La respuesta inicial al diltiazem tópico puede predecir la evolución de la fisura anal crónica

S3-Leitlinie: Analfissur

Die Analfissur ist eine der häufigsten Pathologien, welche sich dem Proktologen präsentiert. Entsprechend ist es wichtig, verlässliche Leitlinien dazu zu entwickeln. Die aktuelle Leitlinie wurde anhand eines systematischen Literaturreview von einem interdisziplinären Expertengremium diskutiert und verabschiedet.

Die akute Analfissur, soll auf Grund ihrer hohen Selbstheilungstendenz konservativ behandelt werden. Die Heilung wird am besten durch die Einnahme von Ballaststoff reicher Ernährung und einer medikamentösen Relaxation durch Kalziumkanal-Antagonisten (CCA) unterstützt. Zur Behandlung der chronischen Analfissur (CAF), soll den Patienten eine medikamentöse Behandlung zur „chemischen Sphinkterotomie“ mittels topischer CCA oder Nitraten angeboten werden. Bei Versagen dieser Therapie, kann zur Relaxation des inneren Analsphinkters Botulinumtoxin injiziert werden. Es ist belegt, dass die operativen Therapien effektiver sind. Deshalb kann eine Operation schon als primäre Therapie oder nach erfolgloser medikamentöser Therapie erfolgen. Die Fissurektomie, evtl. mit zusätzlicher Botulinumtoxin Injektion oder Lappendeckung, ist die Operation der Wahl. Obwohl die laterale Internus Sphinkterotomie die CAF effektiver heilt, bleibt diese wegen dem höheren Risiko für eine postoperative Stuhlinkontinenz eine Option für Einzelfälle.

Common anorectal disorders for the intensive care physician

Although anorectal disorders such as abscess, fissure, and hemorrhoids are typically outpatient problems, they also occur in the critically ill patient population, where their presentation and management are more difficult. This article will provide a brief review of anorectal anatomy, explain the proper anorectal examination, and discuss the current understanding and treatment concepts with regard to the most common anorectal disorders that the intensive care unit clinician is likely to face.

Comparison of observational and controlled clinical trials of diltiazem in the treatment of chronic anal fissure

Diltiazem has been extensively studied in the treatment of chronic anal fissures, but efficacy in clinical practice is not fully established. The aim of the present study was to evaluate the safety and efficacy of topical application diltiazem in observational studies as well as in controlled clinical trials in the treatment of chronic anal fissures. A systematic literature search was carried out from 1966 to 31 December, 2007 on PubMed, Medline, Embase and Cochrane database, using the appropriate search words. We found six observational studies with 392 patients and five controlled clinical trials with 289 patients in which topical diltiazem treatment was given. Efficacy was found to be very high in observational studies (56.88%), whereas it was found to be modest in controlled clinical trials (29.41%). In observational studies, most of the patients reported complete healing of fissures within 6-12 weeks, whereas in controlled trials healing was reported within 8 weeks, with tolerable adverse effects of diltiazem. On the basis of the above studies, it can be concluded that topical application of diltiazem is useful in the treatment of chronic anal fissure, but to fully establish its efficacy, larger prospective double-blind study is required in the near future.

[Retrospective analysis of the use of the Spanish words severo and severidad in CIRUGIA ESPANOLA during 2007]

INTRODUCTION

The Spanish words severo (severe) and severidad (severity) are usually used as a synonyms of grave (serious) and gravedad (seriousness), although the Spanish Royal Academy of Language (Real Academia Española [RAE]) specifically recommends not to use them in this sense. A retrospective analysis to evaluate the use of the words severo and severidad in Cirugía Española during 2007 was performed.

MATERIAL AND METHOD

All the articles published in Cirugía Española during 2007 were reviewed. The articles in which severo and/or severidad were present were selected. For each article, the month of publication, the type of article, the geographic origin and the exact sentence containing these words were analyzed. Correctness and incorrectness of their use was studied according to the RAE normative.

RESULTS

A total of 33 articles were selected. Every month (except for January) had, at least, 2 articles. Thirty-one of the articles were from Spain whereas 2 were from Hispano-America. Eleven cases were original articles, 7 reviews, 6 case reports, 3 editorials, 3 special articles and 3 letters to the editor.

CONCLUSIONS

The Spanish words severo and severidad are inadequately used too often in scientific texts. It must be avoided using them as a synonym of grave, importante or serio, incorrect translations of the English word severe.