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.
A study of the hadiths of supplication orchestration
This study deals with strategic maneuvering in advertisement from a pragmatic point of view found in some commercial advertisements in order to investigate and analyze the pragmatic devices that are used in the strategic maneuvering and stages. The study attempts to shed light on the most fuzzy areas in advertisements that is probably how the language of advertisements employed by advertisers to affect consumers positively. The primary goal of strategic maneuvering is to discover how the pragmatic devices have persuasive techniques that are used to gain a competitive advantage and more sales. This study is a contribution to the field of research in the language used in advertising. In this research, the effectiveness of strategic man
... Show MoreJudicial jurisprudence is one of the important legal solutions to address the shortcomings of legislation. Throughout its long history, human societies have known many cases in which the judge finds himself facing a legislative vacuum in addition to civil legal texts that are difficult for the judge to implement due to ambiguity or contradiction, which requires diligence. To rule on resolving disputes before him in order not to deny justice, but the judge in his jurisprudence was not absolute, but rather bound by certain controls represented by observing the wisdom of legislation on the one hand and taking into account the nature of the texts on the other side, and from here this research came to shed light on the jurisprudence and its cont
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The seizure epilepsy is risky because it happens randomly and leads to death in some cases. The standard epileptic seizures monitoring system involves video/EEG (electro-encephalography), which bothers the patient, as EEG electrodes are attached to the patient’s head.
Seriously, helping or alerting the patient before the seizure is one of the issue that attracts the researchers and designers attention. So that there are spectrums of portable seizure detection systems available in markets which are based on non-EEG signal.
The aim of this article is to provide a literature survey for the latest articles that cover many issues in the field of designing portable real-time seizure detection that includes the use of multiple
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The use of composite materials has vastly increased in recent years. Great interest is therefore developed in the damage detection of composites using non- destructive test methods. Several approaches have been applied to obtain information about the existence and location of the faults. This paper used the vibration response of a composite plate to detect and localize delamination defect based on the modal analysis. Experiments are conducted to validate the developed model. A two-dimensional finite element model for multi-layered composites with internal delamination is established. FEM program are built for plates under different boundary conditions. Natural frequencies and modal displacements of the intact and damaged
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