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Bei einer Hyperplasie des Corpus cavernosum recti und Vorliegen einer analen Beschwerdesymptomatik, die aus transanaler Blutung, perianalem Pruritus, Nassen, Stuhlschmieren oder der Wahrnehmung eines Druck- oder Fremdkorpers bestehen kann, spricht man von einem Hamorrhoidalleiden. Je nach morphologischer Veranderung unterscheidet man zwischen Hamorrhoiden I°, II°, III° und IV°. Die Therapieoptionen werden an den Schweregrad der Erkrankung angepasst und bestehen in den fruhen Stadien aus konservativen Masnahmen wie Stuhlregulation, Sklerosierung und Gummibandligaturen, in den fortgeschrittenen Stadien werden operative Verfahren (z. B. die Segmentexzision und die Staplerhamorrhoidopexie) angewendet. Die gesundheitsbezogene Lebensqualitat wird zunehmend haufiger als Qualitatsmerkmal einer konservativen oder operativen Therapie definiert. Nicht nur die morphologische und funktionelle Wiederherstellung von Korperstrukturen oder -funktionen, sondern die subjektive Einschatzung der Beschwerdebesserung durch den Patienten wird als relevanter Behandlungserfolg gewertet. Entsprechend wird dieses Kriterium zunehmend als primarer oder sekundarer Endpunkt klinischer Studien gewahlt. Trotz der hohen Inzidenz des Hamorrhoidalleidens, die mit jahrlich 4 % in Industrienationen angegeben wird, und aus der in Deutschland 40 000–50 000 operative Eingriffe und ca. 3,5 Millionen Behandlungsfalle pro Jahr resultieren, liegen nur sehr limitierte Daten zur Beeinflussung der Lebensqualitat durch diese Erkrankung vor. Auch aus gesundheitspolitischen Aspekten gewinnt die Kosten-Nutzwert-Analyse unter Verwendung des Mases der lebensqualitatsadjustierten Lebensjahre zunehmend an Bedeutung. In der vorliegenden Arbeit werden Definitionen der gesundheits- und krankheitsbezogenen Lebensqualitat erlautert. Die zur Verfugung stehenden psychometrischen Instrumente zur Lebensqualitatsmessung werden dargestellt und deren Qualitatskriterien und Grenzen diskutiert.

Pyomyositis is in the moderate climate zone a rare and acute bacterial infection of the skeletal muscles without an obvious origin of infection. Initial symptoms contain muscle pain and localized swelling and tension. As different causes are taken into account first, the diagnosis of a pyomyositis is often delayed. We report on three cases of pyomyositis and discuss diagnosis and therapy against the background of the available and recent literature.

AIM The purpose of the present study was to define the diagnostic value of anal endosonography in the diagnostic work-up of fistula-in-ano. METHODS A retrospective study was carried out on 191 consecutive patients (m: 121; f: 70; mean age: 44.0 +/- 12.5 years; range: 0.5-77 years) who were diagnosed to suffer from fistula-in-ano by performing anal endosonography in an outpatient setting. All images were obtained with a Combison 310A ultrasound scanner (Kretz GmbH, Zipf, Osterreich) and 5-Mhz and 7.5-MHz transducer. 131 patients underwent surgery. According to the endosonographic findings fistulas were classified as transsphincteric in 44 %, intersphincteric in 22 %, subanodermal in 16 %, anovaginal in 8 %, suprasphincteric in 5 %, extrasphincteric in 1 % and others in 4 %. RESULTS In 125 patients (95 %) the preoperative diagnosis was confirmed intraoperatively. This cohort included 12 patients with a complex fistula system. In only 6 patients the preoperative ultrasound finding was misinterpreted. CONCLUSION In conclusion this study has shown that anal endosonography is a useful and reliable tool in the preoperative evaluation of uncomplicated and complicated anorectal fistulas.

AIM We tried to evaluate the role of anorectal functional diagnostic tools according to the judgement of German coloproctologists. METHOD Questionnaires concerning accuracy of different diagnostic tests were sent to 585 physicians specialized in coloproctology. RESULTS 261 (44.6 %) completed forms were returned. An analysis of the answers revealed that endorectal sonography is widely (73 %) regarded as useful and reliable diagnostic tool. Though manometry is still frequently used, only 50.5 % of the coloproctologists made their decision concerning the further treatment depending on the results of this method. Other radiologic methods as defecography and colon transit time are still regularly performed, though video-defecography is not accepted by most coloproctologists. Neurological investigations as pudendal nerve terminal latency, surface-EMG and needle-EMG are exclusively applied in specialized departments. DISCUSSION Regarding the variety of diagnostic tools and its different appraisal a consensus should be defined. The usefulness of neurological examination techniques needs to be clarified before their performance can be recommended for a wide-spread routine work up.

In patients suffering from haemorrhoidal disease a hyperplasia of the corpus cavernosum recti is accompanied by various symptoms such as anal bleeding and minor continence disorders as well as itching, soiling and burning. According to the morphological findings, haemorrhoids are staged from grade I up to IV. Therapy strategies are adjusted to this staging. Early stages are treated by conservative measures, such as regulation of defaecation, sclerosis and rubber band ligations. Advanced stages require operative methods, such as segmental excision and stapled haemorrhoidopexy. Since patients demand a greater regard to the subjective experience of their disease and its treatment, quality of life evaluation has become an important issue in medical care. Therefore health-related quality of life is increasingly becoming a relevant primary or secondary end point of clinical studies. Since up to 4 % of the general adult population in industrial nations is annually diagnosed to suffer from haemorrhoidal disease, in Germany per annum 3.5 Mio patients seek medical advice due to this condition and 40 000-50 000 surgical procedures are performed. Nevertheless only very few studies have been carried out to investigate the influence of this widespread disease on the quality of life of those patients. Additionally cost-effectiveness analyses measuring quality-adjusted life years are becoming more and more decisive in health politics. The present article discusses the definitions of health-related as well as disease-related quality of life. Different psychometric tests applied to evaluate the quality of life are summarised, quality criteria are outlined and limitations discussed. Several studies were analysed in regard to the quality of life in patients with haemorrhoidal disease and the specific influence of different operative techniques was reviewed.

Pyomyositis is in the moderate climate zone a rare and acute bacterial infection of the skeletal muscles without an obvious origin of infection. Initial symptoms contain muscle pain and localized swelling and tension. As different causes are taken into account first, the diagnosis of a pyomyositis is often delayed. We report on three cases of pyomyositis and discuss diagnosis and therapy against the background of the available and recent literature.

The purpose of the present study was to define the diagnostic value of anal endosonography in the diagnostic work-up of fistula-in-ano.A retrospective study was carried out on 191 consecutive patients (m: 121; f: 70; mean age: 44.0 +/- 12.5 years; range: 0.5-77 years) who were diagnosed to suffer from fistula-in-ano by performing anal endosonography in an outpatient setting. All images were obtained with a Combison 310A ultrasound scanner (Kretz GmbH, Zipf, Osterreich) and 5-Mhz and 7.5-MHz transducer. 131 patients underwent surgery. According to the endosonographic findings fistulas were classified as transsphincteric in 44 %, intersphincteric in 22 %, subanodermal in 16 %, anovaginal in 8 %, suprasphincteric in 5 %, extrasphincteric in 1 % and others in 4 %.In 125 patients (95 %) the preoperative diagnosis was confirmed intraoperatively. This cohort included 12 patients with a complex fistula system. In only 6 patients the preoperative ultrasound finding was misinterpreted.In conclusion this study has shown that anal endosonography is a useful and reliable tool in the preoperative evaluation of uncomplicated and complicated anorectal fistulas.

We tried to evaluate the role of anorectal functional diagnostic tools according to the judgement of German coloproctologists.Questionnaires concerning accuracy of different diagnostic tests were sent to 585 physicians specialized in coloproctology.261 (44.6 %) completed forms were returned. An analysis of the answers revealed that endorectal sonography is widely (73 %) regarded as useful and reliable diagnostic tool. Though manometry is still frequently used, only 50.5 % of the coloproctologists made their decision concerning the further treatment depending on the results of this method. Other radiologic methods as defecography and colon transit time are still regularly performed, though video-defecography is not accepted by most coloproctologists. Neurological investigations as pudendal nerve terminal latency, surface-EMG and needle-EMG are exclusively applied in specialized departments.Regarding the variety of diagnostic tools and its different appraisal a consensus should be defined. The usefulness of neurological examination techniques needs to be clarified before their performance can be recommended for a wide-spread routine work up.

Anorectal manometry has been developed from an object of clinic oriented scientific interest to an established tool within the spectrum of proctologic diagnostics. At present it represents the only objective diagnostic method with regards to continence disorders; it is routinely applied in the evaluation of constipation, of incontinence, of pre- and postoperative conditions in diseases of the anorectum as well as in the indication and therapeutic control investigations during biofeedback training of the anal sphincter. The new technique of determination of the anal sphincter pressure vector volume allows for the most sensitive functional separation of patients with different degrees of continence; this method delivers a 3-dimensional graphic imaging of the sphincter pressure profile, thus allowing for an objective visualisation of the present mechanic defect and an aid in planning a surgical correction.