3-Dimensional Evaluation of Two PNAM Techniques (Modified Grayson & AlignerNAM) on Facial Soft Tissue Morphology: A Randomised Clinical Trial.

OBJECTIVE: Evaluate facial changes after Presurgical Naso-Alveolar Molding (PNAM) in unilateral cleft lip and palate (UCLP) patients treated with Modified Grayson Technique and AlignerNAM (with DynaCleft nasal elevator) using a 3D facial scan. DESIGN: Randomised clinical trial. SETTING: Institutional study. Participants: 20 UCLP patients allocated to two groups (10 patients each). INTERVENTIONS: Group A patients underwent PNAM with Modified Grayson Technique and Group B patients underwent AlignerNAM (with DynaCleft nasal elevator). Their 3D facial scans were obtained by using an iOSbased application (Bellus3D FaceApp) mounted on a novel frame. These .stl files were analysed using 3D software (GOM INSPECT) at three-time intervals; before intervention (T0), after intervention (T1) and one month after lip repair surgery (T2). MAIN OUTCOME MEASURE(S): Changes in facial and nasolabial morphology. RESULTS: Both techniques brought significant improvement in the columellar length, nasal tip projection, columella angle, nasal tip angle and a significant reduction in cleft width. At T1, a statistically significant difference in angular and linear measurements was present in both groups. At T2, no statistically significant difference in linear parameters was observed between the two groups except for the outer lateral height of the non-cleft side, basal lateral height of the non-cleft side, and philtrum width. Similar pattern was observed in angular measurements with no statistically significant difference between the two groups except in nasolabial angle, anterior nasal base triangle III, and anterior nasal root triangle. CONCLUSIONS: Aligner NAM and Modified Grayson technique are equally effective PNAM methods with similar clinical results in nasolabial morphology after lip repair surgery.

Salmonella enteritis in children in Libya: role of antibiotic therapy.

In vivo sensitivity of salmonella has been studied in 38 children with acute gastroenteritis. They were treated for 7 days with gentamicin, to which the organisms were sensitive in vitro. Stool culture remained positive in 30 of the 38 cases. The children improved on supportive and symptomatic therapy. This study shows that antibiotics have no role to play in the management of acute salmonella gastro-enteritis in children.

Cerebral metabolism following brain injury, III. Transaminase changes.

Glutamic oxalacetic and glutamic pyruvic transaminase levels in CSF and blood were estimated in 25 normal individuals and 50 patients with varying grades of head injury. CSF GOT, and to a lesser extent GPT, showed significant elevation proportionate to the degree of brain injury. Serum GOT was raised in more severe injuries. CSF GOT and GPT levels showed a significant correlation with the prognosis of the case.

Cerebral metabolism following brain injury. I. Acid-base and pO2 changes.

Acid-base parameters and oxygen tension were studied in arterial blood and lumbar CSF of 45 subjects in three groups of controls, head injuries, and postoperative cases. CSF in both groups of head injury and postoperative cases showed changes of metabolic acidosis with the arterial blood changes of respiratory alkalosis. Both groups had significant hypoxaemia. CSF acidosis is an indication of cerebral metabolic disturbance. It is proportional to the severity of brain damage, and permits a prognosis for further clinical progress. It is recommended that patients with severe brain lesions should be put on controlled ventilation to relieve them of respiratory overwork and to combat cerebral oedema.

Cerebral metabolism following brain injury. II. Lactic acid changes.

Lactic acid levels were estimated in cerebrospinal fluid and blood of 25 normal individuals and 50 patients with varying grades of head injury. CSF lactic acid levels showed significant elevation proportionate to the degree of brain injury. Elevation of blood lactic acid was less pronounced. CSF lactic acid levels closely correlated with the prognosis of the case, and an increase above 50 mgm% was not compatible with life.

Pulmonary embolism associated with hemolymphangioma of lower extremity.

We present a case of major pulmonary embolization from a hemolymphangiomatous malformation of the loin and lower extremity. Treatment was with a low-dose infusion of urokinase for a short period directly into the pulmonary artery, and dramatic clinical improvement was noted. Prolonged maintenance therapy was with a low dose of heparin.