An anal fissure which does not heal with conservative measures as sits baths and laxatives is a chronic anal fissure. Physiologically, it is the high resting tone of the internal anal sphincter that chiefly interferes with the healing process of these fissures. Until now, the gold standard treatment modality is surgery, either digital anal dilatation or lateral sphincterotomy. However, concerns have been raised about the incidence of faecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored. A Medline and pub med database search from 1986-2012 was conducted to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure. Pharmacological sphincterotomy using Glyceryl trinitrate , Isosorbide dinitrate or calcium channel blockers are exciting alternative treatment , that relaxes the anal sphincter and, therefore, promote healing, the drawback of such medications are headache and poor compliance. With the introduction of Botulinum toxin as mean of chemical sphincterotom, topical injection of Botulinum toxin reduces the anal hypertonia which lasts for few months, allows the fissure to heal, thus eliminating the need for surgery without incidence of incontinence. Cure rates are over 60%, and the procedure can be repeated safely. Therefore, Botulinum toxin is a reasonable first-line management of chronic anal fissure and the relapses can be managed by surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
Abstract
This study turns about The Military Thinking and His Islamic balance in
The Caliph Ali Bin Abi Talib ( peace is on him ) Compact to Malek Al Ashtar
(God be pleased on him )The military field is very wide in all intellectual and
practically effects at The Caliph Ali Bin Abi Taleb(peace is on him ). Its
considered the first seed for islam ,therefore,there are a lot from military
situtions which proved his practical experience in these affairs , and away
from the details of war and practical battles lets search the sample and the
academic study for fair military thinking (justice) in The Compact of Caliph Ali
to Malek Al Ashtar when he became the ruler of egypt.
The military fair thinking determines fr
The main objective of this study is to understand the work of the pile caps made of lightweight aerated foam concrete and study the many factors affecting the ability and the capacity of the shear. The study was done by analyzing previous practical and theoretical experiences on the reinforced concrete pile caps. The previous practical results indicated that all specimens failed by shear diagonal compression or tension modes except one specimen that failed flexural-shear mode. Based on test specimens' practical results and behavior, some theoretical methods for estimating the ultimate strength of reinforced concrete pile caps have been recommended, some of which evolved into the design documents available on the subject.
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Constitutional Review of 1992 and 1996 and the role of the Party of Progress and Socialism
Our research sheds light on one of the most important aspects of David Grossman's play, "Ricky's Garden, גן ריקי " which is characterized by its realistic portrayal of characters. Grossman gradually moves towards the inner awareness of his characters, expressing their emotions and thoughts through conversations and emotional conflicts, referring to their past and rooted background. Grossman transformed the main subject of his play (psychological depth) into a presentation and arrangement of all the elements of the play in a way that expresses emotional nature more powerfully by each child in the garden. This is reflected in their actions and words, making Grossman's works suitable for study and always of interest to specialized resear
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Succinic acid is an essential base ingredient for manufacturing various industrial chemicals. Succinic acid has been acknowledged as one of the most significant bio based building block chemicals. Rapid demand for succinic acid has been noticed in the last 10 years. The production methods and mechanisms developed. Hence, these techniques and operations need to be revised. Recently, an omnibus rule for developing succinic acid is to find renewable carbohydrate Feedstocks. The sustainability of the resource is crucial to disintegrate the massive use of petroleum based-production. Accordingly, systematically reviewing the latest findings of bacterial production and related fermentation methods is critical. Therefore, this paper aims to stud
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It is no secret to anyone that studying and investigating books of jurisprudence, despite their suffering, is a pleasure that cannot be compared to pleasure, and it has benefits and importance that cannot be limited and summed up, and it has great fruits that researchers and students of knowledge reap, as well as enriching libraries with jurisprudential material, after dusting them and taking them out to the light of libraries to be seen. Researchers and scholars, generation after generation, so that this nation can benefit from this pioneering intellectual and scientific product that was written for us by our first ancestors of working scholars who enriched human civilization with this scientific material, which has become a beacon guid
... Show MoreThe research aims to examine the evaluation of educational quality management and the ways to improve it in the College of Education for Women at the University of Baghdad from the point of view of the academic staff. The research community consisted of (288) participants comprising all members of the academic staff in the College of Education for Women at the University of Baghdad for the academic year (2019-2020). As for the questionnaire, it was distributed to the academic staff of the scientific departments according to their affiliation for the purpose of identifying the availability of the requirements of the quality of the teaching service provided to them by the educational institution. The researcher adopted a questionnaire deve
... Show MoreThe problem of the current paper is embodied in the weakness of the female students
of the department of the Quran sciences in the college of Education for Women in the
University of Baghdad in the subject of reciting and memorizing the Holy Quran. This is what
the professors and the scientific and educational supervisors stress equally through their visits
to the students applicants during the period of their practical application of teaching in the
schools; especially that the subject is thought for four years during their study in the college.
That weakness is so explicit with a quite large number of the students-applicants, who are
supposed to be the future teachers in the subject of the Holy Quran and Islamic Ed