Volume 65 - 2002 - Fasc.4 - Original articles
Misoprostol induces gallbladder contraction during fasting, but does not influence postprandial emptying : an ultrasound study in healthy subjects
Objective : The aim of this study was to evaluate the effect of the PGE1 analogue, Misoprostol, on gallbladder fasting volume and meal-stimulated emptying. Prostaglandins' effects on the gallblad- der were studied principally regarding mucus production during lithogenesis. In the few in vitro and in vivo studies, contradictory results concerning their influence upon gallbladder motility were obtained.
Subjects : 13 healthy subjects, 8 females, 5 males, aged 23.4 years (ranges 22-25).
Methods : Gallbladder volumes were assessed by ultrasound, after measuring the three diameters of the gallbladder in two per- pendicular planes, using a conventional 2D equipment and a 3D equipment, after the 3D-reconstruction of the gallbladder. The volumes were calculated by means of the ellipsoid formula. Gallbladder emptying variables (residual volume, ejection frac- tion, area under emptying curve) were assessed during 90 minutes after a test meal (14 g fat, 425 kcal). Gallbladder emptying was evaluated in each subject on three different days : without prior Misoprostol administration, after 200 mg Misoprostol, and after 400 mg Misoprostol. Misoprostol was given orally as a single dose, 60 minutes before the meal. The two-tailed Student's t test for paired observations was used to compare the results.
Results : Misoprostol induced a significant decrease of the gall- bladder fasting volume : from 12.8 ± 4.4 (SD) ml (controls) to 9.1 ± 3.6 ml (200 mg Misoprostol) and 5.4 ± 2.6 ml (400 mg Misoprostol). Gallbladder meal-stimulated emptying was not influenced by Misoprostol.
Conclusions : Our results indicated that, in healthy subjects, misoprostol induced a dose-dependent gallbladder emptying in the fasting state, but did not influence gallbladder postprandial emp- tying. Pre-prandial Misoprostol administration might be useful to treat gallbladder stasis in patients with chronic constipation, thus preventing gallstone formation. (Acta gastroenterol. belg., 2002, 65, 191-195).
A randomized trial of botulinum toxin vs lidocain pomade for chronic anal fissure
Purpose : As lateral sphincterotomy and anal dilatation causes complications, a reversible chemical sphincterotomy method has been recently proposed as an alternative treatment in patients with anal fissure. In this study, the effect of botulinum toxin causing temporary paralysis in internal anal sphincter was compared with that of lidocaine in patients with chronic anal fissure.
Method : A total of 62 outpatients were randomly assigned to receive botulinum toxin or lidocaine pomade. The patients were evaluated before and after two months of treatment with physical examination and anal manometry. Pain and nocturnal pain were scored.
Results : In an evaluation period of two months, in 24 of 34 patients of botulinum group (70.58%), and in six of 28 patients of lidocaine group (21.42%) showed complete epithelization (p = 0.006). All patients who had previously reported nocturnal pain became symptom free in botulinum group and in four patients of lidocaine group. Pain following defecation disappeared in 24 patients of botulinum group and in 20 patients of control group (p = 0.959). There was no adverse effect in both groups. While resting anal pressure and maximum voluntary pressure were significantly low in botulinum toxin group, both parameters did not change in lidocaine group.
Conclusions : Botulinum toxin is a reliable and effective method for patients with chronic anal fissure. It can be applied easily with- out any anesthesia and instrumentation. It is cheaper in compari- son with surgical methods and it can be a good alternative treat- ment in patients with risk of incontinence. (Acta gastroenterol. belg., 2002, 65, 187-190).
