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
Objective of this research focused on testing the impact of internal corporate governance instruments in the management of working capital and the reflection of each of them on the Firm performance. For this purpose, four main hypotheses was formulated, the first, pointed out its results to a significant effect for each of corporate major shareholders ownership and Board of Directors size on the net working capital and their association with a positive relation. The second, explained a significant effect of net working capital on the economic value added, and their link inverse relationship, while the third, explored a significant effect for each of the corporate major shareholders ownershi
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In this paper, estimation of system reliability of the multi-components in stress-strength model R(s,k) is considered, when the stress and strength are independent random variables and follows the Exponentiated Weibull Distribution (EWD) with known first shape parameter θ and, the second shape parameter α is unknown using different estimation methods. Comparisons among the proposed estimators through Monte Carlo simulation technique were made depend on mean squared error (MSE) criteria
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