The management of patients with primary chronic anal fissure: a position paper

Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty

Time-resolved circularly polarized luminescence of Eu3+-based systems

Chiral Eu3+-based systems are frequently studied via circularly polarized luminescence spectroscopy. The emission lifetimes of each circular polarization, however, are virtually always ignored, because in a homogeneous sample of emitters, there should be no difference between the two. However, we show that in less robust Eu3+ complex structures, as in the chiral complex Eu (facam)3, a difference in the lifetimes of the two circularly polarized emission components arises due to heterogeneity of the complexes. In this case, each species within the sample could have different degrees of circularly polarized luminescence and decay rates at certain emission lines. The superposition of the emission components of the various chiral species leads to an overall difference in decay rate between the two circular polarizations. Such a difference is also shown for Eu3+-doped chiral TbPO4·D2O nanocrystals. We believe that this kind of measurement could be a unique tool for determining the homogeneity of a lanthanide-based chiral system, where other methods might fail in this task