Résumé
Objective: To determine the effectiveness of glyceryl trinitrate [GTN] in the treatment of chronic anal fissure
Study Design: Prospective Study
Place and Duration of Study: Surgical Outpatient department, Khyber Teaching Hospital, Peshawar 06 months [July 2009 to Jan 2010]
Materials and Methods: Six months prospective study was carried out at surgical out patient department of Khyber teaching Hospital, Peshawar. Sixty cases of chronic anal fissure not willing for surgical procedure and fulfilling the inclusion criteria were enrolled. Pain was documented using visual analogue scale. Patients were started treatment with local application of Glyceryl Trinitrate [GTN] gel, twice daily and reassessed after 04 weeks and 08 weeks of treatment respectively. Pain and complications were documented
Results: There were 33 [55%] females and 27 [45%] males with mean age of 37. At presentation all patients [100%] perceived pain as severe pain on Visual Analogue Scale. 80% patients had significant relief with GTN application for a period of 02 months. The commonest complication was constipation [26%], followed by infection [10%], sentinel pile [6%] and fistula [5%]
Conclusion: Glyceryl trinitrate is very effective in the treatment of chronic anal fissure and is the drug of choice in conservative treatment of anal fissures and in patients with contraindications for surgery
Résumé
To determine the frequency of peripheral polyneuropathy in patients having diabetes mellitus with symptoms of polyneuropathy using electrodiagnostic procedure. Observational descriptive study. Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. June 2008 to June 2009 [one year]. Sixty three patients of diabetes mellitus having symptoms of peripheral polyneuropathy fulfilling the inclusion criteria were sampled by purposive sampling. Informed consent was taken. Their demographic data and common symptoms were recorded. All patients underwent Electrodiagnostic procedures for the presence or absence of polyneuropathy, using nerve conduction studies by recording amplitudes, velocities and latencies of minimal two [sural, peroneal] and maximum six nerves. Electromyography was performed only in patients with abnormalities in nerve conduction findings or conditions other than polyneuropathy. Frequencies as percentages were calculated for the presence or absence of polyneuropathy, type of polyneuropathy, associated symptoms and other related diagnosis [if any]. There were thirty three males [52.4%] and thirty female [47.6%]. Forty one [65%] patients had confirmed polyneuropathy on electrodiagnosis, out of which forty patients [97.6%] had axonal polyneuropathy, only one patient [2.4%] had demyelinating polyneuropathy. Twenty two had no polyneuropathy [35%], out of which 65% had other diagnosis like Carpal Tunnel Syndrome [CTS], Radiculopathy and other Compression neuropathies. Majority of symptomatic diabetic patients actually had polyneuropathy. Electrodiagnostic studies are a sensitive tool for early detection of peripheral polyneuropathy, its types and extent