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.
Abstract
This paper discusses the essence of the developmental process in auditing firms and offices at the world today. This process is focused on how to adopt the audit concepts which is based on Information and Communication Technology (ICT), including the Continuous Auditing (CA) in particular. The purpose of this paper is to design a practical model for the adoption of CA and its requirements according to the Technology Acceptance Model (TAM). This model will serve as a road map for manage the change and development in the Iraqi auditing firms and offices. The paper uses the analytical approach in reaching to the target results. We design the logical and systematic relations between the nine variable
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Background: The adenomatoid odontogenic tumor is a relatively rare benign epithelial odontogenic tumor. It contains both epithelial and mesenchymal components. Few cases presented as an extrafollicular lesion or involve the mandible or associated with other odontogenic lesions. This paper represents a rare case of an extrafollicular AOT. Case presentation: A 24-year-old female had a painless swelling on the right side of the lower jaw since one-month duration. Intraorally there was a well defined fluctuant-blue swelling in the right alveolar premolar region measuring 1×2 cm obliterating the right lower buccal vestibule. Grade II mobility in the vital 44 and 45 teeth were observed. Panoramic radiographs showed a well-defined pear shaped
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Due to technological developments in the Iraqi banking sector, which is the use of electronic payment systems within the banking infrastructure. This has led to speed and accuracy in the completion of transactions, reduced costs, increased revenues and efficiency. This research examines the challenges and risks facing the Iraqi banking sector as a result of its use of electronic payment systems. And show its impact on the profitability of commercial banks. The research was based on the main hypothesis that there is a statistically significant moral impact relationship between electronic payment systems and the profitability of banks. Iraqi commercial banks were chosen as a research community, All Iraqi commercial banks that parti
... Show Moreتعد لعبة كرة السلة من الألعاب الرياضية التي تحتاج متطلبات بدنية ووظيفية خاصة بها، وذلك من خلال الانتقال داخل الملعب بالكرة أو بدونها والسبل للتخلص من ملاحقة الخصم أثناء الدفاع وكيفية المناورة أثناء الهجوم مع إجادة التصويب بكافة أنواعه داخل الملعب، ومن هنا تكونت مشكلة البحث في كيفية تطوير تلك العوامل الوظيفية والتي لها الأثر في الارتقاء بمستوى أداء اللاعب أثناء اللعب، وعن طريق استخدام الباحثان لطريقة جهاز ا
... Show MoreThe essay discusses how different environmental factors affect plant growth by explaining how each factor affects the physiological processes within the plant. The essay begins by explaining the effect of temperature on plant growth, as high or low temperatures can significantly affect the rate of photosynthesis and lead to a reduction in water and nutrient absorption. It also discusses the light intensity impacting plants because the more appropriate the light intensity is, the more enhanced the plant's photosynthesis ability, and in the excess or insufficient light condition, the growth can be inhibited. Additionally, the article outlines the effect of water shortage on the plant because this leads to the closure of stomata to avoid water
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