1. The Value of Serial Electrodiagnostic Evaluation’ - Demonstrated Using a Case Referred with the Clinical Impression of Carpal Tunnel Syndrome
   Bhavana Doshi, KA Mansukhani
   Serial Electrodiagnosis, was used in this case who presented with H/o acute numbness in one hand in the Median nerve distribution and slowly progressed over 1 year to develop a widespread sensori-motor demyelinating peripheral neuropathy that responded to corticosteroid therapy. The earliest abnormality detected on EDX evaluation was an abnormal Erb’s point potential to Median nerve stimulation. All other sensori-motor studies were normal. The second study done after 5 months showed only abnormal H reflexes and 2 months later patient had EDX suggestive of a classic CIDP. The EDX study done after treatment showed considerable improvement.
   
   
   
2. Endoscopic Endonasal Trans-sphenoidal Approach for “Non Pituitary” Lesions
   Chinmay P Bhalke, Chandrashekhar E Deopujari, Nishit J Shah, Rajan M Shah, Vikram S Karmarkar, Rakeshkumar C Luhana
   Endoscopic transnasal trans-sphenoidal approach for pituitary tumours has been a significant advance in the surgical management. This approach can also be used for “non pituitary” sellar/suprasellar space occupying lesions successfully with some modifications.
   
   Here we present our experience of 31 “non pituitary” lesions including 3 Rathkes’s pouch cysts, 5 craniopharyngiomas, 2 suprasellar arachnoid cysts, 5 chordoma, 1 cholesterol granuloma, 3 meningioma, 1 plasmacytoma, 2 fungal granuloma and 2 sphenoid mucocoele which have been managed successfully by endoscopic approach.
   
   
3. Clipping of a Partially Coiled Aneurysm : An Early Experience
   Rakeshkumar Luhana, CE Deopujari, Rajan Shah, A Karapurkar, V Karmarkar, A Kakani, C Bhalke
   Coiling is becoming increasingly popular modality of treatment for obliteration of an aneurysm. Inadequate packing and/or delayed recanalization are frequently reported, which may remain asymptomatic. However, the risk of haemorrhage in a partially obliterated aneurysm remains high and definitive treatment is therefore necessary. Clipping of a partially coiled aneurysm is a challenging task.
   We are presenting our experience of 4 cases (1 anterior communicating artery aneurysm, 1 middle cerebral artery aneurysm, 1 posterior communicating artery aneurysm and 1 proximal internal carotid artery aneurysm) of successful clipping of partially coiled aneurysms. Two of them were detected of having incomplete coiling on follow up angiogram while one patient presented after re-rupture and one patient had aneurysm rupture while coiling.
   
   During surgery dissection of the neck is reported to be difficult due to the coils and dissection technique may need to be modified in cases with perforation. However, we found it to be relatively simple if dissection is restricted to the neck in these cases and have not encountered any complication securing complete exclusion of the aneurysm in all 4 cases.
   
   
4. A Prospective Study of Correlation of MR Spectroscopic Findings with Histopathology in 35 Cases of Gliomas
   Shashank S Joshi, KE Turel, Nootankumar Sharma, Joy Varghese, Anand Kakani
   The gliomas are most prevalent primary brain tumours. As their prognosis is dismal and is totally dependent on preoperative imaging and histopathological diagnosis. Low grade gliomas have better prognosis due to slow progression and possibility of complete excision as compared to high grade gliomas. Though routine CT scans and contrast enhanced MRI scans can give anatomical aspects of these terrifying tumours, complex biology can be explained partly by MRS, which is very important for predicting behaviour of particular tumours. MRS thus does not replace the contrast MRI but compliments the already received information. It gives virtual biopsy and non-invasive assessment of metabolites in the tissue studied. This study includes the prospective study of efficacy and sensitivity of preoperative MRS in grading of 35 cases of gliomas. It helps in differentiating tumour from peritumoural oedema, differentiates primary and metastatic tumours, but at the same time intra-tumoural blood, small surfacing lesions can be misinterpreted due to spectral disturbances. Spectroscopy has its own limitations i.e. it cannot subdivide the different types of gliomas, very tiny lesions can be misinterpreted. Tumours with gross necrosis can have difficulty for putting voxels to get proper spectra. MRS is quite useful in selecting proper site for stereotactic biopsy.
5. Syringopleural Shunt : A Novel Treatment for Syringomyelia
   Anand Kakani, KE Turel, Nootankumar Sharma, Joy Varghese, S Joshi
   A syrinx is a low pressure cavity and its constant drainage through a shunt system is essential to keep it collapsed. Plural cavity offers a negative pressure and is the ideal recipient site for such shunt system. Syringopleural shunt is a highly technical operation and fulfills the criteria of an ideal management for syringomyelia.
   The current series involves thirty one patients of syringomyelia treated by senior author at Bombay Hospital Institute of Medical Sciences, Mumbai, India over the past 15 years (1989 to 2004). These patients were investigated by MRI brain and spine and SSEP, with an average follow up of five years. The most common causes of syringomyelia in our series were Arnold chiari malformation (20/31=64.5%), spinal trauma (03/31=9.7%), spinal dysraphism (02/31=6.5%), spinal arachnoiditis (02/31=6.5%), congenital kyphoscoliosis (01/31=3.2%) and unknown (03/31=9.7%). Out of thirty one patients, twenty seven (87%) underwent syringopleural shunt procedure and results, both clinically and radiologically, were quite encouraging. Eighteen patients (67%) were improved, one patient (3.7%) remained stable, two patients initially improved but later on worsened due to progressive kyphosis and spinal arachnoiditis respectively. One patient (3.7%) showed improvement for almost seven years and has become stabilized now. The most common complications were transient pleuritic pain (100%), hydrothorax (4.5%) and shunt migration within pleural cavity (4.5%). Two patients died due to massive hydrothorax and pulmonary embolism. The average follow up was 5 year.
   The current article is a product of senior author’s experience in treating these cases.

Abstracts of Papers Presented at the 139th Research Meeting of the Medical Research Centre of Bombay Hospital Trust on Monday 12th June 2006
(Convener Dr. HL Dhar)

1. Haematological Markers for Diagnosis of Smear Negative Malaria in Children and Adolescents
   V Joshi, SY Bhave, HL Dhar
   Malaria in children differs from that in adults in terms of its varied manifestations and higher mortality especially in very young children. Laboratory tests include a malarial smear, complete blood count : Hb, RBC, WBC, neutrophils, monocytes, retic count and platelet count. When the smear for malaria parasite is negative but the clinical picture and therapeutic response is like malarial infection, there is need to see if there are any haematological tests that can indirectly suggest malaria which will be of help to the clinicians. The aim of the study was to identify various haematological parameters which can be used as indirect evidence of malaria if the smear is negative.
   Prospective and retrospective study of hospitalized cases of malaria at a tertiary hospital over a period of five year period (1994-1998) between the age group (0-17 yrs) was planned. They were divided into 3 groups : P falciparum (n=97), P vivax (n=62) and smear negative cases (n=75). Haematological parameters viz. Hb, leucocytes count, retic count, neutrophils, monocytes and platelet count were correlated with type of malaria and age group. The sample study was divided into four groups viz. < 1 year, 1-5 years, 6-12 years and 13-17 years.
   Haematological profile of 234 cases of malaria (Falciparum, Vivax and Smear negative) over a five year period (1994-98) in tertiary care hospital in children and adolescents were studied. Anaemia was observed in 65.8% of cases. Falciparum malaria were presented with features of severe anaemia. Other haematological parameters seen were high retic count, low platelets, and monocytosis. Leucocytosis was seen in 11.96% and leucopenia in 17.95%.
   Conclusion : Statistical analysis showed that some haematological markers viz: high retic count and low platelets, leucocytosis, thrombocytopenia, neutrophilia were useful indicators suggestive of malaria in smear negative cases.
   
   
2. Correlation between Blood Sugar, Cholesterol and Asthma Status
   R Mansi, SV Joshi, SR Pandloskar, HL Dhar
   Background : Asthma is one of the most common, chronic diseases worldwide. Epidemiological studies have suggested that the dietary pattern may be associated with the prevalence of asthma. The dietary cholesterol may enhance pulmonary inflammation and airway contractility is reduced in a model of diabetes. The aim of the study was to correlate diabetes, cholesterol and severity of asthma.
   Methods : Retrospective study of 168 hospitalised asthmatic patients was done. They were divided into 4 groups: (i) Bronchial asthma (BA), (ii) Acute Exacerbation (AE), (iii) Late onset asthma (LOA), (iv)Status asthmaticus (SA). Attempts were made to correlate severity of asthma, cholesterol and blood sugar.
   Results : Fasting blood sugar was similar in the groups of BA and LOA; however post-prandial blood sugar was found to decrease as severity of asthma increased (p < 0.05). All patients were on inhaled corticosteroids. Out of 168 patients, 41 patients (24%) were diabetic and 127 patients (76%) were non-diabetic. Diabetic status was nearly equal in BA (23.47%) and AE (21.43%).
   It was seen that when severity of asthma and hypoglycaemia co-existed, cholesterol levels were also found to be significantly higher. Out of 18.45% hypertensives, 18% were in BA and 7% in AE. However, hypercholesterolaemia was not related to hypertension in both groups and none had diabetes. Other complications included: Rhinitis (0.71%), Koch’s (0.36%), Hypothyroidism (0.30%), Gastrooesophageal reflux disease (GORD) (0.30%), Stroke (0.18%), Cancer (0.18%), Malaria (0.12%), Anaemia (0.12%), Urticaria (0.12%), Migraine (0.12%), Hyperthyroidism (0.06%) and Pneumonia (0.06%).
   Conclusion : Blood sugar and cholesterol show inverse relationship in bronchial asthma.
   
   
3. R isk Factors Associated with Mortality and Morbidity of Pneumonia
   SR Pandloskar, SV Joshi, HL Dhar
   SR Pandloskar, R Mansi, SV Joshi, HL Dhar
   Purpose : A retrospective study was conducted to assess risk factors in pneumonia cases treated as inpatients. This study describes the clinical picture, prognostic factors and complications.
   Subjects and Methods : A total of 282 consecutive patients admitted to BH between Jan 2001 and Dec. 2005 (ICD code for Pneumonia - J18) from Respiratory Unit (Gr.-I) and other units (Gr.-II) were included in this study.
   Statistical Analysis : All the parameters were analyzed in terms of mean ± SD. Odds Ratio for comparison of percentage was calculated. Paired t-test was applied for comparison of continuous series.
   Results : Patients came with symptoms like fever, cough expectoration, chest pain, vomiting etc. There was significant difference in the mean age in both groups.
   Co-morbidity was found in 94% patients, of which septicaemia, diabetes, Hypertension was seen in both Gr.-I and Gr.-II. Renal complications, Ischaemic Heart Disease, Cancer and HIV were the associated co-morbid conditions in Gr.-II.
   Chest X-ray findings revealed Pleural effusion, Consolidation, infiltration and Pneumonic patch in both groups.
   Right lobe or Left lobe infiltration was seen in Gr.-I whereas in Gr-II Right/Left Lobe infiltration or infiltration in both the lobes was seen.
   Bacterial aetiology was more frequently found (p < 0.01) in-patients with co-morbid conditions. The most common pathogens in Gr.-I and Gr.-II were Gram positive cocci and Gram negative bacilli. Pathology Findings: In the present study we found low cholesterol levels in both the groups. On the other hand, Creatinine levels, LDH levels, blood Urea, Sugar levels, Sodium, Chloride were higher in Gr.-II.
   Mortality : Overall mortality was 29.43%. It was observed that most of the deaths occurred in higher age group (40-80 years of age).
   Conclusion : Our present study shows that Renal, Heart disease, Diabetes, mellitus and Hypertension are the associated risk factors and the leading causes of mortality in Pneumonia.
   
   
4. Obesity and Co-morbid Conditions
   A Ghildyal, SR Pandloskar, HL Dhar
   Aims : The World Health Organisation has identified obesity as leading preventable cause of death second only to smoking. A retrospective study is being conducted to assess the prevalence of obesity and co-morbid conditions in inpatients in our hospital.
   Method : The study spans a total of five years (‘01-’05). Data of 50 patients of the first two years (‘01-’02) has been collected so far. All parameters have been analyzed in terms of mean ± standard deviation, with p value for comparison of data.
   Result : In our study so far maximum patients were from the upper economic strata (88%). Women were significantly older than men when it came to being obese. Although blood levels of LDH, cholesterol, CPK were significantly higher in females, they were within the normal range. Hypertension was seen in 38% (M:F=11:8) cases, whereas diabetes was seen in 34% (M:F=1:1) cases. Other conditions were IHD, sleep disorders, thromboembolic phenomenon, respiratory insufficiency, arthritis and chronic back pain. Lipectomy was carried in 14% patients, 85% of whom were females. Rest (86%) were treated conservatively or other co-morbid conditions. No bariatric surgeries have been documented so far.
   Conclusion : Obesity requires prompt attention to curb its epidemic tendencies. Although it is seen more in the upper strata in our study, it is known to exist in all societies. Except for in 14% cases, it was treated mostly as a secondary condition. Obesity needs to be recognised and treated as a primary condition as its outcome and that of conditions such as hypertension and diabetes are directly co-related.