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.
APDBN Rashid, Southern African Linguistics and Applied Language Studies, 2023
The main intention of this study was to investigate the development of a new optimization technique based on the differential evolution (DE) algorithm, for the purpose of linear frequency modulation radar signal de-noising. As the standard DE algorithm is a fixed length optimizer, it is not suitable for solving signal de-noising problems that call for variability. A modified crossover scheme called rand-length crossover was designed to fit the proposed variable-length DE, and the new DE algorithm is referred to as the random variable-length crossover differential evolution (rvlx-DE) algorithm. The measurement results demonstrate a highly efficient capability for target detection in terms of frequency response and peak forming that was isola
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This research deals with number of novels for Marguerit Doras , specially A Bridge Towards Basfic and The Lover . we specialize the first chapter for discussing a very important issue , which is the Maraguerit Doras novelist world in another word the most important themes . that we discuss and through that we tried to clerify the privacy the characters of Marguerit Doras in comparative with her own generation and in the second chapter we discussed the most important characteristics of the romantic hero spedially the characteristics of women in her novels.
Change the morphological characteristics with the change of the factors affecting it has been shown that the Tigris River has the characteristics of the morphology of the low values in terms of depth, width and perimeter wet and gradient which in turn affected the morphological and other characteristics in terms of the direction and pattern of runoff came through the study of 48 cross-section is taken of the Tigris River Year 2008 by section for each 1 km, it has been shown that the average width of the Tigris River does not exceed 221.1 meters and the average depth of 3.9 meters either wet ocean amounted to 268.9 meters and changed the cross-section area of the last section at a rate of 4594.3 square meters, and through the study turned
... Show MoreThe article describes a certain computation method of -arcs to construct the number of distinct -arcs in for . In this method, a new approach employed to compute the number of -arcs and the number of distinct arcs respectively. This approach is based on choosing the number of inequivalent classes } of -secant distributions that is the number of 4-secant, 3-secant, 2-secant, 1-secant and 0-secant in each process. The maximum size of -arc that has been constructed by this method is . The new method is a new tool to deal with the programming difficulties that sometimes may lead to programming problems represented by the increasing number of arcs. It is essential to reduce the established number of -arcs in each cons
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Background: Obesity is becoming the healthcare epidemic world wide.Obesity is associated with reduced life expectancy, increased morbidity and mortality, and greater healthcare costs.Bariatric surgery is the only effective treatment for morbid obesity and is gaining increasing popularity. There has been a steady rise in the numbers and types of bariatric operations done worldwide in recent years butnon of prove to be ideal .Animal studies and use of animal models are significant element in the evolution of medical knowledge and the use of animals as a model for bariatric surgery is of importance to study the mechanisms of these operationsa and also help to develop new technique in management of obesity.Objectives:Study of effects of slee
... Show MoreImproving" Jackknife Instrumental Variable Estimation method" using A class of immun algorithm with practical application
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This study seeks to shed light on the aspects of visual pollution and its impact on the aesthetics of the town of Al-Eizariya known to suffer from the phenomenon. In order to identify the real causes of the problem which develops in various forms and patterns, threatening not only the aesthetic appearance of the towns, but also causes the emergence of new problems and phenomena that will have negative repercussions on the population. The researcher uses the analytical descriptive method to analyze the phenomenon of visual pollution in terms of reality, development, manifestations and spread and uses photos which document the visual pollution and its impact on the aesthetics of the known. The study concluded the existence of a strong rela
... Show MoreIn this study a concentration of uranium was measured for twenty two samples of soil distributed in many regions (algolan, almoalmeen, alaskary and nasal streets) from Falluja Cityin AL-Anbar Governorate in addition to other region (alandlos street) as a back ground on the Falluja City that there is no military operations happened on it. The uranium concentrations in soil samples measured by using fission tracks registration in (PM-355) track detector that caused by the bombardment of (U) with thermal neutrons from (241Am-Be) neutron source that has flux of (5×103n cm-2 s-1). The concentrations values were calculated by a comparison with standard samples. The results shows that the uranium concentrations algolan street varies from(1.
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