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
This study aimed to identify the business risks using the approach of the client strategy analysis in order to improve the efficiency and effectiveness of the audit process. A study of business risks and their impact on the efficiency and effectiveness of the audit process has been performed to establish a cognitive framework of the main objective of this study, in which the descriptive analytical method has been adopted. A survey questionnaire has been developed and distributed to the targeted group of audit firms which have profession license from the Auditors Association in the Gaza Strip (63 offices). A hundred questionnaires have been distributed to the study sample of which, a total of 84 where answered and
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A theoretical analysis of mixing in the secondary combustion chamber of ramjet is presented. Theoretical investigations were initiated to insight into the flow field of the mixing zone of the ramjet combustor and a computer program to calculate axisymmetric, reacting and inert flow was developed. The mathematical model of the mixing zone of ramjet comprises differential equations for: continuity, momentum, stagnation enthalpy, concentration, turbulence energy and its dissipation rate. The simultaneous solution of these equations by means of a finite-difference solution algorithm yields the values of the variable at all internal grid nodes.
The results showed that increasing air mass flow (0.32 to 0.64 kg/s) increases the development o
The main idea that led me to write such research paper within the framework of Germanic linguistics is that I have not found any topic dealing with the term correlate in the German language, except in several articles in linguistic journals as well as one topic in a book describing the use of such a linguistic phenomenon in the language system. The research initially deals with the definition of the correlate at the level of the German language system. Correlate is unity describes specific relation of two sentences and identifies denoted constructs. Correlate is called a placeholder at the syntactic level because it does not occupy its original topological fields in the syntactic structure. The correlate (es) or the prepositiona
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The research has deal with the relationship between organizational justice and empowerment and their impact on the achievement of organizational commitment in the office of Labour and Vocational Training. To study the research problem which is represented a sense that employees with low levels of organizational justice and empowerment and the reflection on the organizational commitment of the employees, so that Has been collecting data and information relating to research by designing a questionnaire, were distributed to a sample of (50) people in the office mentioned, and the results of the study to confirm the research hypotheses. and the key results of the research was the presence of correlation relationships and the effect o
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A recurrent condition that affects up to 10% of people worldwide is gastric ulceration illness. The existence of gastric juice pH with the lowering of mucous defences is prerequisites for the development of chronic ulcers. The main variables affecting the mucosa susceptibility to damage include Helicobacter pylori (H. pylori) infections or non-steroidal anti-inflammatory medicines (NSAIDs). Proton pump inhibitors (PPIs) including histamine-2 (H2) receptor inhibitors, two common therapies for peptic ulcers, have been linked to side impacts, recurrence or a variety of pharmacological combinations. Conversely, therapeutic herbs or the chemicals they contain may be used to cure or eliminate a wide range of illnesses. Therefore, prominent pharma
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The method of incineration was chosen to treat the most commonly used antimicrobial agents in Iraq (Triclabendazol, Oxfendazol, Mebendazole), which are antibiotics for children. The moisture content and chemical oxygen demand (COD) were examined and the results were (93.34, 94.88, 92.97)%, (52000, 33200, and 64000) mg/ L. The temperature was determined as a variable in the burning process (600, 500, 400)° C for the purpose of calculating the loss of ignition LOI and determining the ideal temperature. The results of the models (Triclabendazol, Oxfendazol, Mebendazole) (94.92, 93.12, 58.81% and 88.87), (62.61, 44.08%, 98.75, 84.98 and 55.086)% respectively. When mixing the three models in equal proportions, the percentage of loss was 92.8
... Show MoreAbstract: Colloidal gold nanoparticles (ringworm Palm or in the form of paper willow) have been prepared from HAuCl4 containing aqueous solution by hot chemical reduction method. The colloidal gold nanoparticles were characterized by SEM, EDX, and UV-VIS absorption spectroscopy. It was found that the variation of reduction time from boiling point affects the size of the nanoparticles and also in chemical reduction approach the size of nanoparticles can be controlled by varying the amount of variation the volume of reductant material with respect to the volume of HAuCL4.