This document contains the guidelines of the German Societies of Neurogastroenterology and Motility, Gastroenterology (committee for proctology), Abdominal Surgery (coloproctology working group), and Coloproctology for anorectal manometry in adults. Recommendations are given about technical notes, study preparation (equipment; patient), technique for performing manometry and data analysis, reproducibility, and indications. Minimum standards for anorectal manometry are measurement of resting and squeeze pressure, testing of rectoanal inhibitory reflex, determination of rectal sensation (first perception and urge), and calculation of rectal compliance. Anorectal manometry is indicated in patients with fecal incontinence and constipation in the context of a structured programme.
Infection following total joint replacement remains a problem that has not been solved so far. The treatment options include removal of the implant and a delayed reconstruction or a direct exchange operation. Among patients with stable implants and short duration of infection as well as in patients who for certain reasons are inoperable, antibiotic therapy with a combination of rifampicin-ciprofloxacin may be a reasonable treatment option for curing staphyloccocal infection without removal of the implant. A case study of a Staphylococcus epidermidis (coagulase-negative) infection following delayed revision total knee replacement after septic loosening of a knee arthroplasty and its successful conservative treatment with rifampicin-ciprofloxacin is described. Alternative rifampicin combinations are discussed with respect to recently developed pharmacodynamical and pharmacokinetical findings of biofilm active drugs.
The effects of a five-week course of haemodilution or pentoxifylline were compared in two matched groups of 10 patients each (18 men, 2 women; mean age 63 [47-77] years) with peripheral vascular disease of the legs, using clinical findings and Doppler ultrasound measurements as the criteria. Ten patients (group I) had six venesections of 400 ml each followed by the injection of 500 ml low-molecular dextran (10%), while the other ten (group II) received 400 mg pentoxifylline four times daily by mouth after initial intravenous loading. Pain-free and maximal walking distance increased in group I by 139 and 598 m, respectively (P less than 0.01), and by 155 (P less than 0.01) and 191 m in group II. The greater increase in maximal walking distance in group I was significant as calculated by regression analysis (P less than 0.05). Only in group I was there a significant prestenotic maximal and effective increase in blood flow velocity (by 66%: P less than 0.001 and 68%: P less than 0.05, respectively), while the poststenotic effective velocity also increased significantly by 66% (P less than 0.01). There was no significant change in group II patients.
By using CAS the implant positioning is significantly improved. Total knee replacements have a lower blood loss. Due to the prolonged operation time, the leasing costs and the single use navigation tools of every navigated operation produced costs for our hospital of 442 euro. As there is so far no reimbursement of these costs, long-term survival studies are needed to reveal the superiority of the navigation method and to show an impact on the medical budget.
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