JJournalournal ofof PostgraduatePostgraduate MedicineMedicine ! Volume 54, Issue 1, January-March 2008 Print ISSN 0022-3859 E-ISSN 0972-2823 President, Staff Society M. E. Yeolekar Contents Editor Sandeep Bavdekar EDITORIAL Associate Editors Clinical Trial Registry - India (CTR-I): A meaningful initiative. How to take it Nithya Gogtay forward? D. Muzumdar Bavdekar SB 1 Consulting Editors Vinita Salvi ORIGINAL ARTICLES Pradip Vaideeswar Detection of Rh antibodies using two low ionic diluents: Extension of the Manjula Sarkar incubation time and the number of Rh antibodies detected Ombudsman Skaik YA 4 Sunil Pandya Immunophenotypic characterisation of peripheral T lymphocytes in pulmonary tuberculosis Managing Editor Al Majid FM, Abba AA 7 D. K. Sahu Relationship between N-terminal pro-B type natriuretic peptide and extensive Members echocardiographic parameters in mild to moderate aortic stenosis Amita Mehta Cemri M, Arslan U, Kocaman SA, Çengel A 12 Anil Patwardhan Atul Goel Relative efficiency of polymerase chain reaction and enzyme-linked Avinash Supe immunosorbant assay in determination of viral etiology in congenital cataract Keya Lahiri in infants Prafulla Kerkar Shyamala G, Sowmya P, Madhavan HN, Malathi J 17 Pritha Bhuiyan Stomaplasty—anterior advancement flap and lateral splaying of trachea, Rajeev Satoskar a simple and effective technique Sucheta Dandekar Trivedi NP, Patel D, Thankappan K, Iyer S, Kuriakose MA 21 Uday Khopkar CASE REPORTS Advisory Board Thomas B. Ferguson, USA Rhodotorula mucilaginosa as a cause of persistent femoral nonunion Nobuo Hashimoto, Japan Goyal R, Das S, Arora A, Aggarwal A 25 Laurence Klotz, Canada Repeated fracture of pacemaker leads with migration into the pulmonary Nora Noni MacDonald, Canada circulation and temporary pacemaker wire insertion via the azygous vein Anand Malaviya, India Udyavar AR, Pandurangi UM, Latchumanadhas K, Mullasari AS 28 Ana Marusic, Croatia V. Mohan, India Recurrent respiratory papillomatosis complicated by aspergillosis: A case Dan J. Ncayiyana, South Africa report with review of literature G. B. Parulkar, India Kuruvilla S, Saldanha R, Joseph LD 32 David J. Pierson, USA Citrobacter freundii infection in glutaric aciduria type 1: Adding insult to injury Andrew P. Schachat, USA Mukhopadhyay C, Dey A, Bairy I 35 Shirish S. Sheth, India Michael Swash, UK IMAGES IN RADIOLOGY P. N. Tandon, India Jim Thornton, UK Chordoma: A rare presentation as solitary ivory vertebra Jean-Louis Vincent, Belgium Kumar S, Hasan R 37 IMAGES IN PATHOLOGY Intracystic papillary carcinoma associated with ductal carcinoma in situ in a male breast Dragoumis DM, Tsiftsoglou AP 39 J Postgrad Med January 2008 Vol 54 Issue 1 i 67 ! ! 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The Journal is printed on acid free paper. Editorial Offi ce Department of Pediatrics, Seth GS Medical College and KEM Hospi- tal, Parel, Mumbai 400012, India. E-mail: [email protected] Administrative Offi ce Medknow Publications, A-108/109 Kanara Business Centre, Ghat- kopar (E), Mumbai - 400075, India. Phone: 91-22-6649 1818/1816 Fax: 91-22-6649 1817 Website: www.medknow.com Websites http://www.jpgmonline.com http://www.journalonweb.com/jpgm http://www.bioline.org.br/jp ! 68 ii J Postgrad Med January 2008 Vol 54 Issue 1 ! Review Article www.jpgmonline.com Implications of HLA sequence-based typing in transplantation Shankarkumar U, Pawar A, Ghosh K Institute of ABSTRACT Immunohaematology, Serology-based conventional microlymphocytotoxicity HLA typing method, which has been regarded as the gold th 13 Floor, K.E.M standard in organ and hematopoietic stem cell transplantation, has been replaced now by DNA-based typing. Hospital, Parel, Mumbai, Maharashtra, India Many laboratories all over the world have already switched over to molecular methods. Microlymphocytotoxicity- based tissue typing was done using commercial sera, while the molecular typing by genomic DNA based. DNA CCorrespondence:orrespondence: quality and its quantity obtained using various DNA extraction protocols was found to be an important factor in U Shankarkumar the molecular method of tissue typing in transplant outcome. Many polymerase chain reaction-based molecular E-mail: shankarkumar16@ techniques have been adopted with far reaching clinical outcome. The sequence-based typing (SBT) has been hotmail.com the ultimate technique, which has been of the highest reliability in defining the HLA alleles. The nonavailability of specific HLA antisera from native populations, large number of blank alleles yet to be defined and comparable low resolution of HLA alleles in SSP or SSOP technique, suggests that highly refined DNA-based methods like Received : 31-10-06 SBT should be used as an adjunct to HLA serology and/or low/intermediate/high resolution HLA typing in order Review completed : 29-10-07 to achieve a better transplant outcome. Accepted : 13-11-07 PubMed ID : J Postgrad Med 2008;54:41-4 KEY WORDS: HLA-A antigens, sequence analysis, transplantation he major histocompatibility complex (MHC), a group of different HLA haplotypes and billions of possible diploid T closely linked genes on chromosome 6, encodes the combinations. class I (HLA-A, -B, -C) and class II (HLA-DR,-DQ,-DP) HLA molecules, which, in concert with T-cell receptors, make possible HLA Null Allele the immune recognition of foreign antigens. HLA molecules are also alloantigens that can trigger immune recognition and graft The occurrence of null alleles has important implications in the rejection in unmatched transplant recipients.[1] An enormous strategies that a laboratory adopts to select HLA typing methods effort to define and characterize new HLA alleles has culminated to be used for routine testing. Most of these expression variants in a large number of alleles and continues to grow at a sustained were identified by discrepant results between serologic and pace, making the polymorphism of the linked genes of the HLA DNA-based testing methodologies and serendipitously in other complex truly astounding. As of October 2007, a total of 2941 instances by the identification of novel DNA polymorphisms in alleles 2009 (of class I), 932 (of Class II) and 97 (other loci) the HLA genes. It must be stressed that there may be important comprising of 617 HLA-A, 960 HLA-B, 335 HLA-C, 9 HLA E, biological differences between low-expression (L) and null (N) 21 HLA F, 28 HLA G, 12