Anthony L.H. Moss

Squamous cell carcinoma and basal cell carcinoma arising in a naevus sebaceous of Jadassohn: case report and literature review

The development of a basal cell carcinoma within a naevus sebaceous of Jadassohn (NSJ) has commonly been reported. However, the development of a squamous cell carcinoma (SCC) is rare. There have been several reports of SCC arising within a NSJ but many contain little or ambiguous clinical information. A thorough review of the current English language literature has identified only three other well documented cases of SCC arising in a NSJ. Of these only one was a case of simultaneous occurrence of squamous and basal cell carcinoma. We report the second case of both malignancies arising within the same NSJ.

Desmoplastic melanoma: a clinico-pathological review

Desmoplastic Melanoma (DM) represents a rare histological variant of melanoma. It has been described in isolated case reports as a cutaneous tumour with a high incidence of local recurrence and nodal metastases, requiring early aggressive surgery. However, overall clinical experience of the tumour is limited. 13 patients with DMM seen over a 20 year period were reviewed. The mean age at presentation was 67 years (range 34-87), and 2/3 of the lesions were in the head and neck. Tumour thickness averaged 5.78 mm (Breslow). 7 patients developed recurrence, 4 as regional nodes, and 3 as skin nodules. Four of these patients developed disseminated disease, of whom 3 died. The mean time to first recurrence was 26 months and mean follow-up time in the review was 40 months (range 3-141 months).

Dental Findings in Parents of Children with Cleft Lip and Palate

The incidence of dental abnormalities in the cleft lip and palate population has been reported to be much higher than in the normal population. The role of genes in the production of a cleft lip and palate, and dental anomalies is thought to be complex, with autosomal dominant, recessive, and x-linked genes all playing a role. Noncleft parents can carry some of the cleft lip and palate genes, which produce clinically subtle manifestations in their facial skeleton. The purpose of this study was to look for evidence of increased dental anomalies in the non-cleft parents of cleft lip and palate children. The dentitions of the parents of 60 children with different types of cleft lip and palate were examined prospectively to see whether or not they exhibited features found more readily in the cleft lip and palate rather than did the normal population. Their dentitions were studied to record the following dental features: congenitally missing teeth, supernumerary teeth, or morphologic changes of the crowns of the permanent teeth. The number and position of any frenal attachments were also recorded. The results of this study did not show any differences in incidence of dental anomalies from the noncleft population. There was no evidence to support the hypothesis that congenital absence of lateral incisors is a microform of cleft lip and palate. Further, these results also failed to reveal any consistent pattern in the number and position of frenal attachments.

Safety of neonatal cleft lip repair

Abstract The timing of repair of a cleft lip continues to be debated. One of the reasons for delaying operation has been the belief that there is an increased risk of anaesthesia during the neonatal period. As a contribution to this debate we have analysed the anaesthetic and surgical complications of neonatal cleft lip repair undertaken at a single centre. We made a retrospective study of 99 babies consecutively referred for repair of cleft lip over a five-year period (January 1995–December 1999). In contrast to other series, all babies were considered for neonatal surgery and no exclusion criteria were set. All repairs were undertaken within 28 days of birth (median 4); the median gestational age was 40 weeks (range 34–42) and median birth weight of 3300 g (range 1500–4600 g). Perianaesthetic complications included one case of hypoxia presumably as a result of transitional circulation, one reintubation for poor respiratory effort in a premature baby, and five cases of nasal obstruction, three of which required a nasal stent. All recovered without long-term effects. There were significantly more surgical complications with bilateral repairs than with unilateral (p < 0.03). Breast feeding was achieved in 54 babies by the time of discharge. We found no evidence that neonatal repair of cleft lip is unsafe. Paediatric anaesthetic and intensive care support within a specialised centre are necessary, and close postoperative monitoring is required, with attention to the nasal airway.

Biceps Rupture in a Patient on Long-Term Anticoagulation Leading to Compartment Syndrome and Nerve Palsies

We report the case of a man on long term anticoagulation who presented with a rupture of the long head of the biceps resulting in a compartment syndrome and nerve palsies.

Audiological issues in children with cleft lip and palate in one area of the U.K.

Objective The purpose of this study was to determine the extent of multidisciplinary care and audiological services rendered to children with CL/P who underwent surgical repair of the cleft in 1998 and 1999. This followed proposals to radically reorganize cleft lip and palate services in the U.K. after unsatisfactory findings in a national review. Method Information was obtained from questionnaires sent to clinicians (audiologists; ear, nose, and throat surgeons; and community pediatricians) from audiology teams, and parents were asked to retrieve information from their Personal Child Health Record. Standards chosen were based on the Clinical Standards Advisory Group, the South Thames Audiology Audit Group, and the National Deaf Childrens Society. Results None of the agreed standards were achieved at an acceptable level. Conclusions This demonstrates the need for better communication systems between teams, including better use by parents and professionals of the Personal Child Health Record. A clinical care pathway is suggested here with other recommendations.

The ski jump deformity of the distal phalanx: a new entity?

A case of a congenital hand anomaly is presented in which the distal phalanx of the little finger was curving dorsally in the sagittal plane. This may be the first reported case. A surgical approach to correct it is described.

Fat atrophy at the site of a subdermal contraceptive implant

Progestogen-only implantable contraceptives are an increasingly popular method of contraception used by women worldwide. The implants are inserted subdermally into the arm and slowly release synthetic progesterone into the systemic circulation to prevent pregnancy. Over the years in response to well-publicised side effect profiles there has been an evolution in the composition and insertion methodology of these implants. Prior to their insertion patients should be counselled regarding associated risks and side effects at both local and systemic levels. Whilst systemic side effects have been extensively researched we discuss a case of fat atrophy located at the site of an implant a hitherto unpublicised local side effect. (excerpt)

Spontaneous cecum perforation following rectus abdominis free flap transfer for isolated lower limb trauma

A case of a 32‐year‐old motorcyclist, who sustained an open comminuted fracture of the left tibia and subsequently developed spontaneous cecal perforation following successful fixation of the fracture and reconstruction of the soft tissue defect with a rectus abdominis free flap, is reported. Although benign cecal perforation has been described in patients with thermal burns and blunt trauma of the abdomen or pelvis, our association has not been reported previously in the medical literature. It is important to recognize cecal perforation early as it is associated with a high mortality from peritonitis and septicaemia.

Keloid scars – an avoidable complication of vaccination

Sir, Although the guidelines for the vaccination programme against Tuberculosis has changed (1), BCG is still given in babies (Mantoux negative) in the deltoid area (2). It is pointed out in the Green Book that the point of the shoulder should be avoided because of the possibility of keloid scarring but the deltoid area is suggested as acceptable (3). However, as can be seen in the two photographs, the deltoid area itself can be included as being an anatomical site prone to bad scarring (Figs. 1 and 2) (4,5). The Green Book also maintains that if keloid scarring results, it is because of faulty injection technique, excessive dosage or patient ‘tuberculin’ positivity (3). However, another factor influencing bad scar formation can be where there is a delay in healing. The Green Book describes the normal reaction to the BCG, where a papule develops and then ulceration in a majority of babies. This can then take several weeks, even months to heal (3). The normal reaction to the vaccine already causes a delay but can be made worse if there is a secondary bacterial infection or an allergic reaction to the vaccine preservative.