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.
Background:Periodontal diseases are infectious diseases in which periodontalpathogens trigger chronic inflammatory and immune responses. Interleukine-6 is a multifunctional cytokine playing a central role in inflammation and tissue injury.The aim of the study IS to determine the level of Interleukin-6(IL-6) in saliva of patients with chronic periodontitis compared to healthy subjects. Materials and Methods:The total subjects of the present study is 60, divided into 3 groups; 20 patients with chronic periodontitis with pocket depth(PD ≥4 mm)(group I), 20 patients with pocket depth(PD <4 mm) with clinical attachment loss (group II), and 20 healthy controls with pocket probing depth (PPD ≤ 3 mm) without clinical attachment loss (g
... Show MoreBackground. Aneurysms of the distal anterior cerebral artery (DACA) are uncommon; they often form near the pericallosal-callosomarginal junction and are typically small. To our knowledge, giant DACA aneurysms developing from the more distant parts of the anterior cerebral artery (ACA), A4-5, have been described only once in the literature. Case description. A 66-year-old gentleman reported with a brief loss of consciousness followed by weakness in his right lower leg. The patient was admitted with a Glasgow Coma Score (GCS) of 15. A computed tomography (CT) scan of the head revealed a left hyperdense mass in the frontal parasagittal supracallosal region. Contrast MRI revealed a heterogeneously enhancing mass measuring 35x30x25 mm. C
... Show MoreThis paper deals with a central issue in the field of human communication and reveals the roaming monitoring of the incitement and hatred speech and violence in media, its language and its methods. In this paper, the researcher seeks to provide a scientific framework for the nature of the discourse of incitement, hatred speech, violence, and the role that media can play in solving conflicts with their different dimensions and in building community peace and preventing the emergence of conflicts among different parties and in different environments. In this paper, the following themes are discussed:
The root of the discourse of hatred and incitement
The nature and dimensions of the discourse of incitement and hatred speech
The n
In the current analysis, the effects of circumferential scratches along the inner surface of a 170ᵒ -arc partial journal bearing has been numerically investigated. Their impact on the thermo-elasto-hydrodynamic performance characteristics, including maximum pressure, temperature, deformation, and stress, has been examined thoroughly. The ANSYS Fluent CFD commercial code was employed to tackle the iterative solution of flow and heat transfer patterns in the fluid film domain. They are then applied to the ANSYS Static Structure solver to compute the deformation and stress resulted in the solid bearing zone. A wide range of operating conditions has been considered, including the eccentricity ratio ( ) and scratch depth (
... Show MoreLet f and g be a self – maps of a rational exterior space . A natural number m is called a minimal coincidence period of maps f and g if f^m and g^m have a coincidence point which is not coincidence by any earlier iterates. This paper presents a complete description of the set of algebraic coincidence periods for self - maps of a rational exterior space which has rank 2 .
The search aims to find out the most important requirements for the success of marshes investment and maximize the expected returns of investment was marked by a problem find aquestion for availability requirements necessary for the success of marshes investment has a research community owners decision in the province Maysan the most important conclusions to the search is that the investment great importance in support of the economy and raising the cultural and social level, there is no investment successful but only with configure the investment environment appropriate economic, social, cultural, political, and security ways. the most important recommendations are working on the provision of the investment environment appropria
... Show MoreThere is much research on the syntax-semantics and the syntax-phonology interaction. However, the exact relation between prosodic patterns and informational structure (as part of pragmatics) is still to be investigated. In this empirical study, we challenge the view that prosody and pragmatics are two autonomous levels of grammar. This paper is an analysis of the narrative poem ‘Mending Wall’ recited by Robert Frost to explore the prosodic features and the associated pragmatic meanings. It is proposed that a set of intentionally manipulated suprasegmental features form a prosodic grammar that works in line with syntax and lexical choices to build the narrative discourse and achieve pragmatic meanings. The paper shows that the am
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