Presurgical unilateral cleft lip anthropometrics: implications for the choice of repair technique.

BACKGROUND: It has been stated that height of the lateral lip is difficult to obtain with the rotation advancement repair only when the lateral lip is short in both its vertical and horizontal dimensions. The authors studied preoperative cleft lip anthropometry to determine the frequency of the "geometrically unfavorable lateral lip"--short in both vertical and transverse dimensions. METHODS: Direct caliper measurements were taken by a single observer of the heights and of the transverse lengths in 100 consecutive patients (age ≥3 months and <6 months) with unilateral cleft lip (51 complete and 49 incomplete) who were under general anesthesia just before cleft lip repair. RESULTS: In 75 patients, the height of the lateral lip was less than that of the noncleft side; on average, 2.1 mm less than (or 82 percent of) the noncleft side (range, 50 to 133 percent). In 86 patients, the lateral lip transverse length was less than on the noncleft side; on average, 2.7 mm less than (or 86 percent of) the noncleft side (range, 66 to 114 percent). Of the 75 patients with height deficiency, 63 patients also had transverse length deficiency. There were 19 patients who exhibited vertical height deficiency of 4 mm or more (>1 SD from the mean), and 79 percent of these patients with extreme height deficiency also exhibited transverse length deficiency. CONCLUSIONS: The lateral lip is frequently short in both vertical and transverse dimensions. These findings warrant consideration for the use of repairs other than rotation advancement (and its variations) in the setting of lateral lip deficiency.

Pilomatricoma: experience of the hospital for sick children.

BACKGROUND: Pilomatricoma (calcifying epithelioma of Malherbe) is a common skin neoplasm in the pediatric population that is often misdiagnosed as other skin conditions or tumours. OBJECTIVES: The objective of the present retrospective study was to review the clinical and histopathological presentation of this neoplasm in children. METHODS: The records of the pathology department at The Hospital for Sick Children, Toronto, Ontario, were searched for all cases of pilomatricoma between 2001 and 2006. The records of these patients were reviewed to determine sex, age, location and size of the tumour, pathological features and recurrence rate. All patients underwent surgical excision of the lesions. RESULTS: A total of 93 lesions in 85 patients were identified. The median age was 8.7 years. Of the 85 patients diagnosed with pilomatricoma, 44 (52%) were female. In all cases, the initial presentation was an asymptomatic, slow growing, superficial hard mass with bluish discolouration. The most common sites of occurrence were the face (48%), neck (21%) and upper limbs (18%). The size of the surgical specimens collected ranged from 0.1 cm to 2.6 cm. The diagnosis was confirmed by histopathological examination in all cases. Ghost cells and basaloid cells were described in most of the cases (83%). There were no recurrences in this series. CONCLUSIONS: This entity should be considered with other benign or malignant conditions in the clinical differential diagnosis of solitary firm skin nodules, especially those on the face, neck and upper limbs. The diagnosis can generally be made by clinical examination. The treatment of choice is surgical excision, and the recurrence rate is very low.

Australian doctors in Bali: the initial medical response to the Bali bombing.

Several Australian medical practitioners were holidaying in Bali at the time of the nightclub bombing on 12 October 2002. On learning of the disaster, they went to Sanglah Hospital to assist. With the very limited resources of the hospital, they helped in providing emergency treatment, stabilising patients, and preparing Australian patients for evacuation.