Prospective and multicentre study of radiofrequency treatment in anal fistula.

BACKGROUND: The most effective treatment for anal fistula is fistulotomy, but it involves a risk of anal incontinence. To reduce this morbidity, sphincter-sparing treatments have been developed, but their success in real life is often less than 50%. The aim is to determine the clinical healing rate 6 months after radiofrequency treatment. METHODS: We planned to evaluate 50 patients from three French proctology centres. Treatment efficacy was evaluated at 6 and 12 months by means of clinical and magnetic resonance imaging examination. We evaluated morbidity and healing prognostic factors. RESULTS: Fifty patients with a mean age of 51 years (22-82) were included. Eleven patients had a low trans-sphincteric fistula (LTS), 21 patients had a high trans-sphincteric fistula (HTS), eight had a complex fistula and nine had Crohn's disease fistula. After 6 months, 17 patients (34.7%) had a clinically healed fistula, including five (45.5%) with LTS fistula, seven (33.3%) with HTS fistula, one (12.5%) with complex fistula, four (44.4%) with Crohn's disease, with no significant difference between these fistula types (p: 0.142). At 12 months, the healing rate was identical. MRI in 15 out of 17 clinically healed patients showed a deep remission of 73.3% at 12 months. Energy power was associated with the success of the treatment. There was an 8.2% incidence of post-surgical complications with 4.1% being abscesses (one required surgical management). Postoperative pain was minor. No new cases or deterioration of continence have been shown. CONCLUSION: Radiofrequency is effective in 34.7% of the cases as an anal fistula treatment in this first prospective study, with low morbidity and no effect on continence. Clinical healing was deep (MRI) in three-quarters at 1 year. The increase in energy power during the procedure seems to be a key point to be analysed to optimise results.

Opponency of astringent and fat sensations.

In most cultures, people ingest a variety of astringent foods and beverages during meals, but the reasons for this practice are unclear. Many popular beliefs and heuristics, such as high tannin wines should be balanced with fatty foods, for example 'red wine with red meat', suggest that astringents such as pickles, sorbets, wines, and teas 'cleanse' the palate while eating. Oral astringents elicit 'dry, rough' sensations [1], in part, by breaking down mucinous lubricating proteins in saliva [2,3]. The introduction of oral lubricants, including fats, partially diminishes strong astringent sensations [4,5]. Thus, it appears that astringency and fattiness can oppose each other perceptually on an oral rheological spectrum. Most teas, wines, and 'palate cleansers', however, are only mildly astringent and an explanation of how they could oppose the fattiness of meals is lacking. Here, we demonstrate that weakly astringent stimuli can elicit strong sensations after repeated sampling. Astringency builds with exposures [6] to an asymptotic level determined by the structure and concentration of the compound. We also establish that multiple sips of a mild astringent solution, similar to a wine or tea, decrease oral fat sensations elicited by fatty food consumption when astringent and fatty stimuli alternate, mimicking the patterning that occurs during a real meal. Consequently, we reveal a principle underlying the international practice of 'palate cleansing'. Repeatedly alternating samples of astringent beverages with fatty foods yielded ratings of fattiness and astringency that were lower than if rinsing with water or if presented alone without alternation.

[Anal fissure]. / Fissure anale.

Chronic anal fissure is an ischemic ulcer related to hypertonic sphincter. Pain and bleeding are the most common complaints. In first instance, treatment combines laxatives, analgesic and ointments. Topical nitrates represent a challenging alternative to surgery where non-specific approaches failed.