Topical Nitroglycerin Research Articles

Making Sense of Topical Pain Relief Options: Comparing Topical Analgesics in Efficacy and Safety.

In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today. Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used. Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed. Level 2. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome. Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost. Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B).

Nitroglycerin challenge identifies microcirculatory target for improved resuscitation in patients with circulatory shock

BackgroundCirculatory shock and multi-organ failure remain major contributors to morbidity and mortality in critically ill patients and are associated with insufficient oxygen availability in the tissue. Intrinsic mechanisms to improve tissue perfusion, such as up-regulation of functional capillary density (FCD) and red blood cell velocity (RBCv), have been identified as maneuvers to improve oxygen extraction by the tissues; however, their role in circulatory shock and potential use as resuscitation targets remains unknown. To fill this gap, we examined the baseline and maximum recruitable FCD and RBCv in response to a topical nitroglycerin stimulus (FCDNG, RBCvNG) in patients with and without circulatory shock to test whether this may be a method to identify the presence and magnitude of a microcirculatory reserve capacity important for identifying a resuscitation target.MethodsSublingual handheld vital microscopy was performed after initial resuscitation in mechanically ventilated patients consecutively admitted to a tertiary medical ICU. FCD and RBCv were quantified using an automated computer vision algorithm (MicroTools). Patients with circulatory shock were retrospectively identified via standardized hemodynamic and clinical criteria and compared to patients without circulatory shock.Results54 patients (57 ± 14y, BMI 26.3 ± 4.9 kg/m2, SAPS 56 ± 19, 65% male) were included, 13 of whom presented with circulatory shock. Both groups had similar cardiac index, mean arterial pressure, RBCv, and RBCvNG. Heart rate (p < 0.001), central venous pressure (p = 0.02), lactate (p < 0.001), capillary refill time (p < 0.01), and Mottling score (p < 0.001) were higher in circulatory shock after initial resuscitation, while FCD and FCDNG were 10% lower (16.9 ± 4.2 and 18.9 ± 3.2, p < 0.01; 19.3 ± 3.1 and 21.3 ± 2.9, p = 0.03). Nitroglycerin response was similar in both groups, and circulatory shock patients reached FCDNG similar to baseline FCD found in patients without shock.ConclusionCritically ill patients suffering from circulatory shock were found to present with a lower sublingual FCD. The preserved nitroglycerin response suggests a dysfunction of intrinsic regulation mechanisms to increase the microcirculatory oxygen extraction capacity associated with circulatory shock and identifies a potential resuscitation target. These differences in microcirculatory hemodynamic function between patients with and without circulatory shock were not reflected in blood pressure or cardiac index.

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...

Topical Tacrolimus Outperforms Topical Nitroglycerin for Pedicled Flap Survival in an Ischemic Rodent Model: Gross and Histologic Analysis

Topical Tacrolimus Outperforms Topical Nitroglycerin for Pedicled Flap Survival in an Ischemic Rodent Model: Gross and Histologic Analysis

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

Comparative study between effect of topical sucralfate cream and glyceryl trinitrate cream on post haemorrhoidectomy pain and wound healing

Comparative study between effect of topical sucralfate cream and glyceryl trinitrate cream on post haemorrhoidectomy pain and wound healing

Comparison of outcome of botulinum toxin injection with and without glyceryl trinitrate in chronic anal fissure in terms of post operative pain and healing.

To compare the outcome of botulinum toxin injection with and without glyceryl trinitrate with respect to postoperative pain and healing in the treatment of anal fissures. The prospective, comparative study was conducted at the Department of General Surgery, Mayo Hospital, Lahore, Pakistan, from September 1, 2021, to August 31, 2022, and comprised adult chronic anal fissure patients of either gender. They were randomised using the lottery method into group A which received botulinum toxin injection, and group B which received botulinum toxin injection plus 1g of 0.2% topical glyceryl trinitrate cream. Post-operative pain was measured 24 hours after the procedure using the visual analogue scale. Healing was assessed by examining the wound for the appearance of granulation tissue 4 weeks post-procedure. Data was analysed using SPSS 26. Of the 88 patients, 44(50%) were in group A; 32(72.7%) males and 12(27.3%) females with mean age 33.91±14.8 years. There were 44(50%) patients in group B; 35(79.5%) males and 9(20.5%) females with mean age range 36.33±14.9 years. The mean postoperative pain at 24 hours in group A was 4.67±1.16 and it was 3.06±0.65 in group B (p=0.009). In group A, 23(69.7%) patients showed complete healing at 4 weeks compared to 30(90.9%) in group B (p=0.030). Botulinum toxin injection with glyceryl trinitrate could be considered as first line of treatment for chronic anal fissure in patients who refuse surgery and with previous sphincter surgery.

Effect of topical nitroglycerin application on flap survival and complications post reconstructive microsurgery: A systematic review and meta-analysis study of the literature

Background and Aims: Several methods have been used in plastic and reconstructive surgery to reduce post-surgical complications, such as partial or complete flap loss due to ischemia and necrosis. Nitroglycerine application has been introduced as a viable alternative to papaverine to act as a local vasodilator to improve perfusion and reduce vasospasm. However, the literature has not thoroughly studied its efficacy and administration dose. This systematic review and meta-analysis study has been designed to assess the efficacy of topical nitroglycerine applications in reducing post-surgical flap necrosis and complications. Methods and Materials: A systematic literature search was performed on PubMed, Scopus, and Web of Science from inception to January 2023 with relevant keywords and terms. Case reports, review articles, letters, articles in any language other than English, and animal studies were excluded. The Newcastle-Ottawa and Jadad scales were used to assess the quality of the included studies. The pooled effect sizes were calculated using the random effect model with the Mantel-Haenszel method. Results: Overall, 2031 studies were obtained, among which 454 articles were duplicated and removed. Of the remaining 1577 articles, based on the eligibility and exclusion criteria, 20 articles were retrieved for full-text review. Finally, eight articles were included in our study. Three thousand nine hundred six patients had undergone reconstructive microsurgery and received topical nitroglycerin for the prevention of possible complications. The pooled rate of flap complication was 15% (95% CI: 8% to 25%, I2 = 96%, p-value &lt; 0.01), and the pooled odds ratio of flap complication was 0.35 (95% CI: 0.15 to 0.83, I2 = 91%, p-value = 0.02). The heterogeneity of the included studies was significantly high. The dose and regimen of application significantly differed between each study. Conclusion: Topical administration of nitroglycerin compounds post reconstructive microsurgery can reduce the risk of flap necrosis. However, the precise dosage, duration of application, and possible underlying factors affecting drug efficacy are yet to be discovered.

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. &#x0D; 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.&#x0D; 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 &amp; 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&lt;0.001. &#x0D; Conclusion: Headache postural hypotension are significant side-effects of GTN; and they lead to non-compliance and thus subsequent failure to achieve healing.

Noradrenaline Extravasation Management in the Absence of Phentolamine: A Case Series

Noradrenaline (norepinephrine) extravasation can lead to tissue ischemia due to its vasoconstrictive properties. Phentolamine is the preferred treatment but is often unavailable in many Malaysian healthcare facilities. Alternative treatments, such as topical glyceryl trinitrate (GTN) and terbutaline injections, have limited data supporting their use. This case series reports two instances of noradrenaline extravasation successfully managed with terbutaline injections and extemporaneously prepared topical GTN in an Emergency Department setting. These cases highlight the effectiveness of terbutaline and GTN as viable alternatives, providing valuable insights for emergency care in settings where phentolamine is not accessible.

Topical glyceryl trinitrate to increase radial artery diameter in neonates: study protocol for a randomized controlled trial

RESUMO Histórico: Os recém-nascidos internados na unidade de terapia intensiva neonatal necessitam de canulação arterial para monitoramento hemodinâmico e coleta de sangue. O acesso arterial é obtido por meio de cateterização das artérias umbilicais ou periféricas. A canulação da artéria periférica é realizada em recém-nascidos em estado grave, mas a localização e a canulação da artéria são, muitas vezes, desafiadoras e sem sucesso. Assim, o aumento do diâmetro interno e a prevenção do vasoespasmo são importantes para o sucesso da canulação da artéria periférica em recém-nascidos. O trinitrato de glicerilo tópico tem o potencial de aumentar o sucesso da canulação ao relaxar a musculatura lisa arterial e, dessa forma, aumentar o diâmetro interno. Nosso objetivo é realizar um ensaio piloto controlado e randomizado para avaliar a eficácia e segurança do trinitrato de glicerilo tópico no aumento do diâmetro da artéria radial em recém-nascidos. Métodos/Desenho: Este estudo será um estudo de centro único, cego para o observador, randomizado, controlado por placebo, conduzido na unidade de terapia intensiva neonatal do Perth Children's Hospital, Austrália Ocidental. Serão recrutados 60 bebês nascidos com mais de 34 semanas de gestação, internados para cirurgia eletiva ou por razões médicas e para os quais é necessária a colocação de um acesso arterial periférico para coleta de amostras ou monitoramento da pressão arterial, após a obtenção do consentimento informado dos pais. O desfecho primário será a mudança no diâmetro arterial radial basal e pós-intervenção. Os desfechos secundários serão a alteração absoluta e percentual basal no diâmetro arterial radial em ambos os membros e a segurança (hipotensão e metemoglobinemia). Discussão: Este será o primeiro estudo controlado e randomizado a avaliar o uso de trinitrato de glicerilo tópico para facilitar a canulação da artéria periférica em recém-nascidos. Se nosso estudo-piloto randomizado e controlado confirmar os benefícios dos adesivos de trinitrato de glicerilo, ele abrirá caminho para grandes estudos multicêntricos randomizados e controlados nesse campo.

Efficacy of local metronidazole with glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: a randomized clinical trial

Introduction Anal fissure is one of the most common diseases of the anorectal region that is frequently encountered in surgical practice, equally affects both women and men. Acute anal fissures last shorter than 6 weeks. The American Society of Colon and Rectal Surgeons favors conservative management of anal fissure as the first line of treatment. A rectal ointment containing 0.2% glyceryl triturate (GTN) can be recommended to promote the healing of anal fissures and decreasing sphincter spasm. Metronidazole is a 5-nitroimidazole derivative antibiotic with a cytotoxic bactericidal effect particularly on anaerobic bacteria. The purpose of the present study was to investigate whether local metronidazole antibiotic cream is effective and safe to use in reducing the symptoms and improving the healing process of acute anal fissure. Patients and methods This study was performed in Mansoura University Hospital, surgery outpatient clinic from the period of July 2022 till July 2023. This study was a single-blinded, randomized controlled trial. Total 100 patients were included in this study and randomly divided into two groups, 50 patients in each group. First group (group 1) treated by combination of local metronidazole 10% with 0.2% GTN while the second group treated only with GTN. Results Anal pain were present in both group in all patients with acute anal fissure while constipation were 88% in group 1 and 76% group 2. To lesser extent itching, bleeding, and diarrhea were presented in both group. Visual analog scale for pain intensity were equal in both groups at the time of first clinical examination. After 1 week and 1 month of treatment there were statistically significant difference between both groups thus the visual analog scale were lower in group 1 than group 2 (0.001 and &lt;0.001, respectively). Healing of acute anal fissure was assessed clinically at variable interval for all patients there is statistically significant difference between both group (0.004) as regard healing, first group showed earlier and faster healing and fewer number of nonhealing of the fissure at the end of follow up. Conclusion Adding local metronidazole 10% to the classic GTN treatment will improve the symptoms of acute anal fissure specially pain and discomfort and markedly accelerate healing process.

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 &lt;0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P &lt;0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P &lt;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.

Relocating Glyceryl Trinitrate as an Anti-Virulence Agent against Pseudomonas aeruginosa and Serratia marcescens: Insights from Molecular and In Vivo Investigations.

The problem of antibiotic resistance is a global critical public health concern. In light of the threat of returning to the pre-antibiotic era, new alternative approaches are required such as quorum-sensing (QS) disruption and virulence inhibition, both of which apply no discernible selective pressure on bacteria, therefore mitigating the potential for the development of resistant strains. Bearing in mind the significant role of QS in orchestrating bacterial virulence, disrupting QS becomes essential for effectively diminishing bacterial virulence. This study aimed to assess the potential use of sub-inhibitory concentration (0.25 mg/mL) of glyceryl trinitrate (GTN) to inhibit virulence in Serratia marcescens and Pseudomonas aeruginosa. GTN could decrease the expression of virulence genes in both tested bacteria in a significant manner. Histopathological study revealed the ability of GTN to alleviate the congestion in hepatic and renal tissues of infected mice and to reduce bacterial and leukocyte infiltration. This study recommends the use of topical GTN to treat topical infection caused by P. aeruginosa and S. marcescens in combination with antibiotics.

Topical Nitroglycerin versus Lateral fnternal Sphincterotomyin Treatment of Chronic Anal Fissure

Background: Anal fissure is common conditions that can affect people of all ages. Most anal fissures are at the rear of anal opening in line with cleft of the buttocks. There are many methods of treatment such as: medication by topical nitroglycerin or nifedipine paste or butulinum toxin injection or surgery by lateral internal Sphincterotomy or V-Y advancement flap.&#x0D; Objectives: Is to compare the result of topical GTN (chemical Sphincterotomy) as primary treatment of chronic anal fissure with lateral internal Sphincterotomy.&#x0D; Methods:&#x0D; Setting: In outpatient clinic and Tikrit teaching hospital from Jan. 2006 to Oct0.2007.&#x0D; Design: prospective study.&#x0D; This study compares the results of two different methods of treatment (chemical sphinecterotomy&amp;lateral internal Sphincterotomy) in 84 cases of chronic anal fissure regarding the efficacy and complication of these procedures.&#x0D; These cases were randomized in equal number into two groups:&#x0D; Group 1: were treated by chemical Sphincterotomy.&#x0D; Group 2: were treated by lateral internal Sphincterotomy.&#x0D; The average period of follow up after completion of treatment was 3 months for both groups.&#x0D; Results:&#x0D; Symptomatic improvement occurs in 30 patients treated by chemical Sphincterotomy (71.42%) at 12 weeks following treatment and 39 patients (92.85%) treated by lateral internal Sphincterotomy.&#x0D; No improvement occurs in 3 cases (7.15%) treated by chemical Sphincterotomy and no case who was treated by lateral internal Sphincterotomy.&#x0D; Conclusion: From this study we find that chemical Sphincterotomy induce rapid healing of chronic anal fissure with 71.42% rate in comparison to lateral internal Sphincterotomy with a 92.85% healing rate after 12 weeks treatment,

MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY

You have accessJournal of UrologyCME1 Apr 2023MP15-03 MONKEYPOX AND THE PENIS: AN EMPIRICAL CARE PATHWAY Piotr Sluzar, Alex Murray, Anna Daunt, Aatish Patel, Achyuta Nori, Geraldine O'Hara, and Tet Yap Piotr SluzarPiotr Sluzar More articles by this author , Alex MurrayAlex Murray More articles by this author , Anna DauntAnna Daunt More articles by this author , Aatish PatelAatish Patel More articles by this author , Achyuta NoriAchyuta Nori More articles by this author , Geraldine O'HaraGeraldine O'Hara More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Monkeypox is a viral illness affecting predominantly gay, bisexual and other men having sex with men. The rapid progression of the recent outbreak meant genital manifestations preceded any guidelines for cases with urological symptoms. This study aims to develop an empirical care pathway for patients presenting with penile and scrotal symptoms secondary to monkeypox. METHODS: From May to September 2022, 198 patients with monkeypox who presented to a tertiary referral hospital were assessed for genital involvement by the infectious disease team, with the involvement of a urologist. Of these, 19 patients (10%) were admitted with genital lesions and were treated in an isolation ward with full personal protection equipment (PPE) in use. Symptoms requiring urological input were present in 8 individuals (4%). The mean time from the onset of symptoms to resolution was 25.3 (range 9-63) days. Based on the management of these patients, an empirical care pathway for genital monkeypox was developed. RESULTS: Four stages of genital monkeypox were observed (Figure 1). Limited penile oedema and discrete lesions should be managed conservatively with analgesia, cold compresses and elevation for swelling control. Patients with moderate oedema, paraphimosis and large coalescing ulcers should be considered for a topical 1% hydrocortisone cream to reduce the inflammation. In severe oedema with necrotic ulcers glyceryl trinitrate (GTN) patches are crucial to improve the vascularization of the necrotic ulcers on the penis. Cases of widespread necrosis and oedema may require imaging to assess the need for surgical debridement. GTN patches require daily changes for tissue salvage. Catheterization should be guided by the extent of oedema, the presence of paraphimosis and lesions close to the external urethral orifice. CONCLUSIONS: Monkeypox cases presenting through lesions on the penis and scrotum often require urological management to reduce penile oedema and prevent catheterisation. All admitted patients require isolation with full PPE. The initial stages of the infection should be managed conservatively with cold compresses, elevation and analgesia. Patients with advanced genital symptoms can benefit from the early use of topical steroid creams and GTN patches applied over the necrotic areas to reduce swelling and aid perfusion. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e192 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Sluzar More articles by this author Alex Murray More articles by this author Anna Daunt More articles by this author Aatish Patel More articles by this author Achyuta Nori More articles by this author Geraldine O'Hara More articles by this author Tet Yap More articles by this author Expand All Advertisement PDF downloadLoading ...

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&lt;0.05 was considered as significant. Results: The VAS scores between the groups was found to be non-significant (p&gt;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.

Methods for increasing distal radial artery diameter.

Our study aimed to find the maximum rate of increase in distal radial artery size. Diameter measurements were obtained on transverse and sagittal sections of the artery with a high-frequency linear transducer (Philips ClearVue L12-4 Mhz). In the baseline evaluation, radial artery and distal radial artery diameters were measured. The patients were divided into two groups: patients with flow-mediated dilatation in Group I and patients with 30 mg Topical Nitroglycerin in Group II. Group II patients were divided into two groups 30 minutes after topical nitroglycerin; patients with flow-mediated dilatation (FDM) in Group IIa, patients with wrist warming plus FMD in Group IIb. A significant increase was found between baseline and second measurements in the radial artery (2.64±0.46 and 2.36±0.39 mm; p=0.02 in Group I, 2.78±0.38 and 2.39±0.25 mm; p=0.01 in Group II) and distal radial artery (2.29±0.49 and 1.93±0.37 mm; p=0.02 in Group I, 2.32±0.28 and 1.96±0.44 mm; p=0.04 in Group II) diameters. Radial (3.02±0.55 and 2.78±0.38 mm; p<0.01) and distal radial artery (2.55±0.32 and 2.32±0.28 mm; p=0.01) diameters increased compared to the second measurements in Group IIa. Radial (3.25±0.35 and 2.78±0.38 mm; p<0.01) and distal radial artery (2.88±0.12 and 2.32±0.28 mm; p<0.01) diameters increased compared to the second measurements in Group IIb. The results of the final evaluations of the two groups were compared, radial (3.02±0.55 and 3.25±0.35 mm; p=0.04) and distal radial artery (2.55±0.32 and 2.88±0.12 mm; p=0.03) diameters were found to be significantly higher in Group IIb than Group IIa. When comparing baseline and final evaluations, the radial artery diameter was increased by 37%, and the distal radial artery diameter was increased by 49% in Group IIb. We increased the radial artery diameter higher proportion than defined in the literature.

PROSPECT guideline for haemorrhoid surgery

BACKGROUND Haemorrhoidectomy is associated with moderate-to-severe postoperative pain. OBJECTIVE The aim of this systematic review was to assess the available literature and update previous PROSPECT (procedure specific postoperative pain management) recommendations for optimal pain management after haemorrhoidectomy. DESIGN AND ELIGIBILITY CRITERIA A systematic review utilising PROSPECT methodology was undertaken. DATA SOURCES Randomised controlled trials published in the English language from January 1, 2016 to February 2, 2022 assessing postoperative pain using analgesic, anaesthetic, and surgical interventions were identified from MEDLINE, EMBASE and Cochrane Database. RESULTS Of the 371 randomized controlled trials (RCTs) identified, 84 RCTs and 19 systematic reviews, meta-analyses met our inclusion criteria (103 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, pudendal nerve block, topical metronidazole, topical diltiazem, topical sucralfate or topical glyceryl trinitrate, and intramuscular injection of botulinum toxin. DISCUSSION This review has updated the previous recommendations written by our group. Important changes are abandoning oral metronidazole and recommending topical metronidazole, topical diltiazem, topical sucralfate, topical glyceryl trinitrate. Botulinum toxin can also be administered. Contemporary publications confirm the analgesic effect of bilateral pudendal nerve block but invalidate recommendations on perianal infiltration. The choice of the surgery is mostly left to the discretion of the surgeons based on their experience, expertise, type of haemorrhoids, and risk of relapse. That said, excisional surgery is more painful than other procedures.