Acute anal fissure; effect of topical glyceryl trinitrate [GTN] on its management

To evaluate the role of topical glyceryl trinitrate [0.2% GTN] on the clinical features of acute anal fissure. A prospective, open label therapeutic trial was carried out at Combined Military Hospital, Kharian Cantonment during one calendar year. All adult males and females presenting with acute anal fissure were included. Patients with chronic anal fissure, associated pathology [hemorrhoids, fistula in ano], age < 15 years, previous surgery of anal canal were excluded. The diagnosis was based upon history and physical examination. A detailed history was taken regarding their symptoms like painful defecation, bleeding per rectum, constipation and itching. Then the patients were examined to look for anal fissure, associated mucus discharge and sphincter tone and recorded in the proforma. 0.2% topical GTN ointment was prescribed twice daily for local application in the anal canal with the help of cotton pledget on a stick [soaked completely in ointment]. The duration of treatment was four weeks and their symptomatology and healing of anal fissure was assessed weekly. A total of 40 patients were treated in this study. Age varied between 22 - 51 years. 36 patients [90%] were male while only 4 patients [10%] were females. Painful defecation [100%], bleeding PR [87.5%] constipation [50%], and itching [40%] were the main complaints. Posterior fissure was seen in 85%, anterior fissure in 12.5%, while both anterior and posterior fissures were seen in 2.5% of patients. Out of 40 patients 21 had complete healing of anal fissure while 03 patients recovered partially. Thus the healing rate was 60%. Topical glyceryl trinitrate is an effective treatment modality for acute anal fissure

Stridor in afebrile children

To enlist the causes of stridor in afebrile children under twelve years of age. Design: Descriptive study. Carried out in ENT Dept CMH Rwp from Sep 2001 to Feb 2003. Fifty children presenting for the first time with symptoms of stridor were selected according to the inclusion criteria by non-probability purposive sampling. Every patient was evaluated by detailed history, thorough physical examination and investigations including radiographic studies, laryngoscopy and bronchoscopy. Data was recorded on the performa attached as Annex 'A'. Of the 50 patients, there were 29 males and 21 females. The mean age at presentation was 3.8 years. About forty-eight diagnostic observations were made during the initial endoscopic procedure on these 50 children. Acquired lesions [76%] outnumbered the congenital lesions [24%]. Of the congenital type, laryngomalacia [42%] was the commonest cause followed by vocal cord paralysis [17%], laryngocele [17%], laryngeal web [8%], tracheomalacia [8%] and tracheal stenosis [8%]. The most important acquired lesion was foreign body in the Aerodigestive tract [55.26%], followed by respiratory papilomatosis [21.05%], traumatic [13.16%] and subglottic stenosis [10.13%] Because of chronic and presistent upper airway obstruction, tracheostomy was electively performed in 02 cases in this series. There was no complication associated with complete endoscopic examination Foreign body in the tracheobronchial tree is the most frequent cause of stridor in afebrile children followed by congenital conditions and recurrent respiratory papillomatosis