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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
Accidental Microcoil Migration into Right Atrium during Portal Vein Embolisation: A Case Report
Correspondence Address :
Dr. Ravi Arya,
Senior Resident, Department of Interventional Radiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune-411018, Maharashtra, India.
E-mail: bakarevishal3@gmail.com
With the advancement of technology in the field of medicine, minimally invasive vascular procedures are widely utilised for therapeutic effects. Embolisation is a minimally invasive approach to occlude a vessel for therapeutic benefit. However, these procedures are associated with a small percentage of complications, one of which is the migration of the embolising agent. Migration refers to the movement of the embolisation agent (mostly a coil) from the original placement site to an unwanted location. A 59-year-old male presented with complaints of abdominal pain lasting 2-3 months. A Contrast-enhanced Computed Tomography (CECT) scan of the abdomen revealed an ill-defined infiltrative lesion arising from the neck and body of the gallbladder. Curative surgery was planned in the form of an extended right hepatectomy; however, the Future Liver Remnant (FLR) calculated was not optimal (19%). The patient was therefore referred for preoperative Portal Vein Embolisation (PVE). During the procedure, there was an accidental microcoil migration to the right heart post-PVE, which was managed by minimally invasive techniques. The importance of multimodality imaging techniques used to identify the location and multidisciplinary approaches to aid management has also been highlighted.
Curative surgery, Embolising agent, Future liver remnant, Right heart
A 59-year-old male presented with complaints of abdominal pain persisting for 2-3 months, unresponsive to routine medical management. A CECT scan of the abdomen revealed an ill-defined infiltrative lesion approximately sized 5.0×4.3×4.6 cm, arising from the neck and body of the gallbladder with direct invasion into the right lobe of the liver, predominantly segments IVa and IVb (Table/Fig 1). On the post-contrast scan, there was heterogeneous enhancement with a central necrotic component within the lesion. A Positron Emission Tomography (PET) scan showed no evidence of metastatic disease elsewhere in the body. An ultrasound-guided biopsy from the lesion revealed moderately differentiated adenocarcinoma of the gallbladder. Curative surgery was planned in the form of an extended right hepatectomy; however, the calculated Future Liver Remnant (FLR) was not optimal (19%). Consequently, the patient was referred for preoperative PVE.
During the PVE procedure, under local anaesthesia, an ultrasound-guided percutaneous puncture of the left portal vein was attempted using a 21G Chiba needle (Cook Medical). However, accidental entry into the left hepatic vein occurred, which was recognised after checking the venogram and revealed filling of the left hepatic vein, Inferior Vena Cava (IVC), and contrast entering into the right atrium (Table/Fig 2). This access sheath was kept in situ with a slow infusion of heparinised saline connected to prevent thrombosis. The plan was to remove this sheath after the final PVE procedure with tract embolisation using micro coils.
This was followed by a repeat ultrasound-guided puncture of the left portal vein radical using a 21G Chiba needle through which a guide wire was passed and access was gained through the introduction of a 5F vascular sheath for further procedure (Table/Fig 3). Using a combination of a 4F Cobra (C1) catheter and Terumo guide wire, the right portal vein was accessed, confirmed by selective venograms. Using a coaxial microcatheter (2.70F Progreat, Terumo), selective embolisation of the anterior and posterior branches of the right portal vein was performed using n-Butyl Cyanoacrylate (n-BCA) mixed with Lipiodol in a 1:5 proportion (16.67%). Post-embolisation check venogram revealed non filling of the right portal vein branch and its anterior and posterior divisions. However, the left portal vein and its branches were patent with the diversion of the main portal vein blood flow to the left side, suggesting a successful procedure (Table/Fig 4).
Ultrasound and fluoroscopy-guided microcoil embolisation of the left portal vein access hepatic tract was successfully done to prevent bleeding. However, during similar tract embolisation of the left hepatic vein access tract, there was a sudden migration of the microcoil (Cook Nester microcoil 18-7-4) into the IVC and right atrium (Table/Fig 5). The microcoil was initially seen to be freely moving inside the right atrium on fluoroscopy. However, after some time, it became static. Through immediate right internal jugular venous access, multiple attempts were made to retrieve the microcoil using a snare, however, they were unsuccessful (Table/Fig 6). After consultation with a cardiologist, a bedside transesophageal echo was performed, which confirmed the position of the microcoil inside the right atrial appendage (Table/Fig 7). The patient had no new complaints related to the microcoil migration, and he was haemodynamically stable. After a thorough discussion with the cardiologist and the patient’s relatives about this incident and future possibilities, it was decided not to further intervene for microcoil retrieval due to the serious risk of right atrial appendage perforation and cardiac tamponade. The patient was started on Tablet Aspirin 75 mg OD for three months to prevent the development of micro-thrombi over the coil and was counseled for close follow-up. No complications related to microcoil migration were observed on follow-up for six months.
Portal Vein Embolisation (PVE) is a commonly performed procedure that increases the Future Liver Remnant (FLR) prior to resection (1). The complications post-PVE can be categorised into puncture-related, which include vascular injury, bilioma formation, abscess formation, and embolisation-related, which include migration of the embolisation agent, liver parenchymal infarction, non-target embolisation, and complete portal vein thrombosis, portal hypertension (2). The present case is unique because there was no migration of the n-BCA used for PVE, but the microcoil used for embolising the liver parenchymal tract had migrated to the right heart. Schechter MA et al., in their review of literature of 19 case series and 115 case reports, with respect to retrieving a fractured medical device, malpositioned coil of migrated IVC filter, found that only 20 intravascular foreign bodies were due to coil migration (3).
In cases with varicocele coil embolisation, Fu J and Hsia D reported a case with coil migration to the left pulmonary artery with a resultant small distant infarct (4). Due to the high risk of retrieval,
the case was managed conservatively. In a similarly treated case, Chomyn JJ et al., described successful percutaneous retrieval of a migrated coil to the right lower lobe pulmonary artery (5). After the literature review, Wang X et al., recommended the early removal of intracardiac foreign bodies. The potential complications included infections, thrombosis, and further distal embolisations (6). Fisher RG and Ferreyron R found that most fatal complications involved foreign objects migrated to the cardiac chambers in cases of catheter embolisations (7).
According to recent reports, intracardiac foreign bodies that are clean, smooth, and embedded within the myocardium can be left in situ due to less risk of life-threatening issues (8),(9),(10). Karia N et al., described a case in which the removal of the migrated coil, postvaricocele embolisation, was necessary as it was in close proximity to the tricuspid valve. Surgical extraction of the coil was performed via a median sternotomy using a full cardiopulmonary bypass (11).
Percutaneous retrieval of the migrated coil from the left atrium postpulmonary arteriovenous malformation Embolisation was described by Lu T and Quanadii SD (12). The success rate of percutaneous coil retrieval was approximately 50% as per Gulati S and Singh AK (13). Kyaw H et al., described a case of coil embolisation to the right side of the heart after elective hypogastric vein embolisation requiring open-heart surgery (14).
The percutaneous approach is the safest and most justified to remove intracardiac foreign bodies. However, in difficult cases when open removal becomes necessary, the associated risk of sternotomy and cardiopulmonary bypass must be weighed against possible complications with a conservative approach (11).
Minimally invasive procedures demand a high level of operator experience and skill because the options available for the management of procedure-related complications are fewer. In the present case, the microcoil was intended to be used for embolisation of the access tract; however, it accidentally became lodged into the hepatic vein and migrated through the IVC into the right heart with the blood flow. All prompt required management procedures were considered, but they were not successful, and hence, a conservative approach was preferred considering the high risk of open surgery. The procedure steps and possible minor/major complications must be discussed prior to prevent any major mishap.
DOI: 10.7860/JCDR/2024/66820.19038
Date of Submission: Aug 01, 2023
Date of Peer Review: Oct 13, 2023
Date of Acceptance: Oct 23, 2023
Date of Publishing: Feb 01, 2024
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: Aug 03, 2023
• Manual Googling: Oct 14, 2023
• iThenticate Software: Oct 20, 2023 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com