Total reconstruction of the nose in settings where resources are limited.

We describe a series of 8 patients who had total reconstruction of the nose during 4 separate missions to Ethiopia. The aetiology was noma (n=3), assault (n=2), acid burn (n=1), squamous cell carcinoma (n=1), and a sequela of meningococcal septicaemia (n=1). Reconstruction was with forehead flaps when adequate tissue was available (n=6) and with radial forearm flaps when it was not (n=2). Some reconstructive approaches require procedures to be done in stages, and in settings where resources are limited, difficulties with the continuity of care and provision for the management of complications, must be overcome.

Dua Dua Theatre: an experiment in health education.

This is an account of an attempt to use theatre as a tool to alleviate health problems. The advantages of using a trained theatre group, and the benefits to audiences and to performers are discussed in the context of two plays devised and presented to community (primary) schools within a province of Papua New Guinea. No formal evaluation has been attempted, but audience involvement and participation has been enthusiastic.

PIP: The Dua Dua Theatre Company was formed in Lae, Papua New Guinea in 1978 by 2 voluntary social workers as an outlet for unemployed "school leavers." The original group consisted of 6 boys and girls aged 13-17, each with an average of 6 years of primary education. They had poor job prospects and some had been in trouble with the police. In March, 1980 the Morobe Province Food and Nutrition Group--an informal group which was concerned with improving health and nutrition--asked Dua Dua to prepare a short play about nutrition, to be performed in urban community schools. 2000 kina (about $1500 US) was made available to fund this project. A play was written about the importance of the food groups and the dangers of eating junk food. Teachers were asked to discuss the production with their classes the following day. Nutrition and health were already in the primary schools' syllabus. The tour of the play was extended to urban health centers and rural schools and communities. The play was seen in more than 40 schools, health centers, and villages by an estimated 10,000 adults and children. The value of this experience to the Dua Dua players was immense. Having previously been recognized as a "rascal group," (local terminology for young offenders) they were now recognized as a professional theater company doing important community work. In 1981, the local committee for the International Year of Disabled Persons voted a small proportion of their budget to the promotion of accident prevention. They invited Dua Dua Theatre to prepare a play on this topic. The play evolved from discussions with the players about accidents experienced in early childhood. These included falling from trees, drinking kerosene from unmarked bottles, incidents involving knives, razor blades, and traffic accidents. All these and more were shown in the play. The Dua Dua Theatre was receiving financial support from the province.

University associated general practices in three Australian states.

University associated practices in Melbourne, Adelaide and Perth were invited to investigate their management structures, funding and academic activities, and compare these with a similar academic general practice in New Zealand. There were a variety of locations, models for funding and delivery of care. There were a number of recurrent themes: balancing competing priorities, the costs of running an academic style of practice, relationships with other local general practitioners, competition for control over the practice, and clinical credibility. These parallelled similar concerns about running an academic practice in New Zealand.

Medicolegal file. Amendments to child protection legislation. New legal accountability for physicians.

In Ontario's past and present child protection legislation, physicians are included in the list of professionals designated to protect children and report their beliefs, suspicions, or knowledge of child abuse and neglect. Ontario's recent legislative amendments broaden the definition of child abuse and thereby widen the scope of the duty to report.

Results following conservative lateral sphincteromy for the treatment of chronic anal fissures.

INTRODUCTION: Lateral sphincterotomy is now the standard surgical treatment for fissure-in-ano. Healing is achieved in 90% of cases, however, sphincterotomy also carries a significant risk of incontinence. Traditional sphincterotomy comprises of division of the internal sphincter up to the level of the dentate line, a more conservative division could lead to a lower incontinence rate, with an equivalent healing rate. MATERIALS AND METHODS: A total of 65 patients undergoing conservative lateral sphincterotomy under a single operator between January, 1996 and January, 2002 were reviewed. Specific questions were asked regarding overall success of the operation, leakage of fluid, faeces or flatus and recurrence of fissure symptoms. Supplemental data was obtained from a retrospective analysis of the patients' case notes to ascertain demographics, length of hospital stay and complication rate. RESULTS: Sixty of 65 patients responded to our postal questionnaire. The male to female ratio was 1:1 and the mean age 40.3 years of age. No complications were recorded and 97% of patients had achieved fissure healing by the time of their out-patient follow-up (mean 6.9 weeks). Two patients reported new incontinence following their procedure; one patient experienced incontinence of fluid and flatus (1.7%) and the remaining patient complained of incontinence to flatus only. No patients experienced incontinence of faeces. Eleven patients experienced persistent symptoms of pain and bleeding but only 6 of these patients required treatment from their general practitioner which consisted of stool softeners and topical analgesia. No patients required re-operation. CONCLUSION: A conservative division of the internal anal sphincter results in adequate fissure healing and a much lower incontinence rate than that previously recorded in the literature for more traditional divisions of the internal anal sphincter.