항문 열창 치료 법 > 닥터 약물 요법

항문 열창 치료 법

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항문 열창 Anal fissure</TD></TR>
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<A href="http://pictures.doccheck.com/en/photos/323/5753/sizes/m/"><?xml:namespace prefix = v ns = "urn:schemas-microsoft-com:vml" /><v:shapetype id=_x0000_t75 stroked="f" filled="f" path="m@4@5l@4@11@9@11@9@5xe" o:preferrelative="t" o:spt="75" coordsize="21600,21600"><v:stroke joinstyle="miter"></v:stroke><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"></v:f><v:f eqn="sum @0 1 0"></v:f><v:f eqn="sum 0 0 @1"></v:f><v:f eqn="prod @2 1 2"></v:f><v:f eqn="prod @3 21600 pixelWidth"></v:f><v:f eqn="prod @3 21600 pixelHeight"></v:f><v:f eqn="sum @0 0 1"></v:f><v:f eqn="prod @6 1 2"></v:f><v:f eqn="prod @7 21600 pixelWidth"></v:f><v:f eqn="sum @8 21600 0"></v:f><v:f eqn="prod @7 21600 pixelHeight"></v:f><v:f eqn="sum @10 21600 0"></v:f></v:formulas><v:path o:connecttype="rect" gradientshapeok="t" o:extrusionok="f"></v:path><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:lock aspectratio="t" v:ext="edit"></o:lock></v:shapetype><v:shape style="WIDTH: 425.25pt; HEIGHT: 328.5pt; VISIBILITY: visible; mso-wrap-style: square" id=그림_x0020_8 o:button="t" href="http://pictures.doccheck.com/en/photos/323/5753/sizes/m/" alt="Anal eczema and fissure" type="#_x0000_t75" o:spid="_x0000_i1025"><v:imagedata o:title="Anal eczema and fissure" src="file:///C:\Users\전성수\AppData\Local\Temp\msohtmlclip1\01\clip_image001.jpg"><IMG src="/_dimg/그림%20항문%20열창%20요ㅕㅇㄹ창20140418_153511.png"></v:imagedata></v:shape></A>
[항문 열창] 항문 열창에  습진이 합병
 
[중상] 
항문 열창은 항문 점막의 표면이 째진 상태이며 배변 시 아프고 
직장 출혈을 하며 항문 괄략근이 경련으 일으키므로 배변 곤란 증
(배변 실금)을 지닌다
 
[병태]
항문 내 괄략근이 과민 상태 인자는 치료 해도 재발
 
[원인]
-외상 
-배변 시 가압
-성병 합병 증(임균 Chlamydia, 매독 바이러스,Herpe)
-크론 씨 병, 궤양성 대장 염
 
[발생 빈도]
350명중 1명
 
[자연 치유]
섬유 식 밀겨을 등 배변 치료 섬유식하면 자연 치유 될 수 있음
 
[국소 약물 요법]
1)  국소 마취 제 진통 lidocaine 1.5% ointment
2)  glyceryl trinitrate국소 바르면 근육 이완 효과 <A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-11">11-13</A> 있으며
24-38 개월 후 완치<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-14">14</A>
3)  0.2% ,0.3% 0.4% topical nifedipine<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-19">19</A>,<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-20">20</A> 
4)  diltiazem 2%<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-16">16-18</A> 
[Botunum A Toxin 주사 법]
1)  botulinum A toxind 주사로 괄략근 마비를 유발.<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-7">7-9</A>하면
대부부의 경우 열창이 완치 되는 기간 만큼 효과있음
98%는 치료된다 그러나 57건의 장기 추적 조사<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-10">10</A>결과 Toxin 약효 살아진 후 재발 율 41.5%
 
2)  botulinum toxin<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-20">20</A> 주와 외용제와 Nifedipine 경구.<A href="http://www.medicinescomplete.com/mc/martindale/current/ms-20959-s.htm#r17169-a7-3-t-21">21</A>  요법 병용
 
[근거]
1.   1. Nelson R. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20systematic%20review%20of%20medical%20therapy%20for%20anal%20fissure.&rft.stitle=Dis%20Colon%20Rectum&rft.date=2004&rft.volume=47&rft.pages=422-31&rft.au=Nelson%20R&rft_id=info:pmid/14994109">A systematic review of medical therapy for anal fissure.</A> Dis Colon Rectum 2004; 47: 422–31. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14994109&dopt=Abstract">PubMed</A>
2.   2. Nelson R. Non surgical therapy for anal fissure. Available in The Cochrane Database of Systematic Reviews; Issue 4. Chichester: John Wiley; 2006 (accessed 08/05/08). <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17054170&dopt=Abstract">PubMed</A>
3.   3. Cook TA, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=The%20pharmacology%20of%20the%20internal%20anal%20sphincter%20and%20new%20treatments%20of%20ano-rectal%20disorders.&rft.stitle=Aliment%20Pharmacol%20Ther&rft.date=2001&rft.volume=15&rft.pages=887-98&rft.au=Cook%20TA%2C%20et%20al.&rft_id=info:pmid/11421863">The pharmacology of the internal anal sphincter and new treatments of ano-rectal disorders.</A> Aliment Pharmacol Ther 2001; 15: 887–98. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11421863&dopt=Abstract">PubMed</A>
4.   4. American Gastroenterological Association. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=American%20Gastroenterological%20Association%20medical%20position%20statement%3A%20diagnosis%20and%20care%20of%20patients%20with%20anal%20fissure.&rft.stitle=Gastroenterology&rft.date=2003&rft.volume=124&rft.pages=233-4&rft.au=American%20Gastroenterological%20Association&rft_id=info:pmid/12512045">American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure.</A> Gastroenterology 2003; 124: 233–4. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12512045&dopt=Abstract">PubMed</A>
5.   5. Madoff RD, Fleshman JW. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=AGA%20technical%20review%20on%20the%20diagnosis%20and%20care%20of%20patients%20with%20anal%20fissure.&rft.stitle=Gastroenterology&rft.date=2003&rft.volume=124&rft.pages=235-45&rft.au=Madoff%20RD%2C%20Fleshman%20JW&rft_id=info:pmid/12512046">AGA technical review on the diagnosis and care of patients with anal fissure.</A> Gastroenterology 2003; 124: 235–45. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12512046&dopt=Abstract">PubMed</A>
6.   6. Wray D, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Anal%20fissure%3A%20a%20review.&rft.stitle=Br%20J%20Hosp%20Med&rft.date=2008&rft.volume=69&rft.pages=455-8&rft.au=Wray%20D%2C%20et%20al.&rft_id=info:pmid/18783093">Anal fissure: a review.</A> Br J Hosp Med 2008; 69: 455–8. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18783093&dopt=Abstract">PubMed</A>
7.   7. Jost WH, Schimrigk K. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Botulinum%20toxin%20in%20therapy%20of%20anal%20fissure.&rft.stitle=Lancet&rft.date=1995&rft.volume=345&rft.pages=188-9&rft.au=Jost%20WH%2C%20Schimrigk%20K&rft_id=info:pmid/7823680">Botulinum toxin in therapy of anal fissure.</A> Lancet 1995; 345: 188–9. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7823680&dopt=Abstract">PubMed</A>
8.   8. Maria G, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20comparison%20of%20botulinum%20toxin%20and%20saline%20for%20the%20treatment%20of%20chronic%20anal%20fissure.&rft.stitle=N%20Engl%20J%20Med&rft.date=1998&rft.volume=338&rft.pages=217-20&rft.au=Maria%20G%2C%20et%20al.&rft_id=info:pmid/9435326">A comparison of botulinum toxin and saline for the treatment of chronic anal fissure.</A> N Engl J Med 1998; 338: 217–20. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9435326&dopt=Abstract">PubMed</A>
9.   9. Jost WH. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Ten%20years%27%20experience%20with%20botulin%20toxin%20in%20anal%20fissure.&rft.stitle=Int%20J%20Colorectal%20Dis&rft.date=2002&rft.volume=17&rft.pages=298-302&rft.au=Jost%20WH&rft_id=info:pmid/12172922">Ten years' experience with botulin toxin in anal fissure.</A> Int J Colorectal Dis 2002; 17: 298–302. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12172922&dopt=Abstract">PubMed</A>
10.             10. Minguez M, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Long-term%20follow-up%20%2842%20months%29%20of%20chronic%20anal%20fissure%20after%20healing%20with%20botulinum%20toxin.&rft.stitle=Gastroenterology&rft.date=2002&rft.volume=123&rft.pages=112-17&rft.au=Minguez%20M%2C%20et%20al.&rft_id=info:pmid/12105839">Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin.</A> Gastroenterology 2002; 123: 112–17. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12105839&dopt=Abstract">PubMed</A>
11.             11. Lund JN, Scholefield JH. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20randomised%2C%20prospective%2C%20double-blind%2C%20placebo-controlled%20trial%20of%20glyceryl%20trinitrate%20ointment%20in%20treatment%20of%20anal%20fissure.&rft.stitle=Lancet&rft.date=1997&rft.volume=349&rft.pages=11-14&rft.au=Lund%20JN%2C%20Scholefield%20JH&rft_id=info:pmid/8988115">A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure.</A> Lancet 1997; 349: 11–14. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8988115&dopt=Abstract">PubMed</A> Correction. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20randomised%2C%20prospective%2C%20double-blind%2C%20placebo-controlled%20trial%20of%20glyceryl%20trinitrate%20ointment%20in%20treatment%20of%20anal%20fissure.&rft.stitle=Lancet&rft.date=1997&rft.volume=349&rft.pages=11-14&rft.au=Lund%20JN%2C%20Scholefield%20JH&rft_id=info:pmid/8988115">ibid.</A>: 656.
12.             12. Bailey HR, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Fissure%20Study%20Group.%20A%20study%20to%20determine%20the%20nitroglycerin%20ointment%20dose%20and%20dosing%20interval%20that%20best%20promote%20the%20healing%20of%20chronic%20anal%20fissures.&rft.stitle=Dis%20Colon%20Rectum&rft.date=2002&rft.volume=45&rft.pages=1192-9&rft.au=Bailey%20HR%2C%20et%20al.&rft_id=info:pmid/12352236">Fissure Study Group. A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures.</A> Dis Colon Rectum 2002; 45: 1192–9. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12352236&dopt=Abstract">PubMed</A>
13.             13. Scholefield JH, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20dose%20finding%20study%20with%200.1%25%2C%200.2%25%2C%20and%200.4%25%20glyceryl%20trinitrate%20ointment%20in%20patients%20with%20chronic%20anal%20fissures.&rft.stitle=Gut&rft.date=2003&rft.volume=52&rft.pages=264-9&rft.au=Scholefield%20JH%2C%20et%20al.&rft_id=info:pmid/12524411">A dose finding study with 0.1%, 0.2%, and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures.</A> Gut 2003; 52: 264–9. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12524411&dopt=Abstract">PubMed</A>
14.             14. Lund JN, Scholefield JH. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Follow-up%20of%20patients%20with%20chronic%20anal%20fissure%20treated%20with%20topical%20glyceryl%20trinitrate.&rft.stitle=Lancet&rft.date=1998&rft.volume=352&rft.pages=1681&rft.au=Lund%20JN%2C%20Scholefield%20JH&rft_id=info:pmid/9853449">Follow-up of patients with chronic anal fissure treated with topical glyceryl trinitrate.</A> Lancet 1998; 352: 1681. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9853449&dopt=Abstract">PubMed</A>
15.             15. Lysy J, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Topical%20nitrates%20potentiate%20the%20effect%20of%20botulinum%20toxin%20in%20the%20treatment%20of%20patients%20with%20refractory%20anal%20fissure.&rft.stitle=Gut&rft.date=2001&rft.volume=48&rft.pages=221-4&rft.au=Lysy%20J%2C%20et%20al.&rft_id=info:pmid/11156644">Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure.</A> Gut 2001; 48: 221–4. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11156644&dopt=Abstract">PubMed</A>
16.             16. Jonas M, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20randomized%20trial%20of%20oral%20vs%20topical%20diltiazem%20for%20chronic%20anal%20fissures.&rft.stitle=Dis%20Colon%20Rectum&rft.date=2001&rft.volume=44&rft.pages=1074-8&rft.au=Jonas%20M%2C%20et%20al.&rft_id=info:pmid/11535842">A randomized trial of oral vs topical diltiazem for chronic anal fissures.</A> Dis Colon Rectum 2001; 44: 1074–8. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11535842&dopt=Abstract">PubMed</A>
17.             17. Jonas M, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Diltiazem%20heals%20glyceryl%20trinitrate-resistant%20chronic%20anal%20fissures%3A%20a%20prospective%20study.&rft.stitle=Dis%20Colon%20Rectum&rft.date=2002&rft.volume=45&rft.pages=1091-5&rft.au=Jonas%20M%2C%20et%20al.&rft_id=info:pmid/12195195">Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study.</A> Dis Colon Rectum 2002; 45: 1091–5. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12195195&dopt=Abstract">PubMed</A>
18.             18. Bielecki K, Kolodziejczak M. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=A%20prospective%20randomized%20trial%20of%20diltiazem%20and%20glyceryltrinitrate%20ointment%20in%20the%20treatment%20of%20chronic%20anal%20fissure.&rft.stitle=Colorectal%20Dis&rft.date=2003&rft.volume=5&rft.pages=256-7&rft.au=Bielecki%20K%2C%20Kolodziejczak%20M&rft_id=info:pmid/12780888">A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure.</A> Colorectal Dis 2003; 5: 256–7. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12780888&dopt=Abstract">PubMed</A>
19.             19. Ezri T, Susmallian S. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Topical%20nifedipine%20vs.%20topical%20glyceryl%20trinitrate%20for%20treatment%20of%20chronic%20anal%20fissure.&rft.stitle=Dis%20Colon%20Rectum&rft.date=2003&rft.volume=46&rft.pages=805-8&rft.au=Ezri%20T%2C%20Susmallian%20S&rft_id=info:pmid/12794583">Topical nifedipine vs. topical glyceryl trinitrate for treatment of chronic anal fissure.</A> Dis Colon Rectum 2003; 46: 805–8. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12794583&dopt=Abstract">PubMed</A>
20.             20. Tranqui P, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Nonsurgical%20treatment%20of%20chronic%20anal%20fissure%3A%20nitroglycerin%20and%20dilatation%20versus%20nifedipine%20and%20botulinum%20toxin.&rft.stitle=Can%20J%20Surg&rft.date=2006&rft.volume=49&rft.pages=41-5&rft.au=Tranqui%20P%2C%20et%20al.&rft_id=info:pmid/16524142">Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin.</A> Can J Surg 2006; 49: 41–5. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16524142&dopt=Abstract">PubMed</A>
21.             21. Cook TA, et al. <A href="http://www.medicinescomplete.com/mc/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rfr_id=info:sid/medicinescomplete.com:www&rft.atitle=Oral%20nifedipine%20reduces%20resting%20anal%20pressure%20and%20heals%20chronic%20anal%20fissure.&rft.stitle=Br%20J%20Surg&rft.date=1999&rft.volume=86&rft.pages=1269-73&rft.au=Cook%20TA%2C%20et%20al.&rft_id=info:pmid/10540130">Oral nifedipine reduces resting anal pressure and heals chronic anal fissure.</A> Br J Surg 1999; 86: 1269–73. <A title="Medline reference" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10540130&dopt=Abstract">PubMed</A> 
 
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