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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 Series
Full Version
Paradigm Shift in the Management of Pseudoaneurysm Following Nephrolithotomy-A Case Series
Correspondence Address :
Dilip Kumar Pal,
Professor and Head, Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
E-mail: urologyipgmer@gmail.com
Renal artery pseudoaneurysm after nephrolithotomy or pyelolithotomy is rare, but is more often following Percutaneous Nephrolithotomy (PCNL) or renal biopsy. It is a potentially life-threatening condition, with an incidence of 0.1 to 0.3% after nephrolithotomy or pyelolithotomy. Manifestation may vary, from asymptomatic to symptoms like local bloody discharge, haematuria, pain, high blood pressure, and rupture causing a life-threatening condition. A minimally invasive technique, selective or super-selective angioembolisation is the treatment of choice. This case series reports, five cases presented with either bloody wound discharge or intermittent haematuria in the Emergency Department, post nephrolithotomy. All patients were resuscitated in the Emergency Department with intravenous fluid and packed red blood cell transfusion. After resuscitation, three patients were diagnosed with renal artery pseudoaneurysm on Computed Tomography of Kidneys, Ureters and Bladder (CT KUB) and angiography, and two patients with digital subtraction angiography during the intervention. All were treated with super-selective renal artery angioembolisation, with endovascular coiling of different sizes. All patients made an uneventful recovery, and on followup no complication was evident. Now-a-days the popularity of angioembolisation for renal artery pseudoaneurysm has increased, which shows a paradigm shift from a traditional surgical intervention.
Angioembolisation, Endovascular coiling, Pyelolithotomy
Pseudoaneurysm after nephrolithotomy is very rare. Incidence of pseudoaneurysm after nephrolithotomy and pyelolithotomy is 0.1 to 0.3%, while during PCNL and percutaneous renal biopsy, it is 0.6 to 1% and 2 to 3.4% respectively (1). It may manifest as local symptoms, haematuria, hypertension, or even catastrophic rupture of the vessel resulting in life-threatening haemorrhage and shock. Selective or super-selective renal embolisation is now the treatment of choice (2). Renal artery embolisation was first introduced in 1964 and advancement in radiology resulted in the development of super-selective renal arterial embolization (3). Tissue loss after embolisation is very important in end organs like kidney (4). Currently selective or super-selective renal embolisation is a safe and effective therapeutic option for pseudoaneurysm or arteriovenous malformation (5). Surgical intervention is rarely required, because it usually results in partial or total nephrectomy. Surgical intervention is reserved for large and refractory renal artery pseudoaneurysm (6).
Case 1
A 58-year-old male presented to Emergency Department, with a bloody discharge from the operated site after 2.5 month of open nephrolithotomy for renal stone, done at a peripheral hospital three month ago. He had a history of 18 units of packed red blood cell transfusion before presenting to our hospital. On admission, haemoglobin was 7 gm/dL. He was resuscitated with 2 units of packed red blood cells and intravenous fluid. After hemodynamic stabilisation, Computed Tomography angiography was done which shows a pseudoaneurysm of size 5.6×3.8×5 cm, arising from the segmental artery of the interpolar region of the left kidney with a large haematoma of size-13.4×11.2×24.6 cm surrounding the interpolar region, effacing the calyx and extending posteriorly in the lumbar region of the left-side of the pelvis over the psoas muscle (Table/Fig 1)a,b,(Table/Fig 2). Selective embolisation with endovascular coil (Two IMWCE 0.035?-3 mm-3 cm) was done (Table/Fig 3)a,b. After endovascular coiling, bloody discharge from the wound subsided. Follow-up was done with Ultrasonography (USG) KUB. On one month of follow-up, the patient was doing well.
Case 2
A 27-year-old female presented to the Emergency Department with intermittent haematuria, after one month of open right nephrolithotomy for large calyceal stone, done at a peripheral hospital two months back. On admission the patient was pale, and her haemoglobin was 6 gm/dL. The patient was resuscitated with 4 units of packed red blood cells with intravenous fluid. After stabilization of the patient, renal angiography was done which showed a lobulated pseudoaneurysm of size 18.9×13.6 mm at the right interpolar region arising from a segmental branch of the interpolar region (Table/Fig 4). CT-guided angioembolisation with endocoil (IMWCE 0.035?-3 mm-3 cm) was done. After angioembolisation haematuria subsided, and the patient made an uneventful recovery. At one month of follow-up, she was doing well.
Case 3
A 23-year-old male presented to the Emergency Department, with haematuria, with the passage of clots after 15 days of open right nephrolithotomy done at another hospital for renal stone, one month back. On admission, patient was resuscitated with 2 units of packed red blood cells and intravenous fluid. After stabilisation of the patient, digital subtraction angiography was done, which showed a renal segmental artery aneurysm (Table/Fig 5)a,b. Selective angioembolisation with the endovascular coil (Two MWCE 0.018?-3 mm-3 cm-HILAL) was done. After angioembolisation haematuria subsided. At one month of follow-up, he was doing well.
Case 4
A 42-year-old male came to the Outdoor patient Department with a complaint of haematuria after 25 days of right nephrolithotomy for large calyceal diverticular stone, done two months back at peripheral hospital. After resuscitation of patient, digital subtraction angiography was done which shows segmental artery aneurysm and treated with selective arterial embolisation (Table/Fig 6)a,b. Postoperative recovery was uneventful. On follow-up, he was doing well.
Case 5
A 29-year-old female presented in the Emergency Department with complaints of pain at the operative site, and haematuria for 18 days after left nephrolithotomy, which was done two months ago at peripheral hospital. On admission, the patient was pale, and her haemoglobin was 5 gm/dL. The patient was resuscitated with 5 units of packed red blood cells with intravenous fluid. After stabilisation of patient, CT KUB and angiography were done, which showed a renal segmental artery aneurysm of size 22 mm×16 mm in the left interpolar region, which was treated with angioembolisation. The patient became asymptomatic afterward. At one month follow-up, patient was doing well. Basic details of all cases are given in (Table/Fig 7).
There are variety of options exist for the treatment of renal stone, including Extracorporeal Shock Wave Lithotripsy (ESWL), PCNL, laparoscopic/ open pyelolithotomy, and nephrolithotomy. Nowadays, most renal stones are managed with ESWL or PCNL. Pyelolithotomy/nephrolithotomy is still performed occasionally if the stone size is large, lack of endourology facilities, or lack of experience in PCNL (1).
Pseudoaneurysm is an unusual condition, associated with nephrolithotomy or PCNL. The most common symptom associated with renal artery pseudoaneurysm is hematuria (7). CT angiography is a valuable non invasive diagnostic modality of choice for the diagnosis of renal artery aneurysm and also for the follow-up. Pseudoaneurysm is best seen in the arterial phase of CT angiography. It also demonstrates the entire urinary tract, along with focal lesions at the same time. Digital Subtraction Angiography (DSA) remains the gold standard for the diagnosis of renal artery pseudoaneurysm. So, it is used both as a diagnostic as well as therapeutic method (8). In this case series, three patients were diagnosed with CECT KUB with CT angiography, and the remaining two patients were diagnosed with DSA, which was both diagnostic and therapeutic.
Treatment options for renal artery pseudoaneurysm are conservative, nephrectomy, open vascular surgery, or angioembolisation, depending on the patient’s clinical condition (6). But now-a-days, angiographic embolisation is the treatment of choice due to its selective and minimal invasive nature, and the maximal preservation of renal parenchyma. Small-sized (<2cm) pseudoaneurysm may be managed conservatively, but if symptomatic in terms of bleeding, pain, and hypertension then selective/super-selective embolisation is the best treatment (1). Embolisation is well-tolerated, relatively safe, and allows maximal preservation of functioning renal tissue (4). Angioembolisation has the disadvantage of arterial injury, infection, haemorrhage requiring nephrectomy, contrast-induced nephropathy, and radiation exposure (4). A large pseudoaneurysm/AV malformation (>2cm), renovascular hypertension, expansion of the aneurysm, and evidence of renal damage, may need nephrectomy or partial nephrectomy (6). Currently, total or partial nephrectomy is reserved for the patient with renal infarction, severe ischaemic renal atrophy, or particularly complex intrarenal aneurysm (1).3
The procedure of angioembolisation starts from renal angiogram through a transfemoral approach. Selective embolisation of renal artery branches can be achieved by using microcatheters, inserted co-axially in a guidewire, minimising loss of viable tissue. Different embolic agents are available to treat pseudoaneurysm like endocoils, particulate agents, and liquid agents. Embolic agents can be used either alone or in combination (9). The choice should be based on the patient’s vascular anatomy and the pathologic process. We have used endocoils agents, because of their availability in our institution.
According to Rami A et al., and Ansari MS et al., successful management of a case of the renal artery pseudoaneurysm was done by angioembolisation (1),(9). Similarly, we managed all the cases of renal artery pseudoaneurysm by angioembolisation with very minimal complications. Angioembolisation is a paradigm shift in the management of renal artery pseudoaneurysm because it is a minimally invasive technique, less time-consuming, nephron sparing procedure, and has less complication. But the limitation of this procedure is, it needs an expert intervention specialist and the high cost of endo coils.
Pseudoaneurysm following nephrolithotomy though rare, can be life-threatening. In the modern era, such cases can be managed by minimal invasion technique, in the form of embolisation of specific branches of the renal artery and thus, kidneys can be saved. Angioembolisation can be regarded as a game changer in the modern era to manage these cases in a minimally invasive way.
DOI: 10.7860/JCDR/2022/57828.17067
Date of Submission: May 19, 2022
Date of Peer Review: Jun 25, 2022
Date of Acceptance: Aug 22, 2022
Date of Publishing: Oct 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 21, 2022
• Manual Googling: Aug 18, 2022
• iThenticate Software: Aug 20, 2022 (15%)
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