RESUMO
Chronic anal fissures are a painful condition frequently seen in general practice, with an incidence of 2,5/1000 per year. According to the practice guidelines of the Dutch College of General Practitioners, isosorbide dinitrate 1% ointment (ISDN) is the treatment of first choice for chronic anal fissures. Systemic side-effects such as headache are reported in 27% of all cases. This side effect in combination with the frequent application of ISDN (4-6 times daily) leads to a low compliance for this therapy. A meta-analysis of the Cochrane Collaboration showed similar efficacy of diltiazem compared to ISDN. Diltiazem has several advantages: the application frequency is only twice daily, no systemic side-effects have been reported, the total costs of treatment are lower than the costs of ISDN and a standard preparation of diltiazem ointment is available. Therefore, diltiazem 2% ointment should be the first line treatment for chronic anal fissures.
Assuntos
Diltiazem/uso terapêutico , Fissura Anal/tratamento farmacológico , Dinitrato de Isossorbida/uso terapêutico , Análise Custo-Benefício , Diltiazem/administração & dosagem , Diltiazem/efeitos adversos , Diltiazem/economia , Humanos , Dinitrato de Isossorbida/administração & dosagem , Dinitrato de Isossorbida/efeitos adversos , Dinitrato de Isossorbida/economia , Pomadas , Cooperação do Paciente , Resultado do TratamentoRESUMO
An 18-year-old male presented at the casualty department with acute right upper abdominal pain. Laboratory examinations showed no abnormalities apart from a mildly elevated leukocyte count. Ultrasound examination revealed hydrops of the gallbladder, with thickening of the wall, with no indication of gallstones. Laparoscopy revealed a necrotic gallbladder due to torsion. The gallbladder was successfully removed. Torsion of the gallbladder is a rare condition, in which the organ twists on its longitudinal axis. It is found primarily in patients under 18 years or over 65 years of age. Laboratory and radiological investigations usually reveal non-specific abnormalities, which means that a correct diagnosis is made preoperatively in < 10% of patients. Treatment of choice is an emergency cholecystectomy. The prognosis is excellent with adequate treatment.