{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T08:35:50Z","timestamp":1765960550103,"version":"3.37.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[1996,6,1]],"date-time":"1996-06-01T00:00:00Z","timestamp":833587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100004264","name":"Robert Luff Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004264","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1996,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The aetiology of anal fissure is unclear, but there is an association with high maximum resting pressure (MRP). Internal sphincterotomy reduces MRP and heals fissure through an increase in local blood supply. Glyceryl trinitrate (GTN) is a nitric oxide donor which contributes to internal anal sphincter relaxation via a non-adrenergic non-cholinergic pathway. GTN ointment was applied topically in different concentrations to the anal margin in patients with chronic anal fissure to monitor its effect primarily on MRP and secondarily on fissure healing. Nineteen patients with chronic anal fissure were treated with ointment containing increasing concentrations of GTN (0\u00b72\u20130\u00b78 per cent) to produce a reduction in MRP of greater than 25 per cent. The actual dose of GTN varied as no standard delivery system has been developed, but a \u2018typical amount\u2019 of GTN ointment weighed about 200 mg. In 15 of 19 patients, a concentration greater than 0\u00b72 per cent was required to lower the MRP by at least 25 per cent. The minimum concentration of GTN that reduced the resting pressure by at least 25 per cent was prescribed and local application was carried out by the patient twice daily for 6 weeks. At 6 weeks, nine patients had healed, six required sphincterotomy and four were lost to follow-up. Eight of the nine patients with healed fistula required a GTN concentration of 0\u00b73 per cent or more. Sixteen patients were resistant to the usually effective dose of 0\u00b72 per cent GTN. In three there was tachyphylaxis and the duration of action of GTN was less than the 12 h described previously in control patients. Two patients did not fulfil the study because of headache.<\/jats:p>","DOI":"10.1002\/bjs.1800830614","type":"journal-article","created":{"date-parts":[[2007,3,2]],"date-time":"2007-03-02T18:25:30Z","timestamp":1172859930000},"page":"771-775","source":"Crossref","is-referenced-by-count":120,"title":["Topical glyceryl trinitrate in the treatment of chronic anal fissure"],"prefix":"10.1093","volume":"83","author":[{"given":"S J","family":"Watson","sequence":"first","affiliation":[{"name":"Department of Surgery and Physiology, St Mark's Hospital , Northwick Park, Watford, Harrow HA1 3JU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M A","family":"Kamm","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, St Mark's Hospital , Northwick Park, Watford, Harrow HA1 3JU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R J","family":"Nicholls","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, St Mark's Hospital , Northwick Park, Watford, Harrow HA1 3JU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R K S","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, St Mark's Hospital , Northwick Park, Watford, Harrow HA1 3JU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1996,6,1]]},"reference":[{"key":"2024092909472437800_bib1","first-page":"110","article-title":"Anal fissure: results of surgical treatment","volume":"13","author":"Jost","year":"1991","journal-title":"Coloproctology"},{"key":"2024092909472437800_bib2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/00000658-199002000-00017","article-title":"A manometric study of anal fissure treated by subcutaneous lateral internal sphincterotomy","volume":"211","author":"McNamara","year":"1990","journal-title":"Ann Surg"},{"key":"2024092909472437800_bib3","first-page":"49","article-title":"Closed lateral internal anal sphincterotomy as an office procedure for the treatment of anal fissures","volume":"9","author":"Vafai","year":"1987","journal-title":"Coloproctology"},{"key":"2024092909472437800_bib4","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1007\/BF02076185","article-title":"Sustained internal sphincter hypertonia in patients with chronic anal fissure","volume":"37","author":"Farouk","year":"1994","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib5","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1007\/BF02054409","article-title":"Relationship between anal pressure and anodermal blood flow. The vascular pathogenesis of anal fissures","volume":"37","author":"Schouten","year":"1994","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib6","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1007\/BF02555487","article-title":"Morbidity of internal sphincterotomy for anal fissure and stenosis","volume":"28","author":"Walker","year":"1985","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib7","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/BF02564886","article-title":"Long-term results of open and closed sphincterotomy for anal fissure","volume":"31","author":"Lewis","year":"1988","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib8","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1002\/bjs.1800760504","article-title":"Sequelae of internal sphincterotomy for chronic fissure in-ana","volume":"76","author":"Khubchandani","year":"1989","journal-title":"Br J Surg"},{"key":"2024092909472437800_bib9","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1002\/bjs.1800791248","article-title":"Manual dilatation of the anus","volume":"79","author":"MacDonald","year":"1992","journal-title":"Br J Surg"},{"key":"2024092909472437800_bib10","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1007\/BF02238595","article-title":"Risk of sphincter damage and anal incontinence after anal dilatation for fissure-in-ano","volume":"36","author":"Nielsen","year":"1993","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib11","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1136\/gut.34.5.689","article-title":"Nerve mediated relaxation of the human internal anal sphincter: the role of nitric oxide","volume":"34","author":"O'Kelly","year":"1993","journal-title":"Gut"},{"key":"2024092909472437800_bib12","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/BF02053596","article-title":"Distribution of nitric oxide synthase containing neurons in the rectal myenteric plexus and anal canal. Morphologic evidence that nitric oxide mediates the rectoanal inhibitory reflex","volume":"37","author":"O'Kelly","year":"1994","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib13","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1002\/bjs.1800810949","article-title":"\u2018Reversible chemical sphincterotomy\u2019 by local application of glyceryl trinitrate","volume":"81","author":"Loder","year":"1994","journal-title":"Br J Surg"},{"key":"2024092909472437800_bib14","first-page":"109","article-title":"Nitric oxide: physiology, pathophysiology and pharmacology","volume":"43","author":"Moncada","year":"1991","journal-title":"Pharmacol Rev"},{"key":"2024092909472437800_bib15","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/BF02556488","article-title":"Manual dilatation of the anus vs lateral subcutaneous sphincterotomy in the treatment of chronic fissure-in-ano: results of a prospective, randomized, clinical trial","volume":"30","author":"Weaver","year":"1987","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib16","first-page":"806","volume-title":"Goodman and Gilman's the Pharmacologic Basis of Therapeutics","author":"Needleman","year":"1985"},{"volume-title":"Chemical sphincterotomy for anal fissure. Tripartite Meeting","year":"1993","author":"Kennedy","key":"2024092909472437800_bib17"},{"key":"2024092909472437800_bib18","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/BF02148842","article-title":"Treatment of benign anal disease with topical nitroglycerin","volume":"38","author":"Gorfine","year":"1995","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib19","first-page":"A16","article-title":"Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide-di-nitrate in patients with chronic anal fissure","volume":"36","author":"Schouten","year":"1995","journal-title":"Gut"},{"key":"2024092909472437800_bib20","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1002\/bjs.1800710517","article-title":"Adequate internal sphincterotomy for chronic anal fissure: subcutaneous or open technique?","volume":"71","author":"Boulos","year":"1984","journal-title":"Br J Surg"},{"key":"2024092909472437800_bib21","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/BF02553100","article-title":"Anal sphincteric pressure in fissure-in-ano before and after lateral sphincterotomy","volume":"25","author":"Cerdan","year":"1982","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib22","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1002\/bjs.1800731123","article-title":"Internal sphincterotomy for chronic anal fissure: long term effects on anal pressure","volume":"73","author":"Chowcat","year":"1986","journal-title":"Br J Surg"},{"volume-title":"Why do anal fissures heal after lateral internal sphincterotomy? 93rd Convention of the American Society of Colon and Rectal Surgeons","year":"1994","author":"Schouten","key":"2024092909472437800_bib23"},{"key":"2024092909472437800_bib24","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1007\/BF02586401","article-title":"Conservative treatment of anal fissure","volume":"21","author":"Shub","year":"1978","journal-title":"Dis Colon Rectum"},{"key":"2024092909472437800_bib25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/bjs.1800700312","article-title":"The conservative treatment of fissure-in-ano","volume":"70","author":"Gough","year":"1983","journal-title":"Br J Surg"},{"key":"2024092909472437800_bib26","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/0002-8703(94)90020-5","article-title":"Phenomenon of nitrate tolerance","volume":"128","author":"Mangione","year":"1994","journal-title":"Am Heart J"},{"key":"2024092909472437800_bib27","first-page":"324","article-title":"Sulfhydryl requirement for relaxation of vascular smooth muscle","volume":"187","author":"Needleman","year":"1973","journal-title":"J Pharmacol Exp Ther"},{"key":"2024092909472437800_bib28","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1161\/01.CIR.89.6.2595","article-title":"Potentiation of isosorbide dinitrate effects with N-acetylcysteine in patients with chronic heart failure","volume":"89","author":"Mehra","year":"1994","journal-title":"Circulation"}],"container-title":["Journal of British Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.1800830614","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.1800830614","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/83\/6\/771\/59427089\/bjs1800830614.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/83\/6\/771\/59427089\/bjs1800830614.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,29]],"date-time":"2024-09-29T11:17:45Z","timestamp":1727608665000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/83\/6\/771\/6167541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,6,1]]},"references-count":28,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1996,6,1]]},"published-print":{"date-parts":[[1996,6,1]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.1800830614","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"type":"print","value":"0007-1323"},{"type":"electronic","value":"1365-2168"}],"subject":[],"published-other":{"date-parts":[[1996,6]]},"published":{"date-parts":[[1996,6,1]]}}}