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 significance of the research lies in the fact that electronic technologies represent an important step in evaluating legal situations, and the research problem centered on the lack of attention to visual requirements and the absence of a clear image of legal situations that may be difficult for the referee to apply correctly in addition to the lack of focus on visual requirements and the unclear depiction of some legal cases which make it difficult for the referee to interpret them correctly This is because the referee's main tool is visual perception, which interprets live situations such as violations, fouls, and other cases that arise during a game Moreover, there are numerous responses and challenges in evaluating legal situ
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The study aimed to identify the role of public relations management in its dimensions (mental image, media, advertising, and the public) on green human resource management practices in Jordanian private hospitals in Amman, and this study relied on the quantitative approach (descriptive and analytical) to test hypotheses. Where the questionnaire was relied upon to collect data and their number was (1771) workers, and the study population consisted of workers in the hospitals that were studied on them and their number was 10 hospitals, where 316 questionnaires were distributed, 300 questionnaires were retrieved, and 16 questionnaires were not valid for analysis. That is, 91.7% of the sample, and the study relied on proportional stratified
... Show MoreA statistical optical potential has been used to analyze and
evaluate the neutron interaction with heavy nuclei 197Au at the
neutron energy range (1-20 MeV). Empirical formulae of the optical
potentials parameters are predicted by using ABAREX Code with
minimize accuracy compared with experimental bench work data.
The total elastic, absorption, shape elastic and total compound crosssections are calculated for different target nuclei and different
incident neutron energies to predict the appropriate optical
parameters that suit the present interaction. Also the dispersion
relation linking between real and imaginary potential is analyzed
with more accuracy. The results indicate the behavior of the
dispersion c
This research deals with the most important indicators used to measure the phenomenon of financial depth, beyond the traditional indicators, which are called quantitative indicators, which is shown to be inadequate to show the facts accurately, but it may come in the results of a counterfactual, although reliable in econometric studies done in this regard.
Therefore, this research has sought to put forward alternative indicators, is the structural indicators, and financial prices, and availability of financial instruments, and cost of transactions concluded, in order to measure the phenomenon of financial depth.
After using and analyzing data collected from countries the research
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(2)
Background: Radial neck fractures in children account for 5 to 10% of all elbow fractures in children. They are extra-articular fractures of the radius proximal to the bicipital tuberosity. The physis is typically involved as a Salter-Harris I or II pattern. Alternatively, the fracture sometimes is extraphyseal, through the metaphysis. In children there is considerable potential for remodeling after these fractures. Up to 30° of radial head tilt and up to 3 mm of transverse displacement are acceptable. Many modalities of treatment are available regarding Surgical &Non-Surgical treatments. Objectives: To evaluate the functional outcome after surgical percutaneous joystick reduction therapy of severely angulated radial neck fracture i
... Show MoreBackground: Radial neck fractures in children account for 5 to 10% of all elbow fractures in children. They are extra-articular fractures of the radius proximal to the bicipital tuberosity. The physis is typically involved as a Salter-Harris I or II pattern. Alternatively, the fracture sometimes is extraphyseal, through the metaphysis. In children there is considerable potential for remodeling after these fractures. Up to 30° of radial head tilt and up to 3 mm of transverse displacement are acceptable. Many modalities of treatment are available regarding Surgical &Non-Surgical treatments. Objectives: To evaluate the functional outcome after surgical percutaneous joystick reduction therapy of severely angulated radial neck fracture i
... Show MoreEducation in it s different levels becomes development in any country. There fore, nations pay great attention to educational systems, because they perceive that preparing human resources is essential to the development of these nations.
The present study deals with the a academic frames which formulate education in each educational system such as educational philosophy , educational aims , educational strategies by which the academic frames are carried out, which is limited to curriculum, teacher preparations, school activities, in addition to guidance and counseling.
This study reaches some conclusion which are derived from the description of the academic and practical frames some suggestion are made for the mechanism which facil
This study examines the dynamic relationship between stock market and economic activity in the United States to verify the possibility of using financial indicators to monitor the turning points in the expected path of future economic activity. Has been used methodology (Johansen - Juselius) for the Co-integration and causal (Granger) to test the relationship between the (S & P 500 , DJ) index and gross domestic product (GDP) in the United States for the period
(1960-2009). The results of the analysis revealed the existence of a causal relationship duplex (two-way) between the variables mentioned. which means the possibility of the use stock market indicators to pre
The research aims to highlight the significance and composition and the diversity of meanings and the Quranic context in the necessary and transgressive verbs in Surat (Abs).
This research consists of : a preamble , and two studies . The researcher addressed in the preliminary the importance of the phenomenon of necessity and infringement, the signs of the necessary action , the structure and controls of the act , the methods of infringement , its sections and signs.
As for the first topic : The researcher addressed the necessary verbs in Surat Abs , an applied study in terms of grammati
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