Biomedical subjects

P Denis

Publications and source records attributed to P Denis.

At least 19 recordsLinked to original sources

PubMed1999

Beta-secretase cleavage of Alzheimer's amyloid precursor protein by the transmembrane aspartic protease BACE.

Cerebral deposition of amyloid beta peptide (Abeta) is an early and critical feature of Alzheimer's disease. Abeta generation depends on proteolytic cleavage of the amyloid precursor protein (APP) by two unknown proteases: beta-secretase and gamma-secretase. These proteases are prime therapeutic targets. A transmembrane aspartic protease with all the known characteristics of beta-secretase was cloned and characterized. Overexpression of this protease, termed BACE (for beta-site APP-cleaving enzyme) increased the amount of beta-secretase cleavage products, and these were cleaved exactly and only at known beta-secretase positions. Antisense inhibition of endogenous BACE messenger RNA decreased the amount of beta-secretase cleavage products, and purified BACE protein cleaved APP-derived substrates with the same sequence specificity as beta-secretase. Finally, the expression pattern and subcellular localization of BACE were consistent with that expected for beta-secretase. Future development of BACE inhibitors may prove beneficial for the treatment of Alzheimer's disease.

Alzheimer Disease↗

PubMed1999

Both familial Parkinson's disease mutations accelerate alpha-synuclein aggregation.

Parkinson's disease (PD) is a neurodegenerative disorder that is pathologically characterized by the presence of intracytoplasmic Lewy bodies, the major component of which are filaments consisting of alpha-synuclein. Two recently identified point mutations in alpha-synuclein are the only known genetic causes of PD, but their pathogenic mechanism is not understood. Here we show that both wild type and mutant alpha-synuclein form insoluble fibrillar aggregates with antiparallel beta-sheet structure upon incubation at physiological temperature in vitro. Importantly, aggregate formation is accelerated by both PD-linked mutations. Under the experimental conditions, the lag time for the formation of precipitable aggregates is about 280 h for the wild type protein, 180 h for the A30P mutant, and only 100 h for the A53T mutant protein. These data suggest that the formation of alpha-synuclein aggregates could be a critical step in PD pathogenesis, which is accelerated by the PD-linked mutations.

Cell Line↗

PubMed1999

Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence.

A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three groups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0. 03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579-590, 1999.

Adolescent↗

PubMed1999

Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence.

PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.

Anal Canal↗

PubMed1999

Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia.

PURPOSE: Pudendal neuralgia caused by nerve compression may be improved by surgical decompression of the pudendal nerve. This study was undertaken to determine if clinical symptoms, electrophysiological investigations, and the efficacy of preoperative pudendal nerve blocks could be used to predict the efficacy of surgery. METHODS: Twelve consecutive patients complaining of anal pain, genital pain, or both, exacerbated in the sitting position and unsuccessfully treated by analgesic drugs before referral were studied. In these 12 patients decompression of the pudendal nerve was performed after unsuccessful CT-guided injection of corticosteroids in the pudendal nerve at the ischial spine or after pain relapse following successful injections. Nineteen nerves were decompressed by surgery, and the compressed area was located between the sacrospinal and sacrotuberal ligaments for 18 nerves. RESULTS: Three months after surgery, four patients were totally relieved, and three were only partially improved. After 21 months of follow-up, three patients were cured, one was slightly improved, and eight remained in pain. In the three patients cured by surgery, pain completely disappeared for at least two weeks after a nerve block repeated twice before surgery, whereas pain relief was observed in only one of the nine other patients (P = 0.018). None of the three patients cured by surgery were being treated for depression, whereas six of the nine remaining patients were receiving antidepressants or were followed by a psychiatrist (P = 0.09). Results of surgery did not depend on other preoperative clinical or electrophysiological data. CONCLUSIONS: This preliminary study suggests that complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. Based on this criterion, surgery would have been performed in four patients in this study, of whom three would have been cured.

Aged↗

PubMed1999

Fecal incontinence in the institutionalized elderly: incidence, risk factors, and prognosis.

PURPOSE: This study was conducted to evaluate the incidence, identify the risk factors, and assess the prognosis of elderly institutionalized patients who develop fecal incontinence. PATIENTS AND METHODS: We enrolled 1,186 patients 60 years of age and older living in long-term care facilities who did not have fecal incontinence. We assessed their medical history, treatment, mobility, and cognitive function. Patients were followed up for 10 months to determine the incidence of fecal incontinence, defined as at least one involuntary loss of feces. Independent risk factors associated with fecal incontinence were identified using Cox proportional hazards models. The prognosis of incontinent patients was assessed by comparing their survival rate with that in the continent patients. RESULTS: Fecal incontinence occurred in 234 patients (20%), and was usually associated with acute diarrhea or fecal impaction. We identified five risk factors for the development of fecal incontinence: a history of urinary incontinence (rate ratio [RR]: 2.0, 95% confidence interval [CI] 1.5 to 2.6); neurological disease (RR: 1.9, 95% CI 1.0 to 3.4); poor mobility (RR: 1.7, 95% CI 1.2 to 2.4); severe cognitive decline (RR: 1.4, 95% CI 1.1 to 1.9); and age older than 70 years (RR: 1.7, 95% CI 1.0 to 2.8). Ten-month mortality in the 89 patients with long-term (> or = 8 days) incontinence was 26%, significantly greater than that observed in the continent group (6.7%) or in the 145 patients with transient incontinence (10%). CONCLUSIONS: Long-lasting or permanent fecal incontinence was associated with increased mortality, suggesting that this symptom is a marker of poor health in older patients. Actions that improve mobility might help prevent fecal incontinence in elderly patients.

Aged↗

PubMed1999

Posterior chamber intraocular lens dislocation with the bag.

We report a rare case of a 46-year-old man presenting with a luxation of a posterior chamber intraocular lens (IOL) with the capsular bag after ocular contusion. Preoperative axial length was 36.58 mm. After trauma, pars plana extraction of the dislocated IOL inside the capsular bag was performed using a forceps. Capsular fibrosis had probably weakened the zonules, which were ruptured by the trauma. This observation confirms the necessity of a large continuous curvilinear capsulotomy and meticulous cleaning of the anterior and posterior capsules to minimize postsurgical fibrosis and capsule contraction.

Contusions↗

PubMed1999

Upper jejunal motility after pancreatoduodenectomy according to the type of anastomosis, pancreaticojejunal or pancreaticogastric.

BACKGROUND: The goal of this study was to compare upper jejunal motor patterns after Billroth II pancreatoduodenectomy according to the type of pancreatic anastomosis (pancreaticojejunostomy [PJA] or pancreaticogastrostomy [PGA]) and the presence or absence of postoperative symptoms. STUDY DESIGN: Manometric recordings during fasting and after a 750-kcal meal were performed in the afferent limb in 12 patients (7 PJA, 5 PGA) and in the efferent limb in 15 other patients (7 PJA, 8 PGA) with a postoperative delay of 15+/-6 days and 3.9+/-2.2 months respectively. Patient data were compared to those of 20 healthy controls. RESULTS: During fasting, the 2 main abnormal findings were a higher incidence (p < 0.05) and a slower migration velocity (p < 0.01) of incomplete phase III by comparison with that recorded in controls. No difference for phase III was observed between the 2 surgical procedures regardless of recording site. Trimebutine, 100 mg intravenously, induced a phase III in 89% (24 of 27) of the patients. Delay of motor response varied from 5 to 10 minutes without difference between the recording site; it was less than 2 minutes in 100% of controls. Trimebutine-induced phase III showed similar propagation abnormalities to the spontaneous phase III. Duration of the fed pattern (p < 0.001) and motor index (p < 0.001) were significantly lower than in controls after the meal, in both limbs, whatever the type of anastomosis. Differences between the 2 surgical procedures were a slower migration velocity of phase III (p < 0.01) and a lower postmeal motor index (p < 0.05) in the efferent limb after PJA than after PGA. Nine of 27 patients were symptomatic. In these 9 patients, mean phase III migration velocity was slower (p < 0.001), and mean area under the postprandial curve was higher (p < 0.01) than in asymptomatic patients. Propagated clusters of contractions were only found in symptomatic patients and in the afferent limb. CONCLUSIONS: Pancreatoduodenectomy is associated with significant motor disturbances, mainly slower phase III and a reduced fed pattern, in the upper jejunum, at least during the first 3 postoperative months. Few motor differences were observed between PGA and PJA pancreatic anastomosis. A lesser occurrence of postsurgical motor anomalies does not appear to be an argument for preferring PGA to PJA.

Aged↗

PubMed1999

Intraocular foreign bodies. Factors influencing final visual outcome.

PURPOSE: To identify the prognostic factors of poor visual outcome (visual acuity < or =6/240) in eyes with intraocular foreign bodies. METHODS: The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. RESULTS: Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)=14.5, p=0.001), largest diameter of IOFB (OR=1.21, p=0.01) and the presence of secondary retinal detachment (OR=9.48, p=0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%). CONCLUSION: Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.

Adolescent↗

PubMed1999

Octreotide in refractory functional epigastric pain with nutritional impairment--an open study.

AIM: To test the therapeutic efficacy of octreotide administered subcutaneously for the relief of chronic refractory epigastric pain severe enough to provoke nutritional impairment. SUBJECTS AND METHODS: Seventeen patients were enrolled in an open trial. Epigastric pain had lasted from 1 to 8 years (median: 5 years), following anti-reflux surgery in eight patients. Median weight loss was 10% (range 10-15). The initial dose of octreotide was 50 microgram b.d, adjusted during the follow-up visits which were scheduled for months 1, 3, 6, 8, 10, 12 and every 3 months. At each visit, overall symptomatic improvement, frequency and intensity of symptoms were checked on a 10-cm visual analogic scale. RESULTS: At month 1, a progressive improvement of pain intensity was reported in 15 of the 17 patients, while octreotide was a therapeutic failure in two. In four out of 15, the daily dose of octreotide was increased to 100 microgram b.d. In these 15 patients, median follow-up was 7 months (3-27). The symptomatic benefit was maintained in each patient at month 3, with a median weight gain of 3.5 kg.2-5 An attempt to stop octreotide led to recurrence of symptoms in 2-3 days which were as intense as before the treatment. The 11 patients followed-up for at least 6 months reported persistent improvement of symptoms with octreotide and a median weight gain of 4 kg.3-7 Four patients were followed up for more 11-27 months: octreotide was withdrawn gradually in two who remained asymptomatic. Six of the 17 patients experienced minor side-effects, but none developed biliary sludge. CONCLUSIONS: This open study suggests that octreotide could be a promising alternative treatment when all others fail in refractory chronic functional epigastric pain severe enough to limit food intake and to induce nutritional impairment. These results must be tested by a placebo-controlled study.

Adult↗

PubMed1999

Increased tone of the rectal wall in response to feeding persists in patients with cauda equina syndrome.

The aim was to study fasting and postprandial rectal tone in patients with cauda equina injury. Electromechanical barostat measurement of rectal tone was made in 13 healthy volunteers and in five patients during a 10 min recording, while fasting and for 1 h after a 1000 kCal intake. A prompt decrease of rectal volume was observed in all control subjects and patients. The delay between the end of the meal and the onset of the rectal response was always less than 3 min in the five patients as well as in the control group. The rapidity of the rectal response to feeding observed in our five patients suggests that the rectal response was mediated via a neural or neurohumoral pathway despite severe injury of the sacral parasympathetic supply.

Adult↗

PubMed1999

Motility in the Roux-Y limb after distal gastrectomy: relation to the length of the limb and the afferent duodenojejunal segment--an experimental study.

Following gastrectomy, the longer is a Roux-Y limb constructed to restore digestive continuity the higher the frequency of postoperative symptoms. The aim of this experimental study was to test how the level of the jejunal transection and the length of the Roux limb affect the motility of the constructed limb and in particular the onset and the propagation of activity fronts (AFs). Three months after a distal Roux-en-Y gastrectomy, electromyographic tracings were recorded in six groups of rats grouped according to the level of the transection (20 or 40 cm from the pylorus) and the length of the limb (10, 20 or 30 cm). Animals in which a simple laparotomy or laparotomy + jejunal transection was performed, served as controls. During the interdigestive period, all animals had AFs in the limb which were independent from those recorded in the duodenum. In the limb, the mean time interval between two AFs was shorter (P < 0.01) and more irregular than in controls. An increase in limb length was associated with a lower incidence of completely propagated AFs (P < 0.05) and a higher incidence of irregularly propagated AFs (P < 0.01). When propagation of the AFs was analysed both in the limb and in the jejunum distal to the anastomosis, propagation abnormalities were more frequent. Below the gastrojejunal anastomosis, for an intestinal length of either 20 or 30 cm, the frequency of abnormal AFs was not different when this length was either only a limb or a limb with the 10 cm of distal jejunum below the jejuno-jejunal anastomosis. Interruption of AFs by a meal was irregular in the limb and more rarely observed in the 30-cm than in 10-cm limbs (P < 0.05). Interruption of AFs was shorter than in controls (P < 0.01). In the duodenum and the jejunum proximal to the limb, the interval between AFs was higher than in controls and in the Roux-Y limbs (P < 0.001). Intraluminal concentrations of bacterial strains were not different in the different types of limb while lactobacillus concentrations and pooled concentrations of bacteria were higher than in controls (P < 0.05). No relationship was found between the incidence of myoelectric abnormalities and intraluminal bacterial concentrations. Increasing the length of a Roux-Y limb resulted in more frequent disturbances in AFs in the limb but had no significant consequence on the overall rate of abnormal AFs in the jejunum distal to the transection. Motor response to food intake was also reduced. Motor changes were not related to intraluminal bacterial concentrations.

Anastomosis, Roux-en-Y↗

PubMed1999

Acute posterior multifocal placoid pigment epitheliopathy associated with Wegener's granulomatosis.

PURPOSE: To report acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in the course of systemic Wegener's granulomatosis. METHODS: A complete ophthalmologic evaluation was undertaken, including fluorescein and indocyanine green angiography. RESULTS: Two patients diagnosed with Wegener's granulomatosis developed multiple white-yellow subretinal areas with smooth margins typical of APMPPE. Case 1 presented with bilateral choroidal involvement and a granulomatous anterior uveitis. In Case 2, placoid lesions were diagnosed 2 months after onset of systemic Wegener's granulomatosis. In both cases, fluorescein angiography showed an early hypofluorescence and a late staining of the lesions. Indocyanine green angiography revealed early and late hypofluorescence corresponding to the areas seen clinically. Wegener's granulomatosis was diagnosed histologically in both cases. After combined steroid and cyclophosphamide therapy, the lesions healed, and after a follow-up period of 1.5 and 4 years, respectively, funduscopic and angiographic examinations showed cicatricial lesions. CONCLUSION: Acute posterior multifocal placoid pigment epitheliopathy is a rare manifestation of Wegener's granulomatosis and should be considered a possible systemic involvement of the disease. A prompt, thorough investigation should be undertaken for an underlying systemic disorder.

Acute Disease↗

PubMed1999

Electrostimulation is not a clinically effective treatment of anal incontinence.

OBJECTIVE: To evaluate the manometric and clinical efficacies of electrostimulation to treat anal incontinence. PATIENTS AND METHODS: Thirty-three women suffering from anal incontinence self-administered anal electrostimulation twice daily for 15-min intervals for 4 months. RESULTS: After 4 months, the incontinence score decreased from 10.4+/-0.5 to 7.1+/-0.8 (P<0.001) but all patients except two remained incontinent The decrease in the incontinence score was more marked in patients receiving medical treatment for an associated bowel disorder, than in patients treated by electrostimulation alone. Anal resting pressures and the amplitude of voluntary anal contractions did not increase after 4 months. CONCLUSION: Electrostimulation decreased the incontinence score but all patients except two remained incontinent after 4 months, suggesting that electrostimulation is not a clinically effective treatment of anal incontinence.

Anal Canal↗

PubMed1999

Motility of the Roux-en-Y hepaticojejunostomy in asymptomatic patients.

OBJECTIVE: The aim of our study was to describe the motility in the limb, the duodenum, and the jejunum distal to the limb after Roux-en-Y hepaticojejunostomy in patients who remained asymptomatic postoperatively. Our objective was to obtain reference manometric recordings for interpretion of recordings in symptomatic patients. METHODS: Manometric recordings were obtained in the Roux-en-Y limb in 13 patients 15.6 +/- 1.1 days postoperatively, using a probe inserted into the limb during surgery and coming out through the abdominal wall. The recording openings were positioned in the limb itself in eight patients, and also in the jejunum immediately distal to the limb in five patients. In four of eight patients, limb manometry was combined with duodenal manometry using a second probe introduced nasally. RESULTS: Phase IIIs were recorded in all 13 patients, either spontaneously or after trimebutine stimulation (100 mg i.v.). Phase IIIs occurred spontaneously in 12 patients. They always migrated throughout the Roux-en-Y limb, and were also most often observed in the distal jejunum; migration stopped in the distal jejunum in three of five patients. Phase IIIs in the limb occurred independently from duodenal phase IIIs. In the limbs, the duration of phase IIIs was longer (p < 0.02), and the migration slower than in the duodenum (p < 0.001) and in controls (p < 0.02). In nine of 13 patients, injection of trimebutine (100 mg i.v.) initiated phase III in the Roux limb or in the distal jejunum within 2 min. During the combined recordings, trimebutine initiated phase III simultaneously in the duodenum and in the limb. The response to meals in the limb was poorer than in controls. Interruption of phase IIIs was shorter, and the area under the postprandial curve was smaller (p < 0.01) for each postprandial half-h. Postprandial motility was poorer in the limb than in the distal small bowel (p < 0.01). CONCLUSIONS: In asymptomatic patients, interdigestive motility is present in the hepaticojejunostomy Roux-en-Y limb, but it is abnormal because of slow migration of phase IIIs. The second abnormality observed in the limb is a response to meals that is both short and of low amplitude.

Adult↗

PubMed1999

Efficacy of topical 0.05% retinaldehyde in skin aging by ultrasound and rheological techniques.

BACKGROUND: The natural precursor of retinoic acid, i.e. retinaldehyde, has been proven to exert retinoid activities. AIM AND METHODS: The aim of this prospective instrument study was to determine the effect of topical retinaldehyde 0.05% on the physical properties of aging skin. This was performed using two devices, namely a high-resolution (70-80 microm) ultrasound scanner, which visualizes the thickness of both the epidermis and the dermis, and an echorheometer, which assesses the stiffness and elasticity of the skin by suction. In a 1-year study, 21 patients applied retinaldehyde cream 0.05% on the face, while another group of 19 volunteers were only treated with an emollient (control group). Epidermal and dermal thicknesses were measured on the forehead and temple, and stiffness and elasticity were measured on the forehead only. All the instrumental parameters were assessed at baseline and at the end of treatment. RESULTS: Compared to the control group, retinaldehyde treatment induced a significant increase in epidermal thickness of the temple, as well as in cutaneous elasticity (p < 0. 01). Similarly, retinaldehyde treatment tended to increase dermal thickness and reduce cutaneous stiffness, but no statistical difference could be observed between the two groups. CONCLUSION: Taken together, the results further suggest that retinaldehyde has counteracting effects on skin aging

Administration, Topical↗

PubMed1999

Pentoxifylline improves insulin action limiting skeletal muscle catabolism after infection.

We investigated the ability of pentoxifylline (PTX) to modulate protein synthesis and degradation in the presence and absence of insulin during incubation of epitrochlearis muscle, 2 or 6 days after injection of Escherichia coli. On days 2 and 6 after infection, protein synthesis was inhibited by 25%, whereas proteolysis was enhanced by 75%. Insulin (2 nM) in vitro stimulated protein synthesis in muscles from infected rats to the same extent as in controls. The ability of insulin to limit protein degradation was severely blunted 48 h after infection. On day 6 after infection, insulin inhibited proteolysis to a greater extent than on day 2. PTX suppressed the increase in plasma concentrations of tumor necrosis factor more than 600-fold after injection of bacteria, and partially prevented the inhibition of protein synthesis and stimulation of protein degradation during sepsis. Moreover, PTX administration maintained the responsiveness of protein degradation to insulin during sepsis. Thus cytokines may influence skeletal muscle protein metabolism during sepsis, both indirectly through inhibition of the effects of insulin on proteolysis, and directly on the protein synthesis and degradation machinery.

Analysis of Variance↗

PubMed1999

Prevalence of anal sphincter defects revealed by sonography in 335 incontinent patients and 115 continent patients.

OBJECTIVE: The aim of this study was to compare the prevalence of anal sphincter defects on anal sonography of incontinent and continent patients. SUBJECTS AND METHODS: Four hundred sixty-eight consecutive subjects who underwent anal sonography were studied. The prevalence of anal sphincter defects was calculated in 335 incontinent patients, 115 continent patients, and 18 asymptomatic female volunteers. All subjects answered a questionnaire about childbirth and proctologic surgery. RESULTS: The prevalence of anal sphincter defects revealed on sonography was 65% in the 335 incontinent patients. The prevalence of anal sphincter defects in incontinent patients was 88% in patients with a history of childbirth and proctologic surgery and 62% with childbirth alone. The prevalence of anal sphincter defects revealed on sonography was 43% in continent patients and 22% in asymptomatic volunteers. The prevalence of anal sphincter defects in continent patients with a history of childbirth and proctologic surgery was 92% and was 41% with childbirth alone. We found no difference in the prevalence of sphincter defects according to the age and sex of patients. CONCLUSION: Anal sonography can be used to identify sphincter defects in approximately two thirds of incontinent patients. Prevalence is greater in patients with a history of proctologic surgery. Because of the presence of sphincter defects in continent patients and in asymptomatic volunteers, caution should be used in attributing incontinence to anal sphincter defects alone.

Adolescent↗