[Evaluation of lidocaine ointment in treatment of chronic anal fissure]

Surgical procedures including open and close lateral sphincterotomy were the main treatment of chronic anal fissure in past years. Nowadays, medical treatments are the standard therapy for this disease, but there are some limitations for this method of treatment. This study aimed to compare the efficacy and complication of surgical and medical treatments by lidocaine ointment for patients with chronic anal fissure. A clinical trial study was conducted on 180 patients with chronic anal fissure who had symptoms for more than 6 weeks. The main symptoms of patients were pain during defecation, anal bleeding and skin tag. After history taking and physical examination, method of treatment was explained for patients to choose one group: Group 1 [surgery] or group 2 [medical treatment with lidocaine H]. Surgery was performed by closed method. Medical treatment was consisted of high fiber regimen, sits baths, C-lax tablet nightly, Naproxen tablet 250 mg twice daily and 5% lidocaine anal application before defecation and anal washing during defecation. Patients were followed for 8 weeks. Data were analyzed using chi-square, Fisher and Mann-Whitney tests. One hundred of patients in group 1 and 80 patients in group 2 completed the study. Duration of symptoms was 8.1 +/- 2.5 weeks in group 1 and 7.9 +/- 3.1 weeks in group 2. Post operative complications in group 1 were skin ecchymosis [10%], large hematoma [2%] and 10 cases [10%] complained from mild incontinency to flatus. There was no complication in group 2. Healing rate was 93% in group 1 and 75% in group 2 [P<0.05]. Medical treatment with lidocaine is a safe and effective treatment for chronic anal fissure

effect of ischioanal fossa block with bupivacain on decreasing post hemorrhoidectomy pain

Hemorrhoidectomy is usually associated with severe pain in the immediate postoperative period. Today, a number of local blockages and sedatives are used to reduce this pain. However, so far, no specific method is recommended for this purpose. Therefore, the aim of this study was to investigate the efficacy of the ischioanal fossa block, in reduction of postoperative pain and analgesic requirements. This clinical-trial study was performed on eighty c and idates of elective hemorrhoidectomy. Patients were randomly assigned to either case [receiving ischioananl fossa block] or control [no ischioananl fossa block]. All aspects of surgery and anesthesia were st and ardized. In the postoperative period, analgesia was maintained with pithedine. Pain was assessed using VAS [Visual analogue scale] at 0 [arousal], 4, 12 and, 24 hours after operations. The time interval for the first request of analgesia and the total amount of analgesic consumption were recorded. There was no statistical difference between the two groups with respect to age, sex, weight, and duration of operation. The pain score of the case and the control group was 2.65 +/- 0.92 and 4.93 +/- 1.09, respectively [p<0.05]. Also, the pain score at 0, 4, 12, and 24 hrs post operation was significantly lower in the case than that in the control group [p<0.05]. The time interval for request of the first analgesic was significantly longer in the case group [8 hr versus 1.5 hrs] [p<0.05]. Total dose of pethedine consumption was statistically different between the two groups [p<0.05]. Based on the results, the administration of ischiorectal fossa block and bupivacain before the operation resulted in a significant decrease in postoperative pain and analgesia requirements. Therefore, this method is recommended

[ evaluation of base deficit as the predictive agent of mortality in geriatric trauma]

Base deficit is a well-characterized feature of occult tissue hypo-perfusion. However, its cut off point value for mortality in geriatric trauma has not been determined. In this study, the prediction value of base deficit and its cut off point were evaluated in old aged patients. In a prospective study, 300 old age [>=65 year] patients with trauma referred to All-Zahra hospital of Isfahan were studied. In each patient, arterial blood gas was taken and base deficit was checked. Risk factors of base deficit changes were determined. Patients were followed until death or discharge. The predictive probability of significant variables of mortality was tested by regression analysis. P value less than 0.05 was considered significant. Our results showed that in stable old aged traumatic patients base deficit was the only significant predictor of death [p<0.01]. A cut off value of 2.55 mmol/L had the best accuracy. Pelvis-AIS, GCS and cardiac disease were significant coefficient of base deficit changes [p<0.05]. Base deficit changes in range of 2.55-3 in old aged traumatic patients indicates occult tissue hypo-perfusion and increased mortality