[Intensive care issues in the management of potential organ donors]. / Probleme de terapie intensiva aparute în pregatirea potentialilor donatori de organe.

Organ transplantation is a multidisciplinary speciality that has undergone a remarkable development in the last two decades, saving the lives of patients in advanced failure of various organs. Medical management of organ donors is an essential component of achieving success in transplantation. It requires a good knowledge and understanding of the pathological changes caused by brain death, changes that usually require a diagnosis and a rapid treatment. In our study we intend to analyse the problems that we encountered during preparation of the donors. Hypovolemia, insipid diabetes, pulmonary edema, maintaining viability of organs in optimal conditions are important aspects which influences donation success to a large number of recipients. Between January 2007 - July 2009 in the ICU department of Bagdasar Arseni Emergency Hospital, Bucharest we had 47 potential organ donors, of which only 20 actually came to organ donation. A significant percentage of potential donors are lost due to complications and/or because of denial of consent by the family.

[Family planning with different contraceptive methods]. / Planificarea familiala prin diferite metode contraceptive.

PIP: Female hormonal contraceptives, introduced commercially in 1959, contained 10 mg of norethynodrel and .15 mg of mestranol. The estrogen and progesterone doses were progressively reduced over time. In 1989, approximately 60 million couples used oral contraceptives (OCs) ranging from 1% in Japan to 40% in the Netherlands. The monophasic pill contains .01 - .04 mg of ethinyl estradiol (EE), and the biphasic pill contains increasing doses of progesterone and estroprogesterone in the course of the menstrual cycle. Triphasic combined pills contain an initially dominant estrogen dose. In oral sequential pills, estrogen is given on days 14-16 followed by a estroprogesterone for 5-7 days. Micropills with progesterone, injectables with medroxyprogesterone, and 3rd-generation OCs such as gestoden with a low progesterone dose of .04 mg/day and reduced androgenic activity are among other OCs. The OCs are administered in 21-22 day packets. Absolute contraindications include history of venous thrombosis, atherogenic lipid profile, hormone-dependent cancer, and allergy. Relative contraindications include arterial ailments, smoking, hypertension, older age, obesity, and familial history of cardiovascular and cerebrovascular accidents. Interactions with antibiotics (ampicillin and tetracycline) occur as the modified intestinal flora reduces the level of deconjugated EE. Most frequent side effects are depression, modification of libido, ocular disorders, headache, and urinary infection. Benefits include favorable modification of menstrual cycle, and reduction of endometriosis and endometrial and ovarian cancer. Systemic risks such as cardiovascular and blood coagulation effects occur mainly with high-dose OCs. Further topics addressed are the cancer risk and protective effect of OCs, postcoital OCs, traditional contraception, the IUD, RU-486, implants, vaccination with the human antigonadotropine, and the vaginal ring.^ieng

Lower oesophageal sphincter pressure during early pregnancy: manometric studies before and after abortion.

Resting lower oesophageal sphincter pressure (L.O.S.P.) was determined in 14 pregnant women with heartburn and 12 pregnant women without heartburn before (10 to 18 weeks of gestation) and in the first week after an elective abortion. Mean L.O.S.P. in pregnant women with heartburn was 11.5 ± 1.5 mm Hg before and 17.3 ± 1.8 mm Hg after abortion, the difference being statistically significant (p < 0.001). In the group of pregnant women without heartburn the mean resting L.O.S.P. before and after abortion was not significantly different. Although the exact mechanism by which gastro-oesophageal reflux occurs during early pregnancy is not entirely understood, it appears that hormonal changes (elevated serum concentrations of progesterone and oestrogens) play a major role by depressing L.O.S., the main antireflux barrier.