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.
John Updike’s use of setting in his fiction has elicited different and even conflicting reactions from critics, varying from symbolic interpretations of setting to a sense of confusion at his use of time and place in his stories. The present study is an attempt at examining John Updike’s treatment of binary settings in Pigeon Feathers and Other Stories (1962) to reveal theme, characters’ motives and conflicts. Analyzing Updike’s stories from a structuralist’s perspective reveals his employment of two different places and times in the individual stories as a means of reflecting the psychological state of the characters, as in “The Persistence of Desire”, or expressing conflicting views on social and political is
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This research seeks to test the influence of intellectual capital as an explanatory variable and its components (human capital, structural capital, relational capital) and sustainable competitive performance as a responsive variable and its components (reducing service delivery cycle time, rapid response to market demand, increasing customer satisfaction, providing better Quality of service, increasing market share)” through a field study, and here the research problem was diagnosed in an attempt to answer the following question: Is there awareness among the senior management within the private colle
... Show MoreThe objective of this investigation was to study the effects of a mixture of three arbuscular mycorrhizae (Glomus etunicatum, G. leptotichum and Rhizophagus intraradices) on the development of fusarium wilt disease in tomato plants in the presence and absence of organic matter (peatmoss). Results indicated an increase in mycorrhizal root dry weight especially in the presence of the organic matter, on the other hand this parameter was significantly decreased when Fusarium oxysporum f. sp. Lycopersiciwas added simultaneously with the mycorrhiza, Moreover, mycorrhiza and organic matter significantly reduced the damping off seedling disease, disease severity and rate of infection of tomato leaves and roots caused by the pathogenic fungus, These
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The research seeks to identify the role of the International Assurance Standard (3402) in the auditor's procedures, as the importance of the research stems from providing assurance services for control tools through reports that are prepared according to this standard, which contribute to strengthening audit procedures through a proposed assurance program. Many conclusions were reached, the most important of which The assurance operations are considered among the operations with a special assignme
... Show MoreThis paper presents an experimental study for strengthening existing columns against axial compressive loads. The objective of this work is to study the behavior of concrete square columns strengthening with circulation technique. In Iraq, there are significantly more reinforced rectangular and square columns than reinforced circular columns in reinforced concrete buildings. Moreover, early research studies indicated that strengthening of rectangular or square columns using wraps of CFRP (Carbon Fiber Reinforced Polymer) provided rather little enhancement to their load-carrying capacity. In this paper, shape modification technique was performed to modify the shape (cross section) of the columns from square columns into circular colu
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The features of the actor's performance in the ritual theater are of great importance and chief in theatrical work since the first emergence of the theater, as the features of the performance were embodied in all Iraqi theatrical performances, but they took personal privacy in some ritual performances because of their differences and similarities between the ritual theatrical performance and the ritual show Al-Khalis, who wanted the researcher to know the similarities and differences in the features of the ritual performance and in the theatrical performance, despite the many transformations that occurred in the theater and affected the features of the performance, but it remained an important and attractive link between the recipient, t
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