In addition to their therapeutic effects on malignant cells, cytotoxic agents have the potential of causing destruction of healthy, normal cells. Extravasation of the drug can produce extensive necrosis of the skin and subcutaneous tissue. Management of these extravasational effects differs from one centre to another and prevention is usually strongly emphasized. We analyzed our management of 12 patients referred to us over five years with extravasation of cytotoxic drugs and reviewed the literature for different approaches with regard to prophylaxis and management of extravasational effects.Materials and Methods:This study was done in the department of plastic surgery of a medical college. Five years of retrospective data were studied of patients referred to our department with extravasation of cytotoxic drugs.Results:We managed 12 cases referred to our department with extravasation of cytotoxic drugs. Mitomycin C was used in seven cases (58.33%), vincristine in two cases (16.66%), 5-Florouracil in another two cases while doxorubicin was responsible for extravasational side effects in one case (8.33%). The size of necrosis ranged from 3.75 cm2 to 25 cm2 with average size of 9.6 cm2. In terms of the area involved, the dorsum of the hand was involved in five cases (41.66%), the wrist in another five cases (41.66%), and the cubital fossa in the remaining two cases (16.66%). All cases were treated with daily debridement of necrotic tissue, saline dressing, and split skin grafting.Conclusion:Extravasation of cytotoxic drugs further increases the suffering of cancer patients. This catastrophe can only be avoided by vigilance and immediate application of antidotes. Once the local toxicity of the drugs takes effect, morbidity is unavoidable

Perineal burn contracture is a rare burn sequel. We conducted a retrospective analysis of cases with perineal burn contractures managed in a tertiary care centre of a Himalayan state. We found that all cases sustained burn injury from burning firewood and the time of presentation was two to six years after the burn injury. We analyzed our treatment method and have classified these contractures into two types.

Peri-anal contracture lead to intestinal obstruction whenever there is involvement of anal orifice. In this case anus and peri-anal skin up to two cm was normal; however both gluteal folds were fused because of post burn scar leaving a very small opening which lead to faecal impaction and sub acute intestinal obstruction.

In at-risk individuals, clinicians should rule out this readily-treatable cause of heart block before proceeding with permanent pacemaker implantation due to enormous clinical and cost implications involved. Missing the diagnosis also exposes the patient to the risk of developing the late complications of Lyme disease. Diagnosis of isolated Lyme carditis is a challenge because the clinician does not have the diagnostic-clues that can usually be gleaned from the more common stigmata of Lyme disease.

Background: Medical Expulsive Therapy (MET) has become an established part of the protocol for treatment of ureteric stones of less than 5 mm size in the lower 1/3rd of the ureter. Drugs like calcium channel blockers and α-1 adrenergic blockers with or without corticosteroid along with hydration have been used to facilitate expulsion of stones. Aims & Objective: In this study effectiveness of α-1 adrenergic blocker Tamsulosin alone and in combination with corticosteroid deflazacort have been compared. Materials and Methods: Total of 70 symptomatic patients of lower ureteric stones, who presented in the OPD of Rohilkhand Medical College Hospital between Jan 2011-May 2013, were selected for the study. Patients were randomly divided in two groups: Group 1 (Tamsulosin Group) & Group 2 (Tamsulosin + deflazacort Group). Results: It was found that with Tamsulosin + deflazacort better stone clearance rate with in shorter period was achieved. There was minimum discomfort to the patients during stone expulsion. Success rate was comparable in both groups up to 10 mm stone size. There was marked difference in stones bigger than 10 mm (25% and 62.66% in 11-12 mm size, 16.66% and 57.14% in 13-15 mm size and 0.0% and 50% in 16-17 mm size). Conclusion: MET using Tamsulosin has definite role in passage of smaller size ureteric stone of less than 10mm size. It has acceptable success rate in bigger size stone in our study up to 17 mm size, when Tamsulosin was combined with Deflazacort.