RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES –KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate & Address(in block letters) / Dr.DEEPU T.
Sri Lakshmi Nilayam, # 25, Bunglow Street Extension, Tirupur – 641 602. Tamil Nadu.
2. / Name of the Institution / J.S.S. MEDICAL COLLEGE, MYSORE
3. / Course of study & Subject / M.S. GENERAL SURGERY
4. / Date of Admission to Course / 31-05-2007
5. / Title the topic / A comparative study of percutaneous catheter drainage versus percutaneous needle aspiration in the treatment of liver abscess.
6.
6.1 / BRIEF RESUME OF WORK, INTENDED
NEED FOR STUDY
Liver abscess both amoebic and pyogenic continue to be an important cause of morbidity and mortality globally. The mainstay of treatment of liver abscess in the recent past has been either a percutaneous catheter drainage or percutaneous needle aspiration. Various studies done in the recent past have not given a concrete conclusion as to which of the two is better in the treatment of liver abscess. Hence the purpose of this study is to compare the above mentioned treatment modalities and identify the better option for treating patients suffering from liver abscess in our setup.
6.2 / AIMS AND OBJECTIVES
1. To compare and correlate the therapeutic effectiveness of percutaneous catheter drainage versus percutaneous needle aspiration in the treatment of liver abscess.
2. To identify and compare the morbidity and side effects associated with percutaneous catheter drainage and percutaneous needle aspiration.
3. To compare the cost effectiveness of both the treatment options.
6.3 / REVIEW OF LITERATURE
In 1953, Mc Fadzean and associates in Hong Kong advocated closed aspiration and antibiotics for the treatment of liver abscess; however, this treatment did not gain widespread acceptance until imaging advancements in the 1980s.1
In recent years, imaging guided percutaneous drainage has been increasingly used to treat liver abscess, with reported success rates ranging from 70-100%. Although percutaneous placement of an indwelling catheter is the method most widely preferred to drain liver abscesses, recent studies have shown therapeutic needle aspiration to be a simpler, less costly and equally effective mode of treatment.2-7
In 1998 Rajat et al did a comparative study of the above mentioned parameters and concluded that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate8.
In 2004 Yu et al did a comparative study of the two mentioned treatment modalities of liver abscesses and concluded that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of liver abscess. Due to additional advantages of procedure simplicity, patient comfort and reduced price, needle aspiration describes to be considered as a first line treatment approach in cases of liver abscesses9.
7. / MATERIALS AND METHODS
(7.1) Source of data:-
The source of data is collected from a pre-tested proforma from the inpatient, outpatient and the inpatient registry of JSS Hospital, Mysore during the study period Aug. 2007 to Aug.2009.
(7.2) Method of collection of data:-
Collection of data is from the clinical history, physical examination, relevant investigations and imaging modalities.
MODE OF SELECTION OF CASES AND METHOD OF ANALYSIS:-
The criteria for selecting cases for the study include various parameters like age, sex, occupation etc. The analysis of the data will be made on the basis of suitable statistical parameters.
A minimum of 30 cases will be studied.
INCLUSION CRITERIA:-
All patients clinically and Radiologically diagnosed to have liver abscess.
EXCLUSION CRITERIA:-
a) Patients with already ruptured liver abscess.
b) Patients with very small volume abscess and multiple abscess.
c) Patients below the age of 12.
(7.3) Does the study require any investigations or interventions to be conducted on patients?
Yes, the study requires the following investigations
a) Serial ultrasonography of abdomen.
b) Percutaneous catheter drainage.
c) Percutaneous needle aspiration.
d) CT scan if necessary
(7.4) Has ethical clearance been obtained from your institution?
Yes, obtained from ethical committee JSS Medical College, Mysore.
8. / LIST OF REFERENCE:-
1. Zinner MJ, Ahley SW, Manigot’s abdominal operation, 11th edition McGraw hill, 2007:757.
2. Gerzof SG, Johnson WC, Robbins AH, Nabseth DC. Intrahepatic pyogenic abscesses: treatment by percutaneous drainage. Am J Surg 1985; 149: 487-494.
3. Attar B, Levendoglu H, Cuasay NS. CT-guided percutaneous aspiration and catheter drainage of pyogenic liver abscesses. Am J Gasimenteml 1986; 8: 550-555.
4. Seeto RK, Rockey DC. Pyogenic liver abscess: change in etiology, management. and outcome. Medicine 1996; 75: 99-112.
5. Singh JP, Kashyap A. A comparative evaluation of percutaneous catheter drainage for resistant amebic liver abscesses. Am J Surg 1989; l58: 58-62.
6. vanSonnenberg E. Muller PR, Schiffman HR. et al. Intrahepatic amebic abscesses: indications for and results of percutaneous catheter drainage. Radioogv 1985; 156: 631-635.
7. Saraswat VA, Agarwal DK, Baijal SS. Percutaneous catheter drainage of amoebic liver abscesses. Clin Radiol 1992; 45: 187-189.
8. Rajak CL, Gupta S, Jain S, Chawla Y, et al. Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. Am J Roentgenol 1998; 170: 1035-1039.
9. Yu CH, Ho SM, Lau Y, Yeung TK, et al. Treatment of pyogenic liver abscesss: prospective randomized comparision of catheter drainage and needle aspiration. Hepatology 2004; 39: 932-938.
9. / Signature of the Candidate:
10. / Remarks of the Guide : / Even though the disease is common. There are no accepted guidelines regarding need for percutaneous drainage and hence the study is relevant.
11. / Name and Designation of
(in block letters)
11.1 Guide : / Dr.G.SIDDESH MS
PROFESSOR, UNIT CHIEF
DEPARTMENT OF SURGERY
JSS MEDICAL COLLEGE AND HOSPITAL
MYSORE
11.2 Signature
11.3 Co-Guide (if any) / None
11.4 Signature / None
11.5 Head of the Department / Dr.S.B.VASANTH KUMAR M.S.
PROFESSOR, AND HOD
DEPARTMENT OF SURGERY
JSS MEDICAL COLLEGE AND HOSPITAL
MYSORE
11.6 Signature
12 / 12.1 Remarks of the principal & Chairman
12.2 Signature