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.
Photonic crystal fiber interferometers are used in many sensing applications. In this work, an in-reflection photonic crystal fiber (PCF) based on Mach-Zehnder (micro-holes collapsing) (MZ) interferometer, which exhibits high sensitivity to different volatile organic compounds (VOCs), without the needing of any permeable material. The interferometer is robust, compact, and consists of a stub photonic crystal fiber of large-mode area, photonic crystal fiber spliced to standard single mode fiber (SMF) (corning-28), this splicing occurs with optimized splice loss 0.19 dB In the splice regions the voids of the holey fiber are completely collapsed, which allows the excitation and recombination of core and cladding modes. The device reflection
... Show MoreThis research addresses the relevance of men and women and the consequent provisions
such as dowry and alimony ... Of the like, marriage is to organize links masculinity and
femininity any sexual meeting between men and women a special system that must be
produces reproduction him and alone, which gets its reproduction in human kind, and has no
family and on the basis of private life is being organized.
The importance of the topic see Islam has urged marriage and forbade celibacy, and ensure
that the Lord of Glory Almighty married subsidy nor the origin of the differences between
men and women in money or workmanship or blue-chip Every Muslim inept any Muslim and
every Muslim efficient for any Muslim.
The impor
The Quiet American could be considered as one of Graham Greene’s most distinguished books; it is an epochal novel written during the phase of the cold war between the United States and the Soviet Union. The novel deals with the interference of the United States in Vietnam ten years before Vietnam’s war. The role the Americans played in arousing an inner political crisis in the country previous to her military invention. The book reflects that this action was not out of American government concern about Vietnamese people themselves but merely a political foreign affair. They wanted to stop communism from spreading widely and reducing its role in the East. This paper attempts to analyse the novel concentrating on the message Greene intend
... Show MoreWith time progress importance of hiding information become more and more and all steganography applications is like computer games between hiding and extracting data, or like thieves and police men always thieve hides from police men in different ways to keep him out of prison. The sender always hides information in new way in order not to be understood by the attackers and only the authorized receiver can open the hiding message. This paper explores our proposed random method in detail, how chooses locations of pixel in randomly , how to choose a random bit to hide information in the chosen pixel, how it different from other approaches, how applying information hiding criteria on the proposed project, and attempts to test out in code, and
... Show MoreBackground : Xanthomatosis is a disease in which large tendon tumors can occur, especially in the Achilles tendon. This disease is a rare interesting orthopaedic condition.
Case Report:A case of a twenty eight year old girl patient with giant bilateral Achilles tendon xanthomas in which both tumors were resected.
There was no ulceration on the both sides. The patient was treated by total resection of the lesion and reconstruction using tendon transfer of the Peroneus brevis and Flexor hallusis longus. Postoperative treatment consisted of six weeks lower leg cast immobilization followed by partial weight bearing. After 4 months the patient was able to walk pain free without any difficultie
... Show MoreBackground : Xanthomatosis is a disease in which large tendon tumors can occur, especially in the Achilles tendon. This disease is a rare interesting orthopaedic condition. Case Report:A case of a twenty eight year old girl patient with giant bilateral Achilles tendon xanthomas in which both tumors were resected. There was no ulceration on the both sides. The patient was treated by total resection of the lesion and reconstruction using tendon transfer of the Peroneus brevis and Flexor hallusis longus. Postoperative treatment consisted of six weeks lower leg cast immobilization followed by partial weight bearing. After 4 months the patient was able to walk pain free without any difficulties. It has been suggested that total resection with au
... Show MoreSoil invertebrates community an important role as part of essential food chain and responsible for the decomposition in the soil, helps soil aeration , nutrients recycling and increase agricultural production by providing the essential elements necessary for photosynthesis and energy flow in ecosystems.The aim of the present study was to investigate the soil invertebrates community in one of the date palms plantation in Aljaderia district South of Baghdad, , and their relationships with some physical and chemical properties of the soil , as Five randomly distributed replicates of soil samples were collected monthly. Invertebrates samples were sorted from the soil with two methods, direct method to isolate large invertebrates and indirec
... Show MoreAs cultures are mainly divided into collectivistic and individualistic, members tend to emphasize, through communication, either their position as part of their group or their independence from the group. This emphasis is manifested in using the pragmatic concepts of positive politeness and negative politeness. The present study looks into the reflection of these two cultures in Rockstar’s renowned video game, Red Dead Redemption 2 (2018). It aims at identifying the two cultures as present in the game and showing their significance to its narrative. It fills the gap in the studies of language used within video games as well as its cultural reflections. The study addresses the following question: What are the positive and negative
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