ABSTRACT
Pregnant women with renal disease are at high risk of perinatal complications and renal impairment. Here, we report the outcomes of 4 pregnancies complicated by renal disease diagnosed during pregnancy and the puerperal period. Case 1: Urine test had been positive for protein from 8 weeks of pregnancy, and chronic kidney disease stage G4 was diagnosed at 25 weeks of pregnancy. Renal impairment worsened over time, and cesarean section was performed due to non-reassuring fetal status at 32 weeks of pregnancy. Case 2: Urine test had been positive for protein since before pregnancy, and chronic glomerulonephritis was diagnosed at 15 weeks of pregnancy. Gradual impairment of renal function started at 31 weeks of pregnancy, and the patient had a vaginal delivery at 37 weeks of pregnancy. Case 3: Urine test had been positive for protein since before pregnancy, and hypertension and urine protein were observed since around 26 weeks of pregnancy. Cesarean section was performed due to acute renal failure at 36 weeks of pregnancy. Chronic glomerulonephritis was suspected after childbirth. Case 4: Blood pressure became uncontrollable beginning around 28 weeks of pregnancy, and cesarean section was performed due to sudden worsening of hepatic and renal functions at 31 weeks of pregnancy. Autosomal dominant polycystic kidney disease was diagnosed after childbirth. Pregnancies complicated by renal disease need to be managed carefully with monitoring of blood pressure and renal function. Cooperation with a renal specialist is crucial throughout the perinatal and puerperal periods.
ABSTRACT
This retrospective study was carried out to clarify the preventive effect of neutral positioning of both arms on upper extremity neuropathy after gynecological laparoscopic surgery compared with right arm abduction positioning. In 93 cases of right arm abduction positioning >90°, with the left arm tucked in at the side, postoperative right hand numbness occurred in 6 cases (6.5%). In these 6 cases, symptoms disappeared in 4 cases after postoperative day (POD) 1, in 1 case after POD 21, and in the remaining case after POD 41. In 81 cases where both arms were in the neutral position tucked in at the sides with shoulder braces applied, upper extremity numbness was not experienced in any cases; however, shoulder pain developed in 4 cases (4.9%) and was thought to be related to using the shoulder braces. The pain disappeared in 2 cases after POD 1, in 1 case after POD 2, and in the remaining case after POD 3. In right arm abduction positioning without the use of shoulder braces, shoulder pain was not experienced in any cases. Neutral positioning of both arms in gynecological laparoscopic surgical patients was effective for the prevention of upper extremity neuropathy, but measures to alleviate the onset of shoulder pain after change in positioning need to be addressed in the future.
ABSTRACT
We report a case of vaginal cuff dehiscence after total laparoscopic hysterectomy that was successfully managed by a newly developed vaginal double-layer circular incision-closure method through a transvaginal approach. The nulligravid postmenopausal patient with cervical cancer received a diagnosis of vaginal evisceration on postoperative day 24. The eviscerated small intestine was pushed back after vaginal douching with normal saline before the procedure. The vaginal mucosa was incised circularly in two layers at the levels of 10 mm and 15 mm from the vaginal stump, and the edges apposed with double-layer closures. She was discharged on postoperative day 3 and followed up for 5 years, with no recurrence of cancer or vaginal dehiscence. This operative method is especially useful for a nulligravida with a small vagina.