ABSTRACT
INTRODUCTION: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. METHODS: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. CONCLUSIONS: In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.
Subject(s)
Colorectal Surgery , Fissure in Ano , Humans , Fissure in Ano/diagnosis , Fissure in Ano/surgery , Lidocaine/therapeutic use , Colon , Chronic Disease , Anal Canal/surgery , Treatment OutcomeABSTRACT
Carcinoids are rare tumour of neuroendocrin origin, characterized by argyrophylic silver stain reaction, positive immunohistochemical reaction with neuron-specific markers, a typical growth pattern; they can express different peptides and biogenic amines. Gastric carcinoid tumours have been classified on the basis of susceptibility to gastric trophic stimulus and characteristics mucosal surrounding into 3 different types. This classification is important with respect to therapeutic strategy (type adapted treatment), but the option of endoscopic or surgical treatment is influenced by the impossibility to distinguish clearly the benignity or malignity of these lesions. A review of international literature and a rare case of gastric carcinoid tumour associated with chronic athrophic gastritis, developed in a female 65-years old, with anaemia and treated by subtotal gastrectomy, are presented.
