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.
Background: Giant middle cerebral artery (MCA) aneurysms are surgically challenging lesions. Because of the complexity and variability of these aneurysms, a customized surgical technique is often needed for each case. In this article, we present a modified clip reconstruction technique of a ruptured complex giant partially thrombosed middle cerebral artery aneurysm.
Case description: The aneurysm was exposed using the pterional approach. Following proximal control, the aneurysm sac was decompressed. Then, we applied permanent clips to reconstruct the aneurysm neck. The configuration of the aneurysm mandated a tailored clipping pattern to account for resi
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In recent years, there has been a significant increase in research demonstrating the new and diverse uses of non-thermal food processing technologies, including more efficient mixing and blending processes, faster energy and mass transfer, lower temperature and selective extraction, reduced thermal and concentration gradients, reduced equipment size, faster response to extraction control, faster start-up, increased production, and a reduction in the number of steps in preparation and processing. Applications of ultrasound technology have indicated that this technology has a promising and significant future in the food industry and preservation, and there is a wide scope for its use due to the higher purity of final products and the
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This study examines the validity of e-poetry as an acceptable literary genre. The
thematic, stylistic and esthetic features of a selected number of e-poems produced by
poetry generators are analyzed for this purpose. The e-poems are then compared with a
number of works written by Dada poets in order to establish the literary merit of the
former.
Summary
The subject ( meaning of added verbs) is one of the main subjects
which study in morphology since in Arabic language. It is include the meaning
of each format, and the increased meaning occurred by this increment in the
verbs.
The (strain) is one of very important meaning in this subject, it takes a
wide area of morphology studies, and interesting of scientists and
researchists.
There are two famous formats for this meaning; (infa la انفع
ل ), and (ifta
la افتع
ل ). Also There are another formats for the same meaning, but less than
the first two in use, they are; (taf ala تفعّ
ل ), (tafa ala تفاع
ل ), (taf lala ) ,(تفعل
ل
ifanlala افعنلل ), (ifanla .(
Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury.
We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull bas
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In today's digital era, the importance of securing information has reached critical levels. Steganography is one of the methods used for this purpose by hiding sensitive data within other files. This study introduces an approach utilizing a chaotic dynamic system as a random key generator, governing both the selection of hiding locations within an image and the amount of data concealed in each location. The security of the steganography approach is considerably improved by using this random procedure. A 3D dynamic system with nine parameters influencing its behavior was carefully chosen. For each parameter, suitable interval values were determined to guarantee the system's chaotic behavior. Analysis of chaotic performance is given using the
... Show MoreTwo- dimensional numerical simulations are carried out to study the elements of observing a Dirac point source and a Dirac binary system. The essential features of this simulation are demonstrated in terms of the point spread function and the modulation transfer function. Two mathematical equations have been extracted to present, firstly the relationship between the radius of optical telescope and the distance between the central frequency and cut-off frequency of the optical telescope, secondly the relationship between the radius of the optical telescope and the average frequency components of the modulation transfer function.
This paper aims at studying the illocutionary speech acts: direct and indirect to show the most dominant ones in a presidential speech delivered by the USA president. The speech is about the most critical health issue in the world, COVID-19 outbreak. A descriptive qualitative study was conducted by observing the first speech delivered by president Trump concerning coronavirus outbreak and surveying the illocutionary acts: directive, declarative, commissive, expressive, and representative. Searle's (1985) classification of illocutionary speech acts is adopted in the analysis.
What are the main types of the illocutionary speech acts performed by Trump in his speech?; Why does
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Social media has become an essential educational tool nowadays. Most existing research on digital learning in EFL contexts has primarily focused on traditional classroom-based instruction and less attention has been paid to social media platforms. The present study aims to fill the gap by using social semiotics to analyze four Instagram posts: two from BBC Learning English (@bbclearningenglish) and the other two from Learn English with Emma (@englishwithemma). Instagram posts are classified as multimodal texts with participatory and representational elements. The study adopts Kress and van Leeuwen’s (2005) Social Semiotic Multimodal Framework to analyze four purposely selected posters by answering the following research questions
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