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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA ANNEXURE – II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION. 1 Name of the Candidate And address (In block letters) : Dr. SHRIKANT BULLA DEPARTMENT OF GENERAL SURGERY. NAVODAYA MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE, RAICHUR.- 584103 2 Name of the Institution : NAVODAYA EDUCATION TRUST’S, NAVODAYA MEDICAL COLLEGE, RAICHUR-584103. 3 4 5 Course of study and subject Date of admission to the course : M.S. (GENERAL SURGERY) : 26-05-2010 Title of the Topic A CLINICAL STUDY OF AMOEBIC AND PYOGENIC LIVER ABSCESS IN PATIENTS ADMITTED TO NAVODAYA MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTRE, RAICHUR 6 Brief Resume of the Intended Work 6.1 Need for the study : Liver abscess is one of the most important and frequent problems in clinical practice. The symptoms and signs simulate a great variety of diseases. Until recently the diagnosis of liver abscess was depended upon variable clinical criteria, characteristics of pus aspired from abscess cavity or on a clinical response to appropriate chemotherapy. After innovation of imaging techniques such as ultra sound, isotope scan, C.T.scan, serological tests, the diagnosis of liver abscess can be made rapidly and accurately. This is one illness for which there are so many effective drugs and so much surgical help available, so that once diagnosed no patient should be allowed to die or deteriorate. In India, where liver abscess is common, one must consider possibility of liver abscess in every case of abdominal discomfort or acute abdomen. 6.2 Review of Literature: Hepatic abscesses are a spectrum of infectious hepatic lesions which differ in etiology, treatment options, and outcomes. Their relative incidence varies worldwide. Significant improvements have been made in the diagnosis, treatment, and outcome. Hippocrates is credited with the first description of a hepatic abscess in the year 4000 BC.1 In 1875, Fredor Alekshandrevitch Losch of St. Petersburg (now Leningrad) found amoebae in the stools of a patient with dysentery and suggested it as the causative factor. In 1887 Robert Koch, identified amoeba as the etiological agent in tropical liver abscess. More recently, Ochsner's2 classic 1938 paper described this disease as one that occurred in young males with underlying intra-abdominal infection. In 1953, McFadzean3 and associates in Hong Kong advocated closed aspiration and antibiotics for treatment of solitary pyogenic liver abscess. Modern times have seen a major shift in etiology, affected patient population, and treatment of pyogenic abscesses in the liver. 1 The incidence of pyogenic liver abscess is on the rise. Pyogenic liver abscess affected 5–13 patients per 100,000 admissions prior to 1970, and accounts for approximately 15 cases per 100,000 admissions today.4 Huang and associates reported that 63% of patients had abscesses involving the right lobe, 14% had abscesses involving the left lobe, and 22% had bilobar disease.5 Amoebic liver abscess is caused by the parasitic protozoan Entamoeba histolytica. The disease was described in association with blood and mucus diarrheal stools in the 5th century BC by Hippocrates and other practitioners. Councilman and LaFleur of Johns Hopkins Hospital went on to detail the pathogenic role of amebae and coined the terms "amoebic dysentery" and "amoebic liver abscess" in 1891.6 6.3 Objectives of the study: 1. Age and Sex distribution 2. Duration of the symptoms and Modes of Presentation. 3. Management modalities 7 Materials and Methods: 7.1 Source of Data: 7.2 Patients admitted with suspected amoebic/ pyogenic liver abscess in Navodaya Medical college hospital and research centre will be included in the study. Methods of collection of Data : INCLUSION CRITERIA: All patients admitted with suspected amoebic/ pyogenic liver abscess in Navodaya Medical college hospital and research centre. EXCLUSION CRITERIA: None 7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly. Along with the clinical findings following examinations/tests will be carried out. 1. Hematological examination. 1. Hemoglobin 2. Total count, differential count 3. E.S.R 2. Liver function tests. 1) Serum bilirubin 2) Serum transaminase 3) Serum alkaline phosphatase. 3. Stool examination for Entameoba- cyst/trophozoite. 4. Urine analysis. 5. X-ray chest. 6. Plain X-ray Erect abdomen 7. Abdominal Ultrasound. 8. Needle aspiration 9. Culture and Sensitivity. 7.4 Has ethical clearance been obtained from your institution in case of 7.3? YES. 8 List of references : 1. Christians CK, Pitt HA. Hepatic abscess and cystic disease of liver. Chapter 28 in Maingot’s abdominal operations. Zinner MJ, Ashley SW. 11ed McGraw Hill: 2007 757-782 2. Ochsner A. Pyogenic abscess of liver. Am J Surg 1938;40:292 3. McFadzean AJS, Chang KPS. Solitary pyogenic abscess of liver treated by closed aspiration and antibiotics: A case report of 14 consecutive cases with recovery. Br J Surg 1953;41:141-152 4. Seeto RK, Rocky DC. Pyogenic liver abscess: Changes in etiology, management, and outcome. Medicine 1996;75:99–113 5. Huang CJ, Pitt HA et al. Pyogenic hepatic abscess: changing trends over 42 years. Ann Surg 1996;223:600-609 6. Martinez Baez M. Historical Introduction. In. Martinez-Palomo A (Ed). Amebiasis, Human parasitic disease Vol-2 Amsterdam, Holland: Elsevier;1986 1-9 9. 10. 11. Signature of the Candidate Remarks of the Guide 11.1 Name and Designation of Guide (In block letters) 12 11.2 Signature 11.3 Co-guide (if any) 11.4 Signature 11.5 Head of the Department 11.6 Signature 12.1 Remarks of Chairman and Principal 12.2 Signature Recommended and forwarded DR. SUBHAS S. HADIMANI ASSOCIATE PROFESSOR DEPARTMENT OF GENERAL SURGERY NAVODAYA MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTER, RAICHUR DR.P.SUBANULLA PROFESSOR AND HEAD, DEPARTMENT OF GENERAL SURGERY NAVODAYA MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTER. RAICHUR