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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
Retrograde Intrarenal Surgery for Nephrolithiasis with Partially Migrated Renal Artery Embolisation Coil: A Case Report
Correspondence Address :
Ashit Shah,
Chief Consultant Urologist, Department of Urology, Aashray Urology Institute, Alkapuri, Vadodara, Gujarat, India.
E-mail: ashit@aashrayuro.com
Transcatheter renal artery embolisation is an effective and minimally invasive treatment option for acute renal bleeding. However, it is associated with a variety of complications, which can be classified as early or late according to the time of presentation. Coil migration leading to renal calculi formation is a late complication of transcatheter or percutaneous renal arterial embolisation. A 47-year-old diabetic male patient presented with a recurrent right renal staghorn calculus. Four years ago, the patient underwent a right Percutaneous Nephrolithotomy (PCNL). Following the procedure, he had to undergo a renal arterial embolisation for postoperative haemorrhage. The patient this time did not consent for repeat PCNL, therefore a staged right Retrograde Intrarenal Surgery (RIRS) was performed. Complete clearance of stone and extraction of the migrated coil was achieved in a three-staged procedure. Embolisation coils in the proximity of the pelvi-calyceal system, can migrate into the system, and form a nidus for stone formation. These stones and the migrated coil can be managed effectively and safely with RIRS.
Calculus, Coil-migration, Nephrolithotomy, Renal bleeding
A 47-year-old male patient, presented with right flank pain for one year, associated with dysuria. He had been on treatment for Type-II diabetes mellitus for five years. He had undergone right PCNL four years back elsewhere, with history of post-PCNL bleed requiring angio-embolisation. Patient was diagnosed with right renal calculus a year back elsewhere, but he was not keen on intervention owing to the stormy post-operative course during his previous PCNL procedure. His abdominal examination was normal.
His Ultrasonography (USG) was suggestive of right renal staghorn calculus with mild right hydronephrosis. X-ray Kidney, Ureter, and Bladder (KUB) (Table/Fig 1) showed a large calculus of about 3 cm with two metal coils in association with the stone. The first coil was in association with the renal pelvis and the second one at the level of the inferior calyx. His renal function tests were normal and urine analysis revealed microscopic haematuria. Intra-venous Pyelogram (IVP)/urography showed normal excreting kidneys bilaterally with calculus in right renal pelvis extending entirely into lower calyx leading to hydronephrosis (Table/Fig 2). He was advised right PCNL, but this time he did not consent for a repeat PCNL, therefore a staged right RIRS was performed. After proper counseling about the procedure and the need for multiple stages, he underwent the right RIRS as a staged procedure, with complete clearance of calculi after three RIRS procedures.
RIRS was done with DEEPRA®-FLEX (UR-332) Flexible Uretero-renoscope. Flexor® Ureteral Access Sheath 12F (FUS-120045, Cook® Medical) was used in all the three procedures. The plan of dusting was to start from the renal pelvis and then proceed to the middle followed by the lower calyx. TraxerFlow™ Irrigation Set (Rocamed) was used as infusion pump for enabling better vision during uretero-renoscopy. Complete dusting of calculi was done using Holmium (Ho:YAG) Laser LITHO (Quanta System), with laser settings 0.7J, 15 Hz. Mean operating time was 80±10 minutes and lasing time was 45±5 minutes. JJ Stent was inserted postoperatively after each procedure. Intraoperative findings were shown in (Table/Fig 3).
After lasting the calculus, embolisation coils were seen to be protruding into the pelvicalyceal system. One coil was cut flush to the pelvic mucosa with holmium laser and the cut part was extracted with NGage® Nitinol Stone Extractor (Cook® Medical). Another coil was identified in the lower calyx; however, it was covered with fibrous tissue and was left as such.
The patient had an uneventful postoperative recovery and was discharged the next day. His postoperative X-ray (Table/Fig 4) and USG three weeks post the 3rd stage, showed complete clearance of calculi with JJ stent-in-situ. The stent was removed after three weeks. X-ray and USG KUB were normal on follow-up done three months after the removal of the stent, and the patient was advised an annual follow-up.
The PCNL is the most frequently used technique for the management of large renal calculi. The incidence of post-PCNL bleed requiring angioembolisation is about 1% (1). Transcatheter Renal Artery Embolisation (RAE) is an efficient and minimally invasive treatment for acute renal bleeding. RAE like any other treatment is associated with its short and long-term complications. Migration of the embolisation coils and its consequences like stone formation are one of the rare complications that a treating urologist may be faced with (2). RAE is used for controlling bleeding of renal origin postinterventions like PCNL’s and renal biopsies. It has also been used for renal tumours, angiomyolipoma’s and vascular malformations of kidney (2).
Various embolic agents used include; mechanical agents such as metallic coils, sclerosants, abgel, autologous blood clot, foams, and microparticles. The choice of material used for embolisation depends on the size of the blood vessel, vascular anatomy, and haemodynamic parameters (2). Metal coils are the most commonly used agent for the embolisation of a segment of renal artery. Acute complications of coil embolisation include distal coil migration, vasospasm, post-embolisation syndrome, non target embolisation, and infarction causing renal dysfunction. Erosion of embolisation coil into the pelvi-calyceal system is a rare late sequela that may lead to the development of calculus or infection. Management of the calculus secondary to coil erosion and the risk of bleeding due to removal of the coil is not discussed extensively in the literature.
Migration of the embolisation coils occurs only in 2% of cases (3). It can occur either soon after embolisation or in later years, presenting with clinical symptoms such as pain, haematuria, urinary system obstruction, and impaired kidney function. Such migration may occur through calyceal tears which occur during PCNL, as these areas remain inherently weak. These weak areas may get eroded by coils consequent to inflammation, thus paving way for their migration into pelvi-calyceal system. Possibly, the coil may have migrated through calyceal tears that may be occurred during PCNL (3).
In this patient, coiling material might have served as a nidus for calculus formation, a late migration which is difficult to treat, as half of the coil may be protruding into the pelvi-calyceal system and the other half would be embedded into the parenchyma. Literature reports suggest, that the calculi can get formed inside and around the coils and migrate in the excretory system; however, the management of such a condition is yet to be standardised (3),(4).
Rutchik S and Wong P, presented the first report describing the use of ureteroscopic pneumatic lithotripsy and grasping devices for the removal of calculus developed around the coil (4). Subsequently, studies were reported by Poyet C et al., and Kumar S et al., where a retrograde intrarenal and percutaneous approach were used respectively to fragment the calculus and to extract the coil (5),(6). In the index case, patient refused to have a PCNL, and shockwave lithotripsy was not an option by virtue of the size of the stone, also one cannot be sure that after fragmentation the coil will pass off spontaneously. Considering the above situation, RIRS was performed.
The case was effectively managed using RIRS, and clear visibility provided by the flexible ureteroscope enabled the convenient identification of the encrusted calculus around the coil. Fragmentation and removal of calculus can be merged with the extraction of the calculus-inducing foreign body using RIRS. The following reasons make this case unique; such as the coil was partially intra-parenchymal and partially intra-luminal, making the removal of the coil challenging, the coil in these situations could be still associated with a segmental vessel, so the operator should be careful while extracting the coil as, a possible vascular injury may result. If the coil was completely covered with mucosa and only its impression was seen, the coil should be left behind as it has not migrated and if the surgeon tries to chase the buried coil, catastrophic bleeding may occur. In view of the same, the second coil was left in-situ.
Complications due to migrated metal coils can occur years after its placement. Calculi can develop adjacent to the migrated metal coil and should not be neglected if identified. Although no single technique is superior to another in stone management in this situation, RIRS can aid in proper identification as well as concurrent removal of calculi and the coiling material. The preventive measures to avoid migration of the remaining coil need to be explored.
DOI: 10.7860/JCDR/2023/62113.17931
Date of Submission: Dec 07, 2022
Date of Peer Review: Feb 06, 2023
Date of Acceptance: Mar 10, 2023
Date of Publishing: May 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: Dec 08, 2022
• Manual Googling: Feb 25, 2023
• iThenticate Software: Mar 02, 2023 (12%)
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