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 surgery Keywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
Objectives: Recently, there have been important advances in the clinical application of targeted hybrid near-infrared (NIR) fluorescent-radioactive tracers. ICG-99mTc-nanocolloid, for example, is already being used by some centres for sentinel lymph node biopsy in head and neck cancer. The radioactive component allows imaging at depths which would not be possible with NIR alone and, once exposed, the NIR fluorescence reporter can be imaged at very high resolution. Gamma detection is currently carried out with a separate hand-held gamma camera or with a non-imaging probe. Visualisation of NIR fluorescence during surgery requires a dedicated NIR camera, several of which are available commercially. We describe a novel hand-held hybrid NIR-gamm
... Show MoreConflict is a common but complicated phenomenon. It has been extensively researched in many domains, including philosophy, sociology, psychology, and linguistics. Using the Critical Discourse Approach, this study examines the issue of self-society conflict in The Handmaid’s Tale. The significance of this work lies in the identification and explanation of the discursive strategies that force the ideological polarization of the positively portrayed self versus the negatively portrayed other. The purpose of this study is to answer two questions: what are the discursive strategies used in The Handmaid’s Tale to create a positive or negative representation, and how are these strategies implemented? Five extracts from The Handmaid’s
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This paper aims at exploring the impact of the Iraq-Iran war in the poetry of Adnan Al-Sayegh. Al-Sayegh participation in this war makes him a first hand witness to the atrocities of the trenches and fight in the first lines. This war did not only change his life and world view for good, it changes the nature of his poetry as well. As aresult, war becomes a central issue not only in the poetry Al-Sayegh wrote in the 1980s and 1990s Iraq, but also in the exile.
Key Words: War, Al-Sayegh, Poetry.
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Idioms are a very important part of the English language: you are told that if you want to go far (succeed) you should pull your socks up (make a serious effort to improve your behaviour, the quality of your work, etc.) and use your grey matter (brain).1 Learning and translating idioms have always been very difficult for foreign language learners. The present paper explores some of the reasons why English idiomatic expressions are difficult to learn and translate. It is not the aim of this paper to attempt a comprehensive survey of the vast amount of material that has appeared on idioms in Adams and Kuder (1984), Alexander (1984), Dixon (1983), Kirkpatrick (2001), Langlotz (2006), McCarthy and O'Dell (2002), and Wray (2002), among others
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Solid waste generation and composition in Baghdad is typically affected by population growth, urbanization, improved economic conditions, changes in lifestyles and social and cultural habits.
A burning chamber was installed to burn cellulosic waste only. It was found that combustion reduced the original volume and weight of cellulosic waste by 97.4% and 85% respectively.
A batch composting study was performed to evaluate the feasibility of co-composting organic food waste with the cellulosic bottom ash in three different weight ratios (w/w) [95/5, 75/25, 50/50].
The composters were kept in controlled aerobic conditions for 7 days. Temperature, moisture, and pH were measured hourly as process succe
... Show MoreThis study was designed to evaluate the ability of bioemulsifier to inhibit the growth of some pathogenic microorganisms. Fourteen isolates belonged to Serratia sp. were collected and tested for their ability to produce bioemulsifier. Results showed that Serratia marcescens S10 (isolated from the gut of the American cockroach) had the highest ability to produce bioemulsifier, among 14 isolates belong to Serratia spp. and it had the ability to inhibit the growth of some microorganisms. The production of bioemulsifier was detected by determination of emulsification index (E24%), qualitative drop-collapse test, emulsification activity (E.A) and measuring the surface tension (S.T). The results of bioemulsifier produced by Serratia marcescens S1
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