Long-term follow-up of chronic anal fissure (CAF) on diltiazem 2% using a telephone questionnaire. Do results change?

INTRODUCTION: Calcium channel blockers have an excellent effectiveness in the conservative management of chronic anal fissure (CAF). OBJECTIVES: To assess the long-term results of management with diltiazem 2% ointment using a telephone questionnaire. METHODS: A descriptive, retrospective study from March 2004 to March 2011 in patients with CAF on diltiazem 2%, 3 applications daily for 4-6 weeks. Starting at 12 months a questionnaire was administered over the phone by medical staff outside the surgery department to record socio-demographic data, predominant manifestations, and response to diltiazem on a 5-point scale measuring symptom relief (1 = poorest, 5 = best). Patients with therapy failure were referred to surgery. RESULTS: The study was completed for 166 patients with a mean age of 54.1 years. CAF was posterior in 82.3% of subjects. Diltiazem tolerability was excellent with only 4 adverse event cases (3 skin irritation, 1 hypotension). We obtained symptom relief in 62.1% of patients and CAF healing in 51.2%, and referred 33.7% to surgery. The questionnaire showed that 74.1% of patients had used only 2 applications daily, and that results were better with an increased number of applications, albeit without statistical significance. CONCLUSIONS: The telephone questionnaire showed symptom relief for 62% and healing for 51.2% of patients with CAF on diltiazem 2%, which should be considered first-choice for the conservative management of this condition.

Seguimiento a largo plazo de la fisura anal crónica (FAC) tratada con diltiazem 2% mediante un cuestionario telefónico. ¿Cambian los resultados? / Long-term follow-up of chronic anal fissure (CAF) on diltiazem 2% using a telephone questionnaire. Do results change?

INTRODUCCIÓN: los antagonistas del calcio son fármacos con una excelente efectividad en el tratamiento conservador de la fisura anal crónica (FAC). OBJETIVOS: evaluar los resultados a largo plazo del tratamiento con pomada de diltiazem al 2% mediante un cuestionario telefónico. MÉTODOS: estudio descriptivo y retrospectivo desde marzo de 2004 a marzo de 2011 de pacientes con FAC y tratados con diltiazem 2%, 3 aplicaciones diarias, durante 4-6 semanas. A partir de los 12 meses se efectuó un cuestionario telefónico por personal médico ajeno al Servicio de Cirugía recogiendo datos sociodemográficos de los pacientes, sintomatología predominante, respuesta al diltiazem mediante una escala de alivio sintomático del 1 al 5 (1 = muy malo, 5 = muy bueno). Los pacientes con fracaso terapéutico se derivaron a cirugía. RESULTADOS: el estudio se completó en 166 pacientes con una edad media de 54,1 años. La localización de la FAC fue posterior en el 82,3%. La tolerancia al diltiazem fue excelente, con sólo 4 casos de efectos adversos (3 por irritación dérmica y 1 por hipotensión). Obtuvimos un alivio sintomático del 62,1% y curación de la FAC en un 51,2%, remitiendo un 33,7% a cirugía. El cuestionario evidenció que el 74,1% de los pacientes utilizó sólo dos aplicaciones al día y que a mayor número de aplicaciones mejoraban los resultados, sin alcanzar significación estadística. CONCLUSIONES: el cuestionario telefónico evidencia un alivio sintomático del 62% y una curación del 51,2% de la FAC con diltiazem 2% debiendo ser considerada como primera opción en el manejo conservador de la misma

INTRODUCTION: Calcium channel blockers have an excellent effectiveness in the conservative management of chronic anal fissure (CAF). OBJECTIVES: To assess the long-term results of management with diltiazem 2% ointment using a telephone questionnaire. METHODS: A descriptive, retrospective study from March 2004 to March 2011 in patients with CAF on diltiazem 2%, 3 applications daily for 4-6 weeks. Starting at 12 months a questionnaire was administered over the phone by medical staff outside the surgery department to record socio-demographic data, predominant manifestations, and response to diltiazem on a 5-point scale measuring symptom relief (1 = poorest, 5 = best). Patients with therapy failure were referred to surgery. RESULTS: The study was completed for 166 patients with a mean age of 54.1 years. CAF was posterior in 82.3% of subjects. Diltiazem tolerability was excellent with only 4 adverse event cases (3 skin irritation, 1 hypotension). We obtained symptom relief in 62.1% of patients and CAF healing in 51.2%, and referred 33.7% to surgery. The questionnaire showed that 74.1% of patients had used only 2 applications daily, and that results were better with an increased number of applications, albeit without statistical significance. CONCLUSIONS: The telephone questionnaire showed symptom relief for 62% and healing for 51.2% of patients with CAF on diltiazem 2%, which should be considered first-choice for the conservative management of this condition

Evisceración vaginal. Abordaje abdominal y reparación con malla sintética / Vaginal evisceration. Abdominal approach and synthetic mesh repair

La evisceración vaginal espontánea es un fenómeno raro en la práctica clínica diaria. Se han publicado más de 70 casos hasta la actualidad desde que McGregor comunicara el primer caso a comienzos del siglo pasado. La situación ocurre generalmente en pacientes posmenopáusicas con hipoestrogenismo asociado a cirugía ginecológica previa. Recientemente, se ha descrito también en situaciones no ginecológicas tras una proctectomía perineal. Presentamos un nuevo caso de evisceración vaginal espontánea en una mujer posmenopáusica con cirugía ginecológica previa. La reparación se efectuó con malla a través de una laparotomía convencional (AU)

Spontaneous vaginal evisceration is a rare phenomenon in daily clinical practice. Since McGregor reported the first case at the beginning of the past century, more than 70 cases have been reported to date. Spontaneous vaginal evisceration usually occurs in patients with postmenopausal hypoestrogenism associated with previous gynecologic surgery. This entity has recently been described in non-gynecological conditions after perineal proctectomy. We present a new case of spontaneous vaginal evisceration in a postmenopausal woman with previous gynecological surgery. Surgical mesh repair was performed through conventional laparotomy (AU)