AUCTORES
Globalize your Research
case report
*Corresponding Author: Shashikant Anil Pol
Citation: Nirmala Yamgar, Shashikant Anil Pol, Shreeya Kulkarni, Rushika Patel, (2023), Surgical Management of Unusual Nasal Masses: A Case Series, J Clinical Otorhinolaryngology, 5(4); DOI:10.31579/2692-9562/086
Copyright: © 2023, Shashikant Anil Pol. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
Received: 09 March 2023 | Accepted: 22 May 2023 | Published: 09 June 2023
Keywords: nasal; orbital; otorhinolaryngologist; pathologies; paranasal sinus; histopathological; surgical
Aim: To evaluate the clinical presentation, histopathology, and surgical management of various nasal masses.
Background: Nasal masses cause symptoms ranging from minor nasal obstruction to orbital problems.
Case Presentations: A 66 yrs male with epistaxis from the left nostril. Imaging was suggestive of a neoplastic lesion. Endoscopic Excision was done which came as capillary haemangioma. An 11yrs female came with nasal blockage and eye proptosis. Imaging was suggestive of a neoplastic lesion. Biopsy showed alveolar rhabdomyosarcoma which was managed by a combined approach. An 83yrs female came with a right eye diminished vision, and proptosis. Imaging revealed a right-sided frontal sinus mucocele extending to the right orbit. Endoscopic marsupialization resulted in drastic improvement in vision. A 66yrs male with sudden diminution of vision of the left eye. Imaging revealed a lesion in the sphenoid sinus abutting the optic nerve. The lesion was removed with left optic nerve decompression. Histopathology was suggestive of tuberculosis. Significant improvement in vision was noted postoperatively. An 18yrs male with right nasal blockage and intermittent bleeding. Imaging suggestive of juvenile angiofibroma. Endoscopic removal was done. Histopathology came as nasal angiofibroma.
Discussion: Nasal endoscopy, radiological assessment, surgical intervention, and histopathological evaluation were performed on five patients which helped in making a specific diagnosis, preventing the possibility of missing unusual cases.
Conclusion: Endoscopic Surgery is the main treatment modality for various nasal masses nowadays because of advantages like scarless surgery, excellent exposure, less bleeding, low morbidity, and early recovery.
Clinical Significance: Imaging helps with pre-surgical planning and histology enables us to make accurate diagnoses.
The presence of any mass in the nose and paranasal sinuses may seem to be a straightforward issue, but it raises a lot of questions about the differential diagnosis. The majority of patients present with complaints of nasal blockage, nasal discharge, sneezing, smell disturbances, epistaxis, and ocular issues such as epiphora, proptosis, diplopia, and visual problems.1 Various differential diagnoses can be made for a sinonasal mass which could be traumatic, congenital, neoplastic, or inflammatory.2 They are primarily classified as nonneoplastic and neoplastic and further in benign and malignant among the neoplastic lesions.1 The basic course of treatment for such nasal mass is surgical excision, but because these tumors may be close to important structures such as the brain or orbit, managing the recurrent or residual disease is challenging. Hence a multidisciplinary approach using radiation and surgery is required for locoregional treatment.3 In this paper, we discuss 5 such unusual cases that we encountered in the last 6 months in tertiary care hospital including capillary hemangioma, rhabdomyosarcoma, frontal mucopyocele, and juvenile nasal angiofibroma which were managed successfully mainly with surgery and in one it was managed by combined modality treatment including ChemoRadiation followed by salvage surgery. All patients were doing fine till six months of follow-up.
Case 1:
A 64 year old male presented with bleeding from the left nostril which was associated with left-sided nasal obstruction. He was hypertensive and on regular medication. There were no complaints of nasal discharge, anosmia, or facial swelling. We did zero degree nasal endoscopy which reveals Vascular Mass which was seen attached to the posteroinferior part of the inferior turbinate and the posterior part of the nasal septum (Figure. 1a). Computed Tomography Scan of Paranasal Sinuses (plain+contrast) showed an ill-defined hypodense soft tissue density lesion measuring approximately 3.2x1.6x2.3cm in the left nasal cavity, extending posteriorly up to choana. In post-contrast study, the lesion is showing mild to moderate heterogeneous enhancement (Figure. 1b). Findings were likely suggestive of the neoplastic lesion. After getting fitness for general anesthesia and written and informed consent from the patient and attendant we did a Transnasal Endoscopic excision of the nasal mass after cauterizing the attachments between the turbinate and septum and the specimen was sent for histopathology (Figure.1c). We did a spurectomy for complete exposure of the mass. On histopathology, it showed stroma with lobular, few dilated, and thick-walled blood vessels likely suggestive of capillary haemangioma (Figure. 1d). Epistaxis was relieved immediately after mass removal. On regular follow-up, till six months there was no bleeding and the patient was doing fine with a healthy bilateral nasal cavity without any mass. In this case, as per the age and radiological findings we thought of neoplastic etiology but surprisingly on histopathology it came as capillary hemangioma which was very unusual at this age.
Figure. 1a: Nasal Endoscopy showing vascular mass between inferior turbinate and septum.
Figure. 1b: Contrast Enhanced Computed Tomography of Nose and PNS showing extent of lesion.
Figure. 1c: Nasal Mass after excision.
Figure. 1d: Histopathology showing Capillary Hemangioma.
Case 2:
A 10 years old female came with chief complaints of right-sided infra-orbital swelling with pain and tenderness with right nasal obstruction. She also had right-sided proptosis with severe ptosis (Figure. 2a). There were no complaints of nasal discharge, anosmia, or epistaxis. On a Computed Tomography scan of paranasal sinuses (plain+contrast), there was a large soft tissue density lesion approx. 3.4x1.7x3.3cm in the right maxillary sinus causing erosion and destruction of the medial wall, posterolateral wall, and part of the anterior wall of the right maxillary sinus. It is bulging posteriorly into masticater space, right pterygomaxillary fissure, and part of the pterygopalatine fossa. Medially the lesion is causing erosion of the right middle, inferior turbinate, right ethmoidal sinus plate, and part of the nasal septum. The lesion is causing erosion of the floor and medial wall of the right orbit and superomedial aspect with intraorbital extraconal extension seen in the right orbit indenting over the inferior rectus muscle (Figure. 2b). Findings were likely suggestive of the neoplastic lesion. We also did Magnetic Resonance Imaging (MRI) Ill-defined T1 hypointense and T2 hyperintense lesion approximately 3.4x1.7x3.3cm in the right maxillary sinus (Figure. 2c).
As Mass was completely occupying the right nasal cavity, the maxillary sinus was approached by Denker’s approach. Around 4-5ml cystic fluid aspirated from the maxillary sinus. A deeper biopsy was taken from the mass and sent for the frozen section which was suggestive of a round cell tumor probably rhabdomyosarcoma (Figure. 2d). Right orbital floor dehiscence note. After confirmation of Rhabdomyosarcoma, she underwent 4 cycles of chemotherapy. Histopathology showed cells with mildly pleomorphic, vesicular nuclei suggestive of a malignant round cell tumor probably alveolar rhabdomyosarcoma (Figure. 2g). Initially patient had given a good response to chemo and radiotherapy but after 4 cycles there was a relapse because the patient became a defaulter and not gone for chemo or radiotherapy. After a gap of about 3 weeks, the patient developed vision loss, and her globe became fixed so after getting fitness for general anaesthesia and written and informed consent we did right-sided salvage subtotal maxillectomy with orbital exenteration (Figure. 2e,f). Before taking the patient for surgery we did a repeat MRI which showed a tumor involving mainly orbit and maxillary sinus with the intracranial component in the frontal lobe. For the intracranial part, the patient underwent 23 cycles of radiotherapy and 6 cycles of chemotherapy. The patient was doing well till six months of follow-up without any relapse
Figure. 2a: Clinical Picture showing ptosis and proptosis.
Figure. 2b: Non Contrast Computed Tomography of Nose and PNS showing extent of lesion.
Figure. 2c: Magnetic Resonance Imaging of Orbit and Brain showing extent of lesion.
Figure. 2d: Endoscopic biopsy from right maxillary sinus.
Figure. 2e: Salvage Subtotal Maxillectomy showing extent of tumor.
Figure. 2f: Intraop picture after maxillectomy and orbital exenteration.
Figure. 2g: Histopathology showing Alveolar Rhabdomyosarcoma.
Case 3:
An 83yrs old female came with chief complaints of right eye diminished vision, right eye proptosis, and swelling over the right side forehead with obvious cosmetic deformity since one year (Figure. 3a). There were no complaints of nasal obstruction, diplopia, reduced extraocular movements, headache, ocular pain, redness, discharge, or facial pain. Non-Contrast Computed Tomography (NCCT) of the Nose and Paranasal Sinuses showed an ill-defined homogenous soft tissue lesion arising from the right-sided frontal sinus showing scalloping of its anterior, posterior and medial walls with the expansion of the sinus cavity with the erosion of superior and inferior frontal sinus walls extending inferiorly to right ethmoidal air cells and right orbital cavity (Figure. 3b). It is causing inferomedial and anterior displacement of the globe abutting the right lateral rectus, superior rectus, and right optic nerve (2.0*2.2*1.5 cm in right orbit). No enhancing septae or calcification in it after contrast. Magnetic Resonance Imaging (MRI) of the Orbit and Brain showed ill-defined expansile T1 hyperintense and T2/FLAIR hyperintense soft tissue density with frontal sinus cavity expansion and erosions, extending extraconally to the right orbit (2.0*2.2*1.5cm) with the anteroinferior displacement of the right globe (Figure. 3c). We did Transnasal Endoscopic Marsupialization of the frontal sinus mucopyocele was done under General Anesthesia after getting written and informed consent from the patient and attendant. The mucopyocele was protruding between the right bulla ethmoidalis and the middle turbinate. Anterior ethmoidectomy was done and the frontal recess was cleared. After exposing the mucosa and eggshell bone, the surgical incision was made on the inferior margin of the mucopyocele, and 30 to 40 cc of pus was drained, along with exteriorizing and marsupialization (Figure. 3d). Saline irrigation was used to flush any leftover debris from the frontal sinus. There was a drastic improvement in right eye vision immediately from finger counting 2.5 meters to 6/12 with a complete reduction of the boggy swelling and proptosis (Figure. 3e). The patient was doing fine till six months of follow-up with patent and wide frontal sinus opening on endoscopy (Figure. 3f).
Figure. 3a: Clinical picture showing proptosis and cosmetic deformity.
Figure. 3b: Non Contrast Computed Tomography of Nose and PNS showing extent of lesion.
Figure. 3c: Magnetic Resonance Imaging showing extent of lesion intraorbitally.
Figure. 3d: Wide Frontal sinus opening after marsupialization.
Figure. 3e: Post op picture showing complete regression of proptosis and cosmetic deformity.
Figure. 3f: Follow up endoscopic view of patent frontal sinus.
Case 4:
We report a case of 66-year-old male presenting with the chief complaints of sudden diminution of vision in the left eye for 10 days. There was no history of nasal blockage, nasal discharge, any facial swelling or facial pain, or eye pain. Pre-operative vision assessment on the Right eye was 6/12 and for the Left eye, it was Finger counting at 3 meters. NCCT of the nose and paranasal sinuses showed an ill-defined soft tissue density in the sphenoid sinus, left optic canal abutting the superior rectus muscle, and left optic nerve with erosion seen in the superior wall of the left orbit (Figure. 4a). The patient was taken under general anesthesia for endoscopic removal of the mass after getting written and informed consent. Intraoperative observations in the sphenoid sinus, there was an unhealthy light pinkish-gritty mass, associated with bony erosion of the left orbit's superomedial wall till the level of the optic chiasma, a mass was observed compressing over the left optic nerve (Figure. 4b). The mass was completely removed, the left optic nerve was decompressed, and tissue was sent for histological analysis. Post-operative day 1 vision assessment showed significant improvement from figure counting to 6/24. The histopathological report showed ill-formed epithelioid cell granulomas with giant cells surrounded by a cuff of lymphocytes suggestive of granulomatous inflammation most common differential diagnosis being mycobacterium tuberculosis. The patient was followed after a week which showed left eye vision 6/9. It was consistent till the last follow-up of six months.
Figure. 4a: Non Contrast Computed Tomography of Nose and PNS showing extent of lesion with erosion of superolateral wall of sphenoid sinus along with compression of optic nerve.
Figure. 4b: Endoscopic view showing optic nerve decompression till chiasma.
Case 5:
An 18 years old male came with chief complaints of right nasal obstruction with right intermittent nasal bleeding since 5 months (Fig. 5a). There were no complaints of nasal discharge, anosmia, or altered sensorium. A computed tomography scan of paranasal sinuses (plain+contrast) revealed a large ill-defined soft tissue lesion noted in the nasopharynx with an epicenter at sphenopalatine foramina measuring approximately 9.3*5.0*4.7cm. It is extending laterally through the pterygomaxillary fissure, pterygopalatine fossa up to the infratemporal fossa. Widening of pterygomaxillary fissure and pterygopalatine fossa noted. The lesion is extending intracranially measuring 2.5x1.5cm. Findings were likely suggestive of juvenile angiofibroma stage 3-Andrews Fisch classification (Figure. 5b). Pre-operative embolization was done 48 hours prior to surgery. The right nasal cavity was completely occupied by mass (Figure. 5c). The maxillary sinus was approached by Denker’s approach and the mass separated from the maxillary sinus and brought medially. The posterior wall of the maxillary sinus was drilled and attachment from the infratemporal fossa was separated and brought medially (Figure. 5d). Attachment from the nasopharynx was separated and the mass was brought medially. Mass removed from the right nasal cavity. Haemostasis was achieved and the bilateral nasal cavity was packed with a merocele nasal pack. On histopathology, it showed blood vessels are lined single layer of endothelium. Stroma shows increased fibrosis and collagenisation suggestive of Angiofibroma (Fig. 5e). On the last follow-up six months the patient was fine without nasal bleeding and recurrence.
Figure. 5a: Clinical picture showing mass filling right nasal cavity with cheek swelling.
Figure. 5b: Non Contrast Computed Tomography of Nose and PNS showing extent of lesion.
Figure. 5c: Endoscopic view showing mass filled in nasal cavity.
Figure. 5d: Endoscopic view of mass after ligation of maxillary artery.
Figure. 5e: Histopathology showing Angiofibroma.
Sinonasal masses have various differential diagnoses. Malignancy should be distinguished from non-malignant lesions. Preoperative diagnosis based on proper clinical examination is consistent with histopathological diagnosis in most cases.1 Capillary hemangioma is the most common vascular tumor of the nasal cavity in the adult population.The development of the mucosal variant of capillary hemangioma most commonly occurs in the anterior nasal septum (Little's area), the inferior turbinate, and the vestibule. In our case, the capillary hemangioma developed in the posterior septum and posterior part of the inferior turbinate in 65yrs old patient.4 Rhabdomyosarcomas are rare soft tissue malignancies that occur mainly in the pediatric population. Treatment for rhabdomyosarcoma can include different combinations of surgery, chemotherapy, and radiation.5 We also treated a female pediatric patient with an alveolar variant of rhabdomyosarcoma by the combined modality of surgery and chemo/radiotherapy and the patient is doing well to date.5 Mucopyocele is a benign, mucosa-lined pseudocystic lesion of the paranasal sinus that, due to mucus secretion, has a tendency to expand giving rise to mass effect on surrounding structures. Endoscopic marsupialization is the modality of choice to achieve complete evacuation of the mucopyocele and reestablish the normal sinus outflow.6 Similarly in our case complete removal of mucopyocele by endoscopic marsupialization was done. Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign, highly vascular tumor that is diagnosed on the basis of clinical and imaging features. It has a characteristic pattern of spread commonly involving the pterygopalatine fossa and pterygoid base. Endoscopic endonasal surgery is currently the treatment of choice for almost any size of tumor and is feasible even for advanced lesions.7 Similarly in our case we excised the whole tumor endoscopically which was extended intracranially.
Numerous pathologies are housed in the nasal and paranasal sinuses. In some unusual cases, histopathology and clinical diagnosis may not always coincide, which presents therapeutic challenges to otorhinolaryngologists. The interdisciplinary approach of the surgeon, a pathologist, and an oncologist should be used to provide the best possible outcomes for the patients
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
