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 contractual imbalance is perceived today by the majority of the doctrine as being one of the pitfalls to the execution of the contracts. As a result, most legislations grant judges the power to intervene to restore it. Granting the judge the power to complete the contract raises the question of the extent to which the judge can obtain such power. Is it an absolute authority that is not limited? If so, is it a broad discretion in which the judge operates in his conscience, or is it a power of limited scope by specific legal texts and conventions? This is what we will try to answer in this research.
The present work is qualitative descriptive. It aims to examine the idiosyncratic schema when deciphering the selected violence-based panel from Nasser Ibrahim’s caricatures. The researchers accordingly adopted part of Sharifian’s (2011) Cultural Schema model, particularly that part that is concerned with the examining the micro/idiosyncratic level of understanding. The study has revealed that the participants have not only differed among themselves regarding the way a figure is being denotatively conceptualized, they also highlighted different exact conceptualizations for the same figure, such as: using various adjectives that reflect various levels of intensity, emphasizing the behavioral aspect or the appearance of the figure, ado
... Show MoreThis article discusses how women have significant abilities to cope with the difficulties of war times. They are not the weak and vulnerable victims who are thought to be. On the contrary, they have the power to control over many-sided fronts, like participating in the battlefield as nurses or activists for peace, or even fighters, as well as through the tasks and responsibilities assigned to them to protect and support their families during wartime. The researcher will examine the impact of war upon women. Like men, women suffer during wartime. They are being injured, tortured and killed. Yet, they are able to give examples of love and courage even in the difficult times of war. Hana is one of those women who lived during wartimes,
... Show MoreIn the light of what is witnessing in the advertising arena of new ways and methods in delivering advertising message to consumers by finding new outlets to communicate with them especially through social networking sites, which became the first choice of advertising companies in order to spread its goods and services. These companies now are relying gradually on celebrities to appear with their products and goods to drive the audience's attention towards them. The thesis aims to find out the attitudes of young people towards the the advertisements that show famous celebrities on social networking sites. The researcher used survey method which aims to record, analyze and interpret the phenomenon after collecting the necessa
... Show MoreA new class of higher derivatives for harmonic univalent functions defined by a generalized fractional integral operator inside an open unit disk E is the aim of this paper.
The current research includes a look at the participation of Iraqi women in the combat roles, which starts from the assumption of the democratic transition that must be led - in one of its aspect - until the army or the military foundation to become a "citizen army," the matter which is represented a demand increasingly needed in the experiences of Democratic transformation that facing serious security challenges such as in Iraq, this means that the army or security foundation - which is involved in counterterrorism - should not reflect a specific group in society , and hence embody the most important democratic principles, which are equality and equal opportunities, especially gender equality. On the other hand, the influence of armed conf
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