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.
Management Representations Letter plays a significant role as an evidence to get conclusions the Auditor is looking for. These conclusions could show the professional opinion of auditor over the fairness and integrity of financial statements for many issues and numbers that management claims, Hereby, the research aims at highlighting the importance of Management Representations Letter and the way of using as an evidence with expressing its meaning and means of application in addition to identify the Responsibility of Auditor on that Letter, This research discusses also the effect of Management Representations Letter on the credibility of financial statement and enhancing the credibility of the submitted reports, From other side, in the t
... Show MoreThis study aims to identify the role of forensic accounting in resolving banking disputes in the Iraqi environment, and to achieve this goal, the fiel
d survey method was used, as it is the most appropriate for studying the phenomenon in question and achieving its objectives. A sample of (50) male and female employees was selected, distributed among five banks listed on the Iraq Stock Exchange in the Baghdad governorate. The questionnaire tool prepared for this purpose was applied to them, which consisted of two main axes. The first axis included paragraphs of questions related to the importance of forensic accounting. The second axis relates to disputes At the end of the research, we reached a set of conclusions, the most import
... Show MoreExtreme conditions will cause the water level of high fill canal segment to change suddenly, which will affect the velocity and pore pressure of the slope. A 9 km irrigation earth canal in the city of Alsyahy, 15 km away from Al-Hilla city, and branching off from the left side of Shatt Al-Hilla at 57 km, was studied. The aim of this work is to study and analyze the effect of rationing system on the Birmana earthen canal during rapid drawdown case. Finite element modeling with Geo-Studio software was used in the present study to analyze the combined seepage and slope stability for three cycles. The resulting minimum safety factor obtained from the analysis using the saturated and
The exchange rate is of great importance at the global and local levels alike, as this importance increases with the increasing rates of development of economic relations between countries of the world due to openness and integration into the global economy, expressed by the expansion of the volume of trade and financial relations between countries. The Central Bank of Iraq has set the need to stabilize this price as a goal to reduce inflation rates and reduce them to the internationally accepted rates by using the foreign currency sale window to achieve a balance between the forces of supply and demand for foreign currency and to preserve the value of the Iraqi dinar. The research concluded that the central bank was It has a maj
... Show MoreBackground: Chronic cigarette smoking is one of the major risk factors for coronary artery disease. However, it has additional cardiac adverse effects independent of coronary atherosclerosis. Patient and Methods: After informed consent and perm- ission from the review board of the hospital, 80 healthy subjects who were classified as smokers or non-smokers were included in the study. They were examined by standard echocardiography protocol which was followed by two-dimensional speckle tracking to assess the functions of the right ventricle. Results: The tricuspid annular plane systolic excursion (TAPSE) was significantly reduced in smokers as compared to non-smokers (P < 0.05). The tricuspid flow peak late diastolic velocity (A wave) was sig
... Show MoreIt is often needed to have circuits that can display the decimal representation of a binary number and specifically in this paper on a 7-segment display. In this paper a circuit that can display the decimal equivalent of an n-bit binary number is designed and it’s behavior is described using Verilog Hardware Descriptive Language (HDL).
This HDL program is then used to configure an FPGA to implement the designed circuit.