CHRONIC ANAL FISSURE TREATMENT: A GREAT REVIEW OF TREATMENT!

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CHRONIC ANAL FISSURE TREATMENT: A GREAT REVIEW OF TREATMENT!

Postby Savaici » 30 Jul 2013, 07:54

Innovations in chronic anal fissure treatment: A systematic review
From World Journal of Gastrointestinal Surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999245/pdf/WJGS-2-231.pdf
(Image to WelshDoubleFissure for finding it)
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Re: CHRONIC ANAL FISSURE TREATMENT: A GREAT REVIEW OF TREATMENT!

Postby Karinann » 30 Jul 2013, 09:35

The reference to the paper provided some useful information for me. Thank you for finding it. I've been having headaches which I thought might be due to the Colace I've been taking, but according to the paper the headaches are more likely due to Diltiazem, which I have been using. Very interesting.
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Re: CHRONIC ANAL FISSURE TREATMENT: A GREAT REVIEW OF TREATMENT!

Postby J-32 » 31 Aug 2013, 08:51

Could anyone please explain me what is first column in the table in this review about? single/double/dual arm? multicentric, (non)randomized? Are these hospitals or dr's names?
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Re: CHRONIC ANAL FISSURE TREATMENT: A GREAT REVIEW OF TREATMENT!

Postby Scientist2516 » 31 Aug 2013, 12:25

Single arm means they only tried one thing. eg number 6, Knight et al, only tried diltiazem.
Double arm means they compared two treatments. eg, number 1 Lund et al tried GTN vs placebo.
Number 5, Kocher et al did a double-arm trial of GTN vs diltiazem. No placebo.
A randomized trial takes a group of patients and randomly assigns them to one group or the other, and then treats both groups exactly the same (except for the drug being tested). For instance, both groups have the same follow-up etc. In a non-randomized trial, I suppose patients are assigned to one group in a less rigorous way. The best (gold standard) randomized trials compare a drug to a placebo, and neither the patient nor the doctor knows who is using the drug and who is using the placebo. That way, the doctor can assess the treatment without being biased in favour of the drug.
How would you like to be in the placebo group for a botox clinical trial? NO THANKS!
Multicentric means the patients are treated at different facilitles, for instance if they were studying large numbers of people from all over the country.
Prospective means that the patients were enrolled in the study before treatment began. The opposite would be a retrospective study, where the doctors would go looking for people who'd had botox (for example) in the past, and they asked them how it went for them.
This looks like an interesting paper, though the table makes depressing reading. There is certainly no magic bullet here.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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