Macroscopic Anatomy, Histopathology, and Image Diagnosis of Joints and Synovial Cartilages

Joints are physiological connections formed by the association of two or more bones that confer mobility to the skeleton of vertebrates. Composed of several structures, these are often related to pathologies of varied origins, which determine symptomatology of varying degrees of intensity and impairment, responsible for the decrease in life expectancy and the well-being of affected populations. Most of the time, the treatment for these diseases is only symptomatic, aiming at the relief of pain and the return of the patient to daily activities. Thus, there has been an increasing interest in the search for new knowledge about the mechanisms that lead to joint disorders and effective therapeutic resources that may contribute to the fight against pain and to the definitive treatment of joint dysfunctions. To this aim, the knowledge of diagnostic methods, especially imaging methods, is of fundamental importance for the recognition of articular affections, enabling a targeted and effective treatment. Among these auxiliary exams currently used to evaluate the joints, the noninvasive ones are the first choice, where radiography, ultrasonography, magnetic resonance imaging (MRI), computed tomography, and arthroscopy are inserted

Fetal Distress during the Last Third of Pregnancy in Bitches - Evaliation by Doppler Ultrasound Imaging

Background: Diagnostic ultrasound has revolutionized obstetric practice. Doppler techniques provided in vivo studies of the fetus-placental and uterus-placental circulations, in an increasingly precise manner. The assessment of fetal well-being is essential in obstetric practice, however, in veterinary medicine, there is a deficit of ultrasound parameters related to fetal distress. The main of this research was to determine the hemodynamic characteristics and behavior, through Doppler ultrasonography, of maternal-fetal vessels during the final third of gestation in bitches with fetuses under stress, as well as correlating them with each other and with fetal distress. Materials, Methods & Results: An observational, prospective study was carried out, in which 30 healthy bitches were examined, during the last third of pregnancy, with fetuses under fetal distress. Fetuses were evaluated in 2 stages: (1st): 50-54 days and (2nd): 55-60 days of gestation. All fetuses were calmly assessed, one by one, and fetal heart rate (FHR) was measured 5 times, for at least 3 min, to identify and confirm fetal distress. At least 3 fetuses were evaluated in each bitch and each measurement was performed in triplicate, setting a hemodynamic mean for each value evaluated. The flow pattern in the middle cerebral artery (MCA), internal carotid artery (ICA) and umbilical artery (UA) was evaluated. The analyzed vessel was initially visualized in B mode, followed by evaluation by color and spectral Doppler. The variables observed were: peak systolic velocity (PSV), end diastolic velocity (EDV) and the resistivity (RI) and pulsatility (PI) index, as well as the systole/diastole ratio (S/D). The analysis of RI and PI of the umbilical artery showed a statistically significant difference between the mean values ​​found for the times studied, increasing from time 1 to time 2. For middle cerebral and internal carotid arteries, PI, RI and the relationship systole/diastole (S/D), showed a statistically significant difference between the mean values ​​found for the times studied, decreasing from time 1 to time 2. Discussion: Fetal heart rate (HR) findings are considered normal above 200 beats per minute (bpm), only if preceded by acceleration and deceleration. This fact confirms the presence of fetal stress, by this parameter, for the fetuses in the present study. Corroborating the picture of fetal distress, another study concluded that HR tends to increase up to 20 days before delivery, a fact that did not occur in the study in question, where animals in the same gestational period were evaluated. Recent research has concluded that an elevated umbilical artery PI at 28 weeks of gestation, in the absence of fetal growth restriction or prematurity, is associated with some adverse cognitive findings in 12-year-olds children. In the present study, a progressive increase in this index was observed throughout the final third of pregnancy. Although the pups were not monitored after birth, this data serves as a warning for veterinarians, and can be useful in the assessment and diagnosis of possible postnatal nervous alterations. Like what was found in the present study, a study reported that from the 4th week to birth, the PSV of the umbilical artery (UA) increased almost linearly, with high significance. For the middle cerebral arteries, the PI showed a statistically significant difference between the mean values ​​found for the times studied, however, decreasing throughout the final third of pregnancy. Keywords: Imaging diagnosis, obstetrics, reproduction, clinical medicine.Background: A ultrassonografia diagnóstica revolucionou a prática obstétrica. As técnicas de Doppler propiciaram estudos in vivo das circulações feto-placentária e útero-placentária, de forma cada vez mais precisa. A avaliação do bem-estar fetal é fundamental na prática obstétrica, no entanto, em medicina veterinária, observa-se um déficit de parâmetros ultrassonográficos relacionados ao sofrimento fetal. O objetivo deste trabalho é determinar as características hemodinâmicas e o comportamento, por meio de ultrassonografia Doppler, de vasos maternofetais durante o terço final da gestação de cadelas com fetos sob estresse, bem como correlaciona-los entre si e com o sofrimento fetal. Material, Métodos e Resultados: Foi realizado um estudo observacional, prospectivo, onde foram examinadas 30 cadelas saudáveis, durante o último terço de gestação, com fetos sob estresse fetal. Os fetos foram avaliados em dois tempos: (1º): 50-54 dias e (2º): 55-60 dias de gestação. Todos os fetos foram avaliados com calma, um a um, e a frequência cardíaca fetal (FCF) foi mensurada cinco vezes, por pelo menos três minutos, para identificação e confirmação do estresse fetal. Parte superior do formulárioForam avaliados pelo menos três fetos em cada cadela e cada mensuração foi realizada em triplicata, configurando uma média hemodinâmica para cada valor avaliado. Avaliou-se o padrão de fluxo em artéria cerebral média (ACM), artéria carótida comum (ACC) e cordão umbilical (CU). O vaso analisado foi inicialmente visualizado em modo B, seguindo-se com a avaliação por Doppler colorido e espectral. As variáveis observadas foram: velocidade de pico sistólico (VPS), velocidade diastólica final (VDF) e os índices de resistividade (IR) e de pulsatilidade (IP), bem como a relação sístole / diástole (S/D). A análise do IR e IP do cordão umbilical, demonstrou diferença estatística significativa entre os valores médios encontrados para os tempos estudados, aumentando do tempo 1 para o tempo 2. Para as artérias cerebral média e carótida comum, o IP, o IR e a relação sístole / diástole (S/D), demonstraram diferença estatística significativa entre os valores médios encontrados para os tempos estudados, diminuindo do tempo 1 para o tempo 2. Discussão: Achados de frequência cardíaca fetal (FCF) são considerados normais acima de 200 batimentos por minuto (bpm), apenas se precedida de aceleração e desaceleração. Tal fato confirma a presença de estresse fetal, por este parâmetro, para os fetos do presente estudo. Corroborando o quadro de sofrimento fetal, outro estudo concluiu que a FCF tende a aumentar até 20 dias antes do parto, fato este que não ocorreu no trabalho em questão, onde foram avaliados animais no mesmo período gestacional. Recente pesquisa concluiu que um IP da artéria umbilical elevado na gestação de 28 semanas, na ausência de restrição do crescimento fetal ou prematuridade, está associado a alguns achados cognitivos adversos em crianças de 12 anos. No presente estudo, observou-se um aumento progressivo deste índice ao longo do terço final de gestação. Apesar de não ter sido realizado o acompanhamento dos filhotes após o nascimento, este dado serve como alerta para médicos veterinários, e pode ser útil na avaliação e diagnóstico de possíveis alterações nervosas pós-natal. Semelhante ao encontrado no presente estudo, um trabalho relatou que da quarta semana ao nascimento, a VPS da artéria umbilical (AU) aumentou quase linearmente, com significância elevada. Para as artérias cerebral média, o IP demonstrou diferença estatística significativa entre os valores médios encontrados para os tempos estudados, no entanto, diminuindo ao longo do terço final de gestação

DO CHANGES IN ANAL SPHINCTER ANATOMY CORRELATE WITH ANAL FUNCTION IN WOMEN WITH A HISTORY OF VAGINAL DELIVERY?

Objectives To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Methods Female with fecal incontinence and vaginal delivery were assessed with Wexner’s score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Results Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Conclusions Avaliar a anatomia do esfíncter anal usando ultra-sonografia tridimensional (3D-US) em mulheres incontinentes com parto vaginal, correlacionar os achados anatômicos com sintomas de incontinência fecal e, determinar o efeito do parto vaginal sobre a anatomia e função do canal anal

Clinical, functional and morphologic evaluation of patients undergoing lateral sphincterotomy for chronic anal fissure treatment. Identification of factors that can interfere with fecal continence

Objective: Evaluate clinical, functional and morphologic outcomes of lateral sphincterotomy for chronic anal fissure treatment, and correlate the findings with factors that influence in the anal continence. Method: In a prospective study, female patients treated by lateral sphincterotomy for chronic anal fissure were assessed using Wexner's incontinence score and grouped according to score: group I (score = 0) and group 2 (score ≥1) and evaluated with anal manometry and anorectal 3D ultrasonography. Results: Thirty-six womens were included, 33% had vaginal delivery. Seventeen patients were included in group I and 19 in group II. We found no difference in age, parity and mode of delivery between groups. A significant difference with respect to percentage reduction in resting pressures was noted, when comparing group 1 versus group 2. The anal sphincter muscle length was similar in both groups. However, the length and percentage of transected internal anal sphincter was significantly greater in group II. Conclusion: There was a correlation between fecal incontinence symptoms after sphincterotomy with the percentage of resting pressure reduction, length and percentage of transected internal anal sphincter. Resumo: Objetivo: Avaliar os resultados clínicos, funcionais e morfológicos de pacientes submetidas à esfincterotomia para tratamento de fissura anal, correlacionando os resultados com os fatores que podem interferir com a continência fecal. Método: Foram avaliadas prospectivamente pacientes do sexo feminino submetidas à esfincterotomia lateral interna devido à presença de fissura anal crônica utilizando o escore de incontinência de Wexner e distribuídas em dois grupos. Grupo 1 – Escore igual a zero e Grupo 2 – maior ou igual a 1. As pacientes foram submetidas à avaliação funcional e anatômica do canal anal utilizando manometria anorretal e ultrassonografia tridimensional anorretal. Resultados: Das 36 pacientes incluídas, 33% tinham história de parto vaginal. Dezessete pacientes foram incluídas no Grupo 1 e 19 no Grupo 2. Não houve diferença quanto à idade, paridade e tipo de parto entre grupos. Houve diferença significante em relação ao percentual de redução na pressão de repouso quando comparado o grupo 1 com grupo 2. Não houve diferença no comprimento da musculatura esfincteriana entre grupos. No entanto, o comprimento e o percentual de esfíncter anal interno seccionado foram significativamente maiores no grupo 2. Conclusão: Há correlação entre os sintomas de incontinência fecal pós esfincterotomia com o percentual de redução das pressões de repouso, tamanho e percentual do esfíncter anal interno seccionado. Keywords: Chronic anal fissure, Lateral internal sphincterotomy, Anorectal manometry, Anorectal three-dimensional ultrasound, Palavras-chave: Fissura anal crônica, Esfincterotomia lateral interna, Manometria anorretal, Ultrassonografia anorretal tridimensiona

Anatomical and functional characteristics of the pelvic floor in nulliparous women submitted to three-dimensional endovaginal ultrasonography: case control study and evaluation of interobserver agreement Características anatômicas e funcionais do assoalho pélvico em nulíparas avaliadas por ultrassonografia tridimensional endovaginal: estudo caso-controle e avaliação da confiabilidade interobservador

PURPOSE: To determine anatomical and functional pelvic floor measurements performed with three-dimensional (3-D) endovaginal ultrasonography in asymptomatic nulliparous women without dysfunctions detected in previous dynamic 3-D anorectal ultrasonography (echo defecography) and to demonstrate the interobserver reliability of these measurements. METHODS: Asymptomatic nulliparous volunteers were submitted to echo defecography to identify dynamic dysfunctions, including anatomical (rectocele, intussusceptions, entero/sigmoidocele and perineal descent) and functional changes (non-relaxation or paradoxical contraction of the puborectalis muscle) in the posterior compartment and assessed with regard to the biometric index of levator hiatus, pubovisceral muscle thickness, urethral length, anorectal angle, anorectal junction position and bladder neck position with the 3-D endovaginal ultrasonography. All measurements were compared at rest and during the Valsalva maneuver, and perineal and bladder neck descent was determined. The level of interobserver agreement was evaluated for all measurements. RESULTS: A total of 34 volunteers were assessed by echo defecography and by 3-D endovaginal ultrasonography. Out of these, 20 subjects met the inclusion criteria. The 14 excluded subjects were found to have posterior dynamic dysfunctions. During the Valsalva maneuver, the hiatal area was significantly larger, the urethra was significantly shorter and the anorectal angle was greater. Measurements at rest and during the Valsalva maneuver differed significantly with regard to anorectal junction and bladder neck position. The mean values for normal perineal descent and bladder neck descent were 0.6 cm and 0.5 cm above the symphysis pubis, respectively. The intraclass correlation coefficient ranged from 0.62-0.93. CONCLUSIONS: Functional biometric indexes, normal perineal descent and bladder neck descent values were determined for young asymptomatic nulliparous women with the 3-D endovaginal ultrasonography. The method was found to be reliable to measure pelvic floor structures at rest and during Valsalva, and might therefore be suitable for identifying dysfunctions in symptomatic patients.OBJETIVO: Avaliar as medidas anatômicas e funcionais do assoalho pélvico utilizando a ultrassonografia tridimensional transvaginal em nulíparas assintomáticas sem disfunções do compartimento posterior evidenciado pela ecodefecografia. Demonstrar o grau de concordância entre observadores do método utilizado para medir as estruturas anatômicas. MÉTODOS: Voluntárias nulíparas assintomáticas foram submetidas à ecodefecografia para identificar alterações dinâmicas no compartimento posterior, incluindo aquelas anatômicas (retocele, intussuscepção, entero/sigmoidocele e descenso perineal) e funcionais (ausência de relaxamento ou contração paradoxal do puborretal) e avaliadas com ultrassonografia tridimensional transvaginal para determinar índices biométricos do hiato dos elevadores do ânus, espessura do músculo pubovisceral, comprimento da uretra, ângulo anorretal, posição da junção anorretal e posição do colo vesical. Todas as medidas foram comparadas em repouso e durante Valsalva; e determinado descenso perineal e do colo da bexiga. A variabilidade interobservador foi avaliada utilizando o coeficiente de correlação intraclasse. RESULTADOS: Foram avaliadas 34 voluntárias com a ecodefecografia e a ultrassonografia tridimensional transvaginal. Dessas, 20 foram incluídas no estudo. As 14 excluídas apresentavam alterações dinâmicas no compartimento posterior. Durante a manobra de Valsalva, a área hiatal foi significativamente maior. A uretra foi significantemente mais curta e o ângulo anorretal foi maior. Medidas em repouso e durante a Valsalva diferiram significativamente em relação à posição da junção anorretal e do colo vesical. A média de valor do descenso perineal e do descenso da bexiga foram de 0,6 cm e 0,5 cm acima da sínfise púbica, respectivamente. O coeficiente de correlação intraclasse variou entre 0,62-0,93. CONCLUSÕES: Foram determinados valores normais para os índices biométricos funcionais, descida perineal e colo vesical em nulíparas assintomáticas utilizando-se a ultrassonografia transvaginal tridimensional. É um método seguro para mensurar a anatomia do assoalho pélvico durante o repouso e a manobra de Valsalva, e pode ser adequado para a identificação de disfunções em pacientes sintomáticos