ABSTRACT
Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram [EEG] is performed in all patients for the determination of brain death while there is some skepticism in relying on EEG as a confirmatory test for brain death diagnosis. In this study, we assessed the validity of EEG and its abnormalities in brain death diagnosis. In this retrospective study, we used 153 EEGs from medical records of 89 brain death patients in organ procurement unit of the Iranian Tissue Bank admitted during 2002-2008. We extracted and analyzed information including EEGs, which were examined by a neurologist for waves, artifacts and EEG abnormalities. The mean age of the patients was 27.2 +/- 12.7 years. The most common cause of brain death was multiple traumas due to accident [65%]. The most prevalent artifact was electrical transformer. 125 EEGs [82%] were isoelectric [ECS] and seven EEGs [5%] were depictive of some cerebral activity which upon repeat EEGs, they showed ECS patterns too. There was no relationship between cause of brain death and cerebral activity in EEGs of the patients. In this study, we could confirm ECS patterns in all brain death patients whose status had earlier been diagnosed clinically. Considering the results of this study, it seems sensible to perform EEG as a final confirmatory test as an assurance to the patients' families.
ABSTRACT
Cardiac involvement in systemic sclerosis [SSc] is more prevalent than previously thought. In this study, the frequency and severity of cardiovascular involvement were assessed in SSc patients referred to Firouzgar Hospital. Fifty-eight patients with SSc, selected from the data bank of SSc patients, were reviewed for the frequency and severity of 8 organ involvements in this case series. The preliminary severity scale, published by international SSc study groups, was employed for the determination of the severity grade in the cardiovascular system. In the cardiac scoring scale, grade 0 represents normal heart [no cardiac involvement], grade 1 denotes mild involvement [electrocardiography [ECG] conduction defect and a left ventricular ejection fraction [LVEF] of 45-49%]], grade 2 signifies moderate involvement [arrhythmia, LVEF = 40-44%], grade 3 indicates severe involvement [LVEF <40%], and grade 4 stands for end stage [congestive heart failure and arrhythmia requiring treatment]. In this study, 24 [41.4%] patients were in the diffuse cutaneous [dcSSc] subset. The female to male ratio was 10.5:1, and the mean duration from symptom onset to diagnosis was 7.35 years for the dcSSc subset and 8.41 years for the limited cutaneous [lcSSc] subset of disease, there being no significant difference. Cardiac involvement in this series was seen in 13 [22.4%] cases; and there was no significant difference in terms of frequency and severity between the two disease subgroups [p value = 0.96 and p value = 0.46 respectively]. Our findings showed that the cardiac involvement in this series was infrequent and that there was no significant difference in the severity of cardiovascular involvement between the two subtypes of SSc in the late stage of the disease