Comparison of topical nifedipine with oral nifedipine for treatment of anal fissure: a randomized controlled trial.

BACKGROUND: Medical sphincterotomy has gained popularity as a treatment for anal fissure. Calcium channel blockers in topical forms could also be appropriate with low adverse effects. OBJECTIVES: This was a prospective randomized controlled trial to compare topical and oral nifedipine in the treatment of chronic anal fissure. PATIENTS AND METHODS: A prospective randomized controlled trial was conducted at two centers of Shahed University. One hundred and thirty patients with chronic anal fissure aged 18 to 60 years managed in our clinics were included in this study. The patients were randomly divided into two groups. Sixty-five patients received topical nifedipine (TN) and the same number received oral nifedipine (ON). RESULTS: Ulcer healing occurred in 43 (73.33%) of topical nifedipine group compared to 29 (49.5%) patients in oral nifedipine, which was significantly different (P < 0.05). Side effects such as headache and flushing in oral nifedipine group were more prevalent than topical nifedipine, which was statistically different. Recurrence rates were the same after six months of follow-up. CONCLUSIONS: Although oral nifedipine can reduce symptom and signs of anal fissure, topical nifedipine has a superior role for anal fissure treatment with higher healing rate and lower side effects.

Frequency of all types of colorectal tumors in the patients referred to selected hospitals in tehran.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide which is not extensively researched in Iran. OBJECTIVES: The present study aims to investigate the epidemiologic characteristics of CRC in patients referred to selected hospitals of Tehran University of Medical Sciences. PATIENTS AND METHODS: In this descriptive-analytic study 218 patients with colorectal cancer were investigated. Data were collected via reviewing recorded pathologic results of patients of these hospitals which then were analyzed by univariant methods. RESULTS: Among 218 patients, 140 (64.2%) were male and 78 (35.8%) were female. Of all patients, 132 (60.0%) suffered from tumors in rectum; 38 (17.4%) in sigmoid; 12 (5.5%) in descending colon; 10 (4.6%) in transverse colon and 26 (11.9%) in ascending colon and cecum. Tumors were well differentiated in 134 patients (61.5%), moderately in 62 cases (28.4%) and poorly differentiated in 22 patients (10.1%). There was no significant difference between males and females regarding the location and degree of tumor differentiation. CONCLUSIONS: Regarding high prevalence of colorectal cancer in Iran and potential environmental and genetic factors, surveillance must be considered for this disease. Its risk factors such as diet, life style and low physical activity should be evaluated and screening should start at younger ages.

Evaluation of patency of arteriovenous fistula and its relative complications in diabetic patients.

PURPOSE: To study the arteriovenous fistula patency, duration of its maintenance, and its relative complications. MATERIALS AND METHODS: One hundred and thirty patients who had undergone hemodialysis during five years (1996 to 2001) were included in this study. The patency rate and complications, including paresthesia, pain induced by ischemia, venous hypertension, infection, erythema, and edema, were assessed. Data were recorded in the pre-designed questionnaire and statistically analyzed using t test. RESULTS: Mean ± standard deviation age of the patients was 58.08 ± 11.73 years (range, 18 to 80 years). Most of the fistulas were created at the left bracheocephalic (58 subjects). Side-to-side technique was the mostly applied technique (99.2%). The fistula patency was 100%, 92.64%, 89.48%, 84.38%, and 83.61% at year 1 to 5, respectively. There was a significant negative correlation between the subjects' age and maintained patency (P = .02). However, no significant difference was observed between the maintained patency and other variables, including gender, location of the fistula, and the type of the technique applied for creation of the fistula (P > .05). CONCLUSION: Diabetes does not have a negative impact on the rate of patency and its duration in arteriovenous fistula. However, further investigations on a larger population are recommended.

The effect of topical nifedipine in treatment of chronic anal fissure.

Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure. A single-blind randomized comparative trial was setup to compare traditional treatment with stool softeners and 2% lidocaine cream against 0.5% nifedipine cream for 4 weeks. 110 patients were included in this study, 60 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded. Healing had occurred in 70% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks treatment (P < 0.005). Recurrence of symptoms occurred in four of healed patients in the nifedipine group and three patients in the control group in two months. The final result of nifedipine application after 12 months follow up was recurrence in 11 patients (26.19%). Mild headache occurred in four patients (6.6%) of the nifedipine group. Patients in the nifedipine group showed significant healing and relief from pain compared with patients in the control group. Recurrence rate with nifedipine use in spite of control of predisposing factors such as constipation was significant. Another finding was low complication rate with this treatment.

Preoperative clinical and paraclinical predictors of choledocholithiasis.

BACKGROUND: Choledocholithiasis is the most common cause of obstructive jaundice and cholangitis and occurs in about 10% of patients with symptomatic gallstone. The aim of this study was to find preoperative and non-invasive tests for predicting common bile duct stones (CBDs). METHODS: Findings of clinical examination, history, laboratory tests and ultrasound (US) in 60 patients with CBDs were compared retrospectively, with 60 patients with gallstones. The data were collected from medical charts. The sensitivity, specificity and positive predictive value (PPV) were determined. RESULTS: The comparison between the two groups showed significant differences in anorexia, itching, dark urine, subicterus (slightly elevated serum bilirubin without clinical evidence of jaundice) and jaundice appearance, increased bilirubin level, aspartate aminotransferase (AST) and alanine aminotranferase (ALT), CBD diameter >6 mm and stone observation under US (P<0.05). The highest specificity (100%) and PPV (100%) were found in dark urine and pale colored stool, history of cholangitis, and icterus. Among paraclinical tests, alkaline phosphatase (ALP) had the highest specificity (72.1%) and PPV (12.5%). Under US, stone observation in CBD was the most important factor with a sensitivity of 94.5%, a specificity of 100% and a PPV of 100%. CONCLUSIONS: The most important factors for predicting CBDs are history of cholangitis and pancreatitis, presence of icterus, dark urine, pale colored stool, elevation of ALP, and sonographic evidence of chledocholithiasis.