Glyceryl trinitrate versus misoprostol for termination of first trimester missed miscarriage

Missed abortion refers to a pregnancy that can manifest as an anembryonic gestation or fetal demise prior to 20 week's gestation. Medical management has been used as a treatment options. A common medical regimen used to evacuate the uterus is vaginal misoprostol [Cytotec] in single or multiple doses. To compare the therapeutic efficacy and adverse effects of intravaginal administration of a nitric oxide donor [glyceryl trinitrate] with that of a prostaglandin [misoprostol] to induce cervical changes in women with missed miscarriages to terminate their pregnancies. A prospective, randomized comparative trial conducted at Al-Yarmouk Teaching Hospital, Department of Obstetrics and Gynaecology/Baghdad-Iraq, enrolled Sixty women with first trimester missed miscarriages that requested pregnancy termination. They were randomly selected to receive either two tablets of 500 microg. glyceryl trinitrate vaginally [n = 30] or 200 microg misoprostol tablet vaginally [n = 30], every 3 hours to a maximum of four doses or until reaching desirable cervical changes. Baseline vital signs were recorded and repeated with monitoring for adverse side effects every 3 hours until finishing therapy. The difference in cervical changes between the two groups was statistically not significant [p > 0.05]. The successful outcome taken as cervical dilatation >/= 10 mm, incomplete, or complete miscarriage was achieved in 30% of women in the glyceryl trinitrate and in 53% of women in the misoprostol group which was statistically not significant [p>0.05]. Systolic and diastolic blood pressure, temperature and heart rate were lower with glyceryl trinitrate than misoprostol, but the differences were not significant [v > 0.05]. The most frequent side effect associated with glyceryl trinitrate administration was headache, which occurred in 27/30 women, compared with only 5/30 women in misoprostol group; relative risk 5.42 [p < 0.05]. Women treated with misoprostol reported mainly lower abdominal pain; relative risk 4.2 [p < 0.05]. Although glyceryl trinitrate was less effective than misoprostol when used prior to termination of missed miscarriage, the difference was statistically not significant. Moreover glyceryl trinitrate caused less adverse effects than misoprostol and it could have a role in the management of this obstetrical problem

Chronic anal fissure; a randomised, double blind, placebo controlled trial of 0.5% glyceryl trinitrate ointment

Topical application of glyceryl trinitrate [GTN] ointment heals anal fissures, providing an alternative to the traditional first line treatment of surgical sphincterotomy. Tathlith General Hospital Saudi Arabia. January 2001 -April 2003. To determine the effectiveness and safety of topical 0.5% glyceryl trinitrate [GTN] in the management of chronic anal fissure. Individual Patients were randomized to receive 0.5%GTN paste or placebo three times per day for six weeks in addition to oral senna and/or lactulose. Patients took laxatives alone for further 6 weeks. Patients were followed every week for six weeks and then fortnightly for another six weeks to assess pain scores and were given advice. Fifty patients were recruited in this study and 44 patients completed the trial [23 in the GTN group and 21 in the placebo group], patients who could not complete the study were excluded. At 6 weeks, 74% of patients had no pain in the GTN group as compared to the 29% in the placebo group. In 26% of cases treatment was unsuccessful. At three month follow up there was no early recurrence. The prevalence of headaches was 65% in GTN group [reported by 15 patients] and 24% in placebo group [reported by 5 patients]. Mean pain scores were lower in the GTN group as compared to the placebo group. The use of 0.5% GTN induces healing of chronic anal fissures and may be used as a first line of treatment in patients with chronic anal fissure. Successful treatment may come at the expense of a high incidence of headaches

Nitroglycerine ointment for anal fissure

To determine long term effectiveness of glyceryl trinitrate [GTN] for treatment of anal fissure and to find out its side effects. This study was done on patients who presented with symptoms of anal fissure in colorectal clinic surgical ward 2 JPMC. Total 498 patients were included out of which 237 had acute anal fissure while 261 patients had chronic fissure. All patients received 8 weeks treatment with 0.2% GTN ointment three times daily applied over perianal area. Those patients who developed side effects i.e. headache were offered treatment with 2% diltiazem. After 8 weeks treatment 228 patients of acute anal fissure had complete healing and 9 patients had partial response. In chronic anal fissure, 229 patients completely healed after 8 weeks of treatment while 32 patients were advised further 4 weeks treatment of GTN due to partial healing and out of them 22 patients had complete healing. Thirteen patients had to undergo lateral sphincterotomy. Five patients complained of headache that settled after shifting to treatment with diltiazem ointment. Ten patients developed recurrence of symptoms. GTN proved to be good first line treatment for most of patients with anal fissure. Small group of patients experience recurrence of symptoms and most of them respond to prolong duration of treatment

use of 0.2% glyceryl trinirate oinment for anal fissures

To assess the clinical efficacy of 0.2% glyceryl trinitrate ointment in the management of acute and chronic anal fissures. A prospective clinical study conducted on consecutive patients presented to the surgical clinic of King Khalid University Hospital, Riyadh with acute and chronic anal fissures, from January to December 2003. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. This study comprised 121 patients, six of them were lost to follow-up and 109 [94.7%] of the remaining 115 patients were cured. Of those cured, 13 patients [11.3%] presented with acute and 102 [88.7%] with chronic fissures. There were 98 male and 17 female patients with median age of 41 years [range, 14-70 years]. Complete symptomatic relief was achieved in all patients within one month of therapy. Two patients, with chronic anal fissures presented with recurrent symptoms within one month of the completion of therapy both of them were successfully treated with repeat glyceryl trinitrate course. Treatment had to be terminated in six [5.2%] patients: five [4.3%] experienced intolerable adverse effects and one [0.8%] patient failed to respond. All these patients were successfully treated with lateral internal sphincterotomy. No patient complained of change in continence. Glyceryl trinitrate ointment produces adequate symptomatic control and healing of the anal fissures and can be considered as one of the recommended treatment options

surgical treatment of chronic anal fissure: One year's experience with GTN past

Assessment of the efficacy of topical 0.2% glyceryl trinitrate [GTN] paste in the treatment of chronic anal fissure. Sixty two patients were treated with 0.2% GTN paste and reviewed at 3, 6 and 12 weeks interval to assess efficacy and side effects. At 6 weeks, 72% of patients were treated successfully. In 28% of cases treatment was unsuccessful. At 12 weeks follow up there was no early recurrence. The prevalence of headaches was 70%. The use of GTN induces rapid healing of chronic anal fissures with a 72% healing rate in this study. But balance is required between fissure healing and headache intolerance

Evaluation of side effects, morbidity and mortality rate in patients with acute inferior infarction following the intravenous use of nitroglycerin

Different methods are being used for treatment of acute inferior myocardial [MI] infarction. Intravenous nitroglycerin is one of these methods although with some side effects especially when reperfusion of the artery is impossible. This research was performed to determine the side effects, mortality and morbidity rate associated with the use of this drug in hospitals. This is an existing data study, which was carried out on 1080 patients with inferior MI who were hospitalized in Kashan Shahid Beheshti Hospital. The patients were treated with or without intravenous nitroglycerin during 8 years from 1994-2001. One hundred eighty eight patients with isolated acute inferior MI with no electrocardiographic sign of right ventricular MI or MI of other parts without any history of MI were chosen. Out of 188 patients, 112 patients were treated with intravenous nitroglycerin [TNG[+]] and 76 patients treated without this drug [TNG[-]]. The age range of patients was between 25 to 85 years old [59.84 +/- 10.82] and with a sex distribution of 40 women and 148 men. The mean value of hospitalization period among the TNG[+] group was significantly more than the control group [P= 0.046]. The rate of hospital mortality and morbidity in patients treated with intravenous nitroglycerin was less than the TNG[-] group, although statistically insignificant. The reduction of blood pressure in TNG+ patients was significantly more than the TNG- group [P=0.027]. Sinus bradycardia in patients treated with TNG was significantly less than the TNGgroup [P= 0.037]. Sinus tachycardia in group treated with TNG was more than the TNG-group, however, no statistically significant difference seen [P= 0.434]. There was no statistical difference between two groups when the signs of other types of dysrhythmia were compared. Regarding the observation of more side effects among the patients with acute inferior MI treated with intravenous TNG, more caution is needed when this type of therapy is administered

Nitratos orgánicos en su segundo siglo / Organic nitrates in their second century

Se hizo una revisión actualizada de los nitratos orgánicos que tienen casi un siglo y medio de introducidos en la terapéutica de la cardiopatía isquémica. Este grupo de drogas induce la formación de óxido nítrico en la célula del músculo liso arterial y así provoca un aumento en los niveles de guanosín monofosfato cíclico, que a su vez, reduce las concentraciones citosólicas de ión calcio lo que causa vasodilatación principalmente venosa. La reducción del retorno venoso al corazón disminuye el trabajo cardiaco y el consumo de oxígeno miocárdico. Su eficacia clínica está ampliamente demostrada, por lo que continúan siendo medicamentos de primera línea en el tratamiento de diversas afecciones cardiacas. Un efecto adverso muy importante es la tolerancia, la cual ha llevado a la búsqueda de combinaciones terapéuticas de nitratos para lograr su reducción. No obstante, parece ser que lo fundamental es lograr un período libre de nitratos, reducir la dosis a la mínima y evitar algunas formas farmacéuticas de larga duración que provocan la aparición de este evento. Parece razonable asumir que ocurra tolerancia cruzada entre nitratos, lo que restaría eficacia al tratamiento de las crisis anginosas. Otro efecto adverso es el síndrome de supresión que puede ser causa de un aumento de la frecuencia y gravedad de las crisis isquémicas

Uso de la nitroglicerina local en el tratamiento de la fisura anal / Local application of nitroglycerin in the anal fissure treatment

La fisura anal (FA) es una entidad común, que produce dolor anal en la defecación, en que participa una isquemia relativa del canal anal, asociado a una hipertonicidad esfinteriana. La aplicación tópica de Glicerolato de Trinitrina (GT) produce relajación del esfínter interno, llevando a la cicatrización de la FA en un plazo de 4 a 6 semanas. Se realizó un estudio prospectivo en el que se trataron 19 pacientes con FA con GT al 0,2 por ciento usando en forma tópica tres veces al día. La desaparición del dolor se evidenció en 17 pacientes (89,5 por ciento), en promedio a los 15 días de tratamiento. La cicatrización de la FA ocurrió en 14 pacientes (73,7 por ciento), en promedios a los 22 días. No cicatrizaron 5 pacientes (26,3 por ciento). Este estudio muestra que la mayoría de los pacientes portadores de FA pueden ser tratados con GT al 0,2 por ciento en forma tópica y aquellos en quienes fracasa el tratamiento o presentan intolerancia al medicamento debieran ser sometidos a cirugía convencional

Disfunção endotelial em pacientes submetidos à terapia com nitroglicerina e à intervenção coronária percutânea / Endothelial dysfunction in patients submitted to nitroglycerin therapy and percutaneous coronary interventions

A terapia com nitroglicerina está associada a modificações bioquímicas na vasculatura que podem levar à alterações na função endotelial. De modo análogo, as intervenções coronárias percutâneas causam intensa lesão mecânica na parede vascular que pode determinar disfunção endotelial...

Tratamento da fissura anal com dinitrato de isossorbida tópico: experiência inicial / Treatment of anal fissure with isosorbide dinitrate ointment: initial experience

O objetivo desse estudo prospectivo foi avaliar os resultados do tratamento tópico da fissura anal com dinitrato de isossorbida a 1 por cento, por 5 semanas. Treze pacientes foram tratados no Seviço de Coloproctologia do Hospital do Andaraí-RJ, no período de junho a outubro de 1996. Quatro eram do sexo masculino e a idade média foi de 42 anos. Todos os pacientes apresentavam dor anal. Onze pacientes (84,6 por cento) estavam assintomáticos após 5 semanas de tratamento e em oito (61,5 por cento) a fissura estava cicatrizada. Efeitos colaterais foram relatados em 6 pacientes (46 por cento). A pressäo média de repouso foi, em média, 14 por cento menor na última avaliaçäo. Em nove semanas a cicatrizaçäo das fissuras ocorreu em 77 por cento dos pacientes. Somente dois pacientes (15,4 por cento) foram operados. Conclusäo: o uso tópico de dinitrato de isossorbida pode ser uma alternativa de tratamento da fissura anal