the superior mesenteric artery (1.4%) (12). Hlaing (12) observed a unique origin of the cystic artery from the middle hepatic artery, which was a branch from the right hepatic artery, which ended in the quadrate lobe of the liver. Michels quoted the term, MHA, which is the extrahepatic branch of the RHA or the LHA that supplies the caudate and the quadrate lobes of the liver (13). A detailed anatomical knowledge on the cystic artery is very important for the surgeons and the radiologists who perform laparoscopic cholecystectomies and intraoperative cystic angiograms during hepatobiliary surgeries respectively (14). The patterns of the arterial supply of the liver are variable. The modifications of the dominant scheme in which the liver receives its total inflow from the hepatic branch of the coeliac axis, occurs in 25-75% of the cases. The surgical anatomy of the hepatic arteries in 1000 cases, has been reported by Hiatt et al., (15). The arterial pattern in the order of frequency, included the normal type 1 anatomy (n=757), with the CHA arising from the CA to form the gastro duodenal and the proper hepatic arteries. Type 3(n=106), A replaced or the ARHA originating from the superior mesenteric artery. Type 2(n= 97) with a replaced or the accessory left hepatic artery arising from the LGA, as was noted in our case. Type 4(n=23), with both the right and the left hepatic arteries arising from the superior mesenteric artery and the LGA respectively. Type 5(n=15), with the entire CHA arising as a branch of the superior mesenteric artery. Type 6(n=2), with the CHA taking direct origin from the aorta. This classification is modified from ten variants to six variants to reflect the presence of the vessels that were either accessory or replaced. These variant patterns are relevant, as they will affect the laparoscopic appearance of the porta hepatis. Yalcin et al., observed in a 25 year old Turkish female cadaver, that the left inferior phrenic artey and the LGA originated from the CT via a common trunk (16). Petrella et al., observed, that in 31 cadavers out of 89 cadavers which they dissected, the inferior phrenic artery had its origin from the CT (17). The knowledge on this type of variation showed that the surgeons must be cautious, to avoid an unintentional sectioning of the small calibre arteries and that these vascular anomalies may become important in patients who undergo a diagnostic angiography for gastrointestinal bleeding and prior to trans catheter therapies.
The arterial variations should not be ignored and with an accurate knowledge on the anatomical variations, many operative and post operative complications can be avoided. The knowledge on the CT variations would enable the radiologists in protecting the important vessels prior to transcatheter therapies, and also in preventing inadvertent injuries. The anatomy of the hepatic artery is of great importance in hepatic surgeries, especially in liver transplantation and in many radiological procedures, to ensure complete arterializations of the grafts, which can prevent necrosis of the liver parenchyma post-operatively. A thorough knowledge on the vascular pattern of the cystic artery and its relations is important for the surgeons who conduct lapThe aroscopic cholecystectomies and it also helps the radiologists in performing intra-operative cystic angiograms.
ID: JCDR/2012/4706:2441
Financial OR OTHER COMPETING INTERESTS:
None.
Date of Submission: Jun 15, 2012
Date of Peer Review: Aug 07, 2012
Date of Acceptance: Aug 17, 2012
Date of Publishing: Sep 30, 2012
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