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EFFICACY OF BOTULINUM TOXIN TYPE A IN THE TREATMENT OF CHRONIC ANAL FISSURE

Author: Ibrahim Falih Noori
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 1 Pages: 69-75
Publisher: Basrah University جامعة البصرة

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Abstract

Lateral partial internal sphicterotomy has been the goal standard for the treatment of chronic anal fissure. The main drawback of this approach remains its effect on the anal continence. Intrasphincteric of botulinum toxin seems to be a reliable and safe option resulting in temporary paralysis of the internal sphincter spasm and so promoting the chronic fissure to heal. The aim of this prospective control randomized study was to compare the effectiveness and the outcome of botulinum toxin injection with the lateral internal sphicterotomy in the treatment of the chronic anal fissure. Ninety male patients who have been presented with chronic uncomplicated anal fissure, were randomized to either lateral internal sphincterotomy or intrasphincteric injection of botulnium toxin. Postoperative complications and pain, healing rate of the fissure, anal incontinence and recurrence of the fissure after treatment during six months follow up period were studied and assessed. The healing rate was 95.5% in the surgical group with recurrence noted in only one patient and one patient had a partial permanent incontinence while in the botulnium toxin group the healing rate was 84.4%. Two patients had transient incontinence which improved spontaneously over six months period. Five patients had recurrence within the same follow period. Lateral internal sphicterotomy and botulinum toxin injection both seems to be effective treatment of the chronic anal fissure. Although surgical approach is still the most common and gold standard treatment for the chronic anal fissure, It shows a higher incidence of incontinence and greater morbidity and pain than botulinum toxin injection. We conclude that the use of botulinum toxin to treat chronic anal fissure is safe, simple and effective approach especially in patients older than 50 years or those with risk of anal incontinence despite the higher rate of recurrence which can be minimized by the second session of botulinum toxin injection.


Article
Assessment of hemorrhoids and anal fissure occurrences in women during pregnancy in Pirmam City/Iraq
تقييم حدوث البواسير و الناسور الشرجى عند النساء أثناء الحمل في مدينة بيرمام/العراق

Authors: Pola Farhad Hassan --- Hamdia Mirkhan Ahmed Lecturer
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2015 Volume: 5 Issue: 2 Pages: 58-64
Publisher: University of Kufa جامعة الكوفة

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Abstract

Aim: The aim of this study was assessment of obstetrical characteristics of women with hemorrhoids and anal fissure. Methods: A cross-sectional study was conducted between 1st September 2013 and 30th July 2014 in Pirmam city in Kurdistan Region of Iraq on 50 women who attend surgical private clinic and complained with signs and symptoms of hemorrhoids and anal fissures and diagnosed by observation and physical examination of the anus. A questionnaire was constructed for the purpose of the study. Chi-square test or Fisher exact test were used for analyzing of the data. Results: Mean (M±SD) age of women were 30.36 (± 7.4). The rate of hemorrhoids, fissures or both were as following respectively: 14%, 48% and 38%. Sixty two percent of the study sample were multipara. The majority (84%) of the sample had vaginal delivery. There was statistically significant association between prolonged labor with aggravation of hemorrhoids and fissures by pregnancy/delivery but there was no statistically significant association between onset of hemorrhoids or fissures and their aggravation by pregnancy/delivery with parity and mode of delivery.Conclusions: Hemorrhoids and anal fissures were most common in multipara and grand multipara women and who delivered vaginally. These conditions may aggravated by pregnancy and delivery.Recommendation: Advising and educating women for appropriate diet and bowel motion during pregnancy and improving care during labor may decrease the hemorrhoids and anal fissures. Further studies with large sample size and case- control study will help to understand the effect of childbearing experience on anal disorders

الهدف: تهدف الدراسة الى اجراء عملية تقييم مواصفات التوليد للنساء المصابات بالبواسير و الناسور الشرجى.المنهجية: أجريت دراسة مقطعيه للفترة من1/9/2013 - 30/7/2014 في مدينة بيرمام في اقليم كوردستان/العراق. و قد شملت الدراسة 50 امرأه من المراجعات العيادة الجراحية الخاصة و اللواتى يعانين و اللذين كان يعانون من اعراض و علامات الاصابه بالبواسير و الناسور الشرجى. و قد تم تشخيصهم من خلال الفحص السريري مسبقا. وتم اعداد استماره استبيانية لهذا الغرض. و تم استخدام مربع كاي لتحليل النتائج .النتائج: اظهرت النتائج ان معدل المتوسط و(الانحراف المعيارى) لأعمار النساء هو 30.36 (±7.4). و كانت نسبة الأصابه بالبواسير(14%) و الناسور (48%) او كلاهما (38%). و أظهرت النتائج بأن 62% من النساء كانت متعددات الولادات. وكان نسبة (84%) منهم لديهم ولادة طبيعية. و كان هنالك دلالة احصائية بين طول فترة الولادة و شدة الصابة الأصابة بالبواسير و الناسور. واظهرت النتائج بأنه لم تكن هنالك علاقة ذات دلالة احصائية بين بداية الأصابة بالبواسير و الناسور و شدة مع عدد الولادات او طريقة الولادة.الاستنتاج: ان البواسير و الناسور الشرجى كانت أكثر شيوعاَ لدى النساء المتعددات الولادات والذين لديهم اكثر من خمسة ولادات و كذلك بين نساء ذات الولادة الطبيعية. التوصيات: اعطا النصيحه و التثقيف للامهات حول الغذاء المناسب و حركة الامعاء خلال حمل و تحسين الرعايه خلال الولادة والتى قد تقلل البواسير والناسور الشرجى. الحاجه الى دراسات اخرى و بعينة اكبر و اجراء دراسة من نوع الشاهد والحالة التي قد تساعد لمعرفة تأثير الحمل على إصابات الشرج.

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