{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T18:19:58Z","timestamp":1760897998815},"reference-count":7,"publisher":"FapUNIFESP (SciELO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:p>OBJECTIVES: To determine the efficacy and safety of \"healer\" cream as monotherapy in the treatment of acute and chronic anal fissure. STUDY DESIGN: A prospective, randomized, single blinded, comparative trial. METHODS: Sixty patients suffering from anal fissure were included in the study. Patients were randomly divided into three groups: group A: treated with \"healer\" local cream application 3 times daily; group B: treated with nitroglycerine 0.25% local cream 3 times daily; group C: treated with a lidocaine 2% cream applied locally 3 times daily. All the followings were followed up and compared between groups. (1) Visual pain analogue score after defecation; (2) severity of straining and discomfort during defecation; (3) frequency of ulcer healed at 30 days; (4) any side effects or complications. RESULTS: The pain scoring after defecation was significantly reduced in the three treatment groups. The group treated with \"healer\" isosorbide-di-nitrate showed the greatest reduction of the visual pain analogue score median from 9 before treatment to 3 &amp; 1 after 10 and 20 days respectively, while the median visual pain analogue score in group B treated with nitroglycerine cream was 9 reduced to 4 &amp; 2 after 10 and 20 days respectively, and the median visual pain analogue score in lidocaine group only dropped from 9 to 6 and 4, respectively. The reduction of both pain scoring and defecation scoring with \"healer\" was statistically significantly greater than the other two treatments by Kruskal-Wallis test, P&lt;0.001. The number of patients experiencing complete relief and passing stools easily after 10 days was significantly higher in \"healer\" group, by Pearson Chi square = 22.94, P&lt;0.001. After 30 days, the fissures were healed in 18 (90%) of 20 patients in the \"healer\" group and in 12 (60%) of 20 in the nitroglycerin group, while only 6 (30%) of patients treated with lidocaine cream had their fissures healed by the 30 days treatment. Chi square = 15 (P = 0.001). CONCLUSION: \"Healer\" is a promising effective and safe line of treatment in acute and chronic anal fissure. The characteristic pharmacokinetics of isosorbide-di-nitrate leads to a better effect than nitroglycerin in healing (more prolonged action). Also the less fast absorption than nitroglycerin leading to a smoother dose concentration curve, may be the cause that headache is less frequent and less severe in \"healer\" treatment versus nitroglycerin.<\/jats:p>","DOI":"10.1590\/s0004-28032009000300007","type":"journal-article","created":{"date-parts":[[2009,11,5]],"date-time":"2009-11-05T06:51:32Z","timestamp":1257403892000},"page":"179-182","source":"Crossref","is-referenced-by-count":11,"title":["Study of efficacy and safety of a new local cream (\"healer\") in the treatment of chronic anal fissure: a prospective, randomized, single-blind, comparative study"],"prefix":"10.1590","volume":"46","author":[{"given":"Mostafa","family":"Yakoot","sequence":"first","affiliation":[{"name":"Green Clinic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Abdel","family":"Salaam","sequence":"additional","affiliation":[{"name":"Alexandria Faculty of Medicine,  Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"key":"ref1","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 R","year":"1994","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1056\/NEJM199801223380410","article-title":"Pharmacologic therapy for anal fissure","volume":"338","author":"Madoff RD","year":"1998","journal-title":"N Engl J Med","ISSN":"http:\/\/id.crossref.org\/issn\/0028-4793","issn-type":"print"},{"key":"ref3","series-title":"Phl\u00e9bologie '89: actes du 10e Congr\u00e8s Mondiale, Union Internationale de Phl\u00e9bologie, Strasbourg, 25-29 septembre, 1989","first-page":"719","volume-title":"The effect of 7-monohydroxyethylrutoside on capillary filtration rate in the lower limb of man","author":"Roztocil K","year":"1989"},{"key":"ref4","series-title":"Phl\u00e9bologie '89: actes du 10e Congr\u00e8s Mondiale, Union Internationale de Phl\u00e9bologie, Strasbourg, 25-29 septembre, 1989","first-page":"728","volume-title":"Ruscus saponines and the flavanoid hesperidinmethylchalcone in the treatment of chronic venous insufficiency","author":"Rudofsky G","year":"1989"},{"key":"ref5","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 WR","year":"1994","journal-title":"Dis Colon Rectum","ISSN":"http:\/\/id.crossref.org\/issn\/0012-3706","issn-type":"print"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"78","DOI":"10.3109\/00365529609094734","article-title":"fissure: new concepts in pathogenesis and treatment","author":"Schouten WR","year":"1996","journal-title":"Scand J Gastroenterol","ISSN":"http:\/\/id.crossref.org\/issn\/0036-5521","issn-type":"print"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.2165\/00003495-199244060-00009","article-title":"Hydroxyethylrutosides: A review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders","volume":"44","author":"Wadworth AN","year":"1992","journal-title":"Drugs","ISSN":"http:\/\/id.crossref.org\/issn\/0012-6667","issn-type":"print"}],"container-title":["Arquivos de Gastroenterologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ag\/v46n3\/07.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,5,26]],"date-time":"2017-05-26T11:30:14Z","timestamp":1495798214000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0004-28032009000300007&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,9]]},"references-count":7,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2009,9]]}},"alternative-id":["S0004-28032009000300007"],"URL":"https:\/\/doi.org\/10.1590\/s0004-28032009000300007","relation":{},"ISSN":["0004-2803"],"issn-type":[{"value":"0004-2803","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,9]]}}}