Role of Topical Glyceryl Trinitrate in the Management of Anal Fissure

1] To evaluate the effectiveness of topical 0.2% Glyceryl Trinitrate [GTN] ointment in symptomatic relief and healing of anal fissure. 2] To establish the role of GTN as a first line treatment for both acute and chronic anal fissure. 3] To elaborate the safety profile of GTN with respect to its side effects. Prospective, randomized case control study. Surgical unit II, Jinnah Hospital, Lahore. 1 year from 1-2-2005 to 31-2-2006. Fifty patients of all ages and either sex with a clinical diagnosis of fissure in ano [both acute and chronic] were included in the study. Patients were randomly divided into two groups. The treatment group [Group-A] was advised 0.2% GTN ointment whereas the control group [Group-B] was prescribed a local anesthetic ointment [Lignocaine Compound [R] Knoll]. Both groups applied the given drugs twice daily for a period of 8 weeks and follow-up at the end of first, second and eighth week was carried out. A long-term follow-up at the end of 6 months was undertaken to look for any recurrence of the disease. 18 patients out of 50 patients presented with acute anal fissure while 32 presented with chronic anal fissure. 77% of patients with acute fissure in Group A showed fissure healing while 44% of patients with acute fissure were benefited in Group B. When the failures of group B were subjected to GTN, 80% of the patients showed healing of their fissures. 81% of patients suffering from chronic anal fissure were cured in Group A while 25% of patients showed improvement in Group B. Nonbenefited patients in group B when subjected to GTN, 66% showed fissure healing. Recurrence was seen in 8 patients in group A [24%] and 3 patients in group [38%] at long term follow-up. Anal fissure is a common general surgical problem associated with severe anal pain. Regarding conservative treatment, the advent of GTN is a healing hope for patients with anal fissure. It has revolutionized the non-surgical treatment, as it is effective, safe and economical in terms of cure of both acute and chronic anal fissures

Anemia in surgical patients

To find out prevalence of surgery related anemia in the patients routinely admitted in a general surgical ward. Prospective Cohort Study. Surgical Unit II, Jinnah Hospital, Lahore. 100 studied patients included males and females of all age groups from 13 years to 70 years. They were assessed for the effect of surgery on the preoperative hemoglobin levels and causes of anemia in relation to socioeconomic status. Total of 100 patients were randomly selected for the study but after applying exclusion principles, 95 patients were left with mean age of 33 years, mean hemoglobin concentration of 8.66 in all and 8.79 after excluding the patients with massive blood losses post trauma/gunshot. Mean postoperative hemoglobin excluding trauma patients was 8.71. 52% of patients had anemia due to nutritional deficiency, of which 82% were females; followed by 31% related to chronic diseases and the rest due to acute blood loss. Anemia is still one the major co-morbidities in preoperative patients and we found that surgical procedures did not cause significant difference to hemoglobin levels postoperatively. Almost all the patients followed by chronic diseases. They are more prevalent in people from socioeconomically deprived groups of society