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Myoxinol is a complex of oligopeptides obtained from the seeds of Hibiscus esculentus used in cosmetic as natural alternative to botulin toxin. The aim of the study was to evaluate the safety and effectiveness of local myoxinol for the treatment of acute anal fissure. All the consecutive patients with acute fissure treated from January to June 2014 underwent 30 days of topical treatment (twice/day) with a mioxinol based ointment. Pain, symptomatic relief, fissure healing and re-epithelization, 1-year recurrence rate, subjective satisfaction and need for further treatments were evaluated. During the study period 157 patients were eligible for data analysis (91 males: 58%; mean age 38 years: range 17-83). Median anal pain score was 7.1 pre-treatment and 1.7 and 0.9 after 30 days and 12 months from treatment, respectively (p: 0.0001). After the treatment period complete healing was achieved in 103 patients (65.5%), relevant improvement in 31 (20%) and no improvement in 21 patients (13.5%). Overall efficacy rate was 85.5%. A significant difference was reported considering patients with pre-treatment VAS between 1-5 and 6-10 (p: 0.004). Twenty-nine patients (18.5%) required further treatments. Hydrolyzed Hibiscus esculentus extract was proven to be an effective and well-tolerated topical treatment for acute fissure, with a high healing rate, a significant reduction of pain and a low 1-year recurrence rate.

A síndrome de Gorlin-Goltz é uma rara desordem hereditária autossômica dominante, causada pela mutação no gene PTCH1. A tríade clássica descrita por Gorlin e Goltz em 1960 é composta por múltiplos carcinomas basocelulares, cistos odontogênicos e costela bífida, porém várias outras alterações podem estar presentes, como pits palmoplantares, calcificações da foice cerebral, neoplasias raras como o meduloblastoma, malformações congênitas, macrocefalia e diversas alterações esqueléticas1. O diagnóstico é baseado em critérios clínicos, radiológicos e presença de parente de primeiro grau com a síndrome1,3. Relatamos dois casos que ilustram a necessidade de exame clínico rigoroso, investigação radiológica e acompanhamento multidisciplinar após a suspeita clínica, já que a expectativa de vida geralmente não é afetada, porém o potencial de morbidade pode ser considerável2.

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