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.
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Stylistics is the analysis of the language of literary texts integrated within various approaches to create a framework of different devices that describe and distinct a particular work. Therefore, feminist stylistics relied on theories of feminist criticism tries to present a counter- image of a woman both in language use and society, to draw attention , raise awareness and change ways that gender represents. Feminist stylistic analysis is related not only to describe sexism in a text, but also to analyze the way that point of view, agency, metaphor, and transitivity choices are unanticipatedly and carefully connected to issues of gender(Mills,1995:1) &nb
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The fall angle of sun rays on the surface of a photovoltaic PV panel and its temperature is negatively affecting the panel electrical energy produced and efficiency. The fall angle problem was commonly solved by using a dual-axis solar tracker that continually maintains the panel orthogonally positioning to the sun rays all day long. This leads to maximum absorption for solar radiation necessary to produce maximum amount of energy and maintain high level of electrical efficiency. To solve the PV panel temperature problem, a Water-Flow Double Glazing WFDG technique has been introduced as a new cooling tool to reduce the panel temperature. In this paper, an integration design of the water glazing system with a dual-axis tracker has been ac
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Finding the shortest route in wireless mesh networks is an important aspect. Many techniques are used to solve this problem like dynamic programming, evolutionary algorithms, weighted-sum techniques, and others. In this paper, we use dynamic programming techniques to find the shortest path in wireless mesh networks due to their generality, reduction of complexity and facilitation of numerical computation, simplicity in incorporating constraints, and their onformity to the stochastic nature of some problems. The routing problem is a multi-objective optimization problem with some constraints such as path capacity and end-to-end delay. Single-constraint routing problems and solutions using Dijkstra, Bellman-Ford, and Floyd-Warshall algorith
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Each language in the world has its special methods in using articles that connected with nouns. There are languages do not have articles and others their articles from one class, that is to say it do not have masculine and feminine such as our Arabic language. Also in some languages the nouns come after article.
The main aim in our research is to analyze the usage of these articles and its presence or not in the structure of sentence for the learners of Spanish language as a foreign language.
The usage of these articles in Spanish language forms one of the problems that face students in the grammar of Spanish language, at the same time it stands as a problem in translation becau
... Show MoreGlobalization has occupied a great deal of studies, research and literature, in addition to being a phenomenon that has imposed itself firmly on the ground. Globalization is considered the main feature of the current moment in today's world. The world is now transforming in an unprecedented way under noticeable titles of successive waves of knowledge and technology.The current research aims to identify the effects of globalization on the variables and their political, social, media and cultural dimensions, as well as culture of consumption and cultural identity.The theoretical framework included two sections: the first is the concept of globalization, its history and its dimensions, and the second is the modernity in contemporary Europea
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This study deals with the intellectual representations whose intellectual systems are incarnated in the Jewish personality, which is considered one of the complex intellectual systems that has caused controversy throughout the ages because of the ambiguity due to the religious and psychological factors that were reflected directly and strongly on the intellectual structure of the Jewish community in general and the Jewish - Zionist personality in particular, in an attempt (to create new dimensions embodied by intellectual representations of a human nature embodied by what that - peaceful - religiously oppressed - psychologically and socially isolated character presents, because of the curse of the peoples of the world that was a cause fo
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