Background: Ruptured posterior communicating artery (PCoA) aneurysms are common; they usually present with subarachnoid haemorrhage (SAH) and oculomotor nerve palsy. The aneurysmal dome projection may influence the safety access and aneurysmal neck clipping. Here, we discuss additional intraoperative steps that may be required to widen the surgical field to ensure safe surgical clipping of a rupture pure posteriorly directed PCoA aneurysm. Case description: A previously healthy 38-year-old male reported sudden severe headache and disturbed level of consciousness with a Glasgow coma scale (GCS) of 13. His initial computed tomography (CT) scan of the head showed SAH in the basal cistern. 3D-constructed CT angiography (CTA) revealed a left pure posteriorly directed PCoA aneurysm. In the surgery, through the left pterional approach, all intraoperative steps were carried out. Additional steps were performed as well. Three additional intraoperative steps were contemplated because a pure posteriorly directed PCoA aneurysm is not well appreciated and is often hidden behind the supra cliniold internal carotid artery (ICA). First, the extension of Sylvian fissure dissection to include the distal part and the proximal. Second, temporal pole mobilization is performed by cutting small anterior temporal veins. Third, a brain retractor is placed on the temporal lobe to gently tract the superficial part of the lobe. All these steps widened the surgical corridor to ensure the aneurysm's safe clipping. Conclusion: Surgical clipping is influenced by the aneurysmal dome projection. In a ruptured pure posteriorly directed PCoA aneurysm, further intraoperative steps may facilitate complete access and safe clipping of the aneurysm.
The aim of the research is to measure the length between the variable the efficiency of the tax examiner with its dimensions represented by (scientific questions, practical process (experience), training and development, impartiality and independence, ethics of the profession) and the approved variable discovering the artificial adaptation of profits, and the degree of arrangement of those dimensions its importance and priority, and the research problem has been identified In a main question that is there any effect of copying the images of the image examiner in discovering the adaptation, the financial statements and reports of the companies (X, Y) and the banks (A, B) were relied on in the interpretation of the results, t
... Show MoreBackground: Teachers are considered as dynamic force who take a pivotal position in any educational system. Since they may play a significant role in passing the preventive information and health promotion, it is important that their own oral health knowledge, attitude, and practices conform to the professional recommendations. The aim of this study was to evaluate oral health knowledge, attitude and practices among kindergarten teachers, and their impact on teachers’ oral health condition in Al-Rusafa Sector, Baghdad, Iraq. Materials and Methods: This cross-sectional survey was conducted among 80 kindergarten teachers. A self-administered questionnaire was distributed among these teach¬ers. This questionnaire format contains two
... Show MoreThe research synthesis variables of competitive advantage and the mechanism achieved by focusing on knowledge abilities and strategic of the administrative leadership, and governments and the developed countries took the racing frantically and my destiny to invest more money and resources to development of wealth and human knowledge is so choice investment winner always and who Aaikhyee never, because God Almighty give humans the abilities of all other creatures and that these abilities varying from person to person, there is the problem of search provoking questions about the essence of what it's about research and both sides theoretical and field, the objective of this research
... Show MoreThe development of the world, and in light of the intensity of competition highlighted the need to research and create a sustainable competitive advantage is sustained from an internal source in the company earned by the scarcity and difficulty of imitation by competitors, and this source is green innovation. In order to achieve the objective of the research, which is the diagnosis and analysis of the relationship between green innovation (in products, processes) and sustainable competitive advantage in the group of companies Kronji, was developed a default model of the research reflects the nature of the relationship and influence among its variables, the research adopted the questionnaire as a key tool for collecting data and i
... Show MoreThe research seeks to identify the dimensions of creative thinking and its impact on the re-engineering of hotel service operations by analyzing the correlation and impact between research variables as well as comparing the research sample The importance of the research comes from the need to motivate managers the importance of creative thinking among workers in the researched hotels because it is an essential part in the re-engineering of hotel services. To achieve this a questionnaire was designed containing (33) items that include the independent research variables (creative thinking) and the accredited (re-engineering the hotel service) and distributed to a sample of (50) individuals represented by (Commissioner Director, Dep
... Show MoreThe research aimed at finding out the effect of functional rotation on the tax performance of the employees of the General Authority for Taxes through the five-meter questionnaire prepared according to the required data. The data obtained from the research sample were analyzed. The results showed a significant effect of recycling In the tax performance, and this is evident from the proportion of his contribution to the interpretation of the total variation, which is a good indicator of the impact of functional rotation in the performance of the body sample research.
Investment in high education is considered to be most important factors of production which the return an individual and social than economic returns found by searching the growing problem of unemployment, especially among youth graduates, where the unemployment rate in 2010 (50%) of these high rates have led to increased migration of scientific minds graduate recently, "to search for job opportunities outside Iraq for not hiring functions and this is in vain" clear "in the human and financial resources lead to structural imbalances in the Iraqi economy. When calculating the correlation coefficient between the graduates and the unemployment rate where it reached (0.21) emerged from the results of
... Show MoreThe study area is witnessing divergence where I am North wind North East wind as we find that the north wind is getting replicated as we move from the south, The reason can be attributed to the nature of the surface of the region, with at least repeat this wind the northern region to the presence of mountain ranges, while we find that energizes the surface in the center and south helped to increase repeat this wind gusts, It also finds that the North wind East prevail in the northern region and least replicated as we move from the north to the south and to the fact that North stations are within blowing this wind sites for the circles near the display of high pressure located centers to the north-east, north and distancing itself from pa
... Show MoreThis experiment was conducted in the season 2001-2000 in station Ishaqi the company's general industrial crops to plant livestock Vigna radala deleted (Khadrawi) carried out the experiment design panels splinter and order in RCBD with three balls two factors are levels nitrogen fertilizer (120 and, 100.0 kg urea / ha)nitrogen ratio of 46%, which put in the main panels mAIN PLOT and Alkiavat three levels that were placed in secondary panels .....