Maternal autonomic responsiveness is attenuated in healthy pregnancy: a phase rectified signal averaging analysis.

Autonomic regulation is essential in enabling a healthy pregnancy. In fact, several pregnancy complications are associated with autonomic dysfunction. Better understanding of the maternal autonomic state during healthy pregnancy may aid in the early detection of such complications. One aspect of autonomic regulation is autonomic responsiveness, which can by assessed by phase rectified signal averaging (PRSA). While other areas of research have found blunted physiological responses in pregnancy, this paper presents the first investigation of maternal autonomic responsiveness as assessed by PRSA. We find significantly reduced rates of responses, as well as an attenuated capacity for heart rate acceleration when comparing pregnant women to non-pregnant controls. We hypothesize that this attenuated autonomic control may serve to protect the mother against her imbalanced autonomic state, as increased sympathetic and decreased parasympathetic modulation accompany healthy pregnancies. Clinical Relevance- Maternal autonomic responsiveness is attenuated in pregnancy in comparison to non-pregnant women. Understanding maternal autonomic state not only improves our knowledge of gestational physiology but also forms the basis for the early detection of pregnancy complications associated with maternal autonomic dysfunction.

Traumatic brain injury in infants and toddlers, 0-3 years old.

OBJECT: Children 0-3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0-3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed ('ping-pong') skull fracture, and extradural hematoma. METHODS: We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0-3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management. RESULTS: We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed ('ping-pong') skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia ('black-brain'). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT-scan, and for follow-up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia ('black-brain') had a poor outcome, death occurring in all 7 cases. CONCLUSION: Children 0-3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in improving the outcome.

New application of diffusion tensor imaging in neurosurgery.

Diffusion tensor imaging is a MRI technique that enables the measurement of the diffusion of water in tissue in order to produce neural tract images. Advanced methods such as color coding and tractography (fiber tracking) have been used to investigate the directionality. The localization of tumors in relation to the white matter tracts (infiltration, deflection), has been one the most important initial applications. A non invasive technique for assessing tumor tissue characteristics, like tumor cell density, is required to assist preoperative surgical planning for malignant brain tumors and help better define the target for tumor biopsy, resulting in more accurate diagnosis and grading of malignant brain tumors. One possible source of this information is diffusion tensor imaging. Date studies have focused on its ability to delineate white matter fiber tracks by fiber tracking and to detect tumor infiltration around the tumor and normal white matter interface. Relationships between cell density and the two key values that diffusion tensor imaging provides, fractional anisotropy and mean diffusivity, still need to be investigated. Mean diffusivity has a good negative correlation and fractional anisotropy has a good positive correlation with tumor cell density within the tumor core. Similar correlation was observed between the Ki-67, on the one hand and fractional anisotropy and mean diffusivity, on the other hand. Thus, measurement of both fractional anisotropy and mean diffusivity within the tumor core has a potential to provide detailed information on tumor cell density within the tumor.

A life threatening problem in infants: supratentorial epidural hematoma.

Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. Authors present a study on 30 infants with epidural hematoma (EDH) admitted in the Pediatric Department of Neurosurgery of the "Bagdasar-Arseni" Clinical Hospital in the period of 1990-2007 (17 years). The most common symptom was irritability, which occurred in 16 cases (53.3%), of our patients. Pallor in all cases (100%) and subgaleal hematoma in 20/30 (66.6%) of the patients. These were the most common clinical signs that occurred upon admission; both of them represent signs of significant clinical importance. Surgical evacuation via craniotomy was required in 26/30 (86.6%) of our patients, while 4/30 (13.3%) of the patients were managed conservatively. The mortality rate was 6.6% in our series, whilst the long-term morbidity rate was 3.3%. EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, the size of EDH, and the presence ofa midline structure shift on the head's CT scan.