. . . You can sleep as you like in the first trimester. As long as you don’t sleep on your stomach during the second trimester, you can lie on your side or on your back. It is generally recommended that the left side is in the third trimester. With the increase of the fetus, the uterus is also enlarged during the second and third trimesters, which will compress the inferior vena cava and abdominal aorta, resulting in poor blood flow, and the inferior vena cava is biased to the right side of the spine. Improve the right rotation of the uterus, which can reduce the uterine vascular tone, increase the blood flow of the placenta, improve the oxygen supply of the fetus in the uterus, and benefit the growth and development of the fetus. , But it is also recommended. It is impossible to sleep in a posture all night, and the standard for measuring the suitability of a sleeping posture is comfortable. As long as the mother is comfortable, the baby is also comfortable. If the left lying position makes you uncomfortable and uncomfortable, then change your sleeping position decisively and change your right side. If a certain sleeping position will significantly increase fetal movement and fetal treasure kicks and beats, it is obvious that the baby tells you that he is uncomfortable and needs to change his sleeping position.
Nutcracker syndrome refers to a series of clinical syndromes caused by the left renal vein “shuttle” between the abdominal aorta and the superior mesenteric artery, and the compression of the gap between the abdominal aorta and the spine, resulting in narrowing of the lumen. The syndrome is also called [Left Renal Vein Compression Syndrome], and it is mostly manifested as hematuria, proteinuria, low back pain, and varicocele. The nutcracker syndrome is more common in children and adolescents, and is more common in male dolls. The incidence rate of male and female is about 24:5.  . Clinical manifestations 1. Hematuria: Hematuria is the most common symptom of nutcracker syndrome. Different levels of hematuria require different treatments. For example, if you have reached severe anemia, then only blood transfusion treatment is performed. However, under normal circumstances, it shows microscopic hematuria after activity, and the red blood cells in the urine are non-glomerular. In 98% of normal people, the pressure difference between the left renal vein and the inferior vena cava <.ImmHg (1.33kPa), hematuria may occur when the pressure difference is ≥3mmHg, but it is not hematuria and the mucosa of the calyx dome has inflammation, edema, and side branches The circulation is not related to other factors. 2. Pain: Mainly manifested as pain in the waist or abdomen, and it will radiate to the buttocks and the middle and back of the thighs, but it may also be part of the genital vein syndrome. The pathogenesis of pain is not completely clear. It may be caused by the continuous contraction of small arteries at the renal cortex resulting in decreased renal blood flow, vascular inflammation caused by increased pressure of the left renal vein, renal congestion, and long-term chronic hematuria. pain. 3. Postural proteinuria: refers to proteinuria that only occurs in a specific posture (such as standing, walking, or exercising). It can disappear with the change of posture. Proteinuria generally does not exceed 1g/d. Nutcracker syndrome can cause orthostatic proteinuria, which is more common in school-age children and adolescents, especially in the short term, the body’s rapid increase or slender body, the incidence rate is as high as 10%. The pathogenesis of orthostatic proteinuria may be upright when the internal organs sag, the abdominal aorta and the superior mesenteric artery are compressed, and the angle becomes smaller, resulting in compression of the left renal vein and blocked renal congestion, resulting in glomerular filtration Excessive increase, excess reabsorption capacity and proteinuria. 4. Erectile dysregulation: The nutcracker syndrome may be accompanied by erectile dysregulation. The patient feels dizzy, nausea, and chest tightness after sitting up or standing. If the symptoms are serious, it will affect normal life and study. The pathogenesis may be related to dysregulation of vasomotor mediators in patients. When standing upright, the patient’s venous system of the lower extremity contracted and the radiation was slow, the amount of returned blood flow decreased, and the cardiac output decreased, causing insufficient blood supply to the brain and causing symptoms. 5. Chronic Fatigue Syndrome: Chronic Fatigue Syndrome is mainly manifested as repeated or persistent fatigue without obvious causes, such as fatigue, dizziness, and decreased concentration. Moreover, the symptoms of fatigue are not relieved after rest, and in severe cases, it will cause a decline in mobility. The pathogenesis of chronic fatigue syndrome may be due to the increased pressure gradient between the left renal vein and the inferior vena cava, resulting in congestion of the vascular bed in the kidney, which affects the renin, angiotensin, and aldosterone systems. 6. Reproductive varicose veins: Testicular and ovarian vein blood flows back to the left renal vein. Under the action of the Nutcracker syndrome, due to the high pressure of the renal veins, the backflow is blocked and congestion is caused, resulting in reproductive varicose veins. The main manifestation of male babies is different degrees of left varicocele, which will develop into severe in most cases, and the improvement is not obvious after lying down. Children and adolescents generally show discomfort on the left side of the scrotum. Earthworm-like masses can be touched in the scrotum; female dolls show symptoms of dysmenorrhea, difficulty in urination, difficulty in sexual intercourse, pelvic pain and increased menstruation. Treatment of NCS depends on the clinical manifestations and severity of left renal venous hypertension, and the choice ranges from conservative treatment to nephrectomy. Treatment methods include conservative treatment, surgical treatment and interventional treatment. 1. Conservative treatment: nutritional support, reduction of strenuous exercise, prevention of colds, etc., regular review of blood, urine routine and renal vascular color Doppler ultrasound. For the baby with mild hematuria, conservative treatment is recommended, especially for those under the age of 18, it is best to choose conservative treatment for at least 2 years. With the increase of age, the angle between the superior mesenteric artery and the abdominal aorta gradually increases, and hematuria is relieved due to the increase of fat and other tissues. During conservative treatment, patients can be asked to increase nutrition and avoid strenuous activities
Yesterday I talked about the Nutcracker Syndrome, so how to treat this disease? When is surgery required and what are the surgical methods? Let me talk about a treatment today? The treatment of NCS depends on the clinical manifestations and severity caused by left renal venous hypertension, and the choice ranges from conservative treatment to nephrectomy. Treatment methods include conservative treatment, surgical treatment and interventional treatment. 1. Conservative treatment: nutritional support, reduction of vigorous exercise, prevention of colds, etc., regular review of blood and urine routine and renal vascular color Doppler ultrasound. Conservative treatment is recommended for dolls with mild hematuria, especially those under the age of 18, it is best to choose conservative treatment measures for at least 2 years. With the increase of age, the angle between the superior mesenteric artery and the abdominal aorta gradually increases, and hematuria is relieved due to the increase of fat and other tissues. During conservative treatment, patients can be instructed to increase nutrition, avoid vigorous activities, and try to position the angle between the superior mesenteric artery and the abdominal aorta to reduce left renal venous pressure when sleeping. And should regularly review blood, urine routine and renal vascular ultrasound. Inhibition using angiotensin-converting enzyme helps improve postural proteinuria. 2. Surgery: Applicable to patients with severe symptoms. The purpose of surgical treatment is to relieve the compression of the left renal vein and reduce the blood stasis of the left renal vein to restore the normal blood return of the left renal vein and its branches. Since the vast majority of NCS can be recovered with age, the indications for surgery should be strictly grasped. Under what circumstances can surgical treatment be performed? 1. After more than 2 years of observation or symptomatic treatment of internal medicine, the symptoms did not alleviate or become more severe. 2. Complications, such as severe dizziness and fatigue, waist pain, etc. 3. Patients with impaired renal function, varicocele and affecting fertility or chronic fatigue syndrome require surgical treatment. What are the surgical methods? 1. Left renal vein transposition: the most common and effective surgical treatment. It is a tension-free end-to-side anastomosis of the transverse end of the left renal vein and the inferior vena cava of the site to be reconstructed. 2. Superior mesenteric angioplasty. 3. Autologous kidney transplantation. 4. Extravascular support of the left renal vein. 5. Other surgical methods, such as left vascular prosthesis, saphenous vein bypass, inferior vena cava bypass, end-to-side anastomosis of the inferior ovarian vein, inferior vena cava anastomosis, splenic vein End-to-side anastomosis of left renal vein, etc.
The 45-year-old Mr. Zhu had no obvious cause of acupuncture-like pain on the right occipital a week ago, and then a CT scan of the head at a local hospital showed that the low-density shadow of the right middle cranial fossa, considering the epidermoid cyst broke into the subarachnoid space, In order to further confirm the diagnosis, he then came to the outpatient department of the Department of Neurosurgery, Zhao Tianzhi, Tangdu Hospital. After the head MRI scan and enhanced examination, the results showed that: the parasaddle space occupying lesions, consider epidermoid cysts and break into the subarachnoid space, to ( Cholesteatoma) Admitted to surgery as soon as possible. Because the intracranial tumor is deep, located in the lower margin of the cerebellum, close to the brainstem, in the absence of damage to the temporal lobe brain tissue, full exposure and complete removal of the tumor tissue is the key to surgery; because the tumor tissue is close to the brainstem, and the brainstem There is a certain amount of pressure, and a little carelessness during the removal of the tumor capsule, which may cause brainstem damage and cause serious consequences. Disease Science: What are the symptoms of intracranial cholesteatoma? Depending on the location of the tumor, the clinical manifestations are also different. (1) Cerebellopontine angle cholesteatoma: It often starts with trigeminal neuralgia (70%), and often has tinnitus, deafness, and late cerebellar cerebellopontine syndrome in the late stage, which is manifested by decreased facial sensation and weak facial muscle strength. , Hearing loss, ataxia, etc. (2) Saddle area cholesteatoma: often visual acuity and visual field defect are the main clinical manifestations in the early stage. A small number of patients may have endocrine disorders, which are manifested as decreased sexual function, polydipsia, polyuria and other pituitary dysfunction and hypothalamic damage. . (3) Cerebral parenchymal cholesteatoma: Cerebral hemisphere tumors often have seizures, mental symptoms, and mild hemiplegia. Cerebellar tumors often have nystagmus and ataxia. (4) Ventricular cholesteatoma: obstruction of cerebrospinal fluid circulation causes symptoms of increased intracranial pressure. (5) Skull cholesteatoma: It is often found that the skull shows uplift for many years, it feels rubbery, and there is no tenderness, and it can be moved or fixed. Director Zhao Tianzhi introduced: Cholesteroloma often spreads in the subarachnoid space or intraventricular cavity, and invades along various physiological channels or spaces. The incidence of intracranial cholesteatoma is generally considered to be 0.5-1.8% of whole brain tumors. It can be sent multiple times, ranging in size from a few millimeters to a few centimeters. The peak age is 40 years old. There are slightly more men than women, about 1.25: 1. The most common incidence is 20-50 years old, accounting for more than 70%. Tumors originate from embryos, but clinical symptoms usually appear after adults, and once found, tumors are often larger, so surgery must be performed as soon as possible after diagnosis.