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.
This research mainly aims to analyze local development strategy in Baghdad Governance, build the Strategic Model based on the study area's spatial interaction, and achieve the Trinity of Excellence based on the global model of excellence.
This research applied SWOT strategic analysis for the strengths and weaknesses of the internal environment and opportunities and threats of the external environment for the provincial council. In conclusion, the research specifies appropriate alternatives and choosing the best in line with the reality of the Baghdad Provincial Council. Also, the strategic goals in the national plan and the spatial interaction of the development goals,
... Show MoreThis research dealt with the subject of negotiation skills of employees in public relations departments which is one of many skills supposed to be available to these employees. These skills combined help in the success of the job of public relations departments; and give them an important and vital role within the roles distributed in the departments of any government institution wither is governmental or non-governmental.
Negotiation is a skill that requires intelligence, tact, culture, information, intuition, and knowing to use the means of communication to access the information that is useful in reaching satisfactory results
... Show MoreThe banking sector is a cornerstone of the national economy because of its large role of economic development of a country, which requires the advancement of this vital sector and interest in all the accompanying changes to him in order to survive and grow and continue Accordingly dealt Find reversal (organizational culture, on the quality of banking service ) sought search to achieve a number of cognitive and practical goals by selecting (10), especially among the working banks in Iraq Iraqi banks and the period is the surveyed period (2005-2014) embodied the research problem in the dialectical relationship between the (organizational culture) and its impacts on banking service quality.
Through a set of
... Show MoreAbstract
The critical success factors of the means of the most modern in determining the main directions for organizations to achieve competitive advantage. and can be a critical success factors in organizations that overlap in the functional areas of the organization. that successful organizations use these factors to get to the uniqueness and distinction. as the entrance of critical success factors with the capacity Evaluative phase correction because discovery increases the perception of managers of what is important to the organization and using them to get to the Strategic Entrepreneurship. as it begins in terms of permanence of success and
... Show MoreThere are two ways that the contract might be formed with (contracting between persons who are attended and contracting between absence persons).the need for determining the precise moment of the contract , is so clear because there is a specify period separate between the declaration of acceptance and the knowledge with it .and it is clear from the four theories known for jurisprudence (theory of the declaration of the acceptance, theory of exporting the acceptance , theory of the arrival of the acceptance , theory of the knowledge with the acceptance ) . It is difficult to promote one theory on another one if we look at each one and the justification of its supporters and what the opponents of each theory expose. Legal background and diff
... Show MoreBackground: Although expression of the HER-
2/neuoncogene may be of some prognostic importance
in advanced ovarian cancer, its role in early-stage
disease has not been established. The current study
examined the prevalence and significance of HER-
2/neu expression in different grades of different types
of surface epithelial ovarian carcinoma.
Methods: Thirty eight female patients with surface
epithelial ovarian cancer were included in this study.
The blocks of corresponding formalin fixed, paraffinembedded
ovarian biopsies were retrieved from the
archives and hematoxylin-eosin slides of each ovarian
biopsy were reviewed and marked their grades of
differentiation , then a new sections from each sampl
Background: Colorectal cancer (CRC) is one of the top ten most common cancers worldwide. There are multiple risk factors for CRC, one of which is aging. However, in recent years, CRC has been reported in children. Objective: To describe the main characteristics and symptoms of CRC as well as highlight pathologic data for early-onset CRC. Methods: 79 CRC patients were recruited from the Oncology Teaching Hospital in the period February–December 2022. A questionnaire was used to collect demographic and clinical data. Results: 25 (31.6%) of patients were below 50 years of age. 52 (65.8%) patients had tumors in the colon. The most common symptom is bleeding per rectum in both age groups. There was no significant difference in patholog
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