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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
Mediastinal Pseudocyst in a Case of Chronic Pancreatitis: A Rare Presentation
Correspondence Address :
Dr. Arjun Heda,
MBBS Intern, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha-442001, Maharashtra, India.
E-mail: arjunheda71@gmail.com
Pancreatic pseudocysts are collections of fluid localised within the pancreas or in the peripancreatic space, which can occur following acute pancreatitis or in patients with a history of acute pancreatitis and chronic pancreatitis. They are well-known complications of pancreatitis. The pathogenesis of pancreatitis depends on its etiology, where enzyme-rich fluid and products of autoregulation accumulate in acute pancreatitis, and cysts are formed due to obstructed ducts in chronic pancreatitis. The development of pancreatic pseudocysts is more commonly associated with chronic pancreatitis than acute pancreatitis. Unless ruptured, pancreatic pseudocysts are usually not hazardous. Diagnosis of pseudocysts has become easier with advanced diagnostic techniques such as ultrasound and Computed Tomography (CT) scans. Patients presenting with abdominal pain and elevated pancreatic enzymes should be suspected of having pseudocysts. Approximately one-third of these cases resolve spontaneously. In the past, surgery was the only management method, but recently, with newer techniques such as percutaneous drainage and endoscopic cyst enterostomy, management has become easier. Percutaneous drainage, performed under local anaesthesia, is a cost-effective procedure with very low complications. The recurrence rate is higher with single-needle treatment, so catheters are used to decrease recurrence. Drainage should be the first choice of management, but with advancing technology and endoscopic techniques, it may become more useful in the future with skilled practitioners. In this case report, we will examine the case of a 30-year-old male who presented with symptoms of pain in the epigastric region and was diagnosed with a pancreatic pseudocyst. This case demonstrates a rare presentation where the pseudocyst extends into the mediastinum and thorax.
Acute pancreatitis, Autoregulation, Cysts, Drainage, Peripancreatic space
A 30-year-old male patient presented to the casualty department with complaints of chest pain, which was of a constricting type and radiated to the back, accompanied by breathlessness for the past eight days. He also reported weight loss. There was no history of vomiting, loose stools, cough, cold, or abdominal pain. The patient did not have a known history of hypertension, diabetes mellitus, bronchial asthma, or tuberculosis. He was a chronic alcoholic and had been consuming alcohol, 300-400 mL daily, for the past 10 years, but had stopped five days ago. On physical examination, his pulse was 78 beats per minute, blood pressure was 110/70 mmHg in the supine position, and respiratory rate was 16 breaths per minute. No pallor, icterus, cyanosis, clubbing, lymphadenopathy, or edema was observed. The patient was then referred to the Department of Medicine, where all relevant investigations, such as Complete Blood Count (CBC), Liver Function Test (LFT), and Kidney Function Tests (KFT), were performed (Table/Fig 1). Additionally, a COVID-19 swab test for RT-PCR was conducted, which was found to be negative. Contrast-Enhanced Computed Tomography (CECT) revealed findings consistent with subacute to chronic pancreatitis, with multiple pseudopancreatic cysts adjacent to the head and tail of the pancreas. Mediastinal implants of pseudopancreatic cysts and small pseudopancreatic cysts around the spleen were also noted. Chronic portal vein thrombosis with cavernoma formation at the porta with perfusion was observed. Left-sided pleural effusion, along with collapsed left lower lung, and multiple splenorenal and gastric varices were also appreciated. A gastroenterologist was consulted, and endoscopy was recommended. Endoscopy findings indicated early oesophageal varices with a large fundal varix and oedematous pylorus. Medications were initiated, including Injection (Inj.) Meropenem 1 gm i.v. TDS for 14 days, inj. Optineuron 1 AMP in 100 mL of normal saline, Inj. Octreotide 25 mg i.v. TDS for 10 days, along with Inj. Pan 40 mg i.v. OD and inj. Emset 4 mg i.v. TDS for five days.
Nebulisation was performed with Duolin 2-4 mg/dose every eight hours, and Budecort 0.5-1 mg/dose every 12 hours. A high protein diet was initiated. Abdominal CECT was conducted, revealing findings consistent with chronic pancreatitis, including multiple pseudocysts in the head and tail of the pancreas extending into the posterior mediastinum, left hemithorax, and left hypochondrium, along with multiple collaterals and splenic infarct. A chest X-ray showed a massive left-sided pleural effusion (Table/Fig 2). Pigtail catheterisation was performed, and the pleural fluid was sent for investigation. Despite daily drainage, there was a massive collection of fluid. Therefore, Magnetic Resonance Cholangiopancreatography (MRCP) was planned to assess the presence of any pleuro-pancreatic fistula tract. MRCP revealed chronic pancreatitis with multiple pseudocyst formation, extending into the mediasternum and left hemithorax (Table/Fig 3). Endoscopic Retrograde Cholangiopancreatography (ERCP) was then planned, but cannulation of the pancreatic duct with a PD stent could not be achieved due to fibrosis. Nasogastric tube feeding was attempted, but due to the distorted abdominal anatomy, repeated attempts to insert the nasogastric tube resulted in it coiling in the stomach. Consequently, the patient was discharged with a pigtail catheter in place and advised to continue inj. Octreotide at home. A follow-up appointment was scheduled after seven days. On follow-up, the patient was doing well, and symptoms were relieved. In (Table/Fig 4), a pseudocyst near the head of the pancreas was visible, extending through the hiatus into the posterior mediastinum, lying anterior to the oesophagus. The lesion further occupied the available space, extending into the entire left hemithorax and causing the collapse of the left lung. The lesion demonstrated peripheral enhancement on post-contrast imaging.
Pancreatic pseudocysts, a complication of pancreatitis, can develop in both acute and chronic pancreatitis. The disease may either remain asymptomatic or develop serious complications. Attacks of acute or chronic pancreatitis may precede pseudocysts. They can be classified based on different criteria. One classification is the Atlanta classification, which is based on the pathogenesis of pseudocyst formation (1). Another classification by D’Egidio and Schein takes into account the underlying disease, as well as, the anatomy of the duct and pseudocyst-duct communication (2). Nealon and Walser’s classification considers the duct anatomy and the presence or absence of contact with the pseudocyst cavity (3). Pancreatic pseudocysts are more commonly seen in patients with chronic pancreatitis compared to the acute form. In acute pancreatitis, the incidence of pseudocysts ranges from 5% to 16%. However, in chronic pancreatitis, the numbers are larger, with incidence rates ranging from 20% to 40% documented. Patients with chronic pancreatitis caused by alcohol consumption have the highest prevalence of pancreatic pseudocysts, with 5 to 12 per 8100,000 people (4). Other causes may include gallstone-induced pancreatitis, postsurgical pancreatitis, and rarely, hyperlipidaemia-induced pancreatitis and idiopathic causes (5).
In the present case, we observed how a patient with a pancreatic pseudocyst presented and received treatment based on their symptoms. Similar cases have been reported in the past. One case involved a 67-year-old female who presented with a three-month history of chest pain, dyspnoea, dysphagia, and weight loss. This patient had experienced an episode of acute alcoholic pancreatitis the previous year due to excessive alcohol intake, indicating regular alcohol consumption. Chest radiography upon admission revealed retrocardiac opacity. A CT scan showed the presence of a hypodense cystic mass extending from the body of the pancreas into the thorax, up to the subcarinal angle, exerting pressure on the distal oesophagus and possibly the cardiac chambers. ERCP was performed, revealing normal duct anatomy. An Endoscopic Ultrasound (EUS) guided drainage of the pseudocyst was performed, creating two paths with a 19-Guage needle through the transoesophageal approach. The fluid was drained, and no drainage stent was left in place (6).
Another similar case involved a 46-year-old man with a history of alcohol consumption who was diagnosed with chronic pancreatitis. Additionally, multiple small and cystic lesions were found in the head of the pancreas, along with two large cystic lesions adjacent to the tail of the pancreas. CT examination revealed calcification of the pancreas, and these findings were confirmed on MRCP. Cholangiopancreatography revealed bile duct stenosis and proximal dilatation in the intra-pancreatic region, as well as, stenosis of the duct in the pancreatic head and dilatation of the distal part of the body and tail. The management involved placing a bile duct stent and a pancreatic duct stent. The patient was also given medication after surgery, and they recovered smoothly (7).
A 22-year-old female patient with recurring upper stomach pain linked to chronic pancreatitis was referred to the hepatobiliary unit. She had a history of long-term alcohol consumption. A CT scan revealed a large fluid buildup in the lesser sac, extending beyond the oesophagus and into the lower mediastinum, up to the level of the carina. The majority of the cyst was located in the mediastinum and was connected to a left-sided pleural effusion. Additionally, the CT scan accidentally revealed a left gastric artery pseudoaneurysm along with pancreatic calcifications. Cyst aspiration was performed, followed by a surgical cystogastrotomy. Three months later, the cyst completely resolved (8).
A 52-year-old man was admitted to the hospital with complaints of severe abdominal pain radiating to his back, which had been ongoing for the past two months. The patient had a history of chronic alcoholism, consuming 100 g of alcohol per day for the last 28 years. Ascites was noted upon examination, and a contrast-enhanced CT scan of the abdomen and chest revealed calcification of the head of the pancreas. Endoscopy showed extrinsic compression of the oesophagus without any varices. The diagnosis of acute-on-chronic pancreatitis was made, and the patient was treated conservatively (9).
A 56-year-old patient with a history of chronic alcoholic pancreatitis was presented. She reported consumption 2-3 drinks per day for 25 years. CT findings of the upper abdomen were consistent with chronic pancreatitis, with posterior mediastinal fluid extending into the peripancreatic area. There was also evidence of mass effect on the oesophagus. MRCP confirmed the diagnosis of acute-on-chronic pancreatitis with a peri pancreatic fluid collection extending into the mediastinum. The patient was managed conservatively and discharged with instructions for regular follow-up (10).
All the cases discussed above share a common history of excessive alcohol consumption. Various diagnostic techniques have been employed, including CT scanning, transcutaneous and EUS, endoscopic retrograde cholangiopancreatography, cyst aspiration, chemistry, and cytology, all of which are used to diagnose pancreatic pseudocysts (11). Rapid advancements in diagnostic instrument development have enabled high sensitivity and specificity in detection (11). Transabdominal ultrasonography should be used as the initial step in identifying pancreatic pseudocysts due to its relatively affordable and non-invasive nature. CT imaging is crucial for treatment planning and has the highest sensitivity (12). The size of the pseudocyst also affects its management, with a higher risk of complications observed in necrosed pseudocysts. Surgical treatment has been the standard approach for pancreatic pseudocysts for nearly 40 years and is still commonly used today (13). With advancements in surgical skills, newer treatments such as cyst gastrostomy and gastrojejunostomy have become well-established. However, some scientists suggest that a nonsurgical procedures like endoscopic drainage are preferable (14). Endoscopic drainage is a minimally invasive treatment with surgicallike efficacy, achieving a cyst clearance rate ranging from 60% to 90% (14). The objective of endoscopic drainage is to establish a connection between the pseudocyst and the digestive tract, which can be accomplished through transmural or transpapillary drainage. Endoscopic retrograde cholangiopancreatography is used for transpapillary drainage when the pseudocyst cavity communicates with the pancreatic duct (15).
Although, there are different types of treatment modalities, in recent years, the endoscopic approach with surgery has gained importance for patients who have failed endoscopic and percutaneous drainage techniques. A complete and thorough history, examination, and diagnosis should be conducted as accurate recognition of the disease will help plan the treatment course. Neglecting symptoms can lead to further complications that may pose a threat to the patient’s life. Therefore, timely diagnosis and treatment are crucial for saving patients’ lives. A proper therapeutic approach involving a team of therapeutic endoscopists, interventional radiologists, and pancreatic surgeons should be considered in all cases, regardless of the technique used. The treatment should be tailored to the patient, and timely follow-up is necessary.
DOI: 10.7860/JCDR/2023/65178.18534
Date of Submission: May 03, 2023
Date of Peer Review: Jun 05, 2023
Date of Acceptance: Aug 11, 2023
Date of Publishing: Oct 01, 2023
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: May 09, 2023
• Manual Googling: Jun 02, 2023
• iThenticate Software: Aug 09, 2023 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 8
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