A comparative study for management of fissure in ano with glycerin-trinitrate and lignocaine ointment: a randomized control trial

Background: Anal fissure is a very common benign anorectal disorder with significant morbidity among otherwise healthy individuals. Of all the patients coming to our OPD 15-20% have anal fissure. So there arises need to study the best and most compliant conservative treatment modality.Methods: Study was randomized, prospective, observational and longitudinal including 200 patients of age group 18-60 equally divided in 2 groups. Group A given 0.2% GTN ointment and group B given lignocaine ointment.Results: Better and early and sustained symptomatic relief was noted with GTN compared to lignocaine. 80% cases showed complete healing by 8 weeks with GTN compared to 52% healing with lignocaine. Headache was main side effect with GTN. Recurrence rate was high with lignocaine.Conclusions: Topical GTN has a statistically and clinically significant success rate for fissure healing and pain improvement at 8 weeks compared to lignocaine ointment (80% vs. 52%). It came at the cost of clinically acceptable level of morbidity (headache).

Download Full-text

Comparison of topical agents minoxidil and diltiazem in medical management of anal fissures: a hospital based study

International Surgery Journal ◽

10.18203/2349-2902.isj20175141 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3939 ◽

Cited By ~ 1

Author(s):

Naseer Ahmad Awan ◽

Irfan Nazir Mir ◽

Hila Ahmad Wani ◽

Mir Mujtaba Ahmad

Keyword(s):

Pain Relief ◽

Anal Fissure ◽

Symptomatic Relief ◽

Complete Healing ◽

Double Blind Study ◽

Double Blind ◽

Anal Fissures ◽

Group A ◽

Group B ◽

Local Side

Background: Anal fissures are associated with spasm of the internal anal sphincter and pain. In present study we compared the efficacy of local application of 0.5% minoxidil and 2% diltiazem in symptomatic relief and healing of anal fissures.Methods: In this prospective, randomized, double blind study, a total of 100 patients with anal fissure were recruited, (50 patients in each group). Patients in group A received local applications of ointments containing 0.5% minoxidil, while patients in group B received topical 2% Diltiazem. Healing of anal fissure and symptomatic relief were observed and analyzed.Results: Rates of complete healing of fissure were similar in the two groups (minoxidil 27/50, diltiazem 29/50). Mean (SD) time taken for complete healing was significantly shorter with minoxidil (3.1 weeks as compared to diltiazem (4 weeks). Rates of pain relief were similar in the two groups. Stoppage of bleeding occurred more often with use of minoxidil than with diltiazem. No patient had systemic or local side effects.Conclusions: Treatment with minoxidil helps in faster healing of anal fissures and provides similar symptomatic relief as that of diltiazem.

Download Full-text

Prospective Randomized Study between Open Vs Closed Lateral Anal Internal Sphincterotomy in Patients with Chronic Fissure in Ano

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.36 ◽

2020 ◽

Vol 3 (1) ◽

pp. 167-171

Author(s):

Anand Shanmugaiah ◽

Saravanan Pandian

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Randomized Study ◽

Fissure In Ano ◽

Internal Sphincterotomy ◽

Post Surgery ◽

Significant Difference ◽

Group A ◽

Group B

Background: One of the the most common cause of pain during defecationin young patientsis chronic fissure in ano. Surgical treatment of choice for chronic fissure in ano is internal sphincterotomy. This procedure can be performed by open or closed method. The aim of the study was to compare the closed and open anal internal sphincterotomy in patients admitted in our hospital with chronic anal fissure. Subjects and Methods: 105 patients admitted in department of general surgery with chronic fissure in ano were divided into two groups. 50 patients (Group A) who were treated by closed method and 55 patients (Group B) who were managed by open lateralanal sphincterotomy method. A 3 months follow up done in both post-surgery to observe for pain, bleeding, infection, incontinence, and recurrence. Results: Significant difference was observed in postoperative acute complications between the two methods of internal anal sphincterotomy. Conclusion: Lateral anal sphincterotomy is the treatment of choice for chronic anal fissure, either open or closed method. However, the closed method was observed to have lesserpost operative complication compared to the open method.

Download Full-text

Comparative study of lateral Internal Sphincterotomy verses Topical Glyceryl Trinitrate for treatment of fissure-in-Ano

Annals of King Edward Medical University ◽

10.21649/akemu.v9i4.1366 ◽

2016 ◽

Vol 9 (4) ◽

Author(s):

Ajmal Farooq ◽

Zahid Niaz

Keyword(s):

Anal Fissure ◽

Chronic Anal Fissure ◽

Symptomatic Improvement ◽

Lateral Internal Sphincterotomy ◽

Fissure In Ano ◽

Internal Sphincterotomy ◽

Group A ◽

Topical Glyceryl Trinitrate ◽

Group B

This prospective randomized interventional study was carried in one of surgical unit of Lahore General Hospital Lahore from 1st January 2002 to 30, December 2002 a total number of 100 patients with both acute and chronic anal fissure were taken and randomly divided in two groups. Group A was treated with 0.2% GTN for 6 weeks and Group B was treated with lateral internal closed Sphincterotomy a follow up after 0, 2nd, 61h weeks and even after 6 months carried out. Peak incidence of disease was observed between 30 and 40 years of age with 56 males and 44 females. 24% patients were with acute fissure and 76% with chronic fissure. In this study with 0.2% GTN overall healing rate of 66.66% for acute fissure and 63.15% for chronic anal fissure was observed. GTN was found less effective in healing the fissure but some what good for initial symptomatic improvement in its comparison 100% healing was observed with lateral internal sphincterotomy with only 10% transient incontinence for flatus. So it was concluded that lateral internal sphincterotomy is superior to GTN and is the procedure of choice for fissure in ano.

Download Full-text

Surgical management of anal fissure versus Glyceryl Trinitrate ointment: a comparative prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20182223 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2205

Author(s):

Sandeep Reddy ◽

Krishnaprasad . ◽

Sreeramulu P. N. ◽

Amal Abraham ◽

Praveen G. P. ◽

...

Keyword(s):

Prospective Study ◽

Anal Fissure ◽

Symptomatic Relief ◽

High Rate ◽

Lateral Internal Sphincterotomy ◽

Nitroglycerin Ointment ◽

Internal Sphincterotomy ◽

Skin Tag ◽

Group A ◽

Group B

Background: Anal fissure is common condition in general population which cause severe pain at the anal region while defecation and associated with bleeding. These symptoms cause reduction in quality of life with considerable morbidity. The objective of this study was to compare the difference in outcome between open lateral anal sphincterotomy and application of topical 0.2% nitroglycerin ointment for the treatment of chronic anal fissure and their individual efficacy.Methods: 68 cases with a clinical diagnosis of anal fissure were recruited in the study. All selected patients met with inclusion criteria. Thus, selected cases were assigned to one of the other groups by odd and even method. Group A was managed conservatively using topical 0.2% nitroglycerin ointment, whereas Group B underwent open lateral anal sphincterotomy. Both groups were followed up at 3 week, 6 weeks, and 12 weeks, after the treatment.Results: Among all the 68 patients, all patients had come with complaint of pain whereas 31 patients had bleeding per rectum along with pain. On clinical examination, hypertonic anal sphincter elicited in 47 patients, sentinel skin tag was noted in the 23 patients. Group A included 34 patients treated with topical 0.2% nitroglycerin ointment and group B included 34 patients who underwent lateral internal sphincterotomy. In group A, 25 (73.5%) patients treated successfully, 9 (26.4%) patients were uncured who underwent lateral anal sphincterotomy, with no fresh complaints during follow up. By contrast, all patients in group B were successfully treated and only one (0.03%) patient came with unexplained discomfort and one patient suffered from flatus incontinency.Conclusions: This prospective study, demonstrates that open lateral internal sphincterotomy is superior to topical nitroglycerin application in the treatment of anal fissure with good symptomatic relief, high rate of healing with very low rate of early incontinence. Patients who are not willing to undergo surgery the glycerin trinitrate ointment can be used as medical line for fissure in ano.

Download Full-text

Stone Cone® in ureteroscopic ballistic lithotripsy of proximal ureteral stones

Urologia Journal ◽

10.1177/039156030807500407 ◽

2008 ◽

Vol 75 (4) ◽

pp. 237-240 ◽

Cited By ~ 2

Author(s):

M. Arancio ◽

S. Guglielmetti ◽

A. Delsignore ◽

A. Landi ◽

C. Marchetti ◽

...

Keyword(s):

The Other ◽

Ureteral Stent ◽

Ureteral Stones ◽

Shockwave Lithotripsy ◽

Boston Scientific ◽

Safety And Efficacy ◽

Group A ◽

Clinically Significant ◽

Group B ◽

The Cost

Stone Cone® (Microvasive-Boston Scientific Corp, USA) is a device which prevents retrograde calculus migration during endoscopic ureterolithotripsy. We have studied the safety and efficacy of this device in endoscopic ureterolithotripsy with ballistic energy in proximal ureteral stones. Materials and Methods. From 01/02/2006 to 01/02/2008 we carried out 36 ureterorenoscopies (URS) for proximal ureteral stones (average age: 46, range: 15–73). A ballistic energy was used for stones fragmentation. In 18 patients (Group A) we carried out URS with the aid of Stone Cone®, which was not used in the other 18 patients (Group B). Semirigid 8 Ch or 10 Ch Storz ureteroscope and ballistic lithotriptor Swiss Lithoclast Master EMS® were used. In cases of migration, edema, and ureteral damage, a ureteral stent was used. Results. In Group B patients (URS performed without Stone Cone®) the migration of the whole stone, or of clinically significant fragments, occurred 8 times (45%). All of these patients underwent external shockwave lithotripsy (ESWL) at a center equipped with a lithotriptor. A ureteral stent was placed in 14 cases (78%). In Group A, the migration of a stone requiring ESWL treatment occurred only once (5%). The ureteral stent was placed 8 times (45%). We had no significant complications during the procedure. Conclusions. The Stone Cone® is a safe and easy-to-use device. The cost of this device can be balanced by the reduction of postoperative ESWL treatments for lithiasic fragments pushing up into the kidneys (p<0.01), and of ureteral stent applications at the end of the procedure (p<0.05).

Download Full-text

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

Proceedings of Shaikh Zayed Medical Complex Lahore - October to December ◽

10.47489/p000s344z774mc ◽

2020 ◽

Vol 34 (4) ◽

pp. 70-75

Author(s):

Mukhtiar Ahmed ◽

Jamil Akhter Munir Ahmad ◽

Muhammad Ali Sheikh ◽

Tariq Latif ◽

Abdul Qayyum

Keyword(s):

Glyceryl Trinitrate ◽

Anal Fissure ◽

Symptomatic Relief ◽

Paediatric Population ◽

Paediatric Surgery ◽

Exact Etiology ◽

Group A ◽

Bleeding Per Rectum ◽

Group B

Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims & Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

Download Full-text

Does Systematic Preliminar Colour Doppler Study Reduce Kidney Biopsy Complication Incidence?

International Journal of Nephrology ◽

10.4061/2011/419093 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5

Author(s):

Antonio Granata ◽

Fulvio Floccari ◽

Angelo Ferrantelli ◽

Ugo Rotolo ◽

Luca Di Lullo ◽

...

Keyword(s):

Kidney Biopsy ◽

Colour Doppler ◽

Doppler Examination ◽

Doppler Study ◽

Group A ◽

Clinically Significant ◽

Perinephric Hematoma ◽

Group B ◽

Biopsy Complications ◽

Optimal Site

While ultrasonography is widely performed prior to biopsy, colour Doppler examination is often used only to discover post-biopsy complications. Aim of this paper was to evaluate the usefulness of colour Doppler examination in planning the optimal site of puncture for renal biopsy. Present analysis includes 561 consecutive percutaneous renal biopsies performed from the same operator. Until August 2000 332 biopsies were performed after a preliminary ultrasonography (Group A). From September 2000, 229 patients underwent even a preliminary colour Doppler study (Group B). Postbioptic bleeding were categorized as minor (gross hematuria or subcapsular perinephric hematoma < 4 cmq of greater diameter) or major (hematoma >4 cmq of greater diameter; requiring blood transfusion or invasive procedures; leading to acute renal failure, urine tract obstruction, septicaemia, or death). Major complications were seen in 2.1% in Group A while in Group B only one case was reported (0.43%). Minor clinically significant complications occur in 7.8% in Group A and in 3.4% of cases of Group B. Colour Doppler reduced drastically the incidence of complications observed before the introduction of routine colour Doppler examination prior to biopsy. In our opinion, these data support the use of preliminary colour Doppler study when a biopsy is planned.

Download Full-text

Modified Lift Versus Cutting Seton for Transphincteric Fistula -Experience at Tertiary Care Hospital

10.53350/pjmhs2115123257 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3257-3260

Author(s):

Muhammad Najam Iqbal ◽

Ashfaq Nasir

Keyword(s):

Comparative Study ◽

Anal Incontinence ◽

Complete Healing ◽

Fistula Tract ◽

Fistula Closure ◽

Fistula In Ano ◽

Group A ◽

Prospective Comparative Study ◽

Cutting Seton ◽

Group B

Background: Fistula in ano is a common disease which has high recurrence rate and high fecal incontinence rate after surgery. We compared modified LIFT (Ligation of the intersphincteric fistula tract (LIFT) through lateral approach ) with cutting seton for transphincteric fistula. Aim: This study is aimed at which procedure is better with respect to postoperative complications Study design: It was a prospective comparative study. Methods: This was a prospective comparative study from 01-01-2019 to 30-06-2021 which was conducted on 50 patients who presented with transsphincteric fistula in ano (FIA) in surgical ward of Bahawal Victoria Hospital Bahawalpur. Patients were divided into two groups .Patients of Group A underwent modified lift procedure and patients of group B underwent cutting seton procedure. Data was collected on a proforma which included patients’ name ,age ,sex, age group, comorbid disease like diabetes mellitus ,chronic liver disease, cardiovascular disease and chronic renal failure, fistula tract involving less than 50% or more than 50% external sphincter ,procedure done, healing time of wound, complications like recurrence and incontinence. Patients were followed for 6 months for healing rate ,recurrence and incontinence. Data was analysed on spss 22 version Results: In Group A, complete healing (fistula closure without recurrence) was achieved in 20 patients (80%) out of 25. There was no case of anal incontinence after the procedure. 5 (20%) patients experienced recurrence in 6 months . In Group B, complete healing (fistula closure without recurrence) was achieved in 21 patients (84%), in 6 months follow up . 4(16%) patients were diagnosed as a case of anal incontinence. There were 4 (16%) patients with recurrence. Conclusion: Modified LIFT is better in terms of incontinence where as cutting seton is better in terms of recurrence.it is suggested that for high lying fistula modified LIFT is better procedure and for low lying fistula involving less than 50% sphincter cutting seton is better procedure.. Keywords: Modified LIFT (ligation of ineter sphincteric fistula tract) ,Cutting seton , transphincteric fistula.

Download Full-text

Antibiotic usage rates in bacterial versus nonbacterial diseases: a new way to monitor hospital-acquired infections in children: a retrospective case analysis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20204540 ◽

2020 ◽

Vol 7 (11) ◽

pp. 2176

Author(s):

Jayendra R. Gohil ◽

Chintu C. Chaudary ◽

Sheena D. Sivanandan

Keyword(s):

Antibiotic Usage ◽

Retrospective Case ◽

Hospital Acquired Infections ◽

Group A ◽

Added Benefit ◽

Reduction Of Mortality ◽

Group B ◽

The Cost ◽

Hospital Acquired ◽

Selection Of

Background: While treating children, the selection of antibiotics, when indicated, should be from the point of its effectiveness, safety, suitability, and cost. However, this flow of action does not take place in all cases. Aim of the study was to assess the antibiotic usage in admitted children and mortality.Methods: The case records between January to July 2012 in children wards was evaluated for the use of antibiotics. Patients were grouped into; group A- ‘must use' antibiotic in all, and group B- where antibiotics are not indicated.Results: There were 1852 admissions, including 719 Thalassemia cases. Antibiotic usage was 63% in 1133 cases after excluding thalassemia. Out of 1133 cases, 423 were in group A and 710 cases were in group B. In group B the antibiotic usage was 41%. The mortality was 6.6% and 4.8% in group A and B. Inside group B, mortality was 5.9% versus 4.0% in those administered versus not administered, antibiotics.Conclusions: There was no increase in mortality in patients in whom antibiotics were not prescribed, and no added benefit of prescribing antibiotics was observed in nonbacterial group B disease patients. The mortality was similar in both the groups. In nonbacterial group B, the antibiotics did not offer any advantage in the reduction of mortality, but increased the cost of the treatment, and possibly the chance of development of drug resistance and adverse events. When analysing the hospital antibiotic usage, only the nonbacterial diseases should be considered to get a true picture of the inappropriate prescription of antibiotics.

Download Full-text

Comparative study of endoscopic tympanoplasty and conventional tympanoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204179 ◽

2020 ◽

Vol 6 (10) ◽

pp. 1804

Author(s):

Priyanka Aggarwal ◽

Barjinder Singh Sohal ◽

J. P. Goyal

Keyword(s):

Success Rate ◽

Cost Effective ◽

Patient Comfort ◽

Hearing Improvement ◽

Post Operation ◽

Group A ◽

Group B ◽

The Cost ◽

Results Of Surgery ◽

Endoscopic Tympanoplasty

Background: To compare the results of endoscopic tympanoplasty with that of conventional tympanoplasty and to evaluate and compare the graft uptake in both of these methods. The study was done to evaluate the improvement in hearing after tympanoplasty and the problems faced while doing the endoscope assisted tympanoplasty.Methods: Between July 2010 to June 2013, 50 patients underwent tympanoplasty, 25 were endoscope assisted (group A) and 25 were microscope assisted (group B). Results of surgery were compared at the end of three and six months post operation.Results: The success rate in terms of graft uptake rate was 88% with endoscope assisted tympanoplasty and 84% with other microscope assisted tympanoplasty. Overall success rate was 86.0%. Mean hearing improvement was (16.24±10.21 dB) and (14.28±7.10 dB) in group A and group B respectively.Conclusions: Tympanoplasty with its visualization of hidden corners, justifies tympanoplasty by using endoscope in selected cases with comparable improved results in the literature. Furthermore, the cost of the endoscope is much less (about 10%) in comparision to operating microscope, making it more cost effective in developing countries. However, the endoscope cannot be employed in every case as one hand is blocked. In terms of Patient comfort, the endoscope assisted outnumbers the benefits of other conventional methods.

Download Full-text