Glioblastoma multiforme (GBM) Patients generally have a dismal prognosis, with median survival of 10-12 months. GBM with long-term survival (LTS) of (3) > or = 5 years is rare, and no definite markers indicating better prognosis have been identified till date. The present study was undertaken to evaluate GBMs with LTS in order to identify additional correlates associated with favourable outcome. The cases were evaluated for relevant clinicopathological data, proliferation index and expression of tumortumour suppressor gene (p53 ), cyclin-dependant kinase-inhibitors (p27 and p16 ) and epidermal growth factor receptor (EGFR) proteins. Six cases of GBM with LTS with an average survival of 9 years (range 5-15 years) were identified. All were young patients with mean age of 27 years (range 8-45 years). Histology of three cases was consistent with conventional GBM, while two showed prominent oligodendroglial component admixed with GBM areas. One was a giant cell GBM, which progressed to gliosarcoma on recurrence. The mean MIB-1LI was 12% (range 6-20%). p53 was immunopositive in 4 out of 5 cases. EGFR and p27 were immunonegative in all, whereas p16 was immunonegative in 3 out of 5 cases. Currently, in the absence of specific molecular and genetic markers, GBM in young patients should be meticulously evaluated for foci of oligodendroglial component and/or giant cell elements, in addition to proliferative index and p53 expression, since these probably have prognostic connotations, as evident in this study. The role of p16 and p27 however needs better definition with study of more number of cases.

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Background Inhalational induction of anaesthesia remains of fundamental technique in paediatric anaesthesia. Halothane used most frequently for inhalational induction in children. Halothane is not an ideal induction agent because of its potential to cause bradycardia, hypotension and ventricular ectopy. The pleasant nonpungent order of sevoflurane, faster induction of anaesthesia and stable vital signs during induction suggest that it may be a suitable alternative to halothane for use in paediatric anaesthesia. Objectives The aim of study is to compare the induction time and haemodynamic response during induction of sevoflurane and halothane. Methods A total number of 60 patients, age within 1-12 years (ASA grade I & II) were selected randomly into two groups, thirty in each group. Group A induction was done by halothane and Group B induction was done by sevoflurane. Anaesthesia was induced with 60% N2O and 40% O2 and starting inspired concentration of halothane was 1% or sevoflurane was 2% followed by stepwise increases in the inspired concentrations of either sevoflurane (1.5-2% increments) or halothane (0.5-1% increments) every three to four breath until the patients no longer blinked in response to touching the eye lashes. Arterial pressure, heart rate, oxygen saturation (SPO2) were recorded every minute for 3 minutes during induction and induction time was recorded. Results Induction time was significantly shorter in the sevoflurane group compared to the halothane group (P < 0.001). In haemodynamic profile heart rate and mean arterial pressure were significantly reduced in halothane group while no significant changes were observed in sevoflurane group during induction period (P < 0.001). Conclusion The study concludes that induction of anaesthesia was faster with sevoflurane than halothane. Vital signs were stable with sevoflurane during induction period. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19794 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 13-17

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