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.
Chapter-1
Problem of the research:
The studies and researches have noticed the aggravation of violence practice in all educational means using different and innovated styles against children in the school and house in order to upbringing by the parents or the school .
It is a training method for the person to participate in the society and prepare him to be an effective member.
The current research confines the children in age (6-12) years old representing the primary stage who face different kind of violence during the familiar or school education.
The current research aims to:
1 – The kinds of violence which happens to the children in the primary
... Show MoreLiterary works include, for the most part, text thresholds, which are the first entry into reading them and understanding their connotations, and (literary works) vary according to text thresholds, some of which are limited to the title and on the cover page only, and others, in addition to these two thresholds, are based on the dedication threshold too, and others ...
This study takes the story of "Mamo Zain" of the poet Ahmed Al-Khani and his translator Sheikh Muhammad Ramadan Al-Bouti as the field of study, as it is a unique literary work, which included a number of textual thresholds which supported each other and cooperated with the content of the work.
The threshold of dedication in the story of "Mamo Zain" was a spee
... Show MoreThis book includes three main chapters: 1. Functions & Their Derivatives. 2. Minimum, Maximum and Inflection points. 3. Partial Derivative. In addition to many examples and exercises for the purpose of acquiring the student's ability to think correctly in solving mathematical questions.
This book includes four main chapters: 1. Indefinite Integral. 2. Methods of Integration. 3. Definite Integral. 4. Multiple Integral. In addition to many examples and exercises for the purpose of acquiring the student's ability to think correctly in solving mathematical questions.
This study aims to identify the level of application of blue ocean leadership activities in public organizations and to build a conceptual and cognitive framework around this concept. The study adopted a descriptive-analytical approach, and the research sample consisted of (95) individuals from the senior management working at the center of the Iraqi Ministry of Communications (director general, department manager, section head). The data analysis technique used is structural equation modeling (SEM) and the Statistical Package for the Social Sciences (SPSS). The results indicate that the senior management in the Ministry of Communications is working to adopt the blue ocean leadership style through its activities, but not to the leve
... Show MoreAbstract: Background: Drug toxicity and chemotherapeutic side effects negatively impact the quality of life of breast cancer patients. Objectives: to evaluate the efficacy of pharmaceutical Interventions (PI) on quality of life (QOL)Among chemotherapy intake breast cancer women. Method: A pre-post interventional study was carried out at the chemotherapy ward of Alhabobi Hospital in Alnasiriyah City. Eligible patients received comprehensive pharmaceutical care and a self-compiled Breast Cancer Patients Medication Knowledge Guide pamphlet. Each patient received two sessions, the first at baseline and the second after 7, 14, or 21 days depending on the next taking dose of chemotherapy. Each session lasted for approximately 15-30 minutes. Par
... Show MoreThe Research deals with the negative phenomena which appeared in the urban scenes of the Iraqi cities after 2003, particularly trespassing the architectural design of the urban Individual houses. Many academic researchers , critics, and cultural circles, drawn attention to the impact of political and cultural variable change on such phenomena without detailed analysis . The research problem is set according to central questions : If the phenomena is the trespass , what
are the sides which are being trespassed in the division of the individual house? , If the diagnosis of the phenomena denotes perceived repetition of the cases , So what's size of this transposes on the architectural design of t
This work bases on encouraging a generous and conceivable estimation for modified an algorithm for vehicle travel times on a highway from the eliminated traffic information using set aside camera image groupings. The strategy for the assessment of vehicle travel times relies upon the distinctive verification of traffic state. The particular vehicle velocities are gotten from acknowledged vehicle positions in two persistent images by working out the distance covered all through elapsed past time doing mollification between the removed traffic flow data and cultivating a plan to unequivocally predict vehicle travel times. Erbil road data base is used to recognize road locales around road segments which are projected into the commended camera
... Show MoreDevelopment of improved methods for the synthesis of metal oxide nanoparticles are of high priority for the advancement of material science and technology. Herein, the biosynthesis of ZnO using hydrahelix of beta vulgaris and the seed of abrus precatorius as an aqueaus extracts adduced respectivily as stablizer and reductant reagent. The support are characterized by spectroscopic methods ( Ft-IR, Uv-vis ).The FTIR confirmed the presence of ZnO band. The Uv-visible showed absorption peak at corresponds to the ZnO nanostructures. X-ray diffraction, scaning electron microscopy (SEM), dispersive X-ray spectroscopy (EDX) techniques are taken to investigation the size, structure and composition of synthesised ZnO nanocrystals. The XRD pattern mat
... Show More