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.
(47)
(40)
(58)
(19)
الخلاصة
تتناول هذه الورقة مخططات وسياسات الاستيطان في الضفة الغربية والقدس الشرقية منذ العام 1967، عبر سياسات قادها حزب العمل وأكملها حزب الليكود وكاديما وبقية الأحزاب الإسرائيلية، تلك السياسات التي استهدفت فرض السيطرة السياسية الكاملة على الأرض، وما نتج عن ذلك من سيطرة حصرية على الأرضوتقييد استخداماتها، ومحاصرة الوجود الفلسطيني والتضييق عليه، وتحويل مراكز ال
... Show More
Any design subject to a set of forces contributing to the establishment of relations working to strengthen the internal elements of the design; any imbalance in these elements can make a fragmented and weak design, thus preventing it from achieving the goal or performance. Poor performance can be attributed to various factors: the extent and function of the elements and principles in the design, realization of the idea, especially in fashion design.
Moreover, there are many aspects of a design that go into achieving the realization of the designer’s idea. The design utilizes a lot of stimulants by drawing attention to its design, which is consistent with the need for psychological and material individuals. In this research, we will
Abstract
The basic orientation of the research is an attempting to apply the cost determining method according in the contract sector projects for Al- Iraq ceneral company, that this subject has a big value according to its modernity and its influence on the future and the eaning of the company.
The research aims to find out the effect of the method for determining cost based on the activity in determining the cost of the construction sector projects.The research was conducted in Iraq General Company for the implementation of irrigation projects. Bani search on three assumptions, the first is (that the application of the method for determining the cost on the basis of
... Show More
Pectin is available in many plants and in this study, the peels of tomatoes and beet were used to be an economical source of pectin production instead of dumping it with waste or using it as animal feed. The pectin extracted from the peels using different solutions, namely citric acid (2 M), oxalic acid (2%) and hydrochloric acid (0.5 M) the outcome of the extraction methods, 7. 1%, 6% and 11% respectively for tomatoes peels, while the pectin of beet peels were 8%, 6.5%, and 8.3%, and the highest percentage obtained in the manner of hydrochloric acid adopted in the manufacture of yogurt.Yogurt was manufactured with four treatments, in the first treatment standard pectin was added and the second treatment in addition to the pectin extracted
... Show More
The public budget is regarded a main tool for economic and social development. The preparation of the public budget constitute an important stream which enriches the developmental efforts and the definition of its priorities, therefore it is the focus point of many specializations. The public budget has numerous functions. It is a means to precise and to execute the political and economic goals of the executive authority, a mirror of the economic structure which reflects its strength and weakness points, specifies its revenues and others. Since the parliament is the voice of the society which expresses its interests, then, it must monitor the performance of the government so that the participation of the legislative authority in
... Show More
This study was conducted to identify the impact of germination in the ratio Almaah of Chemical Constituents of Homs and in the organoleptic properties of the Biskt plant it and compare the results with the treatment control (seeds Almnepth) Adhrt results for a significant increase in the percentage of crude protein with the progress of the process of germination, reaching 24.5% in percentage of crude protein with the progress of the germination process Krbu hydrate college during the germination period, reaching 59.2% in the fourth day
This study was conducted to determine the fungal cause and bio control of damping off and root rot of wheat plants by using pseudomonas fluorescens under greenhouse and field conditions. Results showed isolation of eight species from the soil and roots to deferent region of Baghdad government. Rhizoctonia solani (Rs) and Fusarium solani (Fs) were the predominant damping off fungus with frequency 60 and 52% respectively. Led the using of bacteria formulations such as crud suspension , pure bacteria filtration and pure living cells in culture medium inhibit all type fungi with rates ranging from 84-96% , 80- 93% and 75-88% respectively. Rs and Fs were more pathogenesis under greenhouse conditions, with incidence of 80 and 68% and disease s
... Show More
(1)
The article describes the basic principles of modeling a dictionary article in the “Dictionary of the Language of Russian Folklore Lexicon epics” (M. A. Bobunova, A. T. Khrolenko). Among such principles are the principle of linguocentrism (representation of universal cognitions in strict observance of the traditions of lexicographic science), the principle of anthropocentrism (language learning as a means of human consciousness / subconsciousness), the principle of expansionism (attracting material from various knowledge bases), the principle of explanatory ("explanatory moment"), and fractal principle (synergistic potential of the presented material: nonlinearity and self-similarity; hierarchical organizati
... Show More