Anal Fissure - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

NAL ISSURE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Anal Fissure: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00063-6 1. Anal Fissure-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on anal fissure. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON ANAL FISSURE .......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Anal Fissure.................................................................................. 6 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND ANAL FISSURE................................................................................. 47 Overview...................................................................................................................................... 47 Finding Nutrition Studies on Anal Fissure................................................................................. 47 Federal Resources on Nutrition ................................................................................................... 48 Additional Web Resources ........................................................................................................... 48 CHAPTER 3. ALTERNATIVE MEDICINE AND ANAL FISSURE .......................................................... 51 Overview...................................................................................................................................... 51 National Center for Complementary and Alternative Medicine.................................................. 51 Additional Web Resources ........................................................................................................... 53 General References ....................................................................................................................... 54 CHAPTER 4. PATENTS ON ANAL FISSURE ....................................................................................... 55 Overview...................................................................................................................................... 55 Patent Applications on Anal Fissure ........................................................................................... 55 Keeping Current .......................................................................................................................... 57 CHAPTER 5. BOOKS ON ANAL FISSURE ........................................................................................... 59 Overview...................................................................................................................................... 59 Book Summaries: Federal Agencies.............................................................................................. 59 Chapters on Anal Fissure............................................................................................................. 62 CHAPTER 6. PERIODICALS AND NEWS ON ANAL FISSURE ............................................................. 67 Overview...................................................................................................................................... 67 News Services and Press Releases................................................................................................ 67 Newsletter Articles ...................................................................................................................... 69 Academic Periodicals covering Anal Fissure ............................................................................... 69 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 71 Overview...................................................................................................................................... 71 U.S. Pharmacopeia....................................................................................................................... 71 Commercial Databases ................................................................................................................. 72 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 75 Overview...................................................................................................................................... 75 NIH Guidelines............................................................................................................................ 75 NIH Databases............................................................................................................................. 77 Other Commercial Databases....................................................................................................... 79 APPENDIX B. PATIENT RESOURCES ................................................................................................. 81 Overview...................................................................................................................................... 81 Patient Guideline Sources............................................................................................................ 81 Finding Associations.................................................................................................................... 83 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 85 Overview...................................................................................................................................... 85 Preparation................................................................................................................................... 85 Finding a Local Medical Library.................................................................................................. 85 Medical Libraries in the U.S. and Canada ................................................................................... 85 ONLINE GLOSSARIES.................................................................................................................. 91 Online Dictionary Directories ..................................................................................................... 93

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ANAL FISSURE DICTIONARY ................................................................................................... 95 INDEX .............................................................................................................................................. 123

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with anal fissure is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about anal fissure, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to anal fissure, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on anal fissure. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to anal fissure, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on anal fissure. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON ANAL FISSURE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on anal fissure.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and anal fissure, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “anal fissure” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Anal Fissure Source: Gastroenterology Clinics of North America. 30(1): 167-181. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: Fissure in ano or anal fissure is a linear tear in the lining of the distal anal canal. It is a common condition affecting all age groups, but it is particularly seen in young and otherwise healthy adults. The classic symptoms are anal pain during or after defecation accompanied by the passage of bright red blood per anus. The pain often is severe and may last for a few minutes during or persist for several hours after defecation (having a bowel movement). This article reports on the diagnosis and management of patients with anal fissure. Most anal fissures are acute and relatively

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short lived, resolving spontaneously or with simple dietary modification to increase fiber and stool softening laxatives when appropriate. Fissures failing to heal within 6 weeks despite straightforward dietary measures generally are designated as chronic. Fissures that are resistant to treatment should prompt further investigation, including examination under anesthesia and appropriate biopsy. The authors discuss pathogenesis, including trauma during pregnancy, internal anal sphincter hypertonia, and local ischemia. Treatment for chronic anal fissure can include drug therapy, the use of botulinum toxin injections, and surgery, such as anal dilation, lateral internal sphincterotomy, and anal advancement flap. The authors note that the discovery of pharmacological agents that effectively cause a chemical sphincterotomy and heal most fissures has led to approximately two thirds of patients avoiding surgery. A patient care algorithm is provided. 1 figure. 1 table. 111 references. •

Hemorrhoids, Anal Fissure, and Carcinoma of the Colon, Rectum, and Anus During Pregnancy Source: Surgical Clinics of North America. 75(1): 77-88. February 1995. Contact: Available from W.B. Saunders Company, Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: In this journal article, from a special issue on surgery in the pregnant patient, the authors review the problems of hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. The chapter covers the etiology, symptoms, complications, conservative therapy, and surgery for hemorrhoids; the etiology and treatment of anal fissures; colorectal carcinoma, including presenting symptoms and signs, treatment considerations, and outcome; and anal carcinoma. The authors stress the need for open discussions between patient and physician about the pros and cons of operative and nonoperative approaches. 3 tables. 33 references.

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Comparison of Injections of Botulinum Toxin and Topical Nitroglycerin Ointment for the Treatment of Chronic Anal Fissure Source: New England Journal of Medicine. 341(2): 65-69. July 8, 1999. Summary: Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. This article reports on a comparison of two nonsurgical treatments for chronic anal fissure that may avert the risk of fecal incontinence. The authors randomly assigned 50 adults with symptomatic chronic posterior anal fissures to receive treatment with either a total of 20 U of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline or 0.2 percent nitroglycerin ointment applied twice daily for six weeks. After two months, the fissures were healed in 24 of the 25 patients (96 percent) in the botulinum toxin group and in 15 of the 25 (60 percent) in the nitroglycerin group. No patient in either group had fecal incontinence. At some time during treatment, five patients in the nitroglycerin group had transient, moderate to severe headaches that were related to treatment. None of the patients in the botulinum toxin group reported adverse effects. Ten patients who did not have a response to the assigned treatment (1 in the botulinum toxin group and 9 in the nitroglycerin group) crossed over to the other treatment; the fissures subsequently healed in all 10 patients. There were no relapses during an average of about 15 months of followup. The authors conclude that, although treatment with either topical nitroglycerin or botulinum toxin is effective as an alternative to surgery for patients with chronic anal fissure, botulinum toxin is the more effective nonsurgical treatment. 1 figure. 2 tables. 30 references.

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Practice Parameters for the Management of Anal Fissure Source: Diseases of the Colon and Rectum. 35(2): 206-208. February 1992. Summary: These practice parameters outline principles and provide suggestions to assist physicians in the care of patients with anal fissure. The parameters were developed based on data from published articles, the collective experiences of clinicians, and the opinions of members of the Standards Task Force. The parameters include a statement of the problem and guidelines for diagnosis, medical and surgical treatment, recurrent fissure, and complications. The guidelines stress that the ultimate judgement regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient. 40 references.

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AGA Technical Review on the Diagnosis and Care of Patients with Anal Fissure Source: Gastroenterology. 124(1): 235-245. January 2003. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: This article presents the literature review and research that support the official recommendations of the American Gastroenterological Association (AGA) on anal fissures (published elsewhere in this same journal issue). Anal fissure is a common condition, and the main symptoms include anal pain and bleeding. The often severe pain typically occurs during and after defecation; chronic fissure patients can have pain lasting many hours after bowel movements. Bleeding from anal fissures tends to be bright red and scanty. Fissure patients usually offer a standard history, and the diagnosis should be suspected based on history alone. About half of all fissures heal with conservative care, which consists of fiber supplementation, adequate fluid intake, sitz baths, and topical analgesics. Other treatment options include surgery, topical therapy, and botulin toxin. This article reviews research studies on the diagnosis and treatment of anal fissures. 2 tables. 107 references.

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American Gastroenterological Association Medical Position Statement: Diagnosis and Care of Patients with Anal Fissure Source: Gastroenterology. 124(1): 233-234. January 2003. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.gastrojournal.org. Summary: This article presents the official recommendations of the American Gastroenterological Association (AGA) on anal fissures. Anal fissure is a common condition, and the main symptoms include anal pain and bleeding. The often severe pain typically occurs during and after defecation; chronic fissure patients can have pain lasting many hours after bowel movements. Bleeding from anal fissures tends to be bright red and scanty. Fissure patients usually offer a standard history, and the diagnosis should be suspected based on history alone. About half of all fissures heal with conservative care, which consists of fiber supplementation, adequate fluid intake, sitz baths, and topical analgesics. Other treatment options include surgery, topical therapy, and botulin toxin.

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Anal Fissure: Unclear Causes But Promising New Treatments Source: JAAPA. Journal of the American Academy of Physician Assistants. 13(2): 45-47, 51-52, 55-56, 59. February 2000.

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Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article reviews the medical problem of anal fissure, focusing on patient care management. An anal fissure is a painful linear ulcer involving the epithelium of the anal canal. Many patients experience painful, bright red rectal bleeding, and the typical presenting complaint is a hemorrhoid. The author reviews the anatomy and physiology of the anal canal; the pathogenesis, presentation, and diagnosis of acute and chronic anal fissure; and the treatment options for this condition. An acute anal fissure, whose etiology is often clear, can usually be cured with conservative measures. The etiology of chronic anal ulcer is, however, under debate; hypotheses include anatomic arrangement, ischemia of the anoderm, and high anal resting pressures. The current treatment of choice for a chronic anal ulcer is lateral internal sphincterotomy. This irreversible surgical procedures carries a risk of flatus (gas) and stool incontinence. Several new and safe treatment options are now used, with varying success; the author discusses these options and patient followup, focusing on the care typically provided by a physician's assistant. Appended to the article is a posttest with which readers can qualify for continuing medical education (CME) credit. 3 figures. 2 tables. 25 references. •

Nitroglycerin Ointment for Anal Fissures: Effective Treatment or Just a Headache? Source: Diseases of the Colon and Rectum. 42(3): 383-385. March 1999. Contact: Available from Williams and Wilkins. 352 West Camden Street, Baltimore, MD 21201-2436. Summary: Topical nitrates have been shown to cause nitric oxide mediated relaxation of the internal anal sphincter. Previous reports have suggested the efficacy of nitroglycerin ointment in treating anal fissures. This article reports on a study undertaken to assess the longer term usefulness of this treatment. Thirty three patients who had an anal fissure were treated with topical 0.3 percent nitroglycerin ointment applied to the anoderm three times a day and after bowel movements. Patients were followed up by office visits and telephone calls until symptoms were completely resolved or treatment was noted to be ineffective or intolerable. Of the 33 patients, 16 had acute fissures and 17 had chronic fissures. Nitroglycerin was effective in 9 of 16 acute fissures (56 percent) and 7 of 17 chronic fissures (41 percent). Even when effective, 75 percent of patients reported an adverse reaction, specifically headaches or lightheadedness, or both. However, most of the side effects could be tolerated or controlled, and only 3 patients stopped treatment because side effects were intolerable. The authors conclude that topical nitroglycerin was effective only in approximately half of the patients with an anal fissure. In their experience, nitroglycerin causes a headache more often than it treats the symptoms of anal fissure. 1 table. 14 references. (AA-M).

Federally Funded Research on Anal Fissure The U.S. Government supports a variety of research studies relating to anal fissure. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable 2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to anal fissure. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore anal fissure.

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with anal fissure, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “anal fissure” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for anal fissure (hyperlinks lead to article summaries): •

A comparative study in anal fissure treatment. Author(s): Oueidat D. Source: J Med Liban. 1999 May-June; 47(3): 164-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10550940

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A comparison of botulinum toxin and nitroglycerin ointment for chronic anal fissure. Author(s): Vogel JD. Source: The New England Journal of Medicine. 1999 November 25; 341(22): 1701. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10610442

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A comparison of botulinum toxin and nitroglycerin ointment for chronic anal fissure. Author(s): Kaiser AM. Source: The New England Journal of Medicine. 1999 November 25; 341(22): 1701. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10610441

3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A comparison of botulinum toxin and saline for the treatment of chronic anal fissure. Author(s): Maria G, Cassetta E, Gui D, Brisinda G, Bentivoglio AR, Albanese A. Source: The New England Journal of Medicine. 1998 January 22; 338(4): 217-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9435326

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A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. Author(s): Brisinda G, Maria G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. Source: The New England Journal of Medicine. 1999 July 8; 341(2): 65-9. Erratum In: N Engl J Med 1999 August 19; 341(8): 624. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10395629

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A critical appraisal of pathogenesis and morbidity of surgical treatment of chronic anal fissure. Author(s): Romano G, Rotondano G, Santangelo M, Esercizio L. Source: Journal of the American College of Surgeons. 1994 June; 178(6): 600-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8193753

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A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures. Author(s): Scholefield JH, Bock JU, Marla B, Richter HJ, Athanasiadis S, Prols M, Herold A. Source: Gut. 2003 February; 52(2): 264-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12524411

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A fundamental affair--a short history of anal fissure. Author(s): de Moulin D. Source: Arch Chir Neerl. 1977; 29(3): 163-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=335980

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A manometric study of anal fissure treated by subcutaneous lateral internal sphincterotomy. Author(s): McNamara MJ, Percy JP, Fielding IR. Source: Annals of Surgery. 1990 February; 211(2): 235-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2302000

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A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XV. Chronic anal fissure: a new theory of pathogenesis. Author(s): Shafik A. Source: American Journal of Surgery. 1982 August; 144(2): 262-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7102937

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A nonsurgical approach to chronic anal fissure. Author(s): Scholefield JH, Lund JN. Source: Hosp Pract (Off Ed). 1997 September 15; 32(9): 181-6, 188. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9307603

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A preliminary report on cryosurgical treatment of chronic anal fissure. Author(s): Vajrabukka T, Dhitavat V, Kechanond B, Vajrabukka C. Source: Am J Proctol. 1977 December; 28(6): 47-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=596435

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A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure. Author(s): Bielecki K, Kolodziejczak M. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 May; 5(3): 256-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12780888

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A prospective, randomized, double-blind, placebo-controlled trial of glyceryltrinitrate ointment in the treatment of children with anal fissure. Author(s): Tander B, Guven A, Demirbag S, Ozkan Y, Ozturk H, Cetinkursun S. Source: Journal of Pediatric Surgery. 1999 December; 34(12): 1810-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10626860

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A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Author(s): Lund JN, Scholefield JH. Source: Lancet. 1997 January 4; 349(9044): 11-4. Erratum In: Lancet 1997 March 1; 349(9052): 656. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8988115

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A randomized controlled trial to compare anal dilatation with lateral subcutaneous sphincterotomy for anal fissure. Author(s): Marby M, Alexander-Williams J, Buchmann P, Arabi Y, Kappas A, Minervini S, Gatehouse D, Keighley MR. Source: Diseases of the Colon and Rectum. 1979 July-August; 22(5): 308-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=467194

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A randomized trial of botulinum toxin vs lidocain pomade for chronic anal fissure. Author(s): Colak T, Ipek T, Kanik A, Aydin S. Source: Acta Gastroenterol Belg. 2002 October-December; 65(4): 187-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12619423

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A randomized trial of glyceryl trinitrate ointment and nitroglycerin patch in healing of anal fissures. Author(s): Zuberi BF, Rajput MR, Abro H, Shaikh SA. Source: International Journal of Colorectal Disease. 2000 August; 15(4): 243-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11008725

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A randomized trial of oral vs. topical diltiazem for chronic anal fissures. Author(s): Jonas M, Neal KR, Abercrombie JF, Scholefield JH. Source: Diseases of the Colon and Rectum. 2001 August; 44(8): 1074-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535842

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A review of operative procedures for anal fissure. Author(s): Nelson RL. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 284-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022974

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A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Author(s): Bailey HR, Beck DE, Billingham RP, Binderow SR, Gottesman L, Hull TL, Larach SW, Margolin DA, Milsom JW, Potenti FM, Rafferty JF, Riff DS, Sands LR, Senagore A, Stamos MJ, Yee LF, Young-Fadok TM, Gibbons RD; Fissure Study Group. Source: Diseases of the Colon and Rectum. 2002 September; 45(9): 1192-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12352236

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A systematic review of medical therapy for anal fissure. Author(s): Nelson R. Source: Diseases of the Colon and Rectum. 2004 April; 47(4): 422-31. Epub 2004 March 04. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14994109

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ABC of colorectal diseases. Anal fissures and fistulas. Author(s): Hancock BD. Source: Bmj (Clinical Research Ed.). 1992 April 4; 304(6831): 904-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1392761

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Acute anal fissure: treatment by lateral subcutaneous internal anal sphincterotomy. Author(s): Sohn N, Weinstein MA. Source: American Journal of Surgery. 1978 August; 136(2): 277-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=686276

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Adequate internal sphincterotomy for chronic anal fissure: subcutaneous or open technique? Author(s): Boulos PB, Araujo JG. Source: The British Journal of Surgery. 1984 May; 71(5): 360-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6722464

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Aetiology and treatment of anal fissure. Author(s): Cotton MH. Source: The British Journal of Surgery. 1997 February; 84(2): 279. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9052457

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Aetiology and treatment of anal fissure. Author(s): Lund JN, Scholefield JH. Source: The British Journal of Surgery. 1996 October; 83(10): 1335-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8944447

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AGA technical review on the diagnosis and care of patients with anal fissure. Author(s): Madoff RD, Fleshman JW. Source: Gastroenterology. 2003 January; 124(1): 235-45. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12512046

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Alpha-1 adrenoceptor blockade: potential new treatment for anal fissures. Author(s): Pitt J, Craggs MM, Henry MM, Boulos PB. Source: Diseases of the Colon and Rectum. 2000 June; 43(6): 800-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10859080

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American Gastroenterological Association medical position statement: Diagnosis and care of patients with anal fissure. Author(s): Americal Gastroenterological Association. Source: Gastroenterology. 2003 January; 124(1): 233-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12512045

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An evaluation of the surgical treatment of anal fissures. Author(s): Mazier WP. Source: Diseases of the Colon and Rectum. 1972 May-June; 15(3): 222-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5028586

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Anal canal pressure in anal fissure before and after internal sphincterotomy. Author(s): Aytac B, Cakar S. Source: Acta Chir Belg. 2003 October; 103(5): 511-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14653039

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Anal canal pressures are low in women with postpartum anal fissure. Author(s): Corby H, Donnelly VS, O'Herlihy C, O'Connell PR. Source: The British Journal of Surgery. 1997 January; 84(1): 86-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9043464

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Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking. Author(s): Holly EA, Whittemore AS, Aston DA, Ahn DK, Nickoloff BJ, Kristiansen JJ. Source: Journal of the National Cancer Institute. 1989 November 15; 81(22): 1726-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2810388

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Anal fissure and anal ulcers. Author(s): Mazier WP, De Moraes RT, Dignan RD. Source: The Surgical Clinics of North America. 1978 June; 58(3): 479-85. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=354052

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Anal fissure and stenosis. Author(s): Notaras MJ. Source: The Surgical Clinics of North America. 1988 December; 68(6): 1427-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3057667

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Anal fissure and thrombosed external hemorrhoids before and after delivery. Author(s): Abramowitz L, Sobhani I, Benifla JL, Vuagnat A, Darai E, Mignon M, Madelenat P. Source: Diseases of the Colon and Rectum. 2002 May; 45(5): 650-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12004215

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Anal fissure in Crohn's disease. Author(s): Sweeney JL, Ritchie JK, Nicholls RJ. Source: The British Journal of Surgery. 1988 January; 75(1): 56-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3337953

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Anal fissure in Crohn's disease: a plea for aggressive management. Author(s): Fleshner PR, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC. Source: Diseases of the Colon and Rectum. 1995 November; 38(11): 1137-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7587755

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Anal fissure produced by examination for sexual abuse. Author(s): Baker RB. Source: Am J Dis Child. 1991 August; 145(8): 848-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1858717

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Anal fissure surgical treatment and histopathology. Author(s): Petrozzi CA, Brea RC, Celeste F. Source: Am J Proctol. 1967 April; 18(2): 108-12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6041794

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Anal fissure. Author(s): Metcalf AM. Source: The Surgical Clinics of North America. 2002 December; 82(6): 1291-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12516855

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Anal fissure. Author(s): Jonas M, Scholefield J. Source: Clin Evid. 2002 June; (7): 392-7. Review. No Abstract Available. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12230664

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Anal Fissure. Author(s): Jonas M, Scholefield JH. Source: Gastroenterology Clinics of North America. 2001 March; 30(1): 167-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11394029

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Anal fissure. Author(s): Burke MR, Murtagh J. Source: Aust Fam Physician. 1994 April; 23(4): 716. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8198493

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Anal fissure. Author(s): Alia RT. Source: J S C Med Assoc. 1985 October; 81(10): 553-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3865021

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Anal fissure. Author(s): Allan A, May R. Source: Br J Hosp Med. 1985 January; 33(1): 41-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3971079

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Anal fissure. 20-year experience. Author(s): Oh C, Divino CM, Steinhagen RM. Source: Diseases of the Colon and Rectum. 1995 April; 38(4): 378-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7720444

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Anal fissure: a preferred method of treatment. Author(s): MacLaughlin WJ Jr. Source: J Maine Med Assoc. 1980 November; 71(11): 337-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7452097

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Anal fissure: correlation between symptoms and manometry before and after surgery. Author(s): Melange M, Colin JF, Van Wymersch T, Vanheuverzwyn R. Source: International Journal of Colorectal Disease. 1992 June; 7(2): 108-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1613295

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Anal fissure: new concepts in pathogenesis and treatment. Author(s): Schouten WR, Briel JW, Auwerda JJ, Boerma MO. Source: Scandinavian Journal of Gastroenterology. Supplement. 1996; 218: 78-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8865454

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Anal fissure: unclear causes but promising new treatments. Author(s): Baron K. Source: Jaapa. 2000 February; 13(2): 45-7, 51-2, 55-6 Passim. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11503217

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Anal fissure; comparative study of various lines of treatment with 125 cases. Author(s): Bekheit F. Source: J Egypt Med Assoc. 1974; 57(7-8): 365-72. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4452774

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Anal fissures and fistulas. Author(s): Goldstein SD. Source: Postgraduate Medicine. 1987 November 15; 82(7): 86-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3671218

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Anal fissures in Nigerian children. Author(s): Nwako F. Source: Int Surg. 1974 March; 59(3): 152-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4545122

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Anal fissures, abscesses and fistulae. Alternatives in the management of common anorectal conditions--2. Author(s): Al-Breiki H, Grant C, Khawaja S, Wosornu L. Source: Trop Doct. 1985 July; 15(3): 108-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4035754

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Anal fissures, fistulas, abscesses, and hemorrhoids in a tropical population. Author(s): Ajayi OO, Banigo OG, Nnamdi K. Source: Diseases of the Colon and Rectum. 1974 January-February; 17(1): 55-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4810715

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Anal fissures. Author(s): Lubowski DZ. Source: Aust Fam Physician. 2000 September; 29(9): 839-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11008386

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Anal fissures. Author(s): Smith LE. Source: The Netherlands Journal of Medicine. 1990 August; 37 Suppl 1: S33-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2172846

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Anal manometric evaluation in anal fissure. Effect of anal dilation and lateral subcutaneous sphincterotomy. Author(s): Hiltunen KM, Matikainen M. Source: Acta Chir Scand. 1986 January; 152: 65-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3953221

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Anal manometric studies in hemorrhoids and anal fissures. Author(s): Lin JK. Source: Diseases of the Colon and Rectum. 1989 October; 32(10): 839-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2791768

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Anal manometric studies in hemorrhoids and anal fissures. Author(s): Lin JK, Liang CL, Hsu H, Wang FM. Source: Zhonghua Yi Xue Za Zhi (Taipei). 1989 April; 43(4): 249-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2804776

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Anal pressures in hemorrhoids and anal fissure. Author(s): Arabi Y, Alexander-Williams J, Keighley MR. Source: American Journal of Surgery. 1977 November; 134(5): 608-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=920890

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Anal ulcer and chronic diarrhoea as manifestations of visceral leishmaniasis in a patient infected with human immunodeficiency virus. Author(s): Perez-Molina JA, Fortun J, Lopez-Velez R. Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 1997 JulyAugust; 91(4): 436-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9373645

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Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani. Author(s): Vincent C. Source: Primary Care. 1999 March; 26(1): 53-68. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9922294

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Are non-surgical treatments for anal fissure effective? Author(s): Steele LS, Glazier R. Source: Can Fam Physician. 2000 May; 46: 1063-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10845133

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Assessment of sphincterotomy results in patients treated for anal fissure. Author(s): Simkovic D, Smejkal K, Hladik P. Source: Rev Esp Enferm Dig. 2000 June; 92(6): 399-404. English, Spanish. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10985100

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Attitudes to the treatment of chronic anal fissure in ano after failed medical treatment. Author(s): Karandikar S, Brown GM, Carr ND, Beynon J. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 November; 5(6): 569-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14617242

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Botulinum toxin A in anal fissure: why does it work? Author(s): Jost WH, Aoki KR. Source: Diseases of the Colon and Rectum. 2004 February; 47(2): 257-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15043302

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Botulinum toxin A in anal fissures: a modified technique. Author(s): Wollina U, Konrad H. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2002 September; 16(5): 469-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12428839

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Botulinum toxin and anal fissure. Author(s): Stein E. Source: Current Problems in Dermatology. 2002; 30: 218-26. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12471714

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Botulinum toxin as second-line therapy for chronic anal fissure failing 0.2 percent glyceryl trinitrate. Author(s): Lindsey I, Jones OM, Cunningham C, George BD, Mortensen NJ. Source: Diseases of the Colon and Rectum. 2003 March; 46(3): 361-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626912

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Botulinum toxin for chronic anal fissure. Author(s): Gui D, Cassetta E, Anastasio G, Bentivoglio AR, Maria G, Albanese A. Source: Lancet. 1994 October 22; 344(8930): 1127-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7934496

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Botulinum toxin for the treatment of anal fissure. Author(s): Fernandez Lopez F, Conde Freire R, Rios Rios A, Garcia Iglesias J, Cainzos Fernandez M, Potel Lesquereux J. Source: Digestive Surgery. 1999; 16(6): 515-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10805553

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Botulinum toxin for the treatment of secondary chronic anal fissure. Author(s): Madalinski MH. Source: Techniques in Coloproctology. 2003 July; 7(2): 85-8; Comment 88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605926

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Botulinum toxin in the management of anal fissure: innovative use of a familiar agent. Author(s): Goel AK, Seenu V. Source: Trop Gastroenterol. 1995 January-March; 16(1): 68-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7645058

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Botulinum toxin in the treatment of chronic anal fissure. Author(s): Brisinda G, Maria G. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1144-7; Author Reply 1147-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12907916

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Botulinum toxin in therapy of anal fissure. Author(s): Jost WH, Schimrigk K. Source: Lancet. 1995 January 21; 345(8943): 188-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7823680

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Botulinum toxin injection into only one point in the external anal sphincter: a modification of the treatment for chronic anal fissure. Author(s): Madalinski M, Jagiello K, Labon M, Adrich Z, Kryszewski A. Source: Endoscopy. 1999 November; 31(9): S63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10604632

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Botulinum toxin injections in the internal anal sphincter for the treatment of chronic anal fissure: long-term results after two different dosage regimens. Author(s): Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. Source: Annals of Surgery. 1998 November; 228(5): 664-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9833804

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Botulinum toxin promoted healing and relieved symptoms of chronic anal fissure. Author(s): Phillips RK. Source: Gut. 1998 November; 43(5): 601. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9824336

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Botulinum toxin type B in the treatment of anal fissures: first preliminary results. Author(s): Jost WH. Source: Diseases of the Colon and Rectum. 2001 November; 44(11): 1721-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11719933

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Changing patterns of treatment for chronic anal fissure. Author(s): Kumar N. Source: Annals of the Royal College of Surgeons of England. 1999 March; 81(2): 141. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10364978

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Changing patterns of treatment for chronic anal fissure. Author(s): Farouk R, Gunn J, Duthie GS. Source: Annals of the Royal College of Surgeons of England. 1998 May; 80(3): 194-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9682643

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Chronic anal fissure. Author(s): Lindsey I, Jones OM, Cunningham C, Mortensen NJ. Source: The British Journal of Surgery. 2004 March; 91(3): 270-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14991625

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Chronic anal fissure. A new method of treatment by anoplasty. Author(s): Case JB. Source: Diseases of the Colon and Rectum. 1991 February; 34(2): 198-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1993420

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Chronic anal fissure: advances and insights in pathophysiology and treatment. Author(s): Maria G, Brisinda G. Source: Gastroenterology. 2003 September; 125(3): 995-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974263

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Clinical presentation of chronic anal fissures. Author(s): Petros JG, Rimm EB, Robillard RJ. Source: The American Surgeon. 1993 October; 59(10): 666-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8214967

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Closed lateral subcutaneous sphincterotomy under local anaesthesia in the treatment of chronic anal fissure. Author(s): Hiltunen KM, Matikainen M. Source: Ann Chir Gynaecol. 1991; 80(4): 353-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1814259

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Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Author(s): Mentes BB, Irkorucu O, Akin M, Leventoglu S, Tatlicioglu E. Source: Diseases of the Colon and Rectum. 2003 February; 46(2): 232-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12576897

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Complication of botulinum toxin injections for anal fissure. Author(s): Tilney HS, Heriot AG, Cripps NP. Source: Diseases of the Colon and Rectum. 2001 November; 44(11): 1721-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11711751

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Complications of anal dilatation for acute anal fissure. Author(s): Gutman H, Gonen P, Deutsch AA. Source: Diseases of the Colon and Rectum. 1989 June; 32(6): 545. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2791795

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Computer-generated profiles of the anal canal in patients with anal fissure. Author(s): Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME. Source: Diseases of the Colon and Rectum. 1995 January; 38(1): 72-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7813351

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Concepts in pathogenesis and treatment of chronic anal fissure--a review of the literature. Author(s): Utzig MJ, Kroesen AJ, Buhr HJ. Source: The American Journal of Gastroenterology. 2003 May; 98(5): 968-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12809816

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Conservative and surgical treatment in acute and chronic anal fissure. A study on 308 patients. Author(s): Frezza EE, Sandei F, Leoni G, Biral M. Source: International Journal of Colorectal Disease. 1992 December; 7(4): 188-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1293238

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Controlled digital anal dilatation under total neuromuscular blockade for chronic anal fissure: a justifiable procedure. Author(s): Strugnell NA, Cooke SG, Lucarotti ME, Thomson WH. Source: The British Journal of Surgery. 1999 May; 86(5): 651-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10361188

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Cows milk consumption in constipation and anal fissure in infants and young children. Author(s): Andiran F, Dayi S, Mete E. Source: Journal of Paediatrics and Child Health. 2003 July; 39(5): 329-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887660

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Creation of a treatment protocol for nurse-led management of anal fissure. Author(s): Porrett T, Knowles CH, Lunniss PJ. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 January; 5(1): 63-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12780930

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Cut or paste? The use of glyceryl trinitrate paste in the treatment of acute and chronic anal fissure. Author(s): Ward DI, Miller BJ, Schache DJ, Cohen JR, Theile DE. Source: The Australian and New Zealand Journal of Surgery. 2000 January; 70(1): 19-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10696937

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Dicyclomine for medical management of persistent anal fissure with associated spasm of the internal sphincter. Author(s): Miller LG, Rogers JC, Brown EB, Perkins G. Source: Tex Med. 1992 November; 88(11): 65-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1488725

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Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study. Author(s): Jonas M, Speake W, Scholefield JH. Source: Diseases of the Colon and Rectum. 2002 August; 45(8): 1091-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12195195

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Double-blind manometric assessment of two topical glyceryl trinitrate formulations in patients with chronic anal fissures. Author(s): Bassotti G, Clementi M, Ceccarelli F, Pelli MA. Source: Dig Liver Dis. 2000 November; 32(8): 699-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11142580

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Effect of catheter diameter on resting pressures in anal fissure patients. Author(s): Horvath KD, Whelan RL, Golub RW, Ahsan H, Cirocco WC. Source: Diseases of the Colon and Rectum. 1995 July; 38(7): 728-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7607033

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Effect of isosorbide dinitrate ointment on anal fissure. Author(s): Songun I, Boutkan H, Delemarre JB, Breslau PJ. Source: Digestive Surgery. 2003; 20(2): 122-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686779

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Effect of topical glyceryl trinitrate on anodermal blood flow in patients with chronic anal fissures. Author(s): Kua KB, Kocher HM, Kelkar A, Patel AG. Source: Anz Journal of Surgery. 2001 September; 71(9): 548-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11527267

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Effectiveness of higher doses of botulinum toxin to induce healing in patients with chronic anal fissures. Author(s): Brisinda G, Maria G, Sganga G, Bentivoglio AR, Albanese A, Castagneto M. Source: Surgery. 2002 February; 131(2): 179-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11854696

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Elevated density and plasticity of nerve fibres in anal fissures. Author(s): Horsch D, Kirsch JJ, Weihe E. Source: International Journal of Colorectal Disease. 1998; 13(3): 134-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9689564

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Fissurectomy as a treatment for anal fissures in children. Author(s): Lambe GF, Driver CP, Morton S, Turnock RR. Source: Annals of the Royal College of Surgeons of England. 2000 July; 82(4): 254-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10932659

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Fissurectomy with posterior midline sphincterotomy and anoplasty (FPSA) in the management of chronic anal fissures. Author(s): Di Castro A, Biancari F, D'Andrea V, Caviglia A. Source: Surgery Today. 1997; 27(10): 975-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10870590

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Follow-up of patients with chronic anal fissure treated with topical glyceryl trinitrate. Author(s): Lund JN, Scholefield JH. Source: Lancet. 1998 November 21; 352(9141): 1681. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9853449

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Genital herpes masquerading as anal fissures. Author(s): Winceslaus J, Jones PA. Source: Journal of the Royal College of Surgeons of Edinburgh. 1997 August; 42(4): 2767. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9276570

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Glyceryl trinitrate for anal fissure. Author(s): Simons AJ, Beart RW Jr. Source: Lancet. 1996 August 24; 348(9026): 491-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8757148

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Glyceryl trinitrate for chronic anal fissure--healing or headache? Results of a multicenter, randomized, placebo-controled, double-blind trial. Author(s): Altomare DF, Rinaldi M, Milito G, Arcana F, Spinelli F, Nardelli N, Scardigno D, Pulvirenti-D'Urso A, Bottini C, Pescatori M, Lovreglio R. Source: Diseases of the Colon and Rectum. 2000 February; 43(2): 174-9; Discussion 17981. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10696890

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Glyceryl trinitrate is an effective treatment for anal fissure. Author(s): Lund JN, Scholefield JH. Source: Diseases of the Colon and Rectum. 1997 April; 40(4): 468-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9106698

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Glyceryl trinitrate ointment for chronic anal fissure. Author(s): Herxheimer A. Source: Lancet. 1997 February 22; 349(9051): 573. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9048813

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Glyceryl trinitrate ointment for the treatment of chronic anal fissure: results of a placebo-controlled trial and long-term follow-up. Author(s): Kennedy ML, Sowter S, Nguyen H, Lubowski DZ. Source: Diseases of the Colon and Rectum. 1999 August; 42(8): 1000-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10458121

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Glyceryl trinitrate vs. lateral sphincterotomy for chronic anal fissure: prospective, randomized trial. Author(s): Evans J, Luck A, Hewett P. Source: Diseases of the Colon and Rectum. 2001 January; 44(1): 93-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805569

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Headaches in the treatment of anal fissure. Author(s): Salgado G, Torrbedella L, Berman IR. Source: Diseases of the Colon and Rectum. 1999 August; 42(8): 1106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10458141

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Hemorrhoids and anal fissures. Common problems, current solutions. Author(s): Bubrick MP, Benjamin RB. Source: Postgraduate Medicine. 1985 February 1; 77(2): 165-9, 172-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2982135

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Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. Author(s): Medich DS, Fazio VW. Source: The Surgical Clinics of North America. 1995 February; 75(1): 77-88. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7855720

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Higher or lower doses of botulinum toxin for the treatment of chronic anal fissure? Author(s): Madalinski MH. Source: Gastroenterology. 2003 April; 124(4): 1165. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12671920

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Histopathology of the internal anal sphincter in chronic anal fissure. Author(s): Brown AC, Sumfest JM, Rozwadowski JV. Source: Diseases of the Colon and Rectum. 1989 August; 32(8): 680-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2752854

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Identification of anti-endothelial cell antibodies in patients with chronic anal fissure. Author(s): Maria G, Brisinda D, Ruggieri MP, Civello IM, Brisinda G. Source: Surgery. 1999 September; 126(3): 535-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10486606

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Importance of the anorectal manometry in chronic anal fissure. Author(s): Simkovic D, Smejkal K, Siroky M, Hladik P, Pospisil I. Source: Acta Medica (Hradec Kralove). 2001; 44(3): 105-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11811078

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Incidence of anal fissure in nonselected neurological patients. Author(s): Jost WH. Source: Diseases of the Colon and Rectum. 1999 June; 42(6): 828. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10378614

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Influence of botulinum toxin site of injections on healing rate in patients with chronic anal fissure. Author(s): Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Gui D, Albanese A. Source: American Journal of Surgery. 2000 January; 179(1): 46-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10737578

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Internal anal sphincter derangement with anal fissures. Author(s): Nothmann BJ, Schuster MM. Source: Gastroenterology. 1974 August; 67(2): 216-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4847701

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Internal hemorrhoids coexisting with chronic anal fissure: new nonsurgical modalities. Author(s): Madalinski M, Labon M, Adrich Z, Kryszewski A. Source: Endoscopy. 1998 October; 30(8): S96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9865581

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Internal sphincter spasm in anal fissure. Author(s): Lund JN, Scholefield JH. Source: The British Journal of Surgery. 1997 December; 84(12): 1723-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9448625

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Internal sphincterotomy for chronic anal fissure: long term effects on anal pressure. Author(s): Chowcat NL, Araujo JG, Boulos PB. Source: The British Journal of Surgery. 1986 November; 73(11): 915-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3790924

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Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group. Author(s): Richard CS, Gregoire R, Plewes EA, Silverman R, Burul C, Buie D, Reznick R, Ross T, Burnstein M, O'Connor BI, Mukraj D, McLeod RS. Source: Diseases of the Colon and Rectum. 2000 August; 43(8): 1048-57; Discussion 10578. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10950002

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Irritable colon syndrome in Egyptians with description of cases conditioned by anal fissure. Author(s): Elsheikh A. Source: Gastroenterologia. 1966; 105(3): 148-58. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5927112

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Is there really sphincter spasm in anal fissure? Author(s): Kuypers HC. Source: Diseases of the Colon and Rectum. 1983 August; 26(8): 493-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6872775

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Is topical nifedipine effective for chronic anal fissures? Author(s): Merenstein D, Rosenbaum D. Source: The Journal of Family Practice. 2003 March; 52(3): 190-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12620169

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Ischaemic nature of anal fissure. Author(s): Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Source: The British Journal of Surgery. 1996 January; 83(1): 63-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8653368

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Island advancement flaps in the management of anal fissures. Author(s): Nyam DC, Wilson RG, Stewart KJ, Farouk R, Bartolo DC. Source: The British Journal of Surgery. 1995 March; 82(3): 326-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7795999

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Isosorbide dinitrate in the treatment of anal fissure: a randomised, prospective, double blind, placebo-controlled trial. Author(s): Werre AJ, Palamba HW, Bilgen EJ, Eggink WF. Source: The European Journal of Surgery = Acta Chirurgica. 2001 May; 167(5): 382-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11419556

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Lack of effficacy of botulinum toxin in chronic anal fissure. Author(s): Siproudhis L, Sebille V, Pigot F, Hemery P, Juguet F, Bellissant E. Source: Alimentary Pharmacology & Therapeutics. 2003 September 1; 18(5): 515-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12950424

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Lateral internal anal sphincterotomy for anal fissure: with or without associated anorectal procedures. Author(s): Syed SA, Waris S, Ahmed E, Saeed N, Ali B. Source: J Coll Physicians Surg Pak. 2003 August; 13(8): 436-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12921678

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Lateral internal sphincterotomy for chronic anal fissure. Author(s): Nelson RL, Abcarian HA. Source: Current Surgery. 1981 July-August; 38(4): 223-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7261666

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Lateral internal sphincterotomy in chronic anal fissure--a surgical technique. Author(s): Bell GA. Source: The American Surgeon. 1980 October; 46(10): 572-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7425432

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Lateral internal sphincterotomy is not redundant in the era of glyceryl trinitrate therapy for chronic anal fissure. Author(s): Jonas M, Lobo DN, Gudgeon AM. Source: Journal of the Royal Society of Medicine. 1999 April; 92(4): 186-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10450195

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Lateral internal sphincterotomy remains the treatment of choice for anal fissures that fail conservative therapy. Author(s): Cirocco WC. Source: Gastrointestinal Endoscopy. 1998 February; 47(2): 212-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9512301

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Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure. Author(s): Leong AF, Seow-Choen F. Source: Diseases of the Colon and Rectum. 1995 January; 38(1): 69-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7813349

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Lateral subcutaneous internal sphincterotomy for anal fissure. Author(s): Oh C. Source: The Mount Sinai Journal of Medicine, New York. 1975 November-December; 42(6): 596-601. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1082077

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Lateral subcutaneous internal sphincterotomy for anal fissure. Technic and experience with 22 cases in children. Author(s): Nwako FA. Source: Int Surg. 1975 April; 60(4): 215-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1123273

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Lateral subcutaneous internal sphincterotomy for chronic anal fissure, an outpatient procedure. Author(s): Rudd WW. Source: Diseases of the Colon and Rectum. 1975 May-June; 18(4): 319-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1126267

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Lateral subcutaneous internal sphincterotomy in treatment of anal fissure. Author(s): Hoffmann DC, Goligher JC. Source: British Medical Journal. 1970 September 19; 3(724): 673-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5470113

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Lateral subcutaneous sphincterotomy for anal fissure--a new technique. Author(s): Notaras MJ. Source: Proc R Soc Med. 1969 July 7; 62(7): 713. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5803521

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Lateral subcutaneous sphincterotomy for treatment of anal fissure in children. Author(s): Evans DA. Source: The British Journal of Surgery. 1996 April; 83(4): 571. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8665259

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Lateral subcutaneous sphincterotomy for treatment of anal fissure in children. Author(s): Turnock RR. Source: The British Journal of Surgery. 1996 March; 83(3): 424-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8665219

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Lateral subcutaneous sphincterotomy for treatment of anal fissure in children. Author(s): Cohen A, Dehn TC. Source: The British Journal of Surgery. 1995 October; 82(10): 1341-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7489158

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Left lateral internal sphincterotomy for anal fissure--as an office procedure. Author(s): Zinkin L. Source: N J Med. 1988 January; 85(1): 43-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3422365

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Local nitroglycerin for treatment of anal fissures: an alternative to lateral sphincterotomy? Author(s): Bacher H, Mischinger HJ, Werkgartner G, Cerwenka H, El-Shabrawi A, Pfeifer J, Schweiger W. Source: Diseases of the Colon and Rectum. 1997 July; 40(7): 840-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9221864

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Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Author(s): Minguez M, Herreros B, Espi A, Garcia-Granero E, Sanchiz V, Mora F, Lledo S, Benages A. Source: Gastroenterology. 2002 July; 123(1): 112-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12105839

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Long-term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence. Author(s): Nyam DC, Pemberton JH. Source: Diseases of the Colon and Rectum. 1999 October; 42(10): 1306-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10528769

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Long-term results of open and closed sphincterotomy for anal fissure. Author(s): Lewis TH, Corman ML, Prager ED, Robertson WG. Source: Diseases of the Colon and Rectum. 1988 May; 31(5): 368-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3366036

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Long-term results of topical nitroglycerin in the treatment of chronic anal fissures are disappointing. Author(s): Graziano A, Svidler Lopez L, Lencinas S, Masciangioli G, Gualdrini U, Bisisio O. Source: Techniques in Coloproctology. 2001 December; 5(3): 143-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11875681

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Maintenance therapy with unprocessed bran in the prevention of acute anal fissure recurrence. Author(s): Jensen SL. Source: Journal of the Royal Society of Medicine. 1987 May; 80(5): 296-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3039130

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Manometric study of topical sildenafil (Viagra) in patients with chronic anal fissure: sildenafil reduces anal resting tone. Author(s): Torrabadella L, Salgado G, Burns RW, Berman IR. Source: Diseases of the Colon and Rectum. 2004 May; 47(5): 733-8. Epub 2004 April 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15073662

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Medical or surgical therapy for anal fissure? Author(s): Bhandarkar DS. Source: Indian J Gastroenterol. 2001 September-October; 20(5): 206-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11676342

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Mild form of neonatal necrotizing enterocolitis masked by anal fissures. Author(s): Bowen A 3rd. Source: Radiology. 1980 December; 137(3): 657-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7444052

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Modelling the economic impact of managing a chronic anal fissure with a proprietary formulation of nitroglycerin (Rectogesic) compared to lateral internal sphincterotomy in the United Kingdom. Author(s): Christie A, Guest JF. Source: International Journal of Colorectal Disease. 2002 July; 17(4): 259-67. Epub 2002 January 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12073075

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Morbidity of internal sphincterotomy for anal fissure and stenosis. Author(s): Walker WA, Rothenberger DA, Goldberg SM. Source: Diseases of the Colon and Rectum. 1985 November; 28(11): 832-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4053894

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Neuromyogenic properties of the internal anal sphincter: therapeutic rationale for anal fissures. Author(s): Bhardwaj R, Vaizey CJ, Boulos PB, Hoyle CH. Source: Gut. 2000 June; 46(6): 861-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10807901

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New approaches to the treatment of anal fissure. Author(s): Dziki A, Trzcinski R, Langner E, Wronski W. Source: Acta Chir Iugosl. 2002; 49(2): 73-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12587474

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Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study. Author(s): Antropoli C, Perrotti P, Rubino M, Martino A, De Stefano G, Migliore G, Antropoli M, Piazza P. Source: Diseases of the Colon and Rectum. 1999 August; 42(8): 1011-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10458123

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Nifedipine for treatment of anal fissures. Author(s): Cook TA, Mortensen NJ. Source: Diseases of the Colon and Rectum. 2000 March; 43(3): 430-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10733130

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Nitroglycerin ointment for anal fissures: effective treatment or just a headache? Author(s): Hyman NH, Cataldo PA. Source: Diseases of the Colon and Rectum. 1999 March; 42(3): 383-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10223761

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Non surgical therapy for anal fissure. Author(s): Nelson R. Source: Cochrane Database Syst Rev. 2003; (4): Cd003431. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14583976

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Nonoperative management of chronic anal fissure. Author(s): Maria G, Brisinda G. Source: Diseases of the Colon and Rectum. 2000 May; 43(5): 721-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10826439

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Nonsurgical treatment modalities for chronic anal fissure using botulinum toxin. Author(s): Madalinski MH. Source: Gastroenterology. 1999 August; 117(2): 516-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10465642

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One hundred cases of anal fissure treated with botulin toxin: early and long-term results. Author(s): Jost WH. Source: Diseases of the Colon and Rectum. 1997 September; 40(9): 1029-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9293930

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Open lateral sphincterotomy is still the best treatment for chronic anal fissure. Author(s): Argov S, Levandovsky O. Source: American Journal of Surgery. 2000 March; 179(3): 201-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10827320

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Open vs. closed sphincterotomy for chronic anal fissure: long-term results. Author(s): Garcia-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Source: Diseases of the Colon and Rectum. 1996 April; 39(4): 440-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8878506

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Operative treatment of anal fissure. Author(s): Acheson AG, Scholefield JH. Source: Annals of the Royal College of Surgeons of England. 2001 November; 83(6): 4378. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11777144

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Oral lacidipine in the treatment of anal fissure. Author(s): Ansaloni L, Bernabe A, Ghetti R, Riccardi R, Tranchino RM, Gardini G. Source: Techniques in Coloproctology. 2002 September; 6(2): 79-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12402050

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Oral nifedipine in the treatment of chronic anal fissure. Author(s): Agaoglu N, Cengiz S, Arslan MK, Turkyilmaz S. Source: Digestive Surgery. 2003; 20(5): 452-6. Epub 2003 July 31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12900538

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Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Author(s): Brisinda G, Maria G. Source: The British Journal of Surgery. 2000 February; 87(2): 251. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10744420

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Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Author(s): Cook TA, Humphreys MM, McC Mortensen NJ. Source: The British Journal of Surgery. 1999 October; 86(10): 1269-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10540130

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Outpatient surgical treatment of anal fissure. Author(s): Neufeld DM, Paran H, Bendahan J, Freund U. Source: The European Journal of Surgery = Acta Chirurgica. 1995 June; 161(6): 435-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7548381

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Pain caused by anal fissure--further remarks. Author(s): Georgoulis B, Skalkeas G. Source: Proc R Soc Med. 1970; 63 Suppl: 141. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5525486

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Pathogenesis concepts on anal fissure. Author(s): Arnous J, Denis J. Source: Am J Proctol. 1971 June; 22(2): 184-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5581744

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Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure. Author(s): Schouten WR, Briel JW, Boerma MO, Auwerda JJ, Wilms EB, Graatsma BH. Source: Gut. 1996 September; 39(3): 465-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8949655

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Patient selection and treatment modalities for chronic anal fissure. Author(s): Sharp FR. Source: American Journal of Surgery. 1996 May; 171(5): 512-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8651398

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Perianal and gluteal burns as a complication of hot water bottle treatment for anal fissure. Author(s): Lapid O, Walfisch S. Source: Burns : Journal of the International Society for Burn Injuries. 1999 September; 25(6): 559-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10498369

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Pharmacologic therapy for anal fissure. Author(s): Madoff RD. Source: The New England Journal of Medicine. 1998 January 22; 338(4): 257-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9435334

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Pharmacologic treatment of anal fissure with botoxin, diltiazem, or bethanechol. Author(s): Phillips R. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 281-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022973

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Pharmacological study of the internal and sphincter in patients with chronic anal fissure. Author(s): Regadas FS, Batista LK, Albuquerque JL, Capaz FR. Source: The British Journal of Surgery. 1993 June; 80(6): 799-801. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8330180

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Pharmacological treatment of anal fissure--a future role in primary care. Author(s): Leong AP. Source: Singapore Med J. 2003 March; 44(3): 136-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12953727

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Placebo treatment for anal fissure. Author(s): Madalinski M. Source: Alimentary Pharmacology & Therapeutics. 2003 December; 18(11-12): 1171-2; Author Reply 1172-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14653837

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Practice parameters for the management of anal fissure. The Standards Task Force American Society of Colon and Rectal Surgeons. Author(s): Rosen L, Abel ME, Gordon PH, Denstman FJ, Fleshman JW, Hicks TC, Huber PJ, Kennedy HL, Levin SE, Nicholson JD, et al. Source: Diseases of the Colon and Rectum. 1992 February; 35(2): 206-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1735328

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Precise anorectal sphincter dilatation--its role in the therapy of anal fissures. Author(s): Sohn N, Eisenberg MM, Weinstein MA, Lugo RN, Ader J. Source: Diseases of the Colon and Rectum. 1992 April; 35(4): 322-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1582352

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Presidential address. Lateral subcutaneous internal anal sphincterotomy for anal fissure. Author(s): Ray JE, Penfold JC, Gathright JB Jr, Roberson SH. Source: Diseases of the Colon and Rectum. 1974 March-April; 17(2): 139-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4819265

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Proceedings: Anal pressures in haemorrhoids and anal fissure. Author(s): Keighley MR, Arabi Y, Alexander-Williams J. Source: The British Journal of Surgery. 1976 August; 63(8): 665. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=953506

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Progress in the understanding and treatment of chronic anal fissure. Author(s): McCallion K, Gardiner KR. Source: Postgraduate Medical Journal. 2001 December; 77(914): 753-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11723312

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Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate. Author(s): Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJ, Melville D, Phillips RK. Source: Gut. 1999 May; 44(5): 727-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10205213

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Randomised trial of topical 0.2% glyceryl trinitrate and lateral internal sphincterotomy for the treatment of patients with chronic anal fissure: long-term follow-up. Author(s): Libertiny G, Knight JS, Farouk R. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(7): 418-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12463433

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Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure (Br J Surg 2002; 89: 413-17). Author(s): Balaji NS, Ahmad M. Source: The British Journal of Surgery. 2002 October; 89(10): 1325. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12296913

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Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure (Br J Surg 2002; 89: 413-17). Author(s): Briel JW, Zimmerman DD, Schouten WR. Source: The British Journal of Surgery. 2002 September; 89(9): 1193; Author Reply 11934. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12190689

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Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure (Br J Surg 2002; 89: 413-17). Author(s): Acheson AG, Griffin N, Scholefield JH. Source: The British Journal of Surgery. 2002 September; 89(9): 1193; Author Reply 11934. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12190688

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Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure. Author(s): Kocher HM, Steward M, Leather AJ, Cullen PT. Source: The British Journal of Surgery. 2002 April; 89(4): 413-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11952579

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Randomized, placebo-controlled treatment of anal fissure by lidocaine, EMLA, and GTN in children. Author(s): Clin Evid. 2002 Dec;(8):428-35 Source: Journal of Pediatric Surgery. 2002 September; 37(9): 1313-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603891

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Randomized, prospective trial comparing 0.2 percent isosorbide dinitrate ointment with sphincterotomy in treatment of chronic anal fissure: a two-year follow-up. Author(s): Parellada C. Source: Diseases of the Colon and Rectum. 2004 April; 47(4): 437-43. Epub 2004 March 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14994114

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Regarding internal sphincterotomy for anal fissure. Author(s): Blumberg NA. Source: Diseases of the Colon and Rectum. 1998 August; 41(8): 1071-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9715171

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Relationship between anal pressure and anodermal blood flow. The vascular pathogenesis of anal fissures. Author(s): Schouten WR, Briel JW, Auwerda JJ. Source: Diseases of the Colon and Rectum. 1994 July; 37(7): 664-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8026232

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Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery. Author(s): Gupta PJ, Kalaskar S. Source: Techniques in Coloproctology. 2003 October; 7(3): 155-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14628158

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Repeat botulin toxin injections in anal fissure: in patients with relapse and after insufficient effect of first treatment. Author(s): Jost WH, Schrank B. Source: Digestive Diseases and Sciences. 1999 August; 44(8): 1588-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10492136

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Resolution of chronic anal fissures after treatment of contiguous internal hemorrhoids with direct current probe. Author(s): Machicado GA, Cheng S, Jensen DM. Source: Gastrointestinal Endoscopy. 1997 February; 45(2): 157-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9041002

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Results following conservative lateral sphincteromy for the treatment of chronic anal fissures. Author(s): Garcea G, Sutton C, Mansoori S, Lloyd T, Thomas M. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 July; 5(4): 311-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12814407

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Results of sphincter dilatation under local anesthesia in anal fissure: report of 100 cases. Author(s): Sanan DP, Singh A. Source: Diseases of the Colon and Rectum. 1968 November; 11(6): 470-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5723043

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Riddle of the sphincters in anal fissure. Author(s): Jost WH, Schimrigk K, Mlitz H. Source: Diseases of the Colon and Rectum. 1995 May; 38(5): 555. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7736891

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Safety of botulinum neurotoxin treatment in patients with chronic anal fissure. Author(s): Brisinda D, Maria G, Fenici R, Civello IM, Brisinda G. Source: Diseases of the Colon and Rectum. 2003 March; 46(3): 419-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626924

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Say NO to anal fissures. Author(s): Fricker J. Source: Molecular Medicine Today. 1998 March; 4(3): 94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9575488

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Short- and long-term effect of glyceryl trinitrate (GTN) ointment 0.2% and 2% on anal canal pressure in patients with chronic anal fissures. Author(s): Ciccaglione AF, Grossi L, Cappello G, Malatesta MG, Toracchio S, Ferri A, Marzio L. Source: Digestive Diseases and Sciences. 2000 December; 45(12): 2352-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11258555

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Significance of anal canal ultrasound before sphincterotomy in multiparous women with anal fissure. Author(s): Reissman P. Source: Diseases of the Colon and Rectum. 1996 September; 39(9): 1060. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8797661

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Simple in-office sphincterotomy with partial fissurectomy for chronic anal fissure. Author(s): Gingold BS. Source: Surg Gynecol Obstet. 1987 July; 165(1): 46-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3589925

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Sliding skin grafts in the treatment of anal fissures. Author(s): Samson RB, Stewart WR. Source: Diseases of the Colon and Rectum. 1970 September-October; 13(5): 372-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4919565

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Soiling and recurrence after internal sphincterotomy for anal fissure. Author(s): Pescatori M. Source: Diseases of the Colon and Rectum. 1999 May; 42(5): 687-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10344698

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Solcoderm as alternative conservative treatment for acute anal fissure: a controlled clinical study. Author(s): Chen J, Michowitz M, Bawnik JB. Source: The American Surgeon. 1992 November; 58(11): 705-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1485705

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Subcutaneous lateral internal anal sphincterotomy for anal fissure. Author(s): Millar DM. Source: The British Journal of Surgery. 1971 October; 58(10): 737-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5124401

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Subcutaneous lateral internal sphincterotomy in the treatment of chronic anal fissure. Author(s): Milito G, Arullani A, Brancaleone C, Cesca D, Filingeri V, Casciani CU. Source: Ital J Surg Sci. 1983; 13(4): 275-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6671892

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Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease. Author(s): Wolkomir AF, Luchtefeld MA. Source: Diseases of the Colon and Rectum. 1993 June; 36(6): 545-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8500370

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Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs. fissurectomy--midline sphincterotomy. Author(s): Abcarian H. Source: Diseases of the Colon and Rectum. 1980 January-February; 23(1): 31-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7379649

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Surgical treatment of anal fissures under local anesthesia. Author(s): Al-Raymoony AE. Source: Saudi Med J. 2001 February; 22(2): 114-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11299402

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Surgical treatment of chronic anal fissure. A retrospective study of 1753 cases. Author(s): Hsu TC, MacKeigan JM. Source: Diseases of the Colon and Rectum. 1984 July; 27(7): 475-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6745021

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Sustained internal sphincter hypertonia in patients with chronic anal fissure. Author(s): Farouk R, Duthie GS, MacGregor AB, Bartolo DC. Source: Diseases of the Colon and Rectum. 1994 May; 37(5): 424-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8181401

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Symptomatic care and nitroglycerin in the management of anal fissure. Author(s): McLeod RS, Evans J. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 May-June; 6(3): 278-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022972

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Tailored lateral sphincterotomy for anal fissure. Author(s): Littlejohn DR, Newstead GL. Source: Diseases of the Colon and Rectum. 1997 December; 40(12): 1439-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9407982

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Technical failure of lateral sphincterotomy for the treatment of chronic anal fissure: a study using endoanal ultrasonography. Author(s): Farouk R, Monson JR, Duthie GS. Source: The British Journal of Surgery. 1997 January; 84(1): 84-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9043463

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Ten years' experience with botulin toxin in anal fissure. Author(s): Jost WH. Source: International Journal of Colorectal Disease. 2002 September; 17(5): 298-302. Epub 2002 April 27. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12172922

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The anocavernosal erectile dysfunction syndrome. II Anal fissure and erectile dysfunction. Author(s): Shafik A, El-Sibai O. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2000 October; 12(5): 279-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11424966

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The chronic anal fissure treatment by internal partial lateral sphincterotomy and following anal manometry. Author(s): Simkovic D, Siroky M, Smejkal K. Source: Acta Medica (Hradec Kralove). 1997; 40(1): 13-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9329209

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The expanding spectrum of clinical uses for botulinum toxin: healing of chronic anal fissures. Author(s): Hasler WL. Source: Gastroenterology. 1999 January; 116(1): 221-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9869625

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The higher doses of botulinum toxin and the potentiate effect of its action after nitric oxide donors application for the treatment of chronic anal fissure. Author(s): Madalinski MH, Slawek J. Source: Surgery. 2003 April; 133(4): 455; Author Reply 455-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12717372

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The internal sphincter and anal fissure. Author(s): Hancock BD. Source: The British Journal of Surgery. 1977 February; 64(2): 92-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=890253

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The longer term results of internal anal sphincterotomy for anal fissure. Author(s): Usatoff V, Polglase AL. Source: The Australian and New Zealand Journal of Surgery. 1995 August; 65(8): 576-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7661798

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The medical and surgical management of chronic anal fissure. Author(s): Garner JP, McFall M, Edwards DP. Source: J R Army Med Corps. 2002 September; 148(3): 230-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12469422

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The pathogenetic mechanisms causing anal fissure. Author(s): Rohde H. Source: International Journal of Colorectal Disease. 2003 January; 18(1): 95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12599400

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The role of internal sphincter in chronic anal fissures. Author(s): Abcarian H, Lakshmanan S, Read DR, Roccaforte P. Source: Diseases of the Colon and Rectum. 1982 September; 25(6): 525-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7117055

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The use of botulinum toxin for anal fissure. Author(s): Parikh VA. Source: Journal of the Royal College of Surgeons of Edinburgh. 1997 August; 42(4): 2889. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9276578

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The use of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure in children. Author(s): Simpson J, Lund JN, Thompson RJ, Kapila L, Scholefield JH. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2003 October; 9(10): Pi123-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14523338

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The use of glyceryl trinitrate in inexaminable patients with anal fissure. Author(s): Larpent JL, Dussaud F, Gorce D, Lunaud B, Pelissier E. Source: International Journal of Colorectal Disease. 1996; 11(6): 263. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9007619

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Therapeutic effects of different doses of botulinum toxin in chronic anal fissure. Author(s): Minguez M, Melo F, Espi A, Garcia-Granero E, Mora F, Lledo S, Benages A. Source: Diseases of the Colon and Rectum. 1999 August; 42(8): 1016-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10458124

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Therapy of anal fissure using botulin toxin. Author(s): Jost WH, Schimrigk K. Source: Diseases of the Colon and Rectum. 1994 December; 37(12): 1340. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7995170

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Therapy of anal fissure using botulin toxin. Author(s): Jost WH, Schimrigk K. Source: Diseases of the Colon and Rectum. 1994 December; 37(12): 1321-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7995166

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Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Author(s): Carapeti EA, Kamm MA, Phillips RK. Source: Diseases of the Colon and Rectum. 2000 October; 43(10): 1359-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11052511

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Topical diltiazem ointment in the treatment of chronic anal fissure. Author(s): Knight JS, Birks M, Farouk R. Source: The British Journal of Surgery. 2001 April; 88(4): 553-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11298624

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Topical glyceryl trinitrate cream for anal fissure. Author(s): Catto JW, Hinson FL, Leveson SH. Source: The British Journal of Surgery. 1998 June; 85(6): 874-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9667728

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Topical glyceryl trinitrate in the treatment of chronic anal fissure. Author(s): Watson SJ, Kamm MA, Nicholls RJ, Phillips RK. Source: The British Journal of Surgery. 1996 June; 83(6): 771-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8696736

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Topical ketanserin gel for anal fissure: an open-label, prospective study. Author(s): Zielanowski MM. Source: Adv Ther. 2000 January-February; 17(1): 27-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10915401

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Topical L-arginine gel lowers resting anal pressure: possible treatment for anal fissure. Author(s): Griffin N, Zimmerman DD, Briel JW, Gruss HJ, Jonas M, Acheson AG, Neal K, Scholefield JH, Schouten WR. Source: Diseases of the Colon and Rectum. 2002 October; 45(10): 1332-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12394431

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Topical mononitrate treatment in patients with anal fissure. Author(s): Tankova L, Yoncheva K, Muhtarov M, Kadyan H, Draganov V. Source: Alimentary Pharmacology & Therapeutics. 2002 January; 16(1): 101-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11856083

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Topical nifedipine plus lidocaine gel effective for anal fissures. Author(s): Slawson D. Source: American Family Physician. 2003 April 15; 67(8): 1781. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725459

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Topical nifedipine vs. topical glyceryl trinitrate for treatment of chronic anal fissure. Author(s): Ezri T, Susmallian S. Source: Diseases of the Colon and Rectum. 2003 June; 46(6): 805-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12794583

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Topical nifedipine with lidocaine ointment vs. active control for treatment of chronic anal fissure: results of a prospective, randomized, double-blind study. Author(s): Perrotti P, Bove A, Antropoli C, Molino D, Antropoli M, Balzano A, De Stefano G, Attena F. Source: Diseases of the Colon and Rectum. 2002 November; 45(11): 1468-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12432293

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Topical nitrates and the higher doses of botulinum toxin for chronic anal fissure. Author(s): Madalinski MH, Slawek J, Zbytek B, Duzynski W, Adrich Z, Jagiello K, Kryszewski A. Source: Hepatogastroenterology. 2001 July-August; 48(40): 977-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11490852

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Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Author(s): Lysy J, Israelit-Yatzkan Y, Sestiery-Ittah M, Weksler-Zangen S, Keret D, Goldin E. Source: Gut. 2001 February; 48(2): 221-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11156644

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Topical nitroglycerin in the management of anal fissure: an explosive outcome! Author(s): Manookian CM, Fleshner P, Moore B, Teng F, Cooperman H, Sokol T. Source: The American Surgeon. 1998 October; 64(10): 962-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9764702

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Topical nitroglycerin therapy for anal fissures and ulcers. Author(s): Gorfine SR. Source: The New England Journal of Medicine. 1995 October 26; 333(17): 1156-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7565967

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Topical treatment of chronic anal fissures. Author(s): Miser WF. Source: The Journal of Family Practice. 1997 April; 44(4): 338. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9108823

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Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Author(s): Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Source: Diseases of the Colon and Rectum. 1989 January; 32(1): 43-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2910660

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Treating anal fissure. Author(s): Banerjee AK. Source: Bmj (Clinical Research Ed.). 1997 June 7; 314(7095): 1638-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9193283

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Treatment of anal fissure by lateral subcutaneous sphincterotomy should be under general anaesthesia. Author(s): Keighley MR, Greca F, Nevah E, Hares M, Alexander-Williams J. Source: The British Journal of Surgery. 1981 June; 68(6): 400-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7016242

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Treatment of anal fissure with glyceryl trinitrate in patients referred for surgical management. Author(s): Skinner SA, Polglase AL, Le CT, Winnett JD. Source: Anz Journal of Surgery. 2001 April; 71(4): 218-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11355729

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Treatment of anal fissure. Author(s): Nelson RL. Source: Bmj (Clinical Research Ed.). 2003 August 16; 327(7411): 354-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12919967

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Treatment of anal fissure: a comparison of three different forms of therapy. Author(s): Giebel GD, Horch R. Source: Nippon Geka Hokan. 1989 January 1; 58(1): 126-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2802909

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Treatment of anal fissures with topical nitroglycerin. Author(s): Ehrenpreis ED, Rubin DT, Ginsburg PM, Meyers JS. Source: Expert Opinion on Pharmacotherapy. 2001 January; 2(1): 41-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11336567

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Treatment of chronic anal fissure with isosorbide dinitrate: long-term results and dose determination. Author(s): Lysy J, Israelit-Yatzkan Y, Sestiere-Ittah M, Keret D, Goldin E. Source: Diseases of the Colon and Rectum. 1998 November; 41(11): 1406-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9823807

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Treatment of chronic anal fissure with topical glyceryl trinitrate: a double-blind, placebo-controlled trial. Author(s): Chaudhuri S, Pal AK, Acharya A, Dey A, Chowdhury A, Santra A, Dhali GK, Maity SG, Banerjee PK. Source: Indian J Gastroenterol. 2001 May-June; 20(3): 101-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11400799

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Treatment of chronic anal fissure. Author(s): Perez-Miranda M, Jimenez JM. Source: The New England Journal of Medicine. 1998 June 4; 338(23): 1698-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9616066

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Treatment of complicated anal fissures by sclerosing injections and fisurectomy. Author(s): Vantrappen G, Goethals C, Hendrickx H. Source: Diseases of the Colon and Rectum. 1967 September-October; 10(5): 365-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6052914

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Use of botulinum toxin in anal fissure. Author(s): Jost WH, Schimrigk K. Source: Diseases of the Colon and Rectum. 1993 October; 36(10): 974. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8404394

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Use of glyceryl trinitrate ointment in the treatment of anal fissure. Author(s): Edwards DP, Chisholm EM. Source: The British Journal of Surgery. 1996 November; 83(11): 1655. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9014696

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Use of glyceryl trinitrate ointment in the treatment of anal fissure. Author(s): Lund JN, Armitage NC, Scholefield JH. Source: The British Journal of Surgery. 1996 June; 83(6): 776-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8696737

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Use of hyperbaric oxygen to treat chronic anal fissure. Author(s): Cundall JD, Gardiner A, Laden G, Grout P, Duthie GS. Source: The British Journal of Surgery. 2003 April; 90(4): 452-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12673747

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What causes anal fissure? Author(s): Soybel DI. Source: Gastroenterology. 1996 October; 111(4): 1154-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8831617

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CHAPTER 2. NUTRITION AND ANAL FISSURE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and anal fissure.

Finding Nutrition Studies on Anal Fissure The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “anal fissure” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “anal fissure” (or a synonym): •

Treatment of chronic anal fissure with topical glyceryl trinitrate. Author(s): Department of General Surgery at the Sir Charles Gardiner Hospital, Perth, Western Australia. Source: Dorfman, G Levitt, M Platell, C Dis-Colon-Rectum. 1999 August; 42(8): 1007-10 0012-3706

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

Nutrition

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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51

CHAPTER 3. ALTERNATIVE MEDICINE AND ANAL FISSURE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to anal fissure. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to anal fissure and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “anal fissure” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to anal fissure: •

“Somatoanal” reflex or “thermosphincteric” reflex? Author(s): Shafik A. Source: Diseases of the Colon and Rectum. 2000 May; 43(5): 726-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10826442

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Conservative treatment of anal fissure: an unselected, retrospective and continuous study. Author(s): Shub HA, Salvati EP, Rubin RJ. Source: Diseases of the Colon and Rectum. 1978 November-December; 21(8): 582-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=738173

•

Constipation. Author(s): Mercer RD.

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Source: Pediatric Clinics of North America. 1967 February; 14(1): 175-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6016069 •

Double blind randomised controlled trial of topical glyceryl trinitrate in anal fissure. Author(s): Kenny SE, Irvine T, Driver CP, Nunn AT, Losty PD, Jones MO, Turnock RR, Lamont GL, Lloyd DA. Source: Archives of Disease in Childhood. 2001 November; 85(5): 404-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11668104

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Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. Author(s): Dodi G, Bogoni F, Infantino A, Pianon P, Mortellaro LM, Lise M. Source: Diseases of the Colon and Rectum. 1986 April; 29(4): 248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3948615

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Office management of pilonidal disease and common anorectal lesions. Author(s): Reeder DD, McGehee RN. Source: American Family Physician. 1973 September; 8(3): 179-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4729716

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Psychogenic constipation. Author(s): Salvati EP. Source: Diseases of the Colon and Rectum. 1966 July-August; 9(4): 293-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5940531

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Results of behavioral treatment (biofeedback) for solitary rectal ulcer syndrome. Author(s): Malouf AJ, Vaizey CJ, Kamm MA. Source: Diseases of the Colon and Rectum. 2001 January; 44(1): 72-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805566

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The anal dilator in the conservative management of acute anal fissures. Author(s): McDonald P, Driscoll AM, Nicholls RJ. Source: The British Journal of Surgery. 1983 January; 70(1): 25-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6337670

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Treatment of chronic anal fissure with topical glyceryl trinitrate. Author(s): Dorfman G, Levitt M, Platell C. Source: Diseases of the Colon and Rectum. 1999 August; 42(8): 1007-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10458122

Alternative Medicine 53

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Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran. Author(s): Jensen SL. Source: British Medical Journal (Clinical Research Ed.). 1986 May 3; 292(6529): 1167-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3011180

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to anal fissure; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Crohn's Disease Source: Healthnotes, Inc.; www.healthnotes.com

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Herbs and Supplements Cascara Sagrada Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10013,00.html

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Gotu Kola Source: Prima Communications, Inc.www.personalhealthzone.com Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON ANAL FISSURE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “anal fissure” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on anal fissure, we have not necessarily excluded non-medical patents in this bibliography.

Patent Applications on Anal Fissure As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to anal fissure:

5Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm. 6 This has been a common practice outside the United States prior to December 2000.

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Compositions and methods for treatment of anal fissure Inventor(s): Jossifoff, Azariah; (Ramat Gan, IL) Correspondence: Darby & Darby; 805 Third Avenue, 27th FLR.; New York; NY; 10022; US Patent Application Number: 20020032188 Date filed: July 12, 2001 Abstract: There is provided a pharmaceutical composition comprising isosorbide dinitrate, wherein said composition is in the form of an aqueous gel containing not more than about 15 wt.% of a water-soluble lipophilic substance. Optionally, the gel may comprise a calcium channel blocker as an additional active ingredient. A composition comprising diisosorbide dinitrate and nifedipine is also disclosed. There is also provided a method for treating anal fissure, comprising applying to a locus in need of such treatment an efficacious amount of a composition according to the invention. Excerpt(s): The present invention concerns gel's or emulsion gels for the treatment of anal fissures. An anal fissure is a tear in the lining of the anus. Fissures may be superficial and heal rapidly, but often they become chronic. Such fissures are extremely painful and cause marked spasm of the anal sphincter. Anal fissures are associated with pain (especially during bowel movements), bleeding, and/or itching. Stretching of the anus by defecation or examination can cause extreme distress. The exact cause of anal fissures is at present unknown. However, there is a growing body of evidence which suggests that increased muscle tone (hypertonicity) of the internal anal sphincter is a predisposing factor in the formation of anal fissures, and possibly hemorrhoids. Blood vessels normally supply an adequate blood supply to the site where fissures occur. When sphincter tone is increased, the blood supply to the affected area is decreased and even minimal trauma, such as a hard stool, may increase the susceptibility to a fissure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Nitric oxide donor composition and method for treatment of anal disorders Inventor(s): Gorfine, Stephen; (New York, NY) Correspondence: Townsend And Townsend And Crew; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20010025057 Date filed: March 19, 2001 Abstract: A pharmaceutical composition contains a nitric oxide donor and advantageously an optional corticosteroid and/or topical anesthetic. The composition is useful in a method for treating anal disorders such as anal fissure, anal ulcer, hemorrhoidal disease, levator spasm, and so forth, by topical application to or proximate the affected area. Excerpt(s): This is a continuation-in-part of application Ser. No. 08/250,555, filed on May 27, 1994, which is incorporated herein by reference. This invention is directed to a composition and method for treating anal disorders such as anal fissure, anal ulcer, hemorrhoidal disease and levator spasm, by topical application of the composition to or proximate the affected area. In general, anal fissure (fissure-in-ano), anal ulcer, acute hemorrhoidal disease, and levator spasm (proctalgia fugax) are common, benign conditions of the anal canal which affect humans of all ages, races and sexes. However,

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these conditions can be problematical to treat and inconvenient if not painful to endure. An anal fissure or ulcer is a tear or ulcer of the mucosa or lining tissue of the distal anal canal. Anal fissure/ulcer can be associated with other systemic or local diseases but is more frequently present as an isolated finding. The typical, idiopathic fissure or ulcer is confined to the anal mucosa, and usually lies in the posterior midline, distal to the dentate line. The person with an anal fissure or ulcer frequently experiences anal pain and bleeding, the pain being more pronounced during and after bowel movements. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with anal fissure, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “anal fissure” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on anal fissure. You can also use this procedure to view pending patent applications concerning anal fissure. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON ANAL FISSURE Overview This chapter provides bibliographic book references relating to anal fissure. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on anal fissure include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “anal fissure” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on anal fissure: •

PDR for Herbal Medicines. 1st ed Source: Montvale, NJ: Medical Economics Company. 1998. 1244 p. Contact: Available from Medical Economics Publishing Inc. P.O. Box 10689, Des Moines, IA 50336. (800) 922-0937. Fax (515) 284-6714. Website: www.medecbookstore.com. PRICE: $59.99. ISBN: 1563632926. Summary: Most of today's herbal remedies exhibit varying degrees of therapeutic value. Some, such as ginkgo, valerian, and saw palmetto, seem genuinely useful, while others, such as ephedra, tansy, and nightshade, can actually be dangerous. As the use of unfamiliar botanicals spreads, the need to steer patients toward the few truly useful preparations and warn them away from ineffective, dangerous alternatives is becoming an increasingly significant priority. This volume, from the publishers of Physicians Desk Reference, brings together the findings of the German Regulatory Authority's herbal watchdog agency (commonly caused Commission E). This agency conducted an

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intensive assessment of the peer-reviewed literature on some 300 common botanicals, weighing the quality of the clinical evidence and identifying the uses for which the herb can reasonably be considered effective. This reference book contains profiles of over 600 medicinal herbs. Each entry contains up to 9 standard sections: name(s), description, actions and pharmacology, indications and usage, contraindications, precautions and adverse reactions, overdosage, dosage, and literature. The entries have also been indexed by scientific and common name, indications, therapeutic category, and side effects. To assist in identification, the reference book includes a section of full-color plates of the plants included. The book concludes with a glossary of the specialized botanical nomenclature and other unfamiliar terminology, a list of poison control centers, and a list of drug information centers. Some of the herbs are listed for use for abdominal cramps or distress, acid indigestion, appetite stimulation, rectal bleeding, various bowel disorders, stomach cancer, cholelithiasis (gallstones), colic, colitis, constipation, dehydration, diarrhea, digestive disorders, dysentery, enteritis, anal fissure, flatulence (intestinal gas), gastritis, gastroenteritis, gastrointestinal disorders, gout, helminthiasis, hemorrhage, hemorrhoids, hepatitis, hypercholesterolemia, jaundice, liver and gall bladder complaints, liver disorders, malaria, nausea, abdominal pain, and vomiting. •

Medical Advisor Home Edition: The Complete Guide to Alternative and Conventional Treatments Source: Alexandria, VA: Time-Life Books. 1997. 960 p. Contact: Available from Time-Life Books. 400 Keystone Industrial Park, Dunsmore, PA 18512. PRICE: $20.00. ISBN: 0783552505. Summary: This book offers information about 300 health problems, ranging from relatively benign conditions to the most serious diseases. There are symptoms charts which name several related problems and help readers decide which ailment entry to look up. Ailment entries provide a more complete list of symptoms, plus guidelines to discern whether the condition is potentially serious or requires a doctor's attention. Each entry describes the ailment and how it affects the body. Next, the entry outlines the underlying causes of the ailment and the tests and procedures a doctor may use to confirm the diagnosis. The treatment segment presents conventional and alternative recommendations for curing the problem or alleviating the symptoms. Most ailment entries conclude with advice on preventive measures that can be used to maintain health. Alternative treatments discussed include bodywork, acupuncture and acupressure, herbal therapies, homeopathy, lifestyle changes, and nutrition and diet. The book begins with a section on emergency medicine. Also included is a visual diagnostic guide, an atlas to the body, a medicine chest section (describing herbs, homeopathic remedies, and over the counter drugs), a glossary, a subject index, a bibliography, and a list of health associations and organizations. Topics related to digestive diseases include abdominal pain, AIDS, allergies, anal bleeding, anal fissure, anorexia nervosa, bad breath, bowel movement abnormalities, bulimia, celiac disease, cholesterol problems, colitis, colorectal cancer, constipation, Crohn's disease, diarrhea, diverticulitis, flu, food poisoning, gallstones, gas and gas pains, gastritis, gastroenteritis, heartburn, hiatal hernia, hiccups, incontinence, indigestion, irritable bowel syndrome, lactose intolerance, lupus, obesity, pancreatic cancer, pancreatic problems, stomach cancer, stomach ulcers, swallowing difficulty, trichomoniasis, vomiting, and worms. The book is illustrated with line drawings and full-color photographs.

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Current Therapy in Colon and Rectal Surgery Source: Philadelphia, PA: B.C. Decker, Inc. 1990. 440 p. Contact: Available from C.V. Mosby Company. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. PRICE: $99; plus shipping and handling (as of 1994). ISBN: 1556640439. Summary: This book, comprised of 81 papers by surgeons, provides specific information and guidelines concerning current surgical practices in the treatment of colorectal diseases. The papers cover disease processes occurring proximal to or outside the large intestine, but within the domain of the abdominal or colorectal surgeon. Medical management of certain conditions commonly encountered by surgeons, such as inflammatory bowel disease, also is covered. In certain cases, information which is not readily available is provided on complications of common specific procedures and methods of management. In some sections, such as those dealing with ulcerative colitis and rectal cancer, surgical options are discussed. The 81 papers are grouped among five general categories: anal and perianal region (anatomy and physiology of the anorectum; hemorrhoids; anal fissure and fistula; pruritus ani; Bowen's, Paget's and Hirschsprung's disease; and anal carcinoma); rectal and pararectal region (rectal stricture, prolapse, and trauma; tumors; and rectal cancer); the colon (medical and surgical alternatives for and complications of ulcerative colitis; Crohn's disease; diverticulitis of the colon; vascular ectasia; large bowel obstruction; volvulus of the colon; colorectal cancer, tumors, and polyps; and constipation); the small bowel (small bowel obstruction, short bowel syndrome, Crohn's disease, and small bowel and carcinoid tumors); and other complications (stapling techniques in rectal surgery, nutritional support, urologic complications of colorectal surgery, stoma complications, and enterostomal therapy). Selected tabular data and numerous illustrations are presented throughout the text.

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Handbook of Colon and Rectal Surgery Source: Philadelphia, PA: Lippincott Williams and Wilkins. 2002. 931 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $79.00 plus shipping and handling. ISBN: 0781725860. Summary: This handbook provides a more portable version of the larger textbook with the same title: Colon and Rectal Surgery, 4th Edition. The coverage addresses the entire range of diseases affecting the colon, rectum, and anus. A stepwise approach to treatment guides physicians from evaluation to follow up with incisive coverage of symptoms, testing and diagnosis, preparation, medical and surgical management, and postoperative care. Thirty-three chapters cover anatomy and embryology of the anus, rectum, and colon; physiology of the colon; diet and drugs in colorectal surgery; evaluation and diagnostic techniques; flexible sigmoidoscopy and colonoscopy; setting up a colorectal physiology laboratory; analgesia (pain killing) in colon and rectal surgery; hemorrhoids; anal fissure; anorectal abscess; anal fistula; rectovaginal and rectourethral fistulas; anal incontinence; colorectal trauma; management of foreign bodies; disorders of defecation; rectal prolapse, solitary rectal ulcer, syndrome of the descending perineum, and rectocele; pediatric surgical problems; cutaneous conditions; colorectal manifestations of acquired immunodeficiency syndrome (HIV); polypoid diseases; carcinoma (cancer) of the colon; carcinoma of the rectum; malignant tumors of the anal canal; less common tumors and tumorlike lesions of the colon, rectum, and anus; diverticular disease; laparoscopic-assisted colon and rectal surgery; vascular diseases; ulcerative colitis; Crohn's disease and indeterminate colitis; intestinal stomas;

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enterostomal therapy; and miscellaneous colitides. The handbook includes the same illustrations as the larger text. A subject index concludes the volume. •

Instructions for Patients. 5th ed Source: Philadelphia, PA: W.B. Saunders Company. 1994. 598 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This paper-bound book presents a number of patient instruction fact sheets. Each fact sheet includes three sections: basic information on signs and symptoms, causes, risk factors, etc.; treatment; and when to contact one's health care provider. Digestive system topics include food allergy, anal fissure, celiac disease, appendicitis, Crohn's disease, constipation, ulcerative colitis, cirrhosis of the liver, cholecystitis or cholangitis, diarrhea, diverticular disease, gallstones, gastritis, hiatal hernia, hemorrhoids, heartburn, irritable bowel syndrome, and lactose intolerance, among others. The fact sheets are designed to be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book is available in English or Spanish.

Chapters on Anal Fissure In order to find chapters that specifically relate to anal fissure, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and anal fissure using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “anal fissure” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on anal fissure: •

Anal Pain Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 203-216. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Anorectal pain is the most common reason why patients seek care from colorectal surgeons, and it is also a frequent problem seen in primary care practice. The management of anal pain is dictated by the diagnosis and by other problems that patients may have. In young healthy individuals with anal fissure (the most common cause), treatment may be as simple as raising their fiber intake. This chapter on anal pain is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include the prevalence of anorectal pain; principal diagnoses, including anal fissure, thrombosed external hemorrhoids, perianal and perirectal abscess, infectious proctitis, levator syndrome and pelvic floor abnormality, Crohn's

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disease, and anal cancer; typical presentation, of each of these disorders and the presence of anal incontinence (involuntary loss of stool or feces); key aspects of the patient history, including pain, bleeding, bowel patterns, associated diseases, and anal incontinence; the physical examination and ancillary tests; treatment options; patient education; common clinical errors; controversies; and emerging concepts, including the use of botulinum toxin for anal fissure. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 1 figure. 1 table. 13 references. •

Hemorrhoidal Symptom Complex Source: in Stein, E. Anorectal and Colon Diseases: Textbook and Color Atlas of Proctology. New York, NY: Springer-Verlag. 2003. p. 71-106. Contact: Available from Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (800) SPRINGER or (212) 460-1500. Fax (800) 777-4643 or (201) 348-4505. Email: [email protected]. Website: www.springer-ny.com. PRICE: $199.00 plus shipping and handling. ISBN: 3540430393. Summary: Hemorrhoids are found on proctoscopic examination in about 70 percent of adults over 30 years of age. This high percentage makes clear that the vast majority of individuals with hemorrhoids are asymptomatic. However, when there is impaired blood flow in the sinusoidal cushions associated with inflammation and spread to adjacent tissues, then pain, discharge, bleeding, and other symptoms may occur (the hemorrhoidal symptom complex). This chapter on the hemorrhoidal symptom complex is from a multidisciplinary reference book and atlas that covers all aspects of anorectal and colon disease (proctology). Topics in this chapter include hemorrhoids, anal tags, perianal thrombosis (clotting), anal prolapse, rectal prolapse, cryptitis and papillitis, hypertrophic anal papillae, anal rhagades and erosions, anal fissure, anorectal abscess, and fistulas. For each condition, the author discusses etiology, clinical features, diagnosis, and therapy. The chapter includes full-color and black-and-white illustrations and photographs, to support the heavily-visual aspects of proctology. Each section concludes with a list of references. 20 figures. 1 table. 157 references.

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Office Management of Common Perianal Diseases Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 180-187. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 19355-9725. (215) 2512230. PRICE: $39.50. ISBN: 0812114361. Summary: Perianal disease, including hemorrhoids and fissures, is a common office complaint seen by family practitioners, internists, and gastroenterologists. This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses these common perianal diseases. Topics include external hemorrhoids, internal hemorrhoids, anal fissure, fistula in ano, condylomata acuminata, proctalgia fugax, and pruritis ani. For each condition, the authors discuss symptoms, etiology, diagnosis, and treatment. 4 references.

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Anorectal Diseases of the Elderly Source: in Gelb, A.M., ed. Clinical Gastroenterology in the Elderly. New York, NY: Marcel Dekker, Inc. 1996. p. 101-113.

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Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701-5185. (800) 228-1160 or (914) 796-1919. Fax (914) 796-1772. E-mail: [email protected]. Website: www.dekker.com. PRICE: $135.00 plus shipping and handling. ISBN: 0824793986. Summary: The anorectal area increases in importance as a person gets older. A fixation on normal bowel habits leads older people to perform many ritual acts such as taking oral laxatives as well as using various types of enemas and suppositories. Many conditions result from the use and abuse of these preparations. In addition, certain diseases tend to become more prevalent as people age. This chapter on anorectal diseases is from a textbook that offers an up to date reference source on geriatric gastroenterology. Topics include anorectal and anorectal physiology, anal incontinence (fecal incontinence), rectal prolapse (procidentia), hemorrhoids, fissure in ano (anal fissures), fistula in ano, anorectal inflammation, and benign neoplasms of the rectum, including hyperplastic and adenomatous polyps. The management of older patients with fecal incontinence is based on treating the initiating cause; alleviating diarrhea and constipation will often eliminate the need for more aggressive care such as surgery. The predisposing factors in rectal prolapse are straining associated with intractable constipation or diarrhea, numerous past pregnancies, pelvic operations, and neurologic diseases. Constipation can also lead to hemorrhoid problems, so treating diarrhea, constipation, and intestinal inflammation may ease and resolve hemorrhoids without surgical intervention. Causes of anal fissures in the elderly population include constipation, diarrhea, straining at stool, inflammatory bowel disease, and local trauma such as enema abuse. Again, treating these causes can resolve the fissure. However, treatment of a fistula in ano most often requires surgery, since medical therapy alone rarely leads to healing. 11 figures. 2 references. •

Anorectal Diseases Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1990-2012. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: This chapter on anorectal diseases is from a comprehensive gastroenterology textbook that provides an encyclopedic discussion of virtually all the disease states encountered in a gastroenterology practice. The author of this chapter covers anorectal examination, hemorrhoids, anorectal abscess and fistula, rectal prolapse, anal fissure, anal stenosis, solitary rectal ulcer, fecal incontinence, pruritus ani, rectal foreign bodies and trauma, anal carcinoma, proctalgia fugax and the levator syndrome, and miscellaneous conditions. For each condition, the author summarizes etiology, clinical manifestations, and treatment strategies. 2 figures. 4 tables. 238 references.

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Digestive Disorders Source: in Shaw, M., et al., eds. Everything You Need to Know About Diseases. Springhouse, PA: Springhouse Corporation. 1996. p. 209-256. Contact: Available from Springhouse Publishing. Attention: Trade and Textbook Department, 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 3313170 or (215) 646-4670 or (215) 646-4671. Fax (215) 646-8716. PRICE: $24.95 (as of 1995). ISBN: 0874348226.

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Summary: This chapter on digestive disorders is from a consumer reference guide to over 500 diseases. For each disease, the book covers the causes of the illness, its symptoms, diagnosis, and treatment. Conditions covered in this chapter include anal fissure; anal itching and burning; anorectal abscess; appendicitis; colitis; Crohn's disease; damaged esophagus; diverticulosis; gastroenteritis; groin hernia; heartburn; hemorrhoids; hiatal hernia; inflammation of the stomach lining; intestinal obstruction; irritable bowel syndrome; oral infections; pancreatitis; peptic ulcer; peritonitis; pilonidal disease; pseudomembranous enterocolitis; rectal polyps; rectal prolapse; and volvulus. The chapter includes many sidebars that note common complications and provides readers with guidelines and suggestions. •

Examination and Diseases of the Anorectum Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 2277-2293. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: This chapter on examination and diseases of the anorectum is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include anatomy, examination of the anus and rectum (inspection, palpation, endoscopy), hemorrhoids, anal fissure, anal sepsis (abscesses and fistulas), special fistulas, anal cancer, anal warts, pruritis (itching) ani, anal stenosis (narrowing), unexplained anal pain, hidradenitis suppurative, pilonidal disease, and rectal foreign body. The chapter includes a mini-outline with page citations, illustrations, and extensive references. 7 figures. 3 tables. 100 references.

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Gastrointestinal Disorders Source: in Norris, J., et al., eds. Professional Guide to Diseases. 5th edition. Springhouse, PA: Springhouse Corporation. 1995. p. 653-719. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477-0908. (800) 346-7844 or (215) 646-8700. Fax (215) 646-4508. PRICE: $34.95 (as of 1995). ISBN: 0874347696. Summary: This chapter on gastrointestinal disorders is from an extensive reference guide to diseases. The chapter covers diseases of the mouth and esophagus, including stomatitis and other oral infections, gastroesophageal reflux, tracheoesphageal fistula, esophageal atresia, corrosive esophagitis and stricture, Mallory-Weiss syndrome, esophageal diverticula, and hiatal hernia; diseases of the stomach, intestine and pancreas, including gastritis, gastroenteritis, peptic ulcers, ulcerative colitis, necrotizing enterocolitis, Crohn's disease, pseudomembranous enterocolitis, irritable bowel syndrome, celiac disease, diverticular disease, appendicitis, peritonitis, intestinal obstruction, inguinal hernia, intussusception, volvulus, Hirschsprung's disease, inactive colon, and pancreatitis; and diseases of the anorectum, including hemorrhoids, anorectal abscess and fistula, rectal polyps, anorectal stricture, stenosis, or contracture, pilonidal disease, rectal prolapse, anal fissure, pruritus ani, and proctitis. The book defines each disorder and provides information about causes, signs and symptoms, diagnosis, treatment options, and special considerations. 6 references.

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Common Anorectal Problems Source: in Kelly, K.A.; Sarr, M.G.; Hinder, R.A., eds. Mayo Clinic Gastrointestinal Surgery. St. Louis, MO: Elsevier Science. 2004. p. 589-626. Contact: Available from Elsevier Science. Customer Service Department, 11830 Westline Industrial Drive, St. Louis, MO 63146 (800) 545-2522. Fax (800) 535-9935. Email: [email protected]. Website: www.elsevierhealth.com. PRICE: $195.00. ISBN: 721692877. Summary: This chapter presents the Mayo Clinic's approach to four common anorectal problems: hemorrhoids, anal fissures, anorectal abscesses and anal fistulas, and pilonidal sinuses. The chapter is from a book that focuses on the major diseases treated by gastrointestinal surgeons, from the esophagus to the anal canal. The text has a clinical orientation and a major emphasis on practical applications as they are applied at the Mayo Clinic. For each condition, the author of this chapter discusses nomenclature and classification, prevalence, etiology and pathogenesis, predisposing and associated factors, diagnosis, nonoperative treatment, surgical treatments, special situations, and recommendations for postoperative care. The chapter is illustrated with line drawings and black-and-white photographs. 41 figures. 3 tables. 176 references.

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CHAPTER 6. PERIODICALS AND NEWS ON ANAL FISSURE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover anal fissure.

News Services and Press Releases One of the simplest ways of tracking press releases on anal fissure is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “anal fissure” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to anal fissure. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “anal fissure” (or synonyms). The following was recently listed in this archive for anal fissure: •

Cellegy anal fissure treatment to launch in South Korea Source: Reuters Industry Breifing Date: December 18, 2002

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Cellegy anal fissure pain drug needs another phase III study Source: Reuters Industry Breifing Date: September 09, 2002

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Cellegy pulls NDA for anal fissure pain drug, stock crashes Source: Reuters Industry Breifing Date: April 26, 2002

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Cellegy files anal fissure ointment for approval in South Korea Source: Reuters Industry Breifing Date: March 06, 2001

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Cellegy to file anal fissure pain treatment for approval in Canada Source: Reuters Industry Breifing Date: February 08, 2001

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Botulinum Toxin Treatment For Anal Fissure Effective Alternative to Sphincterotomy Source: Reuters Medical News Date: January 22, 1998 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “anal fissure” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “anal fissure” (or synonyms). If you know the name of a company that is relevant to anal fissure, you can go to any stock trading Web site (such as http://www.etrade.com/) and

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search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “anal fissure” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “anal fissure” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on anal fissure: •

Botulinum Toxin: Can A Poison Help? Source: Mayo Clinic Health Letter. 18(6): 6. June 2000. Contact: Available from Mayo Clinic Health Letter. 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article provides people who have muscular problems with information on the medicinal uses of botulinum toxin. Although botulinum toxin causes muscle paralysis throughout the body when it is ingested, it can halt unwanted movements when injected into specific muscles. Botulinum toxin is currently used to treat spasmodic torticollis; facial tics; eyelid twitching; crossed eyes; muscle spasms associated with cerebral palsy, multiple sclerosis, stroke, and Parkinson's disease; swallowing and speech difficulties; migraines; chronic anal fissures; and vaginal spasms. Injections are usually done in a doctor's office. Several injections are typical, and a few days or weeks may be needed before the toxin becomes fully effective. Treatment usually lasts 3 months or longer before it must be repeated.

Academic Periodicals covering Anal Fissure Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to anal fissure. In addition to these sources, you can search for articles covering anal fissure that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the

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name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 7. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for anal fissure. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with anal fissure. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to anal fissure: Lidocaine •

Topical - U.S. Brands: Lidoderm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500058.html

Nitrates Topical •

Systemic - U.S. Brands: Deponit; Minitran; Nitro-Bid; Nitrodisc; Nitro-Dur; Nitrol; Transderm-Nitro http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202413.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

7

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

8 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “anal fissure” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1336 30 49 4 3 1422

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “anal fissure” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

11

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

15 Adapted 16

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on anal fissure can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to anal fissure. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to anal fissure. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “anal fissure”:

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Anal and Rectal Diseases http://www.nlm.nih.gov/medlineplus/analandrectaldiseases.html Anal Cancer http://www.nlm.nih.gov/medlineplus/analcancer.html Colonic Diseases http://www.nlm.nih.gov/medlineplus/colonicdiseases.html Crohn's Disease http://www.nlm.nih.gov/medlineplus/crohnsdisease.html Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Hemorrhoids http://www.nlm.nih.gov/medlineplus/hemorrhoids.html Ulcerative Colitis http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on anal fissure. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Anal Fissure: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. [2 p.]. Contact: Available from American Society for Colon and Rectal Surgeons (ASCRS). 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Website: www.fascrs.org. PRICE: Single copy free. Summary: This brochure describes anal fissures, which are small tears in the lining of the anus which can cause pain, bleeding, or itching. A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the anorectal area. At least 50 percent of fissures heal either by themselves or with nonoperative treatment, including application of medicated cream, use of stool softeners, avoidance of constipation, and the use of sitz baths. A fissure that fails to respond to treatment should be reexamined to determine if a

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definitive reason exists for the lack of healing. Those fissures that continue to cause pain or bleeding can be corrected by surgery. Surgery usually consists of a small operation to remove the fissure and the underlying scar tissue. Complete healing occurs in a few weeks, although pain often disappears after a few days. More than 90 percent of the patients who require surgery for this problem have no further trouble from fissures. 2 figures. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to anal fissure. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to anal fissure. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with anal fissure. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about anal fissure. For more information, see

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the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “anal fissure” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “anal fissure”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “anal fissure” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “anal fissure” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

18

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

19

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on anal fissure: •

Basic Guidelines for Anal Fissure Anal fissure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001130.htm TB Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm

•

Signs & Symptoms for Anal Fissure Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm Pruritus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm

•

Diagnostics and Tests for Anal Fissure Anoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003890.htm

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Barium enema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Colonoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003886.htm Digital rectal exam Web site: http://www.nlm.nih.gov/medlineplus/ency/article/007069.htm Proctosigmoidoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm Wet prep Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003916.htm •

Nutrition for Anal Fissure Bulk Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm

•

Background Topics for Anal Fissure Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Inspection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002388.htm Mucosa Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002264.htm Sitz bath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002299.htm

Online Glossaries 93

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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ANAL FISSURE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU]

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Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Anal Fistula: A channel that develops between the anus and the skin. Most fistulas are the result of an abscess (infection) that spreads to the skin. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [NIH] Anginal: Pertaining to or characteristic of angina. [EU] Anogenital: Pertaining to the anus and external genitals. [EU] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea.

Dictionary 97

[NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

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Bethanechol: A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Bethanechol is generally used to increase smooth muscle tone, as in the GI tract following abdominal surgery or in urinary retention in the absence of obstruction. It may cause hypotension, cardiac rate changes, and bronchial spasms. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchial Spasm: Spasmodic contraction of the smooth muscle of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU]

Dictionary 99

Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and

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meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH]

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Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colorectal Surgery: A surgical specialty concerned with the diagnosis and treatment of disorders and abnormalities of the colon, rectum, and anal canal. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU]

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Condylomata Acuminata: Sexually transmitted form of anogenital warty growth caused by the human papillomaviruses. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is

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multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

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Dyspepsia: Impaired digestion, especially after eating. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emergency Medicine: A branch of medicine concerned with an individual's resuscitation, transportation and care from the point of injury or beginning of illness through the hospital or other emergency treatment facility. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Enterostomal Therapy: A nurse who cares for patients with an ostomy. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzymes: Biological molecules that possess catalytic activity. They may occur naturally or

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be synthetically created. Enzymes are usually proteins, however catalytic RNA and catalytic DNA molecules have also been identified. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Atresia: Congenital failure of the full esophageal lumen to develop that commonly occurs with tracheoesophageal fistula. Symptoms include excessive salivation, gagging, cyanosis, and dyspnea. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Facial: Of or pertaining to the face. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression

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(return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH]

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Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genital: Pertaining to the genitalia. [EU] Geriatric: Pertaining to the treatment of the aged. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial

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cells that are organized into interconnected plates called lobules. [NIH] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Hidradenitis: The inflammation of a sweat gland (usually of the apocrine type). The condition can be idiopathic or occur as a result of or in association with another underlying condition. Neutrophilic eccrine hidradenitis is a relatively rare variant that has been reported in patients undergoing chemotherapy, usually for non-Hodgkin lymphomas or leukemic conditions. [NIH] Homeopathic remedies: Small doses of medicines, herbs, or both that are believed to stimulate the immune system. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

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Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Incisive: 1. Having the power or quality of cutting. 2. Pertaining to the incisor teeth. [EU] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Information Centers: Facilities for collecting and organizing information. They may be specialized by subject field, type of source material, persons served, location, or type of services. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH]

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Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Involuntary: Reaction occurring without intention or volition. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketanserin: A selective serotonin receptor antagonist with weak adrenergic receptor blocking properties. The drug is effective in lowering blood pressure in essential hypertension. It also inhibits platelet aggregation. It is well tolerated and is particularly effective in older patients. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Leishmaniasis: A disease caused by any of a number of species of protozoa in the genus Leishmania. There are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral leishmaniasis. [NIH] Lesion: An area of abnormal tissue change. [NIH] Levator Syndrome: Feeling of fullness in the anus and rectum with occasional pain. Caused by muscle spasms. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood

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and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical

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Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiparous: 1. Having had two or more pregnancies which resulted in viable fetuses. 2. Producing several ova or offspring at one time. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign

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neoplasms. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blockade: The intentional interruption of transmission at the neuromuscular junction by external agents, usually neuromuscular blocking agents. It is distinguished from nerve block in which nerve conduction is interrupted rather than neuromuscular transmission. Neuromuscular blockade is commonly used to produce muscle relaxation as an adjunct to anesthesia during surgery and other medical procedures. It is also often used as an experimental manipulation in basic research. It is not strictly speaking anesthesia but is grouped here with anesthetic techniques. The failure of neuromuscular transmission as a result of pathological processes is not included here. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful antianginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrates: Inorganic or organic salts and esters of nitric acid. These compounds contain the NO3- radical. [NIH] Nitric acid: A toxic, corrosive, colorless liquid used to make fertilizers, dyes, explosives, and other chemicals. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye

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and the medical and surgical treatment of its defects and diseases. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or

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beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenolphthalein: An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilonidal Sinus: A hair-containing cyst or sinus, occurring chiefly in the coccygeal region. [NIH]

Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH]

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Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Proctalgia Fugax: Intense pain in the rectum that occasionally happens at night. Caused by muscle spasms around the anus. [NIH] Proctitis: Inflammation of the rectum. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein

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C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pruritus Ani: Intense chronic itching in the anal area. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH]

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Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rhagades: Fissures, cracks, or fine linear scars in the skin, especially such lesions around the mouth or other regions subjected to frequent movement. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis,

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and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sitz Bath: A special plastic tub. A person sits in a few inches of warm water to help relieve discomfort of hemorrhoids or anal fissures. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solitary Rectal Ulcer: A rare type of ulcer in the rectum. May develop because of straining to have a bowel movement. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by

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refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomach Ulcer: An open sore in the lining of the stomach. Also called gastric ulcer. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU]

Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subcutaneous: Beneath the skin. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a

Dictionary 121

ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Torticollis: Wryneck; a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Tracheoesophageal Fistula: Abnormal communication between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products

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of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villous: Of a surface, covered with villi. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Volition: Voluntary activity without external compulsion. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]

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INDEX A Abdominal, 60, 61, 95, 98, 100, 103, 106, 110, 111, 114, 115, 121 Abdominal Cramps, 60, 95 Abdominal Pain, 60, 95, 106, 110, 111, 115, 121 Abscess, 61, 62, 63, 64, 65, 95, 96 Acetylcholine, 95, 113 Acquired Immunodeficiency Syndrome, 61, 95 Adaptation, 95, 116 Adrenal Cortex, 95, 102, 108 Adrenergic, 95, 110 Adverse Effect, 4, 95, 119 Affinity, 95, 96, 110, 119 Age Groups, 3, 96 Aged, 80 and Over, 96 Agonist, 96, 98 Algorithms, 96, 98 Alkaline, 96, 99, 115 Alternative medicine, 68, 96 Amenorrhea, 96 Amino Acid Sequence, 96, 97 Anaesthesia, 19, 43, 96 Anal Fistula, 61, 66, 96 Analgesics, 5, 96 Anaplasia, 96, 112 Androgens, 95, 96, 102 Anemia, 96, 111 Anesthesia, 4, 36, 38, 96, 113, 116 Angina, 96, 110, 113 Anginal, 96, 113 Anogenital, 96, 102 Anorectal, 14, 16, 24, 26, 33, 52, 61, 62, 63, 64, 65, 66, 82, 96 Anorexia, 60, 96, 106, 122 Anorexia Nervosa, 60, 96 Antagonism, 97, 103 Antiallergic, 97, 102 Antibacterial, 97, 120 Antibiotic, 97, 120 Antibodies, 23, 97, 116 Antigen, 95, 97, 101, 109 Anti-inflammatory, 97, 102, 107 Anti-Inflammatory Agents, 97, 102 Antineoplastic, 97, 102 Anus, 3, 4, 23, 56, 61, 65, 82, 96, 97, 98, 101, 104, 106, 107, 110, 115, 116, 117

Appendicitis, 62, 65, 97 Aqueous, 56, 97, 104 Arginine, 41, 97, 113 Arterial, 97, 108, 113, 117 Artery, 43, 97, 98 Asymptomatic, 63, 97, 114 Atmospheric Pressure, 97, 108 Autodigestion, 97, 114 Autoimmune disease, 97, 112 B Bacteria, 97, 103, 105, 106, 118, 120, 121, 122 Base, 97, 110, 115, 122 Benign, 56, 60, 64, 97, 99, 107, 112, 122 Bethanechol, 32, 41, 98 Bile, 98, 100, 106, 110, 111 Bile Acids, 98, 106 Bile duct, 98, 100 Bile Pigments, 98, 110 Biliary, 65, 98, 99, 114 Biliary Tract, 98, 99, 114 Biopsy, 4, 92, 98 Biotechnology, 7, 68, 77, 98 Bladder, 60, 98, 109, 112, 122 Bloating, 98, 109, 110, 111 Blood Coagulation, 98, 99 Blood pressure, 98, 108, 110, 113, 119 Blood vessel, 56, 98, 104, 107, 110, 119, 120, 121, 122 Body Fluids, 98, 103, 106, 113, 119 Body Regions, 98, 100 Bowel, 3, 5, 6, 56, 57, 60, 61, 63, 64, 82, 95, 96, 98, 103, 104, 109, 110, 115, 117, 119, 120, 121 Bowel Movement, 3, 5, 6, 56, 57, 60, 82, 98, 103, 119, 120 Bradykinin, 98, 113 Bronchial, 98 Bronchial Spasm, 98 Buccal, 98, 111, 120 Bulimia, 60, 99 Bupivacaine, 99, 110 C Calcium, 56, 99, 101, 103, 113 Calculi, 99, 107 Carbohydrate, 99, 102 Carbon Dioxide, 99, 106 Carcinoid, 61, 99

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Carcinoma, 4, 23, 61, 64, 99 Cardiac, 98, 99, 110, 118 Case report, 99, 100 Case series, 99, 100 Catheter, 21, 99 Caudal, 99, 116 Cecum, 99, 110 Celiac Disease, 60, 62, 65, 99 Cell, 96, 97, 98, 99, 101, 104, 110, 111, 115, 116, 117 Cell Division, 97, 99, 115 Central Nervous System, 95, 99, 107, 112, 118 Central Nervous System Infections, 99, 107 Cerebral, 69, 100, 105, 111, 119 Cerebral Cortex, 100, 105 Cerebral Palsy, 69, 100, 119 Cerebrum, 100 Cervical, 100, 121 Chemotherapy, 100, 108 Cholangitis, 62, 100 Cholecystitis, 62, 100 Cholelithiasis, 60, 100 Cholesterol, 60, 98, 100, 108 Cirrhosis, 62, 100 Clinical study, 37, 100 Clinical trial, 7, 34, 77, 100, 103, 112, 117 Cloning, 98, 100 Colic, 60, 100 Colitis, 60, 61, 65, 82, 100, 110 Collagen, 100, 108, 116 Collagen disease, 100, 108 Colonoscopy, 61, 92, 101 Colorectal, 4, 9, 10, 14, 16, 20, 21, 25, 29, 36, 38, 40, 60, 61, 62, 101 Colorectal Cancer, 60, 61, 101 Colorectal Surgery, 61, 101 Complement, 101 Complementary and alternative medicine, 51, 54, 101 Complementary medicine, 51, 101 Computational Biology, 77, 101 Conduction, 101, 113 Condylomata Acuminata, 63, 102 Consciousness, 96, 102, 103, 118 Constipation, 20, 51, 52, 60, 61, 62, 64, 82, 91, 102, 110, 115 Constriction, 102, 110 Contracture, 65, 102 Contraindications, ii, 60, 102 Coordination, 102, 112

Coronary, 102, 113 Corticosteroid, 56, 102 Cranial, 102, 107 Craniocerebral Trauma, 102, 107 Curative, 102, 120 Cutaneous, 61, 102, 110, 111 Cyanosis, 102, 105 Cyclic, 102, 107, 113 Cyst, 102, 115 D Defecation, 3, 5, 8, 56, 61, 102 Degenerative, 102, 107 Dehydration, 60, 102 Dementia, 95, 102 Diagnostic procedure, 55, 68, 103 Diaphragm, 103, 108 Diarrhea, 60, 62, 64, 82, 103, 110, 111 Diarrhoea, 15, 103, 106 Digestion, 98, 103, 104, 109, 110, 111, 115, 120 Digestive system, 62, 103, 106 Dilation, 4, 15, 98, 103 Dilator, 52, 103, 113 Diltiazem, 9, 10, 20, 32, 34, 41, 103 Diploid, 103, 115 Direct, iii, 35, 71, 103, 117 Distal, 3, 57, 103, 106, 117 Diverticula, 65, 103 Diverticulitis, 60, 61, 103 Diverticulosis, 65, 103 Diverticulum, 103 Dorsal, 103, 116 Double-blind, 9, 21, 22, 42, 44, 103 Drug Interactions, 72, 103 Duct, 103, 105, 114, 118, 120 Duodenum, 98, 103, 114, 115, 120 Dysentery, 60, 103 Dyspepsia, 104, 109 Dyspnea, 104, 105 E Efficacy, 6, 104 Electrolyte, 102, 104, 106, 112, 113, 119, 122 Emaciation, 95, 104 Embryology, 61, 104 Emergency Medicine, 60, 104 Emergency Treatment, 104 Emulsion, 56, 104, 106 Endemic, 104, 111 Endoscopy, 18, 24, 26, 35, 65, 104 Endothelial cell, 23, 104 Endothelium, 104, 113

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Endothelium-derived, 104, 113 Enema, 64, 92, 104 Enteritis, 60, 104 Enterocolitis, 65, 104 Enterostomal Therapy, 61, 62, 104 Environmental Health, 76, 78, 104 Enzymatic, 99, 101, 104 Enzymes, 104, 114 Epidermal, 105, 122 Epigastric, 105, 114 Epithelial, 105, 107 Epithelial Cells, 105, 108 Epithelium, 6, 104, 105 Erectile, 39, 105 Erection, 105 Esophageal, 65, 105, 121 Esophageal Atresia, 65, 105, 121 Esophagitis, 65, 105 Esophagus, 65, 66, 103, 105, 106, 107, 111, 115, 120, 121 Evacuation, 102, 105 Exhaustion, 97, 105, 111 Exocrine, 105, 114 F Facial, 69, 105 Faecal, 103, 105 Family Planning, 77, 105 Fat, 102, 105, 110, 112 Fecal Incontinence, 4, 28, 64, 105, 109 Feces, 63, 102, 105, 120 Fibrin, 98, 105, 115 Fibrosis, 102, 105, 118 Fissure, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 48, 51, 52, 53, 56, 60, 61, 62, 63, 64, 65, 67, 68, 82, 91, 96, 105 Fistula, 12, 61, 63, 64, 65, 105 Fixation, 64, 105 Flatulence, 60, 106 Flatus, 6, 105, 106 Fluid Therapy, 106, 113 Fold, 105, 106 Fovea, 106 G Gallbladder, 95, 98, 100, 103, 106 Gas, 6, 60, 99, 106, 109, 110, 111, 113 Gastric, 97, 106, 107, 115, 120 Gastric Juices, 106, 115 Gastritis, 60, 62, 65, 106 Gastroenteritis, 60, 65, 106

Gastroenterology, 3, 5, 11, 13, 14, 19, 23, 24, 28, 30, 39, 45, 62, 63, 64, 106 Gastroesophageal Reflux, 65, 106 Gastrointestinal, 10, 26, 32, 35, 38, 60, 63, 65, 66, 98, 99, 106, 111, 118 Gastrointestinal tract, 65, 106, 118 Gels, 56, 106 Gene, 98, 107, 116 Genital, 12, 22, 107 Geriatric, 64, 107 Gland, 95, 107, 108, 114, 115, 118, 120 Glucocorticoid, 107, 108 Gluten, 99, 107 Gout, 60, 107 Governing Board, 107, 116 Graft, 107 Groin, 65, 107, 109 Guanylate Cyclase, 107, 113 H Haploid, 107, 115 Headache, 6, 22, 30, 107 Headache Disorders, 107 Heartburn, 60, 62, 65, 107, 108, 109 Helminthiasis, 60, 100, 107 Hemorrhage, 60, 102, 107, 120 Hemorrhoid, 6, 64, 107, 120 Hepatitis, 60, 107 Hepatocytes, 107 Hernia, 65, 108 Herpes, 22, 108 Herpes Zoster, 108 Hiatal Hernia, 60, 62, 65, 108 Hidradenitis, 65, 108 Homeopathic remedies, 60, 108 Hormonal, 102, 108 Hormone, 102, 108 Human papillomavirus, 102, 108 Hydrocortisone, 53, 108 Hyperbaric, 44, 108 Hyperbaric oxygen, 44, 108 Hyperbilirubinemia, 108, 110 Hypercholesterolemia, 60, 108 Hypertension, 107, 108, 110, 122 Hyperuricemia, 107, 108 Hypotension, 98, 108 I Idiopathic, 57, 108 Ileostomy, 108, 112 Immune response, 97, 102, 108, 122 Immune system, 108, 109, 112, 122 Immunity, 95, 109 Immunodeficiency, 15, 95, 109

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Impairment, 109, 110 Impotence, 39, 105, 109 Incisive, 61, 109 Incisor, 109 Incompetence, 106, 109 Incontinence, 4, 6, 60, 61, 63, 64, 109 Indigestion, 60, 109 Infant, Newborn, 96, 109 Infection, 95, 96, 106, 109, 110, 111, 114, 121 Inflammatory bowel disease, 61, 64, 109 Information Centers, 60, 109 Ingestion, 109, 116 Inguinal, 65, 109 Inguinal Hernia, 65, 109 Inhalation, 109, 116 Insulator, 109, 112 Internal Medicine, 106, 109 Intestinal, 60, 61, 64, 65, 99, 104, 109, 110, 111 Intestinal Mucosa, 99, 104, 109 Intestinal Obstruction, 65, 110 Intestine, 65, 98, 101, 104, 110, 122 Intracellular, 109, 110, 113 Intussusception, 65, 110, 117 Involuntary, 63, 105, 110, 118, 119 Irritable Bowel Syndrome, 60, 62, 65, 110 Irritants, 103, 110 Ischemia, 4, 6, 110 Isosorbide Dinitrate, 21, 32, 35, 44, 56, 110 J Jaundice, 60, 108, 110 K Kb, 76, 110 Ketanserin, 41, 110 L Large Intestine, 61, 99, 101, 103, 110, 117, 119, 122 Leishmaniasis, 15, 110 Lesion, 110, 121 Levator Syndrome, 16, 62, 64, 110 Lidocaine, 35, 41, 42, 72, 110 Lipid, 110, 112 Lipophilic, 56, 110 Liver, 21, 60, 62, 65, 95, 98, 100, 103, 104, 105, 106, 107, 110 Localized, 95, 106, 109, 111, 115, 120, 121 Locomotion, 111, 115 Loop, 108, 111 Lower Esophageal Sphincter, 106, 111 Lupus, 60, 100, 111 Lymph, 100, 104, 111

Lymphocyte Count, 95, 111 Lymphocytes, 95, 97, 111 Lymphoid, 97, 111 M Malabsorption, 99, 111, 119 Malabsorption syndrome, 111, 119 Malaria, 60, 111 Malaria, Falciparum, 111 Malaria, Vivax, 111 Malignant, 61, 95, 97, 111, 112 Malignant tumor, 61, 111 Manometry, 14, 24, 39, 111 Medical Records, 111, 118 MEDLINE, 77, 111 Membrane, 101, 103, 112, 115, 116, 117 Memory, 96, 103, 112 Metabolic disorder, 107, 112 Metastasis, 112 Mineralocorticoids, 95, 102, 112 Modification, 4, 18, 112 Molecular, 36, 77, 79, 98, 101, 112, 121 Motion Sickness, 112 Mucocutaneous, 110, 112 Mucosa, 57, 92, 111, 112, 120 Mucus, 103, 112, 121 Multicenter study, 30, 112 Multiparous, 36, 112 Multiple sclerosis, 69, 112 Muscle Relaxation, 112, 113 Mydriatic, 103, 112 Myelin, 112 N Nausea, 60, 106, 109, 112, 122 Necrotizing Enterocolitis, 29, 65, 112 Neonatal, 29, 112 Neoplasms, 64, 95, 97, 112 Nervous System, 99, 100, 113 Neurologic, 64, 113 Neuromuscular, 20, 95, 113, 122 Neuromuscular Blockade, 20, 113 Neuromuscular Junction, 95, 113 Neurotoxin, 36, 113 Nifedipine, 25, 30, 31, 41, 42, 56, 113 Nitrates, 6, 42, 72, 113 Nitric acid, 113 Nitric Oxide, 6, 39, 56, 113 Nitrogen, 96, 106, 113 Nitroglycerin, 4, 6, 7, 8, 10, 25, 28, 29, 30, 38, 42, 43, 110, 113 Nursing Care, 113, 114 Nutritional Support, 61, 113

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O Office Management, 63, 113 Office Visits, 6, 113 Ophthalmology, 106, 113 Opportunistic Infections, 95, 114 Ostomy, 104, 114 Outpatient, 27, 31, 114 Overdosage, 60, 114 P Palate, 114, 120 Palliative, 114, 120 Palpation, 65, 114 Pancreas, 65, 95, 103, 106, 114 Pancreatic, 60, 106, 114 Pancreatic cancer, 60, 114 Pancreatic Juice, 106, 114 Pancreatitis, 65, 114 Paralysis, 69, 114, 119 Parasite, 114, 121 Parasitic, 103, 107, 114 Patch, 10, 114 Pathologic, 98, 102, 108, 114 Pathophysiology, 19, 65, 114 Patient Care Management, 6, 114 Patient Education, 63, 82, 86, 88, 93, 114 Patient Satisfaction, 35, 114 Pelvic, 62, 64, 115 Pelvis, 115 Pepsin, 115 Peptic, 65, 115 Peptic Ulcer, 65, 115 Perforation, 115, 122 Perianal, 32, 61, 62, 63, 115 Perineum, 61, 115 Peritoneal, 65, 115 Peritoneum, 115 Peritonitis, 65, 115, 122 Petrolatum, 104, 115 Phallic, 106, 115 Pharmacologic, 32, 96, 115, 121, 122 Pharynx, 106, 115 Phenolphthalein, 104, 115 Phosphorus, 99, 115 Physical Examination, 63, 115 Physiology, 6, 8, 61, 64, 95, 106, 115 Pilonidal Sinus, 66, 115 Pituitary Gland, 102, 115 Plants, 60, 99, 115, 121 Plasma, 97, 112, 116 Plasma cells, 97, 116 Plasticity, 21, 116 Platelet Aggregation, 110, 113, 116

Platelets, 113, 116, 118 Pneumonia, 102, 116 Poisoning, 60, 106, 112, 116 Polyposis, 101, 116 Posterior, 4, 22, 57, 96, 103, 114, 116 Postoperative, 61, 66, 116 Practice Guidelines, 78, 116 Prevalence, 62, 66, 116 Probe, 35, 116 Procaine, 110, 116 Proctalgia Fugax, 16, 56, 63, 64, 116 Proctitis, 62, 65, 116 Progressive, 100, 103, 116 Prolapse, 61, 63, 64, 116 Prospective study, 20, 41, 116 Protein S, 98, 116 Protocol, 20, 117 Protozoa, 103, 110, 117 Protozoan, 100, 111, 117, 121 Proximal, 61, 103, 117 Pruritus, 16, 61, 64, 65, 91, 117, 122 Pruritus Ani, 16, 61, 64, 65, 117 Psychiatry, 105, 117 Psyllium, 54, 117 Public Policy, 77, 117 Pupil, 103, 112, 117 R Radiation, 108, 117 Radiation therapy, 108, 117 Randomized, 9, 10, 22, 23, 25, 34, 35, 42, 104, 117 Receptor, 95, 97, 110, 117, 119 Rectal, 6, 33, 43, 60, 61, 63, 64, 65, 82, 92, 117 Rectal Prolapse, 61, 63, 64, 65, 117 Recurrence, 28, 34, 37, 117 Refer, 1, 98, 101, 106, 108, 111, 117, 121 Reflex, 51, 118 Refraction, 118, 120 Refractory, 42, 118 Regimen, 104, 118 Regurgitation, 106, 107, 118 Relapse, 35, 118 Remission, 117, 118 Resection, 118, 119 Resuscitation, 104, 118 Retrospective, 38, 51, 118 Retrospective study, 38, 118 Rhagades, 63, 118 Rigidity, 115, 118 Risk factor, 62, 103, 116, 118

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S Saline, 8, 118 Salivary, 103, 114, 118 Salivation, 105, 118 Sclerosis, 100, 112, 118 Screening, 100, 118 Secretion, 102, 112, 118 Sedative, 118, 122 Sensibility, 96, 118 Sepsis, 65, 118 Serotonin, 110, 118 Serum, 101, 112, 115, 119 Shock, 108, 119, 121 Short Bowel Syndrome, 61, 119 Side effect, 6, 41, 60, 71, 95, 108, 119, 121 Sigmoid, 119 Sigmoidoscopy, 61, 119 Signs and Symptoms, 62, 65, 118, 119, 122 Sitz Bath, 5, 53, 82, 119 Skeletal, 96, 119 Skin graft, 37, 119 Small intestine, 99, 103, 104, 108, 109, 110, 119 Smooth muscle, 98, 113, 119 Sodium, 107, 112, 119, 120 Solitary Rectal Ulcer, 52, 61, 64, 119 Spasm, 20, 24, 25, 56, 119 Spasmodic, 69, 95, 98, 119 Spastic, 110, 119 Specialist, 84, 103, 119 Species, 106, 110, 111, 114, 119, 121 Spectrum, 39, 119 Sphincter, 4, 6, 8, 18, 20, 23, 24, 25, 29, 32, 33, 36, 38, 39, 40, 41, 52, 56, 117, 120 Spinal cord, 99, 100, 113, 118, 120 Stenosis, 12, 29, 64, 65, 120 Steroids, 102, 107, 120 Stimulus, 118, 120 Stoma, 61, 114, 120 Stomach, 60, 65, 95, 97, 103, 105, 106, 108, 111, 112, 115, 119, 120, 122 Stomach Ulcer, 60, 120 Stomatitis, 65, 120 Stool, 4, 6, 56, 63, 64, 82, 101, 109, 110, 120 Stress, 4, 5, 106, 110, 112, 120 Stricture, 61, 65, 120 Stroke, 69, 76, 120 Subarachnoid, 107, 120 Subcutaneous, 8, 9, 10, 11, 15, 19, 27, 33, 37, 43, 120 Supplementation, 5, 120 Suppression, 102, 120

Suppurative, 65, 120 Sweat, 108, 120 Symptomatic, 4, 37, 38, 114, 120 Systemic, 57, 72, 98, 100, 109, 117, 120 T Tenesmus, 103, 120 Teratogenic, 103, 120 Therapeutics, 26, 33, 41, 72, 120 Thigh, 107, 120 Thrombosed, 12, 62, 120 Thrombosis, 63, 117, 120, 121 Tissue, 57, 83, 97, 98, 100, 105, 107, 108, 110, 111, 112, 113, 114, 115, 118, 119, 121 Tone, 29, 56, 98, 121 Tonus, 121 Topical, 4, 5, 6, 8, 10, 21, 22, 25, 28, 29, 34, 41, 42, 43, 44, 48, 52, 56, 72, 115, 121 Torticollis, 69, 121 Toxic, iv, 109, 113, 121 Toxicity, 103, 121 Toxicology, 78, 121 Toxin, 4, 5, 7, 8, 9, 16, 17, 18, 19, 21, 23, 24, 26, 28, 30, 35, 38, 39, 40, 42, 44, 63, 68, 69, 121 Tracheoesophageal Fistula, 105, 121 Transfection, 98, 121 Trauma, 4, 56, 61, 64, 105, 114, 121 Trichomoniasis, 60, 121 Tuberculosis, 111, 121 Tunica, 112, 121 U Ulcer, 6, 15, 56, 119, 120, 121 Ulceration, 115, 121 Ulcerative colitis, 61, 62, 65, 109, 121 Ultrasonography, 38, 121 Uraemia, 114, 121 Uric, 107, 108, 122 Urinary, 98, 99, 109, 122 Urinary Retention, 98, 122 Urine, 98, 109, 122 V Vaccine, 117, 122 Vagina, 122 Vaginal, 69, 122 Valerian, 59, 122 Vascular, 35, 61, 104, 107, 109, 113, 122 Vasculitis, 114, 122 Vasodilator, 98, 110, 113, 122 Vein, 120, 122 Venous, 113, 117, 122 Veterinary Medicine, 77, 122 Villous, 99, 122

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Viral, 122 Virus, 15, 95, 100, 108, 122 Visceral, 15, 110, 115, 122 Volition, 110, 122

Volvulus, 61, 65, 122 W Warts, 12, 65, 108, 122

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