One life ends, another begins: Management of a brain-dead pregnant mother - A systematic review -

Background: An accident or a catastrophic disease may occasionally lead to brain death (BD) during pregnancy. Management of brain-dead pregnant patients needs to follow special strategies to support the mother in a way that she can deliver a viable and healthy child and, whenever possible, also be an organ donor. This review discusses the management of brain-dead mothers and gives an overview of recommendations concerning the organ supporting therapy. Methods: To obtain information on brain-dead pregnant women, we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included the age of the mother, the cause of brain death, maternal medical complications, gestational age at BD, duration of extended life support, gestational age at delivery, indication of delivery, neonatal outcome, organ donation of the mothers and patient and graft outcome. Results: In our search of the literature, we found 30 cases reported between1982 and 2010. A nontraumatic brain injury was the cause of BD in 26 of 30 mothers. The maternal mean age at the time of BD was 26.5 years. The mean gestational age at the time of BD and the mean gestational age at delivery were 22 and 29.5 weeks, respectively. Twelve viable infants were born and survived the neonatal period. Conclusion: The management of a brain-dead pregnant woman requires a multidisciplinary team which should follow available standards, guidelines and recommendations both for a nontraumatic therapy of the fetus and for an organ-preserving treatment of the potential donor

Abnormalities in auditory evoked potentials of 75 patients with Arnold-Chiari malformations types I and II Anormalidades nos potenciais evocados auditivos de 75 pacientes com os tipos I e II das malformações de Arnold-Chiari

OBJECTIVE: To evaluate the frequency and degree of severity of abnormalities in the auditory pathways in patients with Chiari malformations type I and II. METHOD: This is a series-of-case descriptive study in which the possible presence of auditory pathways abnormalities in 75 patients (48 children and 27 adults) with Chiari malformation types I and II were analyzed by means of auditory evoked potentials evaluation. The analysis was based on the determination of intervals among potentials peak values, absolute latency and amplitude ratio among potentials V and I. RESULTS: Among the 75 patients studied, 27 (36%) disclosed Arnold-Chiari malformations type I and 48 (64%) showed Arnold-Chiari malformations type II. Fifty-three (71%) of these patients showed some degree of auditory evoked potential abnormalities. Tests were normal in the remaining 22 (29%) patients. CONCLUSION: Auditory evoked potentials testing can be considered a valuable instrument for diagnosis and evaluation of brain stem functional abnormalities in patients with Arnold-Chiari malformations type I and II. The determination of the presence and degree of severity of these abnormalities can be contributory to the prevention of further handicaps in these patients either through physical therapy or by means of precocious corrective surgical intervention.<br>OBJETIVO: Avaliar a freqüência e grau de comprometimento das vias auditivas em tronco cerebral por meio de potencial evocado auditivo, em pacientes afetados por malformações de Arnold-Chiari de tipos I e II. MÉTODO: Foi efetuado um estudo descritivo de tipo série de casos, sendo selecionados 75 pacientes (48 crianças e 27 adultos) nos quais foi realizada avaliação dos potenciais evocados das vias auditivas, com base à determinação dos valores dos intervalos entre picos de potenciais, da latência absoluta e da razão entre as amplitudes dos potenciais V e I. RESULTADOS: Entre os 75 pacientes avaliados, 27 (36%) apresentavam malformações de Arnold-Chiari de tipo I e 48 (64%) apresentavam malformações de tipo II. Em 53 (71%) do total de pacientes os potenciais evocados auditivos mostraram algum grau de anormalidade. Os testes foram normais nos restantes 22 (29%). CONCLUSÃO: O potencial evocado auditivo pode ser considerado valioso instrumento para o diagnóstico e avaliação da gravidade das anormalidades funcionais de tronco cerebral em pacientes portadores de malformações de Arnold-Chiari de tipo I e II. Esta avaliação pode contribuir de maneira significativa não somente no diagnóstico como também na prevenção de ulteriores lesões, pela adoção de medidas preventivas, tanto por meio de fisioterapia como por intervenção cirúrgica precoce

Visual marking and change detection

The preview benefit from prior exposure of response-irrelevant (distracter) objects in visual search has been accounted for in terms of top-down inhibition (i.e. visual marking), bottom-up abrupt onset capture, or asynchrony- dependent perceptual segregation. We assess the relative contribution of abrupt onset and visual marking in a paradigm combining visual search with a visual working memory task. We investigated time-based selection of multiple objects for storage in visual working memory, using a change detection paradigm (Luck and Vogel in Nature 390:279–281, 1997) with distracter preview. We varied preview exposure (short vs. long), in a series of three experiments. The contribution of asynchrony-related perceptual segregation was assessed across experiments by varying the complexity of the stimuli (colored squares, oriented bars and oriented T-shapes) and the type of change detection (color or orientation), resulting in different levels of perceptual segregation between visual elements. The results suggest that bottom-up abrupt onset, visual marking and perceptual segregation factors co-operate in time-based selection for storage in visual working memory