[Ano-rectal abnormalities].

BACKGROUND: Anatomic anal sphincter defects can involve the internal anal sphincter (IAS), the external anal sphincter (EAS), or both muscles. Surgical repair of anteriorly located EAS defects consists of overlapping suture of the EAS or EAS imbrication; IAS imbrication can be added regardless of whether there is IAS injury. The aim of this study was to assess the functional outcome of anal sphincter repair in patients intraoperatively diagnosed with combined EAS/IAS defects compared to patients with isolated EAS defects. METHODS: The medical records of patients who underwent anal sphincter repair between 1988 and 2000 and had follow-up of at least 3 months were retrospectively assessed. Fecal incontinence was assessed using the Cleveland Clinic Florida incontinence score wherein 0 equals perfect continence and 20 is associated with complete incontinence. Postoperative scores of 0-10 were interpreted as success whereas scores of 11-20 indicated failure. RESULTS: A total of 131 women were included in this study, including 38 with combined EAS/IAS defects (Group I) and 93 with isolated EAS defects (Group II). Thirty-three patients (87%) in Group I had imbrication of a deficient IAS, compared to 83 patients (89%) in Group II. All patients had either overlapping EAS repair (n=121) or EAS imbrication (n=10). Mean follow-up was 30.9 months (range, 3-131 months). There were no statistically significant differences between the two groups relative to age (48.3 vs. 53.0 years; p=0.14), preoperative incontinence score (16.1 vs. 16.7; p=0.38), extent of pudendal nerve terminal motor latency pathology (left, 11.1% vs. 8%; p=0.58; right, 8.6% vs. 15.1%; p=0.84), extent of pathology at electromyography (54.8% vs. 60.1%; p=0.43), and length of follow-up (26.9 vs. 32.5 months; p=0.31). The success rates of sphincter repair were 68.4% for Group I versus 55.9% for Group II (p=NS). Both groups were well matched for incidence of IAS imbrication as well as age, follow-up interval, and physiologic parameters. The success rates of anal sphincter repair were not statistically significant between the two groups. CONCLUSION: A pre-existing IAS defect does not preclude successful sphincteroplasty as compared to repair of an isolated EAS defect. Thus, patients with combined anal sphincter defects should not be considered as poor candidates for sphincter repair.

Anal Canal↗

PubMed2006

Distribution of enterobiasis among nursery school children in SE Estonia and of other helminthiases in Estonia.

The occurrence of helminthiases in Estonia was under extensive observation from 1956 until 1989. Enterobiasis had remained the most prevalent helminthiasis in Estonia in the 1990s. After 1990, the number of helminthological studies decreased. This study was conducted to investigate the occurrence and possible risk factors of enterobiasis among nursery school children in Southeast Estonia. A total of 954 nursery school children were examined from 22 nursery schools in Tartu and Põlva counties in Estonia. Enterobius vermicularis infection was detected using the anal swab technique. The parents of tested children were asked to complete questionnaires so as to ascertain the potential risk factors in children's homes and in their families. The overall rate of being positive for E. vermicularis egg was 24.4%. The occurrence of enterobiasis among the examined nursery schools ranged from 11.8 to 46.2% and from 0 to 61.1% in nursery school groups. All nursery schools were infected. Children 5-8 years of age showed a significantly higher rate of being positive for E. vermicularis egg than the younger children. The overall infection rate was higher among boys and among children from larger families. The infection rate was related to washing of hands after closet use. The socioeconomic status of the family was not associated with the frequency of enterobiasis.

Anal Canal↗