Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 54834

AbstractCase ReportDiscussionConclusionReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

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

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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)
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.
On April 2011

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
On Jan 2020

Important Notice

Case report
Year : 2007 | Month : April | Volume : 1 | Issue : 2 | Page : 79 - 81 Full Version

Primary Idiopathic Osteolysis Syndrome: Case Report And Review Of Literature

Published: April 1, 2007 | DOI:

Department of Radiology & Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical sciences Rae Bareily Road , Lucknow, UP, India

Correspondence Address :
: Dr Sanjay S Baijal, Professor,
Department of Radiology,
Sanjay Gandhi Post Graduate Institute of Medical sciences,
Rae Bareily Road, Lucknow, UP, India
E Mail:


Primary idiopathic osteolysis (massive osteolysis, essential osteolysis, progressive atrophy of bone, spontaneous absorption of bone, phantom bone) is an extremely rare occurrence. This disorder is characterised by spontaneous or post traumatic bone resorption of uncertain etiology with unpredictable prognosis, and any effective therapy is largely unknown (1). We report the clinico-radiological features of a 10-year-old male patient with this condition, and present a short review of the available literature.


Osteolysis, Bone disorders

Primary idiopathic osteolysis was first described nearly 150 years back by Jackson in 1838. On literature review, it is evident that various eponyms have been used to describe this mysterious disorder of the musculoskeletal system. In 1955, Gorham and Stout provided a more comprehensive report on this subject (1),(2),(3). Based on their experience and case reports available in literature, they found that most cases of osteolysis syndromes are associated with abnormal vascular proliferation in the vicinity of resorbed bone, the alteration of acid-base balance in local milieu being responsible for the pathology. The nomenclature these authors assigned to such osteolysis secondary to vascular proliferations was “Vanishing Bone Disease”. This disease is also known as Gorham’s disease (2),(3). No specific cause could be ascertained for a minority of cases that have been henceforth classified under the umbrella of “Primary Idiopathic Osteolysis Syndromes”. The purpose of this article is to report this rare entity and to review the etiopathology, clinical presentation, radiographic findings, differential diagnoses, and treatment options for patients with primary idiopathic osteolysis syndromes (3).

Case Report

A 10-year-old male patient presented to us with progressively deforming joints of hands and elbow for the last three years.
He was a school going child demonstrating normal scholastic and developmental milestones. There was a history of insidious onset of pain, limitation of motion, and progressive weakness in bilateral wrist and elbow joints with no associated soft tissue swelling. There was no history of significant trauma.
The routine laboratory blood tests including full blood count and erythrocyte sedimentation rate were normal. Neither rheumatoid factor nor antinuclear factor was detected. The serum alkaline phosphatase level was minimally elevated with a value of 134 IU/l. The pedigree analysis was non-contributory. A skeletal survey was done. The survey indicated that radiolucent intramedullary and subcortical foci with erosions of the periarticular cortex in bilateral metacarpophalyngeal and interphalyngeal joints (Table/Fig 1), at the lower end of humerus and the upper ends of radius and ulna (Table/Fig 2) and in the vertebral end plates (Table/Fig 3). All epiphyses appeared reduced in size and irregular with irregularity and remodelling noted at contiguous metaphyses. Specky periosteal reaction was observed at certain sites.

Tapering or ’pointing‘ of other bones including carpals with atrophy of overlying soft tissues was associated. On the basis of this typical pattern of regional osseous destruction on the radiographs and the exclusion of other differential diagnostic considerations, the patient was diagnosed as a case of primary idiopathic osteolysis. The patient was placed on anti-osteoclastic medication that is , bisphosphonates, with calcium supplements and was doing well till the last out patient follow up.


Destruction of bone (osteolysis) or cartilage (chondrolysis) may be an associated feature of numerous neoplastic, infectious, metabolic, traumatic, vascular, congenital, or vascular disorders. Severe and progressive cartilaginous and/or bone dissolution at multiple sites can lead to considerable deformity in some of these disorders like Rheumatoid arthritis, Juvenile Idiopathic arthritis, Psoriatic arthritis, Systemic Lupus erythematosus, Multicentric Reticulohistiocytosis.
In addition, osteolysis may occur after frost bite, animal bite, irradiation, occupational injury, thermal injury, and electrocution (3). A group of heterogeneous conditions remain in which the cause is not known. These conditions are termed Primary Idiopathic Osteolysis Syndromes. A long list of conditions is included under this rubric, the chief being Acro-osteolysis of Hajdu and Cheney, Massive Osteolysis of Gorham, Idiopathic Multicentric Osteolysis, Carpo-tarsal Osteolysis. Other rarer conditions include neurogenic osteolysis, Acro-osteolysis of Joseph, Acro-osteolysis of Shinz, Farber’s Disease, Winchester Syndrome, and Osteolysis with Dendritic synovitis(3),(5),(6). All the above disorders can be classified or differentiated on the basis of age of onset, presence or absence and type of genetic transmission, major location of osteolysis, and associated clinical features(1).We labelled our patient to be suffering from Carpo-tarsal osteolysis due to the predominant progressive involvement of small bones of the hand and feet (4),(6).
Tyler and Rosenbaum (6) proposed the terminology. Till then, it was known by multiple names, such as Essential Osteolysis, Idiopathic Osteolysis, Essential Acro-osteolysis, Familial Osteolysis, Hereditary osteolysis, Carpal and Tarsal agenesis, Familial Dysostosis Carpi and bilateral carpal necrosis (3),(6). The basic pathophysiological event in these idiopathic conditions is increased osteoclastic activity with increased vascularity but no associated inflammation. The destroyed areas are replaced by fibrous tissue. The joints are primarily normal. Increased urinary hydroxyproline and serum phosphate is a constant feature (1). These metabolites however were at top normal limits. Therefore, they were not considered significant enough for a diagnosis.
Idiopathic Multicentric Osteolysis, which is also known as Carpotarsal Osteolysis, can be further divided into two entities, Multicentric osteolysis with Nephropathy and Hereditary Multicentric Osteolysis. A third miscellaneous group is reserved for conditions that do not have features of either. The former is a sporadic (occasionally dominant) condition having onset in infancy and childhood. It mainly affects the carpals, tarsals, and elbows. Associated features are osteoporosis, deformities, hypertension, and renal failure and could be fatal in a few cases. The latter is mostly Autosomal Dominant (occasionally AR or Sporadic). Its onset is between one to five years of age, with the carpals, tarsal, elbow, and digits being chiefly involved. Progressive deformities are an important feature (6). The present case can be easily classified as group II because no renal insufficiency has been established.
The key imaging feature in both the conditions is progressive dissolution and disappearance of carpals and tarsals. Tapering of adjacent bones is observed mainly in Multicentric osteolysis with Nephropathy (3)-(7).
The main differential diagnostic considerations are Leprosy, Juvenile Chronic Arthritis, Diabetes Mellitus, Winchester’s Syndrome (characterized by the presence of corneal opacities), and Farber disease (chara


The diagnosis of primary idiopathic osteolysis syndrome involves exclusion of other commoner conditions that can affect a particular patient. In our case, we excluded other possibilities, such as Juvenile Idiopathic arthritis and Reticulohistiocytosis by lab and clinical data.


Green HD, Mollica AJ, Karuza AS. Gorham’s disease: a literature review and case reports. J Foot Ankle Surg. 1995 ;34(5):435-41
Gorham LW, Stout AP. Massive osteolysis (acute spontaneous absorption of bone, phantom bone, disappearing bone): its relation to hemangiomatosis. J Bone Joint Surg [Am] 1955; 37-A: 985–1004.
Donald Resnick, Mark J. Kransdorf. Bone and Joint Imaging, 3rd ed Richmond, Va: Elsevier-Saunders, 2005
Amin PH, Evans AN. Essential osteolysis of carpal and tarsal bones. Br J Radiol. 1978 Jul;51(607):539-41
Gorham LW, Wright AW, Shultz HH, Maxon FC jr. Disappearing bones: a rare form of massive osteolysis; report of two cases, one with autopsy findings. Am J Med. 1954 Nov; 17(5):674-82.
Tyler T, Rosenbaum HD .Idiopathic multicentric osteolysis. AJR Am J Roentgenol. 1976 Jan;126(1):23-31.
Hardegger F, Simpson LA, Segmueller G.The syndrome of idiopathic osteolysis. Classification,Review and Case Report. JBJS (Br)1985. 67;89

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)