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.
The general crisis of research methods in the social sciences
Research methodology: philosophy and techniques, founded by philosophers and applied by scientists, and no accurate application of techniques except with a deep understanding of philosophy, as a prerequisite. This fact is almost completely absent from the Iraqi and Arab academic mentality. This constituted one of the dimensions of the double crisis - theoretical and applied - of research methods in the social sciences. As first, there is no philosophy of science, neither as an independent material nor as an introductory subject, but not even an oral confirmation. Secondly, the advancement of quantitative research methods are presented without a background philosophy, as sol
The cyanobacterial neurotoxin
Although war of waters has existed throughout history, it has gained increasing relevance in recent decades, particularly in regions where transboundary rivers are politically contested. One of the most critical and ongoing disputes is between Iraq and Turkey over the control on the Tigris and Euphrates rivers. The study seeks to achieve three primary objectives: investigating the types of transitivity processes most frequently used in the politicians' utterances; analysing how the positive self-representation and negative other-representation are uncovered in the politicians' utterances; and exploring the similarities and differences in these linguistic tools between the two opposing sides. To achieve these objectives, the research
... Show MoreBackground: Fiber-optic endoscopy is an important
investigation of the large intestine, whether or not the
radiologist (barium enema) has discovered a lesion in
the bowel. Colonoscopy affords a unique opportunity
to direct visualization of entire colonic mucosa. At
the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli.
Most experienced endoscopists and well prepared
patients can reach the cecum in over 90% of patients.
If colonoscopy is properly performed, it has a low
risk of complications, such as perforation and bleeding.
Methods: A total of 70 consecutive patients admitted
to Endoscopy department at Al-Kindy Teaching hospital from September- 2008 to July-2009.
The atomic properties have been studied for He-like ions (He atom, Li+, Be2+ and B3+ions). These properties included, the atomic form factor f(S), electron density at the nucleus , nuclear magnetic shielding constant and diamagnetic susceptibility ,which are very important in the study of physical properties of the atoms and ions. For these purpose two types of the wave functions applied are used, the Hartree-Fock (HF) waves function (uncorrelated) and the Configuration interaction (CI) wave function (correlated). All the results and the behaviors obtained in this work have been discussed, interpreted and compared with those previously obtained.
Fibromuscular dysplasia (FMD) is a noninflammatory and nonatherosclerotic arteriopathy that is characterized by irregular cellular proliferation and deformed construction of the arterial wall that causes segmentation, constriction, or aneurysm in the intermediate-sized arteries. The incidence of FMD is 0.42–3.4%, and the unilateral occurrence is even rarer. Herein, we report a rare case of a localized extracranial carotid unilateral FMD associated with recurrent transient ischemic attacks (TIAs) treated by extracranial-intracranial bypass for indirect revascularization. The specific localization of the disease rendered our case unique.
Catalytic wet air oxidation of aqueous phenol solution was studied in a pilot plant trickle bed reactor using copperoxide catalyst supported on alumina and silica. Catalysts were prepared by impregnating method. Effect of feed solutionpH (5.9, 7.3, and 9.2), gas flow rate (20%, 50%, 80%, and 100%), WHSV (1, 2, and 3 h-1), temperature (120°C, 140°C,and 160°C), oxygen partial pressure (6, 9, 12 bar), and initial phenol concentration (1, 2, and 4 g/l).Generally, theperformance of the catalysts was better when the pH of feed solution was increased. The catalysts deactivation is relatedto the dissolution of the metal oxides from the catalyst surface due to the acidic conditions. Phenol oxidation reactionwas strongly affected by WHSV,
... Show MoreA vocative expression can be defined as an expression of direct address where the participant identity is set forth explicitly within a sentence. This study aims at showing how the vocative particles are used in literally texts, namely in the short story “The Garden Party" written by Kathryn Mansfield and identifying the forms of these vocative particles as used by the characters along with the functions of these vocative particles. For the analysis of vocative forms, the researcher used Quirk and Greenbaum (1973) model. Functionally, the data were analyzed based on Quirk et al. (1985) model. However, the results of this study shows that the characters in “The Garden Party” short story used various forms of vocative particles and
... Show MoreThere are still areas around the world suffer from severe shortage of freshwater supplies. Desalination technologies are not widely used due to their high energy usage, cost, and environmental damaging effects. In this study, a mathematical model of single-bed adsorption desalination system using silica gel-water as working pair is developed and validated via earlier experiments. A very good match between the model predictions and the experimental results is recorded. The objective is to reveal the factors affecting the productivity of fresh water and cooling effect in the solar adsorption system. The proposed model is setup for solving within the commercially-available software (Engineering Equation Solver). It is implemented to so
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