Mohammad Ashraf Darzi

Intralesional Corticosteroid Therapy for Childhood Cutaneous Hemangiomas

Response to intralesional steroid therapy (triamcinolone acetonide and betamethasone acetate) was studied in 70 children of all ages with 74 cutaneous hemangiomas located in a variety of locations. One to seven injections were given without anesthesia with a mean interval of 6 weeks between the injections. Results analyzed 2 months after the last injection showed more than 75% reduction in volume in 43 (58.11%), 50% to 75% reduction in 16 (21.62%), 25% to 50% reduction in 9 (12.16%), and less than 25% reduction in 6 (8.11%) lesions. Response was not related to age, sex, or site of the lesion, but only 2 lesions (22.22%) with an initial volume of more than 20 cm 3 showed more than 50% reduction. None showed regrowth within a mean follow-up period of 14 months. Transient cushingoid faces and hypopigmentation were noted in 2 patients each. We feel that intralesional steroid therapy is safe and effective for all cutaneous hemangiomas irrespective of site, sex, or age of the patient.Chowdri NA, Darzi MA, Fazili Z, Iqbal S. Intralesional corticosteroid therapy for childhood cutaneous hemangiomas. Ann Plast Surg 1994;33:46–51

Incidence and pattern of bear maul injuries in Kashmir

BACKGROUND Injuries due to mauling by bears are rarely reported in the literature. The high incidence of such injuries in Kashmir, India, which is a valley surrounded by dense forests and is a habitat of Asiatic Black bears, urged us to undertake such a study in our department. MATERIALS AND METHODS The study was conducted both retrospectively (January 1990-July 2005) and prospectively (August 2005-December 2007). RESULTS A total of 417 cases were recorded and all the injuries were caused by black bears alone. Majority of the patients were young to middle-aged (96.8% of cases) and predominantly males (80.33%). The incidence was highest during July to November (76.82%), and most of the attacks (97%) occurred during daytime. Soft-tissue injury occurred in all 417 cases, bones were involved in 131 (31.41%) while the visceral organs were injured in four (12.94%) patients. The face (80.57%) was most common part of the body injured, followed by the head (54.67%), and all the patients had soft-tissue injury (100%). In spite of devastating injuries caused by bear maulings, the mortality rate was only 2.39%. CONCLUSION Injuries due to mauling by black bear occur mainly between July and November. The young and middle-aged men have a higher tendency to be wounded. The face and head were the most commonly affected sites, while visceral injuries were rare. Mortality was low, and reconstruction of many of the injuries was challenging, often necessitating a staged procedure. Those living in villages close to black bear habitats may benefit from education related to the risk and severity of the attacks in the hope of reducing the number of injuries seen.

Isolated aglossia in a six year old child presenting with impaired speech: a case report

IntroductionThe most mobile organ of the body, the tongue is associated with various congenital anomalies; most of which are in association with many other systemic abnormalities. Rarely do they occur in isolation. Isolated aglossia, that we presented, is one of the more rare presentations.Case presentationOur patient is a 6-year-old male child of Asiatic origin from Kashmir (India), who was physically well built and mentally sound and presented with history of impaired speech. The patient had normal velopharangeal competence but absence of tongue which was replaced by a small mucus membrane projection near the floor of oropharangeal isthmus. The patient had no difficulty in feeding or taste sensation but he was unable to pronounce lingual consonants.ConclusionIsolated aglossia is very rare condition explained on the basis of growth failure of lateral lingual swellings and tubercular impar. Such patients do not usually need reconstruction of tongue; as feeding, swallowing and taste sensations are usually intact and speech cannot be improved by reconstruction. However, malocclusion of teeth needs to be taken care of.

Use of preputial skin for coverage of post-burn contractures of fingers in children

Objective: Hand burns are common injuries. Children frequently sustain burn injuries, especially to their hands. Contractures are a common sequel of severe burns around joints. The prepuce, or foreskin, has been used as a skin graft for a number of indications. We conducted this study to evaluate the feasibility of utilising the preputial skin for the management of post-burn contractures of fingers in uncircumcised male children. Materials and Methods: Preputial skin was used for the coverage of released contractures of fingers in 12 patients aged 2-6 years. The aetiology of burns was “Kangri” burn in eight patients and scalding in four patients. Six patients had contracture in two fingers, four patients in one finger, and two patients had contractures in three fingers. Results: None of the patients had graft loss, and all the wounds healed within 2 weeks. All patients had complete release of contractures without any recurrence. Hyperpigmentation of the grafts was observed over a period of time, which was well accepted by the parents. Conclusions: Preputial skin can be used successfully for male children with mild-to-moderate contractures of 2-3 fingers for restoration of the hand function, minimal donor site morbidity.

Bear maul craniocerebral trauma in Kashmir Valley.

Abstract Craniocerebral injuries constitute the bulk of the trauma patients in all the tertiary-care hospitals. Bear attacks as a cause of trauma to the brain and its protective covering are rare. This was a hospital-based retrospective (January 1990 to July 2005) and prospective study (August 2005 to December 2010). Craniocerebral trauma was seen in 49 patients of bear maul injuries. Loss of scalp tissue was seen in 17 patients, 13 of whom had exposed pericranium and needed split-thickness skin grafting, while 4 patients with exposed skull bones required scalp transposition flaps as an initial procedure. Skull bone fractures without associated brain injury were observed in 24 cases. Frontal bone was the site of fracture in the majority of cases (95%). Surgical intervention was needed in 18 patients for significantly depressed fractures. Three of these patients had depressed frontal bone fractures with underlying contusions and needed brain debridement and duraplasty. Injury to the brain was observed in 8 patients. Trauma to the brain and its protective coverings as a result of bear attacks is rarely known. Brain injury occurs less commonly as compared to soft tissue and bony injury. Craniocerebral trauma as a result of bear assaults has been a hitherto neglected area of trauma as the past reported incidence has been very low. Of late, the incidence and severity of such attacks has assumed grave proportions in areas adjacent to known bear habitats. An innocuous-looking surface wound might be the only presentation of an underlying severe brain trauma. Public awareness has to be generated to protect the people living in hilly areas.

Topical heparin versus conventional treatment in acute burns: A comparative study

Background: In order to alleviate pain, reduce scarring, and to improve the overall outcome in burn patients multitude of novel agents are being utilized. In this regard, heparin has been introduced because of its research proven role in burn wound management. Objective: The objective was to evaluate, whether the addition of heparin, administered only topically, could improve burn treatment. Materials and Methods: The subjects in this study were 40 consecutive burn patients with 10-20% burns, randomly allocated to heparin group (H-group) (20) and control group (C-group) (20). Results: All patients in the H-group were receiving analgesics on demand only from the 2 nd week onwards. This was in contrast to the C-group wherein 35% patients received twice daily dosage of analgesics in the 2 nd week of their treatment. When compared to the average hospital stay of 18.3 days in the C-group, patients belonging to the H-group had an average hospital stay of 12.3 days (P < 0.05). Conclusions: The current comparative study demonstrates that heparin significantly decreases the requirement of analgesics and the time required to prepare a burn wound for grafting. Besides as compared to silver sulfadiazine dressings, heparin appears to be cost-effective.

Burns in Epileptics with Special Reference to Kangri Burns

Background: During seizure attacks patients may suffer severe trauma such as deep burns, limb fractures, head and neck injuries. Most burns in epileptic patients occur during major seizures. Such burns were always full-thickness. Because of extreme cold conditions people in Kashmir valley especially in rural areas use Kangri to keep themselves warm. This Kangri which is already notorious for causing Kangri cancer has an additional disadvantage in causing deep burns mainly to the hands in epileptic patients. Objective: (1) To analyse the epidemiological data of burnt hospitalised epileptic patients. (2) To determine the frequency, causes and consequences of burns in patients with epilepsy stressing on Kangri burns in epileptics. Study design and Method: It was both a retrospective and prospective study. All patients of epileptic burns admitted in the hospital from Jan 2005 to Nov 2012 were included. In the retrospective group, the case records of epileptic burnt patients were carefully analysed. All new patients were evaluated in detail. Results: Out of 73 patients 32(43%) were in the age group of 16–30 years. Mean age was 26 ± 17 years. Majority of the patients 46(63%) were females. 61(84%) patients belonged to rural areas. Kangri was the most common etiological agent of epileptic burns in 46(63%) patients.37 (52%) had sustained full thickness burns and Total Body Surface Area (TBSA) involved was up to 5% only. Commonest site of burns was hands/upper limbs 40 (56%). Amputation of the gangrenous digits/hands was the commonest surgery performed in 22(25%) patients. Complication in burnt epileptic patients was the loss of a body part 22(41%) followed by contracture 16(36%), wound infection 11(21%) and loss of vision in 1(2%) patients. Conclusion: Epileptic patients should avoid high risk situations like working alone in the kitchen. Kangri should be replaced by alternative simple and safe warming devices.

Involvement of head and neck in high voltage injuries: A study from Himalayan valley

Background: With increasing use of electricity in our day-to-day life the incidence of electrical injuries is increasing. Incidence is higher in developing countries where people are less acquainted to proper and safe use of electricity in contrast to developed countries. Objectives: (1) To study the clinical profile of high voltage injuries to the head and neck region (2) To know the reason for the higher incidence of such injuries and find out various preventive measures to reduce such injuries in future (3) To launch an awareness program among the electrical department workers about electrical injuries and their prevention. Materials and Methods: All patients with high voltage electrical injuries to the head and neck region reporting to our center were included in the study. The study was conducted retrospectively from January 2001 to May 2008 and prospectively from June 2008 to December 2010. A total of 54 patients were included in the study. Results: Involvement of head and neck region was seen in 25.35% of high voltage electrical injury victims. The most common age group was 20-30 years with a mean age of 29.13 ± 8.37 years. Incidence was higher in rural population 75.93% compared with urban 24.07%. Incidence was higher in winter months. Electricians comprised 59.26% of victims. The most common mode of injury was touching the live wire directly or indirectly and was seen in 74.07% patients. Average total body surface burn was 16.32 ± 8.13%. An average of 2.91 surgical procedures per patient were performed. Reconstructive procedures were required in 85.18% of patients. Average hospital stay was 26.81 days. Conclusions: High voltage injuries are not uncommon in Kashmir valley and electric department workers are at a greater risk. The incidence of high voltage injuries would not have been so high had the electric workers been properly trained, hazards of high tension lines explained and use of safety equipments made mandatory.