Search

Haemorrhoidal disease belongs to the most common benign disorders in the lower gastrointestinal tract. Treatment options comprise conservative as well as surgical therapy still being applied arbitrarily in accordance with the surgeon's expertise. The aim of this consensus statement was therefore to assess a stage-dependent approach for treatment of haemorrhoidal disease to derive evidence-based recommendations for clinical routine. The most common methods are discussed with respect of haemorrhoidal disease in extraordinary conditions like pregnancy or inflammatory bowel disease and recurrent haemorrhoids. Tailored haemorrhoidectomy is preferable for individualized treatment with regard to the shortcomings of the traditional Goligher classification in solitary or circular haemorrhoidal prolapses.

Aim: Magnetic resonance imaging, computed tomography, endorectal and endoanal sonography are used for imaging of inflammatory and neoplastic conditions of the lower rectum, the anus and the perineum. These methods, however, have their limitations regarding accuracy, cost-effectiveness, and availability in the acute setting. Pain may be a limiting factor when introducing a probe into the anus. Percutaneous transperineal sonography is an acknowledged method for diagnosing anorectal malformations in children and infants and for diagnosis of prostatic disease. Until today, only limited reports regarding the value of transperineal sonography for evaluation of diseases of the lower rectum, the anus and the perianal region in adults are available., Patients and Methods: Between 1997 and 2000 a total of 44 patients underwent transperineal sonography including B-mode and colour Doppler sonography for imaging anorectal structures using 3.5 MHz sector arrays and 7 MHz linear arrays. The lesions were also investigated using colour Doppler imaging. During examination the patient is positioned on his side. Orientation landmarks are the pubic symphysis and the prostate gland in men and the vagina in women., Results: The spectrum of diseases of the current study population (44) included perianal fistulas (10), pararectal abscesses (7), fistulas with abscess (7), perianal inflammation without abscess (1), rectal (6) and anal carcinomas (3) and metastasis of a leiomyosarcoma (1). In 10 cases digital examination of the anus and rectum was not possible because of intense pain. In 34 patients (85 %) sonographic findings were confirmed by intraoperative diagnosis., Conclusion: Transperineal sonography proved to be an inexpensive, easily available diagnostic tool that may help in detecting a variety of pathological conditions of the lower rectum, the anus, and the perianal region.

In spontaneously hypertensive rats (SHR), in normotensive related controls (WKY), as well as in non-related controls (NR), the rarefaction of the capillary bed in the gracilis muscle has been studied. By comparing four different in vivo and in vitro techniques for estimation of the number of capillaries, a rarefaction of about 30% in SHR, was found. The precapillary arterioles revealed a reduced rarefaction by about 25.5% or 40.2% in hypertensive, as compared with normotensive control animals. Age dependency was studied in animals of 6, 12, 24 and 48 weeks with respect to the rarefaction of the capillary bed. An age-dependent reduction of capillaries was seen from 385 to 272 cap/mm2 in NR, from 346 to 276 cap/mm2 in WKY, and an age- as well as hypertension-related rarefaction was found from 285 to 213 cap/mm2 in SHR. Under antihypertensive therapy (nifedipin, 300 mg/kg b.w.) systemic pressure was reduced significantly in all three strains studied and the capillary number changed from 674 to 1051 cap/mm2 in SHR, from 806 to 864 in WKY, and from 779 to 1019 in NR. The results indicate an age-dependency of the capillary rarefaction, which may be protracted and amplified by the hypertension disease. The pathophysiological meaning may be seen in reduction of the capillary surface area during a constantly elevated effective filtration pressure. By that, the increased transvascular fluid permeability of the capillary bed is prevented, which otherwise would cause edema formation in the hypertensive system.

The diffuse peritonitis is a syndrome during the course of which biochemical reactive chains are activated according to a cascade principle. Most of these biochemical reactive chains develop within an acid environment. The solutions applied for abdominal lavage so far had neutral pH value. The present acute peritonitis experiment has shown that a peritoneal pH increase during lavage therapy stopped the septic reactive chain and thus improved significantly the rate of survival in the test animals. These experimental findings ar now subject for clinical examination.

Expectations of early diagnosis of carcinoma of the stomach and pancreas by using the tumour markers CEA and CA 19-9 have been disappointed. Although the sensitivity of CA 19-9 for pancreatic cancer is high, its field of application for screening is not efficient due to poor specificity of the marker. CEA and CA 19-9 are of great importance in the follow-up of pancreatic cancer. Results of tests of CEA and CA 19-9 in 100 patients with gastric cancer and 50 patients suffering from pancreatic cancer are reported.