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.
Improving" Jackknife Instrumental Variable Estimation method" using A class of immun algorithm with practical application
AIM: To analyse our experiences in the management of traumatic retroperitoneal hematoma (RPH), highlighting the various challenges faced and to report on the outcome of these patients. METHODS: From May 2014 to May 2017, all patients with traumatic RPH who underwent surgical treatment were retrospectively analysed. The kind of injury, intraoperative findings, sites of hematoma, postoperative morbidity and the overall outcomes were recorded. RESULTS: Ninety-six patients; 53 with blunt trauma and 43 with penetrating injury, were included in this study. The centre-medial hematoma was observed in 24 (25%) patients, lateral hematoma in 46 (47.9%) patients, pelvic hematoma in 19 (19.8%) patients, and multiple zone hematomas in
... Show MoreThe follower of the history of cinema in the world notes that cinema started recording one and these films are varied in their subjects, while the life of man was the material of these films to be in a creative artistic style.
If the Palestinian films produced by Palestinian directors do not have an impact on the local, Arab and international levels, this is due to the weakness in several technical fields or with the intention to make them bad or negligence of those who produce these films.
This research deals with the role played by Palestinian films in dealing with the internal situation from the point of view of the Palestinian media elite in terms of their exposure to films and the motives of this exposure and the expectation
NiO nanoparticle synthesis by chemical method and characterized by XRD with crystal size 11.72
nm and grain size 13 nm from FESEM image also NiO micro used ,two NiO as an additive to evaluate the
possibility of producing photodegradable polymers, the practical application of solid-phase photocatalytic
degradation of polyvinyl chloride (PVC- NiO composite films) was investigated. PVC has a negative impact
on the environment since its polymer degrades slowly, yet it has a wide range of industrial applications and
the amount used shows no evidence of diminishing use. Thus, a synthesis of modified PVC- NiO micro and
nano has been studied with 0, 50, 100, 150, 200, 250, and 300 (hours) as irradiation time a
The research aims to determine the impact of Human Resources Accounting (HRA) on employee’s performance. The research’s problem was embodied in the lack of interest in HRA, which was reflected on the performance of employees in the Ministry of Education; the research adopted the descriptive-analytical approach, and the research community included the directors of departments and people at the headquarters of the Ministry of Education. The sample size was (224) individuals from the total community of 533. The questionnaire was adopted as the main tool for collecting data and information, as well as the interviews that were conducted by the researcher. In order to analyze t
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In this work, the plasma parameters (electron temperature (Te), electron density( ne), plasma frequency (fp) and Debye length (λD)) have been studied by using the spectrometer that collect the spectrum of Laser produce CdTe(X):S(1-X) plasma at X=0.5 with different energies. The results of electron temperature for CdTe range 0.758-0.768 eV also the electron density 3.648 1018 – 4.560 1018 cm-3 have been measured under vacuum reaching 2.5 10-2 mbar .Optical properties of CdTe:S were determined through the optical transmission method using ultraviolet visible spectrophotometer within the r
... Show MoreThis paper reports an experimental study regarding the influence of vertical oscillations on the natural convection heat transfer from a vertical channel. An experimental set-up was constructed and calibrated; the vertical channel was tested in atmosphere at 25o
C. The channel-to-ambient temperature difference was varied with the power supply to the electrical heater ranging between
15W to 70W divided into five levels. Data sets were measured under different operating condition from a test rig under six vibrating velocities (VVs) levels ranging from (5-30 m/s) in addition to the stationary state. The results show that the maximum heat transfer enhancement factor (E) occurs at Rayleigh number (Ra=2.328×103 ) and vibrational Reynol
The dependence of the energy losses or the stopping power for the ion contribution in D- T hot plasma fuels upon the corresponding energies and the related penetrating factorare arrive by using by a theoretical approximation models. In this work we reach a compatible agreement between our results and the corresponding experimental results.
Transit agencies constantly need information about system operations and passengers to support their regular scheduling and operation planning processes. The lack of these processes and cultural motivations to use public transportations contributes enormously to the reliance on the private cars rather than public transportation, resulting in traffic congestions. The traffic congestions occur mainly during peak hours and the accidents happening as a result of road accidents and construction works. This study investigates the effects of weekday and weekend travel variability on peak hours of the passenger flow distribution on bus lines, which can effectively reflect the degree of traffic congestion. A study of passen
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