Nitroglycerin Ointment Research Articles

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial

ObjectivesTo investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo...

Computational Study and Evaluation of Lidocaine and Nitroglycerin Ointment for External Hemorrhoid Treatment

Computational Study and Evaluation of Lidocaine and Nitroglycerin Ointment for External Hemorrhoid Treatment

Degnala in Water Buffaloes: A Review on a Neglected Disease.

Degnala is one of the primary mycotoxicoses affecting buffaloes, with Fusarium spp. as the main causative agent. This disease is strongly associated with the feeding of rice straw to buffaloes and is considered endemic to regions where rice is cultivated. Cases are concentrated in winter when conditions favor fungal growth in inadequately stored straw. Degnala is characterized by necrosis and gangrene of the extremities, including the tail, lower limbs, ears, tongue, muzzle, and teats. The pelvic limbs are more affected than the thoracic limbs. A tortuous appearance of the tail is very common, and cracks or corneal loss of the hooves may occur, exposing the blades and even the bones. There is no diagnostic method for identifying the disease in animals other than clinical and epidemiological criteria, combined with fungal culture samples. There is no treatment that neutralizes the effects of the toxins; the current treatment is palliative and supportive, consisting of pentasulfate solution, anti-Degnala liquid, 2% nitroglycerin ointment, and broad-spectrum antibiotics for secondary infections. Additionally, the management of drying and proper storage of straw is essential for controlling this disease.

Role of Adding Topical Metronidazole in the Treatment of Acute Anal Fissure

Background: An anal fissure is a longitudinal ulcer in the anoderm of the distal anal canal which extends from the anal verge proximally towards, but not beyond, the dentate line. Anal fissure is a disease characterized by severe pain in the anorectal region with constipation, per rectal bleeding and sometime itching. Recently, anaerobic bacteria are sorted out as a causative factor. Objective: This study investigates patient compliance in the treatment of anal fissure with adding topical metronidazole. Materials and method: A total number of 100 patients attended to the General Surgery Clinic of Delta Medical College Hospital, Department of Surgery, between December 2020 and May 2021 and diagnosed with acute anal fissure were included in this prospective study. Patients older than 18 years, including non-pregnant, pregnant and lactating women are recruited. Patients were randomly divided in two groups. One group (group: 1) was treated with topical glyceryl trinitrate [0.4% nitroglycerin ointment], and the other group (group: 2) was treated with topical glyceryl trinitrate [0.4% nitroglycerin ointment] and topical antibiotic [metronidazole 0.75%]. Results: There is no difference between the groups regarding age and symptoms. From week 1, fissure healing rates were high in group 2. Group 2 VAS score levels were lower than group 1 and achieved by group 1 only in week 4. Compliance of pregnant and lactating lady was more in group 2. Conclusion: Adding topical metronidazole to treatment of acute anal fissure reduces the duration and severity of pain, shortens healing time and increases the healing rate. Delta Med Col J. Jan 2021;9(2): 84-90

F-37 | In patients with acute cardiogenic pulmonary edema without cardiogenic shock, rapid administration of repeated buccal nitroglycerin ointment prevents the need for intubation and mechanical ventilation

F-37 | In patients with acute cardiogenic pulmonary edema without cardiogenic shock, rapid administration of repeated buccal nitroglycerin ointment prevents the need for intubation and mechanical ventilation

Primary Repair of Ear Avulsion with Adjuvant Hyperbaric Therapy and Nitroglycerin Ointment.

Traumatic auricular avulsion is a rare and deforming injury. Classically, repair has required microvascular anastomosis. In this publication, we report two separate cases of pediatric auricular avulsion from dog bites. In both cases, the ear was cleaned and surgically reattached. Adjunctive therapies included hyperbaric oxygen and nitroglycerin ointment. There was complete graft take for one patient and 90% graft take for the second, both achieving satisfactory aesthetic outcome. These unique cases highlight the benefits of surgical reattachment of the avulsed portion of the ear followed by hyperbaric oxygen therapy and nitroglycerin ointment.

Treatment Non-Compliance due to Glyceryl Trinitrate Side Effects in Anal Fissure

Objective: Anal fissures generally respond very well to the glyceryl trinitrate (GTN) ointment. However, it is associated with side effects like headache and hypotension. The objective was to evaluate the noncompliance of patients with topical glyceryl trinitrate due to its side effect in the management of anal fissure. 
 Methodology: After taking ethical approval, a prospective case series was conducted at IIMCT-Pakistan Railway Hospital over a period from 1st March, 2023 to 31st August 2023. A sample size of 112 was calculated using WHO calculator 1.1 and these many patients were subsequently studied for side-effects of GTN and their compliance to the therapeutic regime.
 Results: Of 122 patients studied: 62 (55.4%) were males, mean age was 35.35±10.22 years and mean daily doses of GTN was 2.31±0.56. Sixty-five (53%) of the patients using topical GTN reported side effects. Headache and postural hypotension were the most commonly reported side effects: 29.5% and 21.4% reported these side effects, respectively. Non-compliance was noted in only 14 patients (12.5%). Headache contributed 78.6% whereas postural hypotension & palpations contributed 21.4% towards the non-compliant cases. Thus, these two side effects were the only ones contributing towards non-compliance and had statistically highly significant association with non-compliance at a p value of 0.001. 94% of the compliant patient completely healed completely whereas only 2% of non-compliant patients achieved healing till 3-month follow-up: these results were significant at p<0.001. 
 Conclusion: Headache postural hypotension are significant side-effects of GTN; and they lead to non-compliance and thus subsequent failure to achieve healing.

Comparative Study of Lateral Internal Sphincterotomy versus Local 0.4% Glyceryl Trinitrate Ointment for the Treatment of Chronic Anal Fissure

Objectives: To compare the outcomes of “Lateral Internal Sphincterotomy (LIS)” versus local “0.4% Glyceryl Trinitrate (GTN)” ointment for the treatment of chronic anal fissure. Study Design and Setting: Randomized controlled trial, Combined Military Hospital (CMH) / Pak Emirates Military Hospital (PEMH), Rawalpindi from October 2022 to March 2023. Methodology: A total of 100 patients [50 in GTN group and 50 in LIS group] who underwent treatment for chronic anal fissure were included in study. Patients in both groups were followed up at eight weeks after the surgery to assess for the outcomes including anal pain healing and recurrence of fissure. Data was analyzed by SPSS 22.00. Results: In our study, mean age was 30.48 ± 5.82 years. 61 (61.00%) were male while 39 (39.00%) were female. Mean duration of having anal fissure was 10.69 ± 2.59 weeks. Mean post-therapy pain VAS at week 8 follow up in “GTN” group was 0.64 ± 1.06 while in “LIS” group it was 0.16 ± 0.37, (p = 0.003). Complete healing of chronic anal fissure was achieved in 35 (70.00%) in “GTN” group while in “LIS” group healing was achieved in 42 (84.00%), (p = 0.096). Recurrence occurred in 2 (4.00%) of patients in “GTN” group and none in “LIS” group, (p = 0.153). Conclusion: “Lateral Internal Sphincterotomy (LIS)” is a better treatment option for management of chronic anal fissure.

Outcomes of non-surgical treatment of chronic anal fissure: A comparative study

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred. Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures. Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P <0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P <0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P <0.001). A significant association was observed between treatment adverse effects and patients treated with GTN (P = 0.05). DTZ was found to be more effective for symptomatic relief than GTN. Conclusion: Both DTZ and GTN are effective in the treatment of chronic anal fissures, but treatment with DTZ is accompanied by faster healing and lower side effects.

Protective effect of nitroglycerin ointment and dimethyl sulfoxide on necrosis of skin flaps in rats.

To compare the protective effect of nitroglycerin ointment 2% and Dimethylsulfoxide (DMSO) in dorsal flaps of the rat. A blind, experimental study was conducted in 24 male Wistar rats, with a mean weight of 320 (286-376) grams. Group 1: Control. Petrolatum jelly (Vaseline), n = 8, Group 2: Nitroglycerin (NTG) ointment 2% (Nitro-Bid, Altana Co.) n = 8, and Group 3: DMSO gel 90% (Neogen corp. Lexington KY, 40611), n = 8. A total of 24 rats were operated on in the 6-month period of this study. Using a non-parametric Mann-Whitney U-test analysis, a statistically significant p was obtained between the control group and 2% NTG ointment, both in the area of necrosis and in the healthy area (p = 0.026). In contrast, the comparison between DMSO [CH3) 2SO] and the control group (p = 0.180) and between both study groups, with a p = 0.18, was not significant. Our study concluded that there is a protective effect of 2% NTG ointment for flap survival in relation to the control group (petrolatum). DMSO administered topically did not show a protective effect, compared to the control group.

Autonomic dysreflexia: Current pharmacologic management.

Autonomic dysreflexia (AD) is a frequent complication of spinal cord injury (SCI), though current clinical practice patterns for medication management of this condition are unknown. Correspondingly, it is unclear if national differences in practice patterns exist. To determine trends in current pharmacologic management of AD throughout the Americas. International survey of current physician practice patterns. Academic medical center. Sixty physicians managing patients with SCI and prescribing medications to manage AD. Not applicable. Presence of a formal pharmacologic AD management protocol, first- and second-line medications, patient characteristics influencing pharmacologic management. The majority of physicians (69%) had a formal AD management protocol for inpatient care, with nitroglycerin ointment (82%) being the most common first-line medication. Strong national differences existed regarding the use of nitroglycerin ointment, with 98% of U.S.-based physicians using this as first-line medication and 0% of physicians in Canada or Latin America using this due to recent lack of medication availability. Only 67% of physicians had a preferred second-line medication, with preferences split between hydralazine (48%) and nifedipine (28%). A systolic blood pressure threshold for pharmacologic management was used by 56% of physicians, wheres 26% considered neurological level of injury in decisions to use medications for AD. Heart rate was used by only 5% of physicians in their decision to manage AD with medications. As of 2023, U.S.-based physicians caring for individuals with SCI largely have formal inpatient protocols in place for medication management of AD, with nearly all relying on nitroglycerin ointment as their first-line medication. In areas outside of the United States where nitroglycerin ointment is unavailable, pharmacologic practice patterns significantly differ.

Management of Extravasation Injury in Infants: A Systematic Review of Clinical Trials

Context: One of the common procedures in the neonatal intensive care unit (NICU) is the insertion of a venous catheter, and one of the most important and serious complications is extravasation, which is a leading cause of death in hospitalized infants. Based on the researcher’s experience in the NICU and the necessity of extravasation injury management in infants, this review study focused on extravasation injury management in infants. Methods: The literature was searched in ProQuest, Scopus, and PubMed databases using the terms “extravasation” OR “vascular leakage” OR “Peripheral Infiltration” AND “Neonatal” OR “Newborn” OR “Infants” OR “NICU.” The search procedure was performed in the title, abstract, and full text of articles published in English from 2000 to 2022. Results: In the initial search, 3414 articles were extracted. After removing the duplicates and searching the titles and abstracts of the articles, 132 related articles were found, and their full texts were studied. Finally, 20 articles entered the final analysis stage. Nine case report studies, five case series studies, three clinical trials, and three retrospective review studies were found. The results showed that various treatment methods are available, including elevating limbs, pain relief, hot and cold compresses, flush-out technique with saline, dressings (hydrocolloid, hydrogel, and hydrocellular foam), medications (2% nitroglycerin ointment and subcutaneous administration of hyaluronidase and phentolamine), and new methods such as amniotic membranes, omega-3-rich fish skin (Kerecis), active leptospermum honey (ALH), PRP, and surgical removal. Conclusions: Despite many medical advances, there is still no specific approach to managing extravasation in infants. The ideal approach to extravasation injuries is still to prevent them initially. The best next step is to minimize the damage using antidotes or hyaluronidase. Using saline to remove the solution and physically minimize damage can be useful. Thus, more studies are needed to address extravasation management in infants.

A Multimodal Approach to Analgesia in Anorectal Surgery

Аim: Evaluation of methods for pain prevention and pain reduction after anorectal surgery at all stages of treatment based on publications found in available databases.Key points. Most anorectal diseases are benign and do not affect life expectancy, meanwhile about 40 % of the population suffer from it. Mainly anorectal disorders affect middle-aged people reducing their life quality. At the same time many articles aimed at studying only postoperative anesthesia. 2 researchers independently searched for articles published in Medline, Scopus, Cochrane, Web of Science, E-library databases using keywords. A total of 54 publications were included. A multimodal approach should include the pain prevention during pre-, intra- and postoperative periods. Acetaminophen is recommended for pain reduction according to the dosing protocols. Acetaminophen combined with other systemic analgesics is advisable for patients with severe pain. The opioids use is justified only for moderate-severe postoperative pain. Metronidazole and lidocaine with nitroglycerin ointment/ nifedipine/сorticosteroids effectiveness has been proven for local postoperative anesthesia. Prophylactic use of antibiotics and bowel preparation do not reduce postoperative pain. Stool softeners are recommended for reducing postoperative pain severity. Additional local anesthesia such as nerve blockade or infiltration anesthesia is recommended for all patients. Modern minimally invasive treatment methods of hemorrhoid are associated with less severe postoperative pain.Conclusion. The recommended scheme of multimodal anesthesia for patients after anorectal surgery is shown on Fig.1. Further studies are needed to evaluate preoperative anesthesia effectiveness, the feasibility of the perioperative flavonoids use, as well as comparisons of various minimally invasive treatment methods of anorectal diseases.

D104. Use Of SPY-QP To Predict Mastectomy Skin Flap Wound Complications in Immediate Breast Reconstruction

PURPOSE: SPY-QP® enables surgeons to assess relative perfusion quantitatively and in real-time; however, studies assessing its utility in predicting wound complications following breast reconstruction are limited. METHODS: Perfusion values were prospectively collected on patients undergoing staged breast reconstruction. There is currently no consensus on cut-off values for low perfusion, therefore the following values were used: 33% (reported by Moyer et al) and 30.0145% (calculated by the Youden index based on a logistic regression model). RESULTS: Twenty-four patients with 34 breasts underwent tissue expander (TE) placement at the time of mastectomy. SPY-QP was used after the TE was placed and filled with air to better reflect the postoperative state of the skin flaps. 4 breasts developed wound complications in areas with corresponding SPY-QP values of less than or equal to 30% (9.0-30.0%). The 33% cut-off yielded an odds ratio (OR) of 20.368 (95% CI: 0.9-450.7) for wound development, whereas the 30.0145% cut-off yielded an OR of 28.201 (95% CI: 1.3-632.8). When adjusted for nitroglycerin ointment usage, the OR was 16.827 (95% CI: 0.8-363.0), suggesting that it may interfere with wound development. CONCLUSION: SPY-QP® can safely predict wound development in breast reconstruction patients and guide clinical management of breast skin flaps. We suggest using a perfusion cut-off value of 30.0145%; however, larger, prospective studies are needed.

COMPARATIVE STUDY ON THE EFFICACY OF TOPICAL METRONIDAZOLE, TOPICAL NITROGLYCERINE, AND TOPICAL DILTIAZEM IN THE MANAGEMENT OF CHRONIC ANAL FISSURE

Background and Aims: Chronic anal fissure (CAF) is usually managed with surgical modalities but it imposes huge cost with recurrence rates. Hence, topical therapies are preferred is such cases which has a good patient acceptability rate. The present study aims to compare the topical metronidazole (MTZ), diltiazem (DTZ), and glyceryl trinitrate (GTN) in terms of healing rate and pain reduction in CAF patients. Methods: This was a randomized and prospective study conducted on 90 patients with CAF. The patients were grouped as follows (n=30), Group 1; 1% MTZ gel, Group 2; 0.2% Nitroglycerin ointment, and Group 3 (n=30): 2% DTZ ointment. The patients were evaluated at 2, 4, and 6 weeks for pain using visual analogue score (VAS) and healing rate. The results were compared and p<0.05 was considered as significant. Results: The VAS scores between the groups was found to be non-significant (p>0.05), however the VAS scores where markedly reduced within the group at 6 weeks. The healing rate was higher in MTZ group (90%) as compared to GTN (83.3%) and DTZ group (83.3%) but it was not significant. Regarding side effect, burning sensation was observed in MTZ and GTN, DTZ groups were devoid of side effects. Conclusion: The MTZ was more effective with good healing rate but with few side effects. Regarding the pain reduction, all the groups displayed equivocal effects. Thus topical MTZ is a suitable agent for the faster healing of CAF and thus avoids the requirement of surgical options.

Topical Nitroglycerin Ointment Reduces Mastectomy Flap Necrosis in Immediate Autologous Breast Reconstruction.

Mastectomy flap necrosis (MFN) is a common complication of immediate breast reconstruction that greatly affects patient satisfaction and cosmetic outcomes. Topical nitroglycerin ointment, with its low cost and negligible side effects, has been shown to significantly decrease the incidence of MFN in immediate implant-based breast reconstruction, but its utility has not been studied in immediate autologous reconstruction. With institutional review board approval, a prospective cohort study was performed of all consecutive patients undergoing immediate free-flap breast reconstruction by a single reconstructive surgeon at a single institution between February of 2017 and September of 2021. Patients were divided into two cohorts: those who received 30 mg of topical nitroglycerin ointment to each breast at the conclusion of the operation (September of 2019 to September of 2021) and those who did not (February of 2017 to August of 2019). All patients underwent intraoperative SPY angiography, and mastectomy skin flaps were débrided intraoperatively based on imaging. Independent demographic variables were analyzed, and dependent outcome variables included mastectomy skin flap necrosis, headache, and hypotension requiring removal of ointment. A total of 35 patients (49 breasts) were included in the nitroglycerin cohort and 34 patients (49 breasts) were included in the control group. There was no significant difference in patient demographics, medical comorbidities, or mastectomy weight between cohorts. The rate of MFN decreased from 51% in the control group to 26.5% in the group that received nitroglycerin ointment ( P = 0.013). There were no documented adverse events associated with nitroglycerin use. Topical nitroglycerin ointment significantly decreases the rate of MFN in patients undergoing immediate autologous breast reconstruction without significant adverse effects. Therapeutic, II.

Enhanced efficacy of PDT when combined with nitroglycerin ointment administration on xenografted retinoblastoma in mice.

Enhanced efficacy of PDT when combined with nitroglycerin ointment administration on xenografted retinoblastoma in mice.

Comparative Study of Glyceryl Trinitrate (GTN) Ointment Versus Lateral Internal Sphincterotomy in Management of Chronic Anal Fissure

Objectives: To compare the effectiveness of 0.2% glyceryl trinitrate ointment versus lateral sphincterotomy in management of patients with chronic anal fissure. Materials and Methods: This Comparative study was done in Irfan general hospital THQ Charsadda, and the duration of this study were from April 2022 to September 2022. In this study 80 patients with anal fissure were enrolled. All the patients were divided into two group by lottery method. Group A patients were treated by lateral sphincterotomy while group B was treated by ointment of 0.2% glyceryl trinitrate. A predesign questionnaire were used to collect data. Results: Total 80 patients were enrolled equally divided in to two groups. Group A had 29 (72.5%) male and 11 (27.5%) female while group B had 23 (57.5%) male and 17 (42.5%) female with mean age of 40.47±10.94 years. Group A had 18 (45%) mild pain and 22 (55%) had severe pain while group B had 19 (47.5%) mild pain and 21 (52.5%) severe pain. 23 (57.5%) and 25 (62.5%) patients had bleeding before treatment. The final comparison after 6 weeks of treatment shows the 65% of patients healed with the lateral sphincterotomy and 52.5% of patients healed with ointment of glyceryl trinitrate. The healed proportion was measured high for the lateral sphincterotomy treatment as compared to the ointment of GTN. Practical implication: In our study we find that lateral sphincterotomy is more effective so this study will help the clinical practioner to select the better treatment option inorder to cure the anal fissure soon. Conclusion: It is concluded that for the treatment of anal fissure, the lateral sphincterotomy is considered an effective treatment as compared to ointment of GTN. Keywords: Chronic anal fissure; Glyceryl trinitrate ointment; Lateral internal sphincterotomy

Non-operative adjuncts for the prevention of mastectomy skin flap necrosis: a systematic review and meta-analysis.

Native skin flap necrosis is a potentially devastating complication following skin-sparing or nipple-sparing mastectomy with a reported incidence of as high as 30%. Treatment depends on the depth and extent of tissue necrosis and can range from dressings to surgical debridement and further reconstruction. This can have implications on patient physical and psychological wellbeing as well as cost of treatment. This study aims to identify and appraise cost-effective non-surgical adjuncts for the prevention of native skin flap necrosis. A systematic review was performed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and structured around existing recommended guidelines. A search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov was performed with the medical subject headings 'mastectomy' and 'flap necrosis'. After exclusion, 12 articles were selected for review and analysed. A total of 8439 mastectomies were performed on 7895 patients. Preventative non-surgical adjuncts that demonstrated statistically significant reduction in mastectomy flap necrosis included topical nitroglycerin ointment (P = 0.000), closed-Incision negative pressure wound therapy (P = 0.000), topical dimethylsulfoxide ointment (P = 0.03), oral cilostazol (P = 0.032), and local heat pre-conditioning (P = 0.047). This study identifies multiple adjuncts that may aid in preventing mastectomy skin flap necrosis, especially in high-risk patients. Further studies could aim to define standardized protocols and compare the various adjuncts in different circumstances.

Topical Dimethyl Sulfoxide for Congested Nipple-areolar Complexes in Breast Surgery: A Pilot Study.

We conducted a review of all 15 patients treated with DMSO for NAC congestion at our institution between May 2019 and October 2020. DMSO was applied in liquid form on a soaked gauze pad in the hospital; patients were instructed to apply a DMSO cream to the NAC twice a day following discharge. Patient characteristics and data related to DMSO treatment and NAC healing were compared via univariate analysis. Eighteen congested NACs from 15 patients who underwent mastectomy, breast reduction, mastopexy, or breast reconstruction were treated with DMSO. Of the 18 treated NACs, 15 healed with DMSO treatment alone. The average length of DMSO treatment was 9.4 ± 8.5 days (mean ± standard deviation); NAC healing took place over 9.9 ± 9.6 days. There were no complications related to DMSO treatment. This pilot study shows that DMSO may be an effective topical treatment for NAC congestion following breast surgery. Given its low cost, ease of application, and lack of side effects, future studies should prospectively compare DMSO against other topical treatments, like nitroglycerin ointment.