Morphological Survey of Placenta in Trombophilia Related Hypoperfusion of Maternal-Fetal Blood Flow.

Complex and modern obstetric medical care provides a constant improvement for the pregnancy prognosis. Thus, young women with an undiagnosed pathology become pregnant and, during pregnancy, the previously undiagnosed pathology, without any clinical signs and symptoms, becomes present during pregnancy, having an unfavorable impact on the fetus and the health state of the pregnant woman. The gestational syndromes during pregnancy influence the woman's health state over a long period of time and the quality of the conception product. The recommendation, performance of laboratory tests and imagistic investigations at the right time during pregnancy, as well as a correct interpretation of their results, may prevent the onset of catastrophic occurrences including fetal death in utero and/ or maternal death. We report the case of a 30-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, severe preeclampsia, severe IUGR and thrombophilia.

Prenatal, Obstetric and Perinatal Aspects in Pregnancy Associated with Pregestational Diabetes.

We report the case of a 37-year old primigesta, primipara (IGIP) patient with a singleton, naturally obtained pregnancy, diagnosed with type I diabetes mellitus from the age of three, carrier of an insulin pump for 11 years. The patient was diagnosed in adolescence with with a tumor of the ischio-rectal fossa with multiple attempts of excision which failed due to the particular situation of the tumor. Ultrasound examination diagnosed in the first trimester of pregnancy a voluminous right ovarian cystic tumor. The patient presented pregnancy-induced hypertension starting with 28 gestational weeks. Maternal-fetal and obstetric management assumed sequential ultrasound examination, ovarian tumor and maternal blood pressure drug control, and also the surgical management of the ischio-rectal tumor. Cesarean section was performed at 38 gestational weeks, outcoming with a live fetus, normal weight, good neonatal progression and favorable postoperative progression of the mother. In this case report, we emphasize the fact that in pregestational diabetes mellitus and pregnancy-induced hypertension, constant glycemic control, performed by the insulin pump, prior and during gestation, and the maternal blood pressure control are essential for maternal-fetal outcome.

MATERNAL-FETAL METABOLISM DISORDERS INDUCED BY MATERNAL OBESITY IN AN ANIMAL MODEL.

CONTEXT: Adipokines secreted by fat cells are vital to the control of energy metabolism, communicating the nutrient status with the tissues responsible for controlling both energy intake and expenditure and insulin sensitivity. OBJECTIVE: We aimed to prove in an experimental animal study that maternal obesity has long term adverse fetal metabolic consequences, which pass on even to the next generation of descendants. DESIGN: The effects of maternal obesity have been studied on animal model using 50 obese female Wistar rats, in which we induced obesity by high-calorie high-fat diet administered by gavage. SUBJECTS AND METHODS: Obese rat females were sacrificed at gestation term and we analyzed the secretion of adipokines from maternal venous blood: leptin and adiponectin, placental, pancreatic, liver and brain homogenates lipid peroxidation levels estimated by: MDA (malonyl-dialdehyde), total thiols and GSH - as antioxidant factors and routine biochemistry. RESULTS: Low levels of adiponectin and increased levels of leptin positively correlated with the value of placental and fetal tissue lipid peroxidation (from the liver, pancreas and brain) measured by elevated MDA and total thiols and low levels of GSH. The lipid peroxidation in the organs examined generated consistent results, showing high levels of peroxidation expressed through high values of MDA in the groups with Omega 6 supplements respectively no supplementation, and low levels of antioxidants expressed through glutathione and thiols. CONCLUSIONS: Endocrine secretion of adipokines from the adipocytes and the recruited macrophages of obese mothers is positively correlated with placental and tissue lipid peroxidation level and routine biochemical parameters.

Gait analysis parameters of healthy human subjects with asymmetric loads.

This article focuses on the analysis of gait parameters, ground reaction forces (GRF), and motion signals, for the various asymmetric loads carried by healthy human subjects during walking. Eight asymptomatic human volunteers were enrolled in this study. They were asked to walk, at self-selected pace, with various weights ranging from 0 to 11.33 kg (25 lbs) in 2.26 kg (5 lbs) increments, in one hand on a wooden area equipped with a force platform. Moreover, motion data were recorded from lumbar L1 vertebrae at a frequency of 120 Hz. Three trials of data have been recorded for each subject. In order to quantify the effect of increasing loads on the GRF we define the compression area, restitution area, and coefficient of restitution (COR) for GRF curves. We observe an increase in the compression area with respect to the load and almost constant values for the COR. For motion signals analysis we employ wavelet theory. The signals obtained from the lumbar L1 sensor of the spine vertebrae show a decrease in the wavelet detail energy, for the levels 3, 4, and 5, with respect to increasing loads.

Current principles and practice of ethics and law in perinatal medicine.

One of the most controversial discussion topics in modern bioethics, science or philosophy is represented by the beginning of the individual human life. It is ethically, medically and scientifically correct that the human conception product to be born, so to gain personality and individuality, to be treated as a patient since the intrauterine life. Intrauterine foetal interventions, performed in various therapeutic purposes are still in the experimental stage even in centres with rich experience in perinatal medicine. Progresses truly outstanding are present especially in the prenatal diagnostic methods. Non invasive prenatal testing represents without a doubt a great progress in prenatal diagnosis, but from this point of view, the role of practitioners in the field of perinatal medicine, on counselling and addressing the indication of this test becomes essential. Beyond cultural, national, social or related differences, in perinatal medicine practice is particularly important to respect and permanently reassess the ethical codes. Our paper is targeting to spotlight the essential principles and practice of ethics and law in perinatal medicine nowadays on one hand, and to bring an update review on a controversial topic on the other hand.

In vitro experiment of the modular orthopedic plate based on Nitinol, used for human radius bone fractures.

Shape memory alloys (SMAs) and in particular Ni-Ti alloys are commonly used in bioengineering applications as they join important qualities as resistance to corrosion, biocompatibility, fatigue resistance, MR compatibility, kink resistance with two unique thermo-mechanical behaviors: the shape memory effect and the pseudoelastic effect. They allow Ni-Ti devices to undergo large mechanically induced deformations and then to recover the original shape by thermal loading or simply by mechanical unloading. Diaphyseal fractures of the radius and ulna present specific problems not encountered in the treatment of fractures of the shafts of other long bones. The adaptive modular implants based on smart materials represent a superior solution in the osteosynthesis of the fractured bones over the conventional implants known so far. To realize the model of the implant module we used SolidWorks software. The small sizes of the modules enable the surgeon to make small incisions, using surgical techniques minimally invasive, having the following advantages: reduction of soft tissues destruction; eliminating intra-operator infections; reduction of blood losses; the reduction of infection risk; the reduction of the healing time. Numerical simulations of the virtual modular implant are realized using Visual Nastran software. The stress diagrams, the displacements diagram and the strain diagram are obtained. An in vitro experiment is made, simulating the osteosynthesis of a transverse diaphyseal fracture of human radius bone. The kinematical parameters diagrams of the staple are obtained, using SIMI Motion video capture system. The experimental diagram force-displacement is obtained.

Modular adaptive bone plate for humerus bone osteosynthesis.

The present paper describes a bionics application of shape memory alloy in construction of orthopedic implant. The main idea of this paper is related to design modular adaptive implants for fractured bones. In order to target the efficiency of medical treatment, the implant has to protect the fractured bone, for the healing period, undertaking much as is possible from the daily usual load of the healthy bones. The adaptability of this design is related to medical possibility of the doctor to made the implant to correspond to patient specifically anatomy. Using a CT-realistic numerical humerus bone model, the mechanical simulation of the osteosyntesis process for humerus bone using staples made out of Nitinol. The stress and displacements diagrams for bone, for plate modules and for staples, are presented.

Clinical and histopathological correlations of the modifications of fetal membranes in amniochorial infection.

The paper aims at analyzing the histopathological modifications induced by the amniotic infection on present fetal membranes and in the absence of clinical signs of chorioamnionitis. Such an evaluation is important in the context of postpartum fetomaternal complications. The objective was to determine the relation between the microbial invasion in the amniotic cavity and the severity of inflammatory lesions of the placenta, of the membranes and the umbilical chord.

Endometrial stromal sarcoma: clinico-pathological report of four cases and review of the literature.

Endometrial stromal sarcoma (ESS) represents a very rare pathological entity occurring as a malignant disease in women genital sphere. Our clinical report is based on a group of four women aged 37, 48, 50 and 70-year-old, that have been histologically diagnosed with endometrial stromal sarcoma. The most common symptom sending the patient to the physician has been the vaginal bleeding, occurring in all patients. Other associated symptoms were the abdominal enlargement and the presence of the pelviabdominal mass generated by the tumor, low to medium abdominal pain or polakiuria. Two patients were diagnosed with ESS after accomplishing a biopsic curettage of the uterus. Total abdominal hysterectomy and salpingo-oophorectomy have been successfully performed for all of the patients. Adjuvant therapy-radiotherapy has been administered to three patients. At this time, none of the patients died of the disease. Our paper also includes a concise review of the literature in order to have an up-to-date conception regarding diagnosis, therapy and outcome for ESS.

Morphopathological changes induced by the Obstetrical Antiphospholipid Antibody Syndrome in fetal adnexa and uterus.

The Obstetrical Antiphospholipid Antibody Syndrome (OAAS) is representing a separate entity of the global Antiphospholipid Antibody Syndrome (APS), focusing the pregnancy morbidity. OAAS is generating morphopathological changes in almost all components of the gestational biologic transitory system (GBTS): placenta, umbilical cord or uterine wall. The most important, serious and lengthened anomalies are occuring in placenta. Our research has been developed on a group of 68 patients diagnosed with OAAS, initially using the Sapporo criteria and later using the "Sydney" ones. There have been morphopathologically examined: placenta, umbilical cord and myometrium. Histological examination revealed on one hand macroscopic modifications: fibrinoid deposits, white or red placental infarctions, intervillous thrombosis, marginal or basal decidual hematoma, calcareous deposits, umbilical cord thrombosis, and on the other hand microscopic findings: placental infarction, fibrinoid necrosis, myometrial thrombosis, degenerative myometrial disorders, focal myometrial necrosis, villous stasis and necrosis, umbilical cord thrombosis. Because of the increased prothrombotic background, in APS, any vessel or organ could be involved, with no exception for GBTS elements. The basis of the pregnancy morbidity from the obstetrical APS is represented by the morphopathological changes occurring in fetal adnexa and uterine structures.