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.
عند إطلالتنا على هذا البلد العربي لابد من التقصي ولو بعجاله عن اقتصاده وهو الاهم باعتبار ان الاقتصاد هو شريان الحياة لأي أمة فلا غنى ولا تهاون في نفس الوقت عن هذا الجانب المهم الذي يرتبط مدى تطوره بتطور البلد وهذا الاخير مرتبط بما متوفر لديه من موارد بشريه ومادية وان تفاوتت النسبة بينها فلا ضير في ذلك فالاهم هو وجود الموجه والمخطط بالاتجاه الصحيح نحو الاستغلال الامثل لهذه الموارد
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Justice is a human values that heavenly religions urged, and made her the fundamentals of individual and social and political life, in Allah almighty sent justice messengers, and sent down his books,as the Earth and the heavens with justice, it is a legal system in which a person takes his dues, which protect the rights of the individual And punish him when committing mistakes, so all religions to achieve chiefly Christianity, the Bible that Allah almighty qualities of Justice, and it is not affected by love or hate, and no factors or percentages, but granted to all who are on earth that despite money and prestige, or what was between them. Of affection or no matter, as well as injustice, whether unjustly or self for others, especially the
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