RESUMEN
BACKGROUND: Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries, as well as voiding dysfunction. It is important to develop the retroperitoneal avascular space based on precise anatomical landmarks to minimize the risk of ureteral, rectal, and hypogastric nerve injuries. We herein report the anatomical highlights and standardized and reproducible surgical steps of total laparoscopic hysterectomy for posterior cul-de-sac obliteration. OPERATIVE TECHNIQUE: We approach the patient with posterior cul-de-sac obliteration using the following five steps. Step 1: Preparation (Mobilization of the sigmoid colon and bladder separation from the uterus). Step 2: Development of the lateral pararectal space and identification of the ureter. Step 3: Isolation of the ureter. Step 4: Development of the medial pararectal space and separation of the hypogastric nerve plane. Step 5: Reopening of the pouch of Douglas. CONCLUSION: Surgeons should recognize the importance of developing the retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible.
Asunto(s)
Puntos Anatómicos de Referencia , Fondo de Saco Recto-Uterino , Endometriosis , Histerectomía , Laparoscopía , Humanos , Femenino , Laparoscopía/métodos , Histerectomía/métodos , Endometriosis/cirugía , Fondo de Saco Recto-Uterino/cirugía , Espacio Retroperitoneal/cirugía , Adherencias Tisulares/prevención & control , Uréter/cirugía , Uréter/anatomía & histologíaRESUMEN
Sex hormones are believed to be a risk factor for periodontitis because of their ability to proliferate specific periodontal microorganisms and affect host immunologic response. In this case report, gingival redness and swelling occurred during the menstrual cycle, although the patient maintained good oral hygiene during periodontal treatment. Medical history revealed that exacerbation of gingival inflammation corresponded to the menstrual cycle and occurred during the ovulation period, when estrogen levels are high. Mean bleeding index of the ovulation period (18.9%) showed higher levels than that during the menstrual phase (5.3%). This case indicates that frequent and effective maintenance should be provided while considering the influence of the menstrual cycle, as sex hormones may be involved in exacerbating gingival inflammation.
Asunto(s)
Gingivitis/fisiopatología , Ciclo Menstrual/fisiología , Adulto , Estrógenos/fisiología , Femenino , Hemorragia Gingival/fisiopatología , Humanos , Higiene Bucal , Ovulación/fisiología , Índice PeriodontalRESUMEN
This study was designed to clarify the mechanisms of the hypocholesterolemic action of Spirulina platensis concentrate (SPC) and identify the novel hypocholesterolemic protein derived from SPC. We investigated the effects of casein or SPC on the solubility of cholesterol, taurocholate binding capacity in vitro, cholesterol absorption in Caco-2 cells, and cholesterol metabolism in rats for 10 d. We also evaluated the effects of SPC, C-phycocyanin (PHY), and PHY residue on cholesterol metabolism in rats fed a high-cholesterol diet for 5 d, and SPC or SPC-acetone extract for 10 d. SPC had a significantly greater bile acid-binding capacity than casein in vitro. Micellar cholesterol solubility and cholesterol uptake by Caco-2 cells was significantly lower in the presence of SPC compared with casein. Fecal excretion of cholesterol and bile acids was significantly greater in rats fed the SPC-supplemented diet than in those fed the casein control diet. Serum and liver cholesterol concentrations were significantly lower in rats fed SPC than in those fed casein. Thus, the hypocholesterolemic action of SPC may involve the inhibition of both jejunal cholesterol absorption and ileal bile acid reabsorption. Although no studies to date have found a hypocholesterolemic protein among the algal proteins, we report here the discovery of a hypocholesterolemic effect in the novel protein C-phycocyanin. This study provides the first direct evidence that PHY, a novel hypocholesterolemic protein derived from Spirulina platensis, can powerfully influence serum cholesterol concentrations and impart a stronger hypocholesterolemic activity than SPC in animals.