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Wolff BG, Culp CE (1998) The Whitehead hemorrhoidectomy. Dis Colon Rectum 31: 587-590 51. Wong WD, Jensen LL, Bartolo DC, Rothenberger DA (1996) Artificial anal sphincter. Dis Colon Rectum 39: 1345-1351 52. Young CJ, Mathur MN, Eyers AA, Solomon MJ (1998) Successful overlapping anal sphincter repair. Relationship to patient age, neuropathy, and colostomy forma tion. Dis Colon Rectum 41: 344-349 The Proctologic Examination Examination Positions 19 Disinfection and Sterilization 20 Disinfection 2 1 Sterilization 24 Disinfection and Sterilization of Instruments 25 Methods of Evaluation 27 History 27 Physical Examination 28 Digital Examination 29 Speculum Examination 30 Proctoscopy and Anoscopy 31 Rigid Rectosigmoidoscopy 33 Flexible Rectosigmoidoscopy 37 Colonoscopy 38 Imaging Studies 4 1 Sonography 46 Anorectal Manometry and Electromyography 47 Mycological and Bacteriological Evaluation 50 Allergological Testing Methods 59 Cancer Prevention 64 Examination Positions Positioning of the patient is of crucial importance for a comfortable and complete proctologic examination.

In many instances, operators advanced the mucosal covering further than originally recommended by Whitehead [12,45,50]. • Pathological changes in the rectal mucosa caused by inflammatory bowel processes such as ulcerative colitis, Crohn disease, drug-induced colitis, infection-related diarrhea, and many others. The unifying symptom of these diseases is diarrhea. If the diarrhea can be corrected, in most instances the incontinence will also impro ve. The same is true of incontinence associated with diarrhea caused by with laxative abuse, parasitic infections, and pancreatic insufficiency.

Lancet 346: 1124-1127 28. Matzel KE, Stadelmaier U, Hohenfellner M, Hohenberger W (2001) Chronic sacral spinal nerve stimulation for fecal incontinence: long-term results with foramen and cuff electrodes. Dis Colon Rectum 44: 59-66 29. Mavrantonis C, Matsuoka H, Yamaguchi T, Gilliland R, Wexner SD (1998) Postanal repair for fecal incontinence: is it worthwhile? Dis Colon Rectum 41: A50 30. Mavrantonis C, Wexner SD (1999) Stimulated graciloplasty for the treatment of intractable fecal incontinence: critical influence of the method of stimulation.

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