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1.
J Anus Rectum Colon ; 7(2): 135-138, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37113580

RESUMO

In our previous report, we have noted an increase of computed tomography (CT) attenuation values in perirectal fat tissue after Gant-Miwa-Thiersch (GMT) procedure for rectal prolapse. Based on these results, we hypothesized that the GMT procedure may have a rectal fixation effect due to inflammatory adhesions extending to the mesorectum. Herein, we report a case of laparoscopic observation of perirectal inflammation after GMT. A 79-year-old woman with a history of seizures, stroke, subarachnoid hemorrhage, and spondylosis underwent the GMT procedure under general anesthesia in the lithotomy position for rectal prolapse measuring 10 cm in length. But rectal prolapse recurred 3 weeks after surgery. Therefore, an additional Thiersch procedure was performed. However, rectal prolapse still recurred, and laparoscopic suture rectopexy was performed 17 weeks after initial surgery. During rectal mobilization, marked edema and rough membranous adhesions were observed in the retrorectal space. The average CT attenuation value obtained 13 weeks after initial surgery was found to be significantly elevated in the mesorectum compared with the subcutaneous fat, especially in the posterior side (P < 0.05). These findings suggest that the extension of inflammation to the rectal mesentery after the GMT procedure may have strengthened adhesions in the retrorectal space.

2.
Tomography ; 9(1): 285-298, 2023 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-36828375

RESUMO

The loss of resistance (LOR) method has been used exclusively to identify epidural space. It is difficult to find the epidural space without the risk of dural puncture. Various devices have been developed to improve the accuracy of the LOR method; however, no method has overcome the problems completely. Therefore, we devised a ligamentum flavum rupture method (LFRM) in which the needle tip is placed only on the ligamentum flavum during the epidural injection, and the injection pressure is used to rupture the ligamentum flavum and spread the drug into the epidural space. We confirmed the accuracy of this method using ultrasound with superb microvascular imaging (SMI) to visualize the epidural space. Here, we report two cases of 63-year-old and 90-year-old males. The 63-year-old patient presented with severe pain in his right buttock that extended to the posterior lower leg. The 90-year-old patient presented with intermittent claudication every 10 min. LFRM was performed, and SMI was used to confirm that the parenteral solution had spread into the epidural space. Our results indicate that LFRM can be used for interlaminar lumbar epidural steroid injections.


Assuntos
Ligamento Amarelo , Masculino , Humanos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Ligamento Amarelo/diagnóstico por imagem , Injeções Epidurais/métodos , Espaço Epidural/diagnóstico por imagem , Ultrassonografia , Agulhas
3.
J Ultrasound Med ; 42(1): 239-246, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35420732

RESUMO

Cervical disc degeneration commonly results in referred neck pain, which is traditionally diagnosed via fluoroscopy-guided provocative discography. Herein, we discuss three cases of neck and shoulder pain treated with cervical intradiscal injections administered under ultrasound (US) guidance. The most painful intervertebral disc was identified using the sonopalpation technique, which involved palpation while visualizing anatomical structures using US. Injectant spread within the intervertebral disc was validated using superb microvascular imaging rather than fluoroscopy. Symptoms significantly improved following blocks at the identified sites, suggesting that US can be used to guide cervical intradiscal injections even in the examination room.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Disco Intervertebral , Humanos , Disco Intervertebral/diagnóstico por imagem , Fluoroscopia , Ultrassonografia de Intervenção
4.
Tomography ; 8(4): 1869-1880, 2022 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-35894022

RESUMO

In this case series, we describe a novel ultrasound (US)-guided cervical interlaminar epidural steroid injections (CILESIs) procedure that does not depend on the loss-of-resistance method for epidural space identification. A needle is introduced into three US-identified structures (triple bar sign), the interspinal ligament, ligamentum flavum, and dura mater. The injectants are monitored using superb microvascular imaging during injection. Here, we demonstrate the use of US-guided CILESIs in nine cases and propose the use of sonography, rather than conventional methods, for easier and safer cervical epidural injections. Sonography for direct visualization of cervical epidural injection may allow for outpatient injections.


Assuntos
Vértebras Cervicais , Espaço Epidural , Vértebras Cervicais/diagnóstico por imagem , Espaço Epidural/diagnóstico por imagem , Fluoroscopia/métodos , Injeções Epidurais/métodos , Estudos Retrospectivos
5.
J Ultrasound Med ; 41(7): 1825-1835, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34676569

RESUMO

Sonography is conventionally used to diagnose fractures by identifying cortical discontinuity in the bone. However, its usefulness for diagnosing lumbar transverse process fractures (LTPFs) remains unknown. In this series, we describe static and stress sonography findings during manual application of compression stress on the lateral lumbar vertebrae in 17 patients with LTPFs. Features of LTPFs on static sonography included cortical discontinuity (89.3%), hematoma (71.4%), step-off deformity (67.9%), and focal reverberation echo (78.6%). All LTPFs were confirmed on stress sonography. Thus, stress sonography should be considered for the detection of LTPFs when there is at least one static sonographic fracture sign.


Assuntos
Fraturas Ósseas , Vértebras Lombares , Hematoma , Humanos , Vértebras Lombares/diagnóstico por imagem , Ultrassonografia
6.
J Ultrasound Med ; 36(2): 421-432, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28072472

RESUMO

In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Fratura Avulsão/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ultrassonografia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino
7.
Biochem Biophys Res Commun ; 435(4): 592-6, 2013 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-23684621

RESUMO

Small intestinal epithelial cells (sIECs) express major histocompatibility complex class II molecules even in a normal condition, and are known to function as antigen presenting cells (APCs) at least in vitro. These findings raised the possibility that sIECs play an important role in inducing immune responses against luminal antigens, especially those of intestinal intraepithelial lymphocytes (IELs) and lamina propria lymphocytes (LPLs). We herein showed that antigenic stimulation with sIECs induced markedly greater secretion of interferon-gamma (IFN-γ) by CD4(+) IELs, but not interleukin (IL)-4, IL-10 and IL-17 although the proliferative response was prominently lower than that with T cell-depleted splenic APCs. In contrast, no enhanced IFN-γ secretion by CD4(+) LPLs and primed splenic CD4(+) T cells was observed when stimulated with sIECs. Taken together, these results suggest that sIECs uniquely activate CD4(+) IELs and induce remarkable IFN-γ secretion upon antigenic stimulation in vivo.


Assuntos
Apresentação de Antígeno/imunologia , Linfócitos T CD4-Positivos/imunologia , Células Epiteliais/imunologia , Interferon gama/imunologia , Interleucinas/imunologia , Mucosa Intestinal/imunologia , Intestino Delgado/imunologia , Animais , Células Cultivadas , Células Epiteliais/citologia , Feminino , Mucosa Intestinal/citologia , Intestino Delgado/citologia , Camundongos , Camundongos Endogâmicos BALB C
8.
Gene Expr Patterns ; 5(5): 593-600, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15907457

RESUMO

All four mammalian fasciclin-containing genes are expressed in the adult valves and are localized in partially overlapping and reciprocal patterns during cardiovascular development. Spatiotemporal comparison of the fasciclin-containing secreted adhesion genes, TGFbeta induced clone H3 (betaigH3) and periostin, revealed that they are co-localized within the outflow tract endocardial cushions, but that betaigH3 expression is restricted to the septal cushions within the atrioventricular canal. Conversely, the fasciclin-containing transmembrane gene, stabilin-1, is predominately expressed in the endocardial layer overlaying the cushions and lining the developing heart. However, expression of the fasciclin-containing transmembrane gene, stabilin-2 is only present in the post-natal mature valve endothelial cells. These data illustrate for the first time that the primitive endocardial cushions dynamically express multiple fasciclin-containing adhesion molecules as they undergo the key steps of seeding, proliferation, differentiation, fusion, mesenchymal condensation and remodeling during mouse heart development.


Assuntos
Moléculas de Adesão Celular Neuronais/biossíntese , Moléculas de Adesão Celular/biossíntese , Proteínas da Matriz Extracelular/biossíntese , Regulação da Expressão Gênica no Desenvolvimento , Septos Cardíacos/embriologia , Valvas Cardíacas/embriologia , Fator de Crescimento Transformador beta/biossíntese , Animais , Northern Blotting , Adesão Celular , Moléculas de Adesão Celular/genética , Moléculas de Adesão Celular/metabolismo , Moléculas de Adesão Celular Neuronais/genética , DNA Complementar/metabolismo , Proteínas da Matriz Extracelular/genética , Valvas Cardíacas/patologia , Imuno-Histoquímica , Hibridização In Situ , Camundongos , Miocárdio/metabolismo , Filogenia , Estrutura Terciária de Proteína , Fatores de Tempo , Fator de Crescimento Transformador beta/genética
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