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.
Banks face many of the various risks: which are of dangerous phenomena that cause the state achieved a waste of money and a threat to future development plans to be applied to reach the goals set by: prompting banks and departments to find appropriate solutions and fast: and it was within these solutions rely on Banking risk management and effective role in defining and identifying: measuring and monitoring risk and trying to control and take risks is expected to occur in order to encircle and make it in within acceptable limits: and try to avoid them in the future to reduce the losses that are likely to be exposed to the bank: and it began to emerge and dominate a lot of legislation that seeks to structure the year risk management and t
... Show MoreThe purpose of this study was to measure serum levels of insulin-like growth factor-binding protein (IGFBP7), Insulin-like Growth Factor 1 (IGF-1), Growth Hormone (GH), Interleukin 6 (IL-6) and insulin in acromegaly patients and healthy controls. The acromegaly group had 60 patients, while the population group had 30 people who had never had acromegaly before. The concentration of IGFBP7, IGF-1, GH, IL-6, and insulin were determined. The results of the present study indicate that IGFBP7 level in the acromegaly group was significantly lower (1.690.07 ng/mL vs. 2.740.12 ng/mL, respectively, p = 0.001). IGF-1, GH, IL-6, and insulin concentrations were also significantly higher in acromegaly patients. The diagnostic accuracy (2.194) was exce
... Show MoreThe increased applications of technology in the field of architecture, especially digital technology and aspects of automation, have made a major impact on various aspects of local architecture, especially the traditional ones. As these technologies have succeeded in integrating many technological applications in many traditional and heritage buildings and taking them to more complex uses. And included in it characteristics that were not contained, therefore the research problem was concentrated in the absence of a holistic view of the role of the aspects of automation as a technological and design effect and its mutual effects on traditional buildings (especially the traditional Bagh
Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 166 healthy subjects as a control group. By using conventional Doppler echocardiography, the following parameters were measured—Left ventricular end diastolic diameter, left ventricular end systolic diameter, transmitral early velocity, isovolumic relaxation time, and isovolumic contraction time. Tissue Doppler imaging (TDI) was used in the measurements of the early mitral annular velocity (Ea) and the diastolic stiffness was obtained by calculating the ratio E\Ea\LVIDd. Index myocardial performance (IMP) was calculated
... Show MoreIraq is one of the most important countries in the world that has received its share of terrorist acts by the terrorist organization the Islamic State of Iraq and al-Sham (ISIS), which has caused instability, especially during the period of ISIS's control of seven Iraqi provinces (2014-2017). This stage has caused a decline in the levels of human and economic development and its inconsistency with the capabilities and needs of the Iraqi population. Therefore, this study aims to investigate the hypothesis that there is a close relationship between the decline in development in Iraq and the brutal practices of ISIS that it committed during his period of control over many Iraqi cities and regions. This study used several method
... Show MoreElectro-kinetic remediation technology is one of the developing technologies that offer great promise for the cleanup of soils contaminated with heavy metals. A numerical model was formulated to simulate copper (Cu) transport under an electric field using one-dimensional diffusion-advection equations describing the contaminant transport driven by chemical and electrical gradients in soil during the electro-kinetic remediation as a function of time and space. This model included complex physicochemical factors affecting the transport phenomena, such as soil pH value, aqueous phase reaction, adsorption, and precipitation. One-dimensional finitedifference computer program successfully predicted meaningful values for soil pH profiles and Cu
... Show Moreأن التطور العلمي الحاصل فيما يخص المجال الرياضي أرسى آفاق جديدة لمواكبة التطور الكبير في مجا ل الألعاب والفعاليات الرياضية المختلفة ,و أن تحقيق النتائج الجيدة في فعاليات العاب القوى بشكل عام والثلاثية بشكل خاص في التدريب الرياضي يتطلب إتباع الأساليب العلمية الدقيقة والموضوعية بشكل سليم ومخطط له،فضلا عنة تطبيق نظريات ومنحى جديد لمواكبة الاتجاهات الحديثة في تحقيق النتائج الجيدة للوصول إلى المستويات العالية
... Show MoreTransformations of the actor when acting many characters are the product of joint work between the actor and the director through the instructions and the exercises that facilitate the reach for the desired goal.
The method or way has often been used which is Stanislavsky premises in his work with the actor in the role. The first section consists of two parts under the heading of the actor's work with himself. The two parts are preparing the actor in creative suffering (internal), and in coexistence and embodiment (outside). The second section is the book of the actor's work with the role. The current research aims at identifying the mechanism of the acting performance transformations among many characters of the same actor.
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