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1.
Int Urogynecol J ; 35(4): 793-801, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38240800

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to explore the association between urge urinary incontinence (UUI) and lax uterosacral ligaments (USL) using MRI. METHODS: Sixty-seven female participants were recruited prospectively: 41 continent volunteers (control group) and 26 patients with UUI. Static proton density- and T2-weighted turbo spin echo sequences of MR images were used. A radiologist employed a standardized grid system to record structural observations of the USLs on sequentially numbered axial MR images and then applied a four-point grading scale to assess ligament visibility. MR images were interpreted by a radiologist and a urologist, and then validated by an expert radiologist. RESULTS: The comparison between the mean length of uterosacral ligaments in the control and UUI groups was highly statistically significant (p < 0.001). The mean length of the right USL was 38 ± 11 mm, and the left USL was 35 ± 12 mm in the UUI group. In the control group, the mean length of the USL was 22 ± 9 mm on the right side and 18 ± 9 mm on the left side, along their craniocaudal extent. The highest inter-observer agreement was on the level of origin and insertion (image numbers), whereas the lowest agreement was on the anatomical site of origin and insertion of the USL in both the control and UUI groups. CONCLUSIONS: The average length of USLs in patients with UUI is significantly longer than that in healthy continent women, indicating laxity. Our findings support the relationship between the laxity of the USL and UUI symptoms and have therapeutic implications.


Assuntos
Ligamentos , Imageamento por Ressonância Magnética , Incontinência Urinária de Urgência , Humanos , Feminino , Pessoa de Meia-Idade , Ligamentos/diagnóstico por imagem , Ligamentos/patologia , Adulto , Incontinência Urinária de Urgência/diagnóstico por imagem , Estudos Prospectivos , Estudos de Casos e Controles , Idoso , Útero/diagnóstico por imagem , Voluntários Saudáveis , Sacro/diagnóstico por imagem
2.
Eur Radiol ; 31(11): 8597-8605, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34357449

RESUMO

OBJECTIVE: Radiological findings in solitary rectal ulcer syndrome (SRUS) are well described for evacuation proctography (EP) but sparse for magnetic resonance defecography (MRD). In order to rectify this, we describe the spectrum of MRD findings in patients with histologically proven SRUS. MATERIALS AND METHODS: MRD from twenty-eight patients (18 female; 10 males) with histologically confirmed SRUS were identified. MRD employed a 1.5-T magnet and a standardized technique with the rectal lumen filled with gel and imaged sagittally in the supine position, before, during, and after attempted rectal evacuation. A single radiologist observer with 5 years' experience in pelvic floor imaging made the anatomical and functional measurements. RESULTS: Sixteen patients (10 female) demonstrated internal rectal intussusception and 3 patients (11%) demonstrated complete external rectal prolapse. Anterior rectoceles were noted in 12 female patients (43%). Associated anterior and middle compartment weakness (evidenced by excessive descent) was observed in 18 patients (64%). Cystocele was found in 14 patients (50%) and uterine prolapse was noted in 7 patients (25%). Enterocoeles were detected in 5 patients (18%) and peritoneocoele in 5 patients (18%). None had sigmoidocoele. Sixteen patients (57%) demonstrated delayed voiding and 13 patients (46%) incomplete voiding, suggesting defecatory dyssynergia. CONCLUSION: MRD can identify and grade both rectal intussusception and dyssynergia in SRUS, and also depict associated anterior and/or middle compartment descent. Distinction between structural and functional findings has important therapeutic implications. KEY POINTS: MRD can identify and grade both rectal intussusception and dyssynergia in patients with SRUS. MRD is an acceptable substitute to evacuation proctography in assessing anorectal dysfunctions when attempting to avoid ionizing radiation. SRUS influences the pelvic floor globally. MRD depicts associated anterior and/or middle compartment prolapse.


Assuntos
Doenças Retais , Prolapso Retal , Defecografia , Feminino , Humanos , Masculino , Doenças Retais/diagnóstico por imagem , Prolapso Retal/complicações , Prolapso Retal/diagnóstico por imagem , Retocele , Úlcera/diagnóstico por imagem
3.
Eur Radiol ; 27(5): 2067-2085, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27488850

RESUMO

OBJECTIVE: To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). METHODS: The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. RESULTS: Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the "Rule of three" for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. CONCLUSION: This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. KEY POINTS: • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.


Assuntos
Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/fisiopatologia , Prolapso de Órgão Pélvico/diagnóstico por imagem , Defecografia/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Prolapso de Órgão Pélvico/fisiopatologia , Radiografia Abdominal/métodos , Retocele/diagnóstico por imagem , Retocele/fisiopatologia
7.
Trends Immunol ; 31(6): 205-11, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20418164

RESUMO

A need for antigen-processing and presentation to B cells is not widely appreciated. However, cross-linking of multiple B cell receptors (BCRs) by T-independent antigens delivers a potent signal that induces antibody responses. Such BCR cross-linking also occurs in germinal centers where follicular dendritic cells (FDCs) present multimerized antigens as periodically arranged antigen-antibody complexes (ICs). Unlike T cells that recognize antigens as peptide-MHC complexes, optimal B cell-responses are induced by multimerized FDC-ICs that simultaneously engage multiple BCRs. FDC-FcgammaRIIB mediates IC-periodicity and FDC-BAFF, FDC-IL-6 and FDC-C4bBP are co-stimulators. Remarkably, specific antibody responses can be induced by FDC-ICs in the absence of T cells, opening up the exciting possibility that people with T cell insufficiencies may be immunized with T-dependent vaccines via FDC-ICs.


Assuntos
Linfócitos B/imunologia , Células Dendríticas Foliculares/imunologia , Ativação Linfocitária , Receptores de Antígenos de Linfócitos B/imunologia , Animais , Apresentação de Antígeno , Complexo Antígeno-Anticorpo/imunologia , Humanos , Linfócitos T/imunologia
8.
AJR Am J Roentgenol ; 200(4): 938-40, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23521473

RESUMO

OBJECTIVE: The purpose of this commentary is to highlight several aspects of two main perspectives on sacrocolpopexy: surgical-which includes selection of a route for reconstructive surgery, types of surgical meshes available, advantages and disadvantages of each type of mesh, and the associated postoperative complication-and radiologic, that is, the role of imaging in improving outcome. CONCLUSION: As new modalities and techniques related to sacrocolpopexy are developed, concepts of form and function change. With advances in imaging modalities, especially MRI and CT, and the postprocessing options available, the radiologist's role should extend beyond reporting imaging findings to sharing in the choice of the initial treatment plan.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Imageamento por Ressonância Magnética , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/diagnóstico , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Feminino , Humanos
9.
Abdom Imaging ; 38(5): 912-29, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22653053

RESUMO

In pelvic floor dysfunction (PFD), magnetic resonance imaging of the pelvic floor supporting system from a functional point of view allows radiologists to recognize and classify the types of defects in each supporting structure (namely, the urethral supporting system, the vaginal supporting system, and the anal sphincter complex). Combined analysis of both the static and dynamic images of patients reporting stress urinary incontinence and pelvic organ prolapse has revealed a close relationship between certain anatomical defects in the pelvic organ support system and specific PFD. Because of the consistency and reproducibility of this relationship, radiologists can accurately identify and report the underlying structural defects, allowing clinicians to individually tailor surgical techniques for each patient. This is important because even those patients presenting with the same clinical symptoms may have different underlying structural derangement or abnormalities that may warrant a different treatment plan or approach. In view of the reported high rate of dysfunction recurrence after surgical treatment and clinicians' desire for a test that can pinpoint each patient's structural and anatomical defects, this approach provides the necessary scientific evidence on which best clinical practice can be based, and the data-reporting system used for analysis provides a tool for accurately planning reconstructive surgery, reducing the risk of surgical failure, dysfunction recurrence, and reoperation. With the improved radiological evidence made possible by combined image analysis, clinicians can now have the documentation that they need to plan more effective procedures and thus produce better outcomes. This review focuses on the MRI anatomy of the pelvic floor from a functional point of view and from the urogynecological side of floor dysfunction (UI and POP), adopting a problem-oriented approach. The first section of this article provides the basic essential anatomical information about the pelvic floor and briefly reviews the pathophysiology and clinical features of SUI and POP. The second portion details the vital role of the radiologist in obtaining accurate images for the clinician to use in planning reconstructive surgery. In addition, it includes case examples, illustrating how to report MRI findings systematically and comprehensively on both the static and dynamic images, using a recently developed integrated MRI analytical approach from a purely functional point of view that may enhance radiologists' interaction with clinicians and bridges the gap between radiology and surgery.


Assuntos
Imageamento por Ressonância Magnética/métodos , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/fisiopatologia , Diafragma da Pelve/anatomia & histologia , Diagnóstico Diferencial , Feminino , Humanos , Urodinâmica
10.
J Immunol ; 182(6): 3482-91, 2009 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-19265126

RESUMO

Follicular dendritic cells (FDCs) periodically arrange membrane-bound immune complexes (ICs) of T-dependent Ags 200-500A apart, and in addition to Ag, they provide B cells with costimulatory signals. This prompted the hypothesis that Ag in FDC-ICs can simultaneously cross-link multiple BCRs and induce T cell-independent (TI) B cell activation. TI responses are characterized by rapid IgM production. OVA-IC-bearing FDCs induced OVA-specific IgM in anti-Thy-1-pretreated nude mice and by purified murine and human B cells in vitro within just 48 h. Moreover, nude mice immunized with OVA-ICs exhibited well-developed GL-7(+) germinal centers with IC-retaining FDC-reticula and Blimp-1(+) plasmablasts within 48 h. In contrast, FDCs with unbound-OVA, which would have free access to BCRs, induced no germinal centers, plasmablasts, or IgM. Engagement of BCRs with rat-anti-mouse IgD (clone 11-26) does not activate B cells even when cross-linked. However, B cells were activated when anti-IgD-ICs, formed with Fc-specific rabbit anti-rat IgG, were loaded on FDCs. B cell activation was indicated by high phosphotyrosine levels in caps and patches, expression of GL-7 and Blimp-1, and B cell proliferation within 48 h after stimulation with IC-bearing FDCs. Moreover, anti-IgD-IC-loaded FDCs induced strong polyclonal IgM responses within 48 h. Blockade of FDC-FcgammaRIIB inhibited the ability of FDC-ICs to induce T-independent IgM responses. Similarly, neutralizing FDC-C4BP or -BAFF, to minimize these FDC-costimulatory signals, also inhibited this FDC-dependent IgM response. This is the first report of FDC-dependent but TI responses to T cell-dependent Ags.


Assuntos
Antígenos de Diferenciação de Linfócitos T/imunologia , Antígenos T-Independentes/imunologia , Células Dendríticas Foliculares/imunologia , Células Dendríticas Foliculares/metabolismo , Imunoglobulina M/biossíntese , Animais , Complexo Antígeno-Anticorpo/administração & dosagem , Complexo Antígeno-Anticorpo/imunologia , Fator Ativador de Células B/fisiologia , Linfócitos B/imunologia , Linfócitos B/metabolismo , Células Cultivadas , Humanos , Ativação Linfocitária/imunologia , Camundongos , Camundongos Nus , Ovalbumina/administração & dosagem , Ovalbumina/imunologia , Linfócitos T/imunologia , Linfócitos T/metabolismo , Linfócitos T/patologia
11.
Abdom Radiol (NY) ; 46(4): 1323-1333, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-31332501

RESUMO

Functional defecation disorders (FDD) encompass causes of constipation associated with anorectal dysfunction, which include dyssynergia or inadequate defecatory propulsion. FDD are frequently encountered in clinical practice and may affect up to 33-50% of patients with chronic constipation. The etiology of FDD is unclear, however, it has been defined as an acquired, but subliminal behavioral disorder. Pathophysiologic mechanisms may include discoordination of rectoanal muscles, paradoxical contraction or insufficient relaxation of puborectalis and/or anal sphincter during defecation, and sluggish colonic transit. A combination of comprehensive clinical assessment, digital rectal examination and a battery of physiologic tests are needed to make an accurate diagnosis of FDD. Defecography may play a crucial role in the evaluation of FDD, especially when a balloon expulsion test (BET) and/or anorectal manometry (ARM) are equivocal or demonstrate contradictory results. In this review, we provide a thorough overview of the epidemiology, pathophysiology, diagnostic criteria, clinical and imaging evaluation, and treatment options for FDD, with an emphasis on available diagnostic imaging tools such as defecography and conventional fluoroscopic methods.


Assuntos
Defecação , Defecografia , Canal Anal/diagnóstico por imagem , Constipação Intestinal/diagnóstico por imagem , Humanos , Manometria
12.
Abdom Radiol (NY) ; 46(4): 1302-1311, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-31555847

RESUMO

The pelvic floor is composed of a network of muscles, ligaments, and fasciae, which provide active and passive support for the pelvic organs. Impairment of these pelvic floor elements can result in a variety of functional abnormalities and single or multicompartment organ prolapse. Knowledge of normal pelvic floor anatomy can aid the radiologist in understanding the complex nature of pelvic floor dysfunction and is important for comprehensive image interpretation. This article provides an overview of normal anatomy of the pelvic floor as seen on magnetic resonance imaging, ultrasound, and fluoroscopic studies performed in the evaluation of pelvic floor function.


Assuntos
Distúrbios do Assoalho Pélvico , Diafragma da Pelve , Humanos , Imageamento por Ressonância Magnética , Imagem Multimodal , Diafragma da Pelve/diagnóstico por imagem , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Ultrassonografia
13.
Abdom Radiol (NY) ; 46(4): 1294-1301, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33585965

RESUMO

Pelvic floor disorders are common and can negatively impact quality of life. Imaging of patients with pelvic floor disorders has been extremely heterogeneous between institutions due in part to variations in clinical expectations, technical considerations, and radiologist experience. In order to assess variations in utilization and technique of pelvic floor imaging across practices, the society of abdominal radiology (SAR) disease-focused panel on pelvic floor dysfunction developed and administered an online survey to radiologists including the SAR membership. Results of the survey were compared with published recommendations for pelvic floor imaging to identify areas in need of further standardization. MRI was the most commonly reported imaging technique for pelvic floor imaging followed by fluoroscopic defecography. Ultrasound was only used by a small minority of responding radiologists. The survey responses demonstrated variability in imaging utilization, patient referral patterns, imaging protocols, patient education, and interpretation and reporting of pelvic floor imaging examinations. This survey highlighted inconsistencies in technique between institutions as well as potential gaps in knowledge that should be addressed to standardize evaluation of patients with pelvic floor dysfunction.


Assuntos
Distúrbios do Assoalho Pélvico , Radiologia , Defecografia , Humanos , Imageamento por Ressonância Magnética , Diafragma da Pelve/diagnóstico por imagem , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Qualidade de Vida
14.
Abdom Radiol (NY) ; 46(4): 1351-1361, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-31385010

RESUMO

PURPOSE: To develop recommendations for magnetic resonance (MR) defecography technique based on consensus of expert radiologists on the disease-focused panel of the Society of Abdominal Radiology (SAR). METHODS: An extensive questionnaire was sent to a group of 20 experts from the disease-focused panel of the SAR. The questionnaire encompassed details of technique and MRI protocol used for evaluating pelvic floor disorders. 75% agreement on questionnaire responses was defined as consensus. RESULTS: The expert panel reached consensus for 70% of the items and provided the basis of these recommendations for MR defecography technique. There was unanimous agreement that patients should receive coaching and explanation of commands used during MR defecography, the rectum should be distended with contrast agent, and that sagittal T2-weighted images should include the entire pelvis within the field of view. The panel also agreed unanimously that IV contrast should not be used for MR defecography. Additional areas of consensus ranged in agreement from 75 to 92%. CONCLUSION: We provide a set of consensus recommendations for MR defecography technique based on a survey of expert radiologists in the SAR pelvic floor dysfunction disease-focused panel. These recommendations can be used to develop a standardized imaging protocol.


Assuntos
Distúrbios do Assoalho Pélvico , Radiologia , Defecografia , Humanos , Imageamento por Ressonância Magnética , Diafragma da Pelve , Distúrbios do Assoalho Pélvico/diagnóstico por imagem
15.
Int Immunol ; 21(6): 745-56, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19461124

RESUMO

Reports that follicular dendritic cells (FDCs) produce IL-6 prompted the hypotheses that immune complexes (ICs) induce FDCs to produce IL-6 and that FDC-IL-6 promotes germinal center (GC) reactions, somatic hypermutation (SHM) and IgG production. FDCs were activated in vitro by addition of ICs and FDC-IL-6 production was determined. Wild-type (WT) and IL-6 knockout (KO) mice, as well as chimeras with WT and IL-6 KO cells, were immunized with (4-hydroxy-3-nitrophenyl)-acetyl (NP)-chicken gamma globulin (CGG) and used to study anti-(4-hydroxy-3-iodo-5-nitrophenyl) acetyl (NIP) responses, GC formation and SHM in the VH186.2 gene segment in Ig-gamma. FDC-IL-6 increased when FDCs encountered ICs. At low immunogen dose, 1 microg NP-CGG per mouse, the IgG anti-NIP response in IL-6 KO mice was low and immunohistochemistry revealed a reduction in both the number and size of GCs. The physiological relevance of FDC-IL-6 was apparent in the chimeric mice where total splenocytes from WT mice were unable to provide the IL-6 needed for normal IgG and GC responses in IL-6 KO animals with IL-6-defective FDCs. Moreover, the rate of mutation decreased from 18 to 8.9 mutations per 1000 bases (P < 0.001) in WT versus IL-6 KO mice. Addition of anti-IL-6 to GC reactions in vitro reduced antibody levels and SHM from 3.5 to 0.65 mutations per 1000 bases (P < 0.02). Thus, the absence of FDC-IL-6 correlated with a reduction in SHM that coincided with the reduction in GCs and specific anti-NIP. This is the first study to document that ICs induce FDC-IL-6 and that FDC-derived IL-6 is physiologically relevant in generating optimal GC reactions, SHM and IgG levels.


Assuntos
Linfócitos B/metabolismo , Células Dendríticas Foliculares/metabolismo , Centro Germinativo/imunologia , Imunoglobulina G/imunologia , Interleucina-6/metabolismo , Hipermutação Somática de Imunoglobulina/imunologia , Animais , Complexo Antígeno-Anticorpo/metabolismo , Antígenos/imunologia , Linfócitos B/imunologia , Comunicação Celular , Diferenciação Celular/imunologia , Células Dendríticas Foliculares/imunologia , Feminino , Imunização , Imunoglobulina G/genética , Imunoglobulina G/metabolismo , Interleucina-6/genética , Interleucina-6/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Quimeras de Transplante
16.
Radiol Clin North Am ; 58(2): 291-303, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044008

RESUMO

This article reviews different approaches for describing pelvic floor anatomy; "Classic 3-Compartment Approach", "Active and Passive Conceptual Approach" and "Multilayered System Approach". However, these approaches cannot explain pathogenesis of various dysfunctions. "Functional 3-Part Pelvic Supporting Systems Approach" a new, more function-based classification of the pelvic floor support system is introduced in which all structures that contribute to same function are grouped under 1 system. Indications for MR imaging of pelvic floor dysfunction, patients' preparation, static, dynamic and MR Defecography imaging protocols are detailed according to the concordance of experts in two recently published consensus papers.


Assuntos
Imageamento por Ressonância Magnética/métodos , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/diagnóstico por imagem , Feminino , Humanos , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/fisiopatologia
17.
Radiol Clin North Am ; 58(2): 305-327, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044009

RESUMO

Reporting MR imaging of pelvic floor dysfunction can be made easy if radiologists understand the aim of each MR sequence and what to report in each set of MR images. For an MR imaging report that is critical in decision making for patient management, it is of paramount importance to the radiologist to know what to look for and where to look for it. This article presents a new term, integrated MR analytical approach. A reporting template is included in which all MR findings are presented in a schematic form that can be easily interpreted by clinicians from different subspecialties.


Assuntos
Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/tendências , Diafragma da Pelve/diagnóstico por imagem , Diafragma da Pelve/fisiopatologia , Distúrbios do Assoalho Pélvico/fisiopatologia
18.
Radiology ; 248(2): 518-30, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18574134

RESUMO

PURPOSE: To prospectively analyze static and dynamic magnetic resonance (MR) images simultaneously to determine whether stress urinary incontinence (SUI), pelvic organ prolapse (POP), and anal incontinence are associated with specific pelvic floor abnormalities. MATERIALS AND METHODS: This study had institutional review board approval, and informed consent was obtained from all participants. There were 59 women: 15 nulliparous study control women (mean age, 25.6 years) and 44 patients (mean age, 43.4 years), who were divided into four groups according to chief symptom. Static T2-weighted turbo spin-echo images were used in evaluating structural derangements; functional dynamic (cine) balanced fast-field echo images were used in detecting functional abnormalities and recording five measurements of supporting structures. Findings on both types of MR images were analyzed together to determine the predominant defect. Analysis of variance and the Bonferroni t test were used to compare groups. RESULTS: In the four patient groups, POP was associated with levator muscle weakness in 16 (47%) of 34 patients, with level I and II fascial defects in seven (21%) of 34 patients, and with both defects in 11 (32%) of 34 patients. SUI was associated with defects of the urethral supporting structures in 25 (86%) of 29 patients but was not associated with bladder neck descent. Levator muscle weakness may lead to anal incontinence in the absence of anal sphincter defects. Measurements of supporting structures were significant (P < .05) in the identification of pelvic floor laxity. CONCLUSION: Combined analysis of static and dynamic MR images of patients with pelvic floor dysfunction allowed identification of certain structural abnormalities with specific dysfunctions.


Assuntos
Imageamento por Ressonância Magnética/métodos , Diafragma da Pelve/fisiopatologia , Adolescente , Adulto , Canal Anal/fisiopatologia , Análise de Variância , Meios de Contraste , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Pessoa de Meia-Idade , Compostos Orgânicos , Estudos Prospectivos , Índice de Gravidade de Doença , Incontinência Urinária por Estresse/fisiopatologia , Prolapso Uterino/fisiopatologia
19.
Anim Nutr ; 4(1): 44-51, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30167483

RESUMO

Typical formulated broiler diets are deficient in n-3 poly-unsaturated fatty acids (PUFA) due to widening n-6:n-3 PUFA ratio which could greatly affect performance, immune system of birds and, more importantly, meat quality. This study was conducted to evaluate the effect of modifying dietary n-6:n-3 PUFA ratio from plant and animal oil sources on performance, behavior, cytokine mRNA expression, antioxidative status and meat fatty acid profile of broiler chickens. Birds (n = 420) were fed 7 diets enriched with different dietary oil sources and ratios as follows: sunflower oil in control diet (C); fish oil (FO); 1:1 ratio of sunflower oil to FO (C1FO1); 3:1 ratio of sunflower oil to fish oil (C3FO1); linseed oil (LO); 1:1 ratio of sunflower oil to linseed oil (C1LO1); 3:1 ratio of sunflower oil to linseed oil (C3LO1), resulting in dietary n-6:n-3 ratios of approximately 40:1, 1.5:1, 4:1, 8:1, 1:1, 2.5:1 and 5:1, respectively. The best final body weight, feed conversion ratio as well as protein efficiency ratio of broilers were recorded in the C1FO1 and C1LO1 groups. Compared with the control group, the dressing percentage and breast and thigh yield were highest in the C1FO1 and C1LO1 groups. Narrowing the dietary n-6:n-3 ratio increased (P < 0.05) n-3 PUFA content of breast meat. Moreover, the breast meat contents of eicosapentaenoic acid and docosahexaenoic acid increased (P < 0.05) with increasing dietary FO whereas α-linolenic acid content was higher with LO supplementation. Also, enriching the diets with n-3 PUFA from FO and LO clearly decreased (P < 0.05) serum total cholesterol, triglycerides and very low-density lipoproteins and enhanced antioxidative status. The feeding frequency was decreased (P < 0.05) in the C1FO1 and C1LO1 groups. Likewise, n-3 PUFA-enriched diets enhanced the frequency of preening, wing flapping and flightiness. Animal oil source addition, compared to plant oil, to broiler diets enhanced the relative mRNA expression of interferon gamma, interleukin-1 beta, interleukin-2 and interleukin-6 genes, especially at low n-6:n-3 ratios. This study has clearly shown that narrowing n-6:n-3 ratio through the addition of FO or LO improved performance and immune response of broilers and resulted in healthy chicken meat, enriched with long chain n-3 PUFA.

20.
AJR Am J Roentgenol ; 189(5): 1145-57, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17954653

RESUMO

OBJECTIVE: There has been no uniformity of opinion concerning the structures supporting the female urethra. Therefore, the aims of this prospective study were to define precisely the female urethral support structures at cadaveric anatomic dissection and histologic examination and to determine which of these structures can be detected on MRI of cadaveric specimens and of healthy volunteers. SUBJECTS AND METHODS: Dissection of seven formalin-preserved cadavers (age at death, 25-50 years; no parity history available) was performed by a professor of anatomy to explore the anatomy of the urethral supporting ligaments and was followed by MRI of the cadaveric specimens with ligamentous markers in place and then by histologic analysis of the dissected ligaments. MRI of 17 healthy nulliparous women (age range, 20-35 years; mean age, 25.5 years) was then performed using T2-weighted, dual turbo spin-echo, balanced fast-field echo, and STIR sequences. A standardized grid system that allowed us to record structural observations on sequentially numbered axial MR images was used by a radiologist who then applied a 4-point grading scale to assess ligament visibility. Three authors--one radiologist, one anatomist, and one urologist--then compared the appearance of each ligament seen in a cadaveric specimen with its appearance on MR images of the same cadaver and on MR images of volunteers. RESULTS: At cadaveric dissection we identified ventral and dorsal urethral ligaments. The ventral urethral ligaments included the pubourethral ligaments, which were found to consist of three separate components coursing anteroposterior from the bladder neck to the pubic bone; the periurethral ligament; and the paraurethral ligaments. Dorsal to the urethra, a slinglike ligament, which we believe should be named the "suburethral ligament," was identified. This ligament had a distinct plane of cleavage from the anterior vaginal wall. The MRI findings in the volunteers correlated with the MRI and gross anatomic findings in the cadavers. The proximal pubourethral, periurethral, paraurethral, and suburethral ligaments had visibility scores of 3 (moderately visible) or 4 (easily visible) on MRI in 47%, 65%, 47%, and 53% of volunteers, respectively. CONCLUSION: Our results present evidence that may help resolve previous controversies regarding the MR appearance of the ventral urethral ligaments and that better define the course of the ligament dorsal to the urethra, the suburethral ligament. We hope that this detailed anatomic information about the structures involved in continence may lead eventually to improvements in the treatments for women with stress urinary incontinence.


Assuntos
Ligamentos/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Uretra/anatomia & histologia , Adulto , Cadáver , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Anatômicos , Paridade , Gravidez , Valores de Referência
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