ANAL FISSURES From: Haines Ely One of the neatest letters to the editor I have seen in a long time was written in the NEJM by Stephen R. Gorfine M.D.titled Topical Nitroglycerine Therapy for Anal Fissures and Ulcers, NEJM 333(17) 1156-7, 1995. Anal sphincter hypertonicity is associated with painful anal fissures and ulcers. A derangement of nitric oxide regulation may cause this spasticity. Nitroglycerine was applied as 200mg in an ointment and the investigators asked the fourty patients treated to rate their pain on a scale of one to ten. The mean pain scores before and after treatment were 4.8 and 1.4. The patients were instructed to apply the ointment QID. Fissures healed in two weeks in 30% of the patients, in four weeks or less in 70% of patients. Side effects were limitted to mild transient headaches.