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Glad to see he's still living life to the fullest - I. In , some of the findings were published in the prestigious Journal of the American Medical Association JAMA , and the study has become a widely-referenced illustration of how differently Americans define sex. As flap procedures do not involve disruption of the internal anal sphincter, they are particularly useful in patients with normal anal pressures or in fissures secondary to obstetric trauma where there is often associated internal sphincter disruption. Closed anal sphincter manipulation technique for chronic anal fissure. There is a general consensus that sphincterotomes should be performed with some caution for chronic anal fissures in females, and should be avoided in normal anal pressure chronic anal fissures and fissures secondary to obstetric trauma. Table 1 Studies comparing healing and recurrence rates of different pharmacological therapies.
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