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.
Urban wetlands are one of the complex systems that provide many economic, social and environmental services to the city. In this research, the most important services provided by urban wetlands from the point of view of the urban planner were reviewed, and the types of these lands and their divisions according to the type of services provided by each type were presented. Environmental is represented in its ability to reduce the dangers of floods, mitigate the climate and reduce its negative impacts, purify water and deplete a lot of suspended impurities and pollutants, and social services such as recreational areas and beautiful landscapes that inspire joy and reassurance in the soul, as well as cultural areas and sports activities for m
... Show Moreكان لنهاية الحرب الباردة وعولمة العالم على وفق رؤية كونية تتجاوز حدود ومفاهيم السيادة الوطنية والقومية الاثر الواضح في ترتيب العلاقات الدولية , واصبحت تلك العلاقات تدور حول محورين الاول .. هو الاعتماد المتبادل بين الدول من اجل الوصول الى خطوط مشتركة للمصالح المختلفة بين هذه الدول . والآخر.. هو تبعية الدول الضعيفة للدول القوية لافتقار الاولى توفير الحاجيات الى مواطنيها . هذا يشير الى نشأة علا
... Show More. The concepts of structural flexibility became one of the important goals in the design phases to reach high performance in architecture. The pioneering projects and ideas that linked architecture with technologies and scientific innovations appeared, with the aim of reaching projects that mix the concepts of flexibility with the development of machine thought and modern technology to meet the functional, environmental, and aesthetic requirements for human wellbeing. The aim of this paper is to identify the mechanisms used in order to reach flexible structural systems capable of accommodating technological changes and developments. The research hypothesizes that the structural design according to the concepts of flexibility achieves high s
... Show MoreMercury is a heavy metal that is extremely toxic. There are three types of it: inorganic, organic, and elemental. Mercury in all its forms has been shown to have harmful effects on living things. It can multiply its concentration from lower to higher trophic levels and accumulate in the body's various tissues. Aquatic organisms bodies have been exposed to mercury mostly through various human activities. The largest source of mercury pollution in the air is thermal power plants that mostly use coal as fuel. It is carried to a body of water after being deposited on the ground surface from the air. The way it enters the food chain is through aquatic plants and animals. Mercury accumulations in the kidney, liver, gills, or gonadal tissues of sp
... Show MoreThe study aims to know the role of governance in the consolidation of the principles of business ethics, through the application of the principles of governance and the dimensions of business ethics in the private sector. And knowledge of the validity of the hypothesis key of the current study according to which "increases the ethics of business organizations strength and coherence in the presence of the principles of governance" as it was distributed the questionnaire to a sample of a chairman and board members and managers department and heads of sections in some of the private banks. I have been using correlation analysis and regression testing (t) to see the moral differences and to find out the c
... Show MoreAround 65 million individuals suffer from epilepsy worldwide, and when it is not properly treated, it is linked to higher rates of physical harm and mortality. Due to the requirement for long‐term therapy and the side effects of many medications, medication compliance is a significant issue. The purpose of this review was to summarize the findings of previous studies examining the quality of life (QOL), adherence, patient education, and medication knowledge, as well as the impact of a pharmacist‐led educational intervention. Additionally, to find out if these studies benefit epileptic patients, to find the appropriate method used to help them in all aspects of their lives, and to use these in future studies. A systematic and comprehensi
... Show MoreSouth Sudan is known by its tribal and racial variation .Tribal Perception represents the
procedure of dealings in Southern society .And that what make Sudan as a stable country that
suffer from divisions . Everybody wants to rule in spite of his inability and un qualification
which enables the establishment of an urbanized country .the frustration of the state in
handling the interior variety on religious, tribal and racial basis and contracting national
ideality in spared by shared ingredients between gathered groups in one state, all these reasons
make it hard to create a united national identity which is able to unite atheist and religious
parties together. Due to this ,the study is established to clarify the nat
Break in the bond and its impact on the difference of scholars
Iraq has the second largest proven oil reserves in the world. According to oil experts, it is expected that the Iraq's reserves to rise to 200+ billion barrels of high-grade crude.
Oil is a strategic commodity for producing and exporting countries in general, and Iraq in particular, as demonstrated by the international experience that oil is an important means to achieve economic growth, an important tool in the overall economic, social and political development. It is also an important source of hard currency for any national economy and a means to connect the local economy and the global economy. In this paper we focus our attention on selecting the best regression model that explain the effect of human capita
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