Topical application of LEVORAG® as first-line treatment for chronic anal fissures: a preliminary multicentric study

AIM

The aim of the present study was to assess the safety and efficacy of this new topical agent as a first line treatment in patients with chronic anal fissures.

METHODS

Nine centres were involved in the study. Patients with chronic anal fissures were recruited and received Levorag® for 40 days. Follow-up visits were conducted at 10, 20 and 40 days from the recruitment. Primary outcome was the healing rate, secondary outcome the reduction of pain at the end of the treatment measured with a VAS scale.

RESULTS

Fifty patients completed the treatment. No adverse events were recorded. 60% of patients healed completely at the end of the treatment. In those that did not heal the reduction of mean VAS values was 60%.

CONCLUSION

The use of Levorag® on patients affected by chronic anal fissures achieved in the short term results similar to those experienced by more classic local treatments without any side effect.

[Evaluation of the effectiveness and safety of Fragmin (Kabi 2165) versus calcium heparin in the prevention of deep venous thrombosis in general surgery]

Fourty patients who underwent general surgery have been enrolled in a double-blind controlled trial which evaluated the efficacy and safety of Fragmin, a new low molecular weight heparin, chosen to be the 1st OMS International Standard for LMWH. Fragmin 2500 UI anti-Xa once daily and unfractionated heparin 5000 UI twice daily were administered to prevent postoperative deep venous thrombosis. Prophylaxis began two hours before surgery and continued for the next 5 postoperative days. The incidence of isotopic venous thrombosis, thromboembolic disorders and bleeding complications have been evaluated. Results have shown a similar efficacy and safety profile of the two drugs, although Fragmin doses are markedly inferior to unfractionated heparin's. Moreover, Fragmin has the advantage of a single daily administration, with a better patients' compliance and an easier and less expensive nursing care.

[Involvement of the polypeptide system and ACE in Crohn disease]

The polypeptidyc system was studied and serum concentrations of ACE (Angiotension Converting Enzyme) were assayed in patients with Crohn's disease in the active and stabilising phases. The study was undertaken on the assumption that as a granulomatous condition Crohn's disease involves the polypeptidyc system in much the same way as in sarcoidosis. The results confirm the hypothesis revealing a significant increase in ACE levels in patients with the active disease, whereas levels in the stabilized disease were lower than in the controls. It is suggested that, as in sarcoidosis, ACE levels are useful in the diagnosis, prognosis and follow-up of Crohn's disease, especially in relation to the use of steroid drugs.

[Value of serology and endoscopy and clinical aspects in idiopathic rectocolitis]

The clinical course of ulcerative colitis is characterized by recurring acute attacks and interspersed with periods of remission. The present study correlates the clinical, endoscopic and laboratory results in the follow-up of 22 rectocolitis patients in order to identify any data that might serve as a warning of recurrences. It is claimed that laboratory examinations like titering of alpha 1-antitrypsin, antithrombin III collagenase, C3 and C4 offer useful support for endoscopy which is generally considered the only reliable examination in the diagnosis of idiopathic rectocolitis.

[Variations in serum sialic acid in patients operated on for colonic cancer]

Various Authors believe that an increase in serum sialic acid might indicate the cancerisation of the membrane. Serum sialic acid was assayed pre- and post-operatively in patients with colonic carcinoma and in a control group. Sialic acid concentrations were significantly higher in the cancer group and the data obtained confirm the view that the increase has an effect on immune response in tumor patients.

[Our experience with emergency surgical treatment of acute cholecystitis]

A clinical series of 580 patents (318, F, 199 M) personally observed at the Emergency Surgery and First Aid Division of the Fatebenefratelli and Ophthalmic Hospital Board of Milan between 1975 and 1980, and suffering from acute inflammation of the bile ways (gall bladder empyemas, acute cholecystitis, gangrene of the gall bladder, haemobilia due to gall bladder puncture), has been examined. Of these patients, 558 were subjected to surgery between 12 hours and 6 days after admittance. Operated patients are subdivided into 4 groups on the basis of their anatomo-pathological form and the average time interval between admittance and intervention. Critical examination shows that their behaviour with respect to acute inflammatory forms of the gall bladder can be split up as follows: 1) immediate surgery (within 12 hours) for empyematous and/or punctured forms; 2) emergency surgery (within 2 days of admittance) for cases with certain diagnosis backed up by historical and X-ray data pointing to calculosis of the gall bladder; 3) early surgery (within 3 days) for cases with certain diagnosis but without prior X-ray documentation; 4) deferred surgical intervention (within 6 days) for patients without X-ray documentation and in whom immediate medical treatment leads to a rapid improvement in the clinical picture. The very good clinical results obtained and the observation of a low mortality and morbility index (comparable to those of surgery of choice) suggest that early surgery is certainly the therapy of choice when dealing with acute cholecystitis.

[Emergency surgical treatment of spontaneous internal fistulas of the digestive tract]

The Authors report 16 cases of gastrointestinal fistulas which have been observed during the last 5 years in the Emergency Surgery Division of Milan's Fatebenefratelli Hospital. We have considered only the cases of fistulas between two hollow abdominal organs and which have occurred spontaneously, following local pathology (cholelithiasis, neoplasms, abscesses etc.) and not from iatrogenic causes. Of these 16 patients, all surgically treated, 9 were female and 7 male, their age ranging from 24 to 77 years (average: 58 years). The medium post-operative period was of 11 days; the overall mortality was of 2 patients (12,5 per cent). These, having presented at surgery a serious stercoraceous peritonitis, died of septic shock.