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 surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
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 s
... Show MoreAn 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
... Show MoreBackground: The prevalence of thyroid nodules rise with age and different data available about the risks of thyroid surgery in old age people. In general, old age could be a predictor of perioperative mortality and morbidity. The aim of this study is to prove if there is increased risk accompanying thyroidectomy in elderly patients.
Subjects and Methods: Prospective study of one surgeon of study sample undergoing thyroid surgery at Al-Kindy teaching hospital and Saint Raphael hospital .This study was including two groups; group (A) involved patients 65 years and older, group (B) involved patients below 65 years old who were subjected to thyroidectomy. Taking in consideration hist
... Show MoreBackground: Although uncommon, diseases of the male breast engender a tremendous emotional response. Fortunately, most diseases present with a mass and are easily detected. Unlike the female breast, only ducts but no lobules are present.
Objectives: The aim of this descriptive study is to present the clinical, pathological and ultrasonographic features of different breast lesions amongst males.
Patients & methods: Data obtained from 93 male patients with breast disorders collected between the first of January 2008 to the end of December 2009 and based on clinical examination were done in surgical wards in Baghdad teaching hospital and the main referral training centre for early detection of breast tumors.
Results: Gynecomast
The Financial systems can be classified into two types. The first is the market–oriented, which is applied in United States and United Kingdom. While the second is bank-oriented as in Japan and Germany.
This study tries to explain the reasons which make some countries adopt the first one instead of the second, and the contrary. So the study consists of three sections. The first deals with the concept of financial system and it are functions. The second displays the indicators which are used to classify the financial systems, while the third one is devoted to the factors that determine the type of financial system .These sections followed by some conclusions.
Embracing digital technological advancements in media and communication has led government entities to adopt communication practices fully aligned with the digital and networked system in government communication. Traditional media practices within the government environment increasingly rely on the ability to utilize digital tools and systems for content creation, communication, evaluation, and the management of the entire communication process within an electronic and intelligent framework for government services. Naturally, this transformation has caught the attention of communication and public relations researchers worldwide, as the digital and networked aspects of government communication now form an intelle
... Show MorePurpose: The study aims to investigate the extent to which material and non-material requirements are available in applying budgeting programs and performance in Iraqi governmental companies that are not aimed at achieving profits. whose activities are limited to providing services of public interest. This is done by studying the extent to which the requirements of each stage of preparing the programs and performance budget can be met. Theoretical framework: The process of evaluating financial performance is the main objective of all economic units, whether they are governmental or private economic units. Budgets contribute to the evaluation process by analyzing deviations in the application. The study includes an analytical pres
... Show MoreBackground: The treatment of high anal fistulae needs to meet a balance of cure and continence. There are many surgical treatment options available for high fistula-in-ano. The best surgical operation for high anal fistulas is difficult to define because they have varying cure and incontinence rates. A loose Seton is a loop of flexible material (silastic tube, silk, and nylon) placed through the fistulous track to allow drainage by keeping the external skin opening patent. Some surgeons use the loose Seton to allow drainage and others believe that it promotes healing by inducing fibrosis
Objective: To check the efficacy of loose Seton in the management of high anal fistulas.
Patient and method: A prospectiv