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.
One of the artificial lightweight aggregates with a wide range of applications is Lightweight Expanded Clay Aggregate. Clay is utilized in the production of light aggregates. Using leftover clay from significant infrastructure development projects to manufacture lightweight aggregates has a favorable environmental impact. This research examines the expanded clay aggregate production process and the impact of processing parameters on its physical and mechanical qualities. It also looks at secondary components that can be used to improve the qualities of concrete with expanded clay aggregates. The effect of the quantity of expanded clay aggregate on the fresh, hardened, and durability qualities of concrete is also studied.
... Show MoreDavid Hare (b.1947) is one of the most critically acclaimed, contemporary British dramatists. A playwright, director and filmmaker, he has written more than thirty plays for the stage and seven original screen plays for cinema and TV (Susan Emerling, p.1). He began his dramatic career in the late sixties. Along with such dramatists as Howard Brenton and Trevor Griffiths, he writes in the aftermath of the "Angry Young Men" tradition of John Osborne. It is a well-known fact that the element of anger continued in the drama of the 1960s and became even more radicalized after the social, cultural and political unrests of 1968 by the dramatists of the "second wave" to whom Hare belongs (John Russell Taylor, p.14). Setting his plays in a variet
... Show MoreVisible light communication (VLC) is an upcoming wireless technology for next-generation communication for high-speed data transmission. It has the potential for capacity enhancement due to its characteristic large bandwidth. Concerning signal processing and suitable transceiver design for the VLC application, an amplification-based optical transceiver is proposed in this article. The transmitter consists of a driver and laser diode as the light source, while the receiver contains a photodiode and signal amplifying circuit. The design model is proposed for its simplicity in replacing the trans-impedance and transconductance circuits of the conventional modules by a simple amplification circuit and interface converter. Th
... Show MoreThis study aims to focus on the Motives behind volunteer work among a sample of volunteers working in civil society organizations and check if there are statistical differences with those variables according to (gender, age, job, period of volunteer work, and residence. The sample consists of (220 )volunteers,(189) male and(31) female from southern, northern and central governorate .The Volunteer Functions Inventory(VFI)(Clary & et al,1989)was applied, It consisting of(30) items with six fields( Values, Understanding, Social motives, Career, Protective, Enhancement).
The results show that the most common and important motivations are (Values, Understanding, and social motivations), there are differenc
... Show MoreMarriage is a holly secret in Christian religion .So it id natural that its ceremonies acquired religious form .In general the marriage is contracted by minister of religion in presence of the two parties or by a proxy or presence of parents if it is necessary . And to make the condition of publicity for the marriage ,its procedures must be made before witnesses .Also the minister of religionhave to confirm the agreement of the two parties before beginning the procedures.The marriage ceremonies are made.These procedures are religious traditions that includes praying and make blessings and putting the rings in fingers by thepriest . The marriage is a holly secret performed by the crown pray according to the church religious traditions