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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Consultant
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Aug 2018




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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.
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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
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On Jan 2020

Important Notice

Case report
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : XD01 - XD03 Full Version

Inexplicable Abdominal Pain in a Patient with Advanced Recurrent Osteogenic Sarcoma: A Case Report


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53791.16390
Chaitanya Rangangouda Patil, Prasad K Tanawade, Nilesh A Dhamne, Navnath Dhone, Kiran G Bagul

1. Consultant, Department of Pain and Palliative Care, Kolhapur Cancer Centre, Kolhapur, Maharashtra, India. 2. Consultant, Department of Radiation Oncology, Kolhapur Cancer Centre, Kolhapur, Maharastra, India. 3. Consultant, Department of Medical Oncology, Kolhapur Cancer Centre, Kolhapur, Maharashtra, India. 4. Consultant, Department of Radiology, Kolhapur Cancer Centre, Kolhapur, Maharashtra, India. 5. Consultant, Department of Surgical Oncology, Kolhapur Cancer Centre, Kolhapur, Maharashtra, India.

Correspondence Address :
Dr. Chaitanya Rangangouda Patil,
A/p. R. S. No. 238, Gokul Shirgaon, Karveer, Kolhapur, Maharashtra, India.
E-mail: docterchaitanya@gmail.com

Abstract

Abdominal pain is one of the most common causes of emergency department visits. Comprehensive patient assessment is required to identify the cause of abdominal pain. The origin of abdominal pain can be intra-abdominal or extra-abdominal. The majority of the cases with abdominal pain will have typical symptoms, suggesting intra-abdominal pain. A small subset of patients has atypical symptoms suggesting an extra-abdominal cause for the pain. Reports suggest that patients who presents with pain in the abdomen have the primary aetiology from the spinal column. This case report presents a 32-year-old male patient, with abdominal pain in advanced, recurrent Osteogenic Sarcoma (OGS) with spinal metastasis as the primary aetiology. Compression of nerve roots due to spinal bony metastasis lead to abdominal pain in the present case. Even though it was of spinal origin, clinically it micmicked to be of abdominal origin, so oncologists have to be vigilant in considering the rare causes of abdominal pain. Detailed history and clinical examination of the patients is ideal approach to identify the cause.

Keywords

Pain management, Palliative care, Quality of life

Case Report

The Medical Oncology department referred a 32-year-old male patient, a tobacco chewer and beedi smoker (10 years) with lower socio-economic status, to the pain and palliative care department. His chief complaint was lower abdominal pain (umbilical and peri umbilical region). Upon detailed evaluation, the pain was dragging and pricking type over the adjacent areas of the umbilicus. He scored his pain 8/10 on the Visual Analog Scale (VAS) score. The pain was present for one month, gradual onset, and progressive. For the last two weeks, the pain had increased. His pain increased during sitting and standing for his routine work for long. The pain was continuous in nature, disturbing his sleep in the past two weeks and significantly affecting his quality of life. He had a history of passing hard stools for three days. There was no history of nausea, vomiting, or urinary complaints. There was no history of abdominal surgery in the past. The patient also complained of pain in the lower back (since three weeks), VAS 5/10, dull aching type of pain. History suggested he was operated on for OGS of proximal humerus 1.5 years back. He also had received chemotherapy before surgery for his disease.

The patient was an average-built adult who was depressed and irritable due to his pain on physical examination. The examination revealed rigidity in both the iliac region and hypogastric region. The sensory examination over the abdominal wall was normal. There was no increase in pain with cough. There was no distension. Due to rigidity expressed by the patient, organomegaly could not be appreciated. Auscultation revealed normal bowel sounds. There was mild spinal tenderness. Digital rectal examination was normal. Systemic examination of other sites was uneventful. A provisional diagnosis of pain of abdominal origin was made. The initial pain management had anti-spasmodic (hyoscine butylbromide) thrice a day and non steroidal anti-inflammatory drugs (ibuprofen+paracetamol) thrice a day along with antacids (pantoprazole) once a day.

Laboratory tests like complete blood count, renal and liver function tests, erythrocyte sedimentation rate, C reactive protein, serum electrolytes, serum lipase, and amylase were normal. Electrocardiography monitoring showed no abnormalities. The patient was further subjected to Computed Tomography (CT) of his thorax, abdomen, and pelvis to look for the disease status. There was no visceral metastasis in the lungs, liver, or other organs; however, florid skeletal metastatic deposits in the dorsal spine, lumbar spine, sacral spine, right femur, and left sacrum were noted. Lytic lesions were over D3, D4, D7, D8, D9, L1, L3-5, S1, and S2 (Table/Fig 1). Of these lytic lesions, the most significant lesion was of the spinal process and body of L1 {Size of lesion was 12.1 mm; 8.2 mm3; significant nerve compression (By definition, the size of lesion more than 8 mm along with nerve compression more than 50% in the scan) was seen} (1). Magnetic resonance imaging of the whole spine revealed the lesions specifically causing the symptoms (Table/Fig 2). Axial imaging of the L1 lesion showed destruction of the body and spinal process causing compression of the nerve root (Table/Fig 3).

After the imaging evaluation, a final diagnosis of referred abdominal pain of spinal origin secondary to bony metastasis of OGS was made. Hence, the pain management course was changed to narcotics (morphine 10 mg every four hours), steroids (dexamethasone) thrice a day, antiemetic prokinetic agent (metoclopramide), laxatives (sodium picosulfate+liquid paraffin+milk of magnesia), and antacids (pantoprazole). He was further referred to the radiation oncology department for palliative radiotherapy, and was planned for bisphosphonate therapy in further follow-ups. These medications were given for 15 days. On follow-up, the patient was having pain of 2/10 on the VAS scale and was comfortable in terms of his sleep and other routine activities.

Discussion

Pain in the abdomen is the single most crucial symptom that hampers cancer patient’s quality of life (2). Abdominal pain is one of the most common causes of emergency department visits (4-5%) (3),4],(5). It is also the most common cause of admissions in palliative care patients [6,7]. Comprehensive patient assessment is required to identify the cause of abdominal pain. The origin of abdominal pain can be intra-abdominal or extra-abdominal. The majority of the cases with abdominal pain will have typical symptoms, suggesting intra-abdominal pain (8). A small subset of patients has atypical symptoms suggesting an extra-abdominal cause for the pain. Reports suggest that patients presented with pain in the abdomen with the primary aetiology from the spinal column (9),(10),(11),(12),(13),(14). Diagnostic uncertainty and risk of representation are two factors that make 2abdominal pain a problematic symptom (14),(15). Referred pain to various sites in the body can be understood on the basis of the dermatomal distribution of the nerves. The incidence of referred pain in cancer patients was between 8-20% in various studies (16),(17),(18),(19).

In a general overview idea, abdominal pain can be somatic (parietal) pain, visceral pain, or referred pain (20). In the present case report, the patient had rigidity on per abdominal examination, which was gave the impression that the pain was of somatic origin (20),(21),(22). A dragging type of pain in and around the umbilical region in index patient seemed to be a pointer towards lesion in the urinary bladder, kidney, or lower bowel (visceral) (23). A third reason explains abdominal pain, which is categorised as referred pain. Referred pain is pain that is felt away from the site of origin. It is because of the common anatomical origin or same nerve root innervations (24). Ruch’s convergent-projection theory reports that afferent visceral sensory pain fibres and somatic fibres enter the same spinal dorsal root ganglia segments of the spinal cord, causing misinterpretation by the central nervous system about the origin of the pain (24),(25).

The present case had the most significant lytic lesion of the L1 spinal process and body metastasis which was compressing the nerve root, causing lower abdominal pain. Previous reports of thoracic tumours, schwannoma, and meningioma of the spinal cord have reported similar findings (11),(12),(13). A course of steroids and escalating the pain medications to narcotics relieved his pain completely, suggesting the origin of pain was spinal metastasis and not intra-abdominal. But, it is also important to note that a minor proportion of patients will have abdominal pain, which is of extra-abdominal origin. Therefore, detailed history, physical examination of the patient presented with abdominal pain, and appropriate investigations are crucial in identifying the cause and proper management of the patients.

Conclusion

In the present case, abdominal pain in and around the umbilical region was of spinal origin. Bony metastasis in the spinal column can lead to compression of nerve roots and present as abdominal pain. Clinicians have to be vigilant in identifying such causes. Early identification and prompt treatment will benefit the patients in improving their quality of life.

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Mitera G, Zeiadin N, Kirou-Mauro A, DeAngelis C, Wong J, Sanjeevan T, et al. Retrospective assessment of cancer pain management in an outpatient palliative radiotherapy clinic using the pain management index. J Pain Symptom Manage. 2010;39(2):259-67. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/53791.16390

Date of Submission: Jan 06, 2022
Date of Peer Review: Feb 05, 2022
Date of Acceptance: Mar 17, 2022
Date of Publishing: May 01, 2022

Author declaration:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 08, 2022
• Manual Googling: Mar 07, 2022
• iThenticate Software: Apr 02, 2022 (5%)

Etymology: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com