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.
Waste is one of the most important problems affecting the city’s environment and its urban landscape, which results from the activities and activities of man and the natural environment. Its sources have varied between residential, commercial, industrial, medical and hazardous, and its spread in cities, on roads and on abandoned open lands, has led to significant negative effects and risks to human health and the environment.
Therefore, there were serious attempts to deal with waste and follow sequential steps that formed a waste management system such as (collection, sorting, transport, then treatment and disposal). Preventing and reducing waste, then recycling and recovering by composting or burning, and ending with bu
... Show MoreNegotiations are distinguished in that they are an easy and simple means between the conflicting parties, and it is an effective means at the same time as the conflicting parties seek understanding on the most effective way to solve their dispute, but negotiations are not always appropriate to resolve international disputes, especially when there is a disparity in power between the negotiating countries, or when it is missing Goodwill, or even when one of the parties is absent or less flexible, and the internal circumstances of one of the conflicting countries may play a negative or positive role in the success of the negotiations, away from the influence of the role of external variables in that, a
... Show MoreOur research tends to study the poetic attempt of Badr Shakir Al-Sayyab and examine it stylistically, and we suggested his mature collection '' Rain song'' as a pattern for our textual analysis of the poet's attempt.
In the beginning , we confirm that branches of applied structures meet to produce poetry such as narration , drama , cinema , mythology , allegory , various religious and historical texts , previous events , and special cumentary events related to work production. If all above-mentioned was complicated and disregarded throughout a single text , the text writer would not secure positive results that might keep open continuity between him and his readers.
Therefore , this issue w
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This work deals with a numerical investigation to evaluate the utilization of a water pipe buried inside a roof to reduce the heat gain and minimize the transmission of heat energy inside the conditioning space in summer season. The numerical results of this paper showed that the reduction in heat gain and energy saving could be occurred with specific values of parameters, like the number of pipes per square meter, the ratio of pipe diameter to the roof thickness, and the pipe inlet water temperature. Comparing with a normal roof (without pipes), the results indicated a significant reduction in energy heat gain which is about 37.8% when the number of pipes per m
... Show MoreIn this work, a flat-plate solar air heater (FSAH) and a tubular solar air heater (TSAH) were designed and tested numerically. The work investigates the effect of increasing the contact area between the flowing air and the absorber surface of each heater and predicts the expected results before the fabrication of the experimental rig. Three-dimensional two models were designed and simulated by the ANSYS-FLUENT 16 Program. The solar irradiation and ambient air temperature were measured experimentally on December 1st 2022, at the weather conditions of Baghdad City- Iraq, at three air mass flow rates, 0.012 kg/s, 0.032 kg/s, and 0.052 kg/s. The numerical results showed the advantage in the thermal performance of
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