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.
Organizations nowadays, whether public or private organizations, productive or service (such as banks), face major challenges as a result of rapid and continuous changes, and in front of these challenges traditional management operations and tools become unable to make the organization able to work, which makes it imperative for these organizations to follow the methods and management practices, including the proposed knowledge risk management and strategic direction so that it can elevate its actions at the level of developments in reality, in the sense that these organizations and in the light of environmental developments to characterize their strategic direction as an intellectual approach characterized by mo
... Show MoreBackground: Oral Lichen Planus (OLP) is a chronic inflammatory mucosal disease, presenting in various clinical forms WHO had regarded OLP as a precancerous conditions in 1978 because of its potential with cancer. Both antigen-specific and nonspecific mechanisms involved in the pathogenesis of OLP. Oral Squamous Cell Carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity representing more than 94% of oral cancer. It occurs in different sites and has many etiological factors. Cyclin Dl is a proto-oncogene which consider as the key protein in the regulation of cell proliferation and its overexpression led to the occurrence and progression of malignant tumors.NF-KB p65 is a member ofNF-kB family of transcription factors that
... Show MoreIn this paper, a procedure to establish the different performance measures in terms of crisp value is proposed for two classes of arrivals and multiple channel queueing models, where both arrival and service rate are fuzzy numbers. The main idea is to convert the arrival rates and service rates under fuzzy queues into crisp queues by using graded mean integration approach, which can be represented as median rule number. Hence, we apply the crisp values obtained to establish the performance measure of conventional multiple queueing models. This procedure has shown its effectiveness when incorporated with many types of membership functions in solving queuing problems. Two numerical illustrations are presented to determine the validity of the
... Show MoreBackground: Multi- drug resistant (MDR) Staphylococcus aureus infections have become a major public health concern in both hospital and community settings.Objective: to investigate the antibacterial activity of T. Foenum- groecum essential oil against skin infection with S. aureus and to study probable synergistic activity in combination with Clindamycin.Type of the study: Cross-sectional study.
Methods: Antibacterial activity of T. Foenum- groecum essential oil extract (1.2gm/100 µl) was investigated in multi- drug resistance (MDR) Staphylococcus aureus specimen isolated from patients with skin infection in Baghdad. T. Foenum- groecum use externally for cellulites and skin inflammation due to the presence of diosgenin .fast liq
... Show MoreThe objective of this research is to analyze the relationship between the Factors of critical success and sustainable competitive advantage, and I have tested Search Company Mu'tasim General Contracting, through applied on a sample of (90) manager, engineer and project manager, spread over sections and the company's projects surveyed. has been selected sector construction industry as one of the sectors vital and important that play a major role in the advancement of Iraq's infrastructure under the current circumstances, which epresent a set of Projects are Mu'tasim General Contracting construction imple
... Show MorePurpose/ to build clear perceptions about the level of the effects of organizational failures on the competitiveness of dairy factories and the role of dynamic knowledge capabilities in minimizing these impacts
Mythology/ Design approach Use deduction approach, the research was conducted in four dairy factories in Baghdad (Abu Ghraib, Agriculture, Halal and Ayon Al-Rafidain). It was applied to a sample of (155) individuals representing a sample of the research community from factory owners, managers, Engineers, technicians and experienced workers in the dairy industry. The questionnaire was used as a main tool for collecting data, information and statistical tools in the extraction, testing and analysis o
... Show MoreBackground: Early detection of subclinical left ventricular (LV) systolic dysfunction is crucial and could influence patients' prognosis by aiding the clinician to candidate patients for better management.
Objective: To detect early LV systolic dysfunction in asymptomatic patient with chronic aortic regurgitation by two dimensional speckle tracking echocardiography.
Methods: Sixty one asymptomatic patients with chronic aortic regurgitation, with no ischemic heart diseases (by coronary angiography) or conductive heart diseases, no diabetes mellitus, no hypertension, and no other valvular heart diseases (group 1) and fifty age and sex-matched healthy subjects (
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