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

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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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On Sep 2018




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"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."



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Lucknow
On Sep 2018




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On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
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.
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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
Consultant
(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.


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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.
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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.
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

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 561 - 563

Renal Apical Segmental Artery Variations and its Surgical Importance's

Raghavendra V. P, Manjappa T, Anjana Telkar

1. Corresponding Author: 2. Assistant Professor, Department of Anatomy, 3 Assistant Professor, Department of Microbiology J.J.M. Medical College, Davanagere 577004, Karnataka, India.

Correspondence Address :
Raghavendra V. P.,
Assistant Professor, Department of Anatomy
J.J.M. Medical College, Davanagere 577004,
Karnataka, India.
Phone: 9844758777 (+91)
E-mail: drraghavendravpisale@yahoo.co.in

Abstract

Objectives: The advent of more conservative methods in the renal and renal vascular surgeries has necessitated a more precise knowledge of renal vascularization and its importance in partial and total renal transplantation surgeries. Its main objectives: (a) To study the Intrarenal arterial segmental patterns especially the apical branch and its variations in 60 human kidneys by dissection, corrosion and radiological method, (b) To help the endourologic surgeons to carry out safer surgeries on kidneys, (c) To give reliable information to the anatomists for learning and teaching.

Methods: Totally 60 adult human kidneys were studied in the present work belonging to both sexes; Out of it 40 were procured from dissection cadavers in the Department of Anatomy, J.J.M. Medical College, Davanagere and 20 fresh kidneys from Mortuary, Chigateri General Hospital, Davanagere. Before removal of the kidneys from the bodies, possibilities of additional apical renal segmental arteries from the common iliac, internal iliac, lumbar, sacral, superior mesenteric, hepatic and inferior suprarenal arteries were looked upon. The segmental arteries of the kidneys were studied by three methods i.e. 40 by dissections, 10 each by corrosion cast and radiological method.

Results: A total of 60 kidneys were studied, anterior division is classified into 8 types out of it Type VIII showed maximum of 20% and Type II of posterior segment 51.66%. The incidence of apical, upper, middle and lower remained the normal occurrence of 51.66%, 61.66%, 55% and 51.66% respectively.

Conclusion: Much importance is given to the segmental artery which arises in common and divides within the renal parenchyma, as healthy renal tissue is often involved during partial nephrectomy of the affected part during ligating the specified segmental artery.

Keywords

Human Kidneys, Intrarenal, Endourological surgeries, Arterial segmental pattern

Intr0duction
The present work on the intra-renal apical arterial segmental pattern of the human kidneys and its variations was undertaken because of its urosurgical importance in making a relatively bloodless surgical approach to the kidneys and to save the healthy renal tissue in partial nephrectomy. The advent of more conservative methods in renal surgery has necessitated a more precise knowledge of renal vascularization and its importance in partial and total renal transplantation surgeries. Renal vascular segmentation was originally recognized by John Hunter (1) but the idea of segmental anatomy started with the discovery of bronchopulmonary segments by William Ewart (2). In 1954, F. T. Graves (5) made an outstanding contribution to renal surgeries when he described five segmental branches. Riches (3), Abehouse and Lerman advised renal angiography prior to all the endourological surgeries. Robert (4) and D. Sykes stressed the necessity of knowing the variation in the vascular segmental patterns to prevent the avoidable loss of the normal healthy renal tissue which occurs in total nephrectomy, while the infarcted renal tissue is being removed. Thus, from radical total nephrectomy to conservative partial nephrectomy. The classification which has been adapted here is based mainly on the classification of the various types of the renal segmental arteries which have been made by others and these have been compared.

Material and Methods

The segmental arteries of the kidneys were studied by three methods, 40 specimens were studied by the dissection method and 10 Anatomy Section specimens each were studied by the corrosion cast and radiological methods. For these methods, after identifying the supernumerary renal arteries from the aorta, the kidneys of each pair were separated along with the renal arteries by discarding the piece of the aorta. Before the removal of the kidneys from the bodies, the possibilities of additional renal arteries, especially to the apical region, were looked upon as arising from other sources. 1. THE DISSECTION METHOD: Adult human kidneys from the dissection cadavers were washed and the parenchymatous tissue was removed in piece meal, while tracing the apical and the other segmental arteries as much as possible. 2. THE CORROSION CAST AND THE RADIOLOGICAL METHOD: Fresh kidneys, along with their capsules and the blood from the arteries and veins were washed off by injecting warm saline till a clear fluid came out of them and later, the fluid was drained completely. Through the narrow end of the silicon gum in the stem of the renal arteries, a material was injected slowly till complete resistance occurred and later, the stem of the artery was tightly tagged. It was kept overnight for drying and then it was immersed in HCl for 6 hours. After the soft tissue corrosion was complete, the resulting silicon cast was washed and dried. For the radiological method, barium sulphate was injected through the renal artery and a radiograph was taken. The same kidneys were later dissected, the arterial patterns were compared and the findings were confirmed by comparing them to those which were seen in the radiographs.

Results

(The results and observations which were made on the apical segmental artery) As the apical artery mainly arises from the anterior division of the renal artery, a brief study on the anterior division was also made along with that on the apical segmental artery. The following is the classification which was followed in this work and the total number of specimens which were observed: Totally, 8 types of the anterior division of the renal artery were described, depending upon the mode of its branching and the results are shown graph 1. (A) 6 TYPES OF THE APICAL SEGMENTAL ARTERIAL VARIATIONS ARE SHOWN BELOW: Type I: (51.66%) It arose from the anterior division of the renal artery, along with most of the other segmental arteries. Type II:(25%) It arose from the upper segmental artery. Type III: (1.66%) It arose at the junction of the anterior and the posterior divisions of the renal artery or with the middle segmental arteries. Type IV: (11.66%) It arose from the renal artery much before its division into the other segmental arteries. Type V: (1.66%) It arose from the aorta (superior accessory renal artery). Type VI: (8.33%) It arose from the posterior division of the renal artery.

(B) THE POSTERIOR DIVISION Due to the possibilities of the apical artery arising from the posterior segment or the divisional artery, the posterior division was also studied. In the present work, 4 types of posterior divisions were seen, but out of these, only the type III (16.66%) artery was found to give rise to the apical branch. i.e. The posterior division gives off either the (a) apical or (b) middle or the (c) lower segmental artery or any two of them, which usually are all branches of the anterior division. It supplies the posterior segment before or after giving the above said branches.

Discussion

The advent of more and more conservative methods in the field of endourological surgeries has necessitated a precise anatomical knowledge on the renal segmentations and their vascular patterns. The knowledge on these also help in knowing the renal function by noting the amount of renal perfusion which is caused by the arteries to that of amount of urine which is formed from the collecting system. The description of Brodel`s line in 1901 has revolutionized the renal surgeries since then. Since that time, a variety of complex renal reconstructive procedures have evolved for preservation of the renal parenchyma as an alternative to simple or radical nephrectomy. As a result, the urologic surgeons and anatomists may be calledupon to perform these complex renal preservation procedures in the presence of trauma, neoplasia and urolithiasis. The new techniques which are employed in renal surgery mainly depend upon the segmental resection, namely the wedge–type resections, if the disease affects the upper or the lower segments. But for the mid-portion lesions, either the enucleation technique or partial nephrectomy is indicated, although they are obviously limited to the tumours and they may be employed in other conditions in which there is a minimal loss of the renal functions. The lack of arterial anastomosis in the neighboring segments will affect only the affected segment and it will neither produce ischaemia nor interfere with the blood supply of the neighbouring segments. This lack of the arterial anastomosis will render the technique of the resection easier, since the field of operation will be relatively bloodless, following the ligation of the segmental artery which supplies the area of the operation. It should be remembered that the origins of the segmental arteries are accessible. In a majority of the cases, they are easily seen in the hilum and they are often at the points which are nearer the aorta. This is of practical value, since the segmental resection is best carried out from the hilum towards the periphery. In the type II cases, sometimes the surgeons may have to sacrifice even the healthy upper segmental branch and the soft tissue. The type III cases create more difficulty for the surgeons in the ligature of this segmental branch and in the resection of the artery along with the soft tissue, as ligating may cause disturbances in the neighbouring segments. In the type V cases, the inferior suprarenal artery may arise from the superior accessory renal artery. Type VI: Most of the times, in the type VI cases, the apicalartery arises from the posterior division and this makes it easier for the surgeons to do ligations of the segmental artery which supply the apical region. The apical segmental artery and its variations as per our findings, are shown in Table 2 and these have been compared with others.

Conclusion

The advent of more and more conservative methods in the field of renal surgery has necessitated a more precise knowledge on renal vascularization and its importance in partial and total renal transplantation surgeries. Therefore, the valuable contribution of this anatomical knowledge to operative surgeries, particularly in the partial or segmental resection of the kidneys, will help in the further development of different techniques for the removal of calculi or any affected part of the kidneys. This will also help in partial renal transplantation surgeries with end to end anastomosis of the resected part of the kidney. The presence of the arterial segments within the substance of the kidney does not change, but there is a lot of variation in their course and in the exact point of origin of these segmental vessels from the renal artery or the aorta outside the substance of the kidney. After the advent of the renal segments, the urological complications which followed partial nephrectomy have considerably reduced. Nephrectomy or the total removal of a kidney will no longer be performed, if a lesser procedure can offer a better prospect. Every fragment of the healthy, functional renal tissue should be preserved, provided that it has an arterial supply, a venous drainage, and a urinary exit or a collecting system and provided that expertise is available to preserve the healthy fragment.

References

1.
Hunter J. Vasculature of the body. Br J Surg 1794; 38: 1-8.
2.
Ewart W. Bronchopulmonary segments of the lung. Br J Surg 1889; 38: 1-8.
3.
Riches EW. The present status of the renal angiography. Br J Surg 1955; 42: 462-70.
4.
Merklin RJ, Michels NA. The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and the gonadal arteries. J of Int Col of Surg 1958; 29: 41-76.
5.
Sykes D. The arterial supply of the human kidney with a special reference to the accessory renal arteries. Br J Surg 1963; 50: 368-70.

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