Fazila Hashmi, Faisal Ghani Siddiqui.
Diltiazem (2%) versus glyceryl trinitrate cream (0.2%) in the management of chronic anal fissure.
J Coll Physicians Surg Pak Jan ;19(12):750-3.

Objective: To assess and compare the effectiveness of topical 0.2% glycerl trinitrate (GTN) and topical 2% diltiazem (DTZ), in the management of chronic anal fissure. Study Design: Comparative, descriptive study. Place and Duration of Study: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2004 to August 2005. Methodology: Patients with chronic anal fissure were treated with topical 0.2% GTN (50 patients) and 2% DTZ (47 patients) application for 8 weeks, three times a day at peri anal area. Symtoms, recurrence, wound healing and side effects were compared. Data was analyzed using SPSS version 10 employing X2 test. A p-value below 0.05 were considered statistically significant. Results: There were 53 females and 44 males with a mean age of 30 years. Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glycerl trinitrate terms of wound healing and side effects mainly the headaches (p=0.02 and 0.003 respectively). Improvement in symptoms (p=0.345) and recurrence rates (p=0.612) turned to be statistically insignificant although recurrence rate was lower with DTZ. Conclusion: Chemical sphincterotomy is an effective first line management for chronic anal fissure. Both GTN and DTZ are equally effective in managing the chronic anal fissure. DTZ has fewer side effects, a better healing response and low recurrence rates.

USER COMMENTS

I have no idea how these conclusions were reached. First, does data support that chemical sphincterotomy is an effective first line management? This can only be done if there is a chemical sphincterotomy group and a surgical sphincterotomy group. Second, the last two sentences of the conclusion are contradictory. How can two things be equal in one sentence and then one is better than the other in the very next sentence. Ok, I understand that authors didn't have much experience in writing manuscripts and will continue to improve but how this escaped notice of reviewers and editors of JCPSP?
Posted by: rqayyum on Mar 2010

I have no idea how these conclusions were reached. First, does data support that chemical sphincterotomy is an effective first line management? This can only be done if there is a chemical sphincterotomy group and a surgical sphincterotomy group. Second, the last two sentences of the conclusion are contradictory. How can two things be equal in one sentence and then one is better than the other in the very next sentence. Ok, I understand that authors didn't have much experience in writing manuscripts and will continue to improve but how this escaped notice of reviewers and editors of JCPSP?
Posted by: rqayyum on Mar 2010

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