Time to loss of brain function and activity during circulatory arrest.

PURPOSE: Brain function during the dying process and around the time of cardiac arrest is poorly understood. To better inform the clinical physiology of the dying process and organ donation practices, we performed a scoping review of the literature to assess time to loss of brain function and activity after circulatory arrest. MATERIALS AND METHODS: Medline and Embase databases were searched from inception to June 2014 for articles reporting the time interval to loss of brain function or activity after loss of systemic circulation. RESULTS: Thirty-nine studies met selection criteria. Seven human studies and 10 animal studies reported that electroencephalography (EEG) activity is lost less than 30seconds after abrupt circulatory arrest. In the setting of existing brain injury, with progressive loss of oxygenated circulation, loss of EEG may occur before circulatory arrest. Cortical evoked potentials may persist for several minutes after loss of circulation. CONCLUSION: The time required to lose brain function varied according to clinical context and method by which this function is measured. Most studies show that clinical loss of consciousness and loss of EEG activity occur within 30seconds after abrupt circulatory arrest and may occur before circulatory arrest after progressive hypoxia-ischemia. Prospective clinical studies are required to confirm these observations.

The Importance of Ultrasound Monitoring of the Normal and Lesional Cervical Ectropion Treatment.

OBJECTIVE: to investigate the importance of various ultrasound prognosis features in the assessment of the cervical ectropion treatment monitoring. METHOD: The inclusion criteria was the presence of ectropion and the selection was based on clinical examination performed during routine consultations in specialized clinics, later confirmed by colposcopic evaluation of cervix. The evaluation protocol included: clinical evaluation completed with colposcopy, guided biopsy when lesions were suspected, serological assay of day 21 progesteronemy, presence of Chlamydia, Mycoplasma, Ureaplasma, HVS type II, HPV and bacterial infections, transvaginal ultrasound serial evaluation at the 7th, 14th and 21st day before and after tretment concerning: cervical volumetric calculations and velocimetric measurements of uterine arteries flows. Progestative treatment was prescribed, and antiinfectious specific treatment when needed. Patients were reevaluated after 3 months. RESULTS: The prospective study included 45 patients between 2013-2014. 28 presented serum progesterone levels below the reference range or borderline. We noted a moderate reduction of the ectropion area in 42 % and a marked reduction in 58% of the cases. No statistically significant differences were found between the size of the cervix before or after treatment, except certain evaluations (the 7th and the 14th day) in the presence of bacterial coinfections. Evaluation of pulsed Doppler velocimetric indices of uterine arteries flows showed generally minor variations with no constant positive or negative trend. CONCLUSION: Based on the data obtained in our study, we conclude that ultrasound monitoring of ectropion treatment do not provide reliable prognosis data regarding the evolution of cervical lesion.

Incidence of Pulmonary and/or Systemic Thromboembolism in Pregnancy.

Pregnancy associate with thromboembolism is one of leading causes of maternal morbidity and mortality. Worldwide the incidence of pregnancy related venous thromboembolism is approximately 1 in 1500 deliveries. The arterial thromboembolism risk is increased from 3 to 4 fold and the risk of venous thromboembolism is five times higher in a pregnant that in a non-pregnant woman. With an appropriate prophylaxis and therapy, prevention of death from systemic thromboembolism in pregnancy necessitates a high index of clinical suspicion succeeded by a timely and accurate diagnostic approach. In pregnancy the clinical diagnosis of systemic thromboembolism is notoriously difficult due to the overlap of signs and symptoms between the pulmonary embolus with or without deep venous thrombosis. We performed a retrospective study of 86 pregnant women with Pulmonary thromboembolism (PTE) and Deep venous thrombosis (DVT) diagnosed between 2009-2015 in Obstetrics-Gynecology Clinic 1 at Emergency County Hospital of Craiova. Our study evaluated these cases considering frequency, maternal and fetus risk associated with thromboembolism. In 6 years we had 35 women diagnosed as PTE, 8 women diagnosed as DVT and PTE, and 43 patients diagnosed as DVT. The underlying disease in our study was hypertension and the most frequent symptoms reported were dyspnea and limb swelling.(100%).During the third trimester of pregnancy the incidence of PTE was 45% and DVT 57%. 12 cases of DVT were related to thrombophilia. Also we found 25 % of PTE that occurred after cesarean and 8 % of PTE after vaginal delivery. We notice that vaginal delivery is safer than cesarean surgery. Also the importance of third trimester of pregnancy and postpartum it is evident.

Comparative study of placenta acute fetal distress and diabetes associated with pregnancy.

The authors analyze the main histopathological changes of placentas from pregnancies ended with fetal distress at birth and the tasks associated with diabetes. The parallel between the two types of placentas not trying to prove the existence of pathognomonic lesions. Are set out both the similarities between the two titles of placentas lesions (such as changes in microcirculation and so on) as well as particular aspects. The authors analyze a group of 19 pregnant women hospitalized in Obstetrics and Gynecology Clinics of Emergency County Hospital of Craiova, Romania, in September 2010-September 2011, who were born and who were diagnosed with diabetes. In the same period, were studied 21 pregnant women whose pregnancy ended with the birth of a child with fetal distress. Such were identified as placental lesions suggestive of fetal distress as diverse etiology of placental vascular changes and the placenta in pregnancy associated diabetes as immaturity and vascular edema and fibrinoid changes and glycogen stores. The authors have proposed to highlight some lesions suggestive of two groups of diseases but independent groups were analyzed and conclusions were drawn after discussing results. This study is justified by insufficient knowledge of the causes that lead to fetal distress regardless of its etiology. In conclusion, the authors mention both placenta's common changes as specifically changes of the placenta for each type of disorder.