BACKGROUND: Cortical blindness is one the most disturbing symptoms of reversible posterior encephalopathy syndrome in preeclamptic and eclamptic patients. The disease has been previously associated with a hypertensive breakthrough in the autoregulation of posterior cerebral arterioles followed by extravasation of the fluid into the brain tissue. CASE: 22-year-old primigravida in the 39th week of gestation diagnosed with gestational diabetes mellitus presented with mild preeclampsia and was admitted to our hospital. Antihypertensive treatment was initiated. Her blood pressure remained between 120/80 to 140/90 mm Hg. Glucose levels were within acceptable range. Before the labor induction she developed acute cortical blindness. Magnetic resonance imaging showed vasogenic edema localized in occipital lobes. Cesarean section was performed and anti-edematous treatment initiated. Blindness resolved by the fifth day postpartum. CONCLUSIONS: Reversible posterior encephalopathy developed in our patient in spite of normalized blood pressure that remained within autoregulation limits. Alternative pathogenesis and precipitating factors are discussed.
Blindness, Cortical/diagnosis , Blindness, Cortical/etiology , Hypertensive Encephalopathy/complications , Hypertensive Encephalopathy/diagnosis , Pre-Eclampsia , Antihypertensive Agents/therapeutic use , Blindness, Cortical/drug therapy , Female , Humans , Hypertensive Encephalopathy/drug therapy , Magnetic Resonance Imaging , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Third , Recovery of Function , Visual Acuity , Young Adult
AIM: Obesity is traditionally believed to increase the incidence of perioperative complications in abdominal surgery. Recently this paradigm has been challenged mainly by observations from surgical specialties other than gynecology. Our aim was to assess the impact of obesity on perioperative course in women undergoing total abdominal hysterectomy. METHODS: We analyzed medical charts of 126 patients who underwent total abdominal hysterectomy for benign gynecological conditions through a low transverse incision in the Department of Obstetrics and Gynecology of the Provincial Specialist Hospital in Czestochowa, Poland. Perioperative course was compared between obese [n = 55; body mass index (BMI) ≥ 30 kg/m(2): mean 32.6 ± 3.2 kg/m(2)] and non-obese patients (n = 71; mean BMI 24.3 ± 3 kg/m(2)). RESULTS: The mean operative time in obese women was significantly prolonged (112 ± 32 vs. 100 ± 31 min, P = 0.036). However, complication rates and other perioperative outcomes were comparable between the groups. CONCLUSION: In our study, mild obesity does not significantly affect the perioperative course in women undergoing total abdominal hysterectomy.
Hysterectomy/adverse effects , Obesity/complications , Postoperative Complications/etiology , Adult , Female , Humans , Hysterectomy/methods , Middle Aged , Operative Time , Poland , Treatment Outcome
