Treatment of benign anal disease with topical nitroglycerin

Gorfine, Stephen R.; Billingham, Richard P.

doi:10.1007/bf02148842

Cited by 150 publications

(46 citation statements)

References 17 publications

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“…In 1997, following the publication of successful pilot studies [105][106][107], a randomised prospective, double-blind clinical trial was reported that compared topical 0.2% GTN ointment to placebo in chronic anal fissure. At 8 weeks, two-thirds of patients in the GTN arm had successful healing of their anal fissures compared with only 8% of those applying a placebo [108].…”

Section: Nitratesmentioning

confidence: 99%

A review of chronic anal fissure management

Collins

Lund

2007

Tech Coloproctol

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Anal fissure management has rapidly progressed in the last 15 years as our understanding of fissure pathophysiology has developed. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Surgical techniques have been used for over 100 years with success. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Postoperative impairment of continence remains controversial. Recently, less invasive methods of treatment have been explored. Topical nitrates, calcium channel blockers and botulinum toxin are established treatments. These and other non-surgical treatments are described in this review. Various guidelines and treatment algorithms for anal fissure are also discussed.

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Section: Nitratesmentioning

confidence: 99%

A review of chronic anal fissure management

Collins

Lund

2007

Tech Coloproctol

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“…Recently, its value in wound healing and as an antimicrobial agent has been appreciated (9,16). From a safety standpoint, the worst-case systemic exposure occurs if a lock is inadvertently flushed, in which case a bolus dose is presented.…”

Section: Discussionmentioning

confidence: 99%

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

Rosenblatt

Reitzel

Dvorak

et al. 2013

Antimicrob Agents Chemother

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Antimicrobial catheter lock therapy is practiced to prevent lumenal-sourced infections of central venous catheters. Citrate has been used clinically as an anticoagulant in heparin-free catheter locks. Ethanol has also been widely studied as an antimicrobial lock solution component. This study reports on the synergy of glyceryl trinitrate (GTN) with citrate and ethanol in rapidly eradicating methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans biofilms in an in vitro model for catheter biofilm colonization. GTN has a long history of intravenous use as a hypotensive agent. It is potentially attractive as a component of a catheter lock solution because its physiologic half-life is quite short and its metabolic pathways are known. A lock containing 7% citrate and 20% ethanol required 0.01% GTN to fully eradicate biofilms of all test organisms within 2 h in the model. This GTN concentration is below the levels where clinically significant hypotensive effects are expected. Central line-associated bloodstream infections (CLABSIs) have declined over the past decade but remain a significant medical problem, with a substantial cost burden to the health care system. There are an estimated 250,000 CLABSIs in the United States (1), with an estimated treatment cost of $45,000 or more per infection (2). Significant portions of CLABSIs annually are associated with hemodialysis treatment (3) and treatment of critically ill patients. CLABSIs that present after the first week of catheterization tend to be associated with colonization of the catheter lumenal surfaces (4, 5) and biofilm formation on those surfaces. Colonizing organisms organize within hours into biofilm structures which can serve as a source of CLABSI and can be highly resistant to eradication by antibiotic treatments. Approaches to reducing lumenal colonization include rigorous provider hygiene and use of antimicrobial swabs when connectors are manipulated. Even with these precautions, much of the lumenal surfaces remain vulnerable to colonization. Another approach to combatting lumenal infections has been the use of antimicrobial lock therapy (ALT). Catheter lumens are hydraulically locked when not in use. Typically, lock solutions include anticoagulants to inhibit the formation of blood clots, which can occlude flow through catheters. Heparin has traditionally been used as an anticoagulant; however, there have been concerns about its purity (6), as well as its potential to promote bacterial biofilm colonization (7). Antimicrobial locks have generally fallen into the categories of antibiotic locks and nonantibiotic, antiseptic locks. Antibiotic locks have been pursued both for catheter salvage and for infection prevention. Antibiotic catheter locks have recently been reviewed (8). Significant issues limiting the use of antibiotic locks for prevention are their higher costs and potential to promote the development of antibiotic resistance. We report here on the utility of glycery...

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“…Referências da literatura têm demonstrado que pacientes portadores de doença hemorroidária, assim como de fissura anal, apresentam pressões anais aumentadas, à custa de hipertonia do esfíncter anal interno 5,6,14 . No entanto, ainda não está bem definido se o aumento da pressão anal é secundário à presença dos coxins vasculares 30,31 , e se interfere no retorno venoso do plexo hemorroidário interno, causando degeneração das estruturas fibromusculares e deslizamento progressivo dos coxins anais 32,33 .…”

Section: Manometriaunclassified

“…Vários estudos de eletromanometria anorretal demonstraram que, pacientes portadores de doença hemorroidária, podem apresentar pressão do canal anal aumentada, semelhantemente ao que ocorre na fissura anal 4,5,7,8 . Existem vários relatos na literatura que mostram que a hipertonia do esfíncter interno do ânus exerce um papel etiológico, tanto no desenvolvimento da fissura anal, como na doença hemorroidária 6,9 . Alguns autores sugerem que a esfincterotomia lateral interna associada à hemorroidectomia, pode contribuir para uma melhor evolução clínica no pós-operatório (redução da dor, da retenção urinária, da estenose anal e do tempo de cicatrização da ferida operatória) 4,[10][11][12][13] .…”

Section: Introducãounclassified