Dr rangaswamy. Professor, Dep’t of Pathology. Kims name of the candidate and Address



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PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

 

GUIDE:



Dr. T H ANJANAPPA. Professor, General Surgery, KIMS

C0-GUIDE:



Dr. RANGASWAMY.

Professor, Dep’t of Pathology. KIMS

1. Name of the candidate and Address: Dr. Eshwarappa.M

1ST yr PG KIMS Hospital

Bangalore

 2. Name of the Institution: KEMPEGOWDA INSTITUTE OF

MEDICAL SCIENCES AND

RESEARCH CENTRE,BANGALORE

 3. Course of Study and Subject: M.S. (GENERAL SURGERY)

 4. Date of admission to course: 29/4/2010



TITLE OF THE TOPIC

CLINICOPATHOLOGICAL STUDY OF

CERVICAL TUBERCULAR LYMPHADENOPATHY

AT KIMS HOSPITAL BANGALORE

  • Introduction

Tubercular Lymphadenopathy is a common extra pulmonary manifestation of Tuberculosis.(1) Tuberculosis is a chronic granulomatous infection caused by Mycobacterium tuberculosis, which is acid-fast bacillus. It commonly presents as pulmonary tuberculosis. A common extra pulmonary manifestation of tuberculosis is lymphadenopathy. Tubercular lymphadenopathy often affects young adults. Tubercular lymphadenopathy most commonly involves cervical group of lymph nodes(1,7). A review of literature shows cervical lymphadenopathy to be the commonest site for Tubercular lymphadenitis.(1)

6. BRIEF RESUME OF THE INTENDED WORK:

Tuberculosis remains a problem throughout the world and is still a common cause of cervical lymphadenopathy in many developing countries.(6)

In my study, sample size of 90 will be selected from the patient presenting with cervical lymph node swelling at surgery outpatient and inpatient department. Among selected samples my study needs to know demographic profile of cervical lymph node tuberculosis , to determine the involvement of different groups of cervical lymph nodes and to know the efficacy of clinical investigations. Study group consists patients aged more then 18years and lymph node swelling of more than two weeks duration. Study period of two years .



6.1 NEED FOR THE STUDY:

Tuberculosis remains a problem through out the world, and India is contributing 20% of it. Lymph node tuberculosis is most common among extra-pulmonary tuberculosis . So my study of cervical lymph node tuberculosis is to know its distribution among different age and sex groups, its involvement of different group of cervical nodes and cytological variation with duration of lymph node swelling.



6.2 REVIEW OF LITERATURE:

There are approximately 800 lymph nodes in the body, with no fewer than 300 of them lying in the neck. Inflammation of the nodes of the neck is exceedingly common. Infection occurs from the oral and nasal cavities, pharynx, larynx, ear, scalp and face(2).

Lymphadenopathy is an abnormal increase in size and/or altered consistency of lymph nodes. It is a clinical manifestation of regional or systemic disease and serves as an excellent clue to the underlying disease(4). A review of literature shows cervical lymphadenopathy to be the commonest site for tuberculous lymphadenitis(1).

ANATOMY:

Lymph nodes are discrete structures surrounded by a capsule composed of connective tissue and a few elastic fibrils. The capsule is perforated by multiple afferent lymphatic's that empty into a fenestrated sub capsular peripheral sinus. Lymph extravasates from this sinus and slowly percolates through the node, eventually collecting in medullary sinusoids and exiting through a single efferent lymphatic vessel in the hilus, which is the point of penetration by a single small artery and vein. Situated in the cortex subjacent to the peripheral sinus are spherical or egg shaped aggregates of small lymphocytes, the so-called primary follicles, which contain numerous immunologically naïve B cells. The para cortical region lying between primary follicles is populated by numerous evenly dispersed small T lymphocytes. Deep to the cortex lies the medulla, which contains variable numbers of plasma cells and relatively few lymphocytes. This morphologic description reflects the static organization of a lymph node that is not responding to a foreign invader. As secondary lines of defense, lymph nodes constantly respond to stimuli, particularly infectious microbes, even in the absence of clinical disease. Within several days of antigenic stimulation, primary follicles enlarge and are transformed into pale staining germinal centers, highly dynamic structures in which B cells acquire the capacity to make high-affinity antibodies against specific antigens. Normal germinal centers are surrounded by a dark-staining mantle zone, which contains mainly small naïve B cells. In some reactive conditions, a rim of B cells with slightly more cytoplasm accumulates outside of the mantle zone; cells occupying this region are called marginal zone B cells. The para cortical T-cell zones also frequently undergo hyperplasia in immune reactions in which cellular immunity is particularly important, such as viral infections.(5)



PATHOPHYSIOLGY

Most lymphadenopathy is due to benign self limited disease such as viral infections, and adenopathy is secondary to an increase in normal lymphocytes and macrophages in response to an antigen. Other less common mechanisms responsible for adenopathy include nodal accumulation of inflammatory cells in response to an infection in the node(lymphadenitis), neoplastic lymphocytes or macrophages(lymphoma), or metabolite-laden macrophages in storage disease(3)




 

OBJECTIVES OF THE STUDY

1. To study the demographic profile of cervical lymph node tuberculosis.

2. To study the involvement of different groups of cervical lymph nodes.

3. To determine the efficacy of clinical investigations , Monteux test, FNAC and Biopsy if FNAC is inconclusive.

4. To determine the cytological findings in relation to duration of tubercular cervical lymph node swelling.

7. MATERIAL AND METHODS:


  • Patients with cervical lymphadenopthy who attend surgical OPD as well as patients admit in the department of surgery are the material for the study.

7.1 SOURCE OF DATA

  • All patients presenting to the Surgery OPD, and inpatients of KIMS Hospital Bangalore, over a period of two years with the lymph node swelling in the cervical region.

7.2 METHOD OF COLLECTION OF DATA

a Patient data collection and evaluation.

  • Patient data collected regarding: Name, age, sex, address, occupation

  • Patient data will be collected from all patients attending KIMS general Surgery OPD, and inpatient department, irrespective of their age/gender/ background /socio economic status. The patients will be evaluated and followed up according to the following protocol

  • Detailed history of patient

  • Clinical examination of patient

  • Preliminary investigations – Blood routine

  • Specific investigations – Monteux test, FNAC/BIOPSY(if FNAC is inconclusive) done on OPD or inpatient basis

  • Patient will be informed about any surgical procedure and consent will be taken.

  • Surgery

  • Histopathology reports of FNAC/BIOPSY

 

b. Follow-up of patients:

Patients will be followed up for a period of 6 months on a monthly basis, after discharge.



c. Inclusion Criteria:

All patients above 18 years of age groups presenting with lymph node swelling in the cervical region.

Patients with enlarged neck nodes of more than two weeks duration.

 

d. Exclusion Criteria:

Neck swellings other than lymph node origin.

All patients below18 years of age groups.

Patients with enlarged neck nodes of less than two weeks duration.

e. Sample size: 90 cases.

 

f. Study design: Prospective study.



g. Sample design: Random sampling.

 

h. Duration of study: Two years.

Case selection for the study will be done in the initial one and half year, followed by follow up period of 6 months.

i. Study place: KIMS Hospital, Bangalore.

7.3 ETHICAL ISSUES


  • Patients will be treated with utmost respect and dignity of patient maintained

  • Patients will be informed about the study and consent will be taken before any procedure

  • No investigation other than in standard protocol will be prescribed.

  • No patient will be forced to undergo a test/procedure he/she does not consent for or cannot afford

  • Patient will not be biased towards any treatment.

  • Any investigative/therapeutic modality will be in the best interest of the patient.

7.4 Has ethical clearance been obtained from your institution ?

Yes.


8. LIST OF REFERENCES

1. 2008 volume 9 number 1 The Internet Journal of Orthopedic Surgery

2. Bailey&Love’s short practice of surgery

3. Vikramjit S.Kanwar Alden march Biothics institute, mar 4, 2010

4. A prospective study by Dr.Janardan. V. Bhatt&others, Medical college Elibridge Ahmedabad.

5. Robbins, pathology, basics of disease, 7th ed’n 2005, p-662, ch-14.

6. Volume20 number1 The Journal of Teachers Association RMC Rajashahi TAJ June2007

7. Vol.7 No.1, Issue 25,54-58 Kathmandu University Medical Journal(2009).

 

9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE CO-GUIDE:

 11.NAME AND DESIGNATION OF CO-GUIDE: Dr. RANGASWAMY.



Professor, Dep’t of Pathology. KIMS

11.1. REMARKS OF THE GUIDE:

Among extra-pulmonary tuberculosis, cervical lymph node TB is most common presentation in surgical OPD. In this study it is helpful to know the efficacy of clinical investigation, Monteux test, FNAC, and BIOPSY if FNAC is not conclusive. And also useful to determine the involvement of different group of cervical lymph node and disease progression in relation to duration of symptoms.

 11.2. NAME AND DESIGNATION OF GUIDE: Dr. T H ANJANAPPA.

Professor, General Surgery, KIMS

11.3. SIGNATURE:



11.4. HEAD OF THE DEPARTMENT: Dr . V. SATISH.

Professor and Head of the Department,

General Surgery KIMS Bangalore.

 

11.5. SIGNATURE:



12. REMARKS:

 

12.1. CHAIRMAN AND PRINCIPAL:



 

 

12.2. SIGNATURE:
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