RESUMEN
BACKGROUND: Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures. OBJECTIVE: The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor. DESIGN: This was a prospective study. SETTING: The study was conducted at a large university tertiary care hospital. PATIENTS: Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale. INTERVENTIONS: Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction. MAIN OUTCOME MEASURES: Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm. RESULTS: Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1-1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0-2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus). LIMITATIONS: The study did not include a control group without symptoms. CONCLUSIONS: Three-dimensional endovaginal ultrasonography is a reliable technique for assessment of perineal descent. Using this technique, excessive perineal descent can be defined as displacement of the anorectal junction >1 cm and/or its position below the symphysis pubis on Valsalva maneuver.
Asunto(s)
Estreñimiento , Incontinencia Fecal , Diafragma Pélvico , Rectocele , Anciano , Estreñimiento/diagnóstico , Estreñimiento/etiología , Estreñimiento/fisiopatología , Defecografía/métodos , Incontinencia Fecal/diagnóstico , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Femenino , Humanos , Imagenología Tridimensional/métodos , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Diafragma Pélvico/diagnóstico por imagen , Diafragma Pélvico/patología , Diafragma Pélvico/fisiopatología , Perineo/diagnóstico por imagen , Perineo/fisiopatología , Rectocele/complicaciones , Rectocele/diagnóstico , Rectocele/fisiopatología , Estadística como Asunto , Ultrasonografía/métodosRESUMEN
CONTEXT: Non-alcoholic fatty liver disease is characterized by lipid deposits in the hepatocytes and has been associated with obesity, dyslipidemia and type-2 diabetes. It is considered a hepatic manifestation of the metabolic syndrome, of which the main component is insulin resistance leading to hyperinsulinemia and increased production of inflammatory cytokines. Saturated fat promotes hypertriglyceridemia and hyperinsulinemia, reduces levels of high-density cholesterol and increases levels of low-density cholesterol, while polyunsaturated fat is associated with hypolipidemic, antiinflammatory and imunoregulating action. OBJECTIVE: To evaluate the hepatic and biochemical repercussions of a polyunsaturated fat-rich diet in Wistar rats. METHODS: Twenty-two rats were distributed equally in two groups: GI - standard diet (Biobase Bio-tec Ratos e Camundongos®) providing 3.000 kcal/kg and GII - hypercaloric and hyperlipidic diet providing 4.250 kcal/kg (ω-6:ω-3 = 3:1). The animals were euthanized after 23 weeks of experiment. The weight, biochemical parameters and hepatohistological changes were registered. RESULTS: Findings were submitted to variance analysis with the level of statistical significance at 5%. The average weight did not differ significantly between the groups at baseline (P = 0.711), but was greater in Group II by the end of the experiment (P = 0.000). The levels of triglycerides (P = 0.039), total cholesterol (P = 0.015) and HDL (P = 0.005) were higher in Group I than in Group II. Macrovesicular steatosis was significantly more common in Group II than in Group I (P = 0.03). CONCLUSION: Hypercaloric and hyperlipidic diet rich in polyunsaturated fat promotes weight gain and favors the development of hepatic steatosis while reducing serum levels of triglycerides, total cholesterol and HDL.
Asunto(s)
Grasas Insaturadas en la Dieta/efectos adversos , Ácidos Grasos Insaturados/efectos adversos , Hígado Graso/etiología , Obesidad/etiología , Animales , Grasas Insaturadas en la Dieta/administración & dosificación , Grasas Insaturadas en la Dieta/sangre , Ácidos Grasos Insaturados/administración & dosificación , Ácidos Grasos Insaturados/sangre , Hígado Graso/patología , Masculino , Ratas , Ratas Wistar , Índice de Severidad de la EnfermedadRESUMEN
CONTEXT: Non-alcoholic fatty liver disease is characterized by lipid deposits in the hepatocytes and has been associated with obesity, dyslipidemia and type-2 diabetes. It is considered a hepatic manifestation of the metabolic syndrome, of which the main component is insulin resistance leading to hyperinsulinemia and increased production of inflammatory cytokines. Saturated fat promotes hypertriglyceridemia and hyperinsulinemia, reduces levels of high-density cholesterol and increases levels of low-density cholesterol, while polyunsaturated fat is associated with hypolipidemic, antiinflammatory and imunoregulating action. OBJECTIVE: To evaluate the hepatic and biochemical repercussions of a polyunsaturated fat-rich diet in Wistar rats. METHODS: Twenty-two rats were distributed equally in two groups: GI - standard diet (Biobase Bio-tec Ratos e Camundongos®) providing 3.000 kcal/kg and GII - hypercaloric and hyperlipidic diet providing 4.250 kcal/kg (ω-6:ω-3 = 3:1). The animals were euthanized after 23 weeks of experiment. The weight, biochemical parameters and hepatohistological changes were registered. RESULTS: Findings were submitted to variance analysis with the level of statistical significance at 5 percent. The average weight did not differ significantly between the groups at baseline (P = 0.711), but was greater in Group II by the end of the experiment (P = 0.000). The levels of triglycerides (P = 0.039), total cholesterol (P = 0.015) and HDL (P = 0.005) were higher in Group I than in Group II. Macrovesicular steatosis was significantly more common in Group II than in Group I (P = 0.03). CONCLUSION: Hypercaloric and hyperlipidic diet rich in polyunsaturated fat promotes weight gain and favors the development of hepatic steatosis while reducing serum levels of triglycerides, total cholesterol and HDL.
CONTEXTO: A doença hepática gordurosa não-alcoólica caracteriza-se por depósito de lipídios nos hepatócitos. Desperta grande interesse por sua associação com obesidade, dislipidemias e diabetes mellitus tipo 2. É considerada a manifestação hepática da síndrome metabólica, cujo principal componente é a resistência à insulina, com consequente hiperinsulinemia e produção aumentada de citocinas inflamatórias. Dietas ricas em gorduras saturadas promovem hipertrigliceridemia, diminuição do colesterol de alta densidade, aumento do colesterol de baixa densidade e hiperinsulinemia, enquanto dietas ricas em gordura poliinsaturada podem apresentar efeitos hipolipidêmicos, antiinflamatórios e imunorreguladores. OBJETIVO: Investigar as repercussões hepáticas e bioquímicas da dieta rica em gordura poliinsaturada em ratos Wistar. MÉTODOS: Os animais (22) foram distribuidos nos grupos GI-dieta padrao (Biobase Bio-tec Ratos e Camundongos®) com 3000 kcal/kg e GII-dieta hipercalorica e hiperlipidica, com 4250 kcal/kg, relação ω-6: ω-3 = 3:1. Foram mortos apos 23 semanas de administração das dietas. Avaliaram-se peso, exames bioquimicos e alteracoes histológicas do fígado. RESULTADOS: Foram utilizados testes de análise de variância com nível de significância de 5 por cento (P<0,05). Não houve diferença significante na média de peso entre os grupos (P = 0,711) no início, entretanto GII apresentou maior média que GI ao final do experimento (P = 0,000). GI mostrou níveis significantemente mais elevados de triglicerídeos (P = 0,03), colesterol total (P = 0,039) e HDL (P = 0,015) do que GII. O GII apresentou maior média de esteatose macrovesicular do que GI (P = 0,005). CONCLUSÃO: A dieta hipercalórica e hiperlipídica, rica em gordura poliinsaturada, promove esteatose hepática e incremento de peso, contudo reduz os níveis séricos de triglicerídeos, colesterol total e HDL.