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.
ملخص البحث:
ان الله تعالى هو الذي خلق جميع المخلوقات ، والذي بيده الموت والحياة وان كل هذه المخلوقات تحتاج الى اوامر ، وهذه الاوامر الالهية وجهها الله لعبادة بوساطة انبياءه ( عليهم السلام) فكانوا هم اول المستسلمين والمنقادين لأوامره ، فجاءت الآيات الكريمة مخاطبة للأنبياء واقوامهم بشكل عام ولنبينا محمد (r) بشكل خاص.
اما عن المضمون البحثي فقد جاءت مادته مقسمة الى ثل
... Show MoreIn this paper mildly-regular topological space was introduced via the concept of mildly g-open sets. Many properties of mildly - regular space are investigated and the interactions between mildly-regular space and certain types of topological spaces are considered. Also the concept of strong mildly-regular space was introduced and a main theorem on this space was proved.
Throughout this paper R represents a commutative ring with identity and all R-modules M are unitary left R-modules. In this work we introduce the notion of S-maximal submodules as a generalization of the class of maximal submodules, where a proper submodule N of an R-module M is called S-maximal, if whenever W is a semi essential submodule of M with N ? W ? M, implies that W = M. Various properties of an S-maximal submodule are considered, and we investigate some relationships between S-maximal submodules and some others related concepts such as almost maximal submodules and semimaximal submodules. Also, we study the behavior of S-maximal submodules in the class of multiplication modules. Farther more we give S-Jacobson radical of ri
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Аннотация
в статье рассматриваются проблемы преподавания русской литературы в иракской аудитории.. Использование литературы в преподавании иностранного языка, как правило, имеет две цели. Первая-чисто лингвистическая .. Вторая цель, однако, ассоциируется больше с экстралингвистикой и представляет собой ознакомление студентов с различными аспектами русской жизни, культуры,
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In this paper, a new class of ordinary differential equations is designed for some functions such as probability density function, cumulative distribution function, survival function and hazard function of power function distribution, these functions are used of the class under the study. The benefit of our work is that the equations ,which are generated from some probability distributions, are used to model and find the solutions of problems in our lives, and that the solutions of these equations are a solution to these problems, as the solutions of the equations under the study are the closest and the most reliable to reality. The existence and uniqueness of solutions the obtained equations in the current study are dis
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The paper is devoted to solve nth order linear delay integro-differential equations of convolution type (DIDE's-CT) using collocation method with the aid of B-spline functions. A new algorithm with the aid of Matlab language is derived to treat numerically three types (retarded, neutral and mixed) of nth order linear DIDE's-CT using B-spline functions and Weddle rule for calculating the required integrals for these equations. Comparison between approximated and exact results has been given in test examples with suitable graphing for every example for solving three types of linear DIDE's-CT of different orders for conciliated the accuracy of the results of the proposed method.
The estimation of the parameters of linear regression is based on the usual Least Square method, as this method is based on the estimation of several basic assumptions. Therefore, the accuracy of estimating the parameters of the model depends on the validity of these hypotheses. The most successful technique was the robust estimation method which is minimizing maximum likelihood estimator (MM-estimator) that proved its efficiency in this purpose. However, the use of the model becomes unrealistic and one of these assumptions is the uniformity of the variance and the normal distribution of the error. These assumptions are not achievable in the case of studying a specific problem that may include complex data of more than one model. To
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Throughout this paper R represents a commutative ring with identity and all R-modules M are unitary left R-modules. In this work we introduce the notion of S-maximal submodules as a generalization of the class of maximal submodules, where a proper submodule N of an R-module M is called S-maximal, if whenever W is a semi essential submodule of M with N ⊊ W ⊆ M, implies that W = M. Various properties of an S-maximal submodule are considered, and we investigate some relationships between S-maximal submodules and some others related concepts such as almost maximal submodules and semimaximal submodules. Also, we study the behavior of S-maximal submodules in the class of multiplication modules. Farther more we give S-Jacobson radical of rings
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The present paper deals with studying the effect of electrical discharge machining (EDM) and shot blast peening parameters on work piece fatigue lives using copper and graphite electrodes. Response surface methodology (RSM) and the design of experiment (DOE) were used to plan and design the experimental work matrices for two EDM groups of experiments using kerosene dielectric alone, while the second was treated by the shot blast peening processes after EDM machining. To verify the experimental results, the analysis of variance (ANOVA) was used to predict the EDM models for high carbon high chromium AISI D2 die steel. The work piece fatigue lives in terms of safety factors after EDM models were developed by FEM using ANSY
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