Prevalence and risk factors for anal human papillomavirus infection in human immunodeficiency virus (HIV)-positive and high-risk HIV-negative women.
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Little is known about the epidemiology of anal human papillomavirus (HPV) infection in women. We studied 251 human immunodeficiency virus (HIV)-positive and 68 HIV-negative women for the presence of anal HPV by use of polymerase chain reaction (PCR) and hybrid capture. Medical and behavioral risk factors were evaluated; 76% of HIV-positive and 42% of HIV-negative women were found to have anal HPV DNA via analysis by PCR (relative risk [RR], 1.8; 95% confidence interval [CI], 1.3-2.5). Among 200 women for whom there were concurrent anal and cervical HPV data, anal HPV was more common than cervical HPV in both HIV-positive (79% vs. 53%) and HIV-negative women (43% vs. 24%). By multivariate analysis of HIV-positive women, CD4(+) cell counts 500 cells/mm(3) (RR, 1.4; 95% CI, 1.1-1.5), and cervical HPV infection (RR, 1.3; 95% CI, 1.1-1.4) were associated with anal HPV infection. Women >45 years old had reduced risk, compared with women <36 years old (RR, 0.80; 95% CI, 0.50-0.99), as did African American women (RR, 0.86; 95% CI, 0.72-1.0), compared with white women. Anal HPV infection is underrecognized in HIV-positive and high-risk HIV-negative women. (+info)
A novel bacterial pathogen, Microbacterium nematophilum, induces morphological change in the nematode C. elegans.
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The Dar (deformed anal region) phenotype, characterized by a distinctive swollen tail, was first detected in a variant strain of Caenorhabditis elegans which appeared spontaneously in 1986 during routine genetic crosses [1,2]. Dar isolates were initially analysed as morphological mutants, but we report here that two independent isolates carry an unusual bacterial infection different from those previously described [3], which is the cause of the Dar phenotype. The infectious agent is a new species of coryneform bacterium, named Microbacterium nematophilum n. sp., which fortuitously contaminated cultures of C. elegans. The bacteria adhere to the rectal and post-anal cuticle of susceptible nematodes, and induce substantial local swelling of the underlying hypodermal tissue. The swelling leads to constipation and slowed growth in the infected worms, but the infection is otherwise non-lethal. Certain mutants of C. elegans with altered surface antigenicity are resistant to infection. The induced deformation appears to be part of a survival strategy for the bacteria, as C. elegans are potentially their predators. (+info)
A study of the cortical processing of ano-rectal sensation using functional MRI.
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Investigation of human ano-rectal physiology has concentrated largely on understanding the motor control of defecation and continence mechanisms. However, little is known of the physiology of ano-rectal sensation. There are important differences in the afferent innervation and sensory perception between the rectum and anal canal. This suggests that there could also be differences in the brain's processing of sensation from these two areas; however, this possibility remains unexplored. The aim of our study was to identify the cerebral areas processing anal (somatic) and rectal (visceral) sensation in healthy adults, using functional MRI. Eight male subjects with an age range of 21-39 years were studied on two separate occasions, one for rectal and the other for anal stimulation studies. Single shot gradient echo planar imaging was performed using a 1.5 tesla Phillips MRI scanner. For each subject, a series of 40 image sets containing 24 slices of the brain was obtained during periods of rapid phasic non-painful distension of the rectum or anal canal, alternating with rest periods, without stimulation. After motion correction, the images were analysed using cross correlation to identify the cerebral areas activated by the stimulus. Rectal stimulation resulted in bilateral activation of the inferior primary somatosensory, secondary somatosensory, sensory association, insular, peri-orbital, anterior cingulate and prefrontal cortices. Anal canal stimulation resulted in activation of areas similar to rectal stimulation, but the primary somatosensory cortex was activated at a more superior level, and there was no anterior cingulate activation. In conclusion, anal and rectal sensation resulted in a similar pattern of cortical activation, including areas involved with spatial discrimination, attention and affect. The differences in sensory perception from these two regions can be explained by their different representation in the primary somatosensory cortex. The anterior cingulate cortex was only activated by rectal stimulation, suggesting that the viscera have a greater representation on the limbic cortex than somatic structures, and this explains the greater autonomic responses evoked by visceral sensation in comparison with somatic sensation. (+info)
Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence.
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INTRODUCTION: The internal anal sphincter receives a stimulatory alpha(1) adrenergic innervation. Use of an adrenergic agonist may therefore have a role in treating patients with faecal incontinence. METHODS: Ten patients (seven females, median age 66 years) with passive faecal incontinence related to weak internal anal sphincter were studied. All patients had intact anal sphincters as assessed by endoanal ultrasound. Phenylephrine gel was applied in a double blind manner in concentrations of 0%, 10%, 20%, 30%, and 40% (Slaco Pharma (UK) Ltd, Watford, UK) on separate days. Maximum resting anal pressure (MRP), anodermal blood flow, blood pressure, and pulse rate were measured before, and one and two hours after application. RESULTS: All concentrations of phenylephrine gel increased median MRP (43, 48, 54, 65, and 70 cm H(2)O, for placebo, 10% (p=0.122), 20% (p=0.170), 30% (p=0.002), and 40% (p=0.004), respectively at one hour; comparisons with placebo). This was sustained at two hours. There was a clear dose-response relationship at one hour. Higher concentrations raised median MRP to within the normal range (> 60 cm H(2)O). At two hours, all concentrations greater than 20% increased the pressure to a similar degree, suggesting that the exact concentration may be important for the initial effect but given a certain threshold is less important after a period of time. Toxicity was rare. Two patients experienced transient perianal burning which settled within a few minutes. There was no significant effect on anodermal blood flow, blood pressure, or pulse rate. CONCLUSION: This study has demonstrated the feasibility of using topical phenylephrine to raise resting anal tone in patients with faecal incontinence. Randomised controlled trials are required to assess the efficacy of this agent. (+info)
Comparison of anal and rectal swabs in the diagnosis of anorectal gonorrhoea in women.
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Among 228 women with gonorrhoea (confirmed by culture), swabs taken blindly from the anal canal gave positive results in 26.3% and those taken from the rectum under direct vision in 27.6%. Swabs from both sites gave positive results in 23.2% of patients, from the anal canal alone in 3.1%, and from the rectum alone in 4.4%. Thus, culuture of anal canal swabs seems to give as reliable results as rectal swabs when proctoscopy cannot be carried out. (+info)
Incidence of anorectal malformations in Lodz province.
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PURPOSE: It is difficult to obtain reliable figures on incidence of anorectal malformations (ARM) from literature. The aim of the present study was to reveal the real incidence of these defects in a given area. MATERIAL AND METHODS: Between 1992 and 1997, 86 children with ARM were treated at the departments of paediatric surgery in Lodz. Parents of 30 (34.9%) children treated within the analysed period lived in the Lodz province. The real incidence of ARM in this area was calculated and birth parameters of children with ARM were compared with corresponding parameters of newborns born alive in Lodz. RESULTS: The studied incidence ranged from 1 in 1446 to 1 in 3035 in consecutive years and the average was 1 in 2295. Mean duration of pregnancy in children with low type ARM was 39.4 weeks and in children with high type ARM--38.8 weeks. Mean birth body weight of children with low defects was 3030 g, and of neonates with high defects--3185 g. Apgar score was respectively 8.7 and 8.8. There was also no significant difference in examined parameters (p > 0.05) between ARM children and the population of born alive newborns of Lodz area (respectively 38.9; 3297; 8.9). CONCLUSIONS: Anorectal malformations are among the common congenital anomalies in children. In the analysed group of children with ARM duration of pregnancy, birth weight and Apgar score were similar to these observed in the whole population of newborns born alive in Lodz province. (+info)
Myospasm of internal anal sphincter in children.
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OBJECTIVE: To introduce a common but not well-recognized acute abdominal disease in children. METHODS: Thirty-eight children with spasm of the internal anal sphincter were reviewed. RESULTS: The main symptom was the sudden onset of continuous pain in the lower abdomen with paroxysmal exacerbation. The typical sign was the dilation of the sigmoid colon with tenderness aggravated by pressure. Plain X-ray films showed dilation of the sigmoid colon and rectum. The symptoms could be relieved by digital rectal examination or a glycerin suppository. CONCLUSIONS: It is the temporary achalasia of the internal anal sphincter that causes acute abdominal pain. (+info)
Birth trauma to muscles in babies born by breech delivery and its possible fatal consequences.
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Dissection and histological examination was made of the muscles of 86 babies who died after breech delivery, and of 38 babies who died after vertex presentation. A control group of 50 surviving breech-delivered babies was examined clinically and the results compared. It was concluded that the most common type of birth trauma to a baby born by breech delivery is injury to muscles and soft tissues of the back and lower extremities, which is often extensive. In some severly injured babies histological examination of organs revels signs of crush syndrome and disseminated intravascular coagulation. It is suggested that the extensive muscle trauma forms the background of these fatal conditions. (+info)