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.
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ÖZET
Bir millet veya topluluk kendi varlığını ancak kültürel değerleri ile koruyabilecek; gelecek nesillere aktarabilecek ve dünyanın diğer milletlerine tanıtabilecektir. Böylece dünya milletleri arasında ortak kültürel ve toplumsal değerler tespit edilecek ve bu ortak değerlerden hareketle insanlık hizmetine sunulabilecek çok güzel çalışmalar hazırlanabilecektir. Taşıdıkları zengin kültürel ve toplumsal değerlerinden dolayı masalların halk edebiyatı ürünlerinin şah damarı niteliğinde oldukları söylenebilir. Bu çalışmada Türk okuruna Bağdat halk masallarını tanıtmak için sahadan derlenen on masal metnine yer verilmiştir. Bağdat masal metinlerinin tip ve motif
... Show MoreThis study is an attempt to investigate the conceptual metaphor of UP and DOWN commonly used in Iraqi community. Some of the metaphorical expressions in Iraqi colloquial Arabicarewidely used by Iraqi speakers in everyday language. Ithas been analyzed by following the cognitive theory of metaphor (Lakoff& Johnson,1980).The study indicates that the Iraqi speakerexperiences more of the metaphorical expressions of UP and DOWN to referto many of the abstract concepts that shape his/her impression of everyday life situations.
The problem of research is that there are ways to protect and sustain environmentally important sites in Iraq. There are no documentary sources for these sites, such as the natural landscape of natural and important natural resources, which suffer from severe environmental neglect
Groundwater modelling is particularly challenging in arid regions where limited water recharge is available. A fault zone will add a significant challenge to the modelling process. The Western Desert in Iraq has been chosen to implement the modelling concept and calculate the model sensitivity to the changes in aquifer hydraulic properties and calibration by researching 102 observations and irrigation wells. MODFLOW-NWT, which is a Newtonian formulation for MODFLOW-2005 approaches, have been used in this study. Further, the simulation run has been implemented using the Upstream-Weighting package (UPW) to treat the dry cells. The results show sensitivity to the change of the Kx value for the major groundwater discharge flow. Only abo
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Because of cost-effective production and abundant resources of calcium, Ca-ion batteries (CIBs) are an appropriate option to alternate Li-ion batteries (LIBs). A new category of anode materials for CIBs has emerged since the successful synthesis of carbon nanotubes, which are B and N doped derivatives of it. For high-performance CIBs, BC2N nanotube (BC2NNT) has been studied as promising anode materials. In order to comprehend electrochemical attributes, cycling stability, and adsorption behavior of BC2NNT, first-principles computations have been executed. Based on nuclear magnetic resonance computations, two types of hexagonal rings (B2C2N2 (I) and BC4N (II)) were specified that are non-aromatic. Ca has adsorption on B2C2N2 and BC4N with ad
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The objective review is to inspect the involvement of Interleukin-6 (IL-6) in rheumatoid arthritis (RA) and to highlight the role of IL-6 and its variants in the pathogenesis of RA and response to anti-IL-6 agents. Several genetic and environmental risk factors and infectious agents contributed to the development of RA. Interleukin-6 is engaged in self-targeted immunity by modifying the equilibrium between T regulatory (T-reg) and T helper-17 (Th-17) cells. The evidences reported that IL-6 parti
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Tested effective Alttafaria some materials used for different purposes, system a bacterial mutagenesis component of three bacterial isolates belonging to different races and materials tested included drug Briaktin
Water flow into unsaturated porous media is governed by the Richards’ partial differential equation expressing the mass conservation and Darcy’s laws. The Richards’ equation may be written in three forms,where the dependent variable is pressure head or moisture content, and the constitutive relationships between water content and pressure head allow for conversion of one form into the other. In the present paper, the “moisture-based" form of Richards’ equation is linearized by applying Kirchhoff’s transformation, which
combines the soil water diffusivity and soil water content. Then the similarity method is used to obtain the analytical solution of wetting front position. This exact solution is obtained by means of Lie’s
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