Introduction. Intraoperative rupture (IOR) of an aneurysm is a frightful complication that causes significant morbidity and mortality worldwide. IOR can be attributed to various parameters, including hypertension, increased intracranial pressure (ICP), fragility of the vessels, and inadequate anaesthesia. IOR due to insufficient anaesthesia is scarcely reported in the literature. Here, we describe a re-ruptured anterior communicating artery (ACoA) after incomplete clipping of the neck during craniotomy closure due to unintended early wake-up from anaesthesia with a discussion about the management. Case description. A 38-year-old male suddenly developed a severe headache, a brief loss of consciousness, and vomiting. Computed tomography (CT) scan showed a subarachnoid haemorrhage in the basal cistern. CT angiography showed a bilobed right ACoA aneurysm with a wide neck and Murphy's teat. The patient was considered for surgery. Clipping of the aneurysm neck was done through two curved clips. During craniotomy closure, the patient started coughing and gagging then a huge IOR was encountered. These events can be mainly attributed to unintended inadequate anaesthesia, particularly muscle relaxants. The bleeding ceased after two suction catheters were inserted, temporary clips were applied, and the readjustment of permanent clips. After surgery, the patient showed a left-sided weakness. His postoperative CT scan showed a right distal anterior cerebral artery (ACA) territory infarction. The weakness improved in the follow-up period. Conclusion. Delayed IOR due to early awaking from anaesthesia should be considered a potential source of complications and bad outcomes in aneurysm surgery.
Background. In cases of spontaneous subarachnoid haemorrhage (SAH) with multiple intracranial aneurysms (MIAs) detected on angiography, some radiological clues assist in determining the site of a ruptured aneurysm which is bleeding is quite beneficial for the selection of the best treatment strategy. Case description. We report a case of a 60 years old patient who presented with spontaneous SAH, sellar hematoma, and three different aneurysms detected in angiography. Although the right Posterior communicating artery (PcomA) aneurysms showed Murphy’s teat on angiography intraoperatively, we discovered that the right superior hypophyseal aneurysm (SHA) was the source of the index bleeding. Both aneurysms were clipped successfully. Co
... Show MoreWithin connected speech, RP speakers tend to shorten stressed long vowels end diphthongs in pre. Forties consonants in the same syllable on the basis of complementary Distribution, i.e., the phonological environment decides the influence of the forties plosives and fricatives, as far as they are in find position preceded by stressed long vowels and diphthongs, or particular voiced consonants plus vowels. The Iraqi learners, then, face.
Background: Carpal tunnel syndrome
(CTS) is the most common neuropathy of the
upper limb due to compression of the median
nerve at the wrist.
Objectives: to test the benefit of steroid
irrigation of the wound to alleviate the post
operative pain.
Methods: Forty patients had carpal tunnel
release were divided into two groups with and
without steroid irrigation.
Results: Forty patients 38 female and 2 male
with forty CTS had open surgical release were
studied for postoperative pain at the wrist area.
Group 1 (patients treated with surgery alone)
and group 2 (patients treated with surgery and
steroid).In group1, 11 patients (55%) had
persistent agonizing pain at the ulnar side of
the wrist
BackgroundCarcinoma of the larynx represent 10% of head & neck malignancies. The treatment of advanced carcinoma of larynx may include partial or total laryngectomy, with or without laser , radiotherapy,and or chemotherapy . Carcinoma of the larynx usually affect old age , heavy smoker with possible risk of pulmonary diseases & ischemic heart disease , which add risk to the general anaesthetic complication operative & postoperative - Objectives this study was designed to assess the feasibility of total laryngectomy under local anaesthesia in medically unfit patients for general anaesthesia & to re-establish practice doing total laryngectomy under local anaesthesia in those patients.
Methods a prospective study on 12 pa
BackgroundCarcinoma of the larynx represent 10% of head & neck malignancies. The treatment of advanced carcinoma of larynx may include partial or total laryngectomy, with or without laser , radiotherapy,and or chemotherapy . Carcinoma of the larynx usually affect old age , heavy smoker with possible risk of pulmonary diseases & ischemic heart disease , which add risk to the general anaesthetic complication operative & postoperative - Objectives this study was designed to assess the feasibility of total laryngectomy under local anaesthesia in medically unfit patients for general anaesthesia & to re-establish practice doing total laryngectomy under local anaesthesia in those patients.
Methods a prospective study on 12 pa
Background: For various reasons, inguinal hernia repair under local anaesthesia is not well accepted to both patients and surgeons. The patients fear from pain and surgeons need full relaxation and co-operation to do successful hernia repairMethods: purpose of this study is to evaluate the effectiveness of local anaesthesia in inguinal hernia repair.prospective study was made from January 2011-0ctober 2013 , on a total of 50 patients with inguinal hernia operated on under local anaesthesia. Patients were selected primarily on the basis of their willingness to accept the procedure after the technique was described to them.Results: In this study 50 patient and 58 herniorrhaphies done for them during a period of about 34months were evaluate
... Show MoreThe development of low profile gamma-ray detectors has encouraged the production of small field of view (SFOV) hand-held imaging devices for use at the patient bedside and in operating theatres. Early development of these SFOV cameras was focussed on a single modality—gamma ray imaging. Recently, a hybrid system—gamma plus optical imaging—has been developed. This combination of optical and gamma cameras enables high spatial resolution multi-modal imaging, giving a superimposed scintigraphic and optical image. Hybrid imaging offers new possibilities for assisting clinicians and surgeons in localising the site of uptake in procedures such as sentinel node detection. The hybrid camera concept can be extended to a multimodal detec
... Show MoreBackground: Posterior urethral rupture remains
one of the most difficult and controversial injuries
to treat and its management still controversial.
Aim: To assess the effect of primary
realignment of posterior urethral rupture.
Methods: in this study, 20 patients (mean age
24.7 years, range 12 to 39 years) were admitted to
al-kindey teaching hospital, Baghdad, Iraq, with
complete posterior urethral rupture associated with
fractured pelvis following trauma (3 cases of fall
from high, 17 cases of road traffic accidents). All
the patients were operated upon at the day of
accident to establish the alignment of the posterior
urethra on a Foley's catheter with bladder drainage
by suprapubic catheter.
In this paper, the general framework for calculating the stability of equilibria, Hopf bifurcation of a delayed prey-predator system with an SI type of disease in the prey population, is investigated. The impact of the incubation period delay on disease transmission utilizing a nonlinear incidence rate was taken into account. For the purpose of explaining the predation process, a modified Holling type II functional response was used. First, the existence, uniform boundedness, and positivity of the solutions of the considered model system, along with the behavior of equilibria and the existence of Hopf bifurcation, are studied. The critical values of the delay parameter for which stability switches and the nature of the Hopf bifurcat
... Show MoreBackground. The anterior communicating artery (ACoA) complex consists of the ACoA, the pre-and post-communicating segments of the anterior cerebral artery, and the recurrent artery of Heubner. It is the most common site for anatomical variations in the circle of Willis. Such variations can mimic intracranial aneurysms. Case description. A 30-year-old female presented with recurrent episodes of extreme headache and bilateral tinnitus. A brain computed tomography (CT) scan showed no significant lesions, while her CT-angiography (CTA) showed an enlarged vascular lesion at the ACoA, raising the suspicion for an ACoA aneurysm. A repeated CTA revealed a rare anatomical variation with a pattern of cross dominance in the ACoA complex;
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