RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



ANNEXURE- I

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |Name of the Candidate |DR. AMOGH.V.N. |

| |and address : |ROOM NO: F-1 MEN’S HOSTEL |

| | |M.V.J. MEDICAL COLLEGE & RESEARCH HOSPITAL. |

| | |DANDUPALYA, KOLATHUR POST. |

| | |HOSKOTE, BENGALURU-562114. |

|2. |Name of the Institution: |M.V. JAYARAMAN MEDICAL COLLEGE & RESEARCH HOSPITAL. |

|3. |Course of study and subject: |M.D.RADIO-DIAGNOSIS |

|4. |Date of admission and course: |31-05-2011 |

|5. |Title of the Topic: |COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS. |

|6. |Brief resume of the intended work: |

| | |

| |6.1 Need for the study: |

| | |

| |Acute pancreatitis is a common disease with high rate of morbidity and mortality. It is defined as an acute inflammatory disease of |

| |pancreas, typically presenting with abdominal pain and associated with raised levels of pancreatic enzymes in the blood or urine. It has a |

| |broad spectrum of findings that varies in severity from mild interstitial or edematous pancreas to severe forms with significant local and |

| |systemic complications. Computed tomography is the gold standard technique not only for its global picture of the pathology and |

| |complications but also for the non-invasive method of evaluating the morphology of pancreas and peripancreatic regions in an acute |

| |situation. It is unaffected by bowel gas distension and obesity, which is a definite disadvantage on ultrasonographic evaluation. Computed |

| |tomography helps in early diagnosis and staging of severity of acute pancreatitis and its complications which helps in prediction of |

| |prognosis of the disease. |

| | |

| |6.2 Review of literature: |

| |Computed tomography evaluation of pancreas began in the late 1970s’ with simultaneous publications by authors like Kreel, Stephens et al |

| |and Haaga et al in 1976.Initially only pancreatic masses or contour abnormalities could be detected. Over the last decade, the use of bolus|

| |intravenous contrast material has enabled imaging of normal pancreatic parenchyma, pancreatic duct and peripancreatic vascular structures. |

| |1. Bollen TL, Singh VK, et.al1 The purpose of this study was to compare the modified computed tomography severity index with the computed |

| |tomography severity index regarding assessment of severity parameters in acute pancreatitis. Both computed tomography indices were also |

| |compared with the Acute Physiology, Age, and Chronic Health Evaluation index (APACHE II). A study on 397 cases of acute pancreatitis, 196 |

| |patients underwent contrast-enhanced computed tomography within 1 week of onset of symptoms. They concluded by saying no significant |

| |differences were noted between the computed tomography severity index and the modified computed tomography severity index in evaluating the|

| |severity of acute pancreatitis and when compared with Acute Physiology, Age, and Chronic Health Evaluation index (APACHE II), both computed|

| |tomography indices are more accurately diagnosed, clinically severe disease. |

| |2. Chaudhary V, Bano S2. Computed tomography is the modality of choice for the diagnosis and staging of acute pancreatitis. It is highly |

| |sensitive in detecting the necrosis, the hallmark of severe acute pancreatitis and peripancreatic fluid puted tomography |

| |outclasses all imaging modalities in detecting calcifications, a specific sign of advanced chronic pancreatitis. |

| |3. Koo BC, Chinogureyi A, Shaw AS3. The objective is to know the pathophysiology of acute pancreatitis, the appearances of the various |

| |stages of pancreatitis, the evidence for the use of staging classifications and the associated complications. He stated that acute |

| |pancreatitis can be divided into (two subgroups) mild acute pancreatitis and severe acute pancreatitis that follow a markedly different |

| |clinical course. Imaging with contrast-enhanced computed tomography plays a vital role in diagnosing, staging and identifying the |

| |associated complications of acute pancreatitis. Other imaging modalities such as Endoscopic ultrasonography and Magnetic resonance imaging |

| |have subsidiary role in the early stages of acute pancreatitis but are better at evaluating the aetiology. |

| | |

| |4. Chishty IA, Bari V, et.al4 They conducted a study on 40 patients with age range from 16-71 years were divided in three groups. Group I |

| |was less than 40 years, Group II was between 40-60 years, and Group III was more than 60 years. Computed tomography scans were assessed for|

| |pancreatic necrosis and its complications. Computed tomography Severity Index was calculated according to Balthazar's method. The study |

| |demonstrated the prognosis of acute pancreatitis can be depicted by computed tomography severity index. Computed tomography severity index |

| |has excellent correlation with development of local complications and incidence of death in patients with acute pancreatitis. |

| | |

| |5. Casas JD, Diaz R, et.al5 A retrospective study investigated the prognostic value of early computed tomography in acute pancreatitis, the|

| |role of pancreatic necrosis as an indicator of prognosis, and the need for the routine use of intravenous iodinated contrast material in |

| |early computed tomography to assess prognosis in these patients. Study was concluded as, early unenhanced computed tomography alone was a |

| |good indicator of severity of acute pancreatitis. Computed tomography grade was sensitive for predicting outcome in acute pancreatitis. |

| |Pancreatic necrosis, estimated on early, contrast-enhanced computed tomography and seen only in patients having severe disease, was a |

| |specific predictor of morbidity and mortality. |

| | |

| |6. Balthazar EJ6 In his first study in 1985 the grading of severity of pancreatitis was divided into five distinct groups (from A to E), |

| |and attempted to correlate the computed tomography grade with clinical follow up findings, morbidity, and mortality. He reviewed in 2002, |

| |to describe the accepted new concepts in the development of pancreatic necrosis and staging of acute pancreatitis. The computed tomography |

| |severity index helps in development and extent of pancreatic necrosis as it is important indicators for disease severity. They concluded by|

| |saying contrast-enhanced computed tomography is the imaging modality of choice to stage the severity of inflammatory process, detect |

| |pancreatic necrosis and depict local complications. It yielded overall detection rate of 90% with close to 100% sensitivity after 4days for|

| |pancreatic gland necrosis. |

| | |

| |6.3 Objectives of the study: |

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| |1) To determine the value of computed tomography evaluation in early diagnosis of acute pancreatitis. |

| | |

| |2) To differentiate between acute edematous and acute necrotizing pancreatitis. |

| | |

| |3) To evaluate the complications using computed tomography severity index. |

| | |

| |4) To differentiate between acute pancreatitis and pancreatitis caused by mass lesions. |

|7. |Materials and Methods: |

| | |

| |7.1 Source of data: |

| | |

| |Patients referred to department of Radio-diagnosis in M.V.Jayaraman Medical College and Research Hospital with the Clinically |

| |suspected/Diagnosis/Lab findings / Ultrasonography suggestive of acute pancreatitis of all the age group in the period between 1/11/2011 – |

| |31/08/2013. Sample size will be minimum of 50 cases. |

| | |

| |Imaging will be done by, |

| |Toshiba Asteion spiral Computed Tomography scan. |

| |Protocol – Plain and post-contrast series of the abdomen and pelvis will be taken. It consists of acquisition of contiguous axial |

| |sections, of thickness 7 mm of abdomen and pelvis, 5mm in region of interest in the cranio-caudal direction from the level of the |

| |xiphisternum to pubic-symphysis before and after administration of oral and intravenous iodinated contrast of 80-100 ml. All images will be|

| |viewed in a range of soft tissue window settings. |

| |Clinical details, laboratory, ultrasonography and computed tomography findings of the case will be recorded as per the proforma. |

| | |

| |7.2 Method of collection of data(including sampling procedure if any): |

| | |

| |1) Definition of a study subject: |

| |A prospective study on patient referred to department of Radio-diagnosis in M.V.Jayaraman Medical College and Research Hospital on clinical|

| |suspicion/diagnosis of acute pancreatitis, altered biochemical parameters (serum amylase, serum lipase) in favor of acute pancreatitis, |

| |Ultrasonography suggestive of acute pancreatitis and known case of chronic pancreatitis with features of acute symptoms are taken up for |

| |computed tomography study and evaluated. |

| | |

| |2) Inclusion Criteria: |

| |All the patients who are suspected/diagnosed of acute pancreatitis based on clinical and laboratory findings (serum amylase & serum |

| |lipase). |

| |Patients who are diagnosed acute pancreatitis on ultrasonography. |

| |Patients who present as acute on chronic pancreatitis. |

| | |

| |3) Exclusion Criteria: |

| |Chronic pancreatitis. |

| |Congenital pancreatic lesion. |

| |Pancreatic carcinoma and metastasis. |

| |Pancreatic trauma. |

| | |

| |4) Statistics: Descriptive statistics (Tabulations, graphs & charts, proportions, percentage, |

| |etc.)are used. |

| | |

| | |

| |7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? |

| | |

| |Yes |

| | |

| |Blood – Hemoglobin, Total Leucocyte count, Differential count, serum Amylase, serum Lipase, serum Creatinine. |

| | |

| |Plain and Contrast enhanced computed tomography abdomen and pelvis. |

| | |

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| |7.4 Has ethical clearance been obtained from your institution in case of 7.3? |

| | |

| | |

| |Yes |

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| |List of references: |

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|8. |[1] Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ, Comparative evaluation of the modified CT |

| |severity index and CT severity index in assessing severity of acute pancreatitis. AJR Am J Roentgenol.2011 Aug; 197(2):386-92. |

| | |

| |[2] Chaudhary V, Bano S. Imaging of Pancreas: Recent advances. Indian J Endocr Metab 2011; 15:S25-32. |

| | |

| |[3] Koo BC, Chinogureyi A, Shaw AS. Imaging acute pancreatitis. Br J Radiol.2010 Feb; 83(986):104-12. |

| | |

| |[4] Chishty IA, Bari V, Pasha S, Burhan D, Haider Z, Rafique Z. Role of Computed tomography in acute pancreatitis and its complications |

| |among age groups. Pak Med Assoc. 2005 Oct;55(10):431-5. |

| | |

| |[5] Casas JD, Diaz R, Valderas G, Mariscal A, Cuadras P. Prognostic value of in the early assessment of patients with acute |

| |pancreatitis. AJR Am J Roentgenol. 2004 Mar; 182(3): |

| |569-74. |

| | |

| |[6] Balthazar EJ. Acute pancreatitis: Assessment of severity with clinical and CT evaluation. Radiology. 2002 Jun; 223(3):603-13. |

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|9. |Signature of candidate |

|10. |Remarks of the Guide : |

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| |Acute pancreatitis in rural settings are encountered more often today, computed tomography is the gold standard in the evaluation of|

| |this condition, in early and better management of cases because of high morbidity and mortality. This study gives an insight into |

| |the value of computed tomography from ultrasonography. |

|11. |Name & Designation of (in block letters) |

| |11.1 Guide |DR. T.RAMACHANDRA PRASAD |

| | |DMRD, MDRD. |

| | |PROFESSOR AND HEAD OF DEPARTMENT, |

| | |DEPARTMENT OF RADIO-DIAGNOSIS. |

| | |M.V.J.M.C & R.H. |

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| |11.2 Signature | |

| |11.3 Co-Guide (if any) |DR. N.SRINIVASAN |

| | |MS, F.R.C.S (GLASGOW). |

| | |PROFESSOR OF SURGERY, |

| | |DEPARTMENT OF GENERAL SURGERY. |

| | |M.V.J.M.C & R.H. |

| | | |

| |11.4 Signature | |

| |11.5 Head of Department |DR. T. RAMACHANDRA PRASAD |

| | |DMRD, MDRD. |

| | |PROFESSOR AND HEAD OF DEPARTMENT, |

| | |DEPARTMENT OF RADIO-DIAGNOSIS. |

| | |M.V.J.M.C & R.H. |

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| |11.6 Signature | |

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| |12.1 Remarks of the chairman & principal | |

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| |12.2 Signature | |

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