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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
Air Leak Conundrum following Oesophagectomy: A Case Report and Review of Literature
Correspondence Address :
Dr. Amiy Arnav,
Assistant Professor, Department of Surgical Oncology, All India Institute of Medical Sciences, Deoghar-814152, Jharkhand, India.
E-mail: arnavamiy@gmail.com
Oesophagectomy is an established technique for treating oesophageal cancer. Pulmonary complications during the postoperative period can arise from intraoperative manipulation, thoracic structure injury, or anastomotic leaks. At our institution, it is standard practice to place a soft corrugated drain around the anastomosis in the neck to facilitate the drainage of any anastomotic leakage towards the skin. In this case report, a 55-year-old female underwent video-assisted oesophagectomy in the prone position after neoadjuvant chemoradiation. A corrugated drain was subsequently placed near the anastomosis site in the neck. On the third day postoperatively (POD 3), she developed a sudden pneumothorax and an air leak in the chest tube. Despite the placement of a second intercostal tube and normal findings on fibreoptic bronchoscopy, the air leak persisted. Unexpectedly, the air leak spontaneously ceased, and the lungs re-inflated after 24 hours. Upon analysis, it was discovered that the dressing over the neck drain, which had been changed on POD 3, did not completely cover the wound. This, combined with malpositioning, created a one-way valve effect, leading to pneumothorax. Therefore, the use of a corrugated neck drain following oesophagectomy may result in life-threatening pneumothorax and should either be airtight sealed with dressing or avoided.
Corrugated drain, Pneumothorax, Postoperative complication, Surgical procedure
A 55-year-old female with no known co-morbidities or addictions presented with complaints of progressive dysphagia since July 2017 with associated unquantified weight loss. She was initially evaluated with upper gastrointestinal endoscopy and biopsy and whole-body Positron Emission Tomography Computed Tomography (PET CT) Scan which showed a Stage-III oesophageal squamous cell carcinoma of lower 1/3rd oesophagus. She received neoadjuvant chemoradiotherapy to a total dose of 4140cGy/23# with concurrent chemotherapy (Carboplatin+Paclitaxel) from 5th September to 7th October 2017. Post concurrent chemoradiotherapy, response assessment was done using whole body PET CT scan, which revealed a complete response.
On November 20, 2017, she underwent video-assisted McKeown’s Oesophagectomy (hybrid technique). Intraoperatively, a growth was noted in the middle third of the oesophagus with a good response to neoadjuvant chemoradiotherapy. The oesophagus was densely adherent to the pericardium, but there was no injury to the lung. Following surgery, three drains were placed: one corrugated drain adjacent to the left-sided neck incision and bilateral chest drains.
The immediate postoperative period was uneventful; however, on the 3rd POD, she developed sudden onset tachypnoea with a wide swing in the Intercostal Drain (ICD) column and excessive bubbling suggestive of an air leak. Clinical examination and X-ray revealed a right-sided pneumothorax and collapsed right lung (Table/Fig 1). Another ICD was inserted into the right hemithorax, but the air leak persisted. Fibreoptic bronchoscopy was performed to rule out a possible tracheobronchial tree injury, which was normal. A Non Contrast Computed Tomography (NCCT) of chest confirmed a right-sided pneumothorax with subcutaneous emphysema (Table/Fig 2). With no improvement in her condition over 24 hours, re-exploration was planned due to a high suspicion of lung parenchymal injury. However, she suddenly improved after her dressing over the neck drain was changed. Her lung reinflated within 15 minutes, the air leak stopped in the ICD, and her general condition improved. Upon analysis, it was realised that the neck corrugated drain was acting like a one-way valve through which air was being sucked into the chest. The issue was resolved by shortening the drain and applying a fresh dressing. A chest X-ray confirmed an inflated lung, resolution of pneumothorax, and the patient had an uneventful recovery thereafter (Table/Fig 3).
Commonly encountered pulmonary complications following oesophagectomy include slipped chest drains, tracheobronchial injury, parenchymal air leak, ruptured bullae, anastomotic leaks, lung collapse, pneumonia, and pulmonary thromboembolism. Our present case highlights a rare and potentially life-threatening complication due to a malpositioned corrugated drain in the neck. Orringer MB et al., presented a series of 2,000 oesophagectomies, but did not mention this rare complication of postoperative respiratory distress following transhiatal oesophagectomy. The mentioned complications in their series were wound infection/ dehiscence (3%), atelectasis/pneumonia (2%), intrathoracic heamorrhage, recurrent laryngeal nerve paralysis, chylothorax, and tracheal laceration (<1% each) (1).
During an oesophagectomy, communication between the thoracic cavity and neck is created by mediastinal mobilisation of the oesophagus and gastric pull-up for cervical oesophagogastric anastomosis. Normally, the stomach tube sufficiently seals this communication, and the negative intrathoracic pressure is not transmitted to the neck. A neck drain is placed next to the anastomosis to drain any anastomotic leak. In present case, it was apparent that the corrugated drain in the neck was placed deeper than intended and was possibly acting like a stent with communication between the neck and chest (which otherwise gets plugged or sealed by the stomach tube). Once the dressing was changed to a loose one on the 3rd POD, atmospheric air got sucked into her chest with every respiratory effort, creating a tension pneumothorax along with a collapsed lung. This spontaneously resolved when a more occlusive dressing was put on. Additionally, once the cause of the leak was realised, the drain was also shortened, thus allowing the stomach tube to act like a natural seal.
Persistent massive air leak in a chest tube and collapsed lung in the early postoperative period are usually indicative of airway injury. In present case, there was no airway or lung injury intraoperatively, and there was no evidence of an air leak before the 3rd POD. Minor air leaks from lung parenchymal injury generally settle down within one to two days postoperatively. There was no air leak in the first two days because the neck drain was covered by an occlusive dressing, which was removed on the 3rd POD. A fibreoptic bronchoscopy also ruled out a tracheobronchial injury. A re-exploration was fortuitously averted just in time when the dressing was changed to an occlusive one, and the air leak resolved spontaneously. On literature review (Table/Fig 4), six similar cases reporting pneumothorax caused by malpositioned corrugated drains, three in transhiatal oesophagectomies (2),(3),(4), and three in transthoracic oesophagectomies (5),(6),(7). This suggests that the use of corrugated neck drains may result in life-threatening complications of pneumothorax. The use of corrugated neck drains should be avoided, and alternatives like closed drains can be utilised instead. However, if a corrugated drain is used, proper airtight sealing of the drain site with a dressing is mandatory to prevent this complication.
A malpositioned corrugated neck drain placed during oesophagectomy may cause massive pneumothorax and is now well-documented in the literature. It is recommended to avoid the use of corrugated drains in the neck post-oesophagectomy. If a corrugated drain is used, proper airtight sealing of the drain should always be practiced.
DOI: 10.7860/JCDR/2023/64776.18439
Date of Submission: Apr 16, 2023
Date of Peer Review: Jun 01, 2023
Date of Acceptance: Jun 27, 2023
Date of Publishing: Sep 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: Apr 17, 2023
• Manual Googling: Jun 10, 2023
• iThenticate Software: Jun 24, 2023 (13%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
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- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com