Nisar Ahmad Chowdri

Evaluation of various methods of treating keloids and hypertrophic scars: a 10-year follow-up study

An attempt was made to assess the value of beta radiation alone or in combination with surgery, and of intralesional triamcinolone acetonide in treating 100 keloids and hypertrophic scars in 65 patients. Beta radiation alone was found to be effective in the eradication of symptoms (55% symptomatic relief), while results in the reduction of size of lesions have been poor (11% success rate). Surgery combined with postoperative beta radiation therapy yielded a 67% success rate. The success rate was 75% when radiation was delivered within 48 h of surgery. Preoperative radiation was found to be of no advantage. Intralesional triamcinolone acetonide produced symptomatic relief in 72% and complete flattening in 64% of the lesions.

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

Breast feeding or spoon feeding after cleft lip repair: a prospective, randomised study

It has been a tradition for plastic surgeons to withhold breast feeding from babies after cleft lip repair to prevent wound disruption. A prospective, randomised trial of 40 infants showed that early postoperative breast feeding after cleft lip repair is safe, results in more weight gain at 6 weeks after surgery (P < 0.01) and is more economical than spoon feeding.

A comparative study of surgical results with rotation-advancement and triangular flap techniques in unilateral cleft lip

This paper presents a randomised comparative study of surgical results of unilateral cleft lip repair with 58 rotation-advancement and 50 triangular flap repairs, the two commonly used types of repair at present, carried out over a period of 6 years. The surgical results following both repairs were assessed on a scoring basis. No significant difference was found in overall postoperative appearance of lip and nose between the two types of repair. As a result, we recommend either technique for unilateral cleft of the lip.

Oblique facial clefts: a report of Tessier numbers 3, 4, 5, and 9 clefts.

The oblique facial cleft is an extremely rare and disfiguring congenital anomaly of the face. Tessier (1990) proposed an anatomic classification of the facial, craniofacial, and laterofacial clefts that was a great advance in the study of these clefts. The clefts were found to occur with an incidence of 1.43 to 4.85 in 100,000 births (Kawamoto, 1976). The exact incidence of these unusual facial clefts is unknown, and estimates vary widely because of the rarity of their occurrence and the lack of standard methods of data collection. To adequately examine the occurrence of oblique clefts, the medical community must be aware of the problem, and new cases should be presented. On the basis of clinical, radiologic, and surgical examinations, soft tissue and skeletal disruptions of three patients with the most rare craniofacial clefts (Tessier 3, 4, 5, and 9) are presented.

Primary Closure of the Common Duct over Endonasobiliary Drainage Tubes

The T-tube remains the standard method of intraductal drainage after open choledochotomy for choledocholithiasis. We studied the use of an endonasobiliary drainage (ENBD) tube as an alternative to the T-tube for postoperative intraductal drainage. A series of 20 patients with documented choledocholithiasis in whom endoscopic methods of stone retrieval failed to clear the common bile duct (CBD) were selected for the study. All patients had ENBD tubes placed preoperatively at endoscopic retrograde cholangiopancreaticography and then were subjected to open choledocholithotomy with primary closure of the choledochotomy over the ENBD. The age of the patients in the study group ranged from 18 to 75 years. Three patients (15%) had acute cholangitis at the time of surgery. Stones were confirmed at surgery in 85% of the patients, and the size of the CBD was found to range from 1.0 to 2.3 cm. All 20 patients underwent closure of the common duct over an ENBD tube without any difficulty. None of the patients experienced biliary complications such as bile leaks, biliary peritonitis, biliary fistula, pancreatitis, or cholangitis. No patient had any residual stone as documented by postoperative cholangiograms. Abdominal drains remained in place for 2 to 4 days, and the ENBD tubes were removed between days 6 and 8. The length of the postoperative hospital stay varied from 7 to 15 days, with 65% of the patients going home before postoperative day 8.

Clinicopathological Profile and Surgical Results of Nonhealing Sinuses and Fistulous Tracts of the Head and Neck Region

PURPOSE The sinus and fistulous tracts in the head and neck region often pose a challenge to the surgeon, and are usually misdiagnosed, resulting in treatment failure. MATERIALS AND METHODS This study included 117 patients who presented to the Department of Dental and Maxillofacial Surgery, Department of General Surgery, and Department of Dermatology of the Sheri-Kashmir Institute of Medical Sciences Medical College (Srinagar, India) over a period of 7 years. All 117 patients were analyzed using clinical methods, radiologic studies, and laboratory investigations. RESULTS The mean age of patients was 30 years, with a male-to-female ratio of 3:2. A dental origin was noticed in 55% of these tracts, followed by tracts originating from infected implants or bone grafts (20%) and chronic osteomyelitis (11%). Eighty percent of these tracts had a mandibular origin (and from the anterior part) (53%). Maxillary tracts arose mostly from the posterior part of the bone (70%). The commonest presenting symptom was discharge from a nonhealing wound. Anterior mandibular tracts were straight and short (84%), whereas posterior mandibular tracts were mostly long and curved (75%). Misdiagnosed and mismanaged sinuses and fistulas were mostly of odontogenic origin (70%). Radiologic studies were the most useful diagnostic tools in tracts related to dental pathology, infected implants/bone grafts, and chronic osteomyelitis. Proper treatment of basic pathology was followed by complete healing in 96% of patients. CONCLUSION All patients with sinus or fistulous tracts in the head and neck region should be properly assessed and evaluated for proper diagnosis and treatment, to prevent the recurrence and chronicity of these lesions.

Primary paraspinal hydatid cyst: A rare presentation of Echinococcosis

Hydatid disease is endemic in most cattle rearing areas, particularly Australia, New Zealand, Mediterranean countries, India, Africa and South America.1,2 It is often manifested by a slowly growing cystic mass, with hepatic and pulmonary involvement being most common.3 Unusual sites of involvement frequently cause diagnostic problems and hence delay in diagnosis and many serious complications. Primary skeletal muscle involvement is very rare.4,5 We present a case of hydatid disease of lumbar paraspinal muscles in a middle aged female, who presented to the General Surgery clinic at our Institute.

An Unusual Case of Hashimoto's Thyroiditis with Four Lobed Thyroid Gland.

Hashimotos thyroiditis (HT), an autoimmune disorder, is the most prevalent cause of subclinical or overt hypothyroidism in areas with sufficient iodine intake. The gland is often diffusely enlarged, and the parenchyma is coarsened, hypoechoic, and often hypervascular on ultrasonograpy. Histopathologic appearance of HT includes lymphocyte aggregates with germinal centers, small thyroid follicles, presence of Hurthle cells, and variable fibrosis. We present a case of a 40-year-old female with suspected follicular neoplasm on fine-needle aspiration cytology of neck swelling. Intraoperatively, thyroid gland was found having four lobes separated from each other. Total thyroidectomy was done and histopathology from all four lobes revealed HT. At present, there is no literature to support the fact that such distorted thyroid anatomy may be due to the underlying disease. If we consider it as thyroid gland anomaly, no such anomaly has been mentioned in the literature till date.

Tubercular mastitis – A rare presentation

Breast Tuberculosis is a rare form of tuberculosis even in tuberculosis endemic countries like India and its identity is often mistaken with breast cancer and pyogenic breast abscess. A 22-year-old married female, with history of child birth one month back, lactating, presented at peripheral hospital with progressively increasing pain and redness in the upper outer and central portion of her right breast. She was diagnosed as breast abscess and incisional drainage of abscess was carried out. However, patients symptoms progressed and an ulcer began to appear on upper outer quadrant of her right breast which rapidly progressed to involve almost whole breast destroying nipple-areola complex. She was referred to our institution for further management. Debridement of the lesion was carried out and tissue sent for histopathological examination which revealed chronic granulomatous inflammation with caseating necrosis. Patient was put on anti-tubercular treatment for a period of six months. The whole ulcer healed up and she is doing well at present.