Document Detail

Relation between botulinum toxin and nitric oxide donors in the treatment of chronic anal fissure.
MedLine Citation:
PMID:  15668639     Owner:  NLM     Status:  MEDLINE    
Although the pathogenesis of fissure is not fully understood, we do know that surgical and/or pharmacological sphincterotomy promotes the healing of chronic anal fissures. A number of studies support the hypothesis that local ischemia is the reason for failure to heal in anal fissure. Therefore, sphincterotomy may work because it decreases anal canal resting pressure and enhances microcirculation at the fissure site. The vasomotor tone of arterioles controlled by metabolic and endothelial factors determines perfusion of tissue and fissure healing. In a novel approach, this paper proposes mechanisms for nitric oxide synthesis, regulation and action in the internal anal sphincter. The design demonstrates the direct interdependence between the activity mechanisms of botulinum toxin and nitric oxide. Endothelial lining can modulate not only vascular tone but also internal anal sphincter (IAS) tone. The application of botulinum toxin likely releases the blockage in glyceryl trinitrate bioactivation in smooth muscle cells and suppresses basal continuous sympathetic activity, causing IAS relaxation. Sufficient distension of the IAS during defecation also reduces the risk of trauma during defecation and complication after the trauma. Both eruption of tissue in the fissure region and release of contraction vessel mediators tend to arrest fissure healing.
Mariusz Madaliński; Zygmunt Chodorowski
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical science monitor : international medical journal of experimental and clinical research     Volume:  11     ISSN:  1234-1010     ISO Abbreviation:  Med. Sci. Monit.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-05-02     Completed Date:  2005-05-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9609063     Medline TA:  Med Sci Monit     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  HY1-5     Citation Subset:  IM    
Internal Medicine Department, St. John Hospital, Starogard Gdański, Poland.
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MeSH Terms
Anal Canal / blood supply,  metabolism,  pathology
Botulinum Toxin Type A / pharmacology,  therapeutic use*
Calcium Channel Blockers / pharmacology
Chronic Disease / drug therapy
Fissure in Ano / drug therapy*,  metabolism*,  pathology
Nitric Oxide / biosynthesis,  metabolism
Nitric Oxide Donors / metabolism,  pharmacology,  therapeutic use*
Wound Healing / drug effects
Reg. No./Substance:
0/Botulinum Toxin Type A; 0/Calcium Channel Blockers; 0/Nitric Oxide Donors; 10102-43-9/Nitric Oxide

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