A multi-center, randomized, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy and safety of glyceryl trinitrate (GTN) ointment in the treatment of anal fissure.</p><p><b>METHODS</b>In this multi-center, randomized, double-blind and placebo-controlled trial, 240 chronic anal fissure patients from 7 clinical centers were randomized to receive eight-week treatment with GTN ointment (treatment group) or vaseline ointment (control group) respectively. Healing rate, visual analogue score (VAS), maximum anal resting pressure (MARP) and adverse reactions were recorded and compared.</p><p><b>RESULTS</b>A total of 221 patients (92.1%) finished the trial, including 114 patients in treatment group (95.0%, 114/120) and 107 in control group (89.2%, 107/120). At the endpoint of treatment (56 d), 90 patients in treatment group (78.9%, 90/114) healed completely compared to 31 patients in control group (29.0%, 31/107), and decrease rates of VAS in the two groups were (94.8±15.7)% and (61.2±35.7)% respectively, both differences were statistically significant (P<0.01). MARP after first administration was (20.2±18.5) mm Hg in treatment group (n=12) and (7.1±14.7) mm Hg in control group (n=6), which was not significantly different (P=0.152). Adverse reaction incidence was higher in treatment group (42.1% vs. 9.3%, P<0.05), while these adverse reactions were mainly headache and fullness in head, which were self-limiting.</p><p><b>CONCLUSION</b>GTN ointment can effectively promote healing and relieve pain in anal fissure with safety and tolerance.</p>

Delorme procedure for full-thickness rectal prolapse: a report of 25 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the use of Delorme procedure for full-thickness rectal prolapse.</p><p><b>METHODS</b>A series of 25 patients with full-thickness rectal prolapse were treated by Delorme procedure in four institutions between March 2005 and June 2010. The clinicopathological data were analyzed retrospectively.</p><p><b>RESULTS</b>There were 9 males and 16 females. The mean age was 52(46-72) years old. All the procedures were successfully performed. There were no perioperative deaths. The mean operative time was 65(45-150) min. The intraoperative bleeding was 58(20-200) ml. The mean length of hospital stay was 8.5(5-14) days. Anastomosis dehiscence occurred in 1 patient at post-operative day 7 who was managed under anesthesia. Minor complications occurred in 8(32%) patients, including urinary retention(n=3), intractable pain(n=1), and bowel obstruction(n=4). The follow up time ranged from 2 to 6 years with a median of 3.5 years. Prolapse recurrence was observed in 1(4%) patient during the follow up. The remission rates of fecal incontinence, constipation, bleeding were 37.5%(6/16), 45.5%(5/11), and 15.4%(2/11), respectively. The Wexner incontinence score significantly decreased (median, 5.0 vs. 9.0, P<0.01). The resting pressure and maximum squeeze pressure increased significantly after surgery, while the initial volume and maximal tolerance volume decreased significantly(All P<0.01).</p><p><b>CONCLUSIONS</b>Delorme procedure is safe and easy to perform. The anorectal function is improved after surgery. Therefore it should be considered the procedure of choice for rectal prolapsed.</p>

Oxaliplatin/5-fluorouracil/leucovorin [FOLFOX4] regimen as an adjuvant chemotherapy in the treatment of advanced jejunal adenocarcinoma: a report of 2 cases

To present our clinical experience of 5-fluorouracil/leucovorin/oxaliplatin [FOLFOX4] regimen administered as an adjuvant chemotherapy to 2 patients with advanced jejunal adenocarcinoma. Case Presentation and Intervention: A 55-year-old woman presented with recurrent upper abdominal pain, nausea and vomiting. A small bowel series as well as the abdominal computed tomography scan revealed an irregular narrowing lesion at the proximal jejunum. The patient then underwent an exploratory laparotomy and the jejunal adenocarcinoma with localized peritoneal metastasis was found [R0 resection, T3N1M1, stage IV]. Chemotherapy with FOLFOX4 regimen of 12 cycles was initiated after the curative resection. No adverse event was observed during the period of chemotherapy. She has been well without evidence of recurrence for over 20 months postoperatively. The second case was a 77-year-old female presenting with mechanical ileus. Surgical exploration revealed a proximal jejunal adenocarcinoma with regional lymph node involvement [R0 resection, T3N1M0, stage III]. She also received the FOLFOX4 chemotherapy of 12 cycles with an uneventful course. No obvious toxicity developed except for temporary grade I peripheral neuropathy and skin eruption. This patient has survived well and has been free of this disease for over 12 months since the operation. This report showed that adjuvant chemotherapy with FOLFOX4 regimen seems effective and well tolerated in these 2 patients with advanced jejunal adenocarcinoma. Further investigation of a large number of patients with long-term follow-up is needed to confirm these findings

Comparison of efficacy between procedure for prolapse and hemorrhoids and open hemorrhoidectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the results of procedure for prolapse and hemorrhoids (PPH) and open hemorrhoidectomy.</p><p><b>METHODS</b>A standard questionnaire was given to all patients after PPH or open hemorrhoidectomy from March 2001 to March 2004. In combination with proctological examination, the results including symptoms relief and recurrence were compared between the two groups.</p><p><b>RESULTS</b>There were 184 effective questionnaires, including 96 cases in PPH group and 88 in open hemorrhoidectomy group. PPH and open hemorrhoidectomy both relieved prolapse (92.7% vs 96.8%, P=0.282), bleeding (91% vs 81%, P=0.241) and pain (91.7% vs 91.5%, P=0.977). There were no statistical differences in the overall complication rate (30.2% and 29.5%, P=0.923) and recurrence rate (21.8% vs 20.5%, P=0.814) between the two groups. The overall satisfactory degree was 87.5% in PPH group and 84.8% in open hemorrhoidectomy group (P=0.218).</p><p><b>CONCLUSION</b>PPH is a safe and effective option for prolapsed hemorrhoids compared with open hemorrhoidectomy.</p>