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.
Praise be to God, Lord of the worlds, and the best of prayers, and the completion of the blessing of our master Muhammad Al-Hadi Al-Amin, his family and companions, the righteous and those who followed his path and guided him to the day of judgment.
And after:
It is God's human honor that he has legalized marriage and made optimal goals and intentions for her:
1 establish a safe and reassuring life between the husband and his wife based on the tranquility and love and compassion is achieved through satisfying the instincts of the road project from the verse: and that He created for you mates from among yourselves to find repose in them and put between you affection and mercy in this are Signs for those who reflect ()
The main idea of the financial censorship is to submit the states funds to a censorship because they are the funds of the people and because this censorship is a right and role ensured by the constitution for specific devices in the state, thus the role of the financial censor should be launched to achieve this goal in all walks of the state. • The power of this censorship depends basically on the independence of the censorious bodies over a job which is submitted to this censorship and the censor should have a reverence , this censorship is practiced as a precautionary procedure before preparing the budget to avoid mistakes after and during the execution for maintaining the states funds. • The importance of the censorship comes from
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The primary function of commercial banks is the process of converting liquid liabilities such as deposits to illiquid assets, (also known as a loan), liquid assets, (aka cash and cash equivalent) in a balanced manner between liquid and illiquid assets, that guaranteed the preservation of the rights of depositors and the bank and not by converting liquid liabilities into liquid assets in a very large percentage. This comes from its role as depository and intermediary institutions between supply and demand, therefore, we find that the high indicators of bank liquidity and solvency may reflect a misleading picture of the status of commercial banks, to some extent in terms of the strength of their balance sheets and
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In order to achieve overall balance in the economy to be achieved in different markets and at one time (market commodity, monetary and labor market and the balance of payments and public budget), did not provide yet a model from which to determine the overall balance in the economy and the difficulty of finding the inter-relationship between all these markets and put them applied in the form of allowing the identification of balance in all markets at once.
One of the best models that have dealt with this subject is a model
(LM-BP-IS), who teaches balance in the commodity market and money market and balance of payments and the importance of this issue This research tries to shed light on the reality
Medical image segmentation is one of the most actively studied fields in the past few decades, as the development of modern imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT), physicians and technicians nowadays have to process the increasing number and size of medical images. Therefore, efficient and accurate computational segmentation algorithms become necessary to extract the desired information from these large data sets. Moreover, sophisticated segmentation algorithms can help the physicians delineate better the anatomical structures presented in the input images, enhance the accuracy of medical diagnosis and facilitate the best treatment planning. Many of the proposed algorithms could perform w
... Show MoreThis paper presents the matrix completion problem for image denoising. Three problems based on matrix norm are performing: Spectral norm minimization problem (SNP), Nuclear norm minimization problem (NNP), and Weighted nuclear norm minimization problem (WNNP). In general, images representing by a matrix this matrix contains the information of the image, some information is irrelevant or unfavorable, so to overcome this unwanted information in the image matrix, information completion is used to comperes the matrix and remove this unwanted information. The unwanted information is handled by defining {0,1}-operator under some threshold. Applying this operator on a given ma
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Objective(s): To determine the impact of the electronic Health Information Systems upon medical, medical Backing and administrativedecisions in Al-Kindy Teaching Hospital. Methodology: A descriptive analytical design is employed through the period of June 14th 2015 to August 15th 2015. A purposive "non- probability" sample of (50) subject is selected. The sample is comprised of (25) medical and medical backing staff and (25) administrative staff who are all involved in the process of decision making in Al-Kindy Teaching Hospital. A self-report questionnaire, of (68) item, is adopted and developed for the purpo
The practical picture was clear in the statement of the foundations of moderation and its impact on the future of the nation, and in it a statement of the foundations on which moderation is based as the foundations for building moderation, the goals that moderation seeks and the desired results as a result of the applications of moderation. It was about the positive impact of moderation on the future of the nation in maintaining social balances such as economic, cultural and political balance and preserving freedoms.