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.
الكتابة عن الأندلس بعد تسليم مدينة غرناطة يحمل في ثناياه ألم كبير، لأن الأندلسيين عاشوا تجربة إنسانية قاسية سببها الأساس غياب التسامح الديني والعدالة الاجتماعية، الأمر الذي دفعهم للثورة مطالبين بحقوقهم التي نصت عليها معاهدة تسليم المدينة. فقد عاش أولئك حياة صعبة ، فكانوا صورة للصراع بين حضارتين الإسلامية والغربية ، ويمكن تلمس ذلك الصراع من خلال دراسة ثوراتهم ضد السلطة الحاكمة التي يبدو من تتبع أح
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Applications of quantitative methods, which had been explicit attention during previous period (the last two centuries) is the method of application sales man or traveling salesman method. According to this interest by the actual need for a lot of the production sectors and companies that distribute their products, whether locally made or the imported for customers or other industry sectors where most of the productive sectors and companies distributed always aspired to (increase profits, imports, the production quantity, quantity of exports. etc. ...) this is the part of the other hand, want to behave during the process of distribution routes that achieve the best or the least or most appropriate.
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The aim of the current study is to create special norms of the second edition of Minnesota multi faces personality inventory, and the fifth edition of the sixteen personality factor questionnaire of catel. To this end, the researcher applied the Minnesota multi faces personality inventory over a sample of (1646) secondary and university students as well as plenty of disorders. She also applied the sixteen personality factor questionnaire of catel on (4700) secondary and university students. SPSS tools were used to process data.
Based on analyzing the properties of Bernstein polynomials, the extended orthonormal Bernstein polynomials, defined on the interval [0, 1] for n=7 is achieved. Another method for computing operational matrices of derivative and integration D_b and R_(n+1)^B respectively is presented. Also the result of the proposed method is compared with true answers to show the convergence and advantages of the new method.
The concept of fully pseudo stable Banach Algebra-module (Banach A-module) which is the generalization of fully stable Banach A-module has been introduced. In this paper we study some properties of fully stable Banach A-module and another characterization of fully pseudo stable Banach A-module has been given.
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Objective of the research This study aimed to manufacture an innovative device that enables the player to walk after the operation and improves functional efficiency through improvement in the range of motion as well as improvement in the size of the muscles working on the knee joint Imposing research There are statistically significant differences between the pre and posttests of the experimental and control groups, there are Statistically significant differences between the post-tests between the experimental group and the control group in favor of the experimental group of the research sample. The researchers used the experimental approach by designing the control and experimental groups with a test (pre-post) for the suitabili
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The semiotic trend of recent monetary trends task that took a wide range of attention of critics and readers alike, especially after the deployment, which accompanied him after widespread acts critic Grimas and powers applicable to the literary texts and is thus expanded its care circle, hence the choice of the novel (absent) woman Iraqi novelist (Mahdi ‘Issa falcon) model to be applied to the study chose to be a semiotic approach through the use of procedural mechanisms for its critical tool (Paris School of semiotics), cash and views of its founder critic Grimas.The research in the introduction and pave came we made it a vision for literary semiotic and its impact trend in cash and cash is and what it desire to clarify some poked suc
... Show MoreThis study introduced the effect of using magnetic abrasive finishing method (MAF) for finishing flat surfaces. The results of experiment allow considering the MAF method as a perspective for finishing flat surfaces, forming optimum physical mechanical properties of surfaces layer, removing the defective layers and decreasing the height of micro irregularities. Study the characteristics which permit judgment parameters of surface quality after MAF method then comparative with grinding
A winglet is devices attached at the wing tips, used to improve aircraft wing efficiency by reduction influence wing tips vortices and induct drag, increasing lift force at the wing tips and effective aspect ratio without adding greatly to the structural stress and weight in the wing structure. This paper is presented three-dimensional numerical analysis to proposed modification swept back wing by adding Raked winglets devices at the main wing tips belong the two seat trainer aircraft type Aermacchi Siai S211 by using Fluent ANSYS 13 software. CFD numerical analysis process was performed at the same flight boundary conditions indifferent wing angle of attacks with constant air flow velocity V∞ =50 (m/sec), ambient pressure Po=101325 (P
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Management is considered as most important resource of the society ones in modern era and an exchange
point in societies’ lives in order to achieve its goals and wishes. So far, management behinds the new
electronic society has become different in shape and nature due to the force of the nature of information
technology that shapes the relationships between the world’s individuals at the national level but it goes
beyond the international ones. The study aims at identifying the impact of the electronic management’s
components upon the improvement of the quality of nursing care in Baghdad’s hospitals. The descriptive
design, with a sample-survey approach, is used as appropriate ones for the field study of social