Subject(s)
Bezoars/diagnosis , Bezoars/surgery , Duodenum/surgery , Stomach/surgery , Adolescent , Depressive Disorder/complications , Depressive Disorder/diagnosis , Endoscopy, Gastrointestinal/methods , Female , Follow-Up Studies , Humans , Laparotomy/methods , Risk Assessment , Severity of Illness Index , Syndrome , Treatment OutcomeABSTRACT
INTRODUCTION: The anal fissure is a linear tear in the anal canal mucosa. If healing fails, it evolves into a chronic anal fissure (CAF). This is one of the most frequent proctologic problems affecting younger patients, altering their social and work life. As it is disabling disease, it causes a socioeconomic problem and, hence, it is important to make a proper diagnosis and apply a rapid and efficient treatment.At present, there are different therapeutic options, both medical and surgical. Among the first, there are several options that relax the anal sphincter. One of the options which are most used is the 0.2% Glycerol Trinitrate (GTN) ointment, there being some randomized and controlled studies reporting 48% and 69% healing rates and other studies with comparable results against surgery.The objective was to know the results of the GTN ointment, so as to avoid surgery, and the probable permanent section of the internal anal sphincter. MATERIAL AND METHODS: Topical Glycerol Trinitrate ointment 0.2% was used twice a day during two weeks. All patients diagnosed with CAF who met the inclusion criteria participated in this study for a one-year period, from February 2007 to January 2008. Two controls were carried out, one at the end of the treatment to verify healing and absence of symptoms, and the other after two months to check recidivism. RESULTS: There were 19 female patients (63.3%) and 11 male patients (36.7%). The average age was 34.87 years, with higher prevalence between 21 and 40 years (50%) and minor prevalence between 41 and 50 years (13.3%). The most frequent symptoms found were the association of anal pain with rectal bleeding in 66.6% of the patients, followed by isolated rectal bleeding and anal pain in 23.3% and 10% of cases, respectively. The most common localization of the CAF was the posterior midline in 63.3% of patients, followed by the anterior midline in 16.7% of patients, and by both midlines in 16.7% of cases. Four of the 30 patients included were lost. All the symptoms vanished in 73% (19)of the 26 remaining patients and symptoms persisted to a lower degree in 27% (7).Headache was an adverse effect in three patients. The control performed after 2 weeks of treatment evidenced partial and complete cicatrization of the fissure in 22 patients (84.6%) and persistence in 4 patients (15.4%). The final control performed after 2 months on the 18 patients who attended evidenced healing of the fissure in 16 (69.6%) and recidivism in 2 (8.7%). CONCLUSIONS: The following conclusion was drawn topical Glycerol Trinitrate 0.2% ointment, applied twice a day during two weeks, is effective in the treatment of chronic anal fissure, with a 69.9% success rate after two months of follow-up. Consequently, it must be considered as an alternate therapy in the treatment of CAF.
Subject(s)
Fissure in Ano/drug therapy , Nitroglycerin/therapeutic use , Administration, Topical , Adolescent , Adult , Chronic Disease , Female , Hospitals , Humans , Male , Middle Aged , Ointments , Prospective Studies , Young AdultABSTRACT
INTRODUCCIÓN: La fisura anal es un desgarro lineal de la mucosa del canal anal. Cuando la curación falla progresa a fisura anal crónica (FAC). La FAC es un problema proctológico frecuente, afecta mayormente a pacientes jóvenes, es incapacitante, por lo que es importante un diagnóstico adecuado y un tratamiento rápido y eficaz. Actualmente existen diferentes opciones terapéuticas, médicas y quirúrgicas. Dentro de las primeras existen varias opciones que producen relajación del esfínter anal. Una de las opciones más usadas es el ungüento de Trinitrato de Glicerol (TNG) al 0.2 por ciento, conalgunos estudios randomizados y controlados que reportan tasas de curación entre 48 y 69 por ciento y otros con resultados equiparables comparados con la cirugía. Nuestro objetivo fue conocer los resultados del ungüento de TNG evitando la cirugía yla probable sección permanente del esfínter anal interno. MATERIAL Y MÉTODOS: se utilizó Trinitrato de Glicerol al 0.2 por ciento en ungüento tópico, 2 veces al día durante 2 semanas. En todos los pacientes con diagnóstico de FAC, que cumplían los criterios de inclusión, en el periodo, de febrero de 2007 a Enero de 2008.Se realizaron dos controles, uno al término del tratamiento para verificar cicatrización y desaparición de sintomatología y el otro a los 2 meses para constatar recidiva. RESULTADOS: Ingresaron al estudio 30 pacientes, 19 mujeres (63.3 por ciento) y 11 varones (36.7 por ciento). La edad promedio fue de 34.87 años, con mayor prevalencia entre 21 y 40 años (50 por ciento) ycon menor entre 41 y 50 (13.3 por ciento). La sintomatología más frecuentemente encontrada fue la asociación de dolor anal y rectorragia en 66.6 por ciento, seguida de rectorragia y dolor anal aislados en 23.3 por ciento y 10 por ciento respectivamente. La localización más frecuente de la FAC fue la línea media posterior en 63.3 por ciento, seguida de la línea media anterior en 16.7 por ciento y ambas en16.7 por ciento...
INTRODUCTION: The anal fissure is a linear tear in the anal canal mucosa. If healing fails, it evolves into a chronic anal fissure (CAF). This is one of the most frequent proctologic problems affecting younger patients, altering their social and work life. As it is disabling disease, it causes a socioeconomic problem and, hence, it is important to make a proper diagnosis and apply a rapid and efficient treatment. At present, there are different therapeutic options, both medical and surgical. Among the first, there are several options that relax the anal sphincter. One of the options which are most used is the 0.2 per cent Glycerol Trinitrate (GTN) ointment, there being some randomized and controlled studies reporting 48 per cent and 69 per cent healing rates and other studies with comparable results against surgery. The objective was to know the results of the GTN ointment, so as to avoid surgery, and the probable permanent section of the internal anal sphincter. MATERIAL AND METHODS: Topical Glycerol Trinitrate ointment 0.2 per cent was used twice a day during two weeks. All patients diagnosed with CAF who met the inclusion criteriaparticipated in this study for a one-year period, from February 2007 to January 2008. Two controls were carried out, one at the end of the treatment to verify healing and absence of symptoms, and the other after two months to check recidivism. RESULTS: There were 19 female patients (63.3 per cent) and 11 male patients (36.7 per cent). Theaverage age was 34.87 years, with higher prevalence between 21 and 40 years (50 per cent) and minor prevalence between 41 and 50 years (13.3 per cent). The most frequent symptoms found were the association of anal pain with rectal bleeding in 66.6 per cent of the patients, followedby isolated rectal bleeding and anal pain in 23.3 per cent and 10 per cent of cases, respectively. The most common localization of the CAF was the posterior midline in 63.3 per cent of patients, ...
