INTRODUCTIONExternal ear abnormalities accompany many syndromes and genetic conditions. Yet, there are currently limited Asian references and no local norms for ear measurements and definitions for "low-set ears". The authors therefore describe ear measurements in a Singapore newborn population and seek to establish the applicability of the general accepted definition of "low-set ears" being that of "less than a third of the entire ear height being above the inter-medial canthal line".

MATERIALS AND METHODSBabies managed by the Department of Neonatal and Developmental Medicine during a 3-week period were measured by 2 investigators using the Feingold and Bossert technique. Intra- and inter-rater reliabilities were calculated. The influence of various anthropometric factors on and their relationships with ear length (EL) and width (EW) was analysed.

RESULTSA total of 104 neonates (20% preterm at birth) were included in this study. Median gestation was 38 weeks (range, 32 to 42). Mean birth weight was 2910 +/- 657 g. Mean EW and EL for term infants were 2.1 +/- 0.1 cm and 3.6 +/- 0.3 cm respectively, without significant differences for different-sided ears, investigators, race or gender. Mean percentage of right and left ear above the denoted line was 52 +/- 9% and 47 +/- 10% respectively (P = 0.000), with 3rd percentile being 33%.

CONCLUSIONSSingaporean neonatal ears are comparable with other Asian neonates - larger than Hong Kong Chinese babies, though similar to Japanese newborns - but smaller than Caucasian neonates. The definition of "low-set ears" is consistent with the general accepted definition.

Anthropometry ; Ear Auricle ; anatomy & histology ; Ethnic Groups ; Female ; Humans ; Infant, Newborn ; Male ; Reference Values ; Singapore

Ebstein's anomaly is a congenital malformation characterised by tricuspid valve pathology with right heart enlargement. Cases of Ebstein's anomaly can vary widely in severity, anatomy and presentation. In this article, we presented three cases of Ebstein's anomaly and discussed the presentation as well as electrocardiographic (ECG) changes. Patients may first present to their primary care physicians with cardiac symptoms such as reduced effort tolerance together with an abnormal ECG. ECG changes suggestive of right heart enlargement are important in the initial consideration and eventual formal diagnosis of the condition.

Arrhythmias, Cardiac ; Atrial Flutter/diagnosis* ; Electrocardiography ; Humans

INTRODUCTION: Risk stratification in dilated cardiomyopathy (DCM) is imprecise, relying largely on echocardiographic left ventricular ejection fraction (LVEF) and severity of heart failure symptoms. Adverse cardiovascular events are increased by the presence of myocardial scarring. Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is the gold standard for identifying myocardial scars. We examined the association between LGE on CMR imaging and adverse clinical outcomes during long-term follow-up of Asian patients with DCM. METHODS: Consecutive patients with DCM undergoing CMR imaging at a single Asian academic medical centre between 2005 and 2015 were recruited. Clinical outcomes were tracked using comprehensive electronic medical records and mortality was determined by cross-linkages with national registries. Presence and distribution of LGE on CMR imaging were determined by investigators blinded to patient outcomes. Primary endpoint was a composite of heart failure hospitalisations, appropriate implantable cardioverter-defibrillator shocks and cardiovascular mortality. RESULTS: Of 86 patients, 64.0% had LGE (80.2% male; mean LVEF 30.1% ± 12.7%). Mid-wall fibrosis (71.7%) was the most common pattern of LGE distribution. Over a mean follow-up period of 4.9 ± 3.2 years, 19 (34.5%) patients with LGE reached the composite endpoint compared to 4 (12.9%) patients without LGE (p = 0.01). Presence of LGE, but not echocardiographic LVEF, independently predicted the primary endpoint (hazard ratio 4.15 [95% confidence interval 1.28-13.50]; p = 0.02). CONCLUSION LGE presence independently predicted adverse clinical events in Asian patients with DCM. Routine use of CMR imaging to characterise the myocardial substrate is recommended for enhanced risk stratification and should strongly influence clinical management.