Rationale:Pentalogy of Cantrell, a very rare congenital condition, has an estimated incidence of 5.5 per 1 million live births. It includes five defects: a midline supraumbilical wall defect, a diaphragmatic defect, a cleft distal sternum, a defect in the diaphragmatic pericardium, and an intracardiac defect. Very few cases of this condition have been reported in the literature, most of them diagnosed in the second or third trimester of pregnancy.Patient concerns:We present a case of pentalogy of Cantrell associated with cranioschisis and unilateral anophthalmia diagnosed at 14 weeks of amenorrhea.Diagnoses:The combination of abdominal and vaginal sonography established the diagnosis of 14 weeks of amenorrhea with a plurimalformative syndrome including: ectopia cordis, large suprambilical anterior abdominal wall defect, omphalocele, anomaly of the shape of the skull, and anomalies of the brain.Interventions:After counseling the parents, the pregnancy was interrupted, as requested by the family.Outcomes:Pathological examination of the fetus after the therapeutic abortion confirmed the diagnosis.Lessons:Because of the poor prognosis of Cantrell's pentalogy, early antenatal sonographic detection is important and allows for elective abortion before viability.

The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.

The phenomenon of defensive medicine existed for decades in the United States but in Romania emerged lately following malpractice litigation and mass media aggression. Defensive medicine develops when doctors prescribe tests or procedures and avoid to treat high-risk patients or to perform certain high-risk procedures in order to reduce the risk of medical liability. This essay discusses the basis and principles of defensive medicine, analyses its causes and effects and debates the major problems affectingRomanian healthcare system, notably cross-border medical assistance. Finally, the authors examine alternatives to prevent defensive medicine practices with emphasis on cardiovascular surgery. Among physicians, some degree of defensive medicine will always exist, as long as malpractice risks shadow the doctors' every footstep.

Ethylene glycol intoxication is potentially fatal and associated with typical clinical, laboratory and histopathological findings. The authors present the case of a 57-year-old male with a history of chronic alcoholism and who accidentally ingested approximately 1 litter of antifreeze solution. The patient was discovered comatose in his house and addressed to the emergency department with a Glasgow coma score of 3, severe metabolic acidosis, acute renal failure, atrial fibrillation and liver dysfunction. Despite reanimation manoeuvres and haemodialysis for 2 h the patient deceased 5 h after hospital admission. Necropsy examination revealed a stomach with oedematous walls, mucosa erosions and signs of bleeding together with a disorganised, granular single kidney with unidentifiable corticomedullary border. Histopathological examination displayed typical findings in the kidney such as autolytic changes of the epithelium and abundant calcium oxalate crystals in the lumen of the proximal tubules. Ethylene glycol intoxication is frequent in our country and its metabolites glycoaldehyde, glycolic acid, glyoxylic acid and oxalic acid are responsible for the severe metabolic acidosis and formation of calcium oxalate crystals in various organs and leading to severe multiple organ dysfunction and death. Forensic pathologists should be aware of clinical and biological manifestations as well as of typical histopathological findings as ethylene glycol is commonly ingested accidentally or used in homicidal/autolytical attempts.

Ricin, a toxic glycoprotein found in the seeds of castor oil plant, is capable of irreversible cellular adhesion and inhibition of protein synthesis. The authors performed an up to date review concerning the chemical structure, mechanism of action, poisoning symptoms and treatment, and potential uses of ricin as a biochemical weapon. Castor oil plant is easy to cultivate and harvest worldwide and, except the United States of America, cultures and processing plants are not supervised. Ricin extraction does not require laborious and costly technique and it is undetectable once in the body (except for urine in case of ricin ingestion). Poisoning generates nonspecific symptoms and is potentially fatal with no antidote or specific treatment available. Forensic specialists must be aware of symptoms and post-mortem findings in order to make a correct diagnosis of ricin poisoning.

The present study aims to assess the effects of alcohol and drug consumption on the cerebral status of a newborn with risk. Although there is a vast literature on the quality of life in terms of health, there is no uniform point of view, since the well-being of a person implies other elements that consider not only health but also the economic and educational environment in which the individual evolves and often these factors are connected. Besides, there is no valid instrument for measuring the quality of life either for an adult or for a child. In most cases, alcohol consumption intensifies in time, significantly decresing the quality of life for the mother and especially for the conception product. The study focuses on showing the The study focuses on highlighting the psychosocial and pharmacological aspects relevant to the diagnosis and management of neonatal cerebral status. The study participants, whose responses were the base for the quantitative analyzes, were individually interviewed using a standardized interview protocol. The interviews were conducted between October 2015 and September 2017. The interview protocol included three sections, in this chapter focusing our attention on the following sections: a) socio-demographic characteristics: age of gestation, sex of the newborn; b) clinical data: Presentation, Weight at Birth, Apgar Score, Cerebral Saturation (rSO2), Peripheral saturation (SpO2), The extraction fraction (FTOE), Parameters harvested from the umbilical cord at birth (pH, Base excess (BE), pCO2, pO2, MetHb, COHb), c) risk profile: mother�s alcohol consumption, including during pregnancy and drug use. The study group consisted of 90 infants born full term in Elena Doamna Maternity Hospital in Iasi, between 2015-2017, included in the programme of follow-up of the newborn with risk with the purpose of performing an non-invasive assessment of the fetal and neonatal cerebral status, in order to prevent and establish treatment methods for perinatal asphyxia. Based on the information obtained through the preliminary documentation, 30 newborns with alcohol and / or drug-consuming mothers and 60 neonates with risk-free mothers were selected - the control batch, who accepted to participate in the study.The cases studied showed the homogeneity of the groups depending on the mother�s age and gestational age, as well as the sex of the newborn and the weight at birth (p]0.05). In neonates from mothers at risk, the under-reference level of 1-minute brain saturation, combined with a lower gestational age and the 62.5% probability of performing a caesarean section at low levels of cerebral saturation was noted in 66.7% of newborns.The cut off value of SpO2, was established at 70 mL/ 100g/1 min, with a sensitivity of 50.9% and a specificity of 51.3%, after reading the coordinates of ROC curve, but the prediction was not significant from the statistical point of view (p=0.670). The mean level of base excess was al excesului de baze was slightly lower in newborns with the extraction fraction below the cut off value (-4.64 vs -4.18; p=0.560). According to the cases studied, 1 min after birth, 23.3% of the newborns showed an increased level of pCO2 associated with a reduced level of peripheral saturation (r= -0.231; p=0.05). The correlation between the pO2 level and the cerebral saturation, recorded 1 min after birth, was direct, but reduced as intensity (r= +0.295; p=0.049). About 27% of the newborns associated increased values of pO2 with reduced values of the extraction fraction (r=-0.272; p=0.047). The newborns with an extraction fraction over the cut off value had a level of COHb below 1% (p=0.756) more frequently. Newborns from mothers who have consumed alcohol and / or drugs, including during pregnancy, show a reduced level of cerebral saturation and peripheral saturation 1 minute after birth. In 16.7% of newborns, the extraction limit was below the baseline 1 minute after birth.

Methanol intoxication is a potentially fatal medical condition associated with basal ganglia and subcortical white matter necrosis. The authors present the case of a 34 years-old female with putaminal necrosis and haemorrhagic stroke secondary to methanol intoxication. The patient was hospitalized in the intensive care unit with severe metabolic acidosis and bilateral blindness after ingesting an unspecified amount of methanol. Computed tomography (CT) examination performed at hospital admission revealed a hypodense, inhomogeneous aspect of lenticular nuclei with ischemia in observation. In the 18th day post-ingestion the patient went into deep coma and a new CT examination was performed revealing an intracerebral hematoma involving the right lenticular nucleus, right external and extreme capsule, and right insula with uncal herniation. Neurosurgical decompression was attempted with unfavourable outcome and exitus. Necropsy examination revealed bilateral lenticular necrosis and a hematoma between the base of the right lenticular nucleus and insular cortex with destruction of the claustrum, external and extreme capsules. Methanol poisoning (mostly accidental) is not uncommon in our country and its metabolite, the formic acid, is a potent central nervous system toxin. Bilateral lenticular necrosis is a typical finding in methanol intoxication due to formic acid accumulation with decrease in mitochondrial adenosine triphosphate (ATP) synthesis responsible for cellular toxicity.

Imaging in the major planes (horizontal, coronal, and sagittal) of the uterus is important for determining anatomy and allowing the findings to be standardized, and for evaluating and diagnosing different pathological conditions in clinical practice. Examination of the coronal plane is an important step in identifying uterine pathologies and their relationships to the endometrial canal. Three-dimensional (3D) ultrasound reveals the normal anatomy better and improves the depiction of abnormal anatomy, as the coronal plane of the uterus can easily be obtained using 3D reconstruction techniques. Our pictorial essay demonstrates that adding 3D ultrasound to a routine gynecological workup can be beneficial for clinicians, enabling a precise diagnosis to be made. In addition, the volumes obtained and stored by 3D ultrasound can allow students or residents to become more familiar with normal and abnormal pelvic structures. Clin. Anat. 31:373-379, 2018. © 2017 Wiley Periodicals, Inc.