1. Oligodendroglioma - Recent Advances
   Nitin Sapkal, AR Chitale
   
   Objective : Oligodendroglioma is an infiltrative glioma with aggressive clinical behaviour. The advent of effective chemotherapy against oligodendroglioma, make it obvious to carefully evaluate and properly classify this tumour from look-alike lesions.
   
   Introduction : Oligodendrogliomas are usually well-differentiated, diffusely infiltrative glioma of adults typically located in the cerebral hemispheres and composed predominantly of cells morphologically resembling oligodendroglia.
   
   Awareness about the fact that oligodendrogliomas are less aggressive gliomas than diffuse astrocytomas of comparable grade, encourages us to identify this glioma, either in pure form or as a componant of mixed glioma.
   
   Material and Methods : We evaluated 69 cases containing oligodendrocyte-like component. Clinical details like age, sex, location of tumour, presenting complaints, radiologic features and treatment received are recorded in each case.
   
   Results : Out of 69 cases, 50 are of oligodendroglioma (72.14%), 12 (17.40%) of mixed oligoastrocytoma and 7 look-alike lesions. The latter includes 3 cases each of DNET and Neurocytoma and one of clear cell meningioma.
   
   Analysis of 50 cases of oligodendrogliomas revealed 19/50 (38%) are in age group 31-40 years. The male to female ratio was 1.38:1 for oligodendroglioma (WHO grade II) and 6:1 for anaplastic oligodendroglioma (WHO grade III). The predominant location was found to be frontal lobe 32/58 (64%).
   
   Conclusion : Knowledge of the fact that chemotherapy with PCV protocol has ensured an excellent therapeutic response in oligodendroglioma, make it evident to separate the oligodendroglioma from look-alike lesions.
   
   DNET and neurocytomas are the benign lesions with excellent prognosis. These look-alike lesions do not require chemotherapy and surgical resection the treatment with excellent results.
2. Introduction of NAT in Blood Donor Screening Programme
   Hitesh Pagare, Maya Parihar-Malhotra
   
   Background : In India it is mandatory for all licensed bank’s to test blood for Anti HIV I and II Anti HCV, HBsAg in addition to VDRL and MP. Advancement in technologies have made it possible to test for components of viruses NAT (Nucleic Acid Test) and this being done routinely in most of the blood banks in Europe and America. As the NAT test is sensitive enough to detect low viral loads, it decreases the window period for detection of HIV, HBV and HCV and thus increases the safety of blood meant for transfusion. Presently we are using a fully automated system (Ortho Eci) based on principle of Chemi-luminescent immuno assay (CIA) for routine blood donor screening. (Third generation Elisa kits).
   

   Aim : To compare NAT screening results in blood donors with our routine CIA results and thus evaluate the usefulness of introducing NAT testing in routine donor screening.
   
   Methods : Period of study from 28/9/2004 to 30/11/2004 number of samples 876. These samples were tested by Ortho Eci kits for Anti HIV I and II, HBsAg and Anti HCV. Samples were sent to reference lobaratory for NAT testing by Chiron’s Ultrio, Multiplex NAT assay. Positive results were then put up for differential assay to determine HIV I. HBV or HCV positivity. All results were tabulated and compared.
   
   Results : Total 876 samples were tested 22 samples were detected as reactive by CIA (HIV-1 HBsAg-10, HCV-11). A total of 9 samples were NAT reactive which included 8 for HBV and 1 for HCV. These samples were all CIA reactive for HBV and HCV respectively. There was no sample which was NAT positive and CIA negative. However there were 13 samples which were CIA reactive and NAT negative (HIV-1, HBsAg-2, HCV-10).
   
   Conclusion : We did not detect any NAT positive and CIA negative cases. Thus our current screening by the Ortho Eci for HIV I and II, HBsAg and HCV is competant enough to provide safe blood. Application of NAT in such circumstances will only increase the cost of one blood unit. We also need to evaluate those cases which were CIA positive and NAT negative.
   
   At present we need to study larger data and statistics on NAT before we attempt to introduce NAT for blood donor screening programme in India.

3. Role of Blood Indices in Selection of Donors
   Rajashree Kanade, Maya Parihar-Malhotra
   
   Introduction : Methods used for donors blood screening : Hb - CuSo4 methods; HIV, HBsAg, HCV - Automated machines; VDRL - RPR test; MP - Fluorescent microscopy.
   
   In view of 26 July flood and epidemic scare, we got thinking of how could we defer donors who might have Leptospirosis or Dengue infection.
   
   Since it is not feasible to run any specific test for this and as we are using QBC capillary tubes for MP we thought of running surrogate test using QBC Autoread system which gives instant readings of HCT, HB, WBC, PLT, % Gran, % Lymp, MCHC.
   
   Aim : Use PLT count as surrogate marker to screen donors for infection with Dengue and Leptospira. To record blood indices of all donors bled in Blood Bank to see any variation from normal.
   
   Material and Methods : Anticoagulant coated capillary tubes filled with blood, spinned and read on QBC Autoread which gives readings of HCT, Hb, WBC, PLT, Gran, Lymp, MCHC which are then analysed.
   
   Period of Study - 16.8.2005 - 16.9.2005
   No. of samples studied - 305/336
   
   Observations :
   • Maximum donors are in age group 21-30,
   • Average PLT - 303.55,
   • Average Hb - 14.55,
   • Average WBC - 9.59,
   • Low PLT cases - 5,
   • Low Hb cases - 13,
   • Increase WBC count cases - 47.

   Conclusion :

   • Low PLT cases had no significant history, Leucocytosis or Leucopenia
   • Need for Quality Control of CuSo4 check,
   • Need for Quality Control of QBC check.
4. mportance of Interpersonal Communication (IPC) Skills in Blood Bank
   RK Shah, Maya Parihar - Malhotra
   
   Though advancement of blood bank technology is taken care by CMEs which keeps blood bank personnel updated, little work has been done on IPC (Interpersonal Communication).
   
   Improving communication between blood donor and blood bank staff is extremely important as the blood donor not only has to get motivated to donate blood but he has to be retained as a satisfied donor who has to repeatedly come to blood bank for blood donation.
   
   Secondly, the beneficiary (Patient’s relative) comes to blood bank under lots of tension and pressure. The blood bank has to try and reduce his stress and ensure that he turns into a messenger and motivator for voluntary blood donation.
   
   IPC between Senior and junior staff in department helps to achieve positive results by using all efforts in one single direction, which gives results as no efforts are wasted in any other direction.
   
   IPC can be achieved by few known techniques like ‘GATHER’ and ‘Yes’ but...
   GATHER technique can be summarised as:
   
   G = Greet
   A = Ask
   T = Tell
   H = Help
   E = Explain / Educate
   R = Retain
   
   IPC skills can help us to get desired results and achieve a higher target of voluntary donation. Smooth functioning of blood bank can also be achieved by using IPC skills.
5. Increasing Blood Study Through Voluntary Blood Donation
   Maya Parihar-Malhotra, PK Khadapkar
   
   Introduction : Bombay Hospital is a Private Trust multi speciality Hospital which drains patients from all over India. These patients undergo cardiac surgeries, hip-replacement surgeries, etc. requiring multiple number of blood units. Our Blood Bank was started in 1952. At our Blood Bank we have Replacement blood donors and Voluntary blood donors. Our replacement blood donors are relatives of patients who voluntarily come to blood bank to donate blood after their patient has been transfused blood. There is no compulsion for them to donate. Most of our voluntary donors in the past were indoor voluntary donors. We attended few outdoor blood collection drives till 2003. From 2004 we have actively started concentrating on increasing our outdoor blood camps so that we can shift towards voluntary blood collection. All blood units are tested for the mandatory HIV, HBV, HCV, Syphilis and Malaria Parasite tests.
   
   Today the National Blood Policy has a requirement for 100% Voluntary blood donation. We too are heading towards this goal.
   
   Material and Methods : We have studied the distribution of Replacement and Voluntary blood donors (Table 1). We have tabulated percentage of Seropositivity (Anti HIV/HBsAg/Anti HCV/VDRL/Malaria Parasite) in Replacement and Voluntary donors in our Blood bank (Table 2).

   Table 1 : Replacement vs voluntary blood collection

   Year	2002	2003	2004	Jan to Oct 2005
   % of Replacement Donors	94	94	88	68
   % of Voluntary Donors	6	6	12	32
   Table 2 : Seropositivity in blood donors
   Year	2002	2003	2004	Jan to Oct 2005
   Replacement donors	2.57%	2.62%	2.53%	2.02%
   Voluntary donors	2.44%	1.33%	3.03%	1.64%
   Total donors	2.73%	2.55%	2.59%	1.90%

   Results : Table 1 shows an increase in voluntary donors from 6% in 2002 to 32% in 2005. Table 2 shows that seropositivity in donors has gone down to 1.90 in 2005 from 2.73% in 2002.
   
   Conclusion : Now we have increased blood stock with voluntary donation and are better able to provide blood to patients. Voluntary donors are safe donors in all studies. Seropositivity is also low in voluntary donors. Today through outdoor collection we have maintained a better stock of voluntary blood thus increasing blood safety.

6. Leptospirosis and Dengue : Post-Deluge 26/7
   Marzook Sheikh, MK Gupta, Roopa Viswanathan
   
   Following the terrible floods of 26/7, an increased number of cases of Leptospirosis and Dengue were reported in the city of Mumbai. A retrospective analysis of data from our hospital was done for the month of July, August, September and October. In the month of Aug.; 344 samples were tested for Leptospirosis by Leptospira IgM ELISA, 76 (22%) were positive; 278 samples were tested for Dengue IgM antibodies by Dengue IgM capture ELISA, 55 (19.8%) were Positive and 70 samples were tested for Dengue IgG antibodies by Dengue IgG capture ELISA, 13 (9.1%) were Positive. An analysis of haematological indices, tests for Liver and Renal functions was also done. There was a significant increase in number of Positive tests of Leptospirosis and Dengue in August as compared to other months, we concluded that this increase was related to the deluge of 26/7.
7. Interesting Case of Thrombocytopenia
   Nina Desai
   
   A case of thrombocytopenia secondary to SLE-related antiphospholipid antibody syndrome was presented in a 13 year old female child who was admitted with facial puffiness, high blood pressure and severe lumbar pain. MR angiography of the kidney, chest X-ray and nuclear scan revealed presence of renal vein thrombosis and pulmonary embolism. She was a known case of hypothyroidism under treatment. Three days after admission, the child developed generalised toxic convulsion.
   
   On laboratory investigations, her blood picture showed very high ESR, low haemoglobin, polymorphonuclear leucocytosis and low platelets. She did not show any schistocytes, spherocytes, macrocytes or Pelger Huet cells in peripheral blood smear.
   
   Her renal profile showed picture of nephrotic syndrome with renal dysfunction. Twenty four hour urine examination showed massive proteinuria. Protein electrophoresis showed picture consistent with nephrotic syndrome. SGOT and SGPT were moderately elevated. Retic count was increased with elevated LDH. Direct and indirect Coomb’s test were normal. The platelet count showed persistently low values at various times.
   
   ASO titre, serum C3, C4 levels and S homocystein levels were within normal limits. Test for antinuclear antibody and p-ANCA were positive.
   
   The coagulation parameters, PT and PTT were prolonged and plasma fibrinogen level was increased. Test for lupus anticoagulant - Kaolin clotting time and dilute Russel Viper Venom test were positive.
   
   Patient was diagnosed as a case of SLE-related antiphospholipid antibody syndrome and was put on steroid and Warfarin therapy. The child responded to the treatment.

Abstracts of Papers Presented at the 134th Research Meeting of the Medical Research Centre of Bombay Hospital Trust on Monday 12th December 2005
(Convener Dr. HL Dhar)

1. Orbital lymphatico - Venous Malformation - A Case Study
   Abhijeet Patil, SR Tambwekar, K Khadalia, VS Tambwekar, RF Ginwalla,
   Karapurkar, U Andhar
   
   A 6 year old boy from a foreign country presented with marked proptosis of the left eye, which had first appeared at the age of 2 year. Initially it had increased in size rapidly and thereafter, enlarged gradually. Parents did not recall any precipitating factor. O/e there was severe axial proptosis with downward and lateral displacement. Vision was unaffected and the pupil was normal. Ocular movements were present but restricted. There was no bruit or pulsation. The proptosis was compressible and not affected by postural change. Specialists consulted in his country were not willing to tackle the case.
   
   We present a rare case of orbital lymphatico venous malformation.
2. Hyperbaric Oxygen Therapy in Plastic Surgery
   RF Ginwalla, SR Tambwekar, K Khadalia, VS Tambwekar, A Patil
   
   Hyperbaric Oxygen Therapy or HBOT is a medical treatment during which a patient is placed in an airtight, specially designed chamber at increased atmospheric pressure (upto 2.5 atm), while breathing 100% oxygen.
   
   Mechanisms of action of HBOT
   • Increases O2 concentration in all tissues, even with reduced blood flow
   • Hyperoxic vasoconstriction (during HBOT) à reduces oedema
   • Rebound arterial dilation (after HBOT), improves blood flow to compromised organs
   • Stimulates adaptive increase in SOD (superoxide dismutase) - antioxidant

   Since August 2002, we have used HBOT as an adjunctive therapy for 108 patients with diverse ailments, with very satisfying results.
   
   In our series, 21 of the patients were female, and 87 were male of which, 3 were children.
   Results : In comparison with similar cases who did not receive HBOT these patients had a more rapid recovery and the morbidity was also reduced. We specifically noted an improvement in the quality of wound granulation tissue as well as in flap survival.

Abstracts of Papers Presented at the 135th Research Meeting of the Medical Research Centre of Bombay Hospital Trust on Monday 9th January 2006
(Convener Dr. HL Dhar)

1. Our experience with lymphoscintigraphy
   Atul Marwah, Shefali Gokhale, Sunita Tarsariya
   
   Aim : To assess the utility of lymphoscintigraphy in the diagnosis and management of patients with lower limb oedema.
   
   Lymphoedema is oedema that results from chronic lymphatic insufficiency. It is either misdiagnosed, treated too late or not treated at all.
   
   From the various lymphoscintigraphy patterns, we can determine whether the limb swelling is due to lymphoedema and if so, whether surgery (lymphovenous anastomosis) is indicated or not. It is also useful in documenting the post-surgical improvement.
   
   Timely diagnosis can lead to prevention of secondary effects such as cosmetic deformity and increased susceptibility to recurrent infection.
   
   Besides, it is reproducible, objective and technically less challenging when compared to lymphangiography. The functional information that it offers has significant clinical implications when compared to the anatomic information from other imaging modalities.
   
   We studied a total of 20 patients over a period of 6 months. 0.5 mCi 99mTc sulphur colloid was administered subcutaneously in to the web spaces of both feet. Immediate and delayed sweep images of both lower limbs were acquired.
   
   The varied patterns on lymphoscintigraphy were correlated with the clinical information and conclusions were drawn.
   
   The various patterns on lymphoscintigraphy included delay, asymmetric or absent visualization of regional lymph nodes, and the presence of “dermal backflow”. Additional findings included asymmetric visualization of lymphatic channels, collateral lymphatic channels, interrupted vascular structures, and lymph nodes of the deep lymphatic system (i.e., popliteal lymph nodes after web space injection in the lower extremities).

2. MRI Evaluation in Knee Trauma
   Kiran S Talkelar, Govardhan Maheshwari, Inder Talwar, Sunila Jaggi
   
   The aim is to study MRI appearances in cases of knee trauma and to identify common pathologies. Wherever possible an arthroscopic correlation was obtained.
   
   Fifty patients with prior history of knee trauma were studied on a 1.5 tesla. MR machine, standard spinecho as well as faster sequences such at GRE, FSE and STIR were used.
   
   Three standard planes used : coronal, sagittal, axial with FOV 16 cm and 4 mm slice thickness.
   
   Our study included 34 males and 16 female patients. Commonest finding was tear of the medial meniscus (74%) and anterior cruciate ligament (44%) out of this 2 patients had bucket handle tear. Posterior cruciate ligament tear were seen in 8 cases (16%).
   
   Ten patients revealed injury of the medial collateral ligaments and one had tear of lateral collateral ligaments. PDW images were most diagnostic showing tear as a hyperintense signal.
   
   It is concluded that MRI is an excellent non-invasive, preoperative modality in assessment and treatment planning of meniscal and ligament injuries of the knee joint.