Comparative Efficacy of Intralesional Triamcinolone Acetonide and 5-Fluorouracil for Keloid Scars.

Intralesional triamcinolone acetonide (TAC; a synthetic corticosteroid) and 5-fluorouracil (5-FU; a cytotoxic chemotherapy drug) are the medications most commonly used to treat keloid scars. We investigated the clinical efficacy of TAC compared with 5-FU. We included 40 patients in the study and divided them into two equal groups ( n = 20 Group A; n = 20 Group B). Group A patients received 4 mg/cm 2 or 0.1 ml/cm 2 of intralesional TAC (40 mg/ml) at 3-week intervals. Group B patients received 10 mg/cm 2 or 0.2 ml/cm 2 of intralesional 5-FU (50 mg/ml) at 3-week intervals. We assessed the scar using the Vancouver Scar Scale (VSS), visual analog scale (VAS), and patient satisfaction score (PSS). We found that Group A patients had a lower VAS than Group B patients (2.09 vs. 3.18). We saw a reduction in the VSS in both treatment arms; however, we found that Group B patients had a more marked reduction in the VSS compared with Group A patients (2.57 vs. 2.68). The PSS was higher in Group A than in Group B (1.97 vs. 1.78). We concluded that intralesional 5-FU elicits a better response than intralesional TAC. Although 5-FU is less well tolerated and has more side effects than TAC, we found that 5-FU was more effective in resolving keloid scars. Notably, the PSS was higher in the TAC group, but the VSS and VAS were better in Group B.

Use of intra operative fluorescein dye for prediction of flap viability.

BACKGROUND: A successful flap is dependent on its vascularity. During dissection, flap viability may become compromised due to inadequate perfusion from the vascular pedicle(s) on which the flap is based. Various methods have been proposed to determine viability of a flap both, intraoperatively and postoperatively. The ideal method must be simple, accurate, reproducible and safe. The purpose of this study was to study the role of fluorescein dye for prediction of flap viability.Materials & Methods: Thirty patients undergoing flap coverage for various defects were evaluated. Flaps were elevated and evaluated clinically for viability. Intravenous fluorescein was injected into the patients prior to flap inset and its course through the flap was monitored under ultraviolet light. Fluorescent areas were marked intraoperatively (size and location documented). Areas of viable flaps were documented on post-operative day 5 and comparisons made. RESULT: The area of viable flap as determined using intra operative fluorescein dye administration corresponded to surviving flap area on post-operative day 5, in 27 of the 30 cases studied, giving positive predictive value of 90%. Overall, the dye had an accuracy of 99.03% compared to intraoperative clinical flap assessment accuracy of 95.70%. Marginal necrosis was seen in 16.6 % of all cases. No allergic reaction to the dye was observed. CONCLUSION: - Accurate assessment of flap viability is an area of constant research. Use of intraoperative fluorescein dye for prediction of flap viability has an accuracy of 99.03% compared to intraoperative clinical flap assessment accuracy of 95.70%. In a few cases, the dye is prone to underpredict the area of viable flap tissue. The dye can be used to corroborate clinical asessment of viable flap tissue when used intraoperatively. The dye was found to be safe and easy to use.

Grinder Injury of the Hand: A Rare but Devastating Occupational Hazard.

Food handlers and workers are exposed to several occupational hazards not frequented by the general population. Grinder injuries of the hand present a devastating consequence of industrial food processing that is infrequently described. Herein, we describe two cases that presented to our department with meat grinder injuries of the hand.

Transmigration of a retained surgical sponge: a case report.

BACKGROUND: A retained surgical sponge remains a dreaded complication of modern surgery. Despite the increasing focus on patient safety instances of "a sponge being left in the abdomen", are all too common in popular media. In this article we report the rare phenomenon of transmigration of a retained surgical sponge in a patient who underwent laparoscopic sterilization. CASE PRESENTATION: A 30-year-old female presented with progressive abdominal pain for about one month and vomiting with obstipation for 2 days. The patient had undergone laparoscopic sterilization 7 years back and then underwent re-canalization one year back. She underwent an exploratory laparotomy for suspected adhesive small bowel obstruction. During surgery, an intra-luminal surgical sponge was recovered from the distal small bowel. The patient recovered and was discharged in good health. CONCLUSION: Despite numerous advances in terms of technology and the ever-growing emphasis on patient safety, the problem of a retained surgical sponge remains a dreaded potential complication. All clinicians and health care professionals should be aware of this entity and its various presentations.

Symmetrical peripheral gangrene and tuberculosis: A rare kinship.

Symmetrical peripheral gangrene (SPG) is a rare clinical syndrome characterized by ischemic necrosis of 2 or more limbs, without involvement of large vessels. It is often associated with disseminated intravascular coagulation and septic shock. Usually caused by Gram-positive and Gram-negative organisms, tuberculosis as a cause is extremely rare. We present the case of a 46-year-old man, who initially presented with signs and symptoms suggestive of tuberculosis but later developed SPG along with septic shock after his initial visit. The case highlights the progression of this dreaded complication and touches upon recent developments in its etiology as well as pathogenesis.

Traumatic penile amputation: a case report.

BACKGROUND: Traumatic amputation of the penis is a rare surgical emergency. Although repair techniques have been well described in literature, failure of replantation and its causes are poorly understood and reported. Herein, we report the case of a 9 year old boy who underwent replantation of his amputated penis with delayed failure of the surgery, along with a discussion of recent advances in the management of this condition. CASE  PRESENTATION: A 9-year-old boy was referred to our hospital for traumatic amputation of the penis. Papaverine aided microsurgical replantation of the severed part was performed, but by 48 h, the glans became discoloured and necrosis set in by 4 days. Unfortunately, by day 12 two thirds of the re-implanted penis was lost along with overlying skin. CONCLUSION: Replantation of an amputated penis in a pediatric patient is a daunting task even for experienced surgeons. The vasodilatory effect of papaverine for vascular anastomosis is well described, but the use of a paediatric cannula for identification and instillation of papaverine into penile vasculature, has not been described for the repair of penile amputation. Despite its apparent failure, we believe this technique may be valuable to surgeons who might encounter this rare event in their surgical practice, especially in resource limited settings like ours.

Hernia of Morgagni in the Elderly: A Case Report.

Congenital diaphragmatic hernias are infrequently encountered in adult patients. A rare type of this hernia is the Morgagni's hernia. Although they remain asymptomatic in a majority of patients, we present the case of an elderly patient who presented to us with abdominal pain and upper gastrointestinal bleeding.

Small Bowel Volvulus: A Case Report.

Small bowel volvulus is a rare clinical entity which presents as recurrent intermittent abdominal pain after consumption of food. Although the entity is well described in the literature, diagnosis is often difficult due to its clinical presentation being similar to mesenteric ischemia. Herein we present the case of a 44-year-old male who presented to us with this condition.

Tubercular infection of hydatid cyst.

Tubercular infection of hydatid cyst of the chest wall in an immunocompetent individual is rare. Immune modulation for symbiosis between host cells and the parasite - Echinococcus granulosus favors tubercular infection. In this case report, we describe a case of both these chronic diseases coexisting together, to present as chest wall mass.