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.
The comparative method plays a major role in Maupassant’s novel (A woman’s Life).This is due to a good theme choice and smooth writing style characterized by simplicity, spontaneity and brevity.
The author uses the comparative method in the introduction of his novel where he compares the monastery’s closed world to the open world of the countryside of La Normandie, which represents the dream life of the heroine Jeanne.
The present paper is an attempt to answer the question regarding the importance of applying the comparative method in the novel (A Woman’s Life) by Maupassant. The paper stresses the fact that the novelist employs the comparative method in his book for certain features .One of these features is the
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Stylistics is the analysis of the language of literary texts integrated within various approaches to create a framework of different devices that describe and distinct a particular work. Therefore, feminist stylistics relied on theories of feminist criticism tries to present a counter- image of a woman both in language use and society, to draw attention , raise awareness and change ways that gender represents. Feminist stylistic analysis is related not only to describe sexism in a text, but also to analyze the way that point of view, agency, metaphor, and transitivity choices are unanticipatedly and carefully connected to issues of gender(Mills,1995:1) &nb
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The purpose of this paper is to introduce and study the concepts of fuzzy generalized open sets, fuzzy generalized closed sets, generalized continuous fuzzy proper functions and prove results about these concepts.
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The current research aims to prepare a proposed Programmebased sensory integration theory for remediating some developmental learning disabilities among children, researchers prepared a Programme based on sensory integration through reviewing studies related to the research topic that can be practicedby some active teaching strategies (cooperative learning, peer learning, Role-playing, and educational stories). The Finalformat consists of(39) training sessions.
The main objectives of this study are to study the enhancement of the load-carrying capacity of Asymmetrical castellated beams with encasement the beams by Reactive Powder Concrete (RPC) and lacing reinforcement, the effect of the gap between top and bottom parts of Asymmetrical castellated steel beam at web post, and serviceability of the confined Asymmetrical castellated steel. This study presents two concentrated loads test results for four specimens Asymmetrical castellated beams section encasement by Reactive powder concrete (RPC) with laced reinforcement. The encasement of the Asymmetrical castellated steel beam consists of, flanges unstiffened element height was filled with RPC for each side and laced reinforced which are use
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Air-conditioning systems (ACs) are essential in hot and humid climates to ensure acceptable ambient air quality as well as thermal comfort for buildings users. It is essential to improve refrigeration system performance without increasing the effects of global warming potential (GWP) and ozone depletion potential (ODP). The main objective of this study is to evaluate the performance of an air conditioning system that operates with a liquid suction heat exchanger (LSHX) through implementing refrigerants with zero OPD and low GWP (i.e., R134a and R1234yf). Liquid suction heat exchanger (LSHX) was added to an automobile air conditioning system (AACS).When Liquid suction heat exchanger was added to the cycle, primary results indicated t
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New Fourteen compounds were synthesized in four steps. The first step included synthesis of 2-biphenyl fused ring of imidazo(1,2- a)pyrimidine from the reaction of 2-aminopyrimidine and biphenyl phenacyl bromide . The second step was introduced aldehyde group from the reaction of 2-biphenyl fused rings of imidazo(1,2-a)pyrimidine with POCl3 in presence of DMF and CHCl3. 3-Carbaladehyde derivatives of fused imidazo/pyrimidine was reacted with different aromatic amines to afford new Schiff bases. These new 3- imines derivatives was reduced by using sodiumborohydride to yield another new 3-aminomethyl-2-biphenyl imidazo (1,2-a)pyrimidine derivatives in moderate yield .Some new prepared compounds were identified by melting point, FT- IR , 13C-
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