First Edition 2008
facts about.
possible, the split in the bowel lining at the anus a large amount infrequently. Oral tablets such as may be visible by parting the buttocks. Internal diltiazem and nifedipine can also be tried. All these examination by sigmoidoscopy or colonoscopy agents (ointments and tablets) should be ceased at least 24 hours before using medication for appearance of the anal area) is recommended to erectile dysfunction (eg. Viagra, Cialis, Levitra). exclude other causes of pain and bleeding from the The passage of a proctoscope (an instrument designed to examine the back passage) under Management:
sedation can help to relax the sphincter and aid healing. Vigorous anal dilatation, which had Initial management is directed at minimising been practised in the past, should be avoided, further local trauma, providing adequate pain as it may damage the anal sphincter further, What is it?
relief, relaxing the anal sphincter spasm and predisposing you to loss of bowel control.
An anal fissure is a split in the lining of the bowel that occurs just inside the back passage. It is usually Fissures resistant to these initial conservative caused by the passage of hard stool (related to Stools must be kept soft (the passage of hard stool may undo weeks or months of healing). Laxatives other therapies, including botulinum toxin Occasionally a fissure will heal without difficulty and fibre supplements are recommended to assist (Botox®) injections or even surgery. However but often a cycle of pain and muscular spasm of the with easier evacuations, and need to be continued it is important that an adequate trial of these anus develops. The combination of anal pain and for some weeks or months after symptoms resolve conservative measures is attempted first as the spasm makes it difficult to open your bowels well to prevent recurrent fissure formation, especially if majority of fissures will heal with analgesia, creating a vicious cycle of worsening constipation you have a tendency to constipation.
relief of constipation and the regular use and harder stools leading to more pain and damage of Rectogesic®. Whilst Botox® and surgery when you do open your bowels. This muscular Pain relief measures such as regular warm salted each have a role in the treatment of resistant spasm is also thought to reduce blood flow to the baths, local anaesthetic creams, and oral pain fissures, they should not be viewed as a “quick area contributing to poor healing of the fissure.
medications (analgesics) may be necessary, especially when the pain and spasm are severe.
fix” approach for all fissures as each has the Symptoms:
Be aware that codeine or other strong pain killers possibility of leading to further damage to the Typical symptoms of a fissure include stinging, can cause worsening of constipation which may anal sphincter muscle and the potential for the tearing or burning pain when passing a bowel make the problem worse. Simple analgesics such later development of poor bowel control.
motion (stool), often with a small amount of bright as paracetamol will not cause constipation. bleeding on the stool. The pain may be very severe and throbbing preventing sleep. Constipation often Relaxing the anal sphincter helps with decreasing THE MOST COMMON SYMPTOMS
precedes the development of a fissure and the spasm of the muscle of the anal sphincter and include stinging, tearing or burning
presence of pain with a fissure often compounds may allow increased blood flow to the base of the pain when passing a bowel motion
the problem of constipation. Anal tags may develop fissure. Glyceryl trinitrate 0.2% (Rectogesic®) next to long-standing anal fissures and these may ointment relaxes the smooth muscle of the anal predispose to moistness and irritation of the skin sphincter muscle. It should be applied 2-3 times a day but may cause headaches, especially at first. Headaches can be diminished by applying Clinical appearance:
the ointment with a finger wrapped in clingwrap Often the anal region is too painful to allow the and starting with a lower dose and persisting. doctor to examine the area properly or conduct It is best to use a small amount frequently and an internal examination. If an examination is gradually increase the amount rather than using An information leaflet for patients and interested members of the general public prepared by the Digestive Health Foundation
This information booklet has been designed by the Digestive Health Foundation as an aid to people who need a PEG tube or for those who wish to know more about it.
This is not meant to replace personal advice from your medical practitioner.
The Digestive Health Foundation (DHF) is an educational body committed to promoting better health for al Australians by promoting education and community health programs related to the digestive system. The DHF is the educational arm of the Gastroenterological Society of Australia the professional body representing the specialty of gastrointestinal and liver disease in Australia. Members of the Society are drawn from physicians, surgeons, scientists and other medical specialities with an interest in GI disorders. Since its establishment in 1990 the DHF has been involved in the development of programs to improve community awareness and the understanding of digestive diseases. Research and education into gastrointestinal disease are essential to contain the effects of these disorders on all Australians. Further information on a wide variety of gastrointestinal conditions is available on our website. Digestive Health
Phone: (02) 9256 5454
Facsimile: (02) 9241 4586
[email protected]
cannot be completely comprehensive 145 Macquarie Street


Lyme : démarches diagnostiques,thérapeutiques et préventivesR. Cohen, CHI, Créteil« Borréliose de Lyme : démarches diagnostiques, thérapeutiques et préventives », 16e Conférence deconsensus en pathologie infectieuse, 13 décembre 2006 transmise par la piqûre d’une tique. Ellepeut survenir à tout âge, mais

N. 28.qxd

Comunicato Ufficiale N° 28 del 30/01/2003 1. COMUNICAZIONI DELLA F.I.G.C. 1.1 Elenco sostanze vietate e dei metodi proibiti in materia di doping Si riporta qui di seguito il comunicato ufficiale n. 110/A del 18.12.2002, riguardante l’argomento sopra “COMUNICATO UFFICIALE N. 110/A preso atto che la Giunta Nazionale del CONI ha recepito, con delibera n. 735/2002, l’elenco aggiorna-

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